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 5.Continuity of support on discharge into the community. 6.Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas. 7.Adopt appropriate signage, including posters, signposts, etc and remove all incentives to smoke (such as ashtrays, tobacco sales, etc.). 8.Support systems are in place to protect and promote the health of all that work in the hospital. 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

KEY Aim of the study Audit the current situation of smoking control in all European hospitals and Health districts Helps to identify areas needing attention Provides a guide for policy development By administrating it periodicaly ensures that progress is kept on tracj The audit tool Self Audit Process of Smoke free Hospitals

Self audit of Smoke-Free Hospital A standard auto audit questionnaire has been dressed to assess implementation of the code The audit survey showed that very important variation is observed in hospitals in the same country. Results

Comparison of individual scores for hospitals in 4 European countries

Smoke free hospital is a continuous process Point 1 and 2 : engagement of hospital : Member silver bronze gold

ANNUAL EPIDEMIOLOGY SURVEY OF THE TOBACCO RATE OF HOSPITAL STAFF  KEY Aim of the study To assess the prevalence of smoking among health professionals  Conclusions There persists a high level of smokers amongst the medical staff. Hospitals must be exemplary places of smoke-free health. Nurses must be the first target in the hospitals. Products to assist quitting smoking made free-of-charge for medical staff.

The ENSH members agree to have 13 common questions questionnaire. This questionnaire was tested in small groups in 6 countries and in a large group in one.

Distribution referring to the smoking habit  In all the samples, there is a predominance of women  The level of dependency is medium  Interdictions of smoking in hospitals exist but are not respected, mainly in South and East Results