News Release

National Nurses United Calls on CDC to Hold Public Meetings


National Nurses United (NNU) put out a letter on Sept. 21 calling for the Centers for Disease Control and Prevention to hold public meetings before the agency votes on new infection control guidance updates. The union takes issue with some of the most recent updates to expected guidance for treating patients with respiratory viruses from CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC). 

NNU is urging CDC to involve more experts and stakeholders in the development of these new guidelines, and calls upon the agency to “hold public meetings on the Isolation Precaution Guideline,” a precedent that was set in the 1990s when CDC held public meetings on multi-drug resistant tuberculosis. 

JANE THOMASON; for interviews, contact 
Thomason is an industrial hygienist with National Nurses United. 

In July, NNU told CDC that the new guidance weakens infection control and “fails to fully recognize the available evidence on aerosol transmission” of respiratory pathogens. Hundreds of experts in occupational safety and health, medicine, epidemiology, industrial hygiene, ventilation, aerosol science and public health signed on to the July letter.

Thomason told the Institute for Public Accuracy: The process to develop the guidelines “happens behind closed doors. [HICPAC] is largely composed of infection control and prevention [stakeholders] who run programs at large hospitals and healthcare systems. The committee doesn’t include unions and direct care workers. These updates are the infection control guidance. We call it the bible of infection control. It was last updated in 2007.” 

But CDC offers little opportunity for feedback on these guidelines. “CDC has communicated with [NNU] to come to public meetings and make public comments. But they gave only three minutes for public comment at the August meeting, and only allowed 14 people to speak. Many others weren’t given the opportunity. [HICPAC] isn’t oriented around public input and engagement.”

The new guidelines, which some experts call problematic, create two categories of pathogens––those that spread by touch and those that spread by air––and three tiers of response: routine air precautions (for pathogens like the seasonal coronavirus and seasonal flu), novel air precautions (for pathogens like MERS, “pandemic-phase” SARS-CoV-2) and extended air precautions (for pathogens like measles, tuberculosis, or varicella). 

Thomason argues that this structure “lays the groundwork for SARS-CoV-2 to be downgraded to a ‘routine’ pathogen.” (HICPAC has “not been explicit about when it would be downgraded from a novel pathogen to a routine pathogen.”) Once the virus is downgraded, healthcare workers will be advised to wear surgical masks to treat Covid patients, not N95 respirators. Hospitals will also not be required to set aside airborne infection isolation rooms for such patients. 

Thomason added: The new recommendations suggest that “although seasonal pathogens are transmitted through air, the recommendation is only for surgical masks––even though [surgical masks] don’t offer respiratory protection; they don’t protect you from breathing in infectious aerosols.” The guidance thus fails to “recognize the science on aerosols and fails to protect healthcare workers.”

HICPAC is currently attempting to “revamp” its guidance, condensing the current 200-plus page guidance to just 10–15 pages. The committee claims it wants to “introduce flexibility for employers by offering a minimum standard and instructing employers to conduct [individual] risk assessments. Risk assessments would be done by employers.” That orientation to infection control, Thomason said, “will undoubtedly lead to increased infections in patients and workers. It’s a way that employers can prioritize profits and say that they are compliant with CDC guidance––even while they are locking up N95 respirators. That’s what they’re trying to do for every pathogen.” The new guidance will potentially be cost-saving for hospitals and providers. “It’s about employers screening patients, not wanting to isolate patients, wanting to place patients anywhere to maximize their bed use rate to make money, not paying for fit testing, not paying for N95s, not paying for contact tracing or sick leave or the ventilation that we’ve learned is necessary.”  

Thomason added: “This is the opposite direction than they should be headed in.”