Mercury Use Reduction & Waste Prevention in Medical Facilities

MERCURY IN MEDICAL FACILlf 1
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MeHcury Use R£n^i^K'W
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Table of Contents
&EPA
UnHedStates
Environmental Protection
Agency
Introduction
9
The Big Picture: Mercury in the Environment
9
Risks of Exposure for Humans to Mercury
9
Look in the Mirror; Mercury in Medical Institutions
9
Prevention Measures of Mercury Pollution
9
Tracking Progress of Mercury Pollution Prevention
9
EPA & State Agencies
0
Glossary
9
Bibliography
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General Introductions
This is an interactive environmental education software program developed jointly by Purdue University
and the United States Environmental Protection Agency (EPA) to provide information on the proper
handling and disposal of mercury wastes produced by medical facilities.
EPA recognizes the need to develop, or support the development of incentives to move pollutant
generators to policies and practices that rely more heavily on pollution prevention, rather than on
management practices of pollution of disposal and release. This is especially true for persistent toxic
pollutants which are sometimes managed in ways that essentially shift the pollutant from one media to
another.
Pollution
should be
prevented
or reduced
whenever feasible.
SOURCE REDUCTION
RECYCLING
WASTE
MINIMIZATION
TREATMENT
Disposal or other release to the
environment should be employed
only as a last resort!
DISPOSAL/
RELEASE
Keeping mercury out of water and the atmosphere is critical to
our health and safety.

The purpose of this program is:

1. to introduce you to the dangers of mercury in the
environment, and
2. to identify preventive measures against environmental
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pollution by mercury from medical facilities.
Alternatives to mercury use in health care settings are identified, and proper management techniques for
handling used mercury and mercury spills are described.
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Mercury in Medical Care Settings
Mercury or mercury compounds are found in many
instruments regularly used in medical institutions
such as blood pressure monitors, dental amalgam,
thermometers and thermostats. Mercury and
\ mercury-containing products are used in patient
areas and pathology labs, in clinical procedures
(such as x-rays), and in medicines.

At least 20 different medical products contain mercury, and many mercury-containing solvents and
degreasers are found in labs, housekeeping departments, kitchens, and maintenance areas.

Storage rooms may also be filled with used, damaged, or
outdated equipment or supplies that contain mercury. Mercury
is an ingredient in some proprietary formulas used to
manufacture medical and industrial supplies.

Breakage, waste disposal, and spills from
these products release mercury to the
atmosphere or to drains, where it can
persist for many years.

Some products that formerly contained
mercury are no longer manufactured. However, older products are still part of the
environment. In fact, broken or obsolete equipment is often the primary source of mercury waste at
many hospitals and clinics.

Industrial and chemical uses of mercury are manifold
in the medical community: mercury is present in
fluorescent and high-intensity lamps, thermostats and
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MERCURY IN MEDICAL FACILITIES
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batteries.
switches, and a variety of generators, manometers, and
Non-medical uses of mercury are also present in a variety of products: cleaning
solutions, preservatives, paints, and antifouling agents for wood and other surfaces.
Some uses of mercury are purely frivolous or unnecessary, such as singing greeting
cards, talking refrigerator magnets, lighted athletic shoes, and toys. Patients, visitors,
and employees bring these products into the facility.
According to the EPA's proposed rule for medical waste
incinerators, incinerators are a significant source of mercury
emissions to the atmosphere. Medical care facilities may also
emit mercury through accidental spills and releases, that is,
through discharges to wastewater and landfills. The amount of
mercury in such releases may be quite small. Still, any release is
costly and may add to mercury's buildup in the environment.
Mercury spills may result in additional fish advisories, and in
some circumstances, mercury spill cleanups can be expensive.
The guidelines recommended in this program will help minimize
or eliminate mercury releases from medical facilities.
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What is Mercury?
Mercury (or "quicksilver"), is a naturally occuring element of remarkable qualities, a volatile liquid
metal (at normal temperatures) that easily becomes a gas. Mercury (chemical symbol Hg, atomic
number 80) conducts electricity, and can be used to directly measure temperature and pressure. Its
applications can be found everywhere in human society:

as a catalyst in industrial processes
in solvents, and pesticides:
in temperature and pressure measurement instumentation
in electrical switches, lamps, and batteries
in paints and preservatives
in cosmetics, and Pharmaceuticals
in dental amalgams (fillings)

Mercury is one of the group of elements known as heavy metals. Many of these (including lead,
cadmium, and selenium) are toxic to living things. Mercury can also kill living things, ranging from
bacteria to human beings. In particular, it can be converted into an organic form, methylmercury. which
is especially dangerous because it is easily absorbed into living tissues and it bioaccumulates.
3B 4B SB 6B 7B
Actinides
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Presence of Mercury in the
Environment
Mercury is a naturally occurring mineral that can be found throughout
the environment. Mercury forms can be found as the elemental metal
or in a wide variety of organic and inorganic compounds.
There is a constant biogeochemical cycle of mercury. This cycle
includes:

• release of elemental mercury as a gas from the rocks and waters
(degassing):
• long-range transport of the gases in the atmosphere:
• wet and dry deposition upon land and surface water;
• absorption onto sediment particles;
* bioaccumulation in terrestrial and aquatic food chains.
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Natural and Manmade Emissions of Mercury
MERCURY SOURCES
IN THE MIDWEST
Annual deposition
= 1 gram in a 20
acre lake
Mercury is released to environmental media (air, water,
soil) by a wide variety of natural processes and human
interventions. Worldwide, natural emissions of mercury
from physical and biological processes may equal or
exceed manmade emissions.

The global anthropogenic emission rate for mercury is
estimated to be 650 metric tons (650,000 Kg) annually,
while natural emissions could be as much as 1020 metric
tons (1,020,000 Kg). While the totals are quite uncertain, natural emissions may comprise about 50
percent of them.

Even if all manmade emissions of mercury were eliminated, a significant natural discharge
to the environment —through both biological and physical processes-- would persist.
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Mercury in Nature: Chemistry and
,, ...:•;.:,.. Biology
MERCURY CONTAMINATION IN UXKES
Global Pollution

Regional Pollution
Mercury Vapor
Global Pollution
Particulate Mercury
Ionized
•»
' Mercury Vapor

