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Participants averaged 37.9 (\u00b1\u00a010.7) years of age; 58.5% were male, 59.3% were white and 61.1% had a diagnosis related to skin infection at enrollment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention and comparator<\/jats:title><jats:p>Intervention was a skin hygiene education and skills\u2010training behavioral intervention [short\u2010term efficacy data on a behavioral intervention (SKIN)] consisting of two education\u2010 and skills\u2010based skin\u2010cleaning sessions, one during hospitalization and another 4\u00a0weeks later. The comparator was treatment as usual: an informational brochure about substance use treatment options and needle exchange programs in the area and follow\u2010up clinical appointments as arranged by the inpatient medical staff.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Electronic medical records were reviewed and discharge diagnoses for each ED visit and hospital admission were categorized into injection\u2010related bacterial events (e.g. cellulitis) and non\u2010injection\u2010related events. Negative binomial regression was used to test the intervention effects for the primary outcome and total ED visits, as well as the secondary outcomes, total number of hospitalizations, injection drug use\u2010related (IDU\u2010related) ED visits and IDU\u2010related hospitalizations. We also tested whether the outcomes were moderated by whether the initial hospitalization was IDU\u2010related.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Of people assigned to SKIN, 66 completed two sessions, 55 completed one session and seven completed zero sessions. Adjusting for baseline covariates, the mean rate of total ED visits in the next 12\u00a0months was non\u2010significantly higher [incidence rate ratio (IRR)\u00a0=\u00a01.13, 95% confidence interval (CI) =\u00a00.96, 1.33, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.152] compared with usual treatment. The intervention did not significantly reduce total hospitalizations or IDU\u2010related hospitalizations. Adjusting for baseline covariates, the mean rate of injection drug use\u2010related ED visits in the next 12\u00a0months was lower (IRR\u00a0=\u00a00.57, 95% CI\u00a0=\u00a00.35, 0.91, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.019) compared with treatment as usual.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A skin\u2010cleaning intervention for people who inject drugs delivered during a hospitalization did not significantly reduce either overall emergency department use or hospitalization. There was some evidence that it may have reduced injection drug use\u2010related emergency department visits.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15236","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T10:41:49Z","timestamp":1598265709000},"page":"1122-1130","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Skin\u2010cleaning among hospitalized people who inject drugs: a randomized controlled trial"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2466-5192","authenticated-orcid":false,"given":"Michael D.","family":"Stein","sequence":"first","affiliation":[{"name":"Behavioral Medicine and Addictions Research Butler Hospital  Providence RI USA"},{"name":"Boston University School of Public Health  Boston MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina T.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Center for Integrated Health Care Research Kaiser Permanente Hawaii  Honolulu HI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra S.","family":"Herman","sequence":"additional","affiliation":[{"name":"Behavioral Medicine and Addictions Research Butler Hospital  Providence RI USA"},{"name":"Warren Alpert Medical School of Brown University  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Keosaian","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health  Boston MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Stewart","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health  Boston MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley J.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Behavioral Medicine and Addictions Research Butler Hospital  Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8116-6023","authenticated-orcid":false,"given":"Zoe","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine Boston University School of Medicine  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Liebschutz","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Center for Research on Health Care University of Pittsburgh  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.04.009"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.11.029"},{"key":"e_1_2_9_4_1","first-page":"595","article-title":"Bacterial infections and skin cleaning prior to injection among intravenous drug users","volume":"107","author":"Vlahov D.","year":"1992","journal-title":"Public Health Rep"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04251.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-2124"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2008.08.016"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6622a1"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1424"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy632"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3408-y"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw157"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.1602"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0129360"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-010-1311-3"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.2556"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.2736"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-016-3919-4"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17-1812"},{"key":"e_1_2_9_20_1","article-title":"Psychostimulant drugs for cocaine dependence","volume":"9","author":"Castells X.","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_21_1","unstructured":"ChanB. 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