CDC Recommendations to Reduce Central Line Infections

The Centers for Disease Control and Prevention (CDC) has released a report detailing interventions to help prevent central line bloodstream infections in hospitals. The report was published in the October 14, 2005, issue of Morbidity and Mortality Weekly Report and can be accessed online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5440a2.htm.

An estimated 250,000 central line–associated infections occur each year in U.S. hospitals, and 12 to 25 percent of affected patients die from the condition. In 2001, the CDC and the Pittsburgh Regional Healthcare Initiative began a four-year intervention to prevent central line infections in intensive care units. By 2005, infection rates had decreased 68 percent, suggesting that a coordinated infection-control initiative might be an effective way of reducing bloodstream infections in hospitals.

The intervention consisted of the following five components:

• Promotion of targeted, evidence-based catheter-insertion practices (i.e., use of maximum sterile barrier precautions during insertion, use of chlorhexidine for skin disinfection before catheter insertion, avoidance of the femoral insertion site, use of recommended insertion-site dressing care practices, and removal of catheters when no longer indicated)

• Promotion of an educational module about central line–associated infections and strategies for their prevention

• Promotion of standardized tools for recording adherence to recommended catheter insertion practices

• Promotion of a standardized list of contents for catheter insertion kits that includes all supplies required to adhere to recommended insertion practices

• Measurement of central line–associated infection rates and distribution of data to participating hospitals in confidential quarterly reports to allow comparison of individual unit-specific rates with pooled mean rates from other participating units in the region and pooled mean rates from all other U.S. hospitals participating in the National Nosocomial Infection Surveillance system.

The CDC reports that the results of this intervention suggest that adherence to evidence-based preventive practices can prevent central line infections. It concludes that additional studies are needed to determine whether these success levels can be achieved for other health care-associated infections.

ACSM Recommendations for Endurance Athletes

The American College of Sports Medicine (ACSM) has released evidence-based recommendations for athletes to prevent hyponatremia and dehydration during sporting events. The report, which is based on the analysis of several previous studies, was published in the June 2005 issue of Current Sports Medicine Reports.

The study reinforces the importance of managing hyponatremia and dehydration in persons who participate in endurance events such as races and marathons. The ACSM recommends the following procedures to help prevent these conditions:

• Work to minimize the risk of hyponatremia and dehydration. Hyponatremia occurs when the athlete drinks too much liquid, causing the body’s sodium levels to dilute. The condition is rare and usually affects athletes participating in running events lasting longer than four hours. Dehydration occurs much more frequently, and the ACSM recommends avoiding over- or under-drinking when running.

• Drink on a schedule to match fluid loss. Athletes should know their body’s average hourly sweat rate and drink the appropriate amount of fluids to replace what was lost each hour. The study also recommends drinking early and at regular intervals during a race rather than all at once. Drinking constantly over a set period of time rehydrates more effectively than rapid fluid replacement.

• Consume salty foods and beverages. Eating foods with high levels of sodium helps stimulate fluid intake and promote fluid retention. The ACSM recommends that endurance athletes ingest salty snacks and fluids to help offset the loss of salt in sweat and prevent hyponatremia.