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THE EFFECTS OF SMOKING ON WOUND HEALING
Running head: THE EFFECTS OF SMOKING ON WOUND HEALING 1
EFFECTS OF SMOKING ON WOUND HEALING
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Use of tobacco is still marked as the primary cause of preventable mortality and morbidity in the United States and is reported to kill one every five people. Additionally, health experts in the united states indicate that for every single death there are more than 30 other people who are suffering from health problems related to chronic tobacco smoking. Due to it affecting nearly every body part, smoking causes a multitude of health problems including various types of cancers such as bladder, kidney, lung and stomach cancer, respiratory dysfunction and cardiovascular diseases. The effects of smoking extend not only to those smoking directly but also to bystanders who are at similar risk as those smoking directly. Health experts note that even the briefest exposure to tobacco smoke for bystanders results to short term health damages for healthy adults but may also be fatal to infants. As the discussion on the health effects of smoking continues, there has been another notable health issue in the United States. The prevalence of chronic wound has been on the rise resulting in the creation of socioeconomic burdens on the society(McDaniel & Browning, 2014). Thus this brings about the need to understand how smoking affects the healing of wounds and which the main purpose of this paper.
Stakeholders
The primary stakeholders are smokers as they are the ones at risk of developing chronic wounds that would affect them financially and health-wise. The government is also a stakeholder as reports have indicated the cost of treating smoking-related illness is much higher as compared to treating another ailment. It is estimated that treating smoking related conditions costs the government more than $167 billion without including $92 billion in productivity losses as a result of morbidity and $75.5 billion excess medical expenditure. Health practitioners and health facilities are also stakeholders since the increasing smoking illnesses especially terminal diseases such as cancer requires them to come up with new ways and guidelines to handle the menace. Additionally, they have to train their workers as well as ensure that they are following the set guidelines. Lastly, society, in general, are stakeholders in this issue as the implications of smoking go beyond an individual. For instance, when an individual dies of cancer due to smoking, and they had young children, the burden of taking care of the children rests with society.
Agency policy
Across the system, different policies have been adopted aimed at addressing different aspects of this issue. One of the policies adopted is the smoke-free hospital which aims at making hospitals and their vicinity free of tobacco. This policy aims at creating an environment that is healthy and safe through the implementation of a plan that is carefully crafted by the administrators. The policy identifies that the effects of smoking are adverse to the health and well-being of the employee and patients thus the need to create a safe environment on the hospital premises where smoking will not be a bother. To achieve the smoke-free hospital policy, it is extended beyond the hospital premises by prohibiting smoking within the line of sight of the hospital entrance. This policy aims at reducing the number of cigarettes that a patient or health can be able to smoke per day and increase the quit rate. In other cases, the policy is formulated into a tobacco-free policy which completely bans any use of combustible tobacco product including cigars and pipes anywhere near the premises of the hospital. This ban includes a requirement that health workers change clothes if they have tobacco odor. In the case of patients smoking, the US Public Health service guidelines published in 2000 and updated in 2008 are used which advocate for patient treatment through repeated intervention measures such as guidance( Northeastern Vermont Regional Hospital,2018).
Review of Literature
Various studies that have been conducted have all indicated that exposure to tobacco smoke increases the risk of developing complications during surgery. The research identifies some implications of the surgery complication which include wound taking a longer time to heal and infection. A study by the US Department of Veterans Affairs found that the rate of post-surgery complications associated with delayed wound healing was higher in smokers than in non-smokers ( Lassig et al.,2018). A systemic review of the neck and head injury found that smoking increased the chance of impaired healing which could result in chronic wounds, infection and life-threatening bleeding.
Diabetic foot is a long term obvious implication of diabetes which is feared by many and whose outcome is amputation. Different studies have been conducted to investigate the effect smoking has on the healing of wounds resulting from diabetic foot amputations. In one study, in particular, it was found that smoking increased the risk of amputation by 95% as it was indicated that smokers were prone to developing peripheral vascular diseases which compromise the arteries to a great extent and hence needing amputation (Liu et al., 2017). It was also found that smoking after amputation reduced the rate of healing. The reason was that smoking resulted in the formation of carboxyhemoglobin that reduced the amount of oxygen supplied to the tissues leading to hypoxia and ultimately artery spasm. With continued smoking, chronic hypoxia is developed which leads to tissues developing erythrocytosis as a compensatory measure which results in an increase in blood viscosity and decreases tissue perfusion(McDaniel & Browning, 2014). The latter was found to be detrimental as they increased the risk of diabetic ulcers failing to heal which would result in a chronic wound.
