Updates on the CDC Advisory Committee’s efforts to weaken infection control guidance for health care

Submitted by ADonahue on
Nurse holds sign "Science Matters, We Are Not Expendable"

The U.S. Centers for Disease Control and Prevention (CDC) has recently initiated work to update foundational infection control guidance for health care settings. CDC has tasked its advisory committee on health care infection control (known as HICPAC) with making these updates. HICPAC voted unanimously on Nov 3, 2023 to send its draft to the CDC, but HICPAC’s draft ignores scientific advancements and proposes to weaken existing practice. NNU called on the CDC to reject HICPAC’s draft.

On January 23, 2024, CDC announced the results of its review of HICPAC’s draft—the CDC officially sent the draft back to HICPAC for revisions! This is a major victory!

The CDC is requiring HICPAC to address some of the core issues that NNU has been raising, including the use of respirators vs. surgical masks to protect health care workers from pathogens that transmit through the air.

The CDC also made a public commitment to expand the scope of technical expertise on HICPAC and its workgroup, which is an essential step and something that NNU has been calling for since the beginning. HICPAC membership has been dominated by the health care industry. In May 2024, CDC invited NNU’s lead industrial hygienist to join the workgroup and NYSNA’s lead health and safety representative to join HICPAC — another important win!

But HICPAC’s workgroup has not reached consensus regarding important issues, like the use of N95 respirators vs surgical masks to protect health care workers and patients from pathogens that transmit through the air, based on meeting summaries acquired via NNU’s information requests. We have to keep up the pressure for HICPAC to follow the science and protect health care workers and patients!

Take action: Urge the CDC director to ensure that CDC and HICPAC recognize the important science on aerosol transmission and craft guidance that protects health care workers and patients from infectious diseases!

Background information

What is happening at the CDC?

The CDC has an advisory committee called HICPAC, which stands for Healthcare Infection Control Practices Advisory Committee. This committee recently initiated work to update the CDC’s 2007 guidance, Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

On November 3, 2023, HICPAC voted unanimously to finalize its draft 2024 Guideline to Prevent Transmission of Pathogens in Healthcare Settings, sending the draft to CDC for further review. On December 16, 2023, NNU, along with 53 organizational and nearly 5,300 individual signatures, delivered a petition to CDC Director, Mandy Cohen, to reject HICPAC’s 2024 draft and to actively engage the input of frontline health care workers, patients, and public health experts in developing a new draft (including holding public meetings).

Instead of proceeding with posting HICPAC’s draft in the Federal Register for public comment, the CDC has officially returned the draft to HICPAC and requested revisions. The CDC also announced its intention to expand the expertise represented on HICPAC and its workgroup. This is a major victory!

How does this impact nurses and our patients?

The CDC’s infection control guidance is THE guidance that directs infection control practices in health care settings in the United States. Employers and government agencies in the United States and around the world frequently reference this guidance document.

HICPAC’s 2024 draft guidance fails to recognize updated science on infectious disease transmission and dangerously rolls back current infection control protections in health care settings, which would put nurses, other health care workers and their patients at increased risk of infectious disease exposures and infections. HICPAC’s 2024 draft guidance will exacerbate the current staffing crisis in health care, as more nurses and other health care workers will leave the bedside due to the further erosion of working conditions and health effects from infections.

Who is on HICPAC?

Members of HICPAC and its workgroup are predominantly infection prevention program managers and representatives of health care associations and employers. Only as a result of public pressure has CDC added additional members. In February 2024, HICPAC’s workgroup was reconstituted to include additional experts in industrial hygiene and occupational health. See more information in updated meeting summaries, obtained from the CDC by NNU via information requests.

In May 2024, CDC invited NNU’s lead industrial hygineist to join the workgroup and NYSNA’s lead health and safety representative to join HICPAC. This is a significant win for nurses and other health care workers!

What is CDC/HICPAC’s process to update the infection control guidance?

The CDC initially tasked HICPAC to draft updates. HICPAC’s process to develop these updates has not been transparent and has lacked in public input. NNU’s advocacy has resulted in several significant improvements. 

  • HICPAC appointed an Isolation Precautions (IP) Workgroup to formulate updated recommendations, whose meetings are closed to the public. Updates from the IP Workgroup have not been publicly posted by the CDC. NNU requested and received HICPAC IP Workgroup meeting summaries, which indicate the IP Workgroup has intended to weaken worker protections since the beginning and has relied on biased and flawed evidence in crafting guidance (read more about the IP Workgroup meeting summaries here).
  • While full HICPAC meetings are open to the public, it is only since August 2023 that meeting recordings have been posted. Previously, members of the public had to pre-register and attend the live meeting in order to view proceedings. This change was the result of public advocacy and action by NNU and our allies. 
  • The order of the agenda of full HICPAC meetings has been changed since the August 2023 meeting—previously, voting took place ahead of any public comment. The deadline for written comment has also been extended since August 2023 compared to previous meetings. These changes have come about due to public pressure from NNU and our allies on CDC and HICPAC to improve transparency.
  • However, HICPAC still lacks public input. The public may make short comment (3 minutes per person) during each HICPAC meeting, but this is insufficient time to discuss the complexity of issues under HICPAC’s purview and there are very limited slots provided. There is currently no other mechanism for HICPAC or its working groups to garner input from the frontline health care workers, unions who represent them, experts in addition to infection preventionists who should be consulted, and patients who will be impacted by the updated guidance.
  • The IP Workgroup presented its draft to the full HICPAC membership at the Nov. 2-3, 2023 public meeting. HICPAC voted unanimously to send the draft to the CDC for further review. The CDC’s next step is to review HICPAC’s draft, decide whether to accept, reject, or modify it, and to post it in the Federal Register for public comments. NNU called on the CDC to reject HICPAC’s draft and to develop a new draft crafted with input from patients, frontline health care workers, unions, and other public health experts, including industrial hygienists, ventilation engineers, respiratory protection experts, and aerosol scientists.
  • On Jan. 23, 2024, the CDC sent back HICPAC’s draft requesting revisions to address many of the core issues that have been raised by NNU.  

NNU’s concerns with HICPAC’s Draft—and why the CDC should reject it

Health care employers have a legal and moral obligation to provide a safe and healthful workplace for workers. However, HICPAC’s 2024 draft Guideline to Prevent Transmission of Pathogens in Healthcare Settings is explicitly geared toward frontline nurses and health care workers and what they can do to prevent infectious disease transmission, when it should be aimed at health care employers (frontline health care workers should be able to reference it, but do not bear responsibility or authority for many elements of infection prevention). HICPAC’s choice to focus on individual health care workers inappropriately seeks to shift the responsibility, risk, burden, and blame onto individual workers to protect corporate profits—which comes at the expense of protections.

Problems include: