Use of an alcohol-based hand sanitizer is the preferred method of hand hygiene in most situations in the office, according to a newly updated American Academy of Pediatrics policy statement on infection prevention and control in ambulatory settings.

The updates to the statement, entitled “Infection Prevention and Control in Pediatric Ambulatory Settings,” were prompted by a flurry of new recommendations for preventing the spread of infectious disease, according to Dr. Joseph A. Bocchini Jr., chair of the AAP Committee on Infectious Diseases, which developed the statement (Pediatrics 2007;120:650-65).

Dr. Bocchini, who also is professor and chairman of pediatrics at the Louisiana State University Health Sciences Center, Shreveport, called the statement a must-read for those practicing in pediatric ambulatory care settings. It is “very comprehensive and includes a significant amount of information and guidance on how to reduce infection risk for patients and for personnel.”

Although significant emphasis has been placed on preventing infection in hospitals, most patients are seen in ambulatory settings, so control and prevention of the spread of infection in this setting is very important, he added.

The committee's nod regarding the use of alcohol-based hand sanitizers is one of numerous updates to the statement, which was initially published in Pediatrics in 2000. “This is an important alternative hand hygiene technique that is safe and effective,” Dr. Bocchini said in an interview, noting that the recommendation applies only to alcohol-based sanitizers, and is a category IA guideline, indicating that it is based on a strong recommendation for implementation, strongly supported by well-designed studies.

Such products are more effective than standard handwashing techniques in most cases, and should be the primary mode of hand hygiene before and after each patient contact. Soap and water still are effective—and in fact are preferred when there is a high likelihood of exposure to organisms such as Clostridium difficile, when hands are visibly contaminated with blood or other body fluids from a patient, before eating, and after using the toilet. But, in general, sanitizers are preferred because they are quick and easy to use, so they can improve office flow, he noted.

An emphasis on initiating infection control procedures from the time of a patient's first phone call to the office is another important addition to the statement, Dr. Bocchini noted.

With that first phone call, the likelihood of contagious disease should be assessed, and decisions should be made about how to triage the patient through the office to reduce exposure to other patients, family members, and office staff, he said.

According to the statement, “patients with potentially contagious diseases and immunocompromised children should be promptly triaged. Contact between contagious children and uninfected children should be minimized.” This recommendation is listed as category IB, indicating a strong recommendation for implementation, supported by certain studies and a strong theoretical rationale.

“In addition, there have been considerable updates of recommendations for the prevention of exposure to blood-borne pathogens by needles and other sharps,” Dr. Bocchini said.

Based on new recommendations from the Occupational Safety and Health Administration, the AAP now calls for written policies and specific educational programs to make staff aware of the proper handling of sharps, and for consideration of adopting into practice any new and potentially safer medical devices and systems that become available to reduce the risk of needle-stick injuries. This category IA recommendation also is listed as category IC, indicating that it is required for implementation as mandated by federal or state regulation or standard.

Other important updates to the statement include:

▸ A call for implementation of new Centers for Disease Control and Prevention strategies for respiratory hygiene and cough etiquette for patients with suspected influenza or other respiratory tract pathogens, which were recently added to its list of standard precautions for hospitalized patients. That list was modified by the AAP for children, and includes, among other things, recommendations for providing visual alerts for patients to alert staff of respiratory tract infections and for reminding them of cough etiquette. This is a category II recommendation, indicating it is suggested for implementation based on suggestive studies or theoretical rationale.

▸ More detailed guidelines on infection control and prevention in physician's office waiting rooms. In addition to standard precautions, the statement outlines category IC procedures for sterilization, disinfection, and antisepsis.

▸ Added emphasis on the use of vaccines available for reducing employee's risk of acquisition or transmission of certain infectious diseases, such as influenza, tetanus, pertussis, and hepatitis. This category IB and IC policy states that employees should be vaccinated annually against influenza and should show documentation of immunity to other vaccine-preventable infections.

▸ New emphasis on the importance of developing policies and procedures for communicating with state and local authorities for prompt reporting of communicable disease and suspected outbreaks as required by law (category IC).

AAP Update Highlights Hand Hygiene in Office