Minnesota Pollution Control Agency
Local Deposition
and washout

Methyl Mercm;
Significant amounts of mercury are directly released from the earth's
crust by the process of degassing. Both natural and manmade emissions
are modified by biological processes into forms more directly harmful
to human beings. All forms of mercury are toxic, but the various forms
are more or less available for absorption by animals and humans.
Methylmercury, the organic form of mercury that is often found in fish,
is easily absorbed by the body and is highly toxic. Elemental mercury is
highly volatile, and inhaling elemental mercury vapor can present a
serious health riisk, as often occurs when mercury metal is spilled
indoors. Mercury also occurs in an ionic form as a salt.
Common bacteria of the soil and water have adapted to the presence of mercury.
They have developed methods to detoxify its organic compounds and salts to the
elemental form of mercury. Elemental mercury can be transported long distances
via the atmosphere. Once it reaches inland aquatic environments however,
elemental mercury can again accumulate and be transformed into methylmereury,
the toxic form that bioaccumulates in fish, animals, and humans. This toxic
transformation can occur from any of three causes:
• the photochemical (abiotic) action of sunlight
• the methylcobalamin (a hydrocarbon compound), excreted by bacteria
• the plants of aquatic ecosystems.
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Mercury in the Atmosphere
At least 99 percent of all mercury in the atmosphere exists in the elemental
gaseous form of mercury-zero. Much of the remainder is mercury-two,
which is water soluble and the form most often deposited by rainfall.
Most of the mercury in the atmosphere comes from
natural degassing from water and rocks. Major
manmade discharges to the atmosphere come from:

mining and smelting of mercury ores
industrial processes using mercury
combustion of fossil fuels, primary coal.
Less common manmade sources of atmospheric mercury include:
paint application
waste oil combustion
geothermal energy plants
municipal and waste incineration.
diffuse emissions from dental procedures
One important local source of atmospheric mercury is the incineration of medical wastes.
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Mercury in Water find Soil
Mercury can enter water by many different routes and processes:
wet and dry atmospheric depositions
particle flux to sediments
dissolved species exchange at sediment/water interfaces
gas exchange at air/water/surface interfaces
moving dissolved species exchange and particle flux via stream and
rivers
dissolved species exchange via runoff from groundwater to lakes
direct discharge of dissolved species via groundwater to lakes
gas exchange at soil-air ion interfaces
Manmade discharges may result
from industrial processes, such as:
chlorine-alkali production
mining operations
paper mills
leather tanning
pharmaceutical production
textile manufacture
MERCURY CONTAMINATION IN LAKES
Global Pollution

Regional Pollution
Mercury Vapor
Global Pollution
Participate Mercury

Ioni2ed Local Deposition
Mercury Vapor and washout
Minnesota Pollution Control Agency
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Trouble in the Waters: Methylmercury
In lakes and streams, mercury
is transformed into a toxic form.
Mercury
Bacteria and
chemical processes
Methy! mercury
In the aquatic environment, mercury can be:

• dissolved or suspended in the water
• trapped in the sediments
• ingested by living things (biota)

Methylmercury is the form of mercury most available and most toxic
to biota (including zooplankton. insects, fish, and humans). This form
of mercury is easily taken up by biota and bioaccumulates in their
tissues. Unlike many other fish contaminants, such as PCBs. dioxin.
and DDT, mercury does not concentrate in the fat, but in the muscle
tissue. Thus, there is no simple way to remove mercury-contaminated
portions from fish that is to be eaten.

The local aquatic environment largely determines how much
available mercury takes the accessible toxic for of methylmercury.
Research suggests that sulfur-using bacteria are a major source. The
extent of biomethylation may depend upon such factors such as pH.
(i.e. alkalinity), available sulfur sources, and dissolved organic
materials.
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Mercury in the Soil
Human agricultural activities may release mercury to the soil through
direct applications, such as:

• organic and inorganic fertilizers (especially sewage sludge and
compost)
• lime
• fungicides

Once in the soil, mercury compounds may undergo the same chemical
and biological transformations found in aquatic systems. Elemental •••-.,„ ««**«,
mercury will form various compounds with the chloride and hydroxide
ions of soils. The exact result will depend upon the pH. salt content,
and other characteristics of the soil.

For soil, like water, both inorganic chemistry and the actions of living
things will affect the formation and degradation of organic mercuric
compounds. For example, elevated levels of chloride ions will reduce
methylation of mercury in river sediments, streams and soils. In contrast, increased levels of organic
carbon and sulfate ions will increase methylation in sediments.
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Mercury in the food Chain
Benthic (bottom-dwelling) invertebrates and certain fish and amphibian
species may face exposure to mercury by absorbtion through direct contact
with sediments via skin and gills. They may also release mercury bound in the
sediment by direct ingestion. Having thus entered the food chain, mercury
bioaccumuiates as bottom dwellers are consumed by others.

Toxic methylmercury can inflict increasing levels of harm upon species near
the top of the aquatic food chain. These likely victims include: predatory fish
such as freshwater trout and salmon, ocean swordfish and tuna; turtles; fish-
eating birds such as loons, cormorants, pelicans, ospreys, and eagles; and
humans.

There is a great deal of uncertainty as to the sensitivity of various organisms
to mercury. The exposure levels believed to be safe for humans may protect
certain species but not others. The modes of exposure experienced by many
species, particularly in the aquatic realm, differ drastically from those of
humans. This makes it diifficult to ascertain the methylmercury threshold dose
for adverse effects to the many species of wildlife.
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The Worldwide Mercury Cycle
There is a worldwide cycling and recycling of mercury through the
environment, called the biogeochemical cycle of mercury. The cycle has
six steps, as shown in the adjoining diagram:

1. Degassing of mercury from rock, soils and surface waters.
2. Movement in gaseous form through the atmosphere.
3. Deposition of mercury on land and surface waters.
4. Sorbtion of the element as insoluble mercury sulfide.
5. Precipitation or bioconversion into more volatile or soluble forms.
6. Either:
a. Reentry of mercury into the atmosphere, or
b. Bioaccumulation in terrestrial or aquatic foodchains.
Elemental metallic mercury ("elemental mercury"), released to the atmosphere in vapor form, can be
transported very long distances. Eventually, wet and dry deposition processes return it to land or water
surfaces in the form of compounds.

Wet depositions of mercury by precipitation (rain, snow, etc.) is the primary method of mercury removal
from the atmosphere (perhaps 66 percent of the total). Mercury can also be removed from the
atmosphere by sorbtion of the vapor onto soil or water surfaces.

The particular form of mercury and its compounds strongly influence the movement and partitioning of
mercury among surface waters and soils. Ninety seven percent of all the gaseous mercury dissolved in
water is the elemental form ~ "mercury zero". Volatile forms of mercury, such as the metallic liquid and
dimethyl mercury, will evaporate into the atmosphere. Solid forms particulates in the soil or the water
column, and once in the water column are transported downward to the sediments.
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What Makes Mercury Run?
Sorption of nonvolatile forms of mercury onto soil and sediment particulates is the central process that
determines the distribution of mercury compounds in the environment. This sorbtion process varies
according to the organic matter content of the soil or sediment.

Inorganic mecury sorbed onto particulate material is not easily desorbed. This means that freshwater and
marine sediments will be important storehouses for inorganic forms of mercury, and that leaching from
soils will play a minor role in mercury transport.

Where the soils are rich in humus, surface runoff will be an important route moving mercury from soil
to water.

There are processes that will release the sorbed mercury from particulates:

• Chemical or biological reduction to elemental mercury.
• Byconversion to volatile organic forms.
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Human Exposure to Mercury
A. Ways of Exposure to Mercury
B. Workplace Exposure Limits
C. Ways of Reducing Exposure to Mercury
D. Tests for Mercury Exposure
E. Monitoring for Workers Exposed to Mercury
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Ways of Exposure to Mercury
Mercury in its various forms (pure element, inorganic compounds, organic compounds) is found in air,
water, soil and fauna and flora. AH of these environmental media may be involved in human exposure to
elemental mercury and mercury-containing compounds.

