January 25, 2024

CDC Delays Publication of Infection Control Guidance

CDC has requested more information from the Healthcare Infection Control Practices Advisory Committee (HICPAC) on its draft of revised guidelines for isolation precautions in healthcare facilities. HICPAC submitted the draft to CDC for review on Nov. 3. If CDC had accepted the guidelines, they would have been published in the Federal Register.

Instead, the agency has asked HICPAC to consider four sets of questions that “reflect concerns or areas of confusion that continue to be raised by stakeholders,” as stated in a letter to Drs. Sharon Wright and Michael Lin, the co-chairs of HICPAC’s Isolation Precautions Guideline Workgroup. The questions address matters related to the wearing of masks and respirators. The letter also states that the workgroup will be expanded to include additional experts who can help respond to the questions.

HICPAC’s draft guidelines have stimulated significant opposition, including from AIHA, which sent a letter (PDF) to CDC last July that characterized the draft as “grossly deficient.” AIHA was among the cosponsors of a webinar in October where presenters raised concerns that the draft guidelines were less protective for healthcare workers than current practice.

Another organization critical of the draft guidelines, National Nurses United, applauded CDC’s decision to send the draft back to HICPAC. “We are gratified that the CDC is asking HICPAC to resolve some of our core concerns, including the use of N95 respirators versus surgical masks to protect healthcare workers from pathogens that transmit through the air,” said NNU President Jean Ross, RN. NNU is the largest union of registered nurses in the United States.

A post published yesterday on CDC’s Safe Healthcare Blog provides additional context on CDC’s decision. Coauthored by Dr. Daniel Jernigan, director of the National Center for Emerging and Zoonotic Infectious Diseases, and Dr. John Howard, director of NIOSH, the post indicates that clarification is needed around the terms “routine air precautions,” which involve only basic protections, and “special air precautions,” which would require respirators. Jernigan and Howard state that the workgroup should ensure that the draft “cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct nor the intent of the draft language.”

The post also explains that CDC will seek to appoint new members with appropriate technical backgrounds to HICPAC’s Isolation Precautions Guideline Workgroup and that the expanded workgroup will discuss CDC’s questions at HICPAC’s next public meeting. The date of the meeting has not yet been published.

The draft guidelines (PDF) are the first of two documents intended to replace the existing “Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (PDF), which has been in place since 2007. An earlier post on the Safe Healthcare Blog had indicated that the first document was not expected to be finalized before June 2024. CDC has not yet indicated whether the timeframe has changed to account for additional deliberation of the draft guidelines by HICPAC.