Healthcare Quarterly

Healthcare Quarterly 9(3) May 2006 : 8-8.doi:10.12927/hcq.2006.18217

Opinions: Can a Healthcare Service Safely Operate a Controlled Smoking Area?

Dan Parle and Russel Fleming

The Smoke-Free Ontario Act, which comes into law on May 31, 2006, is a commendable step forward for the province. Among other progressive changes, it provides a province-wide legislative framework for a ban on smoking indoors in public places. Unfortunately, it also places the operators of specified residential care facilities in a quandary.
The Act gives operators of long-term care homes, retirement homes, supportive housing and designated veterans' and psychiatric facilities an exemption to operate Controlled Smoking Areas (CSA). It remains the legal and moral obligation of the Chief Executive Officer to operate these rooms safely. The regulations of the Act provide detailed and stringent specifications for the construction of the CSA.

At the Mental Health Centre Penetanguishene (MHCP), where we went 100% smoke-free on our grounds and campus indoors and outdoors in May of 2003, we remain unconvinced that any healthcare service can operate a CSA without leaking smoke and affecting the health and safety of staff and patients. We tried unsuccessfully for decades.

Even if the new regulations do create a room that does not leak smoke (at significant expense), someone will have to clean it. The new Smoke-Free Ontario Act says all staff members can refuse to enter any CSA. Someone might volunteer to clean it if they are paid a premium and provided with a HAZMAT suit (short for hazardous materials).

However, our experience in a large psychiatric hospital indicates that a significant number of our Code Whites (security crisis) occurred in the CSAs - patients were fighting over tobacco. In the future, will any healthcare service management be in a position to order nurses to intervene in a Code White in a room filled with known toxins? We know the hazards of concentrated environmental smoke and we can avoid exposing staff by not operating CSAs.

There are also occasional Code Blue (medical crisis) calls in CSAs. The nurses will not have time to put on a HAZMAT suit before beginning cardio-pulmonary resuscitation.

Here's the quandary in the new Act: specified services can operate CSAs if they can do it safely, but it is impossible to operate them safely. This lamentable exemption in an otherwise commendable piece of legislation may lead some healthcare facilities to construct expensive CSAs only to shut them down later for safety and operational reasons.

Providing nicotine replacement therapy, effective smoking cessation counselling, withdrawal support, better health teaching and a smoke-free environment makes much more sense.

About the Author(s)

Dan Parle is the Director of Planning and Public Information at MHCP.

Russel Fleming is the Psychiatrist-in-Chief at MHCP.


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