Elemental mercury is a liquid and gives off mercury vapor at room temperature. This vapor can be
inhaled into the lungs and passed into the blood stream. Elemental mercury can also pass through the
skin and into the blood stream. If swallowed, however, this form of mercury is not absorbed out of the
stomach, and usually passes out of the body without harm.

Inorganic mercury compounds (ionic mercury) can also be inhaled and absorbed through the lungs, and
may pass through the stomach if swallowed. Many inorganic mercury compounds are irritating or
corrosive to the skin (see other health effects of mercury), eyes and mucus membranes as well.

Organic mercury compounds, like methylmercury. can enter the body readily through all three routes;
lungs, skin and stomach.

Humans are exposed to mercury primarily through ingestionof fish that contain methylmercury.
Inhalation of mercury vapors is a potential occupational risk in industries that process or use mercury.
Skin contact with materials containing organic mercury and elemental mercury may also result in
mercury exposure. People with dental amalgams that contain mercury have greater exposure.
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t
Workplace Exposure Limits
Environmental Protection Agency (EPA): EPA estimates that for an adult of average weight,
exposure to a very small amount (less than 0.021 milligrams [mg]) of inroganic or organic
mercury per day in food or water will probably not result in any harm to health.

Occupational Safety and Health Administration (OSHA): The legal airborne permissible exposure
limit (PEL) is 0.1 mg/cubic meter, not to be exceeded at any time.

National Institute for Occupational Safety and Health (NIOSH): The recommended airborne
exposure limit is 0.05 mg/cubic meter averaged over an 8-hour workshift.

ACGIH: The recommended airborne exposure limit for mercury vapor is 0.05 mg/cubic meter,
averaged over an 8-hour workshift.

The above exposure limits are for air levels only. When skin contact also occurs, a worker may be
overexposed, even though air levels are less than the limits listed above.
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f
Ways of Reducing Exposure to Mercury

Where possible, enclose operations and use local exhaust ventilation at the
site of chemical release. If local exhaust ventilation or enclosure is not used,
Sf respirators should be worn.
Wear protective work clothing.
Workers whose clothing has been contaminated by mercury should change
into clean clothing promptly and place contaminated clothing into designated recepticles.

Do not take contaminated work clothes home. Family members could be exposed.

Contaminated work clothes should be laundered by individuals who have been informed of the
hazards of exposure to mercury.

Do not eat, smoke, or drink where mercury is handled. Wash hands carefully before eating or
smoking.

For clean-up use a specialized charcoal-filtered vacuum or suction pump to avoid generating
mercury vapor. Care should be taken not to disturb spilled material.

Wash thoroughly immediately after exposure to mercury and at the end of the workshift.

If there is the possibility of skin exposure, emergency shower facilities should be provided.

Post hazard and warning information in the work area. In addition, as part of an ongoing
education and training effort, communicate all information on the health and safety hazards of
mercury to potentially exposed workers.
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Tests for Mercury Exposure
There are two tests available to measure mercury in the body:

The mercury blood test measures exposure to all three types of mercury, but because mercury
remains in the blood stream for only a few days after exposure, the test must be done soon after
exposure. Most non-exposed people have mercury levels of 0 to 2 (all blood measurements are in
micrograms of mercury per deciliter of blood, or ug/dl). Levels above 2.8 ug/dl are required to be
reported to the Health Department. This test can be influenced by eating fish, because fish may
contain high levels of mercury.

The urine mercury test only measures exposure to elemental and inorganic mercury. Organic
mercury is not passed out the body in the urine and thus cannot be measured this way. A person
with no exposure to mercury would probably have a urine mercury level of 0 to 20 ug/dl. Some
Health Departments require reporting levels above 20.
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Mercury Monitoring
Medical monitoring is the periodic evaluation of exposed workers to ensure that they are experiencing
no adverse effects of potentially hazardous workplace exposures. It serves as a backup for a program of
routine air and biological monitoring, which are the primary means for ensuring that exposure levels are
below those known to cause adverse health effects. A medical monitoring program should be designed
to detect adverse effects of exposure as early as possible, at a stage where there are still reversible, so
that exposures can be controlled and serious permanent adverse effects prevented.

An initial medical examination should be performed on all employees exposed to potentially hazardous
levels of mercury. The purpose of this examination is to provide a baseline for future health monitoring.

The examination should include a complete medical history and symptom questionnaire, with emphasis
on the:

nervous system (target organ for chronic exposure)
kidneys (target organ for acute and chronic exposure)
oral cavity (target organ for chronic exposure)
lungs (target organ for acute exposure)
eyes (affected by chronic exposure)
skin (since mercury is a known skin sensitizer).

Signs and symptoms of the earliest signs of mercury intoxication should be elicited; these include
personality changes, weight loss, irritability, fatigue, nervousness, loss of memory, indecision, and
intellectual deterioration. Complaints of tremors and loss of coordination should also be sought. Physical
examination should focus on the target organs described above. A baseline handwriting sample should
be obtained. Laboratory evaluation should include at minimum a complete urinalysis.

This examination should be repeated annually. Results should be compared with the findings on the
baseline examination for changes suggestive of mercury toxicity. Handwriting samples should be
compared to the baseline sample for evidence of tremor. Interim evaluations should be conducted if
symptoms suggestive of mercury intoxication are occuring.
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Biological Monitoring
What is biological Monitoring?
Mercury in the Urine
Mercury in the Blood

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What is Biological Monitoring?

Biological monitoring is the measurement of chemical substances in the urine, hair or fingernails, or in
blood or other body tissues of exposed individuals to determine how much of the chemical has been
absorbed into the body. It serves as a back-up to environmental exposure measurements, since air
measurements cannot assess skin exposure or the effects of protective equipment and work practices.
Since it measures the amount of a substance actually absorbed into the body, it is usually a better
estimate of risk for adverse health effect than air monitoring.

There is no ideal monitoring method for evaluating the risks of contamination from elemental mercury.
Mercury can be measured in both blood and urine. Individual levels may vary greatly from day to day
and even within a given day. While proper interpretation of the results can be difficult, the
measurements can nevertheless provide information on potential overexposure. Measurements should be
carried out regularly (several times a year) in chronically exposed workers. Individual as well as
aggregate results should be evaluated. Where possible, baseline levels should be obtained before
exposure begins for comparison purposes.

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Mercury in the Urine

Measurement of mercury in urine is the recommended approach to biological monitoring for workers
exposed to metallic and inorganic mercury. Ideally, the collection should be over 24 hours, but this is
seldom feasible. Spot urine samples may also be taken, but care must be taken to always collect them at
the same time of day near the end of the work week after several months of steady exposure. Overnight
samples may also be collected; this collection extends from the time the employee goes to bed through
the first urination of the morning.

Samples must be collected in containers provided by the laboratory, since a preservative must be added.
At least 25 mililiters of urine must be collected. Great care must be taken to prevent contamination of
the sample containers or the urine with mercury from the skin or workplace air.

