The achievement of clean air health care: Is it appropriate? Is it feasible?

Article Abstract:

It has been known for decades that smoking is harmful to smokers; more recently, cigarette smoke has been shown to be harmful to nonsmokers who breath it in. Allowing smoking in a hospital implies that the hospital approves of smoking, while a smoke-free hospital reinforces an anti-smoking message. Since many of the patients in hospitals are there because of the harmful effects of smoking, smoking should be discouraged. There is broad support for smoke-free health care environments, and such facilities reinforce the desire of employees to quit smoking. There is also a ''halo effect'' around a smoke-free hospital, leading to smoke-free schools and businesses. It also makes economic sense to ban smoking, because of reduced costs for ventilation, cleaning, and replacement of furnishings. This report summarizes the feasibility of, support for, and potential barriers to smoke-free hospitals. Three strategies for implementing smoke-free policies in hospitals are reviewed. Smoke-free hospitals are the law in Minnesota, and all 200 Indian Health Service hospitals and clinics are smoke-free. Several other state hospital associations have urged voluntary bans. Potential barriers are a decline in patient admissions, employee resistance, the special problems of chemical dependency and mental health units, perceived violations of smokers' rights, and the personal habits of the decision-makers at an institution. The range of options for a smoke-free policy starts with no policy at all to an immediate and total ban. A two-year staged approach is recommended, during which time there may be designated smoking areas and smoke-free rooms for patients. No hospital should sell cigarettes or other tobacco products. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Hospital nonsmoking policies

Article Abstract:

Hospitals should adopt nonsmoking policies because it is wrong for hospitals to treat disease while allowing smoking, the primary cause of preventable disease, to occur on the premises. Knapp and Kottke describe, in the January 1991 Archives of Internal Medicine, a method of implementing a nonsmoking policy without disruption of the staff and patients. Seventy-seven percent of worksites in one survey have adopted policies restricting smoking in the face of mounting evidence of damage from passive smoke inhalation, and 44 states restrict smoking in public or private worksites. The number is likely to increase, especially since an Environmental Protection Agency preliminary report lists tobacco smoke as a class A carcinogen, along with asbestos, benzene, and vinyl chloride. Studies of worksite smoking policies and their effect on smoking cessation differ in their findings; however, it seems that such policies do result in a decline in smoking by the staff. Nonsmoking policies in hospitals are likely to have a strong impact on employees and patients. Studies of nonsmoking policies have found that 9 out of 10 nonsmokers, and two out of three smokers, approve of the implementation of the restrictions. In one study, 98 percent of smokers felt that smoking should be restricted in hospitals, and one-third of them thought it should be banned outright. Hospitals can convey a strong message about smoking and health while also providing supportive environment. There is no reason for hospitals to delay the implementation of nonsmoking policies, thereby closing the gap between prevention and treatment. Medical institutions must recognize their role in prevention as well as in treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Components of a smoke-free hospital program

Article Abstract:

Hospitals have the responsibility of providing leadership in patients' cessation from cigarette smoking and the total elimination of indoor smoking. A multidisciplinary committee at the Oregon Health Services University in Portland, Oregon, initiated a smoke-free hospital and clinic facility in 1987. The key steps in planning the ban on smoking by patients and visitors included involving representatives of the hospital staff, a two-month lead time in preparation for the ban, personal interviews with all patients who smoked cigarettes the eve before the ban, and distribution of survival kits. Employees were offered free classes for smoking cessation, gum and a protected outdoor smoking area. The ban has been well accepted by patients and visitors. Six months after the ban went into effect a survey of hospital employees indicated a modest reduction in cigarette smoking.

Prevention, Lung diseases, Oregon, Indoor air quality, Oregon Health Sciences University

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