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By Renee Gryzkewicz
Health Care Facilities Article Use Policy
A little mercury can cause a world of problems. Breaking or improperly disposing of mercury-containing devices can release toxic fumes into the environment for years. While such releases might be quite small, any release adds to mercury’s build-up. To stop such emissions, many organizations are sweeping their facilities for mercury, properly disposing of it and seeking to make their buildings virtually mercury free.
Since beginning its mercury-elimination program in 2001, the staff at St. Charles Mercy Hospital in Oregon, Ohio, has uncovered mercury throughout its facilities, including maintenance areas, clinical rooms, pathology labs, and housekeeping, kitchen and storage areas.
“It seems like it is almost everywhere,” says Rose Heard, technical services coordinator in the hospital’s facilities management department. “We’ve even checked our gift shop because the cards that play songs have mercury switches.” The 22 employees of the facilities management department maintain the organization’s 1.6 million square feet.
For its mercury-elimination efforts, the hospital received the 2005 Making Medicine Mercury-Free Award from Hospitals for a Health Environment, a program designed to help health care facilities nationwide become better environmental stewards. The other five award recipients include: Denton (Texas) Regional Medical Center; Garden Park Medical Center in Gulfport, Miss; Salinas (Calif.) Valley Memorial Hospital; Anaheim (Calif.) Memorial Medical Center; and Scripps Mercy Hospital in San Diego.
Mercury can be found in fluorescent and high-intensity lamps, thermostats and switches, and a variety of generators and batteries. It is also in some cleaning solutions, preservatives and antifouling agents for wood and other surfaces. Besides these items, medical facilities often house mercury-containing clinical devices such as sphygmomanometers for monitoring blood pressure and thermometers.
Heard, who manages the work-order system for the hospital’s maintenance department, chairs the hospital’s hazardous materials subcommittee. She helped form a five-person team whose goal was to make the hospital virtually mercury-free. The team includes employees from the hospital’s biomedical, employee-health, purchasing, and staff-development departments. The group needed the entire hospital staff’s help to identify and collect mercury-containing products in the facility.
“At first, it was hard for many people to accept mercury as a hazardous substance because they remember playing with it in school,” says Keith Dempsey, the hospital’s safety coordinator. “It’s kind of hard to associate that experience with the fact that mercury is a heavy metal and a hazardous substance. It didn’t take long though before everyone supported the program, and we were able to identify where all of the mercury was located in our facility and start replacing the mercury-containing devices.”
Since then, all mercury-containing devices in the clinical areas have been replaced with mercury-free alternatives, except for a barometer in the hospital’s linear accelerator room, which is used for cancer treatment.
“The barometer used to hang freely on the wall,” Heard says. “Our maintenance crew made a cage for it.” The medical staff still prefers to use the mercury barometer because it is more accurate for performing cancer treatments than other options, such as calling the airport or weather station to get the barometric pressure. While mercury-free barometers are available, the medical staff decided not to replace it because of accuracy concerns.
“One of our biggest challenges has been educating others that mercury-free devices are just as or more effective than the mercury-containing devices,” Dempsey says.
Adds Heard, “Because the medical staff didn’t want to get rid of the barometer, we just made sure it was protected and was still able to be read. We also eliminated almost all of the mercury in the hospital’s building equipment. Because of energy-saving benefits, we had already switched to low-mercury fluorescent lamps before beginning the mercury-elimination project.”
The facility still uses mercury-containing lamps in the parking lot because lighting alternatives do not perform as well. The other remaining mercury-containing devices are located in the facility’s mechanical and power-plant areas.
“The mechanical rooms and the power house are the only places we still have mercury switches, thermostats and thermometers that monitor a variety of engineering controls,” Heard says. “We need to replace them with more acceptable devices, but to do that cost effectively, we replace them when there is a problem with the device or if we are renovating the area.” So far, the maintenance department has replaced four of 19 mercury switches and 10 thermostats on the domestic hot water lines. The maintenance department inspected each device to ensure it is securely sealed.
“We’ve inspected all of the maintenance areas and know exactly where they’re located,” she says. “Everyone in the facilities management department is aware of them, and as we replace them, we will update our inventory records.”
The maintenance department also searched the department’s storage rooms and found four mercury-containing thermometers in unopened boxes.
To prevent additional mercury from entering the facility, the project team members drafted and implemented a purchasing policy that addresses mercury and emphasizes that purchasers must consider viable mercury-free alternatives.
During the first year of the program, the hospital’s team collected and recycled 91 pounds of mercury from a variety of sources. After gathering a significant amount of equipment, Heard contacts Bowling Green State University, which has a grant with the Ohio Environmental Protection Agency (EPA) to collect the mercury. Prior to pick-ups, she keeps the items in labeled 5-gallon buckets in the facility’s maintenance area.