When results are interpreted, the urine values should be corrected for grams of creatinine in the sample,
and should be expressed as ug Hg/gram creatinine. In persons not occupationally exposed to mercury,
urine levels rarely exceed 5 ug/g creatinine.

While many laboratories indicate that only levels above 150 ug/L should be considered toxic, there is

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strong evidence that early signs of mercury toxicity can be seen in workers excreting more than 50 ug
Hg/L of urine (standardized for a urinary creatinine of 1 gram/L). This value of 50 ug/g creatinine is
proposed by many experts as a biological threshold limit value for chronic exposure to mercury vapor,
and in 1980 this was endorsed by a World Health Organization study group. Recent studies have found
subclinical effects (changes in urinary enzymes) as low as 35 ug.

Exposed individuals with levels above 50 ug/g creatinine should be placed in a low-exposure job until
the reason for their elevated level of mercury has been identified and corrected, and worker urine
mercury levels have fallen below the biological threshold limit value.

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Mercury in the Blood

The concentration of mercury in blood reflects exposure to organic mercury as well as metallic and
inorganic mercury; thus it can be influenced by the consumption offish containing methylmercury.

Samples should always be taken at the same time of day near the end of the work week after several
months of steady exposure. The blood should be collected in mercury-free heparinized tubes after
careful skin cleansing.

In unexposed individuals, the amount of mercury in blood is usually less then 2 ug/100 ml. According to
some experts, an average airborne concentration of 50 ug/cubic meter corresponds to a mercury
concentration in blood of about 3-3.5 mg/100 ml. Early effects of mercury toxicity have been found
when the blood concentration exceeds 3 ug/100 ml. Any workers exceeding this level should be placed
in a low-exposure job until dietary and workplace exposures have been evaluated and worker blood
mercury levels have returned to baseline.

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Effects of Mercury Poisoning in
Humans

Larynx
Jugular Vein
Thyroid Gland
Muscle

Pleura! Membrane
Right Lung
Heart

Ribs
V
Sternum
{Breastbone]
Trachea
Thy m us
Gland
Blood vessels
to and from Lungs
-Bronchus
Bronchiole

Intercostal
Muscle
Diaphragm Aorta
Mercury is both a precious metal and a neurotoxin. The "mad hatters" of the 19th century suffered from
mercury poisoning - so did the hat makers in Danbury, Connecticut, who called their disease the
Danbury Shakes. In short, mercury can be harmful to fish, waterfowl, wildlife, and humans.

The mercury felting process prevalent in the nineteenth century and many other industrial uses of
mercury have been discontinued, and today most people are not exposed to dangerously high levels of
mercury in their job settings. However, mercury may still be an occupational hazard for people working
in medical care facilities.

Suppose, for example, a thermometer breaks or a mercury-containing solvent spills. If mercury vapor is
inhaled, as much as 80 percent of the inhaled mercury may be absorbed into the bloodstream.

The biological half-life of mercury is 60 days. Thus, even though exposure is reduced, the body burden
will remain for at least a few months.

The effects of mercury poisoning can be classified as:
- acute.
- chronic, or
- other

The degree of risk varies depending on how much mercury a person is exposed to and how often, and on
stage of life. The work environment can be designed to minimize workers' exposure. We can, for
example, be as careful about mercury as we are with x-rays. But not all of the mercury that we use
remains in the facility. Some of it escapes into the environment, undergoes change, and may eventually
be eaten by fish. Mercury-contaminated fish are the most likely source of mercury's potentially adverse
effects on human health. It is recommended that mercury's uses in medical settings be eliminated, not
because its presence makes medical facilities dangerous places to be, but to help keep mercury out of the
environment.
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Case Studies in Humans
Section Menu:

A. Minamata Disease

B. Iraq

C. Guatemala

D. New Mexico

E. Belle-Glade. Florida

F. Boca Raton. Florida

G. Illinois
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Minamata Disease
What we now call "Minamata disease" was first observed in communities near Minamata Bay in
Southwestern Japan. It was officially "discovered" in 1956, and by 1959 it had been demonstrated that
the disease was caused by ingestion of fish contaminated by mercury discharged from a chemical
manufacturer plant.

Levels of methylmercury chloride reached 50 ppm in fish and 85 ppm in shellfish obtained from the
contaminated areas. One hundred and twenty one persons were poisoned, 46 fatally, from eating the
contaminated fish. Dogs, cats, pigs, rats, and birds living around the bay developed classical clinical
signs and many died.

In most cases, the patients began to show symptoms without any apparent signs. The onset began with
numbness of the limbs and the area around the mouth, sensory disturbance, and difficulty with hand
movements (such as grasping things, fastening buttons, holding chopsticks, writing, etc.); also, there was
lack of coordination, weakness and tremor, slowed and slurred speech, and ataxic gait, followed by
disturbances of vision, and hearing. These symptoms became aggravated and led to general paralysis,
deformity of the limbs, difficulty in swallowing, convulsions, and death.
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Iraq
In 1956 in Northern Iraq, over 100 people were poisoned by eating flour mixed with wheat seed treated
with a fungicide containing 7.7% ethylmercuri-p-toluene sulfonalide. At least fourteen of the intoxicated
people died. They had fed the treated seed to chickens for several days and after observing no ill effects
had eaten it themselves. In addition to central nervous system manifestations, a number of other clinical
signs were observed including polydypsia, polyuria, weight loss, severe proteinuria, deep
musculoskeletal pain refractive to anlagesics, and prurits of the palms, soles, and genitals. Researchers
attributed the other clinical signs to the prevalence of a parasitic disease called ancylostomiasis, and to
dietary deficiencies of protein and vitamins.

Four years later during the winter and spring of 1961, an additional 100 people were poisoned by flour
and wheat seed treated with a fungicide containing 1% mercury as ethylmercury chloride and
phenylmercury acetate. Four of 34 patients died; however, the authorities believed others probably died
after refusing hospitalization or signing out against medical advice. A combination of clinical signs was
observed reflecting insult to the central nervous system by the ethylmercury fraction and to the renal and
gastrointestinal organs apparently due to the phenylmercury component.
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Guatemala
During the wheat-planting seasons of 1963-1965, numerous cases of a disease suspected of being a viral
. encephalitis occurred in and around Panorama, Guatemala. Forty five cases were observed, over 50% of
which occurred in children, and 20 of these died. Autopsy and subsequent tissue analyses disclosed high
levels of methylmercury in brain, liver, and kidney tissue of one victim. Being too poor to buy enough
food to survive, the victim had eaten wheat seed treated with a fungicide containing 1.5% mercury as
methylmercury.
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New Mexico
As a result of human consumption of pigs previously fed organomercurial compounds, mercury
poisoning became evident in a farm family in Alamogordo, New Mexico. On December, 1969, an 8-
year old farm girl living near Alamogordo, New Mexico, developed ataxia, visual disturbances, and a
reduced state of consciousness which progressed to coma within a period of 21 days. Two weeks after
the onset of her illness a 13-year old male sibling developed similar clinical signs and, like his sister,
became comatose within a 3-week period.

