“Mercury Reduction: Practical Experiences from

Healthcare”

Presenters:

St. Joseph Mercy Health System, Michigan

- Pierre Gonyon, Safety Department

Park Nicollet Health Services, Minnesota - Teresa Tice, Safety Manager

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Why Mercury?

• Mercury is defined by EPA as a Persistent Bioaccumulative Toxin – Never degrades in the environment– Accumulates in living tissue, is not

metabolized and excreted from the body

– Toxic effects, including brain, nervous system, and kidney damage

– Pregnant woman at high riskTJT

Why Mercury?

• Health Care Industry a Major Consumer of Mercury and Mercuric Compounds– Patient Care Equipment– Lab Fixatives and other Chemicals and Compounds– Plant Operations

• High Priority Pollutant Targeted by United States and Canada

• Fish Consumption Advisories– States have issued over 1600 Fish Consumption

Advisories. Great Lakes at risk.

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Biggest Environmental Risks

• Mercury devices improperly disposed of in red bags or in sharps containers.

• Mercury spills caused by leaking, broken, or misused devices can lead to exposure and environmental contamination.

• Mercury in chemicals may be released to sanitary sewer system.

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6 Steps to a Successful Mercury Reduction Process

1. Obtain support to investigate

2. Assessment - What do you have and where?

3. Identify Alternative Products – Evaluate and perform cost analysis

4. Develop Mercury Management Policy and Phase Out Plan

5. Educate and Communicate

6. Implementation

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Step 1. Obtaining Support to Investigate

• Develop Resolution or Position Paper– Endorsement of Safety Committee– Present to Administration– Sign Off by Administration and Medical Staff

leadership

• Champions– Find others who believe in the proposal.

Doctors Nurses

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Step 2. Assessment

Mercury-Containing Devices/Equipment• Sphygmomanometers• Thermometers• Esophageal Dilators (Bougies)• Gastrointestinal Tubes • Button Batteries• Thermostats and switches• Fluorescent lights• Steam recorders• Barometers

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Mercury-Containing Chemicals

• Products Containing Thimerosal Preservative

• Lab Test Reagents, Histology Stains

– B5 Fixatives

• Cleaners and Degreasers

• Diuretics

• Vaccines, Ophthalmic Solutions, Nasal Sprays

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Difficulty in Assessing Mercury Content in Chemicals

• Mercury concentrations <1% of the total chemical solution not reported– Certificate of Analysis or Heavy Metal

Analysis– Product Inserts – Letters to Vendors– Technical Support– MASCO http://www.masco.org/mercury

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Performing the Assessment

• Target areas where used– Patient Care, Laboratory,

Pharmacy, Engineering/ Maintenance

• Other sources– Off Site Satellite Facilities– Owned Physician Practices– Leased Spaces– Owned building Leased to Others

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Assessment Method

• Surveys - Advantages and Disadvantages

• Site Visit – Physical Counts

• Preprinted lists

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Step 3. Identify Alternative Products• Literature or internet search• Purchasing Department plays a key role!

– Current vendor contracts– Preferred vendors– Volume Discounts (Bulk order)– Put block on ordering of Mercury items

• Set up vendor demonstrations– Ask about vendor equipment take back programs

• Evaluate products (Clinical input important)• Identify advantages and disadvantages to

mercury-free products

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Justifying the cost

• How much are you spending on:– Spill response and training– Calibration or repair of equipment– Recycling costs

• How much will mercury-free alternatives cost?

• What is the overall cost or savings to the organization?

