HICPAC FAQs

HICPAC is a federal advisory committee [1] that provides advice to HHS and CDC on infection control practices and strategies for the surveillance, prevention, and control of healthcare-associated infections (HAIs), antimicrobial resistance, and adverse events in United States healthcare settings. [2] The work of HICPAC is used to assist HHS and CDC with the development of clinical guidelines, practice guidance documents, resources, and training materials that are used by healthcare professionals, facilities, other federal agencies, state health departments, and accreditation organizations to prevent the spread of infectious diseases wherever healthcare is delivered and to promote the health and well-being of patients and healthcare personnel. It does this by reviewing and assessing existing scientific evidence and identifying knowledge gaps which formulate the basis of its clinical recommendations.

HICPAC is comprised of voting members, non-voting ex officio members of other federal agencies, and non-voting liaison representatives from a range of organizations that engage in infection prevention clinical recommendations and policy. Voting members are non-federal members knowledgeable in the fields of infectious diseases, infection prevention, healthcare epidemiology, nursing, clinical and environmental microbiology, surgery, hospitalist medicine, internal medicine, occupational medicine, epidemiology, health policy, health services research, and public health. Voting members serve for overlapping terms of up to four years. [3] A designated federal officer from the CDC serves as the liaison between HICPAC and CDC

HHS and CDC publishes annually in the Federal Register requests for nominees for individuals who have the expertise and qualifications necessary for service on HICPAC. Nominees in the requisite professional fields (see Q&A #2) are selected based on candidates’ qualifications to contribute to HICPAC’s objectives. Appointments are made in consideration of diversity of representation, points of view, and professional expertise. All candidates must be vetted by HHS and CDC and receive at least one recommendation from a non-HHS employee. Terms begin in July of each year.

When CDC seeks input on specific topics that require focused discussion or the development of a product, HICPAC may convene workgroups to facilitate the additional input and product development with the approval of HHS. Workgroups may be comprised of both members and non-members of HICPAC and include subject matter experts from other professional fields with unique expertise based on the scope of the work conducted by the workgroup. Workgroups report directly to the full HICPAC.

Meetings are held up to eight times a year, as determined by the designated federal officer. Meetings of the full HICPAC are open to the public unless determined otherwise by HHS. All meeting notices are announced in the Federal Register. Meeting materials including agendas are made available on the HICPAC web site shortly before the meeting. Meeting minutes can also be found on the HICPAC website after the conclusion of each meeting. Beginning in 2023, meetings are live streamed, and videos are posted to the HICPAC website after the meeting. Meetings held by workgroups are not open to the public; however, all workgroup findings and recommendations are presented to the full HICPAC in a public forum.

Meetings are presided over by a chair or co-chairs.[2] Voting members are central to the conduct of all HICPAC meetings with ex officio federal and non-voting liaison representatives called upon to provide input as needed. Dedicated time for oral comments from members of the public is included in every meeting. Participants who wish to deliver oral remarks during the live meeting must submit a request prior to the date of the meeting. There is a limit on the amount of time provided for oral remarks, and participants are selected by lottery if the number requesting to provide comments exceeds the time available. Participants unable to provide oral remarks may submit written comments.

The development of recommendations for guidelines involves an extensive process that in most cases takes years to complete from start to finish.

• A working group is established. A workgroup is formed to conduct an extensive literature search and to gather, examine, and interpret data.
• Present data and expert opinion. Data and expert opinion are presented by the workgroup to the full HICPAC for review and discussion.
• The first draft of new or revised guidelines is presented and discussed. HICPAC members weigh public discussion and the presented data. HICPAC voting members conduct a vote to decide when the draft guideline is ready for delivery to the CDC for review.
• Conduct an intra-agency review. CDC reviews a draft of the recommendations and proposed guideline language developed by HICPAC members to ensure continuity and alignment with other CDC guidance such as those developed by The National Institute for Occupational Safety and Health (NIOSH). CDC may also request additional clarification and input from HICPAC members based on questions generated during this inter-agency review process.
• Public comment. If voting members approve, the guidelines are delivered to CDC where they are reviewed and then posted to the Federal Register for public comment.
• Review & revision. CDC and HICPAC review and respond to the public comments. Input gathered from public comments is taken into consideration as the guidelines are further revised by CDC.
• Vote & recommendation. The workgroup presents the revised and pre-final draft for HICPAC approval. The members vote on the guideline and, if approved, recommend the final draft to CDC. Once guidelines are approved by HICPAC and complete a final CDC review, the CDC infection control website and related materials are updated.

