CDC Advisors Defend Infection Control Draft Guidance

Members of the Healthcare Infection Control Practices Advisory Committee (HICPAC) voted Friday to defend what some have called weak standards of infection control for healthcare settings, agreeing nearly unanimously that surgical masks provide adequate protection against airborne pathogens, and that sick healthcare workers may return to work after 3 days of viral respiratory symptoms without testing.

The meeting centered largely on written responses to CDC questions pushing back on draft guidelines to prevent transmission of pathogens in healthcare settings, and on proposed updates to a section of a separate guideline for infection control in healthcare personnel from 1998.

HICPAC, which advises the CDC and HHS on infection control practices, has faced an outcry from some healthcare workers and occupational health experts since the beginning of its guideline revision process in 2023. Critics have condemned the proposed infection precautions as woefully inadequate for protecting healthcare workers and patients, and called for more transparent processes, along with input from those representing their concerns.

HICPAC has since made adjustments, such as adding members to its voting contingent and workgroup. This includes two leaders from a group that has been among its loudest critics, National Nurses United (NNU): Lisa Baum, MA, the lead occupational health & safety representative at the New York State Nurses Association, an NNU affiliate, and Jane Thomason, MSPH, lead industrial hygienist for NNU. Baum is one of 11 HICPAC voting members and Thomason serves on the HICPAC workgroup.

Despite the concessions, HICPAC voted to approve language that kept the recommendations largely the same. Though HICPAC’s guidelines are not mandatory, most healthcare employers use them to guide their infection control practices.

Michelle Gutierrez Vo, RN, president of the California Nurses Association/National Nurses Organizing Committee, an affiliate of NNU, told MedPage Today, “We’re not surprised, you know, it’s not something that we thought was going to be easy. But it doesn’t deter us.”

“They need to be preventing illness, and they need to be sitting at the highest level to make sure that people don’t get sick,” Vo added. “And if they don’t do that, then they’re failing.”

Vo and others noted that HICPAC’s members are largely administrators and managers from institutions including academic research centers and health departments, but also hospitals and health systems with a vested interest in keeping costs down. Throughout the deliberations, Baum stood in stark contrast to the rest of the HICPAC members, arguing for stronger language, and was nearly the sole “disapprove” vote in all six of the items voted on.

Defending the Draft

CDC asked four key questions about the isolation precautions guidance when it sent the draft back to HICPAC earlier this year. For the first question, members approved language stating that “N95 respirators should not be recommended for all pathogens that spread by air.”

As for the draft’s “routine air precautions,” it recommended the use of “masks” — including surgical masks — for “common, often endemic, respiratory pathogens that spread predominantly over short distances.”

To a question about voluntary use of N95 respirators by healthcare staff, the workgroup voted to respond, in part, that the guideline should not include this as a direct recommendation. Language that “clearly supports the concept of voluntary use of N95” masks should be left in the “narrative” portion of the relevant section, the group decided.

Finally, the workgroup responded that a blanket recommendation for source control — the use of masks to prevent transmission of pathogens from the mask-wearer — was not needed.

As for the healthcare personnel guidance, HICPAC recommended workers stay home for 3 days after the onset of a confirmed or suspected respiratory virus, returning if they are fever-free for 24 hours, have improving symptoms, and “feel well enough to return to work.” After the return to work, they should wear a mask until day 7 from onset.

This decision came after reviewing data compiled from a number of studies, from which the workgroup estimated that most viral transmission occurs within the first 5 to 7 days of the primary case.

Public Pushback

Noticeably frustrated public commenters called for universal masking in healthcare settings, better evidence reviews, and stronger protections for healthcare workers and immunocompromised people.

“Who’s going to send the memo to all the firefighters that they should start using surgical masks for wildfire smoke? [Or] to the lab workers that work with other infectious diseases like tuberculosis, bird flu, or whatever else pops up that can spread by the air?” asked Shea O’Neil, a volunteer at the World Health Network and Air Support Project. “Just let them know to put down those coppers and N95s and throw on a baggy blue surgical mask, because it probably works just as fine.”

“It’s a risk you all are willing to take today, and somehow you’ve been put in this position to decide for us. That’s not the precautionary principle,” O’Neil said, calling for N95 respirators or better as a standard precaution.

“If folks are symptomatic, then they should be home [until] they’re not symptomatic — 3 or 5 days does not handle the issue,” said commenter Don Ford, a COVID-19 safety and long COVID advocate. “I hear the committee discussing what is best for hospital management when your role is to determine what is best healthcare practices. The group is not called ‘hospital management practices.’ It’s Health Infection Control Practices Advisory Committee.”