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Demystifying Mercury as the Gold Standard in Healthcare
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Demystifying Mercury as the Gold Standard in Healthcare

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  • 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."
  • Transcript

    • 1. Demystifying Mercury as the Gold Standard in Healthcare Teresa Tice, Park Nicollet Health Services [email_address] and Jamie Harvie, Institute for a Sustainable Future [email_address]
    • 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 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.
    • 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 1998 - 60k 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 http://www.neonatal-nursing.co.uk/pdf/sep00bdi.pdf
    • 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: http://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html
    • 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 0.300 ppb.
      • All B5 should be sent to a mercury refiner.
    • 15. 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
    • 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
      • 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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