1. Erasmus hospital in Brussels 10 years of smoke-free process Jacques Dumont, Hôpital Erasme Infirmier, Licencié en Education pour la santé, Tabacologue

2. The Erasmus Hospital Hospitalisation days280 000 Patients hospitalised in one year30 000 Surgical operations 18 000 Deliveries 1 500 Out patient visits >300 000 One day 12 000 Academic hospital of the free university of Brussels

3. Years 70’ Golden years for smoking...in Erasmus hospital too Ashtrays available ++Ashtrays available ++ Smoking prohibited in rooms and laboratoriesSmoking prohibited in rooms and laboratories Smoking areas ++Smoking areas ++ Years 80’ Different officials prohibition law for smoking in hospitals Restriction of smoking areas Years 90’ 1994 adhesion to smoke free-hospital network 1997 adhesion to HPH network

4. The main steps In Erasmus hospital 1996 : working group 1997 : survey on smoking habits, needs and wishes 1997 : opening of the stop smoking centre 1998 : clinical research on NRT (staff members) intern policy on smoking control intern policy on smoking control 2001 : interventions on external workplaces 2002 : clinical research on Rimonabant (priority staff members) 2004 : training for specialist practitioners on workplace and security coordinators 2005 : clinical research on Varenicline (priority staff members)

5. Working group 1996-2001 : - patient education responsible - quality responsible - quality responsible - two smokers - one ex-smoker - one non smoker Moveto After 2002 : health promotion committee included stop smoking centre responsible Out collaborations with - Public Health School - Ministry of Public Health - Ministry for employment and work conditions - Private organisation of training for work responsible

6. Staff members CommunityPatients Environment

7. Staff members CommunityPatients

8. I don’t want to smoke…

9. Department of pneumology but collaboration with all department in the hospital, spec. : cardiology, gynaecology, vascular pathology unit,... Psychologist, physician, dietetic, tabacologist,... Holistic approach Using of the “French tabacology file” Application of the international guidelines Approx 200 patients/year

10. Patients Help people who are hospitalised to stop smoking Helping out patients to stop smoking Limit smoking places

11. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital - Support for patients and units - nurse specialised in stop smoking

12. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital -support for patients and units - nurse specialised in stop smoking

13. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital -support for patients and units - nurse specialised in stop smoking

14. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital -support for patients and units - nurse specialised in stop smoking General conferences for staff members Specific conferences (cardiology, pneumology, gynaecology…)

15. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital -support for patients and units - nurse specialised in stop smoking

16. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital -support for patients and units - nurse specialised in stop smoking hopitalerasme.org LIENS FARES Stop-Tab@c Société Française de Tabacologie International Tobacco Control Network Réseau français Tobacco Free Initiative (WHO)

17. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital -support for patients and units - nurse specialised in stop smoking

18. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital -Information in the admission leaflet - Availability of NRT in the hospital - support for patients and units - nurse specialised in stop smoking 16 hours patches Microtab ® Microtab ®

19. Help people who are hospitalised to stop smoking - Posters in the smoking areas - Specific leaflet for patients - Training for nurses and physicians - Nursing relay in units - Information on the website of the hospital - Information in the admission leaflet - Availability of NRT in the hospital - support for patients and units - nurse specialised in stop smoking Approx 150 patients/year

20. Staff members CommunityPatients Environment

21. Staff members

22. Help staff members to stop smoking - free access to stop smoking centre for staff members - clinical research with first advertising for staff members - increasing the awareness of the sm by the occupational medicine service - (conferences) - (poster and leaflets)

23. Help staff members to stop smoking - free access to stop smoking centre for staff members - clinical research with first advertising for staff members - increasing the awareness of the sm by the occupational medicine service - (conferences) - (poster and leaflets) 1998 - Cease study - 35 SM 2002 - Rimonabant Study - 10 SM 2005 - Varenicline Study - 20 SM

24. Help staff members to stop smoking - free access to stop smoking centre for staff members - clinical research with first advertising for staff members - increasing the awareness of the sm by the occupational medicine service - (conferences) - (poster and leaflets) Belgium : annual obligatory medical visit for staff members High collaboration between STC and medical physician at Erasmus hospital

25. Environment

26. - Removal of ashtrays - Adaptation of Smoking areas - Official forbidden sign + specific Erasmus smoking tobacco control sign Environment

27. Community

28. Community

29. Environment Staff members CommunityPatients // each year World day AgainstTobacco

30. 31 may 2001 World day without tobacco actions –Design, target - population and process –Intervention –Description –Results

31. Design, target - population population Prospective research non randomisedProspective research non randomised on 31 May 2001 and 1st june :on 31 May 2001 and 1st june : –information desk in the public hall of the hospital –pneumologist + 3 nurses –for all the smokers how are interested in (patients, staff members, visitors) –respiratory quick test + CO test + questionnaire + quick speaking with the physician –posters –leaflets phone calling 3-4 months after the actionphone calling 3-4 months after the action

32. Description : sex

33. Description : age (n=274)

34. Description : statut

35. Results

36. Results after 3-4 months 274 subjects 198 phone contact (= 100%) No modification (44%) Modification(56%) Trying to stop (23,7 %) Quitting(8%) Decreasing min 20% cj (19%)

37. 31 may 2005 Strict restrictions for smokingStrict restrictions for smoking New advertising to help staff members to stop smokingNew advertising to help staff members to stop smoking Increasing of stop smoking activitiesIncreasing of stop smoking activities

38. Assessment regarding European criteria for smoke free hospital 1. Interest management level 2. To have a specific committee 3. To have a training planning 4. Help to quit structure 5. Have a clear identification for smoking-room 6. Have a clear identification for smoke free hospital 7. Avoid possibilities to buy cigarettes and limit ashtrays 8. Inform, inform, inform 9. Follow the process

39. Assessment regarding Health Promotion strategies Build healthy public (local) policy Create supportive environments for health Create supportive environments for health Strengthen community action for health Strengthen community action for health Develop personal skills Develop personal skills Re-orient health services Re-orient health services