Mercury is used in many instruments and products in the healthcare setting because of its uniform response to temperature and pressure changes. Sphygmomanometers (blood pressure monitors), laboratory and patient care thermometers, and gastrointestinal devices use mercury to function. Mercury compounds also are used in preservatives, fixatives, and reagents. Mercury from medical applications can enter the environment through sewers, spills, and land disposal of trash.
Workers in medical, dental, or other health services who work with equipment that contains mercury are at risk of being exposed to the toxic metal.
Other workers who might be exposed to mercury, include:
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The most common potential mode of occupational exposure to mercury is via inhalation of metallic liquid mercury vapors. Since mercury vapor is odorless and colorless, people can breathe mercury vapor unknowingly. For liquid metallic mercury, inhalation is the route of exposure that poses the most significant health risk.
Mercury is a neurotoxin. How someone's health may be affected by exposure to mercury depends on several factors which include:
The effects of mercury exposure can be very severe, subtle, or may not occur at all, depending on the factors above.
Mercury is highly toxic, primarily when metabolized into methyl mercury. It may be fatal if inhaled and harmful if absorbed through the skin. Mercury and most of its compounds are extremely toxic and you should always handle it with care. In cases of spills involving mercury, such as from thermometers or sphygmomanometers, use specific cleaning procedures to avoid exposure to mercury.
Acute exposure (short-term effects) to mercury may result in many health effects, including:
Chronic exposure (long-term effects) to mercury may result in the following:
The hierarchy of controls should be applied to ensure you use the most effective control method. The hierarchy of controls establishes the following control categories in order of preference: elimination, substitution, engineering, administrative, and personal protective equipment (PPE). Controlling hazards within a workplace help prevent accidents or injuries. Controls, such as elimination, substitution, and engineering, are most effective because they do not rely on human behavior. Administrative and PPE controls are least effective since they may not eliminate the hazard and rely on human behavior and performance. A cost-benefit analysis can help guide decision making when implementing the hierarchy of controls.
Whenever possible, exposure to potential hazards should be eliminated or reduced by substituting with less hazardous materials. Choosing mercury-free equipment or equipment made with less toxic substances minimizes the potential for worker exposure. For example, replacing mercury thermometers and sphygmomanometers with mercury-free devices eliminate the hazard.
When in the development phase of a new process, implementing elimination or substitution controls may be inexpensive and easy to implement. It may be more difficult and expensive to implement elimination or substitution controls for existing operations.
When elimination or substitution is not possible, engineering controls should be applied. Engineering controls work by physically preventing worker exposure to the hazard. Engineering controls are considered a more effective control method as compared to administrative controls or PPE because they do not rely on worker compliance.
Well-designed engineering controls, such as a sealed container, can be highly effective in protecting workers from mercury. Engineering controls should be independent of worker behavior and interactions.
Potential engineering controls include:
Administrative controls are policies and procedures established by management to reduce the risk of exposure to a hazard, such as mercury. Administrative controls include implementing work practices, management policies, and training programs to reduce worker risk.
Administrative controls used to protect workers from exposure to mercury include:
Use a variety of work practice controls to protect healthcare workers from accidental mercury spills.
Do not allow workers who are not trained in proper procedures to attempt to clean up spills.
The last line of defense against exposure to workplace hazards is personal protective equipment (PPE). Employers are required to provide appropriate PPE when employees are handling hazardous chemicals, such as mercury [29 CFR 1910.132]. PPE is the least effective control method because it relies on employee behaviors and performance to prevent exposure.
Examples of PPE include:
Only those who have been properly trained should clean up a mercury spill.
What NEVER to Do After a Mercury Spill:
Remember, only people who are properly trained should cleanup a mercury spill. Here are some other important things to remember:
Remember to keep the area well ventilated to the outside (i.e., windows open and fans in exterior windows running) for at least 24 hours after your successful cleanup. You may want to request the services of a contractor who has monitoring equipment to screen for mercury vapors. Consult your local environmental or health agency to inquire about contractors in your area.
For many years it was thought that mercury is indispensable. Although there are instruments that are alternatives to mercury-containing equipment, their use was never widespread. Both mercury and aneroid sphygmomanometers have been in use for many years. The thinking that aneroid sphygmomanometers do not give accurate readings has no base. Of all mercury instruments used in health care, mercury sphygmomanometers (80–100 g/unit) use the most significant amount of mercury. Their widespread use collectively makes them one of the largest mercury reservoirs in the health care setting. By choosing a mercury-free alternative, a health care institution can make a tremendous impact in reducing the potential for mercury exposure to patients, staff, and the environment. When following proper maintenance protocol, aneroid sphygmomanometers provide accurate pressure measurements.
Here are some strategic steps for eventually achieving mercury-free health care:
Short-term: Develop and implement plans to reduce the use of mercury equipment and replace it with mercury-free alternatives. Plans should address clean-up, storage, and disposal of mercury.
Medium-term: Increase efforts to reduce the use of unnecessary mercury equipment in hospitals. Hospitals should have an inventory of their use of mercury. Categorize this inventory into either immediately replaceable and gradually replaceable.
Long-term: Support a ban on mercury-containing devices and promote alternatives. Support countries in developing a national guidance manual for sound management of health care mercury waste. Support countries in the development and implementation of a national plan, policies, and legislation on mercury health care waste. Support the allocation of human and financial resources to ensure the procurement of mercury-free alternatives and sound management of health care waste containing mercury.
Butterworth Hospital in Grand Rapids, Michigan, is a 529-bed hospital that has committed to reaching mercury-free status. To help achieve this goal, the hospital is implementing a new purchasing policy that restricts the purchase of mercury-containing devices unless a mercury-free alternative is not available. The hospital estimates there is one and one-half pounds of mercury used per bed in their facility. Here are some of Butterworth’s outstanding mercury reduction efforts:
Butterworth’s mercury reduction activities are not without difficulties. The labs were resistant because the pathologists relied on mercury chloride slide fixatives. The pathologists believe there are no alternatives as precise and accurate.
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