Employee health is heavily emphasized in new infection control guidelines for ambulatory settings by the American Academy of Pediatrics (AAP).1

In the first update of these guidelines in a decade, the AAP emphasizes the importance of mandatory flu shots, other vaccinations as indicated, staff training to prevent transmission, and heightened awareness of the risks of presenteeism.

“Not only the AAP, but many other associations are recommending mandatory, free flu immunization for healthcare employees,” says lead author Mobeen Rathore, MD, of the University of Florida Center for AIDS/HIV Research, Education and Service in Jacksonville.

The conditions under which a mandatory flu vaccine would be enacted are left to the local facilities.

“I think that it is important to leave the details to each individual facility because conditions vary from practice to practice,/” Rathore says. “While we make a strong recommendation, we do not necessarily advise facilities how they should implement the policy. There are unique challenges and needs around the country.”

Citing studies that show healthcare workers will report for duty when sick, the AAP discouraged presenteeism and said non-punitive but formal policies should make it clear to stay home when ill.

“We are realizing more and more that sick staff are coming to work,” Rathore says. “They present the potential to transmit that infection, not only to patients but to other staff members. We are encouraging those who are sick to not come to work.”

Other AAP employee health recommendations include the following:

• Screening for TB should be performed before employment to ensure that people with a tuberculous infection are detected early and, if necessary, treated. Screening may have to be repeated in certain situations in which the healthcare worker has been exposed to TB.

• In addition to annual influenza vaccination, healthcare workers should be immunized for pertussis, measles, mumps, rubella, varicella, and hepatitis B.

• All healthcare workers should perform hand hygiene using an alcohol-based hand rub or handwashing with soap and water before and after patient contact, or contact with the patient’s immediate environment.

• Needles and sharps should be handled with great care. Safer needle disposal units that are impermeable and puncture-proof should be available next to the areas used for injection or venipuncture. The containers should be used only until filled to three-quarters of capacity and should be kept out of reach of young children. Procedures should be established for the removal and incineration or sterilization of contents.

• Needle devices with safety features should be evaluated periodically with input from staff members who use needles, and the use of devices that are likely to improve safety should be implemented.


1. Rathore MH, Jackson MA. AAP Committee on Infectious Diseases. Infection Prevention and Control in Pediatric Ambulatory Settings. Pediatrics 2017;140(5):e20172857. Available at: http://bit.ly/2C7erOM. Accessed Dec. 29, 2017.