Q&A on HICPAC’s process to update 2007 Isolation Guideline

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

healthcare workers wearing scrubs and masks

One way CDC protects the nation’s health is through guidelines for healthcare settings that protect patients, providers, visitors, and staff from infection. These guidelines are developed through an extensive process of scientific review and stakeholder engagement. This year, one of CDC’s advisory committees, the Healthcare Infection Control Practices Advisory Committee (HICPAC), is reviewing and updating the 2007 Isolation Precautions guideline that helps keep healthcare workers and their patients safe from infections.

The guideline update process includes: 

  • Initial drafting of updated language by a workgroup of the committee. 
  • Input from agency and extramural experts. 
  • Public meeting for approval of a draft by the committee for submission to CDC for review. 
  • Posting of the draft language on the Federal Register for public comment. 
  • Review of public comments by CDC and the workgroup. 
  • Revision of the draft based on public comments. 
  • Public meeting for presentation of a proposed final draft to the committee for approval. 
  • If approved, CDC reviews the proposed final draft and if accepted will post the finalized update.

1. Why does the guideline need to change?

The goal of the revision is to provide the 23+ million healthcare workers in the Unites States with guidelines that are effective, up to date, practical in use, and safe and understandable. The guideline is 16 years old and 206 pages long, making it difficult for healthcare workers to apply quickly and making it susceptible to being misinterpreted. Some of the information is also out of date. HICPAC members and its workgroups have every patient, visitor, and healthcare worker in mind during these updates. This includes visitors, environmental services staff, respiratory therapists, administrative staff, nurses, and all others whose efforts help patients and residents receive the safe care they need.

2. Who will develop the new guideline?

HICPAC workgroups, convened by the committee in accordance with the Federal Advisory Committee Act, develop options for the full committee to discuss during public meetings. The full committee is charged with voting to send a guideline for consideration to CDC to present it for public comment. 

Members and workgroups are made up of external (non-CDC) experts in fields including patient safety, occupational health, healthcare epidemiology infection prevention and control, and frontline patient care. Learn more about the current HICPAC roster. In addition, members of the public are invited and encouraged to participate in the process through the public comment period.

3. What changes do you expect?

The workgroup responsible for the first section has provided updates on their work at public HICPAC meetings since February 2022. So far, they have indicated that they are working to: 

  • Collapse and revise the 2007 content to provide more concise and approachable information. 
  • Include core concepts of how germs spread in healthcare settings and high-level summaries of personal protective equipment, or PPE (such as gloves, gowns, and masks), that healthcare workers can use to prevent or minimize the spread of infections.  
  • Update the categories of Isolation Precautions to better reflect how they are used to prevent pathogens from spreading in healthcare settings.

4. Will the new first section make new recommendations for respiratory viruses?

The revised first section will not include any recommendations for the types of precautions that should be used for specific pathogens. Pathogen-specific recommendations in the second section will be reviewed and updated starting in 2024, to inform the actions healthcare personnel should take, for example, for a patient with Ebola versus a patient with shingles.

5. When will the first section be available for public comment?

The first draft of the new first section will be presented to HICPAC for a review and vote at the public meeting November 2-3, 2023. This first draft and the meeting slides will be shared on the HICPAC website under the Upcoming Meetings tab. Following the meeting, the full meeting recording and the meeting minutes will be posted on the HICPAC website.

If HICPAC votes to approve the draft for CDC review, the first section will then be submitted to CDC where it will be reviewed as part of the clearance process, which includes program staff and Center leadershipIf the draft is approved by CDC for posting for public comment, the draft will be posted to the Federal Register for 60 days for public review and comment (likely during November 2023-January 2024).

6. Will my comment be considered?

It is essential that individuals and organizations that have a comment review a copy of the draft in the Federal Register and make formal comments through that process. HICPAC reviews each comment made through the formal comment process. Comments are categorized by topic and will be presented along with suggested modifications in the public February 29 meeting in 2024. Public comments undergo a thorough review to determine where additional modifications and clarifications might be needed in the draft.

7. When will the first section be final?

The timing of the final guideline will depend on the public comment process and how long it takes to incorporate changes. The first section is not anticipated to be completed before June 2024. Learn more about How the U.S. updates its healthcare guidelines.

8. When will the second section be final?

Once the first section is complete, HICPAC will shift to the new second section: pathogen-specific recommendations. HICPAC and CDC will then review the makeup of the workgroups and solicit participation to ensure that the appropriate expertise is included for work needed on this next section. The recommendations workgroup will not begin until the first section is finalized, likely in 2024. 

CDC will continue to provide updates on the progress of the workgroup and HICPAC discussion on the HICPAC website and on this blog. Learn more about the next scheduled HICPAC MeetingMeeting Information | HICPAC | CDC.


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

15 comments on “Q&A on HICPAC’s process to update 2007 Isolation Guideline”

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 ».

    The words “recommended” needs to be replaced with “required” as the CMS conditions of participation state to follow National Standards for Infection Control and Prevention, which the CDC is the “National Standards for Infection Control and Prevention”. Therefore for healthcare facilities, these are not recommendations, they truly are requirements that should be followed by every CMS surveyed facility, including every CAH unless they are accredited by another organization.
    Please make it easy on the IP’s and change the wording so that they have the ability to enforce the IP regulatory requirements in Hospitals, Long and Short Term Care Nursing Homes, Clinics and other Healthcare facilities in the United States.

    I am writing to ask that HICPAC amend your decision-making process to include patient advocates, infectious disease transmission scientists, aerosols scientists, healthcare personnel (providers and other frontline workers such as cleaning crews), union representatives, and occupational safety and health experts.

