AJN Article -July 2003: Eliminating Mercury in Health Care Facilities

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The American Journal of Nursing

July, 2003 - Volume 103, Issue 7

Eliminating Mercury in Health Care Facilities
The task is daunting, but there is help.

By Anna Gilmore-Hall, MS, RN

Q. What are the health threats caused by mercury exposure, and how can we reduce the amount of mercury in our facility?

A. Mercury is a neurotoxic heavy metal that has been linked to numerous adverse health effects in wildlife and people. According to the National Academy of Sciences, it's a reproductive toxin and a potent neurotoxin that affects the brain and central nervous system. Pregnant women, women of childbearing age and small children are at greatest risk. In addition, mercury can cross the placenta and cause neurologic damage to the fetus.

Mercury exposure most often occurs through the consumption of fish. It's often released into waterways or into the air, where it lands on water and transforms into a toxic organic form known as methyl mercury. This bioaccumulates in fish, especially large fish, which are eventually consumed by humans.

There is approximately 1 g of mercury in a typical fever thermometer. According to a 1996 U.S. Environmental Protection Agency (EPA) report, that's enough mercury to contaminate a lake with a surface area of about 20 acres to such a degree that fish would be unsafe to eat. In addition to the health risks to patients and staff of a mercury spill, cleanup can be very expensive.

Mercury can also reach the waste stream though medical and solid waste. The EPA names medical waste incinerators as the fourth largest source of anthropogenic mercury in the environment. There is up to 50 times more mercury in medical waste than in general municipal waste, and the amount of mercury emitted by general medical waste incinerators averages more than 60 times that emitted by pathological incinerators.

An important first step to reduce mercury is for your hospital to join the Hospitals for a Healthy Environment (H2E) and take its Mercury Free Pledge. H2E is a partnership of the ANA, the American Hospital Association, the EPA, and Health Care Without Harm that was created to advance pollution prevention efforts in hospitals. Under the mercury-free pledge, hospitals use the H2E resources to work toward eliminating mercury products and developing policies to stop purchasing devices that contain mercury.

That's only the beginning of what should be a comprehensive effort to reduce mercury. Mercury can be found throughout hospitals and health care facilities, in thermometers, sphygmomanometers, esophageal dilators (bougies), batteries, fluorescent lamps, thermostats, pharmaceutical supplies, many types of electrical equipment, and even bleach. Facilities should conduct a mercury audit to identify all sources of mercury.

By eliminating mercury from your facility, you can help the health care industry reduce the levels of methyl mercury in fish and the environment. Mercury, by federal law, is a regulated waste and must be managed according to federal guidelines. Using mercury-containing devices necessitates a mercury-management policy and a spill-response plan for emergencies. Facilities can avoid mercury management altogether by using mercury-free devices and products. Safe, effective alternatives exist for nearly all common uses of mercury in health care settings, from temperature and blood pressure measurement to fixatives used in labs.

What You and Your Facility Can Do

  • Take the Mercury Free Pledge

  • Conduct a mercury audit.

  • Phase out use of items containing mercury.

  • Implement a policy of mercury-free purchasing.

  • Educate and train employees in the dangers of mercury and in facility protocols.

  • Hold a mercury thermometer exchange for your employees.

  • Stop sending mercury thermometers home with patients and with parents of newborns.

Resources

Blueprint for Mercury Elimination
www.wlssd.duluth.mn.us/p2.htm

Health Care Without Harm A coalition of 360 organizations in 40 countries.
www.noharm.org

The ANA's Pollution Prevention Kit for Nurses
Order online

Anna Gilmore-Hall is the director of nurse advocacy programs at the ANA.

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