By the end of the same month, a 20-year old sister developed similar clinical signs and became
semicomatose. At the time the pork containing the high levels of mercury was eaten by the 10 members
of the farm family, the mother was 3 months pregnant. She did not eat any of the meat after her sixth
month of pregnancy. Clinical examinations during the last 2 months of her pregnancy disclosed only
normal findings; however, her urine contained high levels of mercury. The pregnancy terminated with
delivery of a 6.7-lb male infant. At birth he manifested intermittent trembling of the extremities which
persisted for several days; however, he was otherwise normal. Electroencephalograms,
electromyograms, blood electrolytes, calcium, magnesium, glucose, and bilirrubin remained normal
during the first 6 weeks. Marked elevation of urinary mercury was present during the first 6 weeks;
however, after that time urinary mercury was no longer detected.

Electroencephalograms became slightly abnormal at 3 months of age; by 6 months of age they were
markedly abnormal, and generalized myoclonic jerks had developed. By 6 months of age, the infant had
nystagmoid eye movements without evidence of visual fixation, was hypotonic and irritable. All of these
clinical signs and other physical examination findings have been observed in Japanese children bora to
parents who consumed various fish caught from Minamata Bay and surrounding areas. The poisoning of
these children presumably resulted from transplacental poisoning with organic mercury.
Six months after the initial appearance of clinical signs among members of the farm family in New
Mexico, their condition remained essentially unchanged. The 8-year old girl and 13-year old boy
remained comatose; however,, the 20-year old sister continued to improve and was able to speak and
walk with difficulty. The neonate's condition remained unchanged.
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Belle-Glade, Florida
August 1994 - more than 500 students in Belle-Glade Florida were contaminated with liquid mercury
after three boys found four jars filled with the silvery metal in an abandoned van. The boys brought the
jars of mercury to school and passed it out to their friends. The children were fascinated by the silvery,
liquid metal. "You ever seen "Terminator II?" asked a 14-year-old boy, "When the bad guy melts into
the ground? That's just what it's like." The students played with the mercury, rubbing it on their teeth,
throwing it at each other, dipping their jewelry into it, and pouring it into a local canal. Many children
took home samples in paper cups and bags.

Although inhaling mercury vapors is by far a more serious threat than swallowing liquid mercury, local
officials were very concerned. "If the children ate small amounts, that is not likely to be toxic," a local
pediatrician stated. "The problem is going to come if the mercury is spilled or if its stays in a child's
pockets. When it is vaporized and inhaled, it can be very, very toxic." Initial symptoms include a cough,
breathing difficulties, and chest pain. Vomiting, diarrhea, fever, and nerve or kidney problems may
develop later.

Hundreds of children had to be decontaminated. The local hazardous waste materials team, dressed in
yellow safety suits, stood the children in a wading pool, hosed their arms, and scrubbed their skin with
brushes. Doctors at area hospitals were on call 24 hours-a-day for several days to examine the children
and adults exposed to the mercury and to give free blood tests. More than 20 homes had concentrations
high enough to be of concern to the U.S. Environmental Protection Agency (EPA). Families had to be
evacuated while EPA decontaminated these homes.

A hospital spokesperson said that he did not think any children had come in contact with enough
mercury to cause any serious damage. No permanent damage to the children is expected.
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Pagel ofl
Boca Raton, Florida
November 1994 - Over the Thanksgiving break, college students at Florida Atlantic University in Boca
Raton, Florida removed liquid mercury from one of the school's laboratories. Although the laboratory
manager noticed the missing chemical when he returned on Tuesday morning, he did not report it to
authorities until the mercury was discovered spilled inside and outside of a university dormitory.
Students living in the dormitory were evacuated and housed in a local hotel while the dormitory was
decontaminated. Potential short- or long-term damage is unknown.
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Illinois
Spring 1994 - A young boy in Moline, Illinois may suffer severe nerve damage due to mercury
poisoning. The child brought home liquid mercury from the school science room and played with it in
his basement. He spread the silvery liquid on his arms and legs in an attempt to look like the Tin Man
from the Wizard of Oz. The home was so contaminated that the family was evacuated for nearly 10
months while the U.S. Environmental Protection Agency (EPA) cleaned up the spilled mercury. Ceiling
tiles and the air conditioning and heating systems also were replaced. Although the boy is now
recovering, the extent of permanent damage is unknown.
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Mercury in Medical Institutions
Section Menu:

1. Virtual Hospital: Mercury Presence by Room Type
2. Mercury Containing Equipment in Medical Institutions
3. Mercury Products Used in Medical Laboratories
4. Mercury Stains Used in Medical Laboratories
5. Mercury Products Used in Dental Clinics
6. Other Sources of Mercury in Medical Institutions
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Virtual Hospital
The following image allows you to discover typical sources of mercury contained in specific rooms
types of a medical institution. Simply click on the room of interest. Each page contains a panorama
image which you can navigate. Either click and drag to rotate the image, or use the cursor keys. Also,
you can zoom in by pressing the the 'a' key, and you can zoom out by pressing the 'z' key.
L Laboratory I
I |
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Mercury Containing Equipment in Medical Facilities
Equipment
Batteries
Mercuric Oxide
Thermometers
Sphgymomanometers
Barometers
Esophageal Dilators
Cantor Tubes
Miller Abbot Tubes
Feeding Tubes
Electrical Instruments
Lamps
Use
Hearing Aids
Pacemakers
Defibrillators
Fetal Monitors
Hofler Monitor
Pagers
Picker Caliber
Spirometer Alarm
Telemetry Transmitter
Temperature Alarm
Blood Analyzer
Temperature Measurement
Blood Pressure
Weather Conditions
Hg is used as weight at the bottom of the tubes.
Laboratory Ovens (including Microwave Ovens)
Nursing Incubators
Room Temperature Controllers
Refrigerators
Relays
Switches (no noise switch used in patient rooms)
(Fluorescent Lamps
Metal Halide Lamps
High Pressure Sodium Lamps
Ultraviolet Lamps
|Cathode Ray tubes
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Analytical Instruments using
mercury chloride as reagent
[Electron Microscope
Sequential Multiple Analyzer (SMAC)
AU 2000
Mercury used as vibration dampner.

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t
Mercury Products Used in Medical Laboratories
I
[ Test Type
Albumin
[Drugs of Abuse
Antifungal/ Anti-Infectious
/Bacteriostatic Enzyme
I/Ammonia
[Herpes EIA
Reagent

All
Merthiolate
Mercury Nitrate
Mercury Iodide
Buffer
Cytology ]|Mucolex
Urine Analysis ||Stabilur Tablets
Hepatitis B Core ][
Hepatitis B AG & AB ]p
Hepatitis C J
HIV
CA125
|Progesterone
Blood Bank Saline
Identification of White Cells
Clostridiwn difficile
Group A Streptococcus
Giardia
Fixatives
Histology
Harris Hematoxylin
Antibacterial Agent

Immu-sal
Cameo

B 5 Fixative
Zenker's Solution
Helly
Ohlamacher
Carnoy-Lebrun
Shardin

Mercuric Oxide
|Mercurochrome
Mercurial Diuretic llMercurophyline
(known as mercupurin) ||
Flame photometer
(obsolete use)
Protain Test
(contain Hydroxyphenol
group)
BUN Test
Mercury Sulfate
Millon's Reagent
Nessler's Solution
Mercury |
Thimerosal |
Thimerosal |
Thimerosal
(26%ofHg).
Thimerosal |
Thimerosal |
Mercuric Oxide |
Thimerosal j
Thimerosal |
Thimerosal |
Thimerosal |
Thimerosal
Thimerosal

