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Infection control is a critical component of pediatric practice in the outpatient setting. Children seen in an office for sick visits frequently have infections that may be transmitted to other patients or staff. In addition, as the delivery of complex medical care continues to shift from the hospital to the outpatient setting, careful attention to infection control practices in the office has become increasingly important. Clinicians should understand the epidemiology and modes of transmission of common pediatric infections. In addition, office practitioners must be familiar with regulations that apply to infectious diseases, including requirements for purchasing safety devices for staff, reporting diseases to public health agencies, and cleaning and disinfection in the office environment to prevent the transmission of infections.

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There are three primary modes of transmission by which microorganisms can be spread between patients and health care workers: contact, droplet, and airborne. (Additional routes of transmission, including common vehicle and vector-borne transmission, will not be reviewed here.) The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee issue national guidelines and recommendations for preventing and controlling health-care-associated infections.1 These guidelines apply to both inpatient and outpatient settings, and they serve as the source for the application of transmission-based precautions in health care settings.

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Many common infections encountered in pediatric practice are transmitted by direct or indirect contact. Direct contact refers to person-to-person spread of an organism through direct physical contact. Indirect contact refers to spread that occurs by means of contact with a contaminated intermediate object (often fomites such as stethoscopes, bed linens, etc.), including the hands of health care workers; this route is the most important means of transmission of infections in health care settings.

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Transmission via the droplet route occurs when large droplets are generated as an infected person coughs, sneezes, or talks. These droplets are propelled a short distance (generally less than 3 ft), and are deposited on the eyes, nasal mucosa, or mouth of a susceptible host.

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Airborne transmission occurs when small droplet nuclei, dust particles, or skin squames containing microorganisms are transmitted to a susceptible host by air currents. Infections that are transmitted by the airborne route may be spread to others who are quite distant in space from the source infection.

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Table 4–1 reviews the primary modes of transmission for many common infections that may be encountered in a pediatric practice. Each of these modes of transmission requires a unique strategy to prevent the spread of infection (see “Isolation Precautions in the Outpatient Setting”).

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Table 4–1. Modes of Transmission of Common Infections

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