Mercury is a metal found naturally in the environment. It comes is a few forms. Elemental (metallic) mercury is the shiny, silver-gray metal found in thermometers, barometers, thermostats, and other electrical switches. Mercury can break into droplets when spilled. The droplets spread easily and can build up in tiny cracks and spaces wherever it is spilled. Mercury can vaporize (evaporate) into the air. The vapor cannot be seen or smelled. Breathing in mercury vapors is the most common way to get mercury poisoning – and also the most dangerous. Mercury can be toxic to the nervous system, lungs, and kidneys.

1. ” Mercury Spillage”
in
Health Care Settings
Dr. Sujnanendra Mishra

2. Commercial products containing mercury
Wiring Devices &
Industrial Measuring Devices
Medical Devices
Pharmaceuticals & Personal Care Products
Batteries, Thermostats, Barometers, Manometers, Temperature & Pressure Gauges, Certain Switches, and Light Bulbs.

3. Pesticides and Fertilizer Explosives/Weapons
Dyes/Vermilion

4. Mercury Facts
• Mercury is the most toxic non-radioactive element on earth
• A silver colored mercury amalgam dental filling normally contains 52%
mercury.
• The typical adult carries ten amalgam fillings containing about 5 grams of
mercury
• 1/2 gram of mercury in a ten acre lake would warrant issuance of a fish
advisory for the lake !

5. Dangers of Mercury
The presence of raised mercury levels, in itself, does not
necessarily cause pathologic reactions - the levels have
to exceed a person’s threshold level.

6. Toxicity effects on humans
• Methyl mercury from fish consumption
(highly toxic) or breathing vaporous mercury
(bodies are more adapted to reducing toxic
effects)
• Methyl mercury affects central nervous
system and irreversible brain damage

7. Dangers, continued
Exposure in the range of 25 to 80 mg/m3 increases the incidence of:
• Defects in psychomotor performance
• Objectively detectable tremors
• Evidence of impaired nerve conduction
• Fatigue
• Irritability
• Loss of appetite
• Proteinuria

8. Occupational Exposure
Occupational exposure to 25 mg Hg / m3 air would correspond to a daily
dose of somewhere about 100-200 mg / day (8 h / day, 5 days / week, 48
weeks / year, breathing of 1-2 m3 of air per hour containing 25 (80) mg Hg
/ m3 of which 80% is absorbed in the lung alveoli's).

9. Concentrated Exposure
Mercury can:
• Selectively inhibit protein and amino acid absorption into brain tissue.
• Induce the thyroid gland to absorb an increasing amount of nuclear radiation from the
environment.
• Impair the adrenal and testicular steroid hormone secretions.
•Selectively inhibit protein and amino acid absorption into brain tissue.
• Induce the thyroid gland to absorb an increasing amount of nuclear radiation from the
environment.
• Impair the adrenal and testicular steroid hormone secretions.

10. Exposure, continued
• Cause chromosomal aberrations and alter the cellular genetic code
• Induce chromosomal breakage
• Alter cellular mitosis
• Cause a drop in t-cell production
• Kill white blood cells.
•Contribute to intelligence disturbances, speech difficulties, limb deformity, and
hyperkinesia (hyperactivity resulting from brain damage)
Studies have been done that suggest elevated levels of mercury can trigger auto-immune disorders (MS, ALS, Alzheimer’s)

11. !! Cleaning It Up immediately
Mercury Spill Management

12. Suggested items for
Mercury Spill Management
1) Four to five zip-lock bags
2) Waste bags (2 to 6 mm thick)
3) Plastic container with lid that seals.(35 mm film canister for example)
4) Nitrile or latex gloves
5) Paper towels
6) Cardboard strips (index cards for example)
7) Eyedropper or syringe (without needle)
8) Face mask
9) Duct or other sticky tape (30 cm or so)
10) Flashlight
11) Powdered sulphur or zinc (this can easily be obtained at a pharmacy)
12) Set of instructions with waste collection and disposal protocols.

