When the Monroe County Department of Health decided to form a Mercury Pollution Prevention Task Force it contacted and received cooperation from a faculty member of the University of Rochester Medical Center's Environmental Health Science Department. A student in the Master's program for Environmental Studies performed initial fact finding as part of a project for a Master of Science degree.
No University or Strong Memorial Hospital administrator was contacted formally by the County until the initial "kick-off" meeting. Informal communication between a faculty member and the University's Director of Environmental Health and Safety prior to the kick-off meeting was not adequate to outline the project intent or scope. The net result was that it took over a year to work out a Memorandum of Understanding (MOU) that was acceptable to all parties involved. Once top administrative staff were on board the rate of progress and access to the facility improved dramatically. This experience yielded Lesson 1: Identify and involve all appropriate facility management in the process before predetermining a program's scope and desired outcome.
The intern wrote a comprehensive report which detailed the status quo of mercury usage and management at the University of Rochester Strong Memorial Hospital (SMH). In addition, other undergraduate interns, along with members of University/SMH staff, investigated mercury usage and gathered existing policies/protocols (official and unofficial). The findings were as follows:
- Mercury thermometers were being used in cases of isolation patients and in-patient care units where electronic thermometers were deemed inappropriate. These units included Newborn and the Neonatal Care Units. Six units were identified as using over half the mercury thermometers at SMH. The rest of the Hospital used non-mercury devices. The Director of Medical Engineering stated that over 1.14 million non-mercury temperatures were taken at SMH during 1996 and that the phase-out would continue as more equipment was purchased.
- Mercury-filled sphygmomanometers were being phased out as the equipment needed replacement. All new construction and renovations included aneroid blood pressure reading devices.
- Gastrointestinal devices that contained mercury were generally being replaced with tungsten-filled equipment unless there was a medical reason for not doing so.
- Laboratory reagents, such as histology fixatives and stains, that contained mercury had not been used since 1992. Only those reagents or procedures in which mercury could not be substituted or were not known to contain mercury were still being used in the Clinical Laboratories.
- Noncontact dental amalgam was being collected for proper disposal.
- Energy efficient lighting was installed as a part of the USEPA Green Lights Program. High mercury T-12 lamps were replaced by lower mercury T-8 lamps.
- Fluorescent lamps that failed Toxicity Characteristic Leaching Procedure (TCLP) testing were being collected and disposed of as hazardous waste.
- Mercury spill protocols were long established (at least since 1983). These were current and the staff trained periodically. A log book of spills was being maintained. In fact, SMH owned a special mercury vacuum cleaner with activated carbon filters for vapor control. An industrial hygienist used a mercury vapor "sniffer" to determine if spill cleanup efforts were successful. The earliest record of a mercury "sniffer" being used at the facility was in the early 1980s. There was also a pre-existing mercury disposal/spill protocol for Nursing Units in existence since 1983 that has been updated periodically.
- Hazardous waste, including mercury, was being collected via a formal program and shipped to off-site facilities for disposal.
- Battery collection sites were already established throughout the Medical Center to prevent batteries from being incinerated. In addition, a letter was on file stating that the alkaline batteries purchased under the University contract contained no added mercury.
- Monthly monitoring for mercury vapors was being performed by an industrial hygienist in areas where mercury equipment was being repaired or stored.
Areas of concern included:
- Initial testing of the wastewater effluent showed mercury levels of 0.8 ppb. This would be required to be reduced once the Great Lakes Water Quality Initiative standards were adopted.
- Existing policy was sometimes decentralized. Gathering information was sometimes difficult and the results from questionnaires or other queries could be conflicting. There was no mercury thermometer take-home policy.
- Substitutes for mercury are still to be identified for thermometers in some applications at SMH.
- Mercury as a contaminant needs to be addressed for various lab reagents and cleaning compounds.
- Mercury pollution prevention training needs to be incorporated into as many pre-existing training programs as feasible.
