Earlier this month, the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) voted unanimously to approve its draft infection control and send it to the CDC for review. This extremely influential document, which was last updated 16 years ago, will be referenced by hospitals and other healthcare facilities to set their infection control policies.
However, we're concerned that the draft offers minimal recommendations to the CDC, and even worse, incorrectly treats surgical masks as respiratory protection. This unscientific guidance puts the U.S. in a weak position to protect patients and staff from currently circulating viruses and will leave us behind the curve in battling future pandemics.
One of the biggest issues is with the new "air" category for pathogen transmission. The category includes three levels of precautions based on the transmissibility of a respiratory pathogen: "routine," "special," or "extended." The guidance states that "routine" air precautions -- the lowest level -- are to be used with "common, often endemic, respiratory pathogens that spread predominantly over short distances." But any delineation of endemic versus pandemic pathogens is arbitrary because the transmission mode of an aerosol-transmissible pathogen remains the same, so protections should also remain the same. (Note the draft guidelines don't refer to "pandemic pathogens"; the "special" guidelines refer to "new or emerging" respiratory pathogens for which "effective treatments aren't available.")
At the "routine" level, HICPAC recommends that masks be worn – but the committee indicates that surgical masks can be used, and healthcare workers may "choose voluntarily" to wear a higher level of protection.
Why is HICPAC suggesting that surgical masks offer sufficient respiratory protection? The , the , the , and even the have indicated that surgical masks do not offer respiratory protection, especially against aerosol particles. These masks are loose fitting and do not filter the air breathed in by the wearer. HICPAC's "flexible" guidance will result in inadequate protection for healthcare workers.
Follow the Science
Nurses are scientists. We follow the precautionary principle, which means we do not wait for proof of harm before taking action to protect people's health. In other words, we should use the highest level of protections when confronted with a novel virus, and ground these decisions in the evidence: show that COVID is primarily via transmission.
HICPAC members claim that this part of the guidance is written to be "pathogen agnostic," and a second part on infection control protocols for individual pathogens -- including viruses like COVID-19 -- is expected to be completed next year. But approving the "pathogen agnostic" guidance leaves us unprotected. Part of the issue stems from the lack of frontline healthcare workers, unions, or patients on the committee.
As a result, we are at risk. We feel betrayed by the institutions that are supposed to safeguard our health. HICPAC's vote lets us know that nurses and other healthcare workers are expendable to our employers -- despite the staffing crisis. The message to us: We are not heroes. We are disposable.
Flashbacks to Early COVID
"We're following CDC guidance," was the answer many registered nurses got in 2020 when we were given a surgical mask instead of an N95 respirator or told to single-use disposable N95s, forcing nurses to risk their lives to care for patients.
In April 2020, RNs at Providence Saint John's Health Center in Santa Monica, California were when they refused to go into COVID patient rooms without an N95. That same month, Celia Yap-Banago, RN, who worked in the cardiac telemetry unit at Research Medical Center in Kansas City, Missouri, died because she contracted COVID at work after her employer failed to screen a patient with active COVID symptoms and did not give her an N95. She had previously about the lack of personal protective equipment (PPE) at her hospital. Her employer had allegedly from all units to one floor of the hospital so it was not available on her unit, which was not "supposed to" have COVID patients.
Back then, the CDC gave healthcare employers flexibility to conduct their own . Employers were following the CDC's crisis and contingency standards that said a surgical mask was acceptable. The result was an enormous number of avoidable COVID infections and tragic deaths among healthcare workers at a time when their care was so desperately needed.
We Need Stronger Guidance
The committee's new recommendations propose to give employers the same kind of flexibility that we've seen lead to needless illness and death. The draft guidance lets employers decide whether to implement the recommendations based on their own risk assessment. If the CDC approves the draft, it will lead to unnecessary infections, deaths, and long-term health consequences from a wide range of pathogens, including COVID, influenza, and RSV.
After nearly 4 years of living with the COVID pandemic, we have all learned hard lessons about PPE and how healthcare employers often focus on the bottom line rather than protecting healthcare workers and patients. What healthcare workers need is more protection, guided by clear and specific guidance for employers.
The updated infection control guidance must follow the science. We urge the CDC to reject HICPAC's guidelines and create a new draft. Input from a broad range of stakeholders must be included: frontline nurses, other healthcare workers who will be implementing the infection control guidance, healthcare worker unions, and experts in infection prevention, ventilation engineering, respiratory protection, and industrial hygienists who have previously been excluded and ignored in HICPAC's process. It's time to revise, and it's time to get the science right.
Jean Ross, RN, is a nurse and a president of , the largest union and professional association of registered nurses in the nation. Jane Thomason, MSPH, is the lead industrial hygienist at National Nurses United.