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Cost Analysis: Sphygmomanometers

BAUMANOMETERBasic Cost of Product $101

Calibration Costs: $3-10

Hazardous Waste Training: $130/(4 staff)

Hazardous Spill Cleanup: $128-700

Storage/Handling/Disposal: $185

Human Health Risks: (difficult to quantify--exposure cost/liability/law suit)

Compliance Costs: (difficult to quanify--

liability costs due to mismanagement, insurance)

Environmental Cost: $461-646(scrubbing incinerator)

TOTAL: $1,008-1,772

ANEROID PRODUCTBasic Cost of Product: $90

Calibration Costs: none

Cost of Training for Use: $20/(4 staff)

TOTAL: $110

ELECTRONIC PRODUCTBasic Cost of Product: $1,200-3,000

Calibration Costs: none

Cost of Training: $80/(4 staff)

TOTAL: $1,280-3,080TJT

Step 4. Develop Policy and Phase Out Plan

• Organizational Resolution to Eliminate Mercury– Hazardous Materials and Waste Policy– Vs. Written Mercury Management Policy

Exposure control plan First Aid/Medical treatment Mercury spill control procedures Recycling of mercury and contaminated waste

– Designate mercury reduction as your organizational PI project under JCAHO Environment of Care requirements

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Organizational Resolution to Eliminate Mercury

– Mercury Free Pledge Healthcare Without Harm, MHA

– Purchasing Controls Eliminate the purchase of any new mercury

containing products or devices Product Selection or Value Analysis Committee

Environmentally Preferred Purchasing Policy

– Immediately discontinue sending thermometers home with new mothers!

– Mercury-Elimination Enforcement in Leasing Arrangements

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Develop Phase-Out Plan

• Phase-out immediately (high risk of breakage, sewered chemicals)– Sphygmomanometers, Thermometers

• Phase out with breakage, expiration, or renovation– Thermostats, switches, Maloney Bougies– Replace Physical Plant devices with non

mercury devices as they go out of service• Building Demolition Checklist

– Switches– Plumbing Traps

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Secure Support

• Secure upper management support• Secure dollars

– Funded Project vs Expensed to Departments– Some States Free Disposal Options (Grant

Projects)– Phased Process vs all at once (Pros and cons)

• Secure commitment of support staff (purchasing, facilities, engineering, biomed, etc)

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Step 5. Education and Communication

• Communicate plan across organization

• Then target to audience and the phase of project– Management Groups– Local safety committees or reps– Physicians and Employees

• Periodic Communications

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Barriers

•Belief barriers and resistance to change

•Lack of awareness among employees

•Availability and credibility of alternatives

•Coordination - Lots of people involved

•Cost - New products

•Proper budgeting by departmentsPG

Step 6. Implementation

• Equipment Phase-out– Order product

Confirm type and number Complete purchase order Obtain signature of dept manager Send to purchasing, order placed

– Upon receipt of product, coordinate change-out with Maintenance/Biomed and the affected department

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Equipment Phase-out

– Arrange for training on new product with vendor

– Perform change-out or installation

– Package old unit for recycling.

Note: Some manufacturers are offering free disposal of old devices with purchase.

Some counties provide free drop off locations for old devices (MDEQ)

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Chemical Phase-out

• Minimize chemical inventory• Evaluate alternative substances

• Lab - Sample drain traps and investigate concentrations above 0.4 ppm

• Find alternative ways to dispose of waste instead of sewering

• Make thimerosol-free pharmaceuticals available

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Waste Management

• Waste Management Considerations

–Florescent Tubes

–Batteries

–Manage for Recycling and Mercury Recovery

Recovery vs. Treatment and Disposal

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Healthcare as Sustainable Community Leader

• Sponsor Community Thermometer Exchange– Partner with county agencies

• Work in Partnership With GPOs and Suppliers to:– Reduce Wasteful Packaging– Use Easy to Recycle Materials– Market Less Hazardous Alternatives– Demand Recycle Content In Health Care

Products to Build Strong Market

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Conclusion

• Embrace and Promote the Concept of “Healthy Communities”

• “The health and well-being of the people and communities we serve, is fundamentally connected to the health and vitality of the environment and natural world we all share”

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Resources

• Hospitals for a Healthy Environment http://www.h2e-online.org/mercury.asp

• MnTAP http://www.mntap.umn.edu/

• Healthcare without Harm http://www.noharm.org/hcwh/issues/mercury.html

• EPA http://www.epa.gov/mercury/index.html

• MASCO http://www.masco.org/mercury