Thimerosal
Thimerosal
Thimerosal
Mercuric Chloride
Mercuric Chloride

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MERCURY IN MEDICAL FACILITIES
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Enzyme
Non Protein Nitrogen
Pharmaceutical Preservative
Takata-ara
uMessler's Solution
(Nessler's Solution
[Phenol Mercuric Acetate
|Takata's Reagent

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f
Mercury Stains Used in Medical Laboratories
\ Test Type
|| Stains |
[Microbiology
Histology
Histology
[Histology
[Histology
(Ganglion Cells
JHBFT
Use in delineating nerve
Gram Iodine |
Carbol-Fuchin |
||Mercury Chloride |
||Carbol Gentian Violet |
||Gomori's |
ID
Cajal's
)|Alum Hematoxylin (Solution A)
cells||Golgi's
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MERCURY IN MEDICAL FACILITIES
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Mercury Products Used in Dental Clinics
Chemical

Dental Amalgam
Use

Dental filling
Dental amalgams do not pose a health risk. However, their disposal is a potential source of mercury to
the environment. Separate collection and recycling are recommended along with predetermined
operating procedures and spill cleanup measures.
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Other Sources of Mercury in Medical Institutions
• Mercury and mercury compound trapped in the sewer
traps during spill.
• Incinerators: Mercury is discharged to air while burning
or discharged to water through water scrubber.
• Manhole Bottom: Mercury accumulates in the sludge at
the bottom of the manhole .
• Cleaning Chemicals.
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Prevention Measures of Mercury Pollution
Section Menu:
1. General Guidelines
2. Case Studies
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t
Preventing Mercury Pollution: General Guidelines
EPA regulates mercury disposal in manufacturing and other industries. However, there are currently no
regulations restricting the discharge of mercury down the drain at medical institutions and laboratories.

Therefore, it is up to the individual facilities to be responsible and
help keep mercury out of their waste streams and thus out of the
environment.

Accidental spills and waste from medical facilities contribute in
some measure to the fate of mercury in the environment.
Other industrial sources and human activities may be quantitatively more significant, but pollution
prevention begins on home ground, and each of us - in even the smallest medical facility - can make a
difference.

Remember: any mercury released to the environment can be converted to methylmercury. which can
bioaccumulate in the food chain. Therefore, eliminating smaller amounts of mercury will have a
beneficial effect on the environment.

This program will help you design a mercury pollution prevention program at your facility. Guidance is
also available from state and federal agencies. Some states even have waste reduction requirements for
hospitals. Still, your program will differ from others in your state, depending on local conditions and
because voluntary efforts are often more flexible than regulatory approaches.

Identify the key players at your facility. Who has access to
doctors and nurses, to engineers, safety officers, suppliers,
and housekeeping and maintenance personnel? Engage
these people as a team to spearhead your program. Their
careful planning will ensure that your program is unique -
notwithstanding that all programs may have similar
strategies and goals. Even if you cannot immediately
replace all the mercury-containing equipment that your
facility has accumulated over the years, every direct action
j, you take will make a difference!

The objective of this section is to get you started in setting up a mercury pollution prevention program
that meets eight sets of guidelines:
GUIDELINES
1. Training and communications
2. Good housekeeping and plant management
3. Auditing your program and facility regularly
4. Setting attainable goals
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MERCURY IN MEDICAL FACILITIES
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5. Proper handling and disposal of mercury products
6. Selecting alternative mercury-free prgducts
7. Recycling mercury-containing products
8. Instituting procedures for immediate spill cleanups
Whatever you do, make it your goal to eliminate mercury entirely. Look carefully at your facility. How
serious is the problem? What are the symptoms? Who else is aware of the problem and will help in
remediation efforts? Once you have developed a case history, it will be far easier to determine die cure.
Pollution
should be
prevented
or reduced
whenever feasible.
SOURCE REDUCTION
RECYCLING
WASTE
MINIMIZATION
TREATMENT
Disposal or other release to the
environment should be employed
only as a last resort!
DISPOSAL/
RELEASE
Disposing of mercury, no matter how carefully, should be the last resort. No matter how small the
quantity, mercury is always a toxic waste. Engage everyone at your facility in the program because
everyone's participation is vital. It takes only one person to begin pollution prevention.
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Preventing Mercury Pollution: Case Studies
Section Menu:

A. St. Mary's Medical Center (Dulluth. Minnesota)
B. University of Michigan Health System (Ann Arbor. Michigan)
C. Alpena General Hospital CAlpena. Michigan)
D. Butterworth Hospital (Grand Rapids.JVIichigan)
E. Genesys Health System (Flint. Michigan)
F. Henry Ford Hospital (Detroit. Michigan)
G. Bronson Methodist Hospital (Kalamazoo. Michigan)
H. Quest Diagnostics. Incorporated (Wyoming. Michigan^
I. Mercury Management at Mavo Clinic
Summary of Mercury Pollution Prevention in Selected Michigan Hospitals

Administrative Directives
- Purchasing, etc.
(Formal vs. Informal)
Clean Drain Traps/Catch Basins
Educate Staff
Install Energy
Efficient Lighting
Inventory Mercury Use
Mercury-free Batteries
Purchase New
Mercury-free
Sphgmomanometers
Replace Broken
Sphgmomanometers
w/ Mercury-free Units
Replace Thermometers
Separate Wastes
Substitute Pathology
Lab Regeants
Training on Spill
Prevention/Management

U of M

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MERCURY IN MEDICAL FACILITIES Page 1 of 2
Preventing Mercury Pollution: Case Studies
A. ST. MARY'S MEDICAL CENTER

L. Build.Support
2. Form team
3, Perform an Assessment
4. Take Action
5. Document Share Results

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1. Build Support

St. Mary's Medical Center is a 326-bed hospital located in Duluth, Minnesota. To begin the mercury
reduction project, WLSSD staff met with hospital management to ensure their interest and commitment
to the project. Once support was assured, an existing team of hospital employees (who had already
implemented an excellent solid waste reduction program) worked with WLSSD staff on the project.

1H To Top of Document
2. Form team

The team was made up of representatives from different areas of the hospital. This was important
because of the wide variety of different activities performed in a hospital. Representatives from
maintenance and purchasing were particularly important. The maintenance staff has knowledge of the
inner workings of the hospital which is especially helpful when conducting monitoring. Toxics
reduction projects often require that changes be made in the use of certain products. For this reason, a
representative from the purchasing department is essential to the team.
3. Perform an Assessment

As a first step in the project, the mercury reduction team completed a survey on mercury use provided
by WLSSD. The survey disclosed that St. Mary's had already replaced some mercury containing items,
such as thermometers and blood pressure cuffs, with alternative electronic devices. In addition, mercuric
chloride, a common reagent used in pathology labs, was being captured and handled as hazardous waste
instead of being flushed to the wastewater treatment plant.