13. Mercury Spill management STEPS
1. Evacuate area
Remove everyone from the area that has been contaminated and shut The door.
Turn off interior ventilation system to avoid dispersing mercury vapor throughout the
facility.
2. Put on face mask
In order to prevent breathing of mercury vapour, wear a protective face mask.
3. Put on old clothes
 Change into old clothes and shoes that can be discarded if they become
contaminated.
4. Remove jewellery
 Remove all jewellery or else mercury will combine (amalgamate) with the precious
metals.

14. 5. Wear gloves
 Put on rubber or latex gloves. If there are any broken pieces of glass or
sharp objects, pick them up with care. Place all broken objects on a paper
towel. Fold the paper towel and place in a zip lock bag. Secure the bag and label
it as containing items contaminated with mercury.
6. Identify surface
 Wood, linoleum, tile and any other like surfaces can easily be cleaned.
Carpet, curtains or other such surfaces cannot. (For carpets, only the affected
portion needs to be cut out and removed.)

15. 7. Locate mercury beads
Locate all mercury beads, then carefully use the cardboard to gather them
together. Use slow sweeping motions to prevent accidentally spreading the
mercury.
Small and hard-to-see beads can be located with the flashlight:
Low angle beam, close to the floor in a darkened room can spot glistening beads of
mercury that may be sticking to the surface or have gathered in small cracks in the surface.
!!! Mercury can move a surprisingly long distance on hard
and flat surfaces: be sure to carefully inspect the entire
room.

16. 8. Use eyedropper and sticky tape
Use an eyedropper or syringe (without a needle) to draw up the mercury
beads. Slowly and carefully transfer the mercury into an unbreakable plastic
container with an airtight lid. Place the container in a zip-lock bag. Label the bag
as containing items contaminated with mercury.
After you remove larger beads, use sticky tape to collect smaller hard-to-see
beads. Place the sticky tape in a zip lock bag and secure.
Powdered Sulphur or zinc stains mercury a darker colour and can make
smaller beads easier to see. Be careful not to breathe the powder, as it can be
mildly toxic.

17. The EPA (Environmental Protection Agency ), US has very strict restrictions on
how to dispose of mercury.
DON’T THROW IT IN THE TRASH OR DOWN THE DRAIN!!!

18. DISPOSAL
Pour in to Leak-Proof Bag
Place all materials used during the cleanup, including gloves, into a leak-proof
plastic bag or container. Seal and label it as -- MERCURY “Danger: Do Not
Touch.”.
Final disposal
Contact your local hospital manager responsible for toxic clean up and proper
disposal to ensure that all mercury contaminated waste now secured in
labelled bags is dealt with in accordance with prevailing Guideline.
Ventilation
Keep the affected area ventilated to the outside (with windows open and
ventilation running) for at least 24 hours after your successful cleanup. If
sickness occurs, seek medical attention immediately.

19. Six things you should NEVER do:
• Never use a vacuum cleaner to clean up mercury: the vacuum cleaner will
vaporise the mercury and drastically increase exposure in the area.
• Never use a broom to clean up mercury: it breaks up the mercury droplets and
moves them around, making it harder to decontaminate the area.
• Never pour mercury down the drain: it can lodge in the plumbing, and
contaminate the septic tank and sludge in sewage treatment plants.
• Never wash mercury-contaminated items in a washing machine: mercury can
contaminate the sewage system and the washing machine.
• Never continue wearing shoes and clothing that might have been contaminated
in the mercury spill: this increases the wearer's exposure and helps spread
contamination.
• Never burn shoes, clothing, fabric or anything that has been contaminated with
mercury: this puts mercury into the atmosphere.

20. ”Do not use
a vacuum cleaner
to clean up
a mercury spill.”
Need to have a Mercury
Audit and Follow-Up
Checklist