In a similar study out to analyze the association between diabetic foot healing and smoking, it was found that smokers had a wound healing range of 20% at 95% confidence level as compared to 40.2% for nonsmokers at the same level (Alvaro & Martinez,2018). Other studies have explained the effect of smoking to wound healing based before the occurrence of the wound. The studies suggest that smoking causes alterations to the skin which predispose the patients to poor healing. Studies have also tried to explain the relationship between smoking and poor wound healing. The explanation is that smoking inhibits inflammatory phase of healing through reducing cell chemotactic response, the oxidative killing of bacteria and migration in addition to causing a protease imbalance(Lassig et al., 2018). In the proliferative wounding healing phase, smoking reduces fibroblast and its migration hence resulting in low production of collagen. Smoking has also been associated with increased oxidative stress and chronic hypoxia all which affect wound healing.
Comparison of Agency Policy to External Data
Agency policy mainly aims at reducing the exposure of patients to tobacco smoke thereby minimizing the risks associated with short term exposure to smoke. As it is noted, exposure even to the slightest amount of smoke leads to the formation of carboxyhemoglobin which reduces the amount of oxygen supplied to the tissues. The further focuses on reducing the number of cigarettes that health workers smoke per day. This reduces the risk of developing chronic hypoxia which further increases the risk of developing chronic wound. The guideline on smoking patients requires that patients be treated towards achieving long term cessation.
Recommendation
Given the increasing case of chronic wounds, it is recommended that hospitals and the health practitioners formulate a clear guideline on how patients who smoke and who require to undergo treatment needing surgery should be handled. It is also recommendable that hospitals work with other stakeholders to come up with a guide that can be used to help those patients that want to quit smoking considering the health implications abrupt quitting may have on them. There is also the need for the government to intervene by formulating policies that will ensure this menace is countered before it becomes a threat to the well-being of the society as a whole. It is recommended that massive awareness campaign be carried out to further raise the awareness levels among the smokers and non- smokers which would serve to discourage those wanting to start and encourage cessation.
Conclusion
Smoking continues to be major health both for active and passive smokers. The health risk posed by tobacco smoking is virtually far much more extensive as compared to some other substance, and hence there is a need for concerted effort to curb the health menace associated with smoking. The rising rate of the chronic wound should be a cause of alarm for all stakeholders as studies have shown that there is a great relationship between impaired wound healing and smoking. Although it is impossible to achieve a total cessation of smoking it however crucial that the information on the adverse effects of smoking be made public.
References
Álvaro-Afonso, F. J., Lázaro-Martínez, J. L., & Papanas, N. (2018). To Smoke or Not To Smoke: Cigarettes Have a Negative Effect on Wound Healing of Diabetic Foot Ulcers. The International Journal of Lower Extremity Wounds,17(4), 258-260. doi:10.1177/1534734618808168
Lassig, A. D., Bechtold, J. E., Lindgren, B. R., Pisansky, A., Itabiyi, A., & Yueh, B. (2018). Tobacco Exposure and Wound Healing in Head and Neck Surgical Wounds. 128(3): 618–625. doi:10.1002/lary.26813
Liu, M., Zhang, W., Yan, Z., & Yuan, X. (2017). Smoking increases the risk of diabetic foot amputation: A meta-analysis. Experimental and Therapeutic Medicine. doi:10.3892/etm.2017.5538
Mcdaniel, J. C., & Browning, K. K. (2014). Smoking, Chronic Wound Healing, and Implications for Evidence-Based Practice. Journal of Wound, Ostomy and Continence Nursing,41(5), 415-423. doi:10.1097/won.0000000000000057
Northeastern Vermont Regional Hospital. (n.d.). Tobacco-Free Environment Resource Guide. Retrieved April 4, 2019, from https://nvrh.org/uploads/1235745955.pdf