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HICPAC Meeting Recap: Infection Control in Healthcare Guidelines

Published on September 7, 2023

At the August 22nd HICPAC Infection Control meeting [1], the CDC advisory group HICPAC faced criticism for their proposed guidance that would lower infection-control standards in healthcare settings. WHN, along with other organizations, including National Nurses United (NNU), created campaigns in August that successfully amplified these concerns. Despite initially announcing a vote would occur during the meeting, HICPAC members provided little information and only announced a delay in the vote on the proposed guidelines. These guidelines focused on infection control standards for COVID-19, specifically the use of N95 masks versus surgical masks (June 2023) [2], and the creation of new categories of PPE based on seasonality versus novelty rather than transmission mechanism (November 2022) [3]. Abandoning inadequate draft standards is essential [4], but the status quo is also not acceptable [5]. The public comments [6][7][8] were clear: many are unable to access healthcare safely.

Prior to the meeting, the committee invited the public to attend with a capacity limit of up to 500 people. While they opened an overflow youtube channel, only 14 members of the public were allotted time to speak, while others were directed to email their comments to HICPAC for inclusion in their meeting minutes. Over 20 members of the public came to a special event hosted by WHN to have their oral comments recorded [7]. HICPAC members were also invited to attend, but did not. Although each public comment was unique, there was a complete consensus that infection control standards in healthcare must be raised, not lowered. Other issues highlighted were the need for N95 respirator masks or better to replace surgical masks for airborne precautions, that guidance should reflect consultation with experts in relevant scientific fields such as aerosol sciences, and for guidance to reflect feedback from other stakeholders including patients, healthcare staff and the public.

In addition to comments during and after the meeting, several petitions arguing for strengthened guidance were sent to HICPAC prior to the August 2023 meeting. The WHN’s public-sign on letter [9] received over 500 signatures, including that of the World Federation of Public Health Associations representing over 5 million public health professionals worldwide. Over 11,000 people signed National Nurses United (NNU’)’ s petition [10]. Another letter came from a group of disability organizations [11], and 900 experts signed a letter to the CDC [12] relaying similar information and concerns.

HICPAC’s decision to focus discussion during the August 2023 meeting away from their drafted guidance alongside their actions after the meeting, such as posting and quickly removing the meeting video [13], then reposting days later after public outcry, reflect an ongoing pattern of lack of transparency leading to loss of trust in HICPAC and CDC. Nearly a year ago, the CDC acknowledged these issues and promised to remedy missteps [14], stating [15] they would: 

  1. “Work in partnership with others in and outside of government to turn science into public health action and results.”
  2. “Engage CDC Senior Leadership and decision makers in ongoing forums to receive feedback on issues and concerns from key stakeholders: State/local/territorial health officials; providers; researchers; employers; community-based organizations; policy makers; and the public.”

This commitment was not apparent at the August 22nd meeting. The inadequate response to the issues raised in June’s meeting [16], as well as those sent in advance of the August meeting, such as WHN’s letter addressed directly to HICPAC members [17], is concerning, and has received media coverage by Forbes [18], Med Page Today [19], and Source New Mexico [13]. 

The next HICPAC meeting is November 2-3 [20]. We welcome individuals who are interested in participating in next steps of action to join WHN’s Infection Prevention Team [21]. 

Of Note:

Hospitalizations [22] and COVID test positivity rates [23] are increasing, with two new variants, one of interest Eris [24] and the other under monitoring Pirola [25] spreading and prompting mask mandates to be instituted at some educational institutions [26] [27], healthcare facilities [28], and in the entertainment industry [29], and masking recommendations [30] elsewhere. For resources and tips on how to self-advocate when seeking healthcare, see Doctors Should Not Infect Patients [31] and Ensuring Equitable Access [32].

Recent Broadcasts:

Early Signals of COVID Surge:

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WHN’s Weekly Actions: 

Join the Long Covid Action Project in calling on the UN to designate March 15th as Long Covid Awareness Day, and March as Long Covid Awareness Month by signing their virtual letter. 

Send this letter from John Snow Project to your local doctors and healthcare facilities. Sign Up here to see other weekly actions. 

