Mercury - a health care waste threat that can be immediately eliminated
Mercury is most commonly identified with diagnostic equipment such as thermometers and sphygmomanometers (blood pressure devices), and has been in use as such for more than one hundred years. When mercury becomes a waste, (e.g., broken thermometers), the waste system must be able to demonstrate that there is an adequate protocol for the management for this waste. Mercury poses a significant known health threat to humans. It has been a useful tool in medicine and science in the past, but today there are new materials which can replace all uses of mercury in health care at affordable prices. The phase-out or elimination of mercury containing products and devices means that there will be less need to provide specialized training and to finance equipment for mercury spills and cleanup. Most significantly, is that a documented public health threat will be avoided. For institutions currently using mercury devices, adequate management includes:
The facility must provide training for all staff who use mercury containing devices, so that they are able to recognize the hazards associated with spills and to respond appropriately. Also the facility must provide special training for staff who perform the clean-up of spills. Signs and educational materials need to be developed and posted. A spill management policy must be enacted. Spill kits and equipment must be available wherever mercury is used. A facility must be able to demonstrate that a trained response team is capable of properly cleaning up the materials, that proper storage is available, and that the institution has identified and contracted with a hazardous waste transporter and a company who has agreed to accept mercury wastes for final disposal (or recycling) and that the company will provide documentation of final disposition. This is often described as demonstrating facility capacity for "cradle to grave" management of wastes.
A sustainable solution in any health system project is a plan for a complete phase out of mercury based equipment, and replacement with electronic and aneroid technology which has been documented as being as accurate as mercury based technology. Aneroid sphygmomanometers are priced the same as their mercury counterparts. Digital thermometers are significantly more expensive still. A switch out would require a capital investment plan for purchase of new equipment, and an operating expense line for the disposal of all existing mercury equipment. A purchasing and operations policy banning mercury based technology in the system would also be required to ensure that the facility remains mercury free. While an expensive initial investment, this reduces the need for annual staff training, clean-up equipment, and an annual hazardous waste disposal budget. Mercury spills in facilities can create significant hazards to patients and workers, and the cost of proper clean-up of even a small spill can be significant. Overall, the elimination of mercury demonstrates a commitment to a more sustainable environmentally responsible system.
Sources of Mercury in Health Care Facilities & Alternative Products
|
PRODUCT
|
POSSIBLE ALTERNATIVES
|
| Batteries used in medical equipment such as defibrillators, hearing aids, pacemakers. Note: every pump, flashlight & beeper has a battery back up. Not all contain mercury but many do. | Lithium, zinc air, or alkaline batteries |
| Dental amalgams in old teeth that are discarded or amalgam packaging | ceramics, porcelain, gold, and polymers |
| Esophageal devices including cantor tubes, miller abbott tubes and esophageal bougies / dialators | similar devices but with tungsten tubing (tungsten for weight) |
| Sphygmomanometers (mercury containing blood pressure monitoring devices) | electronic vacuum gage, expansion or aneroid technologies |
| Thermometers to monitor patient temperature | electronic (digital), expansion or aneroid |
| Lamps, lighting fixture bulbs such as fluorescent, high intensity, ultraviolet or others | ordinary glow lights, low sodium vapor tubes, opticals, high energy, long lasting bulbs |
|
CHEMICAL
|
POSSIBLE ALTERNATIVE
|
|
Mercury chloride Zenkers solution Histological fixatives |
Zinc formalin freeze drying |
| Staining solutions and preservatives Thimersol, Immu-sal, Carbol-fuchin stain, Gram iodine stain, phenoic mercuric, acetate, alum, Hematoxylin "solution A" |
Can replace with a variety of chemical compounds now readily available on the marketplace. Some substitutes, such as copper and chromium compounds also have some risk, but less than the risk associated with mercury |
The Sustainable Hospitals Project, University of Massachusetts at Lowell maintains a web resource page which provides regularly updated information on alternatives to these and other products including direct links to manufacturers.
Other Resources:
Mercury Pollution Prevention in Health Care
A guide for hospitals by the National Wildlife Foundation
US EPA Virtual Hospital Tour - Focus on mercury reduction.
Mercury facts from U.S. Department of Health and Human Services, Public Health Service Agency for Toxic Substances and Disease Registry, Division of Toxicology Atlanta, Georgia USA
What is mercury?
Mercury is a naturally occurring metal which has several forms. The metallic mercury is a shiny, silver-white, odorless liquid. If heated, it is a colorless, odorless gas. Mercury can also combine with carbon to make organic mercury compounds. The most common one, methylmercury, is produced mainly by small organisms in the water and soil. More mercury in the environment can increase the levels of methylmercury that these small organisms make. Metallic mercury is used to produce chlorine gas and caustic soda and also used in thermometers, dental fillings, and batteries.
What happens to mercury when it enters the environment?
How might I be exposed to mercury?
How can mercury affect my health?
The nervous system is very sensitive to all forms of mercury. Methylmercury and metal vapors are more harmful than other forms, because more mercury in these forms reaches the brain. Exposure to high levels of metallic, inorganic, or organic mercury can permanently damage the brain, kidneys, and developing fetus. Effects on brain functioning may result in irritability, shyness, tremors, changes in vision or hearing, and memory problems. Short-term exposure to high levels of metallic mercury vapors may cause effects including lung damage, nausea, vomiting, diarrhea, increases in blood pressure or heart rate, skin rashes, and eye irritation.
Has the federal government made recommendations to protect human health?
The EPA has set a limit of 2 parts of mercury per billion parts of drinking water (2 ppb). The Food and Drug Administration (FDA) has set a maximum permissible level of 1 part of methylmercury in a million parts of seafood (1 ppm). The Occupational Safety and Health Administration (OSHA) has set limits of 0.1 milligram of organic mercury per cubic meter of workplace air (0.1 mg/m_) and 0.05 mg/m_ of metallic mercury vapor for 8-hour shifts and 40-hour work weeks.