Mercury in hospitals

Regulations Covering Mercury in Hospitals
The reader is recommended to obtain a copy of the UK Department of Health Publication: The Control of Substances Hazardous to Health (COSHH)- Guidance for the Initial Assessment in Hospitals by D C Glass, A J Hall and J M Harrington. 1989, HMSO, London. ISBN 0-11-321262-3, £7.30.

In this book, each area within the hospital is carefully considered in terms of risk of exposure to all hazardous substances, including mercury. Under the COSHH regulations, the essential requirements for the control of hazardous substances are:

1. identify the risk
2. assess the risk
3. introduce appropriate control measures
4. maintain the controls
5. inform, instruct and train employees about the risks and necessary precautions

In addition, paragraph 36 of the supporting UK Code of Practice specifically covers spillages:
"If, in spite of the above, spills of a hazardous substance could still occur, means should be available for limiting the extent of risks to health and for regaining adequate control as soon as possible. The means should include, where appropriate, established emergency procedures, safe disposal of the substance and suitable personal protective equipment."

Sources of Exposure in the Hospital
Mercury is present in hospitals mainly in clinical thermometers and sphygmomanometers (blood pressure gauges), where breakage results in a potentially hazardous spillage which can affect both patients and staff. The higher ambient temperatures in hospitals enhances the release of dangerous mercury vapour after a spill. Unless such spillages are dealt with quickly and efficiently, contamination of the floor and fabric of the room will continue to produce harmful mercury vapour for years afterwards. In hospitals, breakage of mercury thermometers is very common and has been estimated at two thermometers per bed per year. In an average hospital this represents the accidental spillage and dispersal of kilogram amounts of toxic mercury, with severe potential adverse health effects.

According to the COSHH Hospital Guidance book, mercury is considered to be a hazard in the following areas in a hospital:

• Accident &Emergency Department
• Dental Department
• Endoscopy Department
• Estates and Works Department
• Fracture Clinic
• Instrument Repair Workshop
• Laboratories
• Outpatients Clinics
• Pharmacy
• Sterile Supplies Department
• Stores
• Wards

The UK Department of Health Safety Information Bulletin SIB(88)14 describes the manner in which mercury spillages should be dealt with:

1. Combine the droplets of mercury if possible
2. Pick up as much mercury as you can using a syringe
3. Apply an absorbent to the affected area
4. Contain the waste mercury in a well labelled, lidded plastic container
5. Ventilate the room well
6. Waste mercury should be sent for reclaiming or disposal as toxic waste

The Mercury Safety Products spillage kits are designed to comply with and exceed these requirements, offering a multiple-use spillage kit with a long shelf life and a unique absorbent wool for use on all surfaces, as well as the facility for decontamination using COSHH-approved technology. Sample spillage kits are available to hospitals for evaluation.

How Many Spillage Kits are Required for my Hospital?
The primary consideration in dealing with mercury spillages is restricting the spread of the spillage. In practice, this relates directly to the speed of access to a spillage kit. Delays in dealing with the spillage result in people walking through the affected area and spreading the contamination even further.

For this reason, spillage kits are best sited close to the likely incident areas. In most hospitals, these will include the wards, Accident and Emergency, clinics, biomedical engineering or repair workshops, pharmacy, stores and all laboratories. Siting just one or two kits in peripheral areas such as the Estates Office or Stores, to be called out by telephone in the event of a spillage, results in major delays and a potential worsening of exposure risk - even closure of parts of the hospital.

When the University Hospital at Nottingham, UK (1300 beds) implemented the Mercury Safety Products kits, which their Pharmacy Unit had helped design, they worked to the following guidelines:

• one kit per ward cluster
• one kit per laboratory cluster
• one kit per workshop
• one kit per consulting/clinic area
• one kit for each pharmacy unit
• plus replacement items held in the Pharmacy Stores
• plus spare kits held in Pharmacy Stores
  TOTAL 70 kits

In our experience, the average hospital with 200 beds will find that 15 spillage kits will meet their needs, based on the above distribution guide, although the exact number will be determined by the layout of the wards and other hospital facilities. Older hospital buildings linked by walkways will require more spillage kits to adequately cover all likely incident areas. Each kit can be used four or five times and has a shelf life of about four years and so the cost of protection is low, even when multiple kits are used to cover the premises.

For the smallest private hospitals or cottage hospitals with 20 or so beds, 3 or 4 kits should suffice. If electronic or disposable patient thermometers are used in the wards, then the risk is mainly from sphygmo- manometers and in the laboratories and repair workshops. This will reduce your total spillage kit requirements considerably, as the incidence of sphygmo breakage is much lower, although under COSHH you will still need to provide cover for mercury exposure wherever sphygmos are used; Health and Safety inspectors will rigorously enforce this.

Don't forget - sample spillage kits are available for evaluation by your hospital.

Developing a Mercury Safety Policy for your Hospital
We have helped many hospitals to develop a mercury safety policy tailored to their exact needs, so that they comply fully with Health and Safety requirements.

Outline of Mercury Safety Policy

1. Basic Principles
   Wherever there is risk of mercury exposure in the hospital following equipment breakage, there should be located, reasonably close by, the means to prevent spreading of the mercury and to limit vapour exposure. Spillages should be reported to the Health and Safety Officer or to a central administration office. Waste mercury must be disposed of in accordance with the regional procedures for dealing with this.
2. Control Measures
   Mercury spillage kits should be provided on the hospital site in order to allow rapid access in the event of spillage. The level of risk should be assess, based on the number of mercury-containing thermometers and sphygmomanometers in use and the frequency of replacement due to breakage or repair.
3. Training
   Staff should be given adequate training in the use of mercury spillage kits; in the reporting procedures required and also the proper routes for obtaining spares and the disposal of waste.
4. Maintenance and Reporting
   The Health and Safety Officer or administration office will be able to monitor the use of the mercury spillage kits deployed throughout the hospital, maintaining them in a condition suitable for use during their storage life. The reporting form will allow the assessment of speed of response in the event of spillage, which in turn can be used in training and target setting. We have drafted some sample forms to help you design yours.
5. Disposal
   Waste mercury should be disposed of as toxic waste. Many hospitals choose to double-bag the full waste containers and incinerate them; however it is more environmentally acceptable to forward the waste for reclaiming of the mercury. This can be arranged through the health authority (as is done for dental waste) or via a contractor. Alternatively, the waste mercury can be disposed of as Special Waste via a contractor.
   Need more help ? If we can help you further, please contact us at Mercury Safety Products.

View further information about Dealing with a Spillage, or about How the Kits Work.