A licensed individual from the university packages the material, prepares it for shipment and transports it off site. When Heard has equipment that is bigger than the buckets, the university contacts a company to either take the devices whole or remove the mercury on site.
“This is a free service as long as the mercury is not contaminated, that is, the device is intact,” Dempsey says. “For example, if a thermometer is broken it is considered hazardous waste and must be handled by a vendor who is licensed to pick up and dispose of hazardous waste.” The EPA would rather pick-up mercury-containing devices that are intact than respond to spills or the improper disposal of these devices, he says.
The hospital has recycling contracts with vendors for batteries and lighting equipment. The biomedical department is responsible for recycling the nickel-cadmium rechargeable and lead-acid batteries batteries used in patient equipment, pumps and monitors. The facilities management department is responsible for recycling fluorescent lights and ballasts.
“Instead of crushing the tubes, we recycle them through our vendor,” Heard says. “It’s important that if a mercury-free substitute is not available, managers manage these products to ensure mercury doesn’t get into the waste stream.”
Should a mercury spill occur, the facilities management department contracts with a company specializing in hazmat cleanup to take care of the spill.
“Even if it is a small spill, like a broken thermometer, the vendor comes with the proper equipment, including respirators and Tyvek suites, to handle the job,” Heard says.
Says Dempsey, “One mercury spill can be a very costly experience. We’ve looked at the possibility of training someone in-house to take care of mercury spills but decided to contract with an environmental firm because training and purchasing the required PPE [personal protective equipment] and equipment needed for spill cleanup would be very costly. Plus, the number of spills that we experienced has been so small that it is difficult to justify the expense.”
Heard encourages managers preparing to undertake a mercury-elimination program in their facilities to first complete a thorough inventory of mercury-containing devices in their buildings. She advises managers to start small by focusing on one type of equipment, such as thermometers.
“Try to work in one area at a time instead of attempting to complete it all at once because it will be overwhelming,” she says. The cost of replacing mercury-containing equipment might have to be spread out over several budget cycles. She also suggests inspecting facilities more than once to ensure all devices are inventoried.
Resources are available to managers interested in starting a mercury-elimination program. Web sites provide statistics and case studies showing that mercury-free products work well, which can be helpful if employees are concerned about equipment performance, Heard says.
“Don’t try to reinvent the wheel,” she says, adding that groups like the Ohio Hospital Association environmental leadership council that she serves on provides expertise to other hospitals.
“Following by example is kind of how we got started,” she says. “One of the hospitals that is on our council had already done mercury elimination in their facility, so I was able to model our strategy after theirs.”
When mercury enters the waste stream or poured down the drain, it doesn’t simply disappear. It finds its way into the environment. Protecting the environment from the effects of mercury depends in large part on efforts by institutional and commercial facilities to locate and properly manage existing mercury-containing devices and to prevent the purchase of new devices.
Managers looking for additional information and guidance in developing their mercury-elimination programs can turn to these organizations:
Hospitals for a Healthy Environment is a voluntary program designed to help health care facilities enhance work place safety, reduce waste and waste disposal costs and become better environmental stewards and neighbors. Its “Making Medicine Mercury-Free Award” is a one-time award given to facilities that have met the challenge of becoming virtually mercury free.
The Sustainable Hospitals Project provides technical support to medical facilities for selecting products and work practices that reduce occupational and environmental hazards. Its web site provides information on alternatives to mercury-containing products.
Bowling Green Ohio State University provides information on its Elemental Mercury Collection Program on its web site.
The Occupational Safety & Health Administration has a list of commonly asked questions regarding mercury on its web site that link to resources that provide useful safety and health information about mercury.
Inform Inc. is an independent research organization that examines the effects of business practices on the environment and on human health. Its web site features a list of questions managers can ask manufacturers regarding mercury in building systems.
The U.S. Environmental Protection Agency has a manual on developing and operating mercury-reduction programs in health care facilities. It includes lists of medical equipment and supplies and alternatives for mercury-containing products.
Health Care Without Harm works with the health care industry in pollution-prevention initiatives, including the phase-out of mercury-containing products. Its online mercury resources include the brochures Mercury Thermometers and Your Family’s Health and How to Plan and Hold a Mercury Thermometer Exchange for hospitals, schools and communities.
The Mercury Policy Project works to promote policies to eliminate mercury uses, reduce the export and trafficking of mercury, and significantly reduce mercury exposures at the local, national, and international levels.
The Association of Lighting and Mercury Recyclers assists government agencies to implement programs and regulations that encourage and promote the recycling of all mercury-containing products and waste materials.
Lamprecycle.org. The lamp section of the National Electrical Manufacturers Association sponsors this program, which is a resource for information on recycling spent mercury-containing lamps.
— Renee Gryzkewicz