Sources:

  1. CDC HICPAC Meeting – Aug 22, 2023. www.youtube.com. Accessed August 26, 2023. https://youtu.be/IQTQc7Lu4Vk?si=SH–bhzty6_zgdHd 
  2. Lin M, Wright S. Isolation Precautions Guideline Workgroup.; 2023. Accessed August 26, 2023. https://www.healthwatchusa.org/HWUSA-Presentations-Community/PDF-Downloads/20230608-CDC-IP_Workgroup_HICPAC-FINAL.pdf 
  3. DEPARTMENT of HEALTH and HUMAN SERVICES CENTERS for DISEASE CONTROL and PREVENTION National Center for Emerging and Zoonotic Infectious Diseases Division of Healthcare Quality Promotion Healthcare Infection Control Practices Advisory Committee.; 2022. https://www.cdc.gov/hicpac/pdf/2022-November-HICPAC-Summary-508.pdf 
  4. Prevent Airborne Transmission in Healthcare. WHN. Published August 8, 2023. Accessed August 26, 2023. https://whn.global/prevent-airborne-transmission-in-healthcare/ 
  5. ‌Chow EJ, Lynch JB, Zerr DM, et al. Lessons From the COVID-19 Pandemic: Updating Our Approach to Masking in Health Care Facilities. Annals of Internal Medicine. Published online August 22, 2023. doi:https://doi.org/10.7326/m23-1230 
  6. ‌CDC HICPAC Meeting – Public Comment – Aug. 22, 2023. www.youtube.com. Accessed August 26, 2023. https://youtu.be/msjoFGnd0KU 
  7. ‌WHN Recorded Public Comments on Infection Control in Healthcare. www.youtube.com. Accessed August 26, 2023. https://youtu.be/IIRFqxK6BWs?si=bsK-4haoSeKTpUv2 
  8. ‌Shea O’Neil (WHN volunteer) written comment, HICPAC Meeting. Google Docs. Accessed August 26, 2023. https://docs.google.com/document/d/1UNAgd-sZ-6SAVWzBl_R5X6YOs9UKCCcwgd-topIBhoQ/edit 
  9. ‌Endorse the WHN HICPAC Letter. Google Docs. Accessed August 26, 2023. https://docs.google.com/forms/d/e/1FAIpQLSehjAoSdenvtQYpAeq-DkPTJ55wI0eKBXPywzLavW-KNp4A2w/viewform 
  10. ‌NNU delivers petition urging CDC to strengthen proposed infection control guidance; CDC cuts off public comments at advisory committee meeting | National Nurses United. www.nationalnursesunited.org. Published August 22, 2023. Accessed August 26, 2023. https://www.nationalnursesunited.org/press/nnu-delivers-petition-urging-the-cdc-to-strengthen-proposed-infection-control-guidance 
  11. Letter from Disability Organizations: CDC/HICPAC’s Plan to Weaken Guidance for Health Care Respiratory Protection and Infection Control. WHN. Published August 25, 2023. Accessed August 26, 2023. https://whn.global/letter-from-disability-organizations/ 
  12. ‌COHEN O, COHEN Y, CHATTARAJ S, ZHANG G, ANSELMO E, TIROSH A. 107-LB: Clinical Performance of Extended Mio 30 Infusion Set. Diabetes. 2023;72(Supplement_1). doi:https://doi.org/10.2337/db23-107-lb 
  13. ‌Fisher A, August 24 SNM, 2023. Patients asked a CDC advisory panel to be more transparent. Then their comments disappeared. Source New Mexico. Published August 24, 2023. Accessed August 26, 2023. https://sourcenm.com/2023/08/24/patients-and-advocates-asked-a-cdc-advisory-committee-to-be-more-transparent-then-their-comments-disappeared/ 
  14. ‌CDC director announces shake-up, citing COVID mistakes. AP NEWS. Published August 17, 2022. https://apnews.com/article/covid-science-health-public-rochelle-walensky-843cd83bf1d616846ff455f7f5f0d30d 
  15. ‌CDC. About CDC. Centers for Disease Control and Prevention. Published September 1, 2022. https://www.cdc.gov/about/organization/cdc-moving-forward-summary-report.html 
  16. HICPAC Public Comments Complete – June 8, 2023. www.youtube.com. Accessed August 26, 2023. https://www.youtube.com/watch?v=L3OQQu1zvzM&t=3136s 
