Kazmi S.M.H.; Patel S.; Watkins L.; Tack G.; Stead R.J.; Babores M; American Journal of Respiratory and Critical Care Medicine, May 2010,

Smoking habits of health care professionals in a district general hospital (DGH) two years after smoking ban

no smokingIntroduction A law was introduced in England and Wales on 1st July 2007 to ban smoking in enclosed public places. We conducted a survey 6 months after this ban to identify how it affected the smoking habits of health care workers in a DGH. It showed that 29% of ex-smokers had stopped following the ban and 49% of current smokers had cut down the number of cigarettes 1. We repeated the survey two years later to assess if the initial improvement has been maintained.

Rationale: To assess the continuous impact of national smoking ban on smoking habits of health care workers.

Methods:  Similar to the previous survey, an anonymous questionnaire was distributed to members of staff at Macclesfield DGH. Data was collected over one month period. Parameters collected included: age, sex, occupation, smoking status and action following ban.

Results: Three hundred questionnaires were distributed, 195 completed giving a response rate of 65%. The mean (SD) age was 35(11) years, females 67%. The distribution of the respondents were as follows: nursing staff 44%, 23% doctors, 11% administrative staff, 8% professions allied to medicine, 14% supportive services staff. 54% of respondents were non-smokers, 22% ex-smokers and 24% current smokers. In the ex smokers group, 17/44 (39%) stopped smoking since the introduction of the ban. 71% of those who had stopped said that the smoking ban had influenced their decision. The most popular methods of smoking cessation were will power and nicotine replacement therapy. In the smokers group, 25/46 (54%) health care workers were smoking less following the ban.

Results were similar to those from 2007 and as in previous survey there was no statistical significance in age, gender, or occupation in those who stopped smoking. There was no difference in average cigarette consumption of both groups which was 13 cigarettes /day.

Conclusion: Our results show that smoking ban has influenced health care workers to change their smoking habit and that this change has been maintained over two year period. The smoking ban has the potential to leave lasting impact on smoking behaviour which will help in reducing the burden of smoking-related lung diseases.

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Chandramouli S.; Alkhalil M.; Babores M.; American Journal of Respiratory and Critical Care Medicine, 2010,

Conference Abstract

Background: Hospital Acquired Pneumonia (HAP) is the most common nosocomial infection contributing to death (1). There are no accepted clinical criteria for diagnosis or prognostic markers. The recognition and treatment of HAP can be difficult, mortality rates are significant and it increases hospital stay by 7-9 days (2).

Aims: Review management of HAP in our trust. Identify adverse prognostic markers associated with increased mortality and prolonged hospital stay.

Methods: All patients with a diagnosis of HAP over a 12 month period from December 2007 were identified using the hospital coding records. A retrospective case note review was undertaken and data such as age,
sex, diagnosis on admission, co-morbidities, date of new symptoms, length of hospital stay and mortality were collected. Laboratory tests comprising white cell count (WCC), albumin and creatinine within 24 hours of onset of new symptoms were recorded We used Odds ratio and Chi square tests which were used to study the effects of laboratory parameters and medical co-morbidities on mortality and length of stay (LOS).

Results:
We identified 53 patients with HAP. Median (range) age was 80 (41-97) years and median (range) LOS following diagnosis of HAP was 5 (1-21) days. The mortality rate was 41.5 % (22/53 patients). We found that recent surgery was the only factor that had significant effect on mortality (Odds ratio 10.66, 95%CI 2.12-53.6, p=0.04). WCC, creatinine and albumin were associated with increased mortality but this was not statistically significant. However, WCC > 11 did prolong LOS (Chi squared test, p<0.05).

Conclusions: In our study, we have found that surgical patients had higher mortality when they developed HAP. The odds of dying were higher in patients with high WCC, abnormal creatinine and low albumin although in our cohort this did not attain statistical significance. In addition, high WCC was also associated with longer LOS. We believe larger studies are needed to corroborate our findings and assess the significance of other risk factors. This would help with risk stratification of patients with HAP and enable objective assessment of management options.

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