CDC panel backs looser guidance on hospital masking

A CDC advisory committee voted Nov. 3 to finalize a draft of infection control guidelines that recommends healthcare workers wear masks during routine care to prevent the spread of common, endemic respiratory infections — a move National Nurses United has condemned for not going far enough to protect patients and staff from aerosol transmission. 

The draft guidelines recommend masks be worn to reduce the transmission of "common, often endemic, respiratory pathogens that spread primarily over short distances," such as the flu and COVID-19. It does recommend N95s and other higher level respirators for "special air precautions," or in cases where patients are infected with a new or emerging respiratory pathogen for which vaccines and treatments are not available. The proposed guidance also recommends N95s be used for "extended air precautions," or when caring for patients with pathogens known to spread through the air over long distances. 

The nation's largest nursing union says the guidance inappropriately treats surgical and medical masks as personal protective equipment and respiratory protection. Hospitals and other healthcare settings typically look to the guidance to set infection control practices within their organizations. 

"A surgical or medical mask does not provide protection against inhalation of infectious aerosols," Jane Thomason, lead industrial hygienist at the NNU, said in a statement to Becker's. "The CDC must redo the biased evidence review on respiratory protection for healthcare workers, taking into account all the available evidence from multiple disciplines. NNU urges CDC to fully recognize the science on aerosol transmission of infectious diseases and respiratory protection (including N95s, powered air purifying respirators, and elastomeric respirators) in creating infection prevention guidance."

The NNU and other clinicians have previously urged the CDC's Healthcare Infection Control Practices Advisory Committee to strengthen the proposals by making a firm recommendation on the use of N95s, noting that common viruses like the flu and other airborne pathogens in hospitals can still harm vulnerable populations. 

HICPAC's draft guidance does state that healthcare personnel may "choose voluntarily" to wear an N95 for routine air precautions, though the NNU says this inappropriately shifts "responsibility and risk to individual workers to protect corporate profits." 

In emailed comments to Becker's, a spokesperson for the CDC said, "the process has been misunderstood," and reiterated that the recommendations are not final. "The advisory committee has not introduced any binding recommendations, but is instead kicking off a process that includes a transparent, lengthy public comment period." 

Now that the committee has voted to finalize the guidance, which includes a collection of infection control recommendations beyond masking, it will go to the CDC to review. If approved by the agency, the draft recommendations will be published to the Federal Register and the public would have 60 days to comment. The guidelines would then potentially be revised based on public comments, according to the CDC.

The CDC's Isolation Precautions Guidance was last updated in 2007. The updates are not expected to be finalized until 2024. 

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