Demystifying Mercury as the Gold Standard in Healthcare

1
Demystifying Mercury as the Gold Standard in
Healthcare

• Teresa Tice, Park Nicollet Health Services
• ticetj_at_parknicollet.com
• and
• Jamie Harvie, Institute for a Sustainable Future
• harvie_at_isfusa.org

2
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

3
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

4
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)

5
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.

6
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

7
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.

8
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

9
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

10
Challenges

• Pt. Isolation Rooms Mercury thermometers
• Alternatives
• DisposableTemp-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

11
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 (lt1)
• Step 3. Eliminate Hg Containing Devices
• Barometers, Thermometers

Reference http//www.sustainablehospitals.org/HTM
LSrc/IP_mercury_removelabs.html
12
B5/Zenkers Elimination
13
Mercury Filter Wastes
14
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.

15
Alternative to Mercury Fixatives

• Formalin
• Zn Formalin
• Anatech 1-800-ANATECH
• IBF
• Surgipath 1-800-225-3035
• St Marys Duluth Clinic
• -218-726-4000

16
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

17
Resources

• HCWH Web Site
• Shygmo resources, Histopathology www.noharm.org
• Sustainable Hospitals Web Site
• Comparing mercury and aneroid Sphygmos
• http//www.sustainablehospitals.org/HTMLSrc/IP_Mer
  c_Tools_CompSphyg.html
• Removing Mercury from Laboratories
• http//www.sustainablehospitals.org/HTMLSrc/IP_mer
  cury_removelabs.html
• Is there Mercury in your Coulter Counter
• http//www.sustainablehospitals.org/HTMLSrc/IP_Mer
  c_Coulter.html
• H2E Website http//www.h2e-online.org/tools/mercur
  y.htm