Just in time for winter cough and cold season, the American Academy of Pediatrics (AAP) is updating its recommendations on the best ways to prevent the spread of germs during doctor visits. The policy statement, "Infection Prevention and Control in Pediatric Ambulatory Settings," published in the November 2017 issue of the journal Pediatrics, (published online October 23) acknowledges that the majority of patients are seen in outpatient facilities or doctor's offices, and so infection control in these places should be just as strict as in hospitals.

The AAP recommends mandatory annual influenza immunization for staff, and documentation of immunity or immunization against other vaccine-preventable infections including pertussis, measles, mumps, rubella, varicella and hepatitis B. In the policy statement, the AAP emphasizes the importance of cough and sneeze etiquette and hand hygiene, and recommends that waiting rooms be equipped with alcohol-based sanitizers and masks. Pediatricians should also post visual reminders to cover your nose and mouth with your elbows rather than your hands when coughing and sneezing, and to properly dispose of tissues.

Among other recommendations, the report recommends avoiding stocking the waiting room with plush toys like stuffed animals, which are difficult to clean and can harbor germs. Instead, parents should be encouraged to bring their own. New recommendations include special precautions for cystic fibrosis patients, whose lungs are especially vulnerable to drug-resistant bacterial infections. These high-risk patients should not share space in the waiting area and instead be placed directly into the exam room.