Replacing
Mercury in Healthcare Facilities—A Step-by-Step Approach Taking
the Leap....
How
do you get a mercury reduction program rolling? Here's
a step-by-step plan for making mercury reduction a
priority at your hospital.
Step
1—Assess the mercury in your facility
Start
by creating an inventory of mercury-containing
products in your facility. Record where the
mercury is, and how much is in each location.
The
inventory will provide:
- a
perspective to help you develop realistic reduction
goals and well-targeted action plans
- a
baseline against which you can measure your progress
Step
1—Tips & Tools
The Mercury
Manager Assessment Toolkit produced by
the CA DHS is a particularly comprehensive,
easy to adapt to hospital-specific conditions,
easy to use, and tracks reductions automatically.
[change website - new tool?]
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Step
2—Make a Commitment
Get support
from the top. Talk to your hospital leadership,
and get a signed statement to
be mercury-free.
Establish
a mercury-free team. Designate a program
leader who will be enthusiastic and dedicated to the
program. The leader should recruit support from a key
person in each department who has the authority to make
departmental changes.
Step
3—Manage What You Have On-Hand
Until
you are able to eliminate all mercury-containing items
in your facility, you should have a comprehensive
management plan in place. This includes
- a
Mercury Management Policy
- a
Mercury-free Purchasing Policy (see step 9)
- a
general Employee Education program covering mercury
use and disposal issues
- a
Spill Prevention and Education program targeted specifically
toward spill prevention and response
Step
4—Replacing Mercury-Containing Clinical Devices
Once
you understand the types, number and location of your clinical
devices that you have assessed in Step
1, you can set reasonable goals for elimination.
The
first step, already taken by healthcare facilities across
the country, is to replace mercury thermometers with
electronic devices, to make sure they are no longer being
sold in your outpatient pharmacy, and to ensure that
you are not sending them home with patients.
Sphygmomanometers are
more expensive to replace, so you might have to consider
a phased in multi-year replacement plan. But always consider
that the cost of a mercury spill clean-up from a sphygmo
may cost thousands of dollars. Include avoided costs
of labor, disposal and liability when determining your
cost benefit.
For other
clinical devices, non-mercury alternatives
exist for each one.
Step
4—Tips & Tools
- For isolation patients,
requisition devices from Central Sterile.
- Assess opportunities
to purchase thermometry probes for existing
electronic devices that have that option.
Contact the vendors
listed at the end of this fact sheet for more
information on mercury-free alternatives to common
hospital devices.
Sustainable
Hospitals Project's List of Mercury-free Alternatives
Sustainable
Hospitals Project's Laboratory Practices
Contact your Group
Purchasing Organization (GPO)—many of them
have made their own commitments to providing
mercury-free alternative products
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Step
5—Replacing Mercury-Containing Devices in Facilities
Facility
devices include
items like switches, gauges, thermometers, x-ray
tubes, barostats and thermostats.
Next
to replacing these devices, the most important task is
to inventory and tag
them as mercury-containing. When
the device is replaced, it can then not only
-
be replaced with
a non-mercury alternative, but also
- be removed
and safely disposed of as
universal waste
Step
6—Replacing Mercury-Containing Laboratory Chemicals
Every
lab should put together an action plan including
operational and policy initiatives to a phased in
approach to prioritizing chemicals. We recommend
a phased-in approach to mercury reduction.
-
The
first phase is to review
and understand your current practices, including
disposal, based on
the inventory from step 1.
-
The
second phase is to identify the fixative and stains
that contain significant amounts of mercury and to
determine which of them can be replaced
by effective mercury-free alternatives.
-
The
third phase is to identify
and list those chemicals
that contain mercury but that do not have readily
available substitutes. Your mercury management
plan should include a provision for periodic
review of
this list to determine whether alternatives have
become available.
Step
7—Replacing Other Mercury-Containing Chemicals
Cleaning
Chemicals
Pharmaceuticals
Step
8—Mercury as a Universal Waste
Many
mercury-containing products when discarded are considered "universal
waste". Examples include batteries, pesticides,
thermostats, and fluorescent lamps, and may also include
cathode ray tubes, depending upon your state's universal
waste rule.
The
universal waste rule enables you to avoid some of the
more cumbersome RCRA requirements, and helps encourage
recycling. Understand the universal waste rule and
let it help you manage and recycle your mercury waste.
Step
8—Tips & Tools
All
fluorescent bulbs, for example, contain mercury
and should be recycled—standard bulbs
contain about 22 mg of mercury; green-tip
bulbs contain about 11 mg.
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Step
9—Keep the Mercury Out
Begin
at the source. Work with your purchasing
department to make sure that mercury products
do not find their way back into the hospital.
Then
use your mercury inventory (from Step
1) to monitor the effectiveness of
the policy. Repeat the inventory periodically and
re-evaluate your facility. Identify your successes
and modify your plan as necessary.
Step
10—Recognition and Awards
Getting
recognition from the work is often a critical component
of its continued success.
H2E's Making
Medicine Mercury Free (MMMF) Awards are given
to facilities that have virtually eliminated mercury
and developed policies to sustain the elimination.
Most
importantly, get the message out to hospital staff that
they are making a difference!
To
apply to the award or for more information, go to
http://www.h2e-online.org/awards/mercury.htm
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