CDC HICPAC infection control committee public comment in support of universal masking in healthcare

We need to broaden, not reduce, the use of N95 or better respirators in healthcare

Now is the time to codify the lessons learned in this ongoing airborne pandemic and broadly protect both patients and healthcare workers with universal masking, ideally with N95 or better respirators. Instead, the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) committee seems poised to reduce protections, allowing surgical masks for some airborne pathogens. Below is the video and transcript of my public comment as delivered in today’s HICPAC meeting.

Public comment in this meeting was very limited, and many concerned healthcare and public health professionals as well as members of the public were not given the opportunity to speak. I was fortunate to be called on to speak during the meeting, and recorded this video afterward. At the time of this writing, the YouTube video of the meeting that was available for livestreaming is marked as private.

This CDC committee has the authority to establish basic infection control practices for all areas of healthcare, including hospitals, clinics, dental practices, and nursing homes. Here is a great compilation of information, resources, and ways to take action regarding this CDC committee’s work and the need for additional oversight to ensure that patients and healthcare workers, rather than healthcare system profits or convenience, are protected. There is still time to submit written comment through Friday August 25 to the email address hicpac@cdc.gov.

---

My name is Kaitlin Sundling - I’m a physician, scientist, and pathologist in Wisconsin. I have no conflicts of interest to disclose. I’m a member of the People’s CDC.

I am speaking today in support of universal masking in healthcare, ideally with broad use of well-fitting N95 or better respirators, as a new addition to standard precautions.

Now is the time to use what we’ve learned from HIV and bloodborne pathogens. Matching our understanding of the science of aerosol transmission to our precautions in healthcare allows us to work toward building public trust and destigmatizing aerosol transmitted infectious diseases, especially where asymptomatic transmission is common as with COVID. 

Denying the well-proven science of N95 respirators would be a significant step backwards. There is no physical basis to support the idea that different aerosol pathogens travel different distances. Appropriate isolation for known or suspected aerosol pathogen infections of any kind including COVID MUST include N95 respirators at minimum and appropriate ventilation controls.

I wanted to share a couple of experiences where universal airborne precautions would have prevented exposure from my work as a pathologist and as medical director of a health professional training program. 

While I was in my fellowship training at a well-known Boston hospital, I found out I had been exposed to tuberculosis when I had performed a small biopsy of a neck lymph node on a patient who, as far as we knew, lacked any symptoms or history that would have caused us to suspect the infection.

More recently, one of my students was also exposed to tuberculosis on a lung biopsy procedure where cancer had been the suspected diagnosis.

If we only protect ourselves against known or certain exposures, we put both patients and workers at risk. We need to expand, NOT reduce, the use of N95 or better respiratory protection including elastomeric respirators with source control and PAPRs in healthcare settings.

Lastly, we have a duty to protect our patients. I have had multiple people in my community ask if I, as a pathologist or laboratory-based clinician, can be their primary care provider. It is incredibly sad to me that so few of my fellow healthcare providers are wearing masks to protect themselves and their patients, and some are not even willing to mask upon request. Where providers are masking, our patients, including those who are immunocompromised, still face unmasked waiting rooms and other spaces with shared air. Should patients have to ask their surgeon to wear sterile gloves? Putting the burden of protection on patients is not an appropriate infection control approach.

In conclusion, I call on you, the CDC’s HICPAC committee members, to recommend universal masking in healthcare, ideally with broad use of well-fitting N95 or better respirators, as a new addition to standard precautions

---

For further reading, please check out People’s CDC’s recommendations to HICPAC.

People’s CDC Recommendations for CDC / HICPAC

Thank you for masking. 😷