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14 INFECTION CONTROL Patients' heavy breathing during labor may boost COVID-19 risk By Mackenzie Bean W omen's heavy breathing during labor could increase the risk of COVID-19 transmission, underscoring the importance of ensuring healthcare workers in obstetrics and gynecology have proper personal protective equipment, according to a study published Sept. 9 in Obstetrics & Gynecology. Researchers analyzed respiratory emissions of three women who tested negative for COVID-19 and had routine vaginal deliveries at Ronald Reagan UCLA Medical Center in Los Angeles. Researchers found the speed of each woman's respiratory emis- sions became progressively faster as labor progressed. Emissions traveled at an average speed of 1.8 meters per second during labor, about 30 percent faster than during normal breathing and at least 6 percent faster than when someone coughs. "These particles travel far and with great speed and remain suspended in the air," study author Rashmi Rao, MD, assistant clinical professor of obstetrics-gynecology at UCLA's David Gef- fen School of Medicine, said in a Sept. 14 news release. At present, N95 masks are not recommended for use in labor and delivery settings, as the CDC and World Health Organi- zation do not identify vaginal delivery as a high-risk or aero- sol-generating procedure. "This study can be used as support that all labor and delivery units should provide full PPE [with N95 masks] for their staff by encouraging the designation of vaginal delivery as a high-risk and potentially aerosol-generating procedure," Dr. Rao said. The study did not assess whether infectious virus particles, or aerosols, were present in respiratory emissions. Researchers said they hope to demonstrate this finding in a future study. n Pandemic fueled large jump in healthcare-associated infections, CDC finds By Mackenzie Bean T he incidence of healthcare-associated infections increased significantly in 2020 after years of steady declines, according to a CDC analysis published Sept. 2 in Infection Control & Hospital Epidemiology. Researchers used data from the National Healthcare Safety Network — the largest HAI surveillance system in the U.S. — to analyze national infection rates by quarter for 2019 and 2020. In the fourth quarter 2020, rates for four of six regularly tracked infections had increased compared to 2019: • Central line-associated bloodstream infections: 47 percent increase • Ventilator-associated events: 44.8 percent increase • Methicillin-resistant Staphylococcus aureus: 33.8 percent increase • Catheter-associated urinary tract infections: 18.8 percent increase Rates of surgical-site infections and Clostridioides diffi- cile either decreased or held steady in 2020. Researchers attributed the increase to various challeng- es related to the COVID-19 pandemic, including staffing shortages and high patient caseloads, which limited hospitals' ability to follow standard infection control practices. "The unfortunate reality is that in one year we lost nearly a decade of progress against HAIs like central line-as- sociated bloodstream infections, catheter-associated urinary tract infections, methicillin-resistant Staphylo- coccus aureus and ventilator-associated events," Ann Marie Pettis, BSN, RN, president of the Association for Professionals in Infection Control and Epidemiology, said in a statement about the report. "APIC is calling on healthcare facilities to assess their infection prevention programs by looking at the care and services they pro- vide and determining the appropriate level of personnel and resources necessary to protect patients and health- care workers." n