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Demystifying Mercury as the Gold Standard in Healthcare

Teresa Tice, Park Nicollet Health Servicesticetj@parknicollet.com

and

Jamie Harvie, Institute for a Sustainable Future

harvie@isfusa.org

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Objectives

• Provide resources to address the barriers to mercury elimination

• Address the typical hold out areas and provide practical solutions to how they are tackled

• Identify the low hanging fruit in laboratories

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Mercury – Low Hanging Fruit

• Mercury is defined by EPA as a Persistent Bioaccumulative Toxin

• Health Care Industry a Major Consumer of Mercury and Mercuric Compounds

• High Priority Pollutant– Released to water and atmosphere– Fish Advisories

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Barriers to Eliminating Mercury Equipment or Chemicals

• Belief Barriers and Resistance to Change– Lack of awareness among employees– Availability and credibility of alternatives

• Purchasing/Costs – Cost of purchasing replacement products– Budgeting process

• Coordination – Lots of People Involved• Lack of Information (e.g. lab chemicals)

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Belief Barriers Mercury: The “Gold” Standard

• Contain 80 -100g / unit• Journal of Human Hypertension

– Study of 444 Hg units..”the majority… had serious problems which would give rise to major errors in bp measurement

• Examples of both inaccurate mercury and aneroid may be found in the literature – related to poor maintenance.

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Belief Barriers – Alternatives Mercury-free Sphygmomanometers

• Aneroid most common as replacement• Comparable in cost to mercury• All must meet same voluntary AAMI testing

requirements• Mayo Clinic program reported aneroids

provide accurate measurements when properly maintained.

• AHA recommends both mercury and aneroid be checked regularly

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Purchasing/CostsJustifying Costs

• Purchasing replacement equip. costs $$– Kaiser study showed life cycle costs of aneroid

1/3 those of mercury– Budgeting – Operational cost

• Spills– Mayo Medical in two year time frame had 50

spills costing 26k– Hartford Hospital in 1998 - 60k cleanup costs.– JCAHO issuing recommendations on lack of Hg

clean up training.

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CoordinationReplacing Hg Equipment

• Impacts wide range of staff– Purchasing, Maintenance, BioMed, Employee

Health, Physicians, Nurses

• Purchasing Dept. Role– Bulk ordering for best price– Contact other hospitals about vendor quality– Trial product– Will vendor manage old mercury units

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3 Keys to Overcome Barriers• A PLAN• SUPPORT

– Upper Management Support Essential– Champions

• EDUCATION– Managers– Support Areas (Maintenance, Biomed,

Safety and Security, Employee Health)– Employees

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Challenges

• Pt. Isolation Rooms: Mercury thermometers – Alternatives

• Disposable:Temp-a-dot• Re-Usable: assign to room

• NICU: Mercury Thermometers and Sphygmomanometers– Most susceptible population to Hg exposure– Thermoregulation very important– Reference: Accurate Measurement of Body

Temperature in Neonate http://www.neonatal-

nursing.co.uk/pdf/sep00bdi.pdf

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Removing Hg from Hospital Laboratories

• Step 1. Examine Chemicals and Reagents– Hg is common in Fixatives (B5)

– Hg is common contaminant (e.g. reagents w/ potassium)

– Hg used in preservatives (thimerosol)

– Hg found in secondary antibodies bound to HPR, ELISA kits, Western blot kits

• Step 2. Require Vendors to Disclose Hazardous Materials in Reagents– MSDS generally do not identify Hg levels (<1%)

• Step 3. Eliminate Hg Containing Devices– Barometers, Thermometers

Reference: http://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html

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B5/Zenkers Elimination

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Mercury Filter Wastes

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Used B5 Management

• Some Histopathology texts recommend precipitation of B5 to “remove” mercury.

• Precipitated B5 supernatant may contain 25 ppm of mercury. – one liter discharge in 20,000 gal

(75,000 l) flow will exceed a pretreatment limit of 0.300 ppb.

• All B5 should be sent to a mercury refiner.

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Alternative to Mercury Fixatives

• Formalin • Zn Formalin

– Anatech 1-800-ANATECH• IBF

– Surgipath 1-800-225-3035• St Mary’s Duluth Clinic

-218-726-4000

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Summary

• Mercury is pervasive in healthcare facilities.• Mercury devices often leak or break.• Mercury containing chemicals have been

disposed of down the drain in the past.• Barriers can be overcome with

perseverance and education• Most mercury-containing items are

identifiable and have cost effective alternatives

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ResourcesHCWH – Web Site • Shygmo resources, Histopathology www.noharm.org

Sustainable Hospitals – Web Site• Comparing mercury and aneroid Sphygmo’shttp://www.sustainablehospitals.org/HTMLSrc/IP_Merc_Tools_CompSphyg.html

• Removing Mercury from Laboratorieshttp://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html

• Is there Mercury in your Coulter Counterhttp://www.sustainablehospitals.org/HTMLSrc/IP_Merc_Coulter.html

H2E Website http://www.h2e-online.org/tools/mercury.htm