Experts advising the U.S. Centers for Disease Control and Prevention on nosocomial infection control guidelines recommend that medical care be provided during routine care to patients who are considered contagious, including those with endemic or regularly occurring respiratory illnesses. voted in favor of recommending that people wear masks. Infection.
The draft recommendation does not specify what type of mask people should wear. Either a loose-fitting surgical mask or a more-fitting, tightly woven N95 mask. The decision frustrated some advocates for front-line health care workers and immunocompromised patients who had hoped to strongly encourage the use of N95s in all patient care situations.
CDC’s Healthcare Infection Control Practices Advisory Committee, known as HICPAC, N95 use is recommended when a patient is infected with a new or emerging pathogen for which no vaccine or treatment is available. N95s were also recommended in situations where the patient might have an infectious disease known to spread efficiently through the air over long distances, such as measles.
Jane Thomason, director of industrial hygiene at National Nurses United, the largest nursing union in the United States, said the draft inappropriately treats surgical and medical masks as personal protective equipment (PPE) and respiratory protection. He said there was.
“Surgical and medical masks do not protect against inhalation of infectious aerosols,” Thomason said in a statement to CNN about HICPAC’s draft recommendations. “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 masks) when developing infection prevention guidance.” wrote Thomason.
The masking recommendation was just one of a series of draft recommendations on infection control in health care settings voted on at the meeting, but it is one of the most controversial.
Its recommendations are not final. They then go to the CDC for approval. Once approved by the CDC, the draft recommendation will be published in the Federal Register and the public will have 60 days to comment on it. After the comment period ends, HICPAC will consider the comments and may make adjustments to the draft guidelines and vote again. The final version of the guidelines is not expected to be published until 2024.
Although the guidelines are not mandatory, many hospitals adhere to them. They are also used as the basis for standards developed by other agencies, such as the Occupational Safety and Health Administration, which follows the CDC when it comes to infectious diseases. The guidelines were last updated in 2007.
In July, NNU drafted a letter to CDC Director Dr. Mandy Cohen expressing concern that the new guidelines, if implemented as drafted at the time, would significantly weaken protections for health care workers. Thousands of health care workers have died during the COVID-19 pandemic, and some have been left disabled by the long-term effects of COVID-19.
NNU’s Thomason worries that if the new guidelines roll back protections for health care workers, the U.S. could suffer a similar catastrophe during the next pandemic.
“What they’re working on… is going to impact patients and health care workers in so many places. Honestly, it’s going to determine whether some of them live or die. ” Thomason said.
The advisory committee set out to streamline and update the outdated document, which is over 200 pages long. We relied on a new review of the medical literature conducted by the CDC to guide our updates. One of those reviews The researchers concluded that surgical masks are as effective as N95s in preventing respiratory infections, prompting alarm among advocates for patients and front-line health care workers.of the committee draft guidelines It also appears to have rolled back other infection prevention measures against the pandemic-causing respiratory virus, advising that keeping patients in airborne isolation rooms is “not routinely recommended.”
HICPAC believes that bacteria are transmitted through the air rather than through droplets, which can only be transmitted over short distances, which was the established theory of infectious disease transmission until the novel coronavirus proved that idea wrong. It was praised by some at the conference for making it clear that the virus would spread through the Internet.
However, NNU and other groups said that while the document appears to update the mode of spread, it still does not adequately address the issue of airborne bacteria. Critics, including groups such as the People’s CDC, is also a concern The draft guidelines only vaguely mention ventilation and strategies to purify indoor air, such as air filtration and ultraviolet light.
“The HICPAC draft is permissive and weak, seeking to maintain existing practices that are known to be insufficiently protective and even rolling back the use of some key measures such as airborne infection isolation rooms. “We are trying to make it happen,” said Zenei Triunfo-Cortés, president of NNU. he said in a statement Friday. “This draft guidance will only exacerbate the already dangerous working conditions of nurses and other health care workers, will further increase mental distress, will take more nurses away from the bedside, and will This will only further exacerbate the staffing crisis in “Care.” ”
During a public comment period on Thursday and Friday, HICPAC asked several patients with long-term COVID-19 infections and conditions that weaken their immune systems to decide whether healthcare workers should wear protective masks while treating them. We heard from people who said they were unsure and didn’t feel safe accessing health care.
Christine Brail said she was commenting on behalf of her 16-year-old son, who has a condition called a primary immunodeficiency that weakens the immune system. She said he contracted the virus from an in-home IV nurse who didn’t wear a mask properly and has now been living with the coronavirus for a long time.