    COVID infection control measures must reflect the science of aerosol transmission through inhalation. CDC and HICPAC need to use current science to develop infection control
    guidelines that recognize the current transmission characteristics of SARS-COV-2.

    Because transmission is often asymptomatic, precautions should be universally recommended. In healthcare environments – where seniors and high-risk and disabled people have no choice but
    to interact with other patients, visitors, and staff – the potential for infection is significant, and precautions should be universally mandated.

    I am 60 years old and has had MS for 25 years. The medication I take for my MS makes me immune-compromised. I should not have to risk COVID infection every time I need to see a doctor or therapist, and I shouldn’t have to ask everyone around me to observe the most basic control precaution – masking – in those settings. It’s bad enough knowing that it never be safe for me to eat in a restaurant again–getting medical care should not increase my risk of COVIUD infection and further disability.

    Glad to read that there will be a difference in respiratory recommendations ! there appears to be a shift toward the “Kiss Principle” rather than an evidence based approach.

    It is also helpful to have access to the make- up of the HICAP group..

    I’m an immunocompromised community member, with an immunocompromised partner who has bone marrow cancer We are urging you to protect both immunocompromised patients, and health care workers, by requiring universal high-quality (N95 or higher) masking at medical facilities, both for all employees, and all patients/visitors who are medically able to mask. The lives of immunocompromised patients, and the health of workers, depend on it.

    Those of us at higher risk of Covid complications (including mortality) have isolated ourselves – I haven’t breathed within 6 feet of anyone but my partner, in 3 years, with the exception of medical/dental procedures. We can avoid restaurants, gatherings, concerts, stores, and all other non-medical settings but it’s unsafe to completely avoid medical care. My partner has a 20% chance of dying if exposed to Covid, due to bone marrow cancer, as Evusheld is no longer available, and has been postponing needed medical care, waiting for the surge to end, but now can’t access health care if mask mandates are removed. Making medical facilities less safe for immunocompromised folks can be life-threatening (both through infection on-site and through avoidance of necessary medical care due to lack of universal protections at the medical facility). Mask mandates, and testing, and separation of Covid-positive folks from Covid-negative at-risk folks, should at least remain in places that immunocompromised people have no choice to avoid, especially places that folks can die from avoiding.

    Lifting mask mandates and other Covid precautions in hospitals and other essential medical facilities, is highly dangerous for people with disabilities, and can violate the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.

    I have had several at-risk friends who were infected in healthcare settings while one-way N95 masking (where others were unmasked or inadequately masked. They avoided all settings but couldn’t avoid medical care, and were infected there. Please consider requiring well-fitting N95 or higher masks for settings with immunocompromised patients.

    Lifting health care mask mandates also risks the health of health care workers. The California Nurse’s Association has spoken out against lifting the mask mandate. Please protect health care workers and their patients. https://www.nationalnursesunited.org/press/cna-condemns-state-decision-to-lift-mask-vaccine-requirements-in-health-care

    Disability Right CA has also spoken out for the protection of immunocompromised patents and health care workers:

    Please protect immunocompromised patients, instead of forcing us to choose between endangering our lives to access needed healthcare, or endangering our lives by avoiding healthcare because of inadequate protections. And, the times between surges is when immunocompromised people are most likely to try to finally complete long-postponed procedures (but not if mask mandates are taken away). I personally will not enter a medical facility if others aren’t masked – and the lack of access of facilities would be violation of my rights to equal access under the Americans with Disabilities Act.

    Why? Isn’t more being done for community spread infections.
    I have an otherwise healthy 3 year old family member in Myrtle Beach SC who got a c-dif Toxin A&B positive infection from her preschool classroom. The school has done nothing to clean the school or test other sick children. The department of health has done nothing to address it. Why? What is the CDc and NIH doing to protect healthy children and families? Where are the guidelines for community spread c-dif disease in schools? This child has never had an antibiotic until this infection made her sick. With guidance and education the community spread could be prevented or contained but there is no intervention.

    A wise decision – if “airborne infections” include doplets, spray etc.
    Two isolation regimes like: a) touch and b) touch- airborne in all settings in healthcare would be more simple and safe.
    Re-aerosolization should be included as “airborne”.
    Caps should be used when airborne infections to prevent contamination of hair.
    Masks N95, surgical masks should be included in care of patients- more often than today.

    A wise decision – if “airborne infections” include doplets, spray etc.
    Two isolation regimes like: a) touch and b) touch- airborne in all settings in healthcare would be more simple and safe.
    Re-aerosolization should be included as “aiborne”.
    Caps should be used when airborne infections to prevent contamination of hair.
    Masks should be included in care of patients- more often than today.

    1. Please do not abandon the precaution category strategy based on mechanism of transmission. Indeed, “Standard” precautions are really a form of transmission-based precautions.
    2. Please propose terminology that distinguishes between distinct sub-categories of “airborne” (e.g., droplet, aerosol & micro-nuclei borne as between cannon ball, ping-pong ball & down feather…all airborne but distinctive ballistics and aerodynamics!). “Airborne” is sufficiently ambiguous so as to be insufficient.
    Thank you.
    Gary Preston, PhD CIC FSHEA

    Hi, I’m an Infection Prevention Director over several hospitals and part of a large system with a microbiology background. I’d love to participate with the HICPAC work and provide more feedback. We really need frontline IPs perspective into operational challenges and nurse work flow.

Comments are closed.

Post a Comment

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