HICPAC invites your comments on revised isolation precautions guideline this fall

Posted on by Mike Bell, MD, and Alex Kallen, MD, MPH

African American female healthcare worker dons a face mask as she approaches a healthcare facility

CDC’s evidence-based guidelines for health care are designed to protect healthcare workers and patients, encourage safe practices, improve health outcomes, and save lives. They are not regulations, but many regulatory bodies consider this advice when they create the rules that lead to penalties and payments for healthcare facilities. We have learned a lot about how to improve CDC guidance, particularly during the COVID-19 pandemic. It is more important than ever that guidance be flexible for future threats, and simple and clear to ensure correct application and uptake.

To ensure its widely used 2007 Isolation Precautions guideline continues to meet the latest science and emerging needs in U.S. health care, CDC recently requested review of the guideline by the Healthcare Infection Control Advisory Committee (HICPAC).


HICPAC, a federal advisory committee, weighs science and public discussion to inform their recommendations to CDC. Consisting of experts from infection prevention and control fields who work outside of CDC, the HICPAC process allows for wide-ranging input while reducing concerns about conflicts of interest. Members and liaisons represent expertise across the continuum of care, including infectious diseases, nursing, pediatrics, kidney care, surgery and perioperative care, critical care, laboratory medicine, clinical operations, occupational and environmental health, healthcare quality improvement, healthcare accreditation, medical engineering, epidemiology, public health, health policy, and more. These experts bring related healthcare and patient safety expertise from their experience working in local hospitals, public health departments, professional associations, consumer groups, government, and global organizations.

When HICPAC recommends guidance for CDC consideration, those can be used at the local level for facilities to adapt to their own needs and practices. See the chart below for more information on the guideline update process.

How the U.S. updates its healthcare guidelines

How the U.S. updates its healthcare guidelines
General process for HICPAC’s review Status of the 2007 Isolation Precaution update
Step 1. Workgroup. A workgroup is formed and meets for an extended period (e.g., months or years) to gather, examine, and interpret data. Complete! Check Box Icon Complete! The workgroup has met since February 2022 to collect and discuss initial data.
Step 2: Data. The workgroup presents data and expert opinion to the full HICPAC membership for review and discussion. The full committee (not the workgroup) is charged with making recommendations to CDC. In Progress. Clock Icon In progress. Meeting notes are being transcribed and will be available soon. There may be additional data presented at the August 2023 meeting.
Step 3: First draft. The first draft of new or revised guidelines are presented and discussed. If ready, the HICPAC members will vote on if the draft guidelines are ready for CDC review and public comment. Members weigh public discussion and the presented data. In Progress. Clock Icon In progress. Expected at the August and/or November 2023 meeting. These dates may shift depending on workgroup progress.
Step 4: Public comment. If voting members approve, the guidelines are reviewed by CDC and then posted to the Federal Register for public comment, including industry input. Incomplete, dependent on previous steps. X Box Icon Coming soon, dependent on previous steps. Expected approximately 2 months after the public meeting and vote. The guidelines usually stay open for comment on the Federal Register for approximately 2 months.
Step 5: Review & revision. CDC and HICPAC review and respond to the public comments. The guidelines are revised to reflect public input. CDC reviews again. Incomplete, dependent on previous steps. X Box Icon Coming soon, dependent on previous steps. Timeline varies depending on the number and type of comments. If changes are significant, the revised guidelines will be further updated, and the process will begin again at Step 2. This cycle will continue until the draft is stable.
Step 6: Vote & recommendation. The workgroup presents the revised and pre-final draft for HICPAC approval. The members vote on the guideline and recommend the final draft to CDC, if approved. Incomplete, dependent on previous steps. X Box Icon Coming soon, dependent on previous steps. If approved, CDC will update its infection control website and related materials. CDC will work with partners to educate and train HCWs on the changes to ensure their safety and patient safety.


HICPAC is reviewing and updating the 16-year-old guideline to incorporate the latest science and lessons learned from the COVID-19 response, as well as reflect feedback from frontline healthcare workers (HCWs), the broad HICPAC membership, and other stakeholders. The updates will make the guidelines more accessible, concise, and useful for protecting patients and HCWs by stopping the spread of pathogens across healthcare delivery.

