Mercury Elimination in Hospitals

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Mercury Reduction in Hospitals
Steve Kubo Hospital Pollution Prevention Program
(HP3) California Department of Health Services
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Mercury Elimination Goal

• The EPA and American Hospital Association
  Pollution Prevention MOU
• Virtual elimination of Hg containing waste from
  hospitals by 2005

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Hg Elimination Programs

• Hospitals for a Healthy Environment (H2E)
  Making Medicine Mercury Free http//www.h2e-onlin
  e.org/

2003 Making Medicine Mercury Free Award
Winners Kaiser Permanente Sacramento Medical
Center Sutter Davis
HospitalSacramento, California Davis,
California Kaiser Permanente South San Francisco
Medical Center Sutter Roseville Medical Center
South San Francisco, California Roseville,
California Kaiser Permanente West L.A. Medical
Center University of California Medical
CenterLos Angeles, California San
Francisco, California Mills-Peninsula Health
Services Sutter Warrack HospitalBurlingame,
California Santa Rosa, California Sutter
Lakeside Hospital Sutter Auburn Faith
HospitalLakeport, California Auburn,
California Sutter Medical Center of Santa
RosaSanta Rosa, California Sutter Medical
Center, SacramentoSacramento, California UCSF/Lan
gley Porter Psychiatric InstituteSan Francisco,
California
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California Mercury (Hg) Elimination Leadership
Program (HELP)
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California HELP Award Program

• Step One Sign up to be a Partner
• Step Two Attend training
• Step Three Submit spreadsheet and certification
• HELP Award !!

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Mercury Assessment Toolkit

• Excel Spreadsheet
• Pareto chart (Descending Contribution)
• Cumulative Percentage

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Assessment Tool
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Total Hg in Facility
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Hospital Before Sphygmomanometer Removal
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After removal of sphygmomanometers and bougies

• Total mercury reduced from 13,816 grams (30.4
  lbs.) to 480 grams (1.06 lbs)
• This represents a 96.5 mercury removal in the
  hospital

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Business or Action Plan

• Recommendations
• Develop Priorities for removal of mercury
  containing devices
• Follow-up implement removal plan

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The Mercury Assessment

• Where to look
• Whom to ask
• What to look for

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Bougies and other GI Devices

• Bougies in Outpatient Surgery
• Bougies in Gastroenterology Lab
• Blakemore tubes in ER
• Blakemore tubes in Supply
• Miller-Abbott Tube

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Bougies over 10 kgs. Of Hg
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A complete set of tungsten gel-weighted bougies
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Miller-Abbott Tube
117 grams of Hg
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Sphygmomanometers

• Bedside
• Examination Room
• Physical Therapy Exercise Room
• In Drawer

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Typical sphygmomanometer
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Sphygmomanometer in patient room
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Hidden sphyg stored in drawer in storage room
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Aneroid Sphygmomanometers
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Replacing mercury-containing sphygs with aneroid
sphygs
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Bulk Mercury

• Associated with Sphygmomanometers
• Kit in Engineering
• Bottles in Engineering
• Other

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Bulk Hg used for sphyg maintenance
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Bulk Hg for sphyg maintenance one bottle of
new Hg and one bottle of Hg waste
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Sphyg service kit Contained bottle of Hg (see
previous slide)
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Wee Bag OMercury over 600 grams
of Hg
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Replacement Device
This device uses air pressure no Hg
(Honan Balloon)
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Barometers

• Pulmonary Laboratory

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Mercury from broken barometer
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Thermometers

• Neonatal Nursery
• Laboratory
• Refrigerators
• Barometer with attached Thermometer

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Laboratory thermometers
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More Laboratory thermometers
NIST-traceable thermometer
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Chemicals in the laboratory
With this
Zinc chloride can cause irritation of the nose
and throat and conjunctivitis
Replace
Mercuric chloride is highly toxic
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Switches

• Vacuum system barostats
• Boiler Barostats
• Boiler water level switch
• Mercury Room Thermostat
• Sump pump switch
• X-ray tube

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Thermostats containing mercury
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Non-mercury thermostat
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Hg devices in mechanical rooms
Bank of Hg switches not in use
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Hg devices in mechanical rooms
Stored devices
Devices in a panel
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More Hg Devices
In mechanical rooms
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Boiler Room
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Fluorescent Lighting

• Fluorescent tubes
• Bilirubin lights

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Other devices
Tip switch 1.25 grams of mercury
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Look for Hg devices -
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For more information

• The Hg Toolkit and other information on pollution
  prevention DHS Medical Waste Management Program
  
• www.dhs.ca.gov/medicalwaste
• Skubo_at_dhs.ca.gov
• 916-449-5684