Electronic Cigarettes

My good friend Tom Cuthrell, Safety Officer at CarolinaEast Health System in New Bern, NC wanted to know if Joint Commission has said anything about the use of electronic cigarettes in hospitals. As far as I can tell, Joint Commission has not addressed the issue of e-cigarettes. That means you get to decide how you want to move on this issue. But before you do, take a serious look at all sides of this subject.

Former smokers who use e-cigarettes say the devices have saved them from a lifetime of smoking-related health problems. Yet public health and tobacco control officials have been loath to embrace them. For one thing, the devices are completely unregulated by the federal government, with no industry standards for safety in manufacturing or marketing. That has prompted some states and municipalities to enact regulations on their own. Please check with your local and state authorities to determine what (if any) regulations they may have.

There is no heat or flame used in e-cigarettes, so from a fire safety point-of-view, they do not present a risk. But other issues may arise if you consider allowing them in your organization. I found some basic information on the website that address e-cigarettes:

What is an E-cigarette?

  • E-cigarettes are battery-powered devices that deliver nicotine through a flavored vapor.
  • They are made so users can feel like they are inhaling tobacco smoke, without the burning tobacco that occurs with a cigarette.

Are E-cigarettes safe?

  • We do not know if E-Cigarettes are safe. The E-cigarette is not currently approved by the FDA as a safe and effective method to help smokers quit.
  • E-cigarettes release secondhand vapor (not smoke) that can be seen and smelled. Further research is needed to determine any health related consequences.

What do we know about the E-Cigarette?

  • The amount of nicotine in an E-cigarette is unknown. Although the E-cigarette cartridges are advertised with specific amounts of nicotine, the U.S. Food and Drug Administration (FDA) testing has shown that their actual amounts can be incorrect.
  • An FDA study found that the E-cigarette products contained toxic chemicals- including the ingredient found in anti-freeze.
  • More research is needed to find out what other ingredients are in the E-cigarettes and what kind of health or other effects they have on people who use them.

What does this information mean?

  • E-cigarettes should not be used to replace smoking because there is no scientific proof that they can help smokers quit.
  • FDA approved medications such as nicotine patches, gum and lozenges are proven to help smokers quit and should be used.
  • Medications approved by the FDA in combination with individual or group counseling are shown to be the most successful ways to help smokers quit.
  • It is important to talk with a health care provider when considering alternatives.

While there are no direct regulations controlling the use (or non-use) of e-cigarettes, I would recommend that they are not allowed in the healthcare organization, for the following reasons:

  • They are not known whether or not they are safe for users or if the second-hand vapor is safe for others
  • The use of an e-cigarettes will inadvertently promote the use of real cigarettes since they look so much like an actual cigarette
  • This is not an area where you want to be a leader… Let someone else blaze the trail, and until more scientific research is accomplished, it is better to take a wait-and-see attitude

Hey Tom… say hello to all my friends there in New Bern, home of the original Pepsi Cola.

Cigarette Butts

The cigarette butts you see in the picture to the left were found inside a walk-in filter bank in the intake side of  a large air handler unit for a hospital.  The walk-in bank was large enough for an adult to stand erect, and there was also room for a chair so the person smoking in this place had a place to rest. To be sure, this is not an approved smoking area.
This particular hospital has a smoke-free policy which did not allow any tobacco products on their campus, let alone inside their building. Joint Commission and CMS inspectors will hold hospitals to what their policy says about smoking. In this case, it is pretty obvious that smoking inside an air handler (which served patient areas below) is not acceptable.
When I first started with the Joint Commission as a Life Safety Sprecialist surveyor, we were instructed to count cigarette butts found on the ground outside of the hospital’s designated smoking areas (or butt-huts as they were called). If we counted more than 5 butts, then the hospital was cited for non-compliance with their smoking policy. Then it wasn’t long that we were instructed to stop counting cigarette butts and stop citing hospitals for non-compliance with their smoking policy. By the time I left The Joint Commission, surveyors were back to citing non-compliance with the smoking policy, but only if they found evidence of smoking in areas of the hospital and campus were only staff and contractors would go, and not areas were the general public may congregate such as the entrance to the ER.
So, now inspectors and surveyors are looking very closely for cigarette butts on rooftops, in mechancial rooms and in staff areas such as break rooms and storage rooms. I even have found evidence of staff smoking in seldom-used stairwells where they think they would not get caught.
I suggest that you have these ‘hot-spot’ areas examined and inspected frequently, such as once per week, looking for evidence of smoking violators. If you don’t spot the locations where smokers are improperly lighting up, the surveyors will. Wouldn’t it be better that you found this problem and took control of it before it becomes a finding on a report?

No Smoking Signs on Patient Rooms

Q. Is there a Life Safety Code requirement to post “No Smoking” signs on patient room doors where oxygen is being administered? Our Respiratory Care department insists on posting No Smoking signs on the door frame for every patient that is currently being administered oxygen.

A: Section ( for new construction) of the LSC requires compliance with NFPA 99 Health Care Facilities (1999 edition) where medical gas is being administered. Section 8-6.4.2 of NFPA 99 requires precautionary signs advising no smoking adjacent to doorways or walls where oxygen is being administered. However, the exception to this standard states that no smoking signs are not required in health care facilities where smoking is prohibited. Currently, The Joint Commission standards prohibit smoking in hospitals except for specific patient circumstances. If your organization permits patient smoking in specific circumstances, then the No Smoking signs will have to be installed where oxygen is being administered. Also, check your organization’s policies about no smoking signs. If a policy requires the No Smoking signs to be in place, then you must have them, regardless what exceptions NFPA 99 offers.