Implementing and monitoring a regional smoke free hospital network in Madrid

Background

Tobacco and e-cigarette use remain major public health challenges despite declining smoking prevalence. The 2025 surveillance report for the Community of Madrid shows persistent exposure to tobacco smoke and increasing use of nontraditional related products. Hospitals are critical implementation settings for translating tobacco control policies into routine practice.Variability in the adoption and maintenance of smoke-free standards could limit their population level impact.

Description

This study assessed the implementation of smoke-free hospital policies within the Madrid Smoke Free Hospitals Network using a standardised self-assessment tool. A cross-sectional evaluation was conducted in March 2026. Online questionnaires were administered by professionals involved in tobacco prevention committees. Sixteen items grouped into 12 implementation standards were assessed, covering governance, signage, communication strategies, cessation service availability, clinical procedures, workforce training, community engagement and reporting of smoking “hot spots” systems.

Results

Among the participating hospitals (n = 42), with a median implementation score of 10.91 (Q1-Q3: 8.82–12.00). High levels of implementation were observed in governance structures (85.7%) staff communication (88.1%) and presence of smoke-free signage at site entrances (76.2%). Major gaps were identified in structured monitoring of compliance with smoke-free regulations (47.6%), communication at admission (50.0%), and integration of cessation support (54.8%). Smoking cessation services were available for staff (69.1%).

Lessons

A structured hospital network with shared standards and routine monitoring supports implementation of WHO strategies. Strengthening enforcement processes, embedding cessation support, improving patient level communication, and addressing smoking prevalence among healthcare workers are priority actions to enhance sustainability, and population health impact.

Key messages

• Hospital networks with shared standards and routine self assessment supports smoke free policies into measurable practice across diverse hospital settings.

• Priorities to strengthen smoke free hospitals include compliance monitoring, cessation support into routine care, communication at entry points, and addressing tobacco use among healthcare workers