Mercury containing product can be found almostanywhere in healthcare facility • Medical insrument • Clinical laboratory chemical to electrical equipment • Cleaning solutions
Medical instrument Fever thermometer (including used in home care) Spygmo manometer Commercial manometer Gastrointestinal diagnostic equipment Feeding tube
1. Mercury is naturally occuring heavy metal2. At ambient temperature and pressure, mercury is silvery-white liquid that readily vaporize and stay at atmoshpere for up one year3. When release to the air, mercury is transported and deposit globally4. mercury accumulates in lake bottom sediment, transformed into its more toxic organic form, methyl mercury (accumulation fish tissue
1. its highly toxic2. It may be fatal if inhaled (80% mercuryvapour is aborbed in blood throughthe lung)3. it harmful if absorbed through skin
METHYLMERCURY Its harmful efects to the nervous system, dygestive, respiratory, immune system, and kidney more causing lung damage Adverse health efects (exposure) : tremor, impaired vision and hearing, paralysis, insomnia, emotional instability, development deficit (fetal), development delays (childhood)
PATIENT SAFETY Several european countries (sweden, france, denmark,norway banned mercury containing thermometer from 1991) A european wide facilities resoution on the issue ofmercury pending In the USA hospitals have significant reduced the amountof mercury found in their facilities more than 1000 hospitals (USA) eliminate mercury medicaldevice and more than 90% pharmacy chains have stoppedselling mercury fever thermometer
• A gradual phase out plan for mercury elimination in the health care facilities (how to prevent the release of mercury into the environment).• Need best management practices for mercury elimination is to replace the mercury containing product with mercury-free products
• It may be not be possible to replace all the health care facilitys mercury products at once.• Need the effective procedures for handling and environmentally safe management of mercury containing products, need mercury recycling facilities
In order to ensure safety and contamination control,mercury elimination in facility must be consistent andpredetermined with the goal of, - Raising awareness on the dangers posed by mercury and mercury containing devices - Developing a clear preference for the use of alternatives to mercury-containing devices - Preventing the further release of mercury to the environment through proper disposal
• Conducted a mercury audit• Developed and managed a mercury containing devices
• Drafted and implemented a purchasing policy that require a vendors to sign a mercury content disclosure agreement• Conducted a facility wide information campaign and employee education on consequences of continued mercury use
• Educate people on how to safety clean-up• How temporarily store broken mercury thermometers• Need the written information at the health care facilities
• It is not yet feasible for the health care facility to replace all its mercury sphygmomanometer make sure there is a policy or guideline for its safe use and handling.
The policy or guideline for example; - Check for possible mercury leaks before and after use - Mark the casing with" containing mercury". - After use safely return to its proper storage - Wear appropriate protective clothing and work within a hood to provide ventilation.
• Use a mercury spill cleanup kit in house or in health care facilities (one kit for every 20 beds).• The kit contents : 4-5 zip lock bags, trash bags (2-6 mm thicks), rubber or latex gloves, paper towels, cardboard paper, syringe (without needle), masking or duct tape, flaslight, powered sulfur (optional), marker for labeling
• Cleanup instruction1. Remove all jewelry from hands and wrists so the mercury does not combine (amalgamate) with the precious metals. Change into old clothes and shoes that can be safely discarde should they happen to become contaminated2. Remove everyone from the area where cleanup will take place. Shut door of impacted area. Turn Off inferiorr ventilation system to avoid dispersing mercury vapor.3. Mercury can be cleaned up easily from the following surfaces; wood, linoleum tile. If a spill occurs on carpet, curtains, upholstery or other like surfaces. Cut and remove the affected portion of the contaminated carpets for disposal
4. Put on rubber or latex gloves5. If there are any broken pieces of glass or sharp objects, pick them up with care,6. Place all broken objects on a paper towel. Fold the paper towel and place in a zip lock back. Secure the bag and label It.7. Locate visible mercury beads. Use squeegee or cardboard to gather mercury beads, keep mercury from becoming ubcontrollable. Take a flashlight hold it at low angle close to a darkened room and look for additional glistening beads of mercury.8. Use the eyedropper to cllect or draw up the mercury heads Squeeze mercury on to a damp papel towel. Place in a zip lock bag and secure.
9. After you remove larger beads, put shaving cream on top of a small paint brush and gently "dot" the affected area to pick up smaller hard to see beads alternatively use the duct tape. Place in zip lock bag and secure. Make sure to label the bag10. Optional step. Use powdered sulfur to absorb the beads that are too small to see. (there may be a color change from yellow to brown and it binds the mercury and suppressed the vapor of any missing mercury) (note: when using powdered sulfur, do not breathe in the powder as it can be moderately toxic)11. Place all materials used with the cleanup, including goves in a trash bag. Place all mercury beds and objects into the trash bag. Secure it and label it.
12. Remember to keep the area well ventilated to the outside for at least 24 hours after your successful cleanup. The all material used in cleanup should be stored and contained in a safe place
• Mercury containing products not in use must be stored in non breakable containers with the tight- fitting lids. Labeled it.In health care facilities. - Rooms where mercury containing products shall be tested periodically using a mercury
There are some conditions,example; - Shall have adequate roof and walls to prevent rain water - Floor must be constructed as a concrete or steel, if mercury is a liquid form , shall be surrounded by a bund wall to contain spills - Visible warning signs and notices - Drainage facilities shall be installed
There are some conditions example; - Emergency showers and eyewash units with adequate water supply - Fire fighting facilities - Adequate security, - Project loading and unloading of containers shall be observed. - A workable emergency plan and trained personnel to handling containers in storage
• How to recognizing the unnecessary risks posed by the continued use of mercury containing products in the health care system• a Hospitals have a guidelines for the gradual phase out of mercury or hospital shall make a mercury minimization program based on regulation.