“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