The goal for the new guidance is to be able to split out all the different aspects of the things we need to consider when we provide care for patients with a range of infections . Again , to recognize that there are times when a surgical mask is appropriate and other times when a respirator is appropriate .” masking everywhere forever . In our organization , we just announced that next week we ’ ll be going back to wearing masks in all clinical areas because our flu , RSV and COVID numbers are all going back up , and we ’ re seeing increased numbers of respiratory virus infections in our staff and in our patients . It ’ s now time to do universal masking again . When we first relaxed our requirements , we made that an explicit part of the communication . We can stop this now , but we ’ ll probably need to do it again . And so , I think that that was missed in the response to our Annals paper -- it wasn ’ t that we were saying , ‘ Go burn all the masks , you ’ ll never have to use them again .’ It was more like , ‘ Here ’ s an opportunity that many of us in our locations can take advantage of to allow for more normal interactions between staff and between patients for a while . But we would bring universal masking back when it was needed .”
It is important to reiterate that the workgroup did not make pathogen-specific recommendations for infection control in this pre-final guideline . Drafting of that section will begin after Part 1 is completed , likely scheduled for the spring of 2024 . Pathogen-specific recommendations will be reviewed and updated in segments based on pathogen types . HICPAC says that current pathogen-specific recommendations found in the 2007 Appendix A should continue to be used until recommendations for all pathogens are updated in the new Part 2 .
It may be that lingering angst from the pandemic and current anxiety over the “ tripledemic ” of influenza , RSV and COVID that has colored the reaction to the pre-final guidance that is now making its way to the CDC .
“ I think that what we ’ ve heard during conversations around COVID could be the reason many are concerned about the guidance ,” Babcock acknowledges . “ COVID was a terrible pandemic that had a huge impact on everyone , but it was also something from which we learned a great deal . And as we learned , we needed to adjust and change the way we did things to reflect what we learned as we went along . Unfortunately , I think that there was confusion around what terms mean when used in different settings . So , it ’ s one thing to say in a non-regulated , non-healthcare setting that COVID is spread through the air . Nobody disagrees with the fact that COVID is spread through the air . When you use the word ‘ airborne ,’ because of its definition in a regulated healthcare environment , it has specific implications about PPE use and about room ventilation , and it wasn ’ t clear that that was the best term to explain what needed to happen for protection in healthcare settings . So , ‘ airborne ’ became a very loaded word , and there was a lot of back-and-forth about whether people were willing to say this word or not . I think when you get to that point on any one particular word when it ’ s being heard in many different ways , it may lose its value as a communication tool because it comes loaded with so many definitions and expectations from different groups , settings and populations . The goal for the new guidance is to be able to split out all the different aspects of the things we need to consider when we provide care for patients with a range of infections . Again , to recognize that there are times when a surgical mask is appropriate and other times when a respirator is appropriate . There are times when routine air handling is appropriate . There are times when special air handling is appropriate , and we should be able to combine those categories in the ways that are the most appropriate for this specific infection that we ’ re talking about -- rather than trying to lump it all together into one word like ‘ airborne .’”
Since COVID , the isolation precautions workgroup members emphasized that different healthcare settings face different challenges when implementing interventions to protect healthcare personnel and patients , and that 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 , as well as emphasized the importance of multiple layers of intervention ( hierarchy of controls ) to reduce transmission risk . As Bell and Kallen ( 2023 ) explain , “ 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 .”
Public comments were considered in the edits to the working draft , HICPAC emphasized . For example , HICPAC specifically expanded considerations for use of source control , even beyond the current CDC recommendations for use when community respiratory virus transmission is high , in the Day 2 draft aligning with public commenter requests . Public comments can be made in the Federal Register as part of the public comment period associated with this guideline draft . HICPAC says it 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 Feb . 29 , 2024 meeting . Public comments undergo a thorough review to determine where additional modifications and clarifications might be needed in the draft .
“ We continue to encourage everyone to use the public comment functionality ,” Babcock emphasizes . “ All comments are reviewed , and we do discuss them in the workgroup . I know that CDC leaders have also
22 december 2023 • www . healthcarehygienemagazine . com