Admission to shared hospital rooms are a risk factor of healthcare-associated( HA) SARS-CoV-2. Quantifying the impact of engineering controls such as ventilation and filtration is essential to informing resource utilization and infection prevention guidelines.”— Williams, et al.( 2025)
clustered patients; 63 percent( 12 / 19) patients had same-unit stay, 26 percent( 5 / 19) had overlapping hospital stays, and 11 percent( 2 / 19) shared common provider. On average, genetically related clusters spanned 16 days( range of 0 to 55 days).
“ This study looked at whole genomic sequencing and other practices, not forgetting that viruses can cause healthcare-associated respiratory viral infections,” Talbot commented.“ It showed the impact of 14 different clusters that were genetically related and not just the majority major viruses of RSV and flu, but human metpneumo virus, rhinovirus as well in pediatric and adult populations impacting an array of patients. Again, I think it underscores the importance of surveillance and prevention of these outcomes.”
In a pivot to long-term care and the prevention of respiratory virus infections in those facilities, Jane Siegel, a former public health officer with the California Department of Public Health, addressed the key elements of a facility plan that includes vaccination, resource allocation, source-control masking, education, ventilation and filtration of indoor air and isolation areas, active daily monitoring for respiratory Illness during periods of increased community activity, management of healthcare personnel with respiratory symptoms or COVID-19 exposures, testing, isolation, transmission-based precautions and cohorting, as well as treatment( influenza, COVID-19)/ chemoprophylaxis( influenza).
“ The main messages are the importance of vaccination, source control, masking, prompt testing and treatment, chemoprophylaxis,” Siegel emphasized, adding that regarding ventilation,“ One does not to feel obligated to have a whole new ventilation system or air handling system, as interventions include regular maintenance, ensuring that outside dampers are open and continuously running, as well as making use of portable air cleaners and checking the direction of the airflow from a room where there are patients in isolation, and also the use of Minimum Efficiency Reporting Values( MERV) 13 or 14 filters.”
Siegel also emphasized the gap in vaccination coverage of nursing home residents compared to other populations.“ Vaccination for influenza, RSV and COVID-19 is fairly flat among nursing home residents and fairly flat for this respiratory season, with coverage being fairly low.”
She continued,“ I don’ t know of any healthcare personnel vaccination rates for influenza more recent than the 2023-2024 flu season, and I wanted to point out that long-term care facility and home healthcare have the lowest rate of personnel receiving the flu vaccine. There’ s a great deal of information out there on how to increase uptake of flu vaccination among personnel and residents and patients.”
The town hall panel then pivoted to the Q & A portion, fielding questions from attendees. Talbot asked panelists if anyone’ s institutions had moved away from the recommended personal protective equipment( PPE) for suspected or confirmed COVID-19 cases.
“ In our healthcare system in 2024, we dropped the gown and glove requirement for COVID patients,” reported Katie Passaretti, MD, vice president and enterprise chief epidemiologist at Atrium Health.“ We continue to require an N95. In the past year we have discussed with our group of physicians that perform hospital infection prevention epidemiology, but after taking a community standard and group comfort level, we’ ve maintained N95s but since we’ ve dropped the gowns and gloves, we haven’ t seen any kind of negative consequences.
We conducted a risk assessment, so we had documentation in case we received any questions from regulatory, but we’ ve had many surveys since making that change and no issues.”
Talbot related what his system did recently, noting,“ Led by our ambulatory care epidemiologist, we looked at the PPE issue in our ambulatory setting and conducted a risk assessment. We felt that the biggest risk in that setting was mainly a regulatory citation because we were differing from formal guidance because we moved away from gowns and gloves for suspect and confirmed COVID. We still do N95s and eye protection, but we have not yet done that in inpatient areas yet because the thought was, we’ re in that room longer, sharing that airspace longer with patients.”
Marci Drees, MD. MS, DTMH, FACP, FSHEA, infection prevention officer and hospital epidemiologist at Christiana Care, added that her system dropped gowns last summer but did include inpatient areas.
“ We continue to use respirators for care of COVID-positive patients and have dropped gowns or gloves unless you are doing something that requires the kind of standard precautions for secretions,” reported Chris Nyquist, MD, MSPH, chief epidemiology officer in pediatric infectious diseases at University of Colorado Medicine.“ I’ d love to move to something different for the future, but I’ m nervous about the regulatory issues and where regulators actually stand, which is kind of a black box right now.
Talbot mentioned that before it had been disbanded, HICPAC had been considering advising the use of a mask instead of a respirator in certain circumstances and inquired what panelists thought of such a potential move. Regarding the guidance for PPE for suspected or confirmed COVID in long-term care, Siegel noted,“ The recommendations on the CDPH website are still gown, gloves, N95 respirator and eye protection. That is also the recommendation on the CDC website. I think we are going to need more data before that’ s changed. Also, in terms of using an N95 respirator, there’ s strong feeling from industrial hygienists that they are necessary. So, there is more work to be done on that.”
Passaretti reported,“ I recently had this discussion with North Carolina DHS because CMS says follow the CDC, and the CDC has been stuck in time a little bit. DHS will hold us accountable in the skilled nursing facility setting, in particular to gowns and gloves. So, while we made that change on the acute-care and ambulatory side, we’ ve maintained all PPE for skilled nursing facilities because of that.”
“ It has come up in our institution around PPE and retroviral patients, regarding patients with suspected or confirmed influenza and undergoing true aerosol-generating procedures like a bronchoscopy,” Talbot said.“ We’ re trying to move to that should be universal N95s potentially.”
Panelists chimed in, with Drees noting,“ Our policy is to treat them with an N95 and move to a negative-pressure space if available. We don’ t really have a good way to monitor how often that happens and I suspect it doesn’ t happen frequently.”
Talbot also asked the panel about non-COVID recommendations for precautions.“ For someone coming in with a suspected acute respiratory infection, where we don’ t know what it is, we’ re implementing the precautions we’ ve all been discussing in this town hall because it could be COVID, but once you have a confirmed case, with the multiplex diagnostic testing where you get the human coronaviruses that are not SARS, like OC 43, what type of PPE, what precautions do you put patients in and implement? We do droplet,
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