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

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

3. Hg Elimination Programs Hospitals for a Healthy Environment (H2E) – Making Medicine Mercury Free http://www.h2e-online.org/http://www.h2e-online.org/ 2003 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

4. California Mercury (Hg) Elimination Leadership Program (HELP)

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

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

7. Assessment “Tool”

8. Total Hg in Facility

9. Hospital Before Sphygmomanometer Removal

10. 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

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

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

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

14. Bougies – over 10 kgs. Of Hg

15. A complete set of tungsten gel- weighted bougies

16. Miller-Abbott Tube 117 grams of Hg

17. Sphygmomanometers Bedside Examination Room Physical Therapy Exercise Room In Drawer

18. Typical sphygmomanometer

19. Sphygmomanometer in patient room

20. Hidden sphyg stored in drawer in storage room

21. Aneroid Sphygmomanometers

22. Replacing mercury-containing sphygs with aneroid sphygs

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

24. Bulk Hg used for sphyg maintenance

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

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

27. Wee Bag O’Mercury – over 600 grams of Hg

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

29. Barometers Pulmonary Laboratory

30. Mercury from broken barometer

31. Thermometers Neonatal Nursery Laboratory Refrigerators Barometer with attached Thermometer

32. Laboratory thermometers

33. More Laboratory thermometers NIST-traceable thermometer

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

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

36. Thermostats containing mercury

37. Non- mercury thermostat

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

39. Hg devices in mechanical rooms Stored devices Devices in a panel

40. MoreHgDevicesMoreHgDevices In mechanical rooms

41. Boiler Room

42. Fluorescent Lighting Fluorescent tubes Bilirubin lights

43. Other devices Tip switch – 1.25 grams of mercury

44. Look for Hg devices -

46. For more information The Hg Toolkit and other information on pollution prevention – DHS Medical Waste Management Program www.dhs.ca.gov/medicalwaste Skubo@dhs.ca.gov 916-449-5684