The updated guideline will:

  • be relevant to all healthcare settings,
  • reflect updated, scientifically transparent descriptions of how pathogens spread in healthcare settings,
  • describe categories of transmission-based precautions, and
  • be suitable for access via multiple platforms, including mobile devices.

In its June 8-9, 2023, public presentation to the HICPAC members, the workgroup shared findings from its review and their discussions so far. Key takeaways from the workgroup findings include:

  • Different healthcare settings face different challenges when implementing interventions to protect HCWs and patients. These differences need to be considered when designing infection prevention interventions.
  • The workgroup and HICPAC members also discussed the concept of how pathogens spread in the air.
  • The workgroup continued to support the importance of multiple layers of intervention (hierarchy of controls) to reduce transmission risk.

The COVID-19 pandemic highlighted that strict implementation of impractical guidelines may yield unintended risks to healthcare workers, patients, and healthcare quality. It also demonstrated that providing clear and unambiguous recommendations helps facilitate implementation and adherence. HICPAC will continue conducting systematic evidence reviews that consider effectiveness in real-world situations, not just success (efficacy) seen in controlled laboratory studies. The revisions being made will include those issues and help ensure every healthcare worker has practical and understandable interventions to protect themselves and their patients.


HICPAC wants to hear from the public, partners, and healthcare workers. The first draft of the updated guideline is expected to be presented this fall, at either the August or November 2023 public meetings. Pending HICPAC member approval, the first draft will later post to the Federal Register for public comment, including industry input.

CDC will continue to provide updates on the progress of the workgroup and HICPAC discussion on the HICPAC website and on this blog. Register for the August meeting now to ensure your voice is heard: https://www.cdc.gov/hicpac/meeting.html.

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About the Healthcare Infection Control Practices Advisory Committee (HICPAC)

About the Authors

Michael Bell, MD Leadership Bio
Alexander J. Kallen, MD, MPH Leadership Bio

Posted on by Mike Bell, MD, and Alex Kallen, MD, MPHTags , ,

55 comments on “HICPAC invites your comments on revised isolation precautions guideline this fall”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Specific guidance for transmission-based precautions in inpatient behavioral health settings, particularly milieu settings, is needed. Please consider adding guidance or considerations for the inpatient behavioral health population to the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.
    Thank you.

    we would like to get clarifications regarding isolation practices for acutely infected vs.old colonized patients with MDROs.
    also, more clarifications regarding herpes zoster specially in immunocompromized patients

    Updating Appendix A is such a good idea. My request in this update to help nurses in skilled nursing facilities would be to look at the Herpes zoster recommendations. I don’t believe it is stated clearly as to when Standard Precautions, contact or airborne are needed.

    totally agree. I would to see more clarifications specially when it come to immunocompromized patients?

    Really hoping we can take a more progressive approach to MDRO’s when it comes to active vs colonization/history, along with clear guidelines on how to room these patients. There is a lot of grey area from the CDC, and when we admit a patient after hours, nursing defers to the CDC site.

    1. Hopefully airborne isolation and SARSCoV2 spread can be clarified, especially considering the lack of airborne isolation rooms in the nursing home setting and limited availability in the hospital setting. 2. Add some clarification on the definition of “duration of illness” for many of the infections and conditions – for example C diff. 3. Add some verbiage about nursing home considerations and enhanced barrier precautions and when to consider going from transmission-based precautions to enchased barrier precautions in this setting. 4. Consider adding droplet to RSV as it is described here: https://www.cdc.gov/rsv/about/transmission.html

    Given the paucity of evidence for contributions of fomites and contact-based transmission of SARS-CoV-2, please consider removing the recommendation for contact precautions for SARS-CoV-2. The literature is clear and abundant that respiratory routes (droplet and airborne) are the primary drivers of SARS-CoV-2 transmission. There is also substantial evidence that contact precautions reduce HCW contact with patients and prolong hospitalization. To ease the burden of unnecessary precautions for primarily respiratory-transmitted diseases, please consider removing contact precautions as a component transmission-based precautions for SARS-CoV-2.

    Please reconsider universal use of gown and gloves for contact precautions. The mandated use of gown and gloves is hindering patient safety.

    Discuss the relevance of eye protection in droplet and airborne transmission. It is difficult to gain compliance with eye protection. Delineation of “droplet” and “airborne” as pertaining to infectious particles would be helpful in educating others.

