You try to do the best you can, but if someone’ s waiting in the emergency department for four hours, they’ re roaming around, and so it’ s really about trying to do sourse control as best as you can with kids who won’ t wear a mask. And also encourage the family members to wear masks. It’ s tough, but we get kids into exam rooms as quickly as possible so you don’ t have them in the waiting room.”— Chris Nyquist
number of days based on severity of illness. But workers will say,‘ What if I don’ t have a fever but just a mild symptom, do I have to stay away and how long?’ We’ re navigating that as well.”
What Talbot referred to is work undertaken by the Healthcare Infection Control Practices Advisory Committee( HICPAC)’ s Healthcare Personnel Guideline Workgroup( HCP-WG) which was in the process of updating the 1998“ Infection Control in Healthcare Personnel” guideline prior to the dissolution of HICPAC in June 2025. The purpose of this guidance is to reduce the risk of transmission of viral respiratory infections to patients, visitors, and other healthcare personnel while balancing the risk to patient safety and workforce fitness for duty with prolonged work exclusions and workforce strain.
“ We were following a modified CDC COVID guideline where they had to be out for five days regardless of symptoms,” Drees said.“ About six months ago I brought up the HICPAC draft guidelines and occupational health was interested but it really never went anywhere, and then our state just published the HICPAC recommendations as guidance in early December. We would have liked to have had a little more forewarning that was going to happen because we had to scramble to update policies. We knew a lot of people weren’ t bothering to get tested because they didn’ t want to be out for five days especially since it’ s on their own PTO, so now our policy is identical to what HICPAC proposed.”
Talbot said his system“ looked at the data, and I think what places traditionally did for non-COVID, for flu and RSV, people were coming back too soon, they were saying they were feeling better after 24 hours, and we know that‘ feeling better’ is in the eye of the beholder,” he said.“ So, at least having some language about being able to fully function in your job, even if that’ s subjective, is advisable. I think the challenge, and probably more so in long-term care, is that you only have so many people and if folks are out, is there a safety issue?”
“ The other thing I would add,” Drees said,“ is that the other barrier when people call out, they’ re not required to say why they are calling out, so it ends up being kind of,‘ these are the guidelines, but the manager may not know why they’ re out.’”
Talbot added,“ The challenge is that PTO is a single bucket, so if I’ m going to Disneyworld for spring break and I’ ve got those days, I
think,‘ Oh I can probably just trudge on through and show up with my quote‘ allergies’ in January.’ There are some good papers about using a model where you get one or two flu days that are separate from your pool of PTO, but you have the burden of proof that you really do actually have influenza.”
“ In the snot-filled pediatric world, we have become respiratory agnostic,” Nyquist said.“ If you’ re well for 24 hours with decreasing symptoms for respiratory illness and no fever, we ask you to come back and wear a mask for at least five days after returning, plus perform good hand hygiene. I walk around the hospital and I see people wearing masks, which is really positive and I say‘ Hey, good job, I appreciate you.’” Talbot then asked panelists to discuss a world without HICPAC.“ One of the challenges, in talking to the CDC lately, is how do you still use the hard work that HICPAC did to try to update guidance, and there are really good folks at the CDC working on that,” Nyquist said.“ The idea that’ s currently developing is there was a call for people who wanted to work with this committee and to have a clearinghouse to examine some of the initial guidelines that came through and act as a vetting body, not redoing everything on HICPAC but to serve as an iterative process to see what’ s needed and how do we continue to move forward.”
References:
California Department of Public Health. Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2025-26 Accessible at: https:// www. cdph. ca. gov / Programs / CHCQ / HAI / CDPH % 20 Document % 20Library / CA _ RecsPrevControl _ RespVirus _ SNFs. pdf
Centers for Disease Control and Prevention( CDC). Case and Hospitalization Rates of Influenza, RSV, and COVID-19 in Nursing Home Residents 10 / 5 / 2025-1 / 11 / 2026( 15,000 nursing homes). https:// www. cdc. gov / nhsn / ltc / ltc-report-overview. html
Centers for Disease Control and Prevention( CDC). Percentage of health care personnel who received influenza vaccination, by work setting— Internet panel surveys, United States, 2014-2015 through 2023-2024 influenza seasons. https:// www. cdc. gov / fluvaxview / coverage-by-season / health-care-personnel-coverage-2023-24. html
Centers for Disease Control and Prevention( CDC). Vaccination Coverage with Influenza, RSV, and COVID-19 Vaccine 10 / 5 / 25-1 / 11 / 26: Nursing Home Residents vs. U. S. Overall. United States, 2014-2015 through 2023-2024 influenza seasons-- https:// www. cdc. gov / fluvaxview / coverage-by-season / health-care-personnel-coverage-2023-24. html
Centers for Disease Control and Prevention( CDC). Viral Respiratory Pathogens Toolkit for Nursing Homes. Accessible at: https:// www. cdc. gov / long-term-care-facilities / hcp / respiratory-virus-toolkit /
Multi-society guidance for infection prevention and control in nursing homes. Infection Control & Hospital Epidemiology( 2025), 46, 1069 – 1096. doi: 10.1017 / ice. 2025.10252
Srinivasa VR, et al. Genomic Epidemiology of Healthcare-Associated Respiratory Virus Infections in Pittsburgh, Pennsylvania, 2018 – 2020. Infect Control Hosp Epidemiol. 2025 Nov 4; 47( 1): 1-11. doi: 10.1017 / ice. 2025.10328.
Williams V, et al. Risk mitigation of shared room ventilation and filtration on SARS-CoV-2 transmission: a multicenter test-negative study. Infect Control Hosp Epidemiol. 2025 Sep 10; 46( 10): 1-7. DOI: 10.1017 / ice. 2025.10256
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