A wastewater monitoring plan was then developed to try to pinpoint mercury sources within the
hospital. Often several discharge points may enter the sanitary sewer system from an older building like
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MERCURY IN MEDICAL FACILITIES
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a hospital. Meeting with maintenance staff to review old blueprints is essential before beginning a
monitoring program. Particularly in facilities that have undergone expansion, the use of dye tablets may
be needed to verify source information.

Monitoring results found mercury concentrations varying from 0.3 ppb to 1.2 ppb. The monitoring also
identified the days on which mercury concentrations were high, and where it came from in the hospital.
In this case, the monitoring results were valuable in educating the reduction team. The team felt they had
already solved their mercury problem, and did'nt anticipate additional discharges. Once they saw the
numbers, however, a "can do" attitude quickly developed.
I To Top of Document
4. Take Action

At this point, the mercury in the wastewater appears to be coming from the hospital laboratories and
from the laundry services. Reagents and bleach are the suspected sources. These products are being
investigated and where possible, alternatives will be substituted. Historic sources are also under
investigation. In older buildings where there has been high mercury use in the past, items such as broken
thermometers may have been disposed of down the drain. The mercury accumulates in waste traps and
is discharged in small amounts each time water is used. Traps in nursing stations and in the labs are
being cleaned as part of the reduction effort.
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5. Document Share Results

WLSSD staff will continue to work with St. Mary's on future reduction efforts. New information about
sources of mercury and additional wastewater monitoring results are shared with the team in regular
meetings. Reductions in mercury discharge will continue to be documented and shared.
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Mercury Case Studies - Michigan Page 1 of 4
Preventing Mercury Pollution: Case Studies
B. UNIVERSITY OF MICHIGAN HEALTH SYSTEM

Contact Person: Trixie Dietrich, (313) 764-4427
The University of Michigan Health System
Safety, Building and Environmental Management
(10/4/96)

1. Overview of Pollution Prevention Efforts
2. University of Michigan Health System
3. History
4. Mercury Identification
5. Communication
6. Case Studies
7. Accomplishments
8. Current Efforts/Quality Assurance Measures
9. Future Goals

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Overview of Pollution Prevention Efforts

Pollution prevention (P2) is an important goal at the University of Michigan and the University of
Michigan Health System. We are firmly committed to the waste minimization efforts, energy
conservation and the efficient and responsible use of resources. Many departments across campus are
involved in these efforts. We believe that by working together, we can enhance the environment in
which we live and work.

The University of Michigan Health System initiated a mercury reduction program to systematically
remove mercury-containing equipment from this facilities. This has mitigated the potential for mercury
to enter the environment by reducing the possibility of mercury escaping during accidental equipment
breakage and traditional disposal methods. As of May 1996,440 pounds of mercury was removed from
blood pressure cuffs, thermometers and other equipment. The mercury collected was recycled.

Evaluating mercury containing reagents from laboratories, changing big specifications requiring
mercury free equipment and providing mercury training and education for employees among other
efforts are being performed. A fluorescent light tube recycling program has been implemented to avoid
the potential release of mercury-containing powder inside the bulbs into the environment. Mercury
reduction efforts are monitored by several quality control measures. The mercury reduction goals are
evaluated periodically to assure continues improvement and success.

Efforts are being coordinated cooperatively through the Safety Building and Environmental
Management Department and the Department of Occupational Safety and Environmental Health. Some
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Mercury Case Studies - Michigan
Page 2 of4
of these effort have been performed in settlement of an enforcement action brought by the Michigan
Department of Environmental Quality.

Hi Top of Document
University of Michigan Health System
872 beads - adult and pediatric
Onsite clinics
8000 employees
37 clinics housed in 25 buildings
15 acquired practices
These numbers are always increasing
I Too of Document
History

1992 Discussions began regarding replacement of Hg sphygmomanometers
- Initiated by incidence of Hg spills
- Concerns for exposure potential
- Environmental concerns for Hg in Great Lakes Program
1995 Hospital Hg reduction efforts became a Supplemental Environmental project (SEP) performed in
settlement of an enforcement action by the MDNR.
TOP of Document
Mercury Identification
Terrace Brochure
Hg Pollution Prevention in Michigan
Discussion with other health care facilities
Surveys
Targeted sources
Review material Services inventory for Hg equipment
I Top of Document
Communication
• Written correspondence to specific groups based on identification efforts
• Written correspondence to inform staff about Hg reduction efforts
- asked for voluntary evaluation of Hg containing equipment & products
• Speaking of Safety Newsletter
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Mercury Case Studies - Michigan Page 3 of 4

Top of Document

Accomplishments

• 660 total Hg sphygmomanometers were replace with aneroid units
• Approximately 440 Ibs Hg sent for recycling
• Eliminate B5 reagent from Pathology
• Eliminated Hg thermometers from Material Services inventory
- Cost effective
- More convenient
- Less hazardous
Eliminated Hg filled esophageal devices
Using only thimerosol free products
Pharmacy is not dispensing Hg for Miller-Abbott tubes
New baby kits do not contain Hg thermometers
Using only Hg free batteries
Change language on new equipment acquisitions requiring Hg free if possible
Eliminated most calibration sphygs
Recently implemented a fluorescent light tube recycling program
Some of the project accomplishments were performed in settlement of an enforcement action by
the MDNR

IH Top of Document

Current Efforts/Quality Assurance Measures

Training the offsite clinics as part of the Hazard Communication Program
Collecting dental Hg amalgams and disposing as hazardous waste
Testing incinerator ash prior to disposal to assure compliant Hg levels
Sampling selected sink traps
Hazard Surveillance Rounds
Waste disposal - monitor billing reports
Collecting "discovered" left over equipment

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Mercury Case Studies - Michigan
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Future Goals
Use a substitute for Hg amalgams
Replace barometer with Hg free alternative
Collect Hg at the newly acquired locations
Perform additional Hg sampling
Conduct feasibility study for Hg containing maintenance equipment replacement
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Mercury Case Studies - Alpena General Hospital Page 1 of 1
Preventing Mercury Pollution: Case Studies
C. Alpena General Hospital (Michigan, August 1995)

Alpena General began instituting mercury pollution prevention measures approximately eight years ago
by adopting a purchasing a policy that eliminated mercury-containing items such as thermometers and
sphygmomanometeres. In addition, the institution purchases only mercury-free batteries from suppliers,
and items such as thimerosal-free saline solution are being used.

Alpena's laboratory conducted its own study on mercury in solvents to determine where mercury was
originating. It was necessary to follow this procedure because manufacturers might not list the solvents'
ingredients if the formula is under copyright protection. Material Safety Data Sheets might not list
mercury in a solvent if amounts are too small or if the formula is protected. After completing roughly
350 analyses, Alpena contacted their suppliers and requested that mercury-free solvents be supplied.
Analyses were completed by examining lab results and testing and cleaning drain traps. This last method
is currently used as a spot-check system to isolate any mercury discharges. Wastes generated within the
institution are separated, and disposed of according regulations. The institution has a procedure policy
on spill prevention and management in case of mercury spills or leakages.