    There needs more enforcement and monitoring of covid prevention in healtcare facilities. I was hospitalized on May 7, 2023 in Luminis Doctors’ Hospital in Lanham, Maryland. The hospital required staff to mask if patients asked them to do so. I had an infection and an autoimmune disease. A hospitalst visited without a mask. When I requested it, she refused in a very hostile manner. I reported this to the Patient Advocacy group who took my complaint and said they reported it to the Administration. That was the last I heard. Patients should NOT needd to request life saving practices and should not have to follow the complaint. I am still waiting. All other staff masked with surgical masks while I used an N95.

    Since you only allowed 30 minutes for public comments during the meeting which had over 900 registrants, I sincerely hope that you will actually take the time to read and consider all of the public comments submitted in writing.

    Please understand the sickest of the sick of us go into hospitals and medical facilities all of the time. We need to be protected by the people taking care of us. They should be in N95s but at the very least a surgical mask. Protect the workers and protect the patients. Keep masks in healthcare we KNOW they work to prevent the spread of illness and that is what we must do. Please mask and get better masks. I can’t believe I’d go to the doctor in an N95 and they only had surgicals. We need to protect each other better as a society. I should not worry about getting a new illness now every time I need medical care. Masks work. Use the science and protect people from more serious illness.

    Just a personal observation, after years of COVID, and staff not being compliant with masking, as well as non-NIOSH approved masks, etc., it seems that the reality is that COVID is not airborne but droplet borne and certified respirators which have been fit-tested is overkill. I totally agree with the person saying long-term care patients/residents should NEVER be prevented from having family visit.

    Hello! Thank you for the opportunity to submit suggestions!

    Can the following be discussed/considered:
    1. Recommend face shields for Droplet Precautions
    2. Contact with Droplet Precautions for MDRO’s in Sputum (requiring masks and possibly face shields)
    3. Airborne “Plus” Precautions for SARS-CoV2

    Thank you!

    Contact precautions for MRSA colonized patients should not be required. Only in MRSA wounds that cannot be contained by dressing. Should change from transmission based to standard precaution. The burden of PPE and patient assignments in the acute care and long term care settings is so high…contact precautions should be reserved for active infections not colonized status.

    Please consider requiring a surgical mask with Droplet Precautions instead of recommending using a mask per Standard Precautions.

    Can we just say to use airborne plus contact for Covid patients? It’s confusing having the extra Covid precautions. Thanks

    Can we please remove eye protection for COVID precautions? There is no data supporting COVID can spread through contact with eyes (unless generating aerosol procedure is being performed).

    Could use some clearer pictures for PPE. Recommend everything in a patient care area be easy to clean and disinfect (including beside keyboards). Please include organism/condition specific recommendations for length of precautions in immunocompromised patients. Please include droplet size in appendix A for respiratory organisms. Define duration of illness. Recommend droplet + contact for influenza, metapneumovirus, parainfluenza, RSV, rhinovirus, and viral resp diseases not covered elsewhere

    I feel Standard applies to each infection/condition and does not need to be placed under type of precaution.

    It is well past time for these guidelines to be updated, and the guideline I feel most strongly about is the COVID-19 isolation. COVID-19 is causing a fraction of the deaths and illnesses that it did three years ago, and it is time to reclassify it as a respiratory illness that cycles around like rhinovirus, flu, and RSV.

    I stand with all of the people, patients and medical staff alike, who speak in favor of keeping high quality masks in our healthcare system. As a disabled person who has spent time in both the transplant floor and the ICU during the active and unchecked pandemic, I shouldn’t have to ask medical staff to mask around me. Putting patients in the position of having to request our providers to wear masks puts our health and our access to healthcare at risk. We shouldn’t have to be subjected to unnecessary exposure to contagious illnesses such as Covid that could further disable and kill us. Additionally, we are at the mercy of our medical providers and often experience repercussions for so much as disagreeing with our doctors treatment (or lack of treatment) suggestions. I’ve had more than one doctor treat me with complete disrespect and disregard for asking them to mask after major surgery when there was a mandatory mask mandate in the hospital. Could you imagine what it’s like when there isn’t a mask mandate? Disabled people have been secluded by society even more so during this ongoing pandemic, at the very least masks should be implemented permanently in medical settings. We are simply asking that the remainder of our health not be further compromised when we are seeking care.

