Central line-associated bloodstream infection (CLABSI) rates above the national average precipitated a quality improvement project aimed at reducing this trend. We implemented daily chlorhexidine bathing and used 4 strategies to promote a change in practice and culture in our medical/surgical units. These strategies include the following: (1) staff education, (2) leadership support, (3) resource availability, and (4) increased awareness and accountability. Since implementing these strategies, there has been a significant reduction in CLABSI rates in the medical/surgical units.

Drinking water appears to accelerate weight loss in adults consuming hypocaloric diets when the volume of water is over 1L/d or associated with decreases in urine osmolality. This study explored whether drinking water to dilute urine similarly accelerates weight loss in pre‐adolescents, and if the effect is mediated by cell hydration effects on insulin. Boys and girls (n=25, 9–12y, BMI>;85th%) were randomly instructed to drink enough water to dilute urine or drink water following thirst. All were instructed to avoid other beverages and high glycemic foods. Random saliva insulin, urine osmolality and body weight were assessed weekly for 8 weeks. In completer analyses, participants who ate high glycemic foods at >;50% of meals did not lose significant weight over 8 weeks (−0.4 (0.5)kg). Participants who had high glycemic foods at <25% of meals and urine osmolality <500 mmol/kg over time had significantly lower saliva insulin over time (13(2) vs. 22(3) pmol/L) and greater weight loss (−3.3 (1.2) kg vs. −2.2 (0.9)kg) than participants who also adhered to the study diet but drank to thirst and maintained elevated urine osmolality (887 (27) mmol/kg). Urine osmolality significantly modified the effect of saliva insulin on weight loss. Drinking water to dilute urine may accelerate weight loss for overweight adolescents by limiting insulin levels. Further work is needed to characterize this effect.