Clearing the air: why Ontario hospitals are going smoke free

Summer 2016

As of June 30, 2016, London Health Sciences Centre (LHSC) will implement a new policy in response to changes to the Smoke-Free Ontario Act to ban smoking on hospital grounds. This means that smoking at LHSC will be prohibited in all hospital buildings, exterior grounds, parking lots and garages, as well as inside cars – a move the hospital supports wholeheartedly as a healthier approach for our community.

The wide-ranging negative effects of smoking tobacco on health and quality of life are well-documented. Cigarettes contain 600 ingredients, 7,000 chemicals while burning, plus 43 known carcinogens, and are the cause of 36 deaths in Ontario – each day. As one of the leading causes of illness and preventable death, the case for implementing legislation on a provincial scale to ban smoking in hospitals has been in development for several years. We explore what this policy means as a health-care organization, and how it aligns with providing the best possible patient care.

What is the Smoke-Free Ontario Act?

The Smoke-Free Ontario Act limits tobacco use in public spaces with the intention of reducing the many health risks associated with smoking and second-hand smoke. The Act, which was implemented in 2006, first took measures to ban smoking in all enclosed work spaces, including businesses, organizations and hospitals. The Act was amended in 2012 to prohibit smoking outside enclosed workplaces, including LHSC, except in specifically-designated smoking areas. This measure required that designated smoking areas were located at least nine metres away from any hospital entrance, with clear signage to alert patients, visitors and staff of this policy requirement. At that time, LHSC installed three gazebos at both the University and Victoria hospital sites to be used as designated smoking areas for patients, visitors and staff.

What is changing in the Act?

In January 2016, the Ontario government announced that further amendments to the Smoke-Free Ontario Act would include a two-year transition period in which hospitals must move to being 100 per cent smoke free, including a ban on the use of e-cigarettes. During the two-year transition period, only one designated smoking area would be allowed per hospital site, rather than the current three – a change that is simply not feasible to enact or enforce at sites as large as LHSC. As such, LHSC is shifting to become a completely smoke-free hospital effective June 30, 2016 and the current gazebos will remain on hospital property for staff, patients and visitors to enjoy as outdoor spaces.

With the implementation of this new policy at LHSC, any individual found smoking on hospital property will be reminded of LHSC’s smoking policy and will be asked to extinguish their product immediately. Any person found in contravention of the Smoke Free Ontario Act could also be charged by London Middlesex Health Unit Enforcement Office as part of their ongoing enforcement of the Act.

As per the legislation, LHSC will set aside an indoor area in the facility for Aboriginal patients using tobacco for traditional Aboriginal cultural or spiritual purposes upon request.

How does this affect patients at LHSC?

Smoking cessation can significantly reduce the risk of cancer and chronic disease as well as improve surgical outcomes and recovery. At LHSC, all patients are asked if they smoke upon admission to ensure cessation support resources are offered when appropriate.

In addition to encouraging patients to refrain from smoking to reduce smoking-related illness, patients who require surgery are encouraged to quit smoking prior to their procedure. Patients who quit smoking before surgery heal faster, face fewer complications, improve breathing, reduce their risk of infection following surgery, speed up bone fusion (healing) time, and in turn shorten their hospital stay post-operatively.

At LHSC, different departments across the hospital provide a variety of cessation options to patients. This includes connections to supportive community resources and nicotine replacement therapy when appropriate. Patients may also be provided with follow-up contact upon discharge to offer counseling and support services to maintain their commitment of remaining smoke-free. This method has proven to double the success rate for long-term quitting.

Why is going smoke-free important for hospitals?

Hospitals across the province are heeding the call to play a pivotal role in reducing smoking-related illness in their respective communities.  LHSC is one of a growing number of Ontario hospitals that have elected to go smoke-free, joining the ranks of St. Joseph’s Health Care London, Sunnybrook Health Sciences Centre, Credit Valley Hospital, Kingston General Hospital, Cambridge Memorial Hospital, St. Joseph’s Hospital in Hamilton, Health Sciences North and the Centre for Addiction and Mental Health, among others. To date, more than 50 per cent of Ontario hospitals have implemented a property-wide smoking ban.

As facilities that are solely dedicated to health and wellness, hospitals have a responsibility to uphold when it comes to protecting patients, visitors, staff, and the wider community from habits that reduce quality of life and cause a wide range of illnesses. Allowing smoking on hospital grounds is not consistent with promoting health and wellness. Additionally, for patients who are trying to quit smoking, seeing others smoking can have a negative impact on their treatment. Therefore, the new approach in the Smoke-Free Ontario Act supports the hospital’s desire for a healthier community. 

It is well recognized that the effects of smoking and second-hand smoke are devastating to patients, families and the wider community. Tobacco use also places significant economic costs on the health-care system, which has faced challenges in addressing the needs of patients with a wide range of severe conditions that result from tobacco use and exposure. Significantly, the cancer care system has seen the full impact of the effects of smoking on people of all ages. It is well known that smoking is a leading cause of lung cancer, but smoking and second-hand smoke also cause cancers of the esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia.

Another significant health impact of smoking and burden on health-care system resources is the treatment and management of patients with chronic obstructive pulmonary disease (COPD). COPD is a primary cause of hospital admissions in Canada. At LHSC, there were 512 cases of COPD admitted to the hospital in 2014-2015, and approximately 97 of these patients were readmitted within 30 days. As an incurable disease, hospitals are tasked with developing programs that help patients to manage their symptoms in order to maintain and improve quality of life.

Smoking is also known to be a major risk factor for heart disease and stroke. An estimated 1.6 million Canadians are living with heart disease or the effects of a stroke. Smoking can also cause complications with fertility, as well as asthma and emphysema, presenting further economic costs and challenges to the health-care system.

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