    Current data from health departments around the US and the rest of the world show that covid is still a major concern in 2023 and is likely to remain for a significant amount of time.
    Facility managers/owners needs to be required to make mandates for all staff. The management needs to make compliance to all recommendations simple and easy by e.g. providing readily accessible masks, and other PPE to individuals. The burden should be on the facility managers to enforce good action just as much as for individuals. Both individuals and managers need to be responsible and accountable for infection control.

    Covid is airborne. Long Covid is disabling millions of Americans. Medical settings need filtered air and mandatory respirators. No one should risk infection from Covid or any other airborne illness because they have to get medical attention. And healthcare workers must protect themselves as well with these precautions, just as they protect themselves with gloves. Air is shared.

    The CDC and HICPAC must consult virologists and indoor air transmission experts. Clean indoor air can be achieved through ventilation, air scrubbers, frequent air changing, and upper room far UV lights.

    Hospitals and medical facilities need mandatory respirators and filtered indoor air, or we risk needless infections

    We need universal airborne precautions in all healthcare facilities to protect patients and staff from covid, RSV, flu and other airborne pathogens. People sick enough to be hospitalized are by definition vulnerable. No one should have to risk catching covid in order to access essential medical care. It is not possible to schedule most visits during times of relatively low viral circulation since appointments must often be made months in advance. On a personal note, my mother was hospitalized for an entirely treatable medical emergency and caught covid in the hospital, likely from an emplyee wearing a droplet protection surgical mask. She is now in hospice care because of long covid damage, and went from being an active artist and gardener to completely bed bound and on oxygen 24/7. This should not happen to anyone ever again.

    The American people don’t want anti-science, anti-masking policies in healthcare.

    Air filtration and ventilation works to reducing airborne illness transmission. So do respirators. But one-way masking and poorly ventilated spaces puts patients and healthcare staff at risk.

    The long term effects of Covid are many, but even mild cases disrupt lives. Medical staff need to go above and beyond to prevent the spread of airborne illnesses, and that means masking with respirators (N95 or elastomeric) and filtering/ventilating buildings

    Clean indoor air reduces transmission of Covid, Flu, RSV, TB, and many other airborne illnesses.

    When a vulnerable patient needs medical care, filtered air and N95s need to be required. This is the same as wearing gloves to prevent transmission by touch.

    No patient or healthcare worker should be needlessly exposed to other illnesses just because they had to go to a medical setting.

    Ventilation, masking, and air filtration is the most effective tool for fighting a wide variety of airborne illnesses and will help patients and medical staff alike.

    Covid is airborne. Start acting like it. Vulnerable patients should not have to risk infection with any airborne illness when seeking medical care.

    Wearing respirators and having ventilated, clean indoor air and air filtration reduces transmission of not just Covid, but also RSV, Flu, common cold, and more. N95 respirators offer better protection than surgical masks. All masks are not equal. And one-way masking is not nearly as effective.

    Any future airborne illnesses or pandemics will also be helpless against ventilation, respirators, and air filtration. Ventilation protects the vaccinated and unvaccinated alike. We cannot risk death, disablement, or even disruption when a simple answer is right in front of us. Failing to do this is the equivalent of not wearing gloves or washing your hands. It is incredibly dangerous to ignore this.

    Ventilation works against all variants of covid, which is extremely transmissible and airborne. Ventilation and air filtration also helps workers be more alert which improves quality of work. And with fewer infections, that means less staffing outages in the already strained medical system. We must go above and beyond with these safety precautions. The benefits of clean air are tremendous. If I, a member of the public, can easily figure out how viral transmission works, and how respirators and ventilation help, surely you can too.

    We clearly need airborne infection control in healthcare settings. SARS-Cov-2 is still out there and still a threat, especially to the most vulnerable members of our society—the ones accessing the healthcare system. COVID-19 has upgraded our understanding of how diseases spread, namely via the airborne route, as acknowledged clearly by the White House Office of Science and Technology Policy. Our healthcare systems must adapt accordingly to protect patients. We are all of us one infection or one diagnosis away from needing care. Airborne protections in healthcare are the definition of “do no harm.”

