Great Lakes Binational Toxics Strategy

Stakeholder Forum - 1998

IMPLEMENTING THE BINATIONAL TOXICS STRATEGY
Mercury Workgroup

Reducing Mercury Use in Healthcare
Promoting a Healthier Environment
A How-To-Manual

Prepared by the Monroe, County Department of Health, In cooperation with Strong Memorial Hospital, Rochester, New York and the Monroe County Department of Environmental Services, with funding by a grant from the U.S. Environmental Protection Agency

Table of Contents

List of Tables
List of Figures
Acknowledgments

Chapter 1.    Introduction

Background on Mercury
Health Impacts of Mercury Exposure
Mercury in Medical Facilities
Mercury Pollution Prevention
Benefits of Mercury Pollution Prevention

Chapter 2.    How to Establish Mercury Pollution Prevention in Your Hospital

Get Started
Gather Data
Establish Realistic Goals and Implementation Plans
Institute Best Management Practices
Measure and Document Success
Advertise Success

Chapter 3.    Best Management Practices for Mercury - Containing Products in the Hospital

    Introduction
    Fever Thermometers
    Sphygmomanometers
    Gastrointestinal Tubes
    Dental Amalgam and Mercury
    Laboratory Chemicals
    Pharmaceutical Products
    Cleaners and Degreasers
    Batteries
    Lamps
    Electrical Equipment
    Thermostat Probes in Gas Appliances
    Industrial Thermometers
    Pressure Gauges
    Plumbing
    Spills
    Storage Areas
    Hospital Employee Health and Safety

Appendices

A. Instruments and Products, Used in Hospitals, That May Contain Mercury    
B. Laboratory Chemicals That May Contain Mercury   
C. Regulatory Information Contacts for Counties in the Rochester Embayment Watershed
D. Benefits of a Mercury Pollution Prevention Program in Your Hospital (Handouts)    
E. Annual Assessment of the Hospital's Mercury Pollution Prevention Program    
F. Wastewater Sampling and Analysis   
G. Mercury Pollution Prevention Cost or Savings Worksheets   
H. Sample Letter Requesting Certificate of Analysis and Sample Certificate of Analysis    
1. Vendor Product Mercury - Content Disclosure   
J. Educational Resources for a Mercury Pollution Prevention Program   
K. Disposal of Take - Home Household Mercury Thermometers by Patients   
L. Mercury Reduction Case Studies   

1. Strong Memorial Hospital, Rochester New York 
2. F.F. Thompson Hospital, Canandaigua, New York
3. Case Studies of Mercury Pollution Prevention Measures in Michigan Health Care Institutions 
4. Massachusetts Water Resources Authority (MWRA)/Medical, Academic and Scientific Community Organization (MASCO) Mercury Work Group
5. Mercury Management at Mayo Clinic 
6. St. Mary's Medical Center, Duluth, Minnesota   

M. Prevent Mercury Pollution: Use Best Management Practices for Amalgam Handling and Recycling   
N. Mercury Waste Recyclers   
0. Infrastructure Control Measures   
P. Strong Memorial Hospital Mercury Spill Clean - Up Procedures   
Q. Glossary of Terms   
R. Bibliography   

Tables

1. Alternatives for Mercury - Containing Fever Thermometers
2. Alternatives for Mercury - Containing Sphygmomanometers
3. Alternatives for Mercury - Containing Gastrointestinal Tubes
4. Alternatives for Mercury - Containing Laboratory Chemicals
5. Pharmaceutical Uses of Mercury
6. Mercury Content of Selected Cleaning Products: Information from    MWRA/MASCO Mercury Work Group
7. Batteries (Newly Purchased) That May Contain Added Mercury (1998)
8. Mercury - Containing Electrical Equipment
9. Alternatives for Mercury - Containing Industrial Thermometers
10. Alternatives for Mercury - Containing Laboratory Manometers

Figures

1. Mercury Transport and Bioaccumulation
2. How to Establish Mercury Pollution Prevention in Your Hospital

Acknowledgments
Many individuals contributed to the research, preparation and review of this manual. In addition to the persons listed below, there were numerous others who contributed by sharing information and knowledge.

Mercury Pollution Prevention Team:
    Carole Beal, Monroe County Department of Health, primary author
    Mary Joy DelConte, Nixon, Hargrave, Devans & Doyle
    Richard Elliott, Monroe County Department of Health
    Dr. Thomas Gasiewicz, University of Rochester Medical Center
    Dr. Grant LeMasters, University of Rochester Eastman Dental Center
    Anna Madden, Monroe County Department of Health
    Dr. Charles Oster, University of Rochester Eastman Dental Center
    Margaret Peet, Monroe County Department of Health
    Harry Reiter, Monroe County Department of Environmental Services
    Michael Schifano, Monroe County Department of Environmental Services
    Lynn Schramel, Monroe County Department of Environmental Services
    Dr. Carol Scott, University of Rochester Environmental Health and Safety
    Drew Smith, Monroe County Department of Environmental Services
    Marvin Stillman, University of Rochester Environmental Health and Safety

University of Rochester Medical Center Mercury Reduction Work Group:
    Kathy Parrinello, Chair, Hospital Administrator
    John Borrelli, Department of Dentistry
    Nils Gurdin, Medical Engineering Laboratory
    Tracy Herbert, Facilities
    Ernest Myers, Hospital Stores
    Vivian Palladoro, Clinical Laboratories
    Jane Pleasants, Procurement Services
    David Roney, Hospital Housekeeping
    Melinda Spry, Quality Assurance
    Marvin Stillman, Environmental Health and Safety
    Nancy Vanderhoof, Nursing Practice
    Chris Van Stean, LEARN

Others Who Assisted with Research, Preparation and/or Review.
    Robert Barczak, Emerson - Swan, Inc.
    Alexis Cain, U.S. Environmental Protection Agency
    Randy Case, Wisconsin Department of Natural Resources
    Margaret Cleary, Monroe County Department of Health
    Richard Dapson, Anatech Ltd.
    Joanne DelMonte, Monroe County Publication Services
    Dr. Andrew Doniger, Monroe County Department of Health
    Kathy Fulton, University of Rochester Medical Center
    John Gilkeson, Minnesota Office of Environmental Assistance
    Matt Gluckman, U.S. Environmental Protection Agency
    Danielle Green, U.S. Environmental Protection Agency
    Jamie Harvie, Western Lake Superior Sanitary District
    Andrea Jacobs, Xerox Corporation
    Ann Jones, Monroe County Environmental Health Advisory Board
    Ed Klappenbach, U.S. Environmental Protection Agency
    Mark Kress, University of Rochester Environmental Health and Safety
    Bruce Lourie, Pollution Probe
    Charles Monahan, Panasonic Industrial Company
    Dr. Gary Myers, University of Rochester Medical Center
    Lawrence Nadler, New York State Department of Environmental Conservation
    Barbara Nuffer, New York State Department of Environmental Conservation
    Susanne Quarterman, Monroe County Environmental Management Council
    Karen Rondeau, Massachusetts Water Resources Authority
    Tim Tuominen, Western Lake Superior Sanitary District
    Chris Urban, U.S. Environmental Protection Agency
    Wanda Welles, New York State Department of Health
    Michael Zanghi, F.F. Thompson Hospital