- Contact amalgam (amalgam that has been in the patient's mouth) was being considered regulated medical waste.
- Mercury thermometers from isolation patient care rooms were being considered regulated medical waste.
- Nursing staff surveys indicated that not all staff understood fully what to do with used mercury thermometers or with mercury in the event of a spill, in spite of existing policy and training. Similar knowledge gaps were also discovered in other areas of the institution.
This information led to Lesson 2: In spite of policy or training, there are always items that can fall through the cracks. It pays to compare practice with policy in order to identify and solve a problem.
A Mercury Work Group was established at SMH. It included representatives of:
- Administration
- Clinical Laboratories
- County Health Department
- Dentistry
- Education
- Environmental Health and Safety
- Facilities
- Housekeeping
- Medical Engineering Laboratory
- Nursing Practice
- Procurement
- Quality Assurance
- Stores
The Hospital's mercury pollution prevention program accelerated after the formation of the Work Group in the following areas:
Elimination of mercury
- Non-mercury thermometers were identified and tested in some of the areas where no substitute was previously identified.
- Some nursing units no longer give out take-home thermometers.
- Laboratories were surveyed to verify that mercury was still no longer being used. If discovered, the use and disposal route were determined.
- Mercury sphygmomanometer replacement was tracked more closely and the rate of replacement increased.
Education
- Mercury-specific training was included in the annual required training video. A specific test question about mercury disposal was included. Also a new segment about mercury was added to the Facilities Operations and Maintenance training presentation.
- Educational packets were created for nursing managers and the housekeeping supervisor.
- A mercury survey for nursing personnel was developed that was intended to be used both before and after training. (See survey at the end of this case study.)
- Articles were written and published in SMH/University newspapers that pointed out some of the issues and concerns with mercury.
- Designated containers for mercury thermometer disposal were placed in the "soiled utility rooms." The containers are marked with a specially designed sticker (see end of this case study).
- Specially designed stickers (see end of this case study) were placed on or near red bag containers to discourage the placement of a mercury thermometer there.
- An overview of the mercury pollution prevention program was given to department heads at a meeting. The overview included the reasons for the program and successes that have been achieved so far.
- A pamphlet on "Mercury Management for Nursing Units" was distributed to the nursing personnel (see end of this case study).
- A plan was developed to display educational materials about mercury for the general public in the corridor to the Hospital cafeteria.
Policy
- Nursing Policy was updated to cover mercury thermometers from isolation units (disinfection prior to collection).
- Policies about mercury have been collected from various departments and are being consolidated.
Best management practices
- A disposal container for mercury-containing electrical parts, such as switches, was placed at the location where the replacement equipment is distributed.
- A protocol for the care, use and recycling of dental materials was implemented in the Department of Dentistry and Eastman Dental Center.
- The Hospital entered into an agreement with the Monroe County Department of Environmental Services that establishes best management practices to reduce mercury loading from the Hospital to the County's wastewater treatment system.
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Case Studies
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Strong Memorial Hospital, Rochester, New York
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F.F. Thompson Hospital, Canandaigua, New York
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Case Studies of Mercury Pollution Prevention Measures in Michigan Health Care Institutions
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Massachusetts Water Resources Authority (MWRA)/Medical, Academic and Scientific Community Organization (MASCO) Mercury Work Group
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Mayo Clinic, Rochester, Minnesota
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St. Mary's Medical Center, Duluth, Minnesota
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Related Topics:
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Why is mercury a problem?
The background and health effects of mercury, as well as the benefits of mercury pollution prevention.
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How to establish mercury pollution prevention in your hospital.
How to get started, gather data, establish goals, institute best management practices, and measure and document success.
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Best management practices for mercury-containing products in the hospital
A description of all the products and locations where mercury is used in your hospital, and what alternatives exist for reducing mercury use.
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Bibliography
Citations for books, articles, and reports that support the information in this section.
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