    Why did you make the live streamed video of this meeting private? What was discussed in this meeting is important to everyone in the country and now nobody can watch it. Do you intend on releasing it again? If so, when? If not, why not? Hiding it from public view can only be interpreted as a coverup to keep the public from seeing the presentation and public comments.

    Respirators and clean indoor air in healthcare should be standard. Immunocompromised/disabled people should NOT be forced to fear going for treatment and acquiring preventable airborne illnesses from healthcare providers due to lack of protections.

    Healthcare facilities should not be infecting their patients. Every single person working in healthcare should be wearing an N95 or reusable respirator with source control at all times. That means doctors, nurses, janitors, cooks, receptionists, pharmacists, billing specialists, etc. In all healthcare settings: dental offices, hospitals, primary care clinics, retail pharmacies and more.

    Covid-19 is airborne.
    It is also commonly – up to 40% of infections per recent studies – asymptomatic, and we have known for years now that asymptomatic people can carry a high enough viral load to transmit covid-19. The ONLY way to safeguard all those who seek healthcare is to require standard masking with N95 respirators. Surgical masks are insufficient barriers for aerosols, as we know from TB and other aerosol-transmitted pathogens. They are, of course, still better than nothing.
    My son has hypogammaglobulinemia, and his anti-mask infusion nurse gave him covid two years ago. He narrowly avoided hospitalization and a liver biopsy. Since then, he has had 7 new diagnoses, including chronic *constant* refractory abdominal & head pain. He has seen dozens of specialists and is on heart, thyroid, and GI meds. He needs an elective surgery to relieve discomfort but without masks it is unsafe for him to be in a recovery room. A second infection could reduce his 50% functioning (on a good day) back to being bedbound.

    The CDC needs to reckon with its premature removal of masking in healthcare. They created an environment where hospital-acquired covid, which according to a UK study has a 10 percent mortality rate – is common. What so many do not acknowledge is the significant MORBIDITY associated with covid-19: increased vascular event risk, increased diagnoses of diabetes, and that does not even address Long Covid.

    There is only so much that we can do to prevent covid exposure. One-way masking for an hour in a closed exam room for a specialist appt is not sufficient, and we have had several providers refuse to mask.
    Requirements that focus on increased ventilation, filtration, and appropriate respirator masks in healthcare would also make it safe for even those who cannot mask, like infants and the developmentally disabled, two groups who suffer greater harm from covid than others.

    According to the latest WHO guidelines, COVID-19 is an airborne infectious disease, BSL-3 category, capable of triggering severe epidemic outbreaks despite vaccination thanks to its high mutation capacity. Therefore, health workers need adequate protection against this risk of airborne transmission and this can only be achieved with respirators N95 or better, elastomeric masks with P100 filters.
    I hope you take into account that the health of millions of workers depends on your decisions about the protection they should have against the risk of contagion / transmission from airborne infectious diseases.

    Please recommend N95s, which studies have shown to be far superior to surgical masks for COVID, and HEPA filters and ventilation. The US has a shortage of healthcare workers now & a retirement cliff coming. Why not include these simple, reliable, validated and replicated measures which have been demonstrated to slow the spread?

    I am pleased that the committee has decided to delay voting on the proposed updated Isolation and Precautions guidelines, and hopeful that this may indicate a willingness to factor in critical input from stakeholders including healthcare workers and patient advocates, but I am dismayed that the process is still closed to the public and that National Nurses United’s request for the current version of the proposed updates and the evidence review has been denied.

    The most recent version of the guidelines for which the slides have been made available will further weaken, against all evidence and common sense, the already inadequate protections for both staff and patients. As noted by HICPAC, “infections are not uniform in severity or consequence” and “less intensive effort might be indicated when outcomes are not usually severe, the population has a high degree of immunity, and effective therapeutics and vaccines are available.”

    However. The ending of the PHE and the PHEIC do not mean the pandemic is over, as the WHO has stated, it means that government assistance and mitigations are largely over, unless one works at the White House.

