The time has come to manage SARS- CoV-2 as we generally manage other endemic respiratory viruses in healthcare settings , which is through correct and consistent application of Standard Precautions and Transmission-
Based Precautions ( pathogenspecific ).
Under Standard
Precautions , healthcare personnel use a mask ( and eye protection ) to protect themselves from exposure when they are engaging in activities that could generate splashes or sprays to the face , regardless of patient symptoms .” been documented in the medical literature nor by the version of the guidance that HICPAC has sent to CDC , despite workgroup and HICPAC members working diligently to provide balanced instruction on transmission-based precautions that take into account local and global clinical considerations .
““ I do think it ’ s important that opinions vary by where you are and by whom you ’ re talking to and what you ’ re seeing locally ,” Babcock says . “ In committee meetings during public comment , we hear from certain populations in certain places that may not reflect the majority opinion of healthcare providers across the country . Opinion probably varies a lot by geographic area and by many other factors . That said , I would agree there are some practitioners who are worried about what the guidance will consist of and what the impact of that guidance will be on the way care is provided ,” Babcock says . “ All the people on that committee and on the workgroup work with healthcare providers and work in clinical settings all the time . We also have conversations at work and conversations with colleagues about their perspectives and how they are thinking about what the guidance might look like and what their concerns are or are not around it . We hear from a range of people with many different opinions , and we want to consider everyone ’ s opinions . But again , we work in those same settings , and we work with healthcare providers who aren ’ t calling in to HICPAC but who also have perspectives to consider . We want to be to be thoughtful about taking all perspectives into consideration . The other key point is I think there is some misapprehension about the draft guidance that we ’ ve put forward so far , that we have changed the recommendations for COVID ; we are writing a document that is designed to address protection against all infectious pathogens . It ’ s a pathogen-agnostic framework that we can apply to many different pathogens . We understand that people are worried , but we haven ’ t made any changes in any recommendations for the care of COVID patients with what we have put together so far . So , I do wish that that would be more recognized . I think the voices who are speaking are accusing us of changing the COVID guidance and we have not .”
It would be remiss to not address the issue of universal masking in any conversation about transmission-based precautions , especially given that the worst of the pandemic is over but that cases still linger , and so does the concern about spread in the healthcare setting ( as well as in the community ).
In April 2023 in a commentary first published online in Annals of Internal Medicine , experts Hilary Babcock , MD , MPH , Erica Shenoy , MD , PhD , and Sharon Wright , MD , MPH , and their co-authors stated that the time had come to de-implement policies that are not appropriate for an endemic pathogen , such as universal masking . In this commentary , the authors reviewed the utility of universal
masking in health care settings during the COVID-19 pandemic , the potential downsides of maintaining such policies , and why universal masking should not be incorporated as a required component of Standard Precautions for all direct patient-care encounters , regardless of symptoms or diagnosis . They also addressed future circumstances that could prompt reconsideration for masking requirements , beyond what are included in Standard Precautions and Transmission-Based Precautions . They say they “ advocate for considering masking requirements as a tool in our arsenal that can be deployed as part of a dynamic approach to infection prevention policy that adapts to changing circumstances .”
As the commentary authors add further , “ The time has come to manage SARS-CoV-2 as we generally manage other endemic respiratory viruses in healthcare settings , which is through correct and consistent application of Standard Precautions and Transmission-Based Precautions ( pathogen-specific ). Under Standard Precautions , healthcare personnel use a mask ( and eye protection ) to protect themselves from exposure when they are engaging in activities that could generate splashes or sprays to the face , regardless of patient symptoms . Respiratory hygiene , a component of Standard Precautions , means individuals with respiratory symptoms should use a mask for source control in healthcare settings . Finally , when caring for patients with suspected or confirmed respiratory infection , healthcare personnel should implement Transmission-Based Precautions , which include specific personal protective equipment and other interventions . These practices in combination effectively limit and minimize the risk for transmission of pathogens in healthcare settings . Moving away from universal masking policies should be accompanied by reconsideration of other pandemic-era strategies ( for example , asymptomatic testing , resource-intensive contact tracing ), which similarly have experienced a shift in their risk – benefit balance over the course of the pandemic .” It is indeed a delicate balancing act . “ There ’ s no clear definition or line that we can all point to and say that was pandemic and this is endemic ,” Babcock emphasizes . “ The way I tend to think about it is that as we move from a pandemic into accepting that COVID is going to be an endemic pathogen like our other endemic pathogens -- and to reiterate that ‘ endemic ’ doesn ’ t mean ‘ benign ’ and endemic doesn ’ t mean that it ’ s no big deal if you got it . Malaria is endemic in parts of Africa , but it ’ s a deadly disease that we try to prevent in whatever ways that we can , so , to me , endemic means that we know it ’ s going to be there , and it has fairly predictable patterns of infection and spread . We know its seasonality , and we know who ’ s most at risk . We know what kind of disease it causes , how to identify it and how to treat and manage it . With COVID , we ’ re not all the way there yet . We don ’ t
20 december 2023 • www . healthcarehygienemagazine . com