Many hospitals have already made the move to virtually eliminate mercury. While the order of the steps can vary from facility to facility, the framework for elimination remains consistent. Work with the facility to enact the following steps to eliminate mercury.
Identify Mercury-Containing Items
Healthcare facilities can get started by first taking an inventory of the mercury-containing products they currently purchase, use or have in stock. There are several good tools that facilities can utilize to identify mercury-containing products in their facility.
- Health Care Without Harm has developed a List of Mercury-Containing Items in a Hospital Setting. (pdf)
- The MWRA / MASCO Mercury Management Guidebook provides a database of mercury-containing items as well as resources on mercury in wastewater.
- The Mercury Assessment Worksheet (requires Microsoft Excel to view and use) was designed to help organizations inventory their mercury-containing devices. This spreadsheet was developed by the California Office of P2 and Technology Development and the California Department of Health Services' Hospital Pollution Prevention Program.
- See Sections 5A and 5B of the Mercury Checklist (pdf) from the Hospitals for a Healthy Environment (H2E) Self-Assessment for Facilities.
Implement Mercury-Free Policies
Once the facility has created an inventory of existing mercury-containing devices, equipment and chemicals, the next step is to create and implement a set of policies that will prevent additional mercury from coming into the facility. Creating a facility-specific or system-wide policy to eliminate certain types of toxic products is beneficial because administration, clinicians, material managers and purchasing agents are all working under the same guidelines about what not to purchase. Additionally, a policy outlives staff turnover and can remain consistent over time. Practice Greenhealth’s Making Medicine Mercury Free Award requires that facilities have a policy in place that states their commitment to elimination of mercury, avoidance of purchasing new equipment or devices containing mercury, and proper handling, management and disposal of existing mercury materials onsite—as well as staff education on mercury toxicity. Some facilities create an integrated policy that addresses elimination, proper management and purchasing, while others enact separate policies. Here is a sample to help the organization develop what works best:
Set Mercury Reduction Goals
Once the organization has a sense of what mercury remains onsite, and has executive support for elimination, it can begin to set goals for elimination. Goals for mercury elimination should be set according to facility priorities and financial parameters. Some non-mercury alternatives may be slightly more expensive in comparison to mercury products, though most are cost-effective and prices have dropped dramatically as demand for the alternatives has grown. Many facilities begin by phasing out the use of mercury thermometers and then move on to eliminate mercury sphygmomanometers (blood pressure devices). Others begin with recycling fluorescent lamps or eliminating mercury-containing fixatives in the lab. Note: Mercury-containing devices can be recycled and managed as Universal Waste under EPA’s Universal Waste Rule.
Defining small goals and achieving them creates momentum for the program and keeps staff engaged. Mercury elimination efforts should be documented carefully and systematically, and can be used as a Performance Improvement Initiative for Joint Commission.
Sample goals might include:
- Eliminate use of mercury thermometers within 12 months, including sale in hospital pharmacy.
- Reduce existing inventory of mercury blood pressure devices by 50% within 12 months.
- Initiate pilot program to test use of mercury-free reagents and stains in the lab.
- Implement recycling program for all fluorescent lamps (green tip or black tip).
Educate Staff and Assess Progress
It’s important to both ensure staff are aware of mercury reduction goals and that the organization keep on top of progress being made relative to elimination of mercury. Keep track of decreasing mercury-containing inventory. Report progress toward goals monthly to the Green Team and Environment of Care Committee. Make sure the Value Analysis Team (or equivalent) is aware of the organization's mercury-free purchasing policy.
Get Recognized for Mercury Elimination Efforts
Practice Greenhealth recognizes outstanding efforts in environmental improvement with its annual Environmental Excellence Awards. The Making Medicine Mercury-Free award recognizes facilities that have virtually eliminated mercury from their facilities and have made a commitment to continue to be "mercury-free." If the organization has virtually eliminated the use of mercury, check out the requirements for the Making Medicine Mercury Free award and help the organization get recognized for its hard work!