    Millions of deaths from both acute- and post-acute phase COVID infection, and millions of people of all ages becoming disabled with little in the way of resources available, is the very definition of severe outcomes. As Dr. Fauci has noted, population/herd immunity is unattainable with a rapidly mutating virus, particularly with poor population uptake of vaccines and boosters. Evusheld is no longer effective or authorized and has not been replaced. One monoclonal antibody treatment is currently approved for limited use, and ALL prior MABs have lost authorization as they became ineffective. The scientific community has reason to be concerned about the long term efficacy of Paxlovid, which is not equitably available. Despite emerging data, Metformin is not routinely offered. The free N95 program has ended. Tests have become less accurate and more difficult and expensive to obtain. We are not in a better place than in 2020 and we do not have the tools to justify less intensive efforts, indeed, this demonstrates the necessity of much more, robust effort. In this environment, further weakening protections instead of strengthening them makes no sense.

    Many colleagues have testified to the abundant, definitive data conducted with scientific rigor- unlike the deeply flawed, cherry-picked data cited by HICPAC-clearly showing that surgical masks are, as intended, mere splash guards and do not seal adequately to provide respiratory protection from aerosol inhalation, unlike N95 respirators, with which CDC, EPA, and NIOSH concur, as well as to the necessity for infection-control level IAQ controls to protect healthcare workers.

    So building on their expert testimony, I am speaking up on behalf of patients, both professionally as a nurse practitioner and personally as the caregiver of very high-risk individuals who receive care at leading Boston hospitals, and who are rightfully concerned about their risk of being harmed or killed by becoming infected while seeking essential treatment.

    HICPACs proposed changes to PPE guidelines refer to “Well-fitted masks – Fit closely against the face, especially along edges of mask, to minimize the ability of air to bypass the material of the mask (e.g., medical/surgical mask that fits well alone or with knotted ear loops or mask fitters, facemasks conforming to ASTM F3502-21)”


    Here in the real world, when masking in healthcare was still required, healthcare staff were not wearing optimal PPE, and were not optimizing what they had to work with, placing themselves, their patients, and each other at risk and exacerbating the vicious cycle of uncontrolled disease spread and understaffing. Hundreds of thousands of HCWs are dead or disabled, which could readily have been prevented. Hospital acquired COVID is on the rise, with a horrific 5-10% reported mortality rate. Cancer patients who acquire COVID are at particularly high risk for adverse outcomes. And people who have been infected, especially if repeatedly, suffer endothelial damage and immune dysregulation which ultimately makes everyone at higher risk.

    From the beginning of the pandemic, I have spent a lot of time at Mass General, Brigham and Womens Hospital, and the Dana Farber Cancer Institute, and am constantly being put in the position of having to constantly advocate for and protect my disabled loved ones from inhalation exposure to airborne pathogens during medical treatment.

    What I continue to observe over and over and over again, is staff noses on display – staff at every level from Attending/Nursing/Techs to Admin/Security/Housekeeping, wearing loosely fitting surgical masks, often below the nose and even below the mouth, in patient areas, with very few respirators in use. When I enquired, I was told that no training on optimizing fit with correct knot-and-tuck technique (NOT “knotting earloops” in front of the ears, which widens the side gaps) was offered, and neither were adaptive devices such as mask fitters, let alone fit-tested respirators. Over the past 3-1/2 + years, in many many encounters, I literally saw exactly one PACU nurse using an adaptive device to improve fit. At one point I spent 16 hours in BWH ED with a frail elder who is also a physician, both of us in elastomeric respirators. We waited a long time and were evaluated on a cot in the hallway, which we expected in the current environment and accepted patiently as the staff did their best. What we did not expect was the very poor masking practices of the staff, despite prominent signage requiring masks at that time. Not only were they worn very poorly, if at all, by staff, but patients who clearly had respiratory infections were not isolated or masked, and we were placed right next to the security desk, where not one of the security staff wore a mask. I requested that they mask, explained the reason. pleaded, and finally spoke with a supervisor, to no avail. We were eventually moved to another area in a hallway across from a staffed desk, and that staffer did not wear a mask all night. A nurse came to see us and when I explained that the patient was hard of hearing, rather than simply speak louder, he pulled down his mask, leaned into the patient’s face, and introduced himself! Much, much more happened that night, and this visit is only one example, but it is representative of repeated experiences.

    And now with mask requirements being dropped in a manner that stigmatizes masking so intensely that against all reason, they are not being used even in situations which pre-pandemic would have been no-brainers, healthcare settings have become unnecessarily even more hazardous. Even if areas which treat the highest risk, most immune compromised patients required masking (they generally don’t), how does that protect patients who must navigate security, waiting rooms, elevators, restrooms, labs, exam, radiology and treatment rooms which were previously occupied by unmasked patients and staff?

