Secondhand smoke in hospitals of Catalonia (Spain) before and after a comprehensive ban on smoking at the national level

Objective To assess changes in secondhand smoke exposure by means of airborne nicotine concentrations in public hospitals of Catalonia (Spain) before and after a comprehensive national smoking ban. Methods We monitored vapor-phase nicotine concentrations in 44 public hospitals in Catalonia (Spain) before the smoking ban (September–December 2005) and one year after (September–December 2006). We installed 5–7 sampling devices per hospital for 7 days in different places (228 pairs of samples), and 198 pairs of samples were available for the final analysis. Results The median nicotine concentration declined from 0.23 μg/m3 (interquartile range: 0.13–0.63) before the law to 0.10 μg/m3 (interquartile range: 0.02–0.19) after the law (% decline = 56.5, p < 0.01). We observed significant reductions in the median nicotine concentrations in all hospital locations, although secondhand smoke exposure was still present in some places (main hospital entrance, emergency department waiting rooms, fire escapes, and cafeterias). Conclusions Secondhand smoke in hospitals has decreased after the ban. Assessment of airborne nicotine concentrations appears to be an objective and feasible system to monitor and reinforce the compliance of smoke-free legislations in this setting.