Blog | Friday, March 21, 2014

Well child, sick child

Who doesn’t get a little bit nervous in a pediatric clinic waiting room? Even in an office that divides “sick” from “well” waiting areas, kids tend to move pretty freely, and of course the pathogens contained in respiratory droplets move even more freely. I always assumed that the risk from these exposures (of the “well-children” to the “sick-children” in ambulatory clinics) was fairly small, at least compared with the usual community exposures kids have at home, at day care, at the children’s museum, etc.

Our colleague Phil Polgreen and his group analyzed some “Big Data” (the Medical Expenditure Panel Survey) to try to determine if well-child visits are indeed a risk factor for subsequent influenza-like illness (ILI). Their findings are published in this month’s issue of Infection Control and Hospital Epidemiology, and confirm the suspicion that the ambulatory pediatric clinic is likely to contribute to viral respiratory pathogen transmission. The odds ratio for ILI after a well-child visit (within prior 2 weeks) was 1.54 (95% CI, 1.43 to 1.66), which seems pretty large, though the absolute risk was modest (~3% increased risk). However, if you consider the total number of such visits annually, the number (~800K) and cost ($500 million) of excess ILI cases is substantial.

Lisa Saiman has an excellent editorial discussing the implications of these findings, the main message being that we need to pay more attention to infection prevention in ambulatory settings. My only additional suggestion (which, admittedly, may be unrealistic for many clinics): forget about separate waiting rooms, instead have physically or temporally separate clinics for well-child versus sick-child visits (with clear signage to direct kids who happen to be sick during a well-child visit to the “sick-child” clinic).

Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.