10 steps to stop infections in the physician office
AAP guidance applicable to other settings
The American Academy of Pediatrics recommends the following basic infection control measures for physician offices:1
- All health care workers should wash their hands before and after patient contact. Parents and children should be taught the importance of hand washing.
- Standard precautions should be used in dealing with all patients. Standard precautions, as recommended for hospitalized patients, should be used in the care of every child because it cannot be determined which child harbors an infectious agent. Gloves should be available for use by all health care professionals. Gloves should be worn when contact with blood, body fluids, secretions, excretions, and items contaminated with these fluids is reasonably anticipated. Gloves do not need to be worn for routine well-child care, such as wiping a nose or changing a diaper. When gloves are used, hands should be washed after they are removed because contamination can occur during removal or from a break in the glove. Masks, face shields, and protective eyewear should be worn if splashing of body fluids is anticipated. When soiling of clothes with blood, body fluids, secretions, or excretions is highly likely, gowns can be worn. Water-impermeable gowns are needed if splashes of blood or blood-containing body fluids might occur.
- Contact between infected, contagious children and uninfected children should be minimized. Policies to deal with children who present with infections, such as varicella or measles, should be implemented. Prompt triage of immunocompromised children should be performed routinely.
- Alcohol is preferred for skin preparation before immunization and routine venipuncture. Skin preparation for incision, suture, and collection of blood for culture requires iodine; solutions of choice are 1% or 2% tincture of iodine or povodine iodine. (Editor's note: The AAP is in the process of revising infection control guidelines for physician offices. More current guidelines by other groups recommend using chlorhexidine solution for skin preparation.2)
- Needles and sharps should be handled with great care. Needle disposal units that are impermeable and puncture-proof should be available next to the areas used for injection or venipuncture. The containers should not be overfilled and should be kept out of the reach of young children. Policies should be established for removal and incineration or sterilization of contents.
- Policies for management of needlestick injuries also should be in place.
- Standard guidelines for sterilization, disinfection, and antisepsis should be followed.
- Judicious use of antimicrobial agents is essential to limit the emergence and spread of drug-resistant bacteria.
- Outpatient offices and clinics should develop policies and procedures for communication with local and state health authorities regarding reportable diseases and suspected outbreaks.
- Ongoing educational programs that encompass appropriate aspects of infection control should be implemented, reinforced, and evaluated on a regular basis.
References
- Abramson J, et al. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine. Infection Control in Physicians' Offices. Pediatrics 2000; 105[6]:1,361-1,369.
- Centers for Disease Control and Prevention. The 2002 Hospital Infection Control Practices Advisory Committee Guideline for Prevention of Intravascular Device-Related Pediatrics 2002; 110:1,009-1,013.
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