Presentation on theme: "Demystifying Mercury as the Gold Standard in Healthcare"— Presentation transcript:
1 Demystifying Mercury as the Gold Standard in Healthcare Teresa Tice, Park Nicollet Health ServicesandJamie Harvie, Institute for a Sustainable Future
2 ObjectivesProvide resources to address the barriers to mercury eliminationAddress the typical hold out areas and provide practical solutions to how they are tackledIdentify the low hanging fruit in laboratories
3 Mercury – Low Hanging Fruit Mercury is defined by EPA as a Persistent Bioaccumulative ToxinHealth Care Industry a Major Consumer of Mercury and Mercuric CompoundsHigh Priority PollutantReleased to water and atmosphereFish Advisories
4 Barriers to Eliminating Mercury Equipment or Chemicals Belief Barriers and Resistance to ChangeLack of awareness among employeesAvailability and credibility of alternativesPurchasing/CostsCost of purchasing replacement productsBudgeting processCoordination – Lots of People InvolvedLack of Information (e.g. lab chemicals)
5 Belief Barriers Mercury: The “Gold” Standard Contain g / unitJournal of Human HypertensionStudy of 444 Hg units..”the majority… had serious problems which would give rise to major errors in bp measurementExamples of both inaccurate mercury and aneroid may be found in the literature – related to poor maintenance.
6 Belief Barriers – Alternatives Mercury-free Sphygmomanometers Aneroid most common as replacementComparable in cost to mercuryAll must meet same voluntary AAMI testing requirementsMayo Clinic program reported aneroids provide accurate measurements when properly maintained.AHA recommends both mercury and aneroid be checked regularly
7 Purchasing/Costs Justifying Costs Purchasing replacement equip. costs $$Kaiser study showed life cycle costs of aneroid 1/3 those of mercuryBudgeting – Operational costSpillsMayo Medical in two year time frame had 50 spills costing 26kHartford Hospital in k cleanup costs.JCAHO issuing recommendations on lack of Hg clean up training.
8 Coordination Replacing Hg Equipment Impacts wide range of staffPurchasing, Maintenance, BioMed, Employee Health, Physicians, NursesPurchasing Dept. RoleBulk ordering for best priceContact other hospitals about vendor qualityTrial productWill vendor manage old mercury units
9 3 Keys to Overcome Barriers A PLANSUPPORTUpper Management Support EssentialChampionsEDUCATIONManagersSupport Areas (Maintenance, Biomed, Safety and Security, Employee Health)Employees
10 Challenges Pt. Isolation Rooms: Mercury thermometers AlternativesDisposable:Temp-a-dotRe-Usable: assign to roomNICU: Mercury Thermometers and SphygmomanometersMost susceptible population to Hg exposureThermoregulation very importantReference: Accurate Measurement of Body Temperature in NeonateNICU - Neonatal Intensive Care UnitsSince they are the most susceptible population to even minute quantities of mercury, it was clear that the NICU was the first place to eliminate mercury."
11 Removing Hg from Hospital Laboratories Step 1. Examine Chemicals and ReagentsHg is common in Fixatives (B5)Hg is common contaminant (e.g. reagents w/ potassium)Hg used in preservatives (thimerosol)Hg found in secondary antibodies bound to HPR, ELISA kits, Western blot kitsStep 2. Require Vendors to Disclose Hazardous Materials in ReagentsMSDS generally do not identify Hg levels (<1%)Step 3. Eliminate Hg Containing DevicesBarometers, ThermometersReference:
14 Used B5 ManagementSome Histopathology texts recommend precipitation of B5 to “remove” mercury.Precipitated B5 supernatant may contain 25 ppm of mercury.one liter discharge in 20,000 gal (75,000 l) flow will exceed a pretreatment limit of ppb.All B5 should be sent to a mercury refiner.
15 Alternative to Mercury Fixatives FormalinZn FormalinAnatech ANATECHIBFSurgipathSt Mary’s Duluth Clinic
16 Summary Mercury is pervasive in healthcare facilities. Mercury devices often leak or break.Mercury containing chemicals have been disposed of down the drain in the past.Barriers can be overcome with perseverance and educationMost mercury-containing items are identifiable and have cost effective alternatives
17 Resources HCWH – Web Site Sustainable Hospitals – Web Site Shygmo resources, HistopathologySustainable Hospitals – Web SiteComparing mercury and aneroid Sphygmo’sRemoving Mercury from LaboratoriesIs there Mercury in your Coulter CounterH2E Website