Feasibility and patient satisfaction with smoking cessation interventions for prevention of healthcare-associated infections in inpatients.
BACKGROUND
Smoking increases hospitalization and healthcare-associated infection. Our primary aim of this pilot, randomized-controlled trial was to examine the feasibility and acceptability of a tobacco cessation intervention compared with usual care in inpatients. S. aureus carriage, healthcare-associated infections and infections post discharge were exploratory outcomes.


METHODS
Current inpatient smokers from a university hospital facility were randomized to usual care or a face to face tobacco cessation counseling session where patients' tobacco use and strategies for quitting were discussed. Patient engagement, satisfaction and withdrawal symptoms were measured at 1 week and 12 weeks post discharge. Nasal swabs were collected at enrollment and discharge and assessed for S. aureus colonization. P-values were calculated using Fisher's exact and t-tests were used to compare groups.


RESULTS
For the study's primary outcome, participants reported the intervention as being generally acceptable and reported high overall levels of satisfaction, with a Likert scale score of at least 4/5 for all measures of satisfaction. No subjects utilized free tobacco cessation services after discharge. 83 % of the intervention group and 93 % of the control group smoked at least one cigarette after discharge. Secondary outcomes with regard to infections showed that, at discharge, 12 % of the intervention group (n = 17) and 18 % of the control group (n = 22) tested positive for S. aureus. After 3 months, 9 % of the intervention group developed infection, 41 % visited an emergency room, and 24 % were readmitted within 3 months post-discharge, compared to 27, 32 and 36 % of the control group respectively.


CONCLUSIONS
With regards to the primary aim of this study, there were overall high levels of satisfaction with the intervention, indicating good feasibility and acceptance among patients. However, more intensive interventions in hospitalized patients and impact on healthcare-associated infections and post-discharge infections should be explored.
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.|Department of Population Health Sciences, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA.
Danielle M
DM
Schulte
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Megan
M
Duster
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Simone
S
Warrack
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Susan
S
Valentine
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.|Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, WI, USA.
Douglas
D
Jorenby
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Daniel
D
Shirley
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
James
J
Sosman
Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA, USA.
Sheryl
S
Catz
Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA. ns2@medicine.wisc.edu.|University of Wisconsin Hospitals and Clinics, Madison, WI, USA. ns2@medicine.wisc.edu.|William S. Middleton Memorial Veterans Affairs Medical Center, 5221 MFCB, 1685 Highland Avenue, Madison, WI, 53705, USA. ns2@medicine.wisc.edu.
Nasia
N
Safdar
D000328:Adult; D003428:Cross Infection / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D017060:Patient Satisfaction; D010865:Pilot Projects; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013375:Substance Withdrawal Syndrome; D014922:Wisconsin
Healthcare-associated infections; Infection control; MRSA; Staphylococcus aureus; Tobacco cessation