Anyone interested in the business of the HICPAC is encouraged to attend as many meetings as possible. Full HICPAC meetings are held virtually and in-person as determined by the designated federal officer. Members of the public seeking to attend meetings in person must register in advance. Registration information is included in Federal Register notices and on HICPAC website. Virtual participants do not need to register in advance to watch the meeting. Members of the public can deliver oral comments during the meeting, although a request in advance is required and time limits may prevent all oral comments from being delivered. Anyone can submit written comments for a limited time period after the meeting concludes. All comments received are reviewed by HICPAC and CDC. Meetings held by workgroups are not open to the public, however, all workgroup findings and recommendations are presented to the full HICPAC in a public forum. Outreach to non-voting liaison representatives between meetings also may be possible.

The current process has been in place for decades. HICPAC has an established track record of producing highly valued recommendations and subsequent updates for guidelines on wide range of topics pertaining to preventing the transmission of infectious diseases in healthcare settings.

Clinical guidelines are recommendations for the performance of routine delivery of healthcare based on up-to-date scientific knowledge. [4] They are written for physicians, nurses and other healthcare clinical staff in a manner that enables them to follow recommendations in daily practice uniformly within patient populations and settings. Clinical guidelines are developed using evidence generated by medical research that is systematically collected, reviewed, and evaluated by a committee of scientific experts who specialize in the subject of the guideline under development. In determining how best to deliver care, these experts must weigh the benefits and risks as determined by the evidence collected before making recommendations that reflect the consensus view of the expert group. Guidelines are not legally binding, but deviations must be justified. HICPAC guidelines are evidence-based infection control strategies for surveillance, prevention, and control of HAIs, antimicrobial resistance, and related events and represent the consensus view of the subject matter experts responsible for developing recommendations. HICPAC follows a publicly available recommendations and evidence categorization scheme that details how the authors translate evidence into specifically classified and graded recommendations.

HICPAC’s clinical guideline recommendations are developed by workgroups of subject matter experts convened to systematically collect, review, and evaluate data and information gathered from the scientific literature. Members of the workgroup are identified based on their clinical experience and knowledge in the clinical practice that is the subject of the guideline under development. Some of the subject matter experts may not be voting members or members of HICPAC. However, HICPAC and CDC officials may invite non-voting and non-member subject matter experts to participate directly in the development of recommendations for guidelines to ensure robust points of view and expertise. HICPAC utilizes a specific process that is summarized earlier in this FAQ and can be found in detail on the HICPAC web site.

HICPAC guidelines are not legally binding. But as is the case with all consensus-based clinical guidelines, there is an expectation of adherence to guidelines or adherence to an equally justified rigor of practice to protect patients. Federal agencies are not required to cite or adopt HICPAC guidelines. However, HICPAC guidelines are based on high-quality evidence and the consensus-based opinion of top subject matter experts in the field of infection prevention and antimicrobial resistance. Because of this, HICPAC guidelines are frequently cited by federal and state regulatory agencies when evaluating the quality care being delivered by any given provider.

The isolation precautions guideline was last updated in 2007. All consensus-based clinical guidelines are expected to be updated regularly using a systematic approach to collecting, reviewing, and evaluating the scientific literature since the time of the previous publication. The isolation precautions guideline was scheduled to be updated earlier, but the systematic review process was disrupted by the COVID-19 pandemic leading to delays in progress. This guideline will also address recommendations that apply in all types of healthcare settings (such as ambulatory clinics and post-acute care facilities) to provide clear standard practice based on pathogens.

The full isolation precautions guideline is not being updated as of December 2023 and will exclude updated recommendations for the types of precautions that should be used for specific pathogens. Pathogen-specific recommendations in the second section will be reviewed and updated starting in 2024. [5]

The isolation precautions guideline update is currently in draft form and has recently undergone intra-agency review with a request for some clarifications by the workgroup. The draft must complete CDC review and the public comment process and then undergo another round of review, edits, and voting before the draft guideline can be converted to the status of “final.” [5]