“Relaxing protections for patients against respiratory diseases, especially the coronavirus, will only hurt patients and further deplete staffing levels,” Brail told the committee.
“Respirators, ventilators, air filtration equipment and UV protection are all needed to protect at-risk patients like my son.”
Other commenters expressed similar concerns.
Saifa Almasy, who spoke as a member of the public, said, “I am truly afraid that we will find ourselves in a situation where we cannot avoid medical treatment.” He said he recently found himself in such a situation when he decided he couldn’t put off getting the COVID-19 and influenza vaccinations. He said he made 34 calls to find a health care provider who would wear an N95 while administering the vaccine and was put on hold for more than four hours.
“HICPAC must recommend clear, strong and authoritative precautions against airborne transmission of pathogens. Anything less is medical malpractice and causes harm,” Almasy said.
Many called on HICPAC to postpone the vote until it hears from vulnerable patients, worker protection experts, and aerosol scientists.
All nine voting members of the committee approved the recommendations considered at this meeting.
However, one of the 22 members without voting rights expressed concerns about the committee’s process.
Paul Conway, chair of policy and global affairs for the American Kidney Patients Association and liaison member for HICPAC, said: “We echo many of the continuing concerns raised by those entering the public comment period today. We’re sharing it,” he said.
Conway said if the CDC wants to increase its engagement with the public, there are available resources available through the World Health Organization, the Department of Veterans Affairs, and the U.S. Food and Drug Administration for “substantial engagement of people with lived experience.” He pointed out that there is a model.
The CDC says the public will have an opportunity to comment on the guidelines.
“The advisory committee has not introduced binding recommendations, but has instead begun a process that will include a transparent and lengthy public comment period,” the spokesperson said.
Still, Thomason and National Nurses United have already filed the following public records request: Meeting overview Members of the working group developing the new guidelines.
“As you can see from the first meeting, there is a tendency to focus on flexibility and feasibility, and what are the real costs to employers beyond protecting health care workers and patients? “There’s a trend. They’re really focused on things like business concerns,” she said.
three of them Representatives from the CDC committee were also among the authors of the June editorial. Annual report of internal medicine The statement argued against universal mask-wearing in medical settings to protect against the coronavirus. The editorial said masking impedes communication and increases “cognitive load” for health care workers and patients, who must make extra efforts to listen without the benefit of lip reading or facial expressions.
“We have made significant progress in the prevention and control of SARS-CoV-2 since the pathogen was first identified in 2019,” the editorial said. “It is time to recognize these achievements and eliminate policies that are inappropriate for endemic pathogens when the expected benefits of such policies are low. Universal masking in health care should be implemented now. However, this is a policy whose era is over.”
The CDC had already heard several complaints and concerns about the draft guidelines.
In October, Dr. Michael Bell, deputy director of CDC’s Office of Healthcare Quality Promotion, and CDC Director Cohen responded to concerns about an initial evidence review from several experts on airborne transmission of infectious diseases and worker protection. I listened. Bell said the session was not a public meeting, so he was not able to interact with experts, but he promised to bring comments back to HICPAC.of meeting minutes was posted online.
Dr. David Michaels, an epidemiologist and professor at the George Washington University School of Public Health, said the new guidelines should have benefited from all the knowledge about the transmission of respiratory infections gathered during the pandemic. In fact, “this is going backwards,” he said.
Evidence study’s conclusion that surgical masks work as well as N95 masks contradicts 2022 study findings study Researchers from the University of California, Berkeley and the California Department of Public Health found that people who said they always wore an N95 mask in public were more likely to wear a surgical or cloth mask than those who wore a surgical or cloth mask. It showed that there is a low possibility of a positive reaction in a virus test.
“I think what’s going on here is that members of this committee came to us with preconceived notions about how infection control should be applied,” Michaels said. . He was part of an expert group that raised concerns about the draft with HICPAC at its October meeting. listening session.
“There are no members on this committee with expertise in worker protection or aerosol science,” said Michaels, who is also a former director of the Occupational Safety and Health Administration. “So their view of infection control is a hospital-based view, and it hasn’t changed in decades.”
The Infectious Diseases Society of America said in a statement that it continues to support HICPAC and its efforts.
“We believe that health care epidemiologists are uniquely qualified to lead HICPAC efforts given their specialized training, knowledge, and professional experience in preventing the transmission of infectious diseases in health care settings,” the statement said. ing.