Without fanfare, the CDC dropped its universal masking recommendation for healthcare settings, with the exception of areas of high COVID-19 transmission and other special circumstances.
“Updates were made to reflect the high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools,” noted the guidance issued on Friday, which the agency said “provides a framework for facilities to implement select infection prevention and control practices.” Those practices include universal masking “based on their individual circumstances.”
The agency also made several other changes related to infection control among healthcare workers, including recommending that:
- Vaccination status should no longer guide masking, screening, or post-exposure practices
- Testing of healthcare workers who are asymptomatic and have no known exposure is now at the discretion of the facility, with certain exceptions
- Broadly speaking, asymptomatic patients should no longer be required to isolate (or follow “transmission-based precautions“) due to close contact with a person who has a SARS-CoV-2 infection
The agency also clarified that the decision to screen asymptomatic healthcare workers, including those working in nursing homes, be “at the discretion of the healthcare facility.”
Community transmission is now the key metric for guiding recommendations of “select practices in healthcare settings,” CDC noted, and when levels are high, “source control [i.e., masking] is recommended for everyone in a healthcare setting when they are in areas of the healthcare facility where they could encounter patients.”
Currently, 70% of the nation is at a “high” level of community transmission, according to the CDC’s COVID-19 data tracker.
However, even when transmission levels are high in an area, healthcare providers can opt not to mask when in “well-defined areas that are restricted from patient access,” such as staff meeting rooms, if individuals do not meet the following criteria:
- Have a suspected or confirmed SARS-CoV-2 infection or another respiratory infection
- Have had a close contact with a patient or visitor or a higher-risk exposure with a healthcare provider
- Work in an area of the facility where there is a SARS-CoV-2 outbreak
- Have received a recommendation for masking from public health authorities
With regard to facility outbreaks, the guidance noted that “universal use of [masking] could be discontinued as a mitigation measure once no new cases have been identified for 14 days.”
When community levels are high — a distinct metric used to assess COVID’s strain on the healthcare system — it would be recommended that everyone in the community mask indoors, including healthcare workers.
As for testing, the CDC noted that the benefits of screening testing to identify asymptomatic infection are likely lower in counties where SARS-CoV-2 transmission is lower, adding that such results continue to be useful in certain circumstances — such as when performing higher-risk procedures or caring for immunocompromised patients — to determine which infection control protections are warranted.
“If implementing a screening testing program, testing decisions should not be based on the vaccination status of the individual being screened,” the CDC said. “To provide the greatest assurance that someone does not have SARS-CoV-2 infection, if using an antigen test instead of a NAAT [nucleic acid amplification test], facilities should use 3 tests, spaced 48 hours apart, in line with FDA recommendations.”
Broadly speaking, pre-procedure and pre-admission testing is “at the discretion of the facility”; however, it is still recommended for nursing home admissions, particularly in counties where community transmission levels are high, although admission testing is again at the discretion of the nursing home when at lower levels of community transmission.