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Rewriting Infection Control Guidelines: Ensuring Science Guides Safety for Healthcare Workers

Updated guidelines for infection control recommended by the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) have been met with concern by healthcare professionals across the U.S. The guidelines, last updated 16 years ago, are foundational for shaping infection control practices in hospitals and healthcare facilities. However, worry arises from the insufficient recommendations made to the CDC and questionable handling of surgical masks as viable respiratory protective gear.

One of the notable objections relates to the introduction of a new ‘air’ category for pathogen transmission, which includes mufti-level precautions based on the potential transmittable nature of different respiratory pathogens, categorized under ‘routine’, ‘special’, or ‘extended’. ‘Routine’ air precautions, intended for commonplace, frequently endemic respiratory pathogens, have raised significant concerns due to an apparent lack of adequate protection for healthcare workers on the frontline.

Interestingly, even though surgical masks have been criticized by various institutions, such as the FDA and the National Institute for Occupational Safety and Health for their loose fitting and inadequate filtration capabilities, HICPAC continues to recommend their usage. This has prompted grave concerns about the potential risk to healthcare workers exposed to aerosol-transmissible pathogens.

Healthcare professionals, such as nurses, are calling for adherence to the precautionary principle. Implementing this principle in practice would mean taking prompt proactive action to prevent harm to people’s health rather than waiting for evidence of harm. With the knowledge garnered from multiple research regarding COVID-19’s primary transmission via aerosols, it’s clear that advocating for the highest level of protection when dealing with new viruses is non-negotiable.

The outcry comes from the lack of frontline healthcare workers’ representation on the committee, which brings the potential for inadequate consideration of their direct experience and insights. Incidents from the early days of COVID-19’s outbreak where nurses were issued surgical masks instead of capable N95 respirators, prompting protests and highlighting the risk these professionals were exposed to, further amplify the need for protective guidance.

The proposed recommendations appear to offer flexibility to employers in implementing safety measures based on their own risk assessment, which has been criticized for potentially leading to unnecessary illness and fatalities. What is imperative now is stronger, clear, and specific instructions to employers on how to protect healthcare workers effectively, consequently safeguarding patients.

Healthcare professionals urge the CDC to reject the current HICPAC guidelines and propose a new one, which includes input from a diverse range of stakeholders, including frontline nurses, other healthcare workers, healthcare worker unions, experts in infection prevention, ventilation engineering, respiratory protection, and industrial hygienists. Given the hard lessons learnt throughout near 4-year-long COVID-19 pandemic, a revision in the guidance that truly represents the science is overdue, aiming reliably to protect lives.


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