Over the past two decades, U.S. hospitals have been moving steadily toward establishing smoke-free campuses in a bid to promote healthier lifestyles among their patients and their staff. But the movement has had a secondary benefit — a reduction in the number of hospital fires.

According to a new report issued by the National Fire Protection Association, smoking materials accounted for an average of 50 fires per year in hospitals and hospices from 2009 to 2013. That’s down from 100 fires per year from 2006 to 2010, and 3,800 fires per year from 1980 to 1984, when nearly half of smoking-related fires occurred in patient rooms.

“That was one of the biggest things we fought for,” said Chad Beebe, deputy executive director of the American Society for Healthcare Engineering in Boston. “We had a number of fires 20, 30 years ago in linen hampers, where patients would end up stashing their cigarette butts under their pillow and they would get picked up and thrown in the linen hamper.”

In the early ’80s, smoking materials accounted for 30 percent of all hospital and hospice fires, but today cause less than 4 percent of the total.

“Now you don’t even see it at the top of the list,” Beebe said.

Downward trend

The NFPA count generally reflects only those fires where the fire department was called, and includes some adjustments for possible missing or unreported data. According to the report, U.S. fire departments responded to an average of 5,650 structure fires in health care properties each year from 2009 to 2013, with 160 injuries and four deaths per year. Nearly half of the fires occurred in nursing homes, while 1 in 5 fires happened in hospitals or hospices.

In 2013, fire departments responded to an estimated 1,190 hospital fires, down from a high of 8,330 fires in 1980. While experts say the reductions reflect a variety of trends including better construction materials, improved fire suppression systems and stronger regulatory oversight, more than half of the improvement has been by eliminating smoking-related fires.

“Reductions in fires caused by smoking materials do seem to stand out,” said Richard Campbell, senior research analyst at the NFPA, who authored the report.

The trend mirrors an overall reduction in smoking in the U.S., from about 33 percent of American adults smoking in 1980 to about 18 percent in 2013.

Smoking-related fires started to decline in the 1980s after the American Medical Association called on hospitals to stop selling cigarettes and to restrict smoking to designated areas. In 1992, the Joint Commission on Accreditation of Healthcare Organizations, which inspects and certifies hospitals, required hospitals to develop plans for banning smoking inside hospitals. Within a decade, cities and states started passing indoor smoking bans that applied to hospitals as well.

“At that point, you had hospital staff pushing patients outside in a wheelchair to smoke, or people having to go through a gauntlet of smoking hospital employees in order to get into a health care facility,” said Bronson Frick, associate director of Americans for NonSmokers’ Rights. “It’s been simpler to have a smoke-free or tobacco-free property-wide policy, and it’s helping to create a healthier workforce and creating a healthier environment for patients.”

The anti-smoking group has compiled a list of smoke-free campuses since the Mayo Clinic first banned smoking in 2001. In 2005, the group documented 110 hospitals with smoke-free campus policies. By 2015, the list was just shy of 4,000 of the 5,600 U.S. hospitals.

Lawmakers in New York and Hawaii have mandated hospitals in those states ban smoking on their grounds, as have 40 municipalities throughout the U.S.

“It’s a very hard policy to manage,” said Todd Shields, director of outreach and support services at St. Charles Bend. “It’s a very stressful time when somebody is here in our hospital or you might have a loved one pass.”

The St. Charles Health System’s official policy is that they are striving to be smoke-free on their four Central Oregon campuses. Shields said they have still had two small mulch fires on their properties after visitors tossed their cigarette butts. The hospital is considering changes in its landscaping to prevent that. St. Charles Redmond, for example, has all rock.

Tighter rules

Fire safety managers say the reduction in hospital fires also reflects stronger regulatory oversight. Inspectors routinely check to see the hospital is up to code with its fire prevention and mitigation equipment, and routinely tests its systems.

“They’re pretty specific in terms of what you have to do and how often you have to do it,” said Doug Spencer, senior director for facilities and safety for Providence Health and Services, which operates 34 hospitals in the Pacific Northwest. “We have these built into our automated systems, so all of our facility managers are looking at that schedule to make sure those happen on time.”

Inspectors will check to see whether tests were done on time, and if any part of the system failed, whether it was addressed and retested. Those inspections, said Garth Didlick, Oregon region director for facility and safety at Providence, have become much more rigorous over the past decade.

“Ten years ago, surveyors would show up at the hospital, and there was maybe a nurse or doctor that was assigned to life safety,” he said. “Now we’ve got life safety inspectors. A number of them are ex-facility managers and some professional engineers.”

Regulations for hospitals are also getting stricter. The Centers for Medicare & Medicaid Services issued new rules this year, requiring hospitals and other health care facilities to adhere to the 2012 version of the NFPA fire safety codes. Hospitals had previously been following the 1999 version.

“There’s been a lot that’s happened since then,” Beebe, the health care engineer, said. “We’ve had the Houston floods, we had Hurricane Sandy, we had Hurricane Katrina. We’ve had all these things that have updated those standards.”

The new codes include a requirement for all hospitals over 75 feet tall to install automatic sprinkler systems within 12 years. According to the last NFPA survey, only about 69 percent of hospitals were had full sprinkler capabilities.

Those gains have left cooking facilities as the biggest risk for fires, accounting for 62 percent of fire department calls to hospitals and hospices in 2013. Kitchen facilities rely on hood systems and sprinkler systems to douse fires when they occur.

Several hospitals have also experienced problems with staff leaving popcorn in the microwave for too long, prompting many facilities to consider banning the product altogether.

“Many hospitals do prohibit popcorn,” said Wendy Walker, manager of environmental health and radiation services at Oregon Health & Science University in Portland. “We stopped ourselves from outright prohibiting it, but we eliminated it from vending machines and cafeterias. You can’t buy it here.”