Alpena provides an ongoing educational and advisement program with those departments directly
involved in mercury pollution prevention, such as advising the nursing department to check for materials
that may contain mercury like thimerosal-containing saline solution. The plant superintendent has the
responsibility of seeing mat all mercury pollution prevention measures are being instituted, as well as
cleaning the drain traps and testing for mercury residues.
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Preventing Mercury Pollution; Case Studies
D. Butterworth Hospital (Grand Rapids Michigan, August 1995)

Hospital: 529 beds
Goal: Eliminate 300 Ibs of elemental mercury
Contact: Dan Stickles (616) 391-1801

Butterworth Hospital recently hired a local environmental consultant to devise a disposal plan for
mercury that will be safe and economical for the entire hospital. In addition, Stock Environmental will
develop a spill response plan that is in accordance with the Occupational Safety and Health
Administration and the Joint Commission for the Accreditation of Health care Institutions, as well as
offer training on spill response, prevention and management. Educational materials about mercury,
specifically the Terrene Institute brochure produced by the Health Care Sector Subgroup, have been
distributed to all hospital departments, administrative personnel, and regional facilities.

Butterworth Hospital has made a commitment to reach mercury-free status, and is attempting to reach
that goal by instituting a purchasing department policy stating unless there is no suitable, mercury-free
alternative, no mercury-containing devices are to be purchased. This list includes thermometers,
sphygmomameters, esophageal dilators and batteries. Administrative approval has been given to replace
all sphygmomameters currently in use with anaeroid devices, which will speed the transition to mercury-
free status. In addition, Butterworth Hospital has made a commitment to discontinue sending mercury-
containing devices overseas in their humanitarian products, and is currently in the process of
discontinuing sending mercury thermometers home with new mothers in the obstetrics department.

Last year two new buildings that are part of Butterworth Hospital opened. Administrative groups
managing these buildings have committed them to be mercury-free. Applying the Butterworth Hospital
purchasing policy concerning mercury has been difficult with office space being rented to private
doctors. The challenge now lies with making the buildings 100% mercury free, in both public and
private doctor facilities. The purchasing policies implemented at Butterworth has allowed the facility to
explore options of recycling mercury at mercury refining centers, and look to minimize hazardous waste
disposal costs. For example, fluorescent tubes are now being recycled using a mobile collection unit.
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Preventing Mercury Pollution: Case Studies
E. Genesys Health System (Michigan, August 1995)

Group of 4 hospitals, 750 physicians

A formal policy that replaces mercury-containing thermometers and sphygmomameters with electrical
devices where medically acceptable and feasible has been instituted by Genesys Health System, as well
as a purchasing policy that allows only mercury-free items to be purchased. Also in effect is a goal to
eliminate clinical lab procedures that contain mercury. Currently, the health system laboratory removes
mercury from the waste stream by precipitating and filtering out the material. The wastes are then
separated and mercury waste recycle by reusing the material on site, or sending it to a mercury
recovering company.

Genesys Health System has devised programs to train its employees on spill response and spill
prevention and management that properly clean up mercury spills in accordance with applicable
regulations, as well as to evaluate fluorescent tubing. An Environmental Control Advisory Committee
within Genesys has formed an Environmental Control Policy stressing reduction of waste into the
environment. The committee has also provided education materials concerning mercury pollution
prevention to staff people.
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Preventing Mercury Pollution: Case Studies
F. Henry Ford Hospital (Michigan, August 1995)

Perhaps one of the most important aspects Henry Ford stresses in environmental matters, including
mercury pollution prevention, is education. Educational at the clinical, administrative, and emergency
planning levels focus on being environmentally responsible while at the same time meeting the
community health needs. The alternatives to mercury-containing items must be clinically viable in order
to be used, and a product that is not environmentally sound will not be purchased. First-response teams
are able to minimize patient discomfort and maximize their care, tuning into the emotional element of
pollution prevention.

Thermometers and esophageal dilators containing mercury have been or are being replaced with
mercury-free alternatives. Blood pressure cuffs that contain mercury are in the process of being replaced
with aneroid devices. While there are still devices that contain mercury located and used at the hospital,
the safe storage of these devices is an important consideration for Henry Ford.

Henry Ford's laboratory does not release any chemicals down its drains, thereby minimizing chemical on
their laboratory sites, buying only the necessary amounts of chemicals needed for their procedures.
Henry Ford has removed their old drains and catch points and replaced them with up-to-date systems.
The sediment within the pipes are cleaned systematically, and the sludge is treated as hazardous waste.
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Preventing Mercury Pollution: Case Studies
G. Bronson Methodist Hospital (Michigan, August 1995)

Capacity: 414 beds

Educating the staff at Bronson Methodist Hospital, including the proper use of mercury-containing
devices, eliminates breakages, and the proper procedures to follow in case of a breakage, has helped to
decrease mercury from its system. In addition, instituting a purchasing policy to ban the purchase of
mercury-containing items, if an alternative exists, has been formalized. A company that purchases the
mercury-containing devices from the hospital has been located. Batteries that contain mercury are in the
process of being phase out and replaced with mercury-free batteries. Sphygmomanometers containing
mercury are being replaced with aneroid devices throughout the facility.

Bronson is also working in conjunction with Kalamazoo's waste-water department to remain below their
mercury discharge detection limit of 0.5 parts per billion, and to further decrease their concentration to
0.3 parts per billion. The hospital has monitored its systems, located areas to clean up, and has since
decreased its emissions significantly.

Bronson's work in mercury was recognized by Kalamazoo with the first annual Industry Excellence
Award for having the best mercury minimization results of all the significant industrial users
discharging to the Reclamation Plant.
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Preventing Mercury Pollution: Case Studies
Quest Diagnostics, Incorporated (Wyoming Michigan, August 1995)

Contact: Neil Findley, (616) 538-6700

Quest Diagnostics Incorporated has instituted a wide range of mercury pollution prevention measures to
meet the city's strict water guidelines of 0.5 ppb. Initially, Quest Diagnostics isolated manufacturer
contributions of mercury within its waste water system by testing its list of reagents for mercury content.
Reagent manufacturers might not list mercury in their Material Safety Data Sheets because the amount
is so small; therefore Quest Diagnostics did not know the sources of mercury until test results were
finalized. Once the sources where determined, a formal mercury reduction policy to continually decrease
mercury in its effluent, as well as evaluating mercury content of the reagents it purchases, was instituted.
If the vendor cannot provide mercury-free reagents, Quest Diagnostics will locate a vendor that does or,
where possible, change methodologies to processes that do not involve mercury; if the purchase of
mercury-free reagents is not possible, waste is segregated. This policy was submitted by the laboratory
to the city, and is updated quarterly with the report sent to Wyoming semiannually.

In addition, Quest Diagnostics separates their wastes and packages them to send to the correct hazardous
waste facility. Test spickets are inserted into 100% of all laboratory drains to regularly test the material
being released. If the tests are above the limits, the drain traps are replaced, the material is handled as
hazardous waste, and investigation begins as to the source of the contamination.

The staff and employees of Quest Diagnostics Incorporated service 3,000