Now in our second month of respiratory illness season, healthcare settings continue to await updated guidance from the Centers for Disease Control and Prevention (CDC). CDC's guidance for managing COVID in healthcare settings, on which nursing homes previously relied for determining testing, source control, personal protective equipment (PPE), and duration of isolation, has been archived, leaving many to wonder: What do we do now?

First, recall that the Centers for Medicare and Medicaid Services (CMS) requires nursing homes to establish an infection prevention and control program that includes "a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases . . .following accepted national standards." While "accepted national standards" has been synonymous with "CDC recommendations" in recent years, recall that CDC guidelines are not the only accepted national standards. Other national organizations and state/local public health can offer meaningful information to drive your infection prevention and control practices. But should you choose to follow CDC guidelines, the following information can help make sense of what's out there.

Should nursing homes choose to follow CDC guidelines for managing COVID and other viral respiratory illnesses, they can start with CDC's updated materials for Preventing Transmission of Viral Respiratory Pathogens in Healthcare Settings. CDC's previous guidance for managing COVID-19 in healthcare settings, last updated in 2023, has been archived. Relevant recommendations from that guidance have been adopted in Appendix A of the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

The healthcare settings guidance and the Viral Respiratory Pathogens Toolkit for Nursing Homes provide general recommendations for treatment and management of viral respiratory illnesses. This includes environmental considerations, communicating with residents, families, and staff, determining when to require source control, and strategies for preventing spread. Both the guidance and toolkit refer to Appendix A for more pathogen-specific guidance.

Of note, CDC is changing tactics related to testing for COVID-19. CDC recommends testing at the onset of respiratory illness symptoms to determine the specific pathogen, which in turn helps determine treatment and transmission-based precautions. However, most other recommendations for testing related to COVID were not included in Appendix A. There are no longer recommendations for testing asymptomatic individuals following exposure or for conducting serial testing.

Testing to end duration of isolation is recommended only for individuals who are moderately to severely immunocompromised and CDC does not consider nursing home admission alone as qualifying an individual for that designation. That said, healthcare providers may continue to test individuals if they feel testing is warranted. Information on available tests for SARS-CoV-2, flu, and RSV remain active.

CDC continues to review respiratory illness guidance for potential updates. Any new guidance would likely be released to the Federal Register for a public comment period, then revised and finalized for release and endorsement. LeadingAge will continue working with CDC and monitoring for any changes to recommendations.