Isolation Precautions Guidance Undergoing Significant Revision for 2024, as Preventing Transmission of Pathogens Comes Into Sharper Focus

By Kelly M. Pyrek

Even as the healthcare sector continues to re-examine transmission-based precautions considering the clinical, fiscal and operational fall-out from the COVID pandemic, one agency is taking on an update of 16-year-old isolation precautions and are poised to identify transmission modes as either air or touch, rather than aerosol, droplet or contact.

In its early November 2023 meeting, the Isolation Precautions workgroup of the Healthcare Infection Control Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) presented a revised draft document and members voted unanimously to approve all sections of Part 1 of the workgroup’s recommendations to update the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. The revised guideline is now called the 2024 Guideline to Prevent Transmission of Pathogens in Healthcare Settings. HICPAC, a federal advisory committee, weighs scientific literature, expert opinion and public discussion to inform their recommendations to CDC. Consisting of physician and nursing experts from infection prevention and control fields who work outside of CDC, the HICPAC process allows for wide-ranging input while reducing concerns about potential conflicts of interest. Members and liaisons represent expertise across the continuum of care. These experts bring relevant healthcare and patient safety expertise from their experience working in local hospitals, public health departments professional associations, consumer groups, government, and global organizations.

During the two-day meeting, input from experts from both days of discussion was incorporated into a revised draft of Part 1 of the guideline, which will be sent to the CDC for review and posted for public comment. CDC program staff and leadership will review to determine if the draft should be returned to
the workgroup for revisions or if it is ready for posting to the Federal Register. If the draft is approved for posting by CDC, it will be available on the Federal Register for 60 days for public review and comment.

It is important to note that Part 1 of the guideline cannot be considered final until posted in the Federal Register for public comment, revised for public comment, and presented and voted on again in 2024. HICPAC says the timing of the final guideline will depend on the public comment process and how long it
takes to incorporate changes. The first section is not anticipated to be completed before June 2024.

At the November meeting, the Isolation Precautions workgroup presented its 24-page draft for committee review and consideration. The draft’s first section focuses on infection control concepts, including pathogen transmission pathways and type of personal protective equipment (PPE) available to
healthcare personnel. The most significant revisions in the transmission-based framework are focused on pathogen-transmission through air, with three categories of routine, special and extended air precautions which HICPAC members say will better reflect the ability to separate out personal protective equipment (PPE) requirements and the air handling requirements into specific categories.

To read further, access the December 2023 issue HERE