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HICPAC Hub: Highlights from the March 2021 Meeting

About the HICPAC Blog Series

The Healthcare Infection Control Practices Advisory Committee (HICPAC) is a federal committee that provides guidance on infection prevention practices in U.S. to the federal Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) in U.S. healthcare settings. As Infection Preventionists, we are all familiar with the HICPAC guidelines including, but not limited to, the Hand Hygiene and the Environmental Infection Control Guidelines. HICPAC meets several times each year, where among other activities, new guidelines are developed and older guidelines are updated. This blog series will highlight the key discussions at these meetings. Because of the lengthy delay from meeting to posting of the minutes, we hope you will find our HICPAC meeting summary blog posts helpful to keep you informed in a timely manner.

Introduction

Welcome to the first edition of the HICPAC Hub for 2021. This post will highlight the key topics addressed in the March 4, 2021 meeting which included updates on COVID-19, CDC guidelines, Project Firstline, and the Long-Term Care workgroup.

COVID-19 Update

With the worst of the pandemic behind us (hopefully), the CDC is taking a closer look at which COVID-19 guidance and practices are applicable for future pandemics. They are also investigating the sustainability of both local and regional responses. Issues that have bubbled to the surface are also CDC priorities such as:

  • Increase in central line bloodstream infection (CLABSI) rates,
  • Health disparities and inequities,
  • Staffing and training of healthcare workers, and
  • Inappropriate antibiotic prescribing which of course drives antimicrobial resistance. This is particularly concerning at a time when the country – the world actually — is focused on a single pathogen.

With vaccinations underway across the country, the CDC has released updates on post-vaccination activities such as small maskless gatherings with other vaccinated individuals. The CDC did acknowledge that they need to be clearer moving forward to differentiate guidance intended for the public versus that for healthcare workers. A great example was the recent double masking guidance which targeted the general population and not healthcare personnel. The lack of a clearly stated target audience for the guidance caused much confusion among healthcare personnel.

CDC also announced that there will be a work group assembled to focus on rethinking the respiratory illness isolation precautions.

CDC Guideline Updates

Several guidelines for neonatal intensive care units (NICU) as well as the Infection Control in Healthcare Personnel guidelines continue to be updated. On March 8th, HICPAC reopened the public comment period for the following sections of the Healthcare Personnel guidelines:

  • Diphtheria,
  • Group A Streptococcus,
  • Meningococcal Disease, and
  • Pertussis

                                

Project Firstline Update

CDC’s Project Firstline was launched late last year to educate frontline staff on the fundamentals in infection prevention and control (IP&C). This 2-year pilot intends to address gaps in IP&C knowledge and aims to provide the rationale behind the recommendations. Topics will be timely and will cover the fundamentals, as well as grounded in adult learning theory and provided in bite-sized formats. For example, there are some great short videos on cleaning and disinfection including why it matters and about contact times. Currently, materials are available in English, with Spanish versions to follow. CDC does recognize the need for the materials to be available in other languages too.

Long-Term Care Work Group Updates

The Long-Term Care (LTC) Work Group continues to make progress on its White Paper to address the new enhanced barrier precautions guidance for MDRO infections (EBP). Multidrug-resistant organism (MDRO) infections disproportionately affect LTC residents. They contribute significantly to morbidity and mortality for residents and high costs for the healthcare system. Standard Precautions are inadequate to prevent transmission of MDROs and Contact Isolation Precautions are impractical in this setting. In comes EBP which fall somewhere between Standard and Contact Precautions. Essentially, with EBP, gown and gloves are recommended for certain residents infected or colonized with novel or targeted MDROs or who have wounds or indwelling medical devices during specific high-touch care activities such as bathing or providing wound care. Gowns, gloves, and alcohol-based hand sanitizer should be available outside of every resident room. While there will be costs up front to implement EBP, savings should be realized through prevention of healthcare-associated infections.

Summary

A few action items for IPs include 1) take a moment to review the section of the Healthcare Personnel guidelines that is open for public comment, 2) check out the resources available from Project Firstline, and 3) watch for more to come on EBPs for LTC settings. For additional information the HICPAC meeting minutescan be reviewed once they are posted. We hope that you find these meeting summaries helpful in your day-to-day practice.