1HPH Dublin 2005

HPH Dublin

European Network

Smoke-free Hospitals (ENSH)

Bertrand DAUTZENBERG, Ariadni Ouranou, Ann O’Riordan, Anne-Marie Schoelcher

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European Network Smoke-free Hospitals

1996National Network France - Loi Evin1998-99 Foundation of ENSH

EU funding – 6 Countries

2000-2003 Development of tools

European Code, Guidelines implementation/training Self-audit questionnaire, Smoking habits HCW

2004-2006ENSH Extension

Network of smoke free maternities Partnership building - Communication

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Why smoke–free hospitals ?

1. To prevent and treat tobacco consumption in patients

General mission for an hospital1. Hospital is a work place and had to be smoke

free at least at the same level than other workplace

Hospital =workplace2. Hospital had to be a model of health for general

population Health Promoting hospital

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Why a network of smoke-free hospitals ?

Organization of hospitals is very different among European Countries

For example, the role of nurse in the tobacco feel in not the same in north and in south of Europe

In one country tobacco is available in Hospital but not nicotine replacement therapy.

Networking is useful for all national networks to improve national practice and to develop European standards and European Tools

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ENSH Network

The European Network Smoke-Free Hospitals is a growing partnership involving 13 National Networks and more than 900 hospitals from 17 countries, including 1 million HCW.

ENSH

13 National Networks

900 Hospitals in Europe

1.000.000 Health Professionals

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ENSH- National Networks

BR ( Belgium)Pierre BartschFARESE-mail :m.pettiaux@skynet.be

DE (Germany)Christa RustlerDeutsches Netz Gesundheitsfördernder Krankenhäuser gem.e.V.E-mail : dngflk@compurserve.de

FI (Finland)Reetta-Maija LuhtaFinnish Cancer Societye-mail : Reetta-Maija.luhta@epshp.fi

IE (Ireland)Ann O’RiordanHPH National NetworkE-mail : ihphnet@iol.ie

PT (Portugal)Luis OliveiraHôpital de l’Université de CoimbraE-mail : lcoliv@mail.telepac.pt

SE (Sweden)Goran Boëthius

Swedish Network of Doctors against Tobacco

E-mail : goran.boethius@jll.se

GR (Greece)Yannis Tountas

Institut of Social and Preventive Medecine

E-mail : ispm@compulink.gr

UK (Great Britain)Joe Travers

Erne Hospital Enniskillen

E-mail : jtravers@slt.n-i.nhs.uk

RO (Romania)Mihaltan Florin

Institute of Pneumology M.Nasta

E-mail : mihaltan@starnets.ro

IT (Italy)Stefano Nardini

Hôpital Civile Vittorio Veneto

E-mail : snardini@qubisoft.it

FR ( France)Anne-Marie Schoelcher

Réseau Français Hôpital sans tabac

DK (Denmark)Lillian Moeller

HPH National Network

E-mail : lmo4@bbh.hosp.dk

 ES (Spain)Elvira Mendez (Galicia)

General Direction of Public Health

E-mail : m.margale@ico.scs.es

Begona Alonso Iglesia (Cataluna)

Catalan Ongology institut

E-mail : begona.alonso.iglesia@sergas.es

6 New members-Cyprus - Ministry of Health-Luxembourg - St Louis Ettelbuck Hospital-Austria - Universitat Wien -Estonia - HPH National Network-Hongrie - HPH National Network -Slovenia - University clinic of resp and al disGolnik

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New countries

ENSH make effort to :

• Build networks in countries without national network

• To include new EU countries

• To increase bilateral exchanges

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ENSH Policy

The first step for hospitals who wish to adhere and join the ENSH, is the adoption of the European Smoke-Free Hospital Code. The code is available in 11 European languages. This common code provides a set of 10 basic guidelines for the implementation of a smoke-free hospital policy. The code is further illustrated in a set of standards, the European Standards for Smoke-Free Hospitals.

The standards are accompanied by a Self-audit Questionnaire, which is used by the hospital to evaluate its progress and performance as a smoke-free hospital.

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ENSH- Code

EUROPEAN CODE FOR SMOKE FREE HOSPITALS

1 Engage decision-makers. Inform all personnel and patients. 2 Appoint a working group. Develop a strategy and an implementation plan. 3 Set up a training plan to instruct all staff on how best to approach smokers. 4 Organise cessation support facilities for patients and staff in the hospital and

ensure continuity of support on discharge into the community. 5 Indicate smoking zones clearly, for as long as they are considered necessary, and

keep them away from clinical and reception areas. 6 Adopt appropriate signage, including posters, signposts, etc and remove all

incentives to smoke (such as ashtrays, tobacco sales, etc.). 7 Support systems are in place to protect and promote the health of all that work in

the hospital. 8 Promote smoke-free actions in the community setting. 9 Renew and broaden information to maintain commitment to the policy. Ensure

follow-up and quality assurance. 10. First convince, then constrain considering legislation if needed. Have patience!

