On October 23, the American Academy of Pediatrics released an updated set of infection control guidelines for pediatricians' offices.
The statement includes guidelines for employee vaccination, waiting room disinfection, and hand hygiene, among others.
These guidelines are important to employees at pediatricians' offices, who have a responsibility to keep patients safe from infection. But the AAP guidelines also have valuable lessons for parents about how to reduce the spread of illness at pediatric offices, not just for their own children but for all patients.
Practice sneeze and cough hygiene
The AAP statement includes guidelines for "respiratory hygiene and cough etiquette," such as sneezing or coughing into elbows instead of hands and maintaining a distance of at least three feet from patients when sneezing or coughing.
You and your kids can model these same practices. In the case of a serious cough or unrelenting sneezing, request a mask. If you don't see tissues in the waiting room, or a trash can to toss used tissues in, ask the receptionist to make those items available.
Bring your own toys
The AAP statement recommends establishing routine cleaning schedules for waiting room toys and books, and recommends against using fluffy toys, which are more difficult to clean and therefore more likely to spread disease.
You can help further prevent the spread of disease by ensuring there are no infected toys to begin with. You can bring your own toys, or, better yet, build a repertoire of office waiting room games that don't require any toys. You might even encourage your child's pediatrician to hang posters with songs and games to keep waiting kids busy while keeping waiting rooms fomite-free.
If your pediatrician’s office doesn’t already support Reach Out and Read, a program that offers free books at each visit, ask your pediatrician’s office to join the program or even step up and coordinate the program yourself. New books cut down on waiting room germs while fostering early childhood development.
Stay up to date on your vaccinations
The AAP recommends office-wide immunization policies, which can help ensure that employees do not spread vaccine-preventable illnesses like the flu to patients.
But children at pediatrician’s offices are often exposed to another source of disease: unvaccinated parents. Parents may choose to go unvaccinated for many reasons, but one of the main factors is time: Parents make time for their children’s health appointments, but often neglect their own health.
One of the best ways to ensure parental vaccination is for pediatricians to offer immunizations to parents and close family members during pediatric appointments. If your child’s pediatrician offers this service, set the example for your child by getting your needle sticks first. If the office doesn’t currently support vaccinations for parents, be an advocate for changing the policy.
Accept inconvenience for the safety of other patients
Before you fume at the receptionist about your half-hour wait while that little girl who just showed up got walked right back, consider how the AAP guidelines work to protect especially vulnerable pediatric patients. The guidelines recommend keeping immunocompromised patients, including those with cystic fibrosis, out of waiting rooms.
Pediatricians' offices adhering to the new guidelines may occasionally inconvenience patients and their parents. The AAP encourages pediatric offices to establish written, non-punitive policies for illness-related absences. If your child's appointment is cancelled due to staff member illness, you should be pleased that the office keeps sick employees home and away from patients.
The same absence policy should hold for parents accompanying their children to visits. If you're sick, find another adult to accompany your child or reschedule the appointment. If those measures aren't possible, ask for a mask during the appointment to prevent sickening other kids.
Demand proper hand cleaning
The AAP statement makes clear that all employees need to clean their hands "before touching a patient, before cleaning and aseptic procedures, after body fluid exposure and/or risk, after touching a patient, and after touching patient surroundings." How those employees clean their hands is up to them – some may use alcohol-based sanitizers, while others may use soap and water.
It is your health care worker's responsibility to use proper hand hygiene, but there are many obstacles to proper hand washing. Chief among them may be time: It's easy to overlook hand washing when running behind.
You can help prevent the spread of illness by demanding good hand hygiene of your health providers. Although it may be awkward to ask your child's pediatrician to wash her hands, you can ask the question more obliquely by mentioning right at the start of the appointment that a hand sanitizer bottle is empty or missing. Could the doctor fill or replace it before starting the appointment? If there are not hand sanitizer dispensers in front of every room, you can ask your pediatrician's office to install them.
Stay in the waiting room
Parents who read the AAP guidelines may want to avoid the waiting room altogether, or at least question their pediatrician about sick and well waiting rooms. But the AAP guidelines do not recommend either practice, because there is no scientific evidence to support the practice of separating children into “sick” and “well” waiting rooms.
There are many shared spaces within each doctor’s office, including bathrooms, exam rooms, stock rooms, and reception desks. And even if a pediatrician’s office maintained separate versions of all of these rooms for sick and well patients, both the personnel and the air would still flow freely between them.
Although it may be tempting to try to “skip” the waiting room in order to avoid germs, parents who wait outside of the waiting room can delay a tightly-packed office schedule, leading to longer wait times for everyone else and, as a result, the kind of waiting room crowding most likely to spread disease.