Demystifying Mercury as the Gold Standard in Healthcare Teresa Tice, Park Nicollet Health Services [email_address] and  Ja...
Objectives <ul><li>Provide resources to address the barriers to mercury elimination </li></ul><ul><li>Address the typical ...
Mercury – Low Hanging Fruit <ul><li>Mercury is defined by EPA as a Persistent Bioaccumulative Toxin </li></ul><ul><li>Heal...
Barriers to Eliminating Mercury Equipment or Chemicals <ul><li>Belief Barriers and Resistance to Change </li></ul><ul><ul>...
Belief Barriers  Mercury: The “Gold” Standard   <ul><li>Contain 80 -100g / unit </li></ul><ul><li>Journal of Human Hyperte...
Belief Barriers – Alternatives  Mercury-free Sphygmomanometers <ul><li>Aneroid most common as replacement </li></ul><ul><l...
Purchasing/Costs Justifying Costs <ul><li>Purchasing replacement equip. costs $$ </li></ul><ul><ul><li>Kaiser study showed...
Coordination Replacing Hg Equipment <ul><li>Impacts wide range of staff </li></ul><ul><ul><li>Purchasing, Maintenance, Bio...
3 Keys to Overcome Barriers <ul><li>A PLAN </li></ul><ul><li>SUPPORT </li></ul><ul><ul><li>Upper Management Support Essent...
Challenges <ul><li>Pt. Isolation Rooms: Mercury thermometers   </li></ul><ul><ul><li>Alternatives </li></ul></ul><ul><ul><...
Removing Hg from  Hospital Laboratories <ul><li>Step 1.  Examine Chemicals and Reagents </li></ul><ul><ul><li>Hg is common...
B5/Zenkers Elimination
Mercury Filter Wastes
Used B5 Management  <ul><li>Some Histopathology texts recommend precipitation of B5 to “remove” mercury. </li></ul><ul><li...
Alternative to Mercury Fixatives <ul><li>Formalin  </li></ul><ul><li>Zn Formalin  </li></ul><ul><ul><li>Anatech 1-800-ANAT...
Summary <ul><li>Mercury is pervasive in healthcare facilities. </li></ul><ul><li>Mercury devices often leak or break. </li...
Resources <ul><li>HCWH – Web Site  </li></ul><ul><li>Shygmo resources, Histopathology  www.noharm.org </li></ul><ul><li>Su...
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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.&amp;quot;
  • Demystifying Mercury as the Gold Standard in Healthcare

    1. 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. 2. Objectives <ul><li>Provide resources to address the barriers to mercury elimination </li></ul><ul><li>Address the typical hold out areas and provide practical solutions to how they are tackled </li></ul><ul><li>Identify the low hanging fruit in laboratories </li></ul>
    3. 3. Mercury – Low Hanging Fruit <ul><li>Mercury is defined by EPA as a Persistent Bioaccumulative Toxin </li></ul><ul><li>Health Care Industry a Major Consumer of Mercury and Mercuric Compounds </li></ul><ul><li>High Priority Pollutant </li></ul><ul><ul><li>Released to water and atmosphere </li></ul></ul><ul><ul><li>Fish Advisories </li></ul></ul>
    4. 4. Barriers to Eliminating Mercury Equipment or Chemicals <ul><li>Belief Barriers and Resistance to Change </li></ul><ul><ul><li>Lack of awareness among employees </li></ul></ul><ul><ul><li>Availability and credibility of alternatives </li></ul></ul><ul><li>Purchasing/Costs </li></ul><ul><ul><li>Cost of purchasing replacement products </li></ul></ul><ul><ul><li>Budgeting process </li></ul></ul><ul><li>Coordination – Lots of People Involved </li></ul><ul><li>Lack of Information (e.g. lab chemicals) </li></ul>
    5. 5. Belief Barriers Mercury: The “Gold” Standard <ul><li>Contain 80 -100g / unit </li></ul><ul><li>Journal of Human Hypertension </li></ul><ul><ul><li>Study of 444 Hg units..”the majority… had serious problems which would give rise to major errors in bp measurement </li></ul></ul><ul><li>Examples of both inaccurate mercury and aneroid may be found in the literature – related to poor maintenance. </li></ul>
    6. 6. Belief Barriers – Alternatives Mercury-free Sphygmomanometers <ul><li>Aneroid most common as replacement </li></ul><ul><li>Comparable in cost to mercury </li></ul><ul><li>All must meet same voluntary AAMI testing requirements </li></ul><ul><li>Mayo Clinic program reported aneroids provide accurate measurements when properly maintained. </li></ul><ul><li>AHA recommends both mercury and aneroid be checked regularly </li></ul>