  17. ‌Letter to HICPAC Members. WHN. Published August 7, 2023. Accessed August 26, 2023. https://whn.global/letter-to-hicpac-members/ 
  18. ‌Stone J. Public Pushes Back On CDC’s Plan To Weaken Infection Control. Forbes. Accessed August 26, 2023. https://www.forbes.com/sites/judystone/2023/08/25/public-pushes-back-on-cdcs-plan-to-weaken-infection-control/?sh=72d7088f7179 
  19. ‌CDC Advisory Group Under Fire for Proposed Infection Control Guidelines. www.medpagetoday.com. Published August 24, 2023. Accessed August 26, 2023. https://www.medpagetoday.com/infectiousdisease/infectioncontrol/106030 
  20. ‌Meeting Information | HICPAC | CDC. www.cdc.gov. Published August 22, 2023. Accessed August 26, 2023. https://www.cdc.gov/hicpac/meeting.html 
  21. ‌Join WHN’s Infection Prevention Team. WHN. Published July 19, 2023. Accessed August 26, 2023. https://whn.global/join-infection-prevention-team/ 
  22. ‌Hollowell A. Hospitalizations rise as experts monitor new COVID-19 variant. www.beckershospitalreview.com. Published August 24, 2023. Accessed August 26, 2023. https://www.beckershospitalreview.com/public-health/hospitalizations-rise-as-experts-monitor-new-covid-19-variant.html 
  23. ‌EHRN. Epic Research. Epic Research. Accessed August 26, 2023. https://epicresearch.org/data-tracker 
  24. ‌All we know about new Covid variant Eris and its symptoms amid surge in cases. The Independent. Published August 26, 2023. Accessed August 26, 2023. https://www.independent.co.uk/news/health/new-covid-variant-symptoms-eris-b2399859.html 
  25. ‌What to know about the new BA.2.86 “highly mutated” COVID variant found in the US. TODAY.com. Published August 24, 2023. Accessed August 26, 2023. https://www.google.com/amp/s/www.today.com/today/amp/rcna100944 
  26. Wells N. Mask Mandates Return Amid COVID-19 Spike. Newsmax. Published August 24, 2023. Accessed August 30, 2023. https://www.newsmax.com/newsfront/covid-19-mask-mandates-vaccines/2023/08/24/id/1131940/ 
  27. Dillard University brings back mask mandate amid new COVID strain. wwltv.com. Published 2023. Accessed August 30, 2023. https://www.wwltv.com/article/news/health/dillard-university-covid-strain-new-orleans-louisiana/289-6e009888-8bab-4975-9194-e9f99a3d5438 
  28. Hollowell A. Hospitals, health systems begin to bring back mask policies. www.beckershospitalreview.com. Published August 24, 2023. Accessed August 26, 2023. https://www.beckershospitalreview.com/public-health/hospitals-health-systems-begin-to-bring-back-mask-policies.html 
  29. Hibberd J. Lionsgate Brings Back Mask Mandates in Office. The Hollywood Reporter. Published August 21, 2023. Accessed August 30, 2023. https://www.hollywoodreporter.com/movies/movie-news/hollywood-studio-covid-rates-mask-mandates-back-1235571466/ 
  30. ‌Bekiempis V. Americans at high risk advised to wear masks as new Covid variant detected. The Guardian. Published August 24, 2023. Accessed August 26, 2023. https://www.theguardian.com/world/2023/aug/24/new-covid-variant-masking-high-risk-people 
  31. ‌Nerode, Nathaniel. Doctors Should Not Infect Patients. WHN. Published March 21, 2023. https://whn.global/doctors-should-not-infect-patients/ 
  32. ‌Ensuring Equitable Access During Inequitable Times – Resources from the Vermont Center for Independent Living. WHN. Published April 26, 2023. Accessed August 26, 2023. https://whn.global/ensuring-equitable-access-vcil/