Steve Kubo Hospital Pollution Prevention Program (HP 3 ) California Department of Health Services Mercury Reduction in Hospitals

Mercury Elimination Goal: The EPA and American Hospital Association Pollution Prevention MOU “Virtual elimination of Hg containing waste from hospitals by 2005”

Hg Elimination Programs Hospitals for a Healthy Environment (H2E) – Making Medicine Mercury Free Making Medicine Mercury Free Award Winners Kaiser Permanente Sacramento Medical Center Sutter Davis Hospital Sacramento, California Davis, California Kaiser Permanente South San Francisco Medical CenterSutter Roseville Medical Center South San Francisco, California Roseville, California Kaiser Permanente West L.A. Medical CenterUniversity of California Medical Center Los Angeles, California San Francisco, California Mills-Peninsula Health ServicesSutter Warrack Hospital Burlingame, CaliforniaSanta Rosa, California Sutter Lakeside HospitalSutter Auburn Faith Hospital Lakeport, CaliforniaAuburn, California Sutter Medical Center of Santa Rosa Santa Rosa, California Sutter Medical Center, Sacramento Sacramento, California UCSF/Langley Porter Psychiatric Institute San Francisco, California

California Mercury (Hg) Elimination Leadership Program (HELP)

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

Mercury Assessment Toolkit Excel Spreadsheet “Pareto” chart (Descending Contribution) Cumulative Percentage

Assessment “Tool”

Total Hg in Facility

Hospital Before Sphygmomanometer Removal

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

Business or Action Plan Recommendations Develop Priorities for removal of mercury containing devices Follow-up – implement removal plan

The Mercury Assessment Where to look Whom to ask What to look for

Bougies and other GI Devices Bougies in Outpatient Surgery Bougies in Gastroenterology Lab Blakemore tubes in ER Blakemore tubes in Supply Miller-Abbott Tube

Bougies – over 10 kgs. Of Hg

A complete set of tungsten gel- weighted bougies

Miller-Abbott Tube 117 grams of Hg

Sphygmomanometers Bedside Examination Room Physical Therapy Exercise Room In Drawer

Typical sphygmomanometer

Sphygmomanometer in patient room

Hidden sphyg stored in drawer in storage room

Aneroid Sphygmomanometers

Replacing mercury-containing sphygs with aneroid sphygs

Bulk Mercury Associated with Sphygmomanometers Kit in Engineering Bottles in Engineering Other

Bulk Hg used for sphyg maintenance

Bulk Hg for sphyg maintenance – one bottle of “new” Hg and one bottle of Hg waste

Sphyg service kit – Contained bottle of Hg – (see previous slide)

Wee Bag O’Mercury – over 600 grams of Hg

This device uses air pressure – no Hg Replacement Device (Honan Balloon)

Barometers Pulmonary Laboratory

Mercury from broken barometer

Thermometers Neonatal Nursery Laboratory Refrigerators Barometer with attached Thermometer

Laboratory thermometers

More Laboratory thermometers NIST-traceable thermometer

Chemicals in the laboratory Mercuric chloride is highly toxic Zinc chloride can cause irritation of the nose and throat and conjunctivitis Replace With this

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

Thermostats containing mercury

Non- mercury thermostat

Hg devices in mechanical rooms Bank of Hg switches – not in use

Hg devices in mechanical rooms Stored devices Devices in a panel

MoreHgDevicesMoreHgDevices In mechanical rooms

Boiler Room

Fluorescent Lighting Fluorescent tubes Bilirubin lights

Other devices Tip switch – 1.25 grams of mercury

Look for Hg devices -

For more information The Hg Toolkit and other information on pollution prevention – DHS Medical Waste Management Program