EUROPEAN CODE FOR SMOKE FREE HOSPITALS

1 Engage decision-makers. Inform all personnel and patients. 2 Appoint a working group. Develop a strategy and an implementation plan. 3 Set up a training plan to instruct all staff on how best to approach smokers. 4 Organise cessation support facilities for patients and staff in the hospital and

ensure continuity of support on discharge into the community. 5 Indicate smoking zones clearly, for as long as they are considered necessary, and

keep them away from clinical and reception areas. 6 Adopt appropriate signage, including posters, signposts, etc and remove all

incentives to smoke (such as ashtrays, tobacco sales, etc.). 7 Support systems are in place to protect and promote the health of all that work in

the hospital. 8 Promote smoke-free actions in the community setting. 9 Renew and broaden information to maintain commitment to the policy. Ensure

follow-up and quality assurance. 10. First convince, then constrain considering legislation if needed. Have patience!

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ENSH Self-audit QS

A web module has been developed offering the possibility for all member ENSH hospitals to conduct on line the audit survey in English, French and German.

(specific web address : http://www.hopitalsanstabac.org/questionnaire/open.php

National co-coordinators you can have automatically the data synthesis for all their member hospitals.

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Membership

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Third level – demonstrates:

High level of implementation of

the ENSH code & standards 1 to 9Grading Criteria: At least a total of 76 points for sections 1-9 of the ENSH self audit QS

Hospitals can categorise their progress under 4 levels

Definite expression of intend to progress towards the attainment of a smoke-free hospital environment.

Grading Criteria:-A signed letter of commitment-ENSH self audit QS

Second level -demonstrates: hospital management commitment, activity of working group communication of smoke free policy.

Grading Criteria:At least a total of 14 points for sections 1&2 of the ENSH self audit QS

The ultimate level : Totally smoke free environment inside & outside the hospital

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ENSH directory of smoke-free hospitals

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Newsletters

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Smoke-Free hospital educational material

15

Dissemination of

training materials in

10 European

languages to

implement smoke-

free hospital and to

train staff on

tobacco control.

Mac PCPower point 4 ou latter

ariadni.ouranou@sap.ap-hop-paris.fr

© ensh 2005

Code ENSH EN FR IT GR PT SW GE FI SP ROLogo ENSH EN FR IT GR PT SW GE FI SP ROimplementation EN FR IT PT GE FI SP ROTraining module EN FR IT PT GE FI SP HCW survey EN FR IT GE FI SP ROSFH audit EN FR IT GE FI RO miscellaneous EN FR IT GR GE FI SP RO

ENSHEuropean Network of smoke-free hospital

Implementation of smoke free hospitalTraining of health care workers

Miscellaneous material

Availability of the chapters in the 10 langages

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ENSH HCW Questionnaire

Study Among Health Care Workers Co-ordinated by theEuropean Network for Smoke-free Hospitals

Questionnaire strictly confidential and anonymous

COUNTRY:

HOSPITAL IDENTIFICATION: |_____________________________________________

AGE GROUP: Years old

SEX: Female Male

JOB: Doctor Nurse Student Administrative Other Non-Health Professional Other Health Professional

YOU ARE: Non-smoker Ex-smoker Daily smoker Occasional smoker (non every day)

------- If you have never smoker, the questionnaire is finished, thank you for your participation ----------

IF YOU ARE DAILY SMOKER

HOW LONG AFTER WAKING UP DO YOU SMOKE ? < 5 minutes 6-30 minutes 31-60 minutes > 60 minutes

ON AVERAGE HOW MANY CIGARETTES, CIGARS OR PIPES DO YOU SMOKE PERDAY?

cigarettes/day cigars/day pipes/day

ARE YOU PLANNING TO QUIT? no In the next month In the next 3-6 months in the next 6-24 months someday

IF YOU ARE AN EX-SMOKER

AT WHAT AGE DID YOU STOP SMOKING? Years old

IF YOU ARE A SMOKER OR EX-SMOKER

HOW OLD WERE YOU WHEN YOU STARTED TO SMOKE? Years old

HAVE YOU RECEIVED SMOKING CESSATION HELP FROM YOUR ORGANISATION? Yes Not existing not desired not easily accessible