    7. 7. Purchasing/Costs Justifying Costs <ul><li>Purchasing replacement equip. costs $$ </li></ul><ul><ul><li>Kaiser study showed life cycle costs of aneroid 1/3 those of mercury </li></ul></ul><ul><ul><li>Budgeting – Operational cost </li></ul></ul><ul><li>Spills </li></ul><ul><ul><li>Mayo Medical in two year time frame had 50 spills costing 26k </li></ul></ul><ul><ul><li>Hartford Hospital in 1998 - 60k cleanup costs. </li></ul></ul><ul><ul><li>JCAHO issuing recommendations on lack of Hg clean up training. </li></ul></ul>
    8. 8. Coordination Replacing Hg Equipment <ul><li>Impacts wide range of staff </li></ul><ul><ul><li>Purchasing, Maintenance, BioMed, Employee Health, Physicians, Nurses </li></ul></ul><ul><li>Purchasing Dept. Role </li></ul><ul><ul><li>Bulk ordering for best price </li></ul></ul><ul><ul><li>Contact other hospitals about vendor quality </li></ul></ul><ul><ul><li>Trial product </li></ul></ul><ul><ul><li>Will vendor manage old mercury units </li></ul></ul>
    9. 9. 3 Keys to Overcome Barriers <ul><li>A PLAN </li></ul><ul><li>SUPPORT </li></ul><ul><ul><li>Upper Management Support Essential </li></ul></ul><ul><ul><li>Champions </li></ul></ul><ul><li>EDUCATION </li></ul><ul><ul><li>Managers </li></ul></ul><ul><ul><li>Support Areas (Maintenance, Biomed, Safety and Security, Employee Health) </li></ul></ul><ul><ul><li>Employees </li></ul></ul>
    10. 10. Challenges <ul><li>Pt. Isolation Rooms: Mercury thermometers </li></ul><ul><ul><li>Alternatives </li></ul></ul><ul><ul><ul><li>Disposable:Temp-a-dot </li></ul></ul></ul><ul><ul><ul><li>Re-Usable: assign to room </li></ul></ul></ul><ul><li>NICU: Mercury Thermometers and Sphygmomanometers </li></ul><ul><ul><li>Most susceptible population to Hg exposure </li></ul></ul><ul><ul><li>Thermoregulation very important </li></ul></ul><ul><ul><li>Reference: Accurate Measurement of Body Temperature in Neonate http://www.neonatal-nursing.co.uk/pdf/sep00bdi.pdf </li></ul></ul>
    11. 11. Removing Hg from Hospital Laboratories <ul><li>Step 1. Examine Chemicals and Reagents </li></ul><ul><ul><li>Hg is common in Fixatives (B5) </li></ul></ul><ul><ul><li>Hg is common contaminant (e.g. reagents w/ potassium) </li></ul></ul><ul><ul><li>Hg used in preservatives (thimerosol) </li></ul></ul><ul><ul><li>Hg found in secondary antibodies bound to HPR, ELISA kits, Western blot kits </li></ul></ul><ul><li>Step 2. Require Vendors to Disclose Hazardous Materials in Reagents </li></ul><ul><ul><li>MSDS generally do not identify Hg levels (<1%) </li></ul></ul><ul><li>Step 3. Eliminate Hg Containing Devices </li></ul><ul><ul><li>Barometers, Thermometers </li></ul></ul><ul><ul><li>Reference: http://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html </li></ul></ul>
    12. 12. B5/Zenkers Elimination
    13. 13. Mercury Filter Wastes
    14. 14. Used B5 Management <ul><li>Some Histopathology texts recommend precipitation of B5 to “remove” mercury. </li></ul><ul><li>Precipitated B5 supernatant may contain 25 ppm of mercury. </li></ul><ul><ul><li>one liter discharge in 20,000 gal (75,000 l) flow will exceed a pretreatment limit of 0.300 ppb. </li></ul></ul><ul><li>All B5 should be sent to a mercury refiner. </li></ul>
    15. 15. Alternative to Mercury Fixatives <ul><li>Formalin </li></ul><ul><li>Zn Formalin </li></ul><ul><ul><li>Anatech 1-800-ANATECH </li></ul></ul><ul><li>IBF </li></ul><ul><ul><li>Surgipath 1-800-225-3035 </li></ul></ul><ul><li>St Mary’s Duluth Clinic </li></ul><ul><ul><li>-218-726-4000 </li></ul></ul>
    16. 16. Summary <ul><li>Mercury is pervasive in healthcare facilities. </li></ul><ul><li>Mercury devices often leak or break. </li></ul><ul><li>Mercury containing chemicals have been disposed of down the drain in the past. </li></ul><ul><li>Barriers can be overcome with perseverance and education </li></ul><ul><li>Most mercury-containing items are identifiable and have cost effective alternatives </li></ul>
    17. 17. Resources <ul><li>HCWH – Web Site </li></ul><ul><li>Shygmo resources, Histopathology www.noharm.org </li></ul><ul><li>Sustainable Hospitals – Web Site </li></ul><ul><li>Comparing mercury and aneroid Sphygmo’s </li></ul><ul><li>http://www.sustainablehospitals.org/HTMLSrc/IP_Merc_Tools_CompSphyg.html </li></ul><ul><li>Removing Mercury from Laboratories </li></ul><ul><li>http://www.sustainablehospitals.org/HTMLSrc/IP_mercury_removelabs.html </li></ul><ul><li>Is there Mercury in your Coulter Counter </li></ul><ul><li>http://www.sustainablehospitals.org/HTMLSrc/IP_Merc_Coulter.html </li></ul><ul><li>H2E Website http://www.h2e-online.org/tools/mercury.htm </li></ul>

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