    Patients are being forced to do a risk assessment every time they seek needed care to decide if it’s worth risk of contracting COVID. They have to beg for their lives in order to receive treatment in a safe and caring manner, and then be refused, be callously told “we don’t have to,” when really, a mask is such a small ask. And some patients have no choice – when they cannot forego care without certainty of extreme adverse outcomes, or when they are sedated, anesthetized, or otherwise unconscious and debilitated, or when they are babies or small children who cannot mask effectively. Their right to equitable access to safe care has been taken away from them without their consent.

    HICPAC: It’s ok to reconsider. It’s ok to say we’ve made some missteps during a complex, evolving situation, but the data has become clear and irrefutable and it is now time to change course. This is HICPAC and CDC’s big opportunity to come out on the right side of history.
    Reframing would be an opportunity to turn around the largest public health crisis in the past 100 years, change direction, acknowledge that COVID is airborne and most likely to be present in healthcare settings, and institute universal, robust respiratory protections.

    Why would you hide the draft behind closed doors until the meeting? These things thoughtful require consideration and the lack of transparency is seriously harmful to an informed public being able to prepare before public comment meeting.

    It is very harmful if as is being said by many, this draft will weaken infection control in healthcare. SARS-CoV-2 is an Airborne pathogen and not making that clear will lock in the currently unsafe conditions as “acceptable” and “per guidelines”. Just because something is allowed by the rules doesn’t mean it’s not harmful.

    As an immunocompromised individual, I find it appalling that the HICPAC Committee would even consider the practice/use of surgical masks instead of the proven N-95 masks for healthcare professionals caring for patients with infectious airborne diseases, including COVID. This action, together with the removal of mandatory masking from outpatient healthcare settings, disregards the science of aerosol transmission and puts both patients and staff at considerable risk. In years past, didn’t the CDC mandate fit-tested N-95 respirators to be worn by all staff caring for patients with infectious airborne diseases? It is a disgrace for this committee to consider the cost factor and related business interests of hospitals over the science of aerosol transmission as a basis for recommendations regarding infection control practices. I strongly encourage the HICPAC Committee not to compromise its standards by succumbing to pressure from overpaid hospital administrators. Instead, I implore this committee to make responsible decisions and recommendations based on evidence-based science. Not only will these decisions uphold the high standards of the HICPAC Committee, but they will provide for optimum infection control practices that ensure the highest protection for patients and healthcare professionals alike. Simultaneously, health worker absences will be minimized such that the nursing shortage will not be perpetuated. My hope is that the HICPAC Committee will make responsible recommendations that are morally right and science-based to keep the best interest of all citizens, including those at high-risk, in mind.

    With revision of isolation precautions I would like to see more of a specific duration of time that a person should be on isolation for specific respiratory infections like; parainfluenza, rhinovirus, RSV, adenovirus, verses the current recommendations of 24 hours fever free without fever reducing medications or until s/s are getting better with basically ignoring the cough that could linger for weeks. In long term care most people are on sch pain medications that reduce fever also, and many times may only have the s/s of a cough, but since the pandemic just a new sniffle seems to have the providers ordering respiratory panels on a regular basis with finding more cases of other resp viruses

    Universal airborne protections in health care facilities are needed now and need to continue permanently (or at least until a long lasting sterilizing vaccine is available and has >99% uptake, which is unlikely within the next decade). Covid is airborne and can be contagious before symptoms appear or a positive test is likely. People needing healthcare are all vulnerable, and people with covid are more likely to be present in a healthcare setting than in a random public place, so airborne precautions need to continue even if cases in the general population appear to be low. This would also preent HAI such as RSV and flu.

    Thank you for revising this important document! A few thoughts:
    1. Ideally the revised isolation precaution guidance will not “overly” dictate specific requirements — instead include the elements a facility should consider when performing a risk assessment to inform how isolation precautions are implemented at their hospital.
    2. The use of engineering controls to mitigate healthcare transmission of respiratory pathogens should be considered. When should facilities use supplemental HEPA filters or directional air flow into the patient room?
    3. Should use of respirators as PPE to prevent healthcare worker exposure be expanded to all infectious aerosols — not just a few pathogens.

