| The Solution
Mercury is present or contained in various items found in hospitals and other healthcare facilities including fever thermometers, blood pressure cuffs, esophageal dilators, Cantor tubes and Miller Abbott tubes, feeding tubes and dental amalgams. Mercury is also found in chemicals and measurement devices used in healthcare laboratories. In addition it is present in fluorescent light bulbs, batteries, non_electronic thermostats, pressure gauges, some electrical switches used for lights and appliances and many cleaning products.
Mercury is a toxic metal that occurs naturally in the environment. When human activity releases it to the water or soil, microorganisms convert inorganic mercury into a more toxic organic form called methylmercury. Mercury found in healthcare facilities can enter the environment in various ways. This can occur when mercury-containing items are broken or spilled and improperly disposed of in landfills and the wastewater stream. Medical waste incinerators emit mercury to the air when they burn waste that contains mercury. Mercury in the air can end up in bodies of water in the form of precipitation. Fish absorb methylmercury from their diet and from the water they live in. Methylmercury concentrates in the tissues of a fish throughout its lifetime, this effect is called bioaccumulation and it can build up to very high levels as it moves up the food chain. These levels can be up to a million times higher than the mercury in the surrounding water. Forty states have fish consumption advisories because of widespread mercury contamination.
While both organic and inorganic mercury can have health effects, the organic form is much more toxic and acts as a neurotoxin affecting the CNS. The US EPA reports that mercury exposure can cause tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, neurological deficits during fetal development, attention deficit, and developmental delays (US EPA 1997, A Mercury Report to Congress). Infants and developing fetuses are particularly vulnerable to these affects and can be exposed via maternal milk or blood when the mother has consumed mercury-containing fish. Inorganic forms of mercury can also act as neurotoxins, but primarily affect the kidney. Other organs and systems of the body can be harmed by exposure to mercury including the skin, the eyes and the cardiopulmonary, and gastro intestinal systems.
In addition to ingestion a human can be exposed to mercury dermally and through inhalation. Inhalation and skin contact is a particular risk in many work environments, including healthcare work, when spill or breakage occurs.
Hospitals can avoid the risks associated with mercury use, and adding to the environmental burden posed by mercury, by switching to non-mercury alternatives. This page contains many resources meant to assist healthcare facilities to make the switch to practicing mercury-free medicine. If mercury is present, when a mercury spill occurs it needs to be cleaned up appropriately and in accordance with an institutional mercury management policy. Spill kits should be available on all units or a hazard control team should be contacted. However, even proper disposal has serious drawbacks; it can be expensive, pose exposure risk and the mercury can eventually find its way back into the environment via a waste incinerator or by being recycled into new mercury-containing products which may then be disposed of improperly.