HOW MANY TIMES DID YOU SERIOUSLY ATTEMPT TO QUIT? 0 1 2-5 more than 5

Thank you to answer to these questions

OFFICE USE ONLY

E000E001

E010

E011

E020

E030

E031

E032

E40

E041

E050

E042

E043

Study Among Health Care Workers Co-ordinated by theEuropean Network for Smoke-free Hospitals

Questionnaire strictly confidential and anonymous

COUNTRY:

HOSPITAL IDENTIFICATION: |_____________________________________________

AGE GROUP: Years old

SEX: Female Male

JOB: Doctor Nurse Student Administrative Other Non-Health Professional Other Health Professional

YOU ARE: Non-smoker Ex-smoker Daily smoker Occasional smoker (non every day)

------- If you have never smoker, the questionnaire is finished, thank you for your participation ----------

IF YOU ARE DAILY SMOKER

HOW LONG AFTER WAKING UP DO YOU SMOKE ? < 5 minutes 6-30 minutes 31-60 minutes > 60 minutes

ON AVERAGE HOW MANY CIGARETTES, CIGARS OR PIPES DO YOU SMOKE PERDAY?

cigarettes/day cigars/day pipes/day

ARE YOU PLANNING TO QUIT? no In the next month In the next 3-6 months in the next 6-24 months someday

IF YOU ARE AN EX-SMOKER

AT WHAT AGE DID YOU STOP SMOKING? Years old

IF YOU ARE A SMOKER OR EX-SMOKER

HOW OLD WERE YOU WHEN YOU STARTED TO SMOKE? Years old

HAVE YOU RECEIVED SMOKING CESSATION HELP FROM YOUR ORGANISATION? Yes Not existing not desired not easily accessible

HOW MANY TIMES DID YOU SERIOUSLY ATTEMPT TO QUIT? 0 1 2-5 more than 5

Thank you to answer to these questions

OFFICE USE ONLY

E000E001

E010

E011

E020

E030

E031

E032

E40

E041

E050

E042

E043

A QS for measuring

the smoking habits

among health care professionals

within the hospitals members

of ENSH.

This survey is applied now

to more than 80 000 HCW

2003- pilot survey of smoking habits in European hospitals

0%10%20%30%40%50%60%70%80%90%

100%

Belgium France Spain Ireland Romania Greece

0%10%20%30%40%50%60%70%80%90%

100%

Belgium France Spain Ireland Romania Greece

Non-smoker

Ex-smoker

Smoker

Non-smoker

Ex-smoker

Smoker

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« SMOKING BAROMETER 2003»ANNUAL EPIDEMIOLOGY SURVEY OF THE TABACCO

RATE OF HOSPITAL STAFF

Recent decrease of smoking habit in staff

>4% in rate in France. Same decrease in Italy, ..

n=64 540n=16 500

51,745,2

24,424,0

5,68,6

18,4 22,8

0

10

20

30

40

50

60

70

80

90

100

Baromètre 2002 New Baromètre

%

Daily smokers

Occasionels smokers

Ex smokers

No smokers

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Maternity Services

An example of 8300 CO measurement in mother in delivery room

Body weight of newborn

33283302

3192

3066

3000

3100

3200

3300

3400

3500

0-5 ppm 6-10 ppm 11-20 ppm >20 ppm CO

No tween over 10 ppm

49% female 53% female 61% female

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Psychiatric hospitals

Psychiatric patients but also psychiatric doctor and nurses are less ready to quit than others hospital staffs : specific procedures had to be implemented.

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Air quality in hospital

Study on influence of measurement of air quality on management of smoke-free workplace in hospital.

1°Questionnaire opinion on manager on tobacco control in 10 hospital location

Measurment of air quality in 10 hospital location

2° questionnaire change of opinion ond plan to decision

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ENSH ToolsMany tools have been implemented: A questionnaire for survey of the smoking habit of HCW applied now to more

80 000 HCW. A self audit questionnaire to assess implementation of smoke free policy, now

applied to 1000 hospitals. A protocol to implement CO measurement in maternity services to pregnant

women. Module for training HCW in 10 European languages. Module for implementation smoke free hospital

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http://www.ensh.aphp.fr

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Conclusion

Differences in the implementation of a smoke free policy exist between European countries as hospitals organisations depend on national health care systems.

The Europe is reach of theses differences an local particularities, but networking is useful and had European value to each national initiatives.