“Mercury Reduction: Practical Experiences from Healthcare”

1. “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 PG

2. 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 risk TJT

3. 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. PG

4. 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. TJT

5. 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 TJT

6. 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 PG

7. Step 2. Assessment Mercury-Containing Devices/Equipment • Sphygmomanometers • Thermometers • Esophageal Dilators (Bougies) • Gastrointestinal Tubes • Button Batteries • Thermostats and switches • Fluorescent lights • Steam recorders • Barometers TJT

8. Mercury-Containing Chemicals • Products Containing Thimerosal Preservative • Lab Test Reagents, Histology Stains • B5 Fixatives • Cleaners and Degreasers • Diuretics • Vaccines, Ophthalmic Solutions, Nasal Sprays PG

9. 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 TJT

10. 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 PG

11. Assessment Method • Surveys - Advantages and Disadvantages • Site Visit – Physical Counts • Preprinted lists TJT

12. 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 PG

13. 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? TJT

14. Cost Analysis: Sphygmomanometers ANEROID PRODUCT Basic Cost of Product: $90 Calibration Costs: none Cost of Training for Use: $20/(4 staff) TOTAL: $110 BAUMANOMETER Basic 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 ELECTRONIC PRODUCT Basic Cost of Product: $1,200-3,000 Calibration Costs: none Cost of Training: $80/(4 staff) TOTAL: $1,280-3,080 TJT

15. 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 PG

16. 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 PG

17. 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 TJT

18. 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) PG

19. 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 TJT

20. 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 departments PG

21. 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 TJT

22. 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) TJT

23. 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 PG

24. Waste Management • Waste Management Considerations • Florescent Tubes • Batteries • Manage for Recycling and Mercury Recovery • Recovery vs. Treatment and Disposal PG

25. 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 TJT

26. 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” PG

27. 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