Transcript Demystifying Mercury as the Gold Standard in Healthcare

Demystifying Mercury as the
Gold Standard in Healthcare
Teresa Tice, Park Nicollet Health Services
[email protected]
and
Jamie Harvie, Institute for a Sustainable
Future
[email protected]
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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
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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
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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)
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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.
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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
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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 1998 - 60k cleanup costs.
– JCAHO issuing recommendations on lack of Hg
clean up training.
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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
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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
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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 http://www.neonatalnursing.co.uk/pdf/sep00bdi.pdf
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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
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Reference: http://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html
B5/Zenkers Elimination
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Mercury Filter Wastes
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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.
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Alternative to Mercury
Fixatives
• Formalin
• Zn Formalin
– Anatech 1-800-ANATECH
• IBF
– Surgipath 1-800-225-3035
• St Mary’s Duluth Clinic
-218-726-4000
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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
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Resources
HCWH – Web Site
• Shygmo resources, Histopathology www.noharm.org
Sustainable Hospitals – Web Site
• Comparing mercury and aneroid Sphygmo’s
http://www.sustainablehospitals.org/HTMLSrc/IP_Merc_Tools_CompSphyg.html
• Removing Mercury from Laboratories
http://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html
• Is there Mercury in your Coulter Counter
http://www.sustainablehospitals.org/HTMLSrc/IP_Merc_Coulter.html
H2E Website http://www.h2e-online.org/tools/mercury.htm
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