    Why is society and the medical field regressing after decades of breath throughs? Is hand washing going to become optional too? Everyone who enters a medical facility should be protected from getting a hospital acquired infection of any kind. It makes complete sense to ask staff, patients, and visitors to wear masks at all times to help lessen spread of any illnesses. Do the right thing and help save lives.

    To protect patients, families, and healthcare workers alike, it’s imperative that we maintain quality masking in all healthcare facilities. Covid-19 droplets become aerosolized, this is well documented. Along with adequate ventilation and filtration, having healthcare workers wear n95 masks is a necessary step in mitigating the ongoing pandemic. People should go to healthcare facilities to get well not to get infected with a new viral illness. There are many hospitals who have had to reinstate masking protocols in response to outbreaks. Outbreaks of illness in healthcare settings is not a standard of care we want to set. While masking has become a highly politicized topic, it is imperative that institutions of public health rise above and set examples of integrity, science, and community care.

    We know that COVID is an airborne virus. Why are we settling for inferior droplet standards, which protects neither patients nor healthcare workers?

    From the CDC itself:
    “The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that #COVID19 is nothing to worry about”-@DrTedros

    Covid 19 hasn’t gone anywhere, tho the world’s leaders have done everything they can to dismantle anything that could inform or warn the public about this disease. Because we know a little about long-term effects of this disease: diabetes, brain fog/shrinkage,vascular damage, organ damage,ED etc., we should do much more around educating people and building protective measures into our societies. Leading with clean indoor air EVERYWHERE is the best, non-politicized place to start. CDC recommended this itself: 6 + air exchanges per hour, Hepa filtration, and Far-UVC lights are the technologies we HAVE to make indoor air safe quickly and effectively, not only for Covid, but any airborne virus. Creating a department in the CDC for messaging around the effectiveness of masks and vaccines in a multi-layered approach to protection would be more helpful than whatever it is the CDC has been doing the whole pandemic with messaging. There are too many instruments of misinformation out there and CDC does nothing to counter it effectively. Long Covid is nothing to be trifled with. It’s real and much more possible with each infection. We should be protecting our immunocompromised, elderly and especially, children, who have to live the longest with our poor decisions. Clean the air, educate minds,and make basic medical practices and environments safe for all citizens to use them. So many have put off and medical services because they are more concerned about getting sicker in the hospital or doctor’s office. We MUST fix this now!

    I am an infection preventionist since the the pandemic for Covid started and seen the effect of it to people when it first started. And maybe I am one of those that was very scared when the public opened no masking, no social distancing. But at this moment, I believed both public and all health care settings should be treated the same way. Isolation of patients/residents in a home care setting should be shortened into a 5 day period rather than 10 days. It causing a lot of depression and overall decrease in function for them. Also for healthcare setting staff members, 10 days of missing work affects the people income to support their family. I hope CDC and CMS will be able to see, the CovSars/Covid-19 as not as harmful when it first started. People were vaccinated and new medications were available for everyone. Healthcare settings like Home Care Facility deserved to have the same freedom as other health care settings.

    I think it is important to NEVER prevent family from seeing their loved ones in Nursing homes. If they no longer have family then a close friend. There is plenty of evidence showing those isolated in their rooms, without provision to walk in the halls for brief periods, or see in person their family gave up , became depressed and may have died. That is a travesty that should never happen again

    Thank you for posting, Sandra. I experienced this as well the last 3 years. I would expand this to ALL areas of life, hospitals and community. Even other countries who captured their own citizens and put them in camps against their will for being associated with other people. Contract tracing ill-will.

    Please consider requiring a surgical mask with Droplet Precautions instead of recommending using a mask per Standard Precautions.

    Can we just say to use airborne plus contact for Covid patients? It’s confusing having the extra covid precautions. Thanks !

    COVID is not airborne and we need to transition to droplet unless in certain conditions which are one offs. COVID is a droplet respiratory disease and is here to stay like Influenza.

    Very interested in modifications and recommendations for oral healthcare facilities

    Great news looking forward to reviewing the guidelines-very timely after the COVID-19 epidemic
    Kind regards
    Ms Helen Murphy | NMBI:24389
    Infection Prevention and Control Lead Nurse Adviser/ Manager AMR HCAI Health Protection

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Page last reviewed: December 5, 2023
Page last updated: December 5, 2023