1 HPH Dublin 2005 HPH Dublin European Network Smoke-free Hospitals (ENSH) Bertrand DAUTZENBERG, Ariadni Ouranou, Ann O’Riordan, Anne-Marie Schoelcher

2 HPH Dublin 2005 European Network Smoke-free Hospitals 1996 National Network France - Loi Evin Foundation of ENSH EU funding – 6 Countries Development of tools European Code, Guidelines implementation/training Self-audit questionnaire, Smoking habits HCW ENSH Extension Network of smoke free maternities Partnership building - Communication

3 HPH Dublin 2005 Why smoke–free hospitals ? 1.To prevent and treat tobacco consumption in patients  General mission for an hospital 1.Hospital is a work place and had to be smoke free at least at the same level than other workplace  Hospital =workplace 2.Hospital had to be a model of health for general population  Health Promoting hospital

4 HPH Dublin 2005 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

5 HPH Dublin 2005 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 Health Professionals

6 HPH Dublin 2005 ENSH- National Networks BR ( Belgium) Pierre Bartsch FARES DE (Germany) Christa Rustler Deutsches Netz Gesundhei tsfördernder Krankenhäuser gem.e.V. FI (Finland) Reetta-Maija Luhta Finnish Cancer Society IE (Ireland) Ann O’Riordan HPH National Network PT (Portugal) Luis Oliveira Hôpital de l’Université de Coimbra SE (Sweden) Goran Boëthius Swedish Network of Doctors against Tobacco GR (Greece) Yannis Tountas Institut of Social and Preventive Medecine UK (Great Britain) Joe Travers Erne Hospital Enniskillen RO (Romania) Mihaltan Florin Institute of Pneumology M.Nasta IT (Italy) Stefano Nardini Hôpital Civile Vittorio Veneto FR ( France) Anne-Marie Schoelcher Réseau Français Hôpital sans tabac DK (Denmark) Lillian Moeller HPH National Network ES (Spain) Elvira Mendez (Galicia) General Direction of Public Health Begona Alonso Iglesia (Cataluna) Catalan Ongology institut 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

7 HPH Dublin 2005 New countries ENSH make effort to : Build networks in countries without national network To include new EU countries To increase bilateral exchanges

8 HPH Dublin 2005 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.

9 HPH Dublin 2005 ENSH- Code EUROPEAN CODE FOR SMOKE FREE HOSPITALS 1Engage decision-makers. Inform all personnel and patients. 2Appoint a working group. Develop a strategy and an implementation plan. 3Set up a training plan to instruct all staff on how best to approach smokers. 4Organise cessation support facilities for patients and staff in the hospital and ensure continuity of support on discharge into the community. 5Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas. 6Adopt appropriate signage, including posters, signposts, etc and remove all incentives to smoke (such as ashtrays, tobacco sales, etc.). 7Support systems are in place to protect and promote the health of all that work in the hospital. 8Promote smoke-free actions in the community setting. 9Renew 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 1Engage decision-makers. Inform all personnel and patients. 2Appoint a working group. Develop a strategy and an implementation plan. 3Set up a training plan to instruct all staff on how best to approach smokers. 4Organise cessation support facilities for patients and staff in the hospital and ensure continuity of support on discharge into the community. 5Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas. 6Adopt appropriate signage, including posters, signposts, etc and remove all incentives to smoke (such as ashtrays, tobacco sales, etc.). 7Support systems are in place to protect and promote the health of all that work in the hospital. 8Promote smoke-free actions in the community setting. 9Renew 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 !

10 HPH Dublin 2005 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 : National co-coordinators you can have automatically the data synthesis for all their member hospitals.

11 HPH Dublin 2005 Membership

12 HPH Dublin 2005 Third level – demonstrates: High level of implementation of the ENSH code & standards 1 to 9 Grading 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

13 HPH Dublin 2005 ENSH directory of smoke- free hospitals

14 HPH Dublin 2005 Newsletters

15 HPH Dublin 2005 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 PC Power point 4 ou latter © ensh 2005 Code ENSHENFRITGRPTSWGEFISPRO Logo ENSHEN FRITGRPTSWGEFISPRO implementationENFRITPTGEFI SP RO Training module ENFRITPTGE FI SP HCW surveyENFRITGEFISPRO SFH auditENFRIT GE FI RO miscellaneousENFRITGRGEFISPRO ENSH European Network of smoke-free hospital Implementation of smoke free hospital Training of health care workers Miscellaneous material Availability of the chapters in the 10 langages

16 HPH Dublin 2005 ENSH HCW Questionnaire 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 HCW

17 HPH Dublin 2005 « 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= n= ,7 45,2 24,4 24,0 5,6 8,6 18,4 22, Baromètre 2002New Baromètre % Daily smokers Occasionels smokers Ex smokers No smokers

18 HPH Dublin 2005 Maternity Services An example of 8300 CO measurement in mother in delivery room No tween over 10 ppm 49% female 53% female61% female

19 HPH Dublin 2005 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.

20 HPH Dublin 2005 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

21 HPH Dublin 2005 ENSH Tools Many tools have been implemented:  A questionnaire for survey of the smoking habit of HCW applied now to more 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

22 HPH Dublin

23 HPH Dublin 2005 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.