In the absence of updated federal guidance, several states have developed their own approaches to managing respiratory viral illnesses in healthcare facilities in their jurisdictions. These frameworks integrate recommendations for COVID‑19, influenza, respiratory syncytial virus (RSV), and other acute respiratory infections into a unified strategy. They streamline expectations by removing testing requirements for healthcare personnel (HCP), clarifying work‑restriction timelines, and providing clear guidance for source control (masking). States have also implemented updated isolation guidance for patients with COVID-19, removing the requirement for gowns and gloves and thus maintaining evidence-based protection against transmission while eliminating substantial medical waste.
This consistent, evidence-based approach helps healthcare facilities prepare for respiratory virus season by ensuring policies are clear, aligned, and operationally feasible. These strategies also reflect the framework presented by the Healthcare Infection Control Practices Advisory Committee (HICPAC) in November 2024, prior to its dissolution.
The Council for Outbreak Response: Healthcare-Associated Infections (HAIs) and Antimicrobial-Resistant (AR) pathogens (CORHA) has compiled examples of state-issued guidance and regional approaches into a single resource for public health agencies and health systems. This effort aligns closely with CORHA’s mission: to improve practices and policies at the local, state, and national levels for detecting, investigating, controlling, and preventing HAI/AR outbreaks across the healthcare continuum, including emerging infections and other pathogens with potential for healthcare transmission. By supporting both public health and healthcare partners, CORHA aims to strengthen coordinated responses, and enhance preparedness, particularly as facilities plan for future respiratory virus seasons.
One example of regional collaboration is the West Coast Health Alliance (WCHA), a partnership among California, Hawaii, Oregon, and Washington. These states are working together to ensure public health recommendations are guided by principles of safety, efficacy, transparency, access, and trust. As part of its broader efforts in response to evolving national public health policy changes, WCHA formed an Infection Control working group to identify and prioritize healthcare infection control guidance gaps and emerging issues. This working group’s role includes recommending approaches or evidence reviews from trusted sources as “shared principles” that participating states may use or adapt to inform their own guidance in accordance with state-specific processes and in consultation with relevant regulatory entities.
To date, WCHA has not issued any joint statements or "shared principles" regarding IPC guidance, although several of the member states issued their own guidance including California’s HCP RTW guidance, which was based on the HICPAC framework referenced above and the associated CDC evidence review: Risk period for transmission of SARS-CoV-2 and seasonal influenza.
Washington State has issued updated guidance aligned with recent changes in California and Massachusetts. Washington’s, update process included a comprehensive review of respiratory virus prevention literature and existing public health guidance, along with input from healthcare providers, regulators, public health officials, and labor union stakeholders. A series of stakeholder meetings, led by the Washington Department of Health (DOH) guided these discussions, and included both an evidence review and deliberation on key guidance elements, including respiratory virus HCP return- to- work (RTW) criteria and COVID-19 personal protective equipment (PPE) recommendations.
Following this process, a DOH workgroup developed and secured approval for updated guidance documents. While the DOH recommendations are broadly consistent with those of other states, one notable distinction is that Washington provides more prescriptive guidance for managing HCP who work with high-risk patient populations. These differences reflect insights gained from its robust stakeholder engagement process.
The Northeast Public Health Collaborative also developed guidance that has been implemented by individual states, including Vermont. Illinois has also developed interim guidance. While these state and regional approaches cannot replace national-level efforts, they offer a practical path forward for healthcare settings. These frameworks align with existing workflows and policies.
In parallel, national partners such as the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) have launched the Healthcare Infection Prevention Advisory Group (HIPAG). The initiative reflects a shared commitment to enhancing transparency, inclusivity, and scientific rigor in national infection prevention discussions. Selected Members from APIC and SHEA including invited representative experts across medical societies, healthcare organizations, public health and patient advocacy groups, will help maintain a unified approach to infection prevention as emerging challenges and threats continue to evolve.
Together, these efforts from state innovation to national collaboration demonstrate how the field is adapting to fill critical guidance gaps while maintaining consistency, feasibility, and evidence-based practice.