Infection control is an integral part of pediatric practice in ambulatory care settings as well as in hospitals. All health care professionals should be aware of the routes of transmission and techniques used to prevent transmission of infectious agents. Written policies and procedures for infection control and prevention should be developed, implemented, and reviewed at least every 2 years. Standard Precautions, as outlined for the hospitalized child (see Infection Control for Hospitalized Children) and by the Centers for Disease Control and Prevention,¹ with a modification by the American Academy of Pediatrics exempting the use of gloves for routine diaper changes and wiping a child's nose or tears,² are appropriate for most patient encounters. Key principles of infection control in an outpatient setting are as follows:

• Infection control should begin when the child enters the office or clinic. Standard Precautions should be used when caring for all patients.


• Contact between contagious children and uninfected children should be minimized. Policies for children who are suspected of having contagious infections, such as varicella or measles, should be implemented. Immunocompromised children should be kept away from people with potentially contagious infections.


• In waiting rooms of ambulatory care facilities, use of some or all components of respiratory hygiene/cough etiquette should be considered for patients and accompanying people with suspected respiratory tract infection.³


• All health care professionals should perform hand hygiene before and after each patient contact. In health care settings, alcohol-based hand products are preferred for decontaminating hands routinely. Soap and water are preferred when hands are visibly dirty or contaminated with proteinaceous material, such as blood or other body fluids. Parents and children should be taught the importance of hand hygiene.


• Health care personnel should receive influenza immunization annually as well as immunizations against other vaccine-preventable infections that can be transmitted in an ambulatory setting.


• Health care professionals should be familiar with aseptic technique, particularly regarding insertion or manipulation of intravascular catheters, performance of other invasive procedures, and preparation and administration of parenteral medications.


• Alcohol is preferred for skin preparation before immunization or routine venipuncture. Skin preparation for incision, suture, or collection of blood for culture requires 10% povidone-iodine, 70% alcohol, alcohol tinctures of iodine, or 2% chlorhexidine. After application of iodophor skin preparations, the skin should dry for 2 minutes.


• Needles and sharps should be handled with great care. The use of safer medical devices designed to reduce the risk of needlesticks should be evaluated and implemented. Needle-disposal containers that are impermeable and puncture proof should be available adjacent to the areas where injections or venipunctures are performed. The containers should not be overfilled and should be kept out of reach of young children. Policies should be established for removal and incineration or sterilization of contents consistent with local regulations.


• A written bloodborne pathogens exposure control plan that includes policies for management of exposures to blood and body fluids, such as through needlesticks and exposures of nonintact skin and mucous membranes, should be developed, readily available to all staff, and reviewed regularly (see Hepatitis B; Hepatitis C; and Human Immunodeficiency Virus Infection).


• Standard guidelines for decontamination, disinfection, and sterilization should be followed.


• Appropriate use of antimicrobial agents is essential to limit the emergence and spread of drug-resistant bacteria (see Appropriate Use of Antimicrobial Agents).


• Policies and procedures should be developed for communication with local and state health authorities about reportable diseases and suspected outbreaks.


• Ongoing educational programs that encompass appropriate aspects of infection control should be implemented, reinforced, documented, and evaluated on a regular basis.


• Physicians should be aware of requirements of government agencies, such as the Occupational Safety and Health Administration, as they relate to the operation of physicians' offices.