unny noses. Contaminated Teddy bears. Germs that somersault through the air toward unsuspecting nostrils. A doctor's waiting room can be a scary place, especially when you're not the person who is sick.
But new guidelines released Monday by the American Academy of Pediatrics may diminish the risk of you or your child getting sick as the cold and flu season approaches. The guidelines are aimed at health-care providers, but they contain information that parents should know, too.
For one thing, don't count on your pediatrician to provide a basket of toys for your child to play with while you wait to be seen.
Books and toys — stuffed animals in particular — can be a breeding ground for germs, the report says. Let your child bring his or her own toy instead.
And don't be alarmed if a staff member comes out and asks to put a surgical mask on your coughing child while you're waiting. It's not that they think your child has the plague.
The recommendations urge doctors to employ the same hygiene standards as hospitals to ensure that families who come in for well check-ups don't go home with the flu. To that end, a doctor may ask you or your child to don a mask so that you're not spewing germs in the air.
The policy statement released Monday was the first to address infection prevention and control in pediatric offices since 2007. Among other things, authors Dr. Mobeen Rathore and Dr. Mary Anne Jackson address waiting rooms, cough etiquette and hand washing, and they acknowledge what worried parents have long suspected: The place you go to get healthy is a place where you risk getting sick.
"In addition to the risk of health care-associated infection during medical evaluation and treatment, the reception and waiting areas of ambulatory facilities present opportunities for the transmission of infectious agents," the authors wrote, adding that transmission of measles, tuberculosis, hepatitis B and C, and other infectious diseases have been traced to encounters there.
Illness is most often spread through contaminated hands, but pathogens can be passed through the air and through bodily fluids and droplets. And you don't have to be sitting next to someone to get sick. Some particles travel 3 to 6 feet through the air. Other germs may be picked up on door handles and countertops. Then there are the toys, and interactions among children themselves as they wait.
"Waiting rooms are similar to child care settings, where contamination of the environment and transmission of infectious agents occur at an increased rate compared with the home setting," the authors said.
Toys, if provided by the office, should be disposable or washable, the authors said, and ideally, should be washed after each use, although "the value of antibacterial agents incorporated within toys is unproven."
Plush or furry toys are the worst, the report said, because they can't be cleaned effectively.
"A suggestion can be made to parents to bring along their child's personal book and toys for the office visit to minimize sharing of toys."
The academy urges doctors to segregate sick and well children and to work to shorten waiting times to limited exposure. But parents have responsibilities, too.
"Accompanying adults, if sick, should be encouraged not to come to the office with the child if possible. If such adults do come with the child, they may need to wear a mask," the report says.
And everyone should know by now that we're no longer supposed to cover a cough or a sneeze with our hands, but with our elbows, unless you happen to be carrying a handkerchief.
The World Health Association says that health-care providers should wash or clean their hands up to five times during an encounter with a patient: before touching a patient, before cleaning and aseptic procedures, after body fluid exposure, after touching the patient, and after touching the patient's surroundings.
Alcohol-based sanitizers can be used, and surprisingly, the report says that these are not as hard on hands as soap and water.
As for proper hand-washing hygiene, the report says this is the proper way to do it:
(1) wet hands with warm (not hot) water
(2) apply soap to hands
(3) vigorously rub the hands together for at least 15 seconds, covering all of the surfaces of the hands and fingers
(4) rinse with warm water
(5) dry hands with a disposable towel
(6) use the towel to turn off the faucet
As for the debate over antibacterial versus plain soap, the authors say to use plain soap, citing the recommendation of the Society for Healthcare Epidemiology of America.
A study published in 2014 found a slight uptick — about 3 percent — in illness among children 6 and younger who had recently been at a doctor's office for preventive care.
Of course you can pick up a cold or the flu at the supermarket just as easily as in a doctor's waiting room. But doctor's offices, like pharmacy counters, may have a higher percentage of sick people during the cold and flu season, which begins this month.
Other tips on how to avoid getting sick in a waiting room:
If possible, schedule well check-ups for spring and summer when fewer people are sick, says Scripps.org.
Try to snag the earliest appointment of the day, before germs accumulate. Offices are often cleaned at night.
The American Academy of Pediatrics urges doctors' offices to have hand sanitizers available, but if they're not, carry your own hand cleaner or wipes.
Consider a telemedicine visit if your insurance allows it and you're not a high-risk patient. Some doctors believe the growth of telemedicine may cut down on the spread of the flu.