Sustainable Hospitals - Mercury Reduction

Case Studies of
Mercury Pollution Prevention Measures
in Michigan Health Care Institutions

The following information is adapted from: Michigan Mercury Pollution Prevention Task Force (1996), "Mercury Pollution Prevention in Michigan: Summary of Current Efforts and Recommendations for Future Activities."

As part of the compilation of the Mercury Pollution Prevention in Michigan report, a health care group was formed to identify the uses of mercury in hospitals and alternatives for those uses. Several hospitals were contacted regarding the topic of mercury pollution prevention measures currently underway in their institutions. While there are measures that must be adhered to under federal and state laws, for example training on spill prevention and management, many of these health care institutions go beyond mere compliance with existing law by educating a broad spectrum of employees in the proper procedures in handling mercury spills and minimization of mercury use. The following are examples of some of the ongoing activities.

Bronson Hospital, Kalamazoo, Michigan
Educating the staff about the proper use of mercury-containing devices and spill clean-up procedures has helped to decrease mercury in water discharge. Bronson Hospital formalized a policy to ban the purchase of mercury-containing items where alternatives exist. In areas undergoing remodeling, sphygmomanometers containing mercury are being replaced with aneroid devices.

Bronson is also working in conjunction with Kalamazoo's wastewater department to meet their mercury discharge limit of 5 parts per billion, and to further decrease their concentration to 3 parts per billion.

Butterworth Hospital, Grand Rapids, Michigan
Butterworth Hospital has made a commitment to reach mercury-free status. They have instituted a purchasing department policy stating that, unless there is no suitable mercury-free alternative, no mercury-containing devices are to be purchased. Administrative approval was given to replace all sphygmomanometers currently in use with aneroid devices. The obstetrics department stopped sending mercury thermometers home with new mothers.

Butterworth Hospital hired a local environmental consultant to devise a mercury spill response and disposal plan that is safe and economical for the entire hospital. The consultant also offered training on spill response, prevention and management. Educational materials about mercury, including the Terrene brochure (see Appendix J), were distributed to all hospital departments, administrative personnel and regional facilities.

Butterworth Hospital is introducing mercury pollution prevention in all entities in the Butterworth health system, such as free-standing medical centers, clinics, nursing homes and affiliated rural hospitals.

Corning Clinical Laboratory (now Quest Diagnostics), Wyoming, Michigan
Corning Clinical Laboratory instituted mercury pollution prevention measures to meet the City's strict water guidelines of 0.5 ppb. Corning isolated manufacturer contributions of mercury within its wastewater system by testing its list of reagents for mercury content. Manufacturers might not list mercury on their Material Safety Data Sheets if the amount is less than one percent. Therefore Corning did not know the sources of mercury until test results were finalized. Once the sources were determined, a formal mercury reduction policy was instituted. Corning located vendors that could provide mercury-free reagents or, where possible, changed methodologies to processes that do not involve mercury.

The following is a list of the top nine mercury-containing reagents discovered at Corning Clinical Laboratory. It should be noted that the survey of these reagents occurred over time and the manufacturers may have reduced their mercury content since the original testing:

Prostatic specific antigen (Hybertech)
Cryptococcus antigen wash (Meridian)
Clostridium difficile wash (Meridian)
Cesium diluent for lithiums (CMS)
Wash solution for Hitachi analyzers (BMC)
FTA antibody test kit (Zeus)
Lyme antibody test kit (Mardx)
EBV antibody test kit (Organon)
Herpes antibody test kit (Biowhittak)

Riverside Osteopathic Hospital, Trenton, Michigan
Riverside Osteopathic Hospital's Mercury Minimization Plan includes identifying sources of mercury, developing a spill management procedure, providing educational material to staff, and developing an action plan that sets up a timetable for implementing mercury pollution prevention measures.

Riverside Hospital identified some mercury sources and found mercury-free alternatives. Riverside informally instituted a policy allowing only mercury-free devices to be used in the Hospital, including thermometers, thermostats and sphygmomanometers. The Hospital discontinued using mercury-containing batteries, and has substituted water-containing esophageal dilator tubes for the mercury-containing tubes. Riverside is investing in T-8 lamps with electronic ballasts that contain less mercury than the lamps previously used. The Hospital has also eliminated caustic drain cleaners and switched to the alternative organic oils and compounds that are not as harmful to the environment. A spill prevention kit was purchased for mercury cleanup.

University of Michigan (UM) Health System, Ann Arbor, Michigan
An informal policy exists in the institution allowing only mercury-free items to be purchased. This includes sphygmomanometers, thermometers and batteries. Sphygmomanometers containing mercury have been replaced with aneroid devices, including those in newly acquired physicians' practices and offsite clinics. The same holds true for mercury thermometers, which are being replaced by their digital counterparts in all areas.

Laboratories within the University Hospitals are investigating whether or not laboratory procedures that contain mercury can be substituted by those that are mercury-free. However, laboratories are hesitant to switch procedures where the same effectiveness is not guaranteed. The pharmacy has successfully discontinued using mercury in any items dispensed. The UM Health System has also implemented a fluorescent tube recycling project.

The Terrene brochure entitled "Educational Resources for a Mercury Pollution Prevention Program" was distributed to individuals within the UM Health System who are responsible for disposing and dispensing mercury-containing items. UM Hospitals utilize a mercury vacuum as appropriate during spill response activities.