1. Mercury in Health Care: WHO Policy Paper Hisashi Ogawa WHO Western Pacific Regional Office

2. Sources of mercury in health care Thermometers Sphygmomanometers Dental amalgam Gastrointestinal tubes Laboratory chemicals Pharmaceutical products Electrical applications Medical waste incineration, open burning, burning in barrels, gasification, pyrolysis, etc.

3. Occupational exposure to mercury Common pathway is inhalation of mercury vapours (odourless and colourless) Permissible concentration for occupational exposure by NIOSH – 0.05 mg/m 3 Equipment breakage and spills occur frequently, but risk perception is low Spillage accident is often not reported, and handled carelessly with no protective gear

4. Mercury release from health care Health care facilities are one of the main sources of mercury release into the atmosphere because of emissions from medical waste incineration Health care facilities are responsible for mercury pollution taking place in water bodies from the release of untreated wastewater Mercury contained in dental amalgam is the greatest source of mercury vapour in non-industrial settings

5. Strategies WHO recognizes that a significant portion of mercury release comes from the health-care sector, and therefore proposes to work with countries through the following strategies Short- term Medium-term Long-term

6. Short-term strategies Develop clean up and waste handling procedures Procedures should include: - Spill clean up response, - Educational programmes - Use of protective gear - Waste storage containment - Staff training Countries to initiate phasing out process

7. Medium-term strategies Reduce the number of unnecessary use of mercury equipment Inventory of mercury use and the categorization of items into immediate replaceable and gradually replaceable Return of replaceable devices to the manufacturer or to the provider of alternative devices Progressively discourage the sale and use of mercury containing devices Ensure support to countries so that recovered mercury equipment is not recycled back to the supply chain

8. Long-term strategies Support a ban of use of mercury devices and promote the use of alternatives Support in developing & implementing national plan, policies & legislation on mercury Support allocation of human and financial resources Promoting principles of environmentally sound management of health-care waste under the Basel Convention