Hospitals are meant to be places of hope and healing. However, the refusal of some individuals to comply with smoke-free regulations not only violates the law but also poses a direct threat to the lives and well-being of patients. Vulnerable groups in hospitals, including people of all ages and with various medical conditions, are particularly susceptible to the harmful effects of tobacco smoke and vapour. Exposure to an unhealthy environment can weaken their immune systems and delay the healing process, putting their recovery at greater risk.

Three Levels of Danger: You May Be Carrying a 'Silent Killer' Every puff of cigarette smoke or vape aerosol not only pollutes the air but also releases toxic residues containing carcinogens (cancer-causing substances) that can delay and even hinder patients' recovery. It is common to see people smoking at emergency staircases, behind hospital blocks, or in corners of car parks. Many believe they are not disturbing anyone. However, the facts prove otherwise. Outdoor Areas: Distance Does Not Guarantee Safety Studies have shown that cigarette smoke and vape aerosol can be detected up to 6–9 metres away in outdoor environments, depending on wind speed and direction (Hwang & Lee, 2014). Indoor Areas: There Is No Safe Distance Inside buildings, cigarette smoke is even more hazardous because its microscopic particles can spread throughout enclosed spaces via ventilation systems and may even travel to other hospital wards through air circulation channels (U.S. Department of Health and Human Services, 2006).

You Need to Know! Three Levels of Harm from Cigarette Smoke and Vape Aerosols: Category of Exposure How It Spreads Impact on Individuals Firsthand Smoke (Smoker) Directly inhaling smoke from a cigarette or aerosol from a vape. Damages the smoker's own internal organs and overall health. Secondhand Smoke (Passive Smoker) Breathing in smoke or vape aerosol exhaled by others. Affects breathing and increases health risks for patients and people nearby. Thirdhand Smoke (Toxic Residue) Contact with surfaces contaminated by toxic residues, such as walls, chairs, clothing, and other objects. Toxic particles can be absorbed into the body through the skin or inhalation, posing health risks even after smoking or vaping has stopped.

Toxic Residues (Thirdhand Smoke): A Hidden Threat That Lingers Absorbs into porous materials Harmful chemicals from cigarette smoke and vape aerosols can be absorbed into porous materials such as clothing fibres, hospital chair cushions, carpets, and even building walls. Can persist for months These toxic residues do not disappear once the smoke has cleared. They remain on surfaces and can continue to release harmful chemicals back into the air for months—or even years—unless thoroughly removed through intensive cleaning. Forms new harmful chemicals Nicotine deposited on indoor surfaces can react with naturally occurring air pollutants, such as nitrous acid, to form highly carcinogenic compounds known as Tobacco-Specific Nitrosamines (TSNAs). In conclusion, even if you smoke at the far end of a corridor or at an emergency staircase located 20 metres away from a hospital ward, toxic residues on your clothing, hair, and personal belongings can still be carried into clinics and wards. These residues may then transfer to visitors' chairs, bed linens, walls, and other surfaces, becoming a silent threat to patients who touch or inhale contaminants from these surfaces.

New Legislation: No More Compound Fine Discounts Under the Control of Smoking Products for Public Health Act 2024 (Act 852), all areas within a hospital's premises are designated as No-Smoking Areas. This includes hospital buildings, car parks, walkways, and all other areas within the hospital compound. The prohibition is no longer limited to tobacco cigarettes but also applies to electronic cigarettes (vapes) and all smoking substitute products. Once you enter the hospital through its main entrance, you are subject to the provisions of the law. Anyone found violating the smoking prohibition may be issued a compound notice of up to RM5,000. The Ministry of Health Malaysia (MOH) has also implemented a "No Compound Fine Discount" policy to strengthen enforcement and maximise the deterrent effect on offenders: Maximum Compound Fine – A compound of up to RM5,000 must be paid in full within the prescribed payment period (generally within 30 days). No appeals for reduced compound amounts will be entertained. Court Action – Failure to pay the compound within the stipulated period, or committing repeated offences, may result in prosecution in court.

Our Role: The Challenges of Enforcement and Compliance The enforcement of the no-smoking policy at Hospital Sultan Abdul Aziz Shah (HSAAS), UPM, is led comprehensively by the Public Health Section, particularly by its Environmental Health Officers and Assistant Environmental Health Officers. In reality, this responsibility extends far beyond simply pointing to no-smoking signs. Enforcement officers must deal with individuals who deliberately conceal their smoking or vaping activities, face provocation from those who refuse to comply, and overcome the challenges posed by newer generations of vaping devices that are increasingly compact and difficult to detect. However, HSAAS is committed to more than just enforcement. Through our dual approach of "Educate & Treat," we aim not only to ensure compliance but also to support meaningful behavioural change. Staff members and visitors who wish to quit smoking or vaping are encouraged to seek assistance through the Smoking Cessation Clinic (mQuit Services), where they can access evidence-based treatment and professional support on their journey towards a smoke-free life.

Conclusion: Respect Lives, Protect Patients Keeping our hospital a completely smoke-free environment is not solely the responsibility of enforcement officers—it depends on the collective awareness and cooperation of every individual. Putting out your cigarette or switching off your vape before entering the hospital is one of the greatest acts of respect you can show to our frontline healthcare workers and, most importantly, to the patients whose lives and recovery depend on a safe and healthy environment. If you or a family member needs support to quit smoking or vaping, contact the mQuit Smoking Cessation Services at your nearest healthcare clinic today.

Prepared by, Noraisyah binti Sabtu Pegawai Kesihatan Persekitaran Seksyen Kesihatan  Awam, Jabatan Kesihatan Komuniti Hospital Sultan Abdul Aziz Shah, UPM

Date of Input: 09/07/2026 | Updated: 09/07/2026 | ahmadfaiq