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Asia Regional Conference

15-16th March, Manila, Philippines

Dr. S. KulshresthaDirectorate General of Health Services

Ministry of Health & Family WelfareNirman Bhawan, New Delhi

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Background:-

Mercury is a heavy metal, very toxic, have

potential for long range transport global

contamination

Toxicity known since long

-Mad Hatters;

- Minamata tragedy in Japan in 1992

-Detected in Arctic region.

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ACTIONSAT INTERNATIONAL

LEVEL

UNEP:

In 2001: Governments asked for global study

on mercury. Report received in 2002.

In 2003: Based on the report, it decided that

to reduce the human health and environmentimpact, actions at national, international

(global) level are required.

In 2005: Considered the possibility of a

legally binding instrument to deal with theadverse impact of mercury and called for

partnership between Government and other

stakeholders.

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In 2007: Called for strengthening of the UNEP

mercury program partnerships and established an

ad hoc open enabled working group to review and

assess options for enhanced voluntary measures

and new or existing international legal

instruments.

In 2009,Countries agreed to negotiate on legally binding

instrument for mercury.

In 2010,

1st meeting of INC

In 2011,

2rd meeting of INC

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Health Care and Mercury Scope of Mercury Free Health Care is not limited to

thermometers and sphygmomanometers.

Mercury is used in many products used by Healthcareindustry ,Viz.-

Measurement equipments: thermometers in variousinstruments, other pressure gauge.

Dental Amalgam

Chemicals in laboratories zenkers soln, histologicalfixatives

preserving vaccine , contact lens solution(Thimersol & phenyl mercury nitrate)

Dilators & GI tubes

Neon tubes/mercury bulbs/florescent lamps/ germicidal

Batteries : used in pacemakers, ear aids, fibrillators etc.

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OTHER EQUIPMENTS/PRODUCTS USED BYHEALTH CARE FACILITY:

Electrical equipment: Tilt switches; airflowcontrol; building security system; lap-top screen

shut off; washing machines etc; thermostats indifferent equipments.

Generators etc.

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Mercury used in thermometer andsphygmomanometer is in elemental form _liquid. It has very low vapor pressure, and easily

absorbed through skin.- Risk to medical and paramedical personnel of

mercury toxicity if spill due to breakage (as themercury is usually filled in glass columns) orleakage occur and is not handled properly.

Manufacturing units of devices which containmercurypollution of environmentRisk toHealth of workers

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Efforts made to address problem

International

WHO in 2005 issued policy paper onmercury in healthcare.

WHO emphasized for assessment ofmercury usage

Short, medium and long term strategies

for substitution of mercury based medicaldevices.

Waste management programes.

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Regional Efforts

1st South Asian Conference forMercury Free Healthcare,2008Delhi Declaration.

2nd South-East Asia- regionalconference has been organized tolearn form the success and share theexperiences among therepresentatives of various counties inthe Region.

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Degree to which mercury is still used inthermometers, B.P. devices and otherequipments in the country.

The assessment for quantitativeestimate is lacking.

Besides thermometer and BP instrumentit is used in many other devices used byhealth care industry.

Study needs to be carried out to makeassessment.

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MANUFACTURE OR IMPORT OF MERCURY

BASED DEVICES

Mercury based devices (thermometers,

sphygmomanometer) are manufactured inthe country as well as imported.

Alternative devices (Digital thermometersand aneroid B.P. Instruments) are also

manufactured as well as imported in thecountry.

Alternative devices are not cost-effective.

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Actions At National Level: INDIA

A) To phase out mercury from commonly used

medical devices like thermometer andsphygmomanometer:

1. Most of the big hospitals (AIIMS, RMLH,SJH, LHMC

and its allied hospitals, LNJPH) in Delhi havestopped procurement of mercury containingthermometers and sphygmomanometers and

gradually replacing the old with non-mercurycontaining devices (aneroid sphygmomanometer;digital thermometer).

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2. Delhi Pollution Control Committee has issuedpublic and individual notices for

minimizing/eliminating the use of mercury basedequipments and the condition is being imposed in

this regard while granting authorization to health

care units.3. Guidelines have been issued by DGHS in March,

2010 and these are being included in IndianPublic Health Standards which are under revision.

The guidelines advice all Central Government

Hospitals and Health Centers to gradually phase

out mercury containing equipments and replace

them with good quality non-mercury equipments.

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B) For management of mercury waste:

1. Mercury is included in Hazardous Waste(Management, Handling and Trans boundaryMovement) Rules framed by Union Ministry of E &Forest.2. Mercury waste disposal guidelines have beenincluded in the National Policy document andOperational guidelines developed to address the

infection control and waste management issuesfor CHC; PHCs and sub-centers under Reproductiveand Child Health Programme.

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3. Self learning documents ( 3) have been developedfor Doctors and Administrators; Nurses and

paramedical staff; and Group D employees of healthcare facilities on Bio- medical waste management.These documents include guidelines on mercury spillmanagement.

4. Inclusion of these guidelines in course curriculum ofdoctors and nurses is under process.5. CPCB has framed draft guidelines entitledEnvironmentally sound Management of Mercury

Waste in Health Care Facilities emphasizing thecollection and storage of mercury from discardeddevices.

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6. Government and non-Government sectors areorganizing regular training for different levels of

health care workers for Bio-medical wasteincluding mercury waste management.

7. TN & UP_ UNDP aided project ondemonstrating and promoting best practices &techniques for reducing healthcare waste toavoid environmental release of dioxins and

mercury.

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Challenges

Change of mindset of Healthcare Professionals.

Availability of cost-effective, good quality alternatives

Collection and management of mercury containingdevices, their storage, disposal etc.

Lack of Awareness

Both fever thermometers andsphygmomanometers are being purchased by generalpublic for use in homes. Lack of awareness of harmscaused by such devices which are being used for long

for the purpose makes people purchase comparativelylow cost device containing mercury.

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Future Strategies

Study to assess quantum of mercury used in

health care.

Gradual phase out of Mercury thermometers

and sphygmomanometers is advisable.

. No new thermometer or shygmomanometercontaining mercury be purchased

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Future Strategies(contd.)

No study to show that medical orparamedical personnel suffered frommercury toxicity. There are chances of

acute or chronic toxicity if spill is nothandled properly.

Collection, storage and disposal of mercurydevices is a big task and may pose hazard

to human health and environment if notmanaged properly.

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Future Strategies (contd.)

promoting manufacture ofalternative devices good quality.

Programme to collect broken/ non

functional mercury thermometersand sphygmomanometers fromvarious health care facilities.

Capacity building for waste disposal.

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Future Strategies(contd.)

Besides thermometers andsphygmomanometer, alternatives be

developed and promoted for other

products also used in health care facilities.

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THANK YOU