Replacing Mercury in Healthcare Facilities—A
Taking the Leap....
How do you get a mercury reduction program rolling? Here's
a step-by-step plan for making mercury reduction a priority at your hospital.
Step 1—Assess the mercury
in your facility
Start by creating an inventory of mercury-containing
products in your facility. Record where the mercury is, and how
much is in each location.
The inventory will provide:
- a perspective to help you develop realistic reduction
goals and well-targeted action plans
- a baseline against which you can measure your progress
Step 2—Make a Commitment
Get support from the top. Talk to your hospital
leadership, and get a signed statement to
Establish a mercury-free team. Designate a
program leader who will be enthusiastic and dedicated to the program. The leader
should recruit support from a key person in each department who has the authority
to make departmental changes.
Step 3—Manage What
You Have On-Hand
Until you are able to eliminate all mercury-containing items
in your facility, you should have a comprehensive management plan in
place. This includes
- a Mercury Management Policy
- a Mercury-free Purchasing Policy (see step 9)
- a general Employee Education program covering mercury
use and disposal issues
- a Spill Prevention and Education program targeted specifically
toward spill prevention and response
Step 3—Tips & Tools
Step 4—Replacing Mercury-Containing
Once you understand the types, number and location of your clinical
devices that you have assessed in Step 1,
you can set reasonable goals for elimination.
The first step, already taken by healthcare facilities across
the country, is to replace mercury thermometers with electronic
devices, to make sure they are no longer being sold in your outpatient pharmacy,
and to ensure that you are not sending them home with patients.
Sphygmomanometers are more expensive to replace,
so you might have to consider a phased in multi-year replacement plan. But
always consider that the cost of a mercury spill clean-up from a sphygmo may
cost thousands of dollars. Include avoided costs of labor, disposal and liability
when determining your cost benefit.
For other clinical devices, non-mercury alternatives
exist for each one.
Step 4—Tips & Tools
- For isolation patients, requisition devices from
- Assess opportunities to purchase thermometry probes
for existing electronic devices that have that option.
Contact the vendors listed at the end of this fact
sheet for more information on mercury-free alternatives to common hospital
Hospitals Project's List of Mercury-free Alternatives
Hospitals Project's Laboratory Practices
Contact your Group Purchasing Organization (GPO)—many
of them have made their own commitments to providing mercury-free alternative
Step 5—Replacing Mercury-Containing
Devices in Facilities
Facility devices include items like switches,
gauges, thermometers, x-ray tubes, barostats and thermostats.
Next to replacing these devices, the most important task
is to inventory and tag them as mercury-containing. When
the device is replaced, it can then not only
be replaced with
a non-mercury alternative, but also
- be removed
and safely disposed of as universal waste
Step 6—Replacing Mercury-Containing
Every lab should put together an action plan
including operational and policy initiatives to a phased in approach to prioritizing
chemicals. We recommend a phased-in approach to mercury reduction.
The first phase is to review and
understand your current practices, including disposal, based
on the inventory from step 1.
The second phase is to identify the fixative and stains
that contain significant amounts of mercury and to determine which of them
can be replaced by effective mercury-free alternatives.
The third phase is to identify and list those
chemicals that contain mercury but that do not have readily available substitutes. Your
mercury management plan should include a provision for periodic
review of this list to determine whether alternatives have become
Step 7—Replacing Other Mercury-Containing
Step 8—Mercury as a Universal
Many mercury-containing products when discarded are considered "universal
waste". Examples include batteries, pesticides, thermostats, and fluorescent
lamps, and may also include cathode ray tubes, depending upon your state's
universal waste rule.
The universal waste rule enables you to avoid some of the
more cumbersome RCRA requirements, and helps encourage recycling. Understand
the universal waste rule and let it help you manage and recycle your
Step 9—Keep the Mercury
Begin at the source. Work with your purchasing
department to make sure that mercury products do not find their
way back into the hospital.
Then use your mercury inventory (from Step
1) to monitor the effectiveness of the policy. Repeat
the inventory periodically and re-evaluate your facility. Identify
your successes and modify your plan as necessary.
Step 10—Recognition and
Getting recognition from the work is often a critical component
of its continued success.
Practice Greenhealth's Making Medicine Mercury Free (MMMF) Awards are
given to facilities that have virtually eliminated mercury and developed policies
to sustain the elimination.
Most importantly, get the message out to hospital staff that
they are making a difference!
To apply to the award or for more information, go to