Advisors to the U.S. Centers for Disease Control and Prevention have voted to recommend that health providers wear masks during routine care for patients who are thought to be contagious.
Still, health care workers were frustrated that the draft recommendation does not specify what kind of mask should be worn — loose-fitting surgical masks or fitted, tightly woven N95 masks.
The CDC advisors did recommend using N95s when patients are infected with new or emerging pathogens for which vaccines and treatments are not available, and those masks were also recommended when patients may have infections that are known to spread easily through the air, such as measles, CNN reported.
The new draft guidelines, issued Friday from Healthcare Infection Control Practices Advisory Committee (HICPAC) aren’t mandatory, but they’re often used and agencies like the Occupational Safety and Health Administration tend to base worker safety standards on them.
“HICPAC’s draft is permissive and weak and seeks not just to maintain existing practice — which has been shown to be inadequately protective — but even rolls back the use of some important measures, such as airborne infection isolation rooms,” Zenei Triunfo-Cortez, president of National Nurses United, said in a statement. “This draft guidance will only further degrade the already dangerous working conditions of nurses and other health care workers and further contribute to high rates of moral distress, which will only serve to drive more nurses away from the bedside and further deepen the staffing crisis in health care.”
“HICPAC is missing the perspective of frontline nurses, other health care workers, our unions,” Triunfo-Cortez added. “As nurses, we carry out many essential pieces of infection prevention. We have insights and expertise that are essential to crafting protective guidance."
“During the COVID pandemic, nurses saw too many patients and colleagues become infected, get sick and even die because of inadequate infection prevention," she said.
More than 4,500 physicians died between early 2020 and December 2021, which was 600 more than would have been expected, according to a recent study from researchers at Stanford and the University of Southern California at Los Angeles.
“This is going backward,” Dr. David Michaels, an epidemiologist and professor at the George Washington University School of Public Health told CNN, noting the guidelines could have benefited from knowledge gained during the pandemic about transmission of respiratory infections.
“I think what’s happened here is the members of this committee came to us with prejudgment on how infection control should be applied,” said Michaels, who was part of a group of experts that addressed the committee with its concerns in October.
“This committee has no members who have expertise in worker protection, or in aerosol science,” noted Michaels, who is also the former head of the Occupational Safety and Health Administration. “And so their view of infection control is a hospital-based view and hasn’t changed in decades.”
Among the committee members are three people who published an editorial in June arguing against universal masking in health care settings to protect against the spread of COVID, CNN reported.
“We have achieved major advancements in the prevention and management of SARS-CoV-2 since the pathogen was initially identified in 2019,” the editorial in the Annals of Internal Medicine said. “In recognition of these achievements, the time has come to de-implement policies that are not appropriate for an endemic pathogen when the expected benefits of such policies are low. Universal masking in health care is a policy whose time has come and gone … for now.”
The draft guidelines say personal protective equipment are a “critical component in healthcare settings,” but the committee found “no difference” in lab-confirmed seasonal viral respiratory infections in workers who used surgical masks instead of N95s.
The committee’s vote will be forwarded to the CDC for approval, though the agency could ask for more review. The guidance may again be revised after a 60-day comment period.
Final guidelines aren’t expected until 2024, CNN reported.