Chris Piehler John Rogers LDEQ Staff Acknowledgement This program has been made possible by a generous grant from the Environmental Protection Agencys Persistent Bioaccumulative and Toxic Pollutants PBT Program ID: 708262
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Mercury in Hospitals
Chris Piehler, John Rogers
LDEQ Staff
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Acknowledgement This program has been made possible by a generous grant from the Environmental Protection Agency’s Persistent, Bioaccumulative, and Toxic Pollutants (PBT) Program. Region VI staff: Ruben R. Casso, PBT/Toxics Coordinator, Donna Cooper, Project ManagerSlide3
Naturally occurring
Metallic mercury is a shiny, silver-white, odorless liquid
If heated, it is a colorless, odorless gas.
What is mercury ?Slide4
Mercury combines with other elementsSlide5
Mercury is pervasive
Naturally occurring
Garbage and coal combustion Industrial processes
In productsSlide6
Mercury is in the home
Thermostats 46.7%
Dental Amalgams 21.0%
Light Switches 14.1%
Auto switches 4.7%
Thermometers 4.7%
Appliances switches 2.4%
Batteries 0.6%
Fluorescent Lights 0.5%Slide7
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Health Effects Inorganic and Elemental Mercury Renal toxicitySkeletal muscle degeneration
Gastrointestinal irritationPulmonary edema - fluid in the lungsElevated blood pressure
Low grade/intermittent feversFlushing of palms and solesSlide9
Health Effects MethylmercuryNeonatal brain damage
Nephritis - inflammation of the kidneyParesthesia - tingling skin sensationMuscle fasciculation - twitching muscles
Abnormal heart rhythmsChromosomal aberrationsDermatitis - skin inflammation
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The Agency for Toxic Substances and Disease Registry & the Environmental Protection Agency
Issued a Warning About Continuing Patterns of Metallic Mercury Exposure!Slide11Slide12
Context of PoisoningThere is a continuing pattern of metallic mercury exposure in: children and teenagers, persons using certain folk medicines, or participating in certain ethnic or religious practicesSlide13
Children and teenagersIncreasing numbers of metallic mercury spills and contamination involving schoolchildren have been reported:Florida Atlantic University in Boca Raton, FloridaA middle school in St. Joseph, Missouri
A high school in Oskaloosa, Kansas A convalescent home in Johnson County, Kansas
A high school and a home in Dallas, TXWilkes-Barre Montgomery County, Pennsylvania. Slide14
LDEQ/LDHH Fish Consumption Advisory Areas for MercuryLouisiana Water Bodies Slide15
The LDEQ Mercury ProgramSlide16
Mercury Program Components
Sampling – biota, water, sediment
Data Management
Risk Assessment
Risk Communication
Recycling
Remediation
Pollution Control
ResearchSlide17Slide18
Mercury CycleSlide19Slide20
Fish Consumption Advisories due to Methyl MercurySlide21Slide22Slide23
Statewide Mercury SweepA voluntary statewide collection program. Universities & colleges, medical facilities, laboratories, maintenance facilities Auto salvage yard operators
A voluntary dental mercury reduction program.Slide24
Focus on HospitalsFever thermometers Laboratory thermometersSphygmomanometersGastroenterology instruments (Cantor and Miller Abbot tubes)
Non-clinical barometers, repair kits, switches.Other (thermostats, manometers, lamps)Slide25
ThermometersContains about ½ gram of mercury.Small portion of total mercury but often improperly disposed.Broken thermometers in red bags may be incinerated.Most common source of mercury spillsFrequent patient and staff exposureAlternatives availableSlide26
SphygmomanometersContain 70-90 grams of mercuryLocated in heavy use areas with high exposure potential
Often contains the largest amount of mercury in one deviceCan be inaccurate without regular maintenanceAlternatives readily availableSlide27
Gastroenterology instrumentsSecond largest concentration of mercuryFDA data – 1991 to 2000 there were 58 incidents where tubes broke and released mercury inside patients.Alternatives available Tungsten weighted just as effective and are opaque on x-raysSlide28
How do you tame the problem?Slide29
Get Onboard On June 24, 1998, the American Hospital Association (AHA) and the United States Environmental Protection Agency
(EPA) signed a landmark agreement identifying goals to reduce the impact of health care facilities on the environmentSlide30
Nuts and BoltsCommitTalk to your hospital leadershipTake the mercury-free pledgeEstablish a mercury-free teamSlide31
Conduct a mercury inventoryInvolve your materials management staffComputerize the inventory by locationMercury inventory tools are widely available on internet. We have included an Excel inventory tool* on the mercury CD for Louisiana Hospitals along with EPA’s Mercury in Hospitals and this presentation.
* California Department of Health Services, Medical Waste Management ProgramSlide32
Where is mercury found in hospitals?Sphygmomanometers and gastroenterology instruments can be as high as 90% of the elemental mercurySlide33
Evaluate AlternativesContext of your hospital’s operationsPerformance comparisonsPurchase costOffsets for lower handling, disposal, maintenanceSlide34
Institute Best Management PracticesEducate staff on hazards, handling and recoveryEliminate mercury equipment and products Establish and monitor mercury-free purchasingSlide35
Measure SuccessUse your inventory to chart your progressIdentify your successesCommunicate your successes to your staffSlide36
Keep the Mercury OutPurchasing agents to act as gatekeepersRequire vendors disclose mercury contentDevelop a mercury free purchasing policySlide37
Mercury SpillsDecide on your policy Specify amount of spill to evacuate. In all cases evacuate children, infirmed, and pregnant women.Allow small spill cleanup by trained staff personCall in a spill teamPut it in writingSlide38
ContactsEnforcement – Chris Piehler 225.219.3609chris.piehler@la.govRecycling – John Rogers225.219.3266
800.305.6621john.rogers@la.gov Slide39
Websites DEQ www.deq.louisiana.govEPA www.epa.gov/pbtSustainable Hospitals www.sustainablehospitals.orgHospitals for a Healthy Environment
http://www.h2e-online.org/Health Care Without Harm http://www.noharm.orgNortheast Waste Management Officials' Association
http://www.newmoa.org/Newmoa/htdocs/about/AboutUs.cfmSlide40
Questions