1. Demystifying Mercury as the Gold Standard in Healthcare
Teresa Tice, Park Nicollet Health Services
and
Jamie Harvie, Institute for a Sustainable Future

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 g / 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/Costs Justifying 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 k cleanup costs.
JCAHO issuing recommendations on lack of Hg clean up training.

8. Coordination Replacing 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
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
NICU - Neonatal Intensive Care Units
Since they are the most susceptible population to even minute quantities of mercury, it was clear that the NICU was the first place to eliminate mercury."

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 (<1%)
Step 3. Eliminate Hg Containing Devices
Barometers, Thermometers
Reference:

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 ppb.
All B5 should be sent to a mercury refiner.

15. Alternative to Mercury Fixatives
Formalin
Zn Formalin
Anatech ANATECH
IBF
Surgipath
St Mary’s Duluth Clinic

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 Sustainable Hospitals – Web Site
Shygmo resources, Histopathology
Sustainable Hospitals – Web Site
Comparing mercury and aneroid Sphygmo’s
Removing Mercury from Laboratories
Is there Mercury in your Coulter Counter
H2E Website