Joining the Association for Professionals in Infection Control and Epidemiology and many other professional organizations, the American Academy of Pediatrics (AAP) has issued new guidelines for outpatient clinics that call for mandatory flu vaccination of healthcare staff.

In its first update for ambulatory settings in 10 years, the AAP has published infection prevention guidelines¹ that also include a section on patients with cystic fibrosis, guidance during outbreaks, and an emphasis on communication with other healthcare facilities when transferring patients. While calling for mandated flu shots in ambulatory settings, the AAP left it to individual clinics to accomplish that according to their local situation.

“I think that it is important to leave the details to each individual facility because conditions vary from practice to practice,” says lead author Mobeen H. Rathore, MD, FAA. “There are unique challenges and needs to implementing these policies around the country.”

The AAP guidelines also focus on hand hygiene, the cardinal principle of infection control. “I think the major emphasis is on hand hygiene, and how we tell our staff and patients to do that appropriately,” Rathore says.

The guidelines also draw attention to the special needs of pediatric patients with cystic fibrosis, who are at risk of respiratory infections with pathogens like drug-resistant Pseudomonas aeruginosa and Burkholderia cepacia.

“Patients with cystic fibrosis can also be a source of resistant pathogens that could spread to other patients with cystic fibrosis,” the AAP states. “In general, in ambulatory medical settings, standard IPC guidelines should be followed. In addition, when caring for patients with cystic fibrosis, HCP should follow the ‘Contact Precautions,’ and all patients with cystic fibrosis should wear a mask throughout their visit except when in an examination room.”

A summary of some of the other AAP infection control recommendations includes the following:

• Written policies and procedures concerning IPC should be developed, incorporated into the ambulatory practice safety program, available at all times to office staff, and reviewed at least every two years.
• Educational programs for staff concerning IPC should be implemented, reinforced, and evaluated on a regular basis. All staff should be required to review the policies at the time of employment.
• In waiting rooms of ambulatory care facilities, the use of respiratory hygiene and cough etiquette should be encouraged for patients and accompanying people, especially those with suspected respiratory infection.
• Patients with potentially contagious diseases and immunocompromised children should be promptly triaged. Contact between contagious children and uninfected children should be minimized. Policies to deal with children who present with highly contagious infections (such as varicella, measles, pertussis, influenza, mumps, and TB) should be devised and implemented; travel, immunization, and exposure history is key to identify patients who may be at increased risk for such infections.
• Alcohol is preferred for skin antisepsis before immunization and routine venipuncture. Skin preparation for incision, suture, and collection of blood for culture requires either 2% CHG in 70% isopropyl alcohol-based solutions (for children older than two months) or iodine (1% or 2% tincture of iodine, 2% povidone-iodine). Most skin preparation agents must be allowed to dry before surface bacteria are killed.
• Policies and procedures should be developed for communication with local and state health authorities regarding reportable diseases and suspected outbreaks.
• Antimicrobial agents should be used appropriately, and standard precautions should be observed to limit the emergence and spread of antimicrobial-resistant bacteria.

REFERENCE

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.