Chapter 4: Infection Prevention and Control in the Office

INTRODUCTION

Infection prevention and control are essential practices within the office setting to help ensure patient safety and prevent transmission of infectious agents to patients, their families, and the healthcare team. Nearly all children have contact with a healthcare professional each year. Primary healthcare provider visits represent over half of the 900 million ambulatory visits performed annually in the United States.¹ Adherence to good infection control practices within the office setting are of paramount importance as the delivery of complex medical care shifts from the hospital to the outpatient setting. National guidelines and recommendations for preventing and controlling healthcare-associated infections from the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee apply to both inpatient and outpatient settings and serve as the source for the application of transmission-based precautions in healthcare settings.^2–4 The American Academy of Pediatrics policy statement regarding infection prevention and control in pediatric ambulatory settings is regularly updated by the Committee on Infectious Diseases.⁵

Clinicians should understand the epidemiology and modes of transmission of common pediatric infections. In addition, office practitioners must be familiar with regulatory requirements 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.

STANDARD PRECAUTIONS

The cornerstone of routine infection prevention for every patient encounter is the use of standard precautions because all patients may potentially harbor an unrecognized infectious agent that can be transmitted by blood or body fluids or via their skin or mucous membranes.³ Gloves should be worn when contact with blood, body fluids, secretions, excretions, and items contaminated with these fluids is reasonably anticipated, and hand hygiene should be performed before donning gloves and after they are removed.⁵ Gloves are not required when administering vaccines unless the hands of the healthcare worker have open lesions or will contact potentially infectious body fluids.^6,7 Medical masks and face shields or protective eyewear, such as goggles, should be worn if splashing of body fluids is anticipated.

HAND HYGIENE

Contact with contaminated hands of healthcare workers is the primary means of transmission of infections in the healthcare setting. Hand hygiene, with the use of either alcohol-based hand rub or washing with soap and water, is the single most important method of preventing transmission of infectious agents.^8,9 Numerous studies in healthcare facilities have demonstrated the effectiveness of hand hygiene in reducing healthcare-associated infections.^10–13 Alcohol-based hand sanitizers are preferred products for decontaminating the hands of healthcare workers and have several advantages, including increased killing of many organisms compared with soap and water, no requirement for access to running water, and less time required for proper use.⁸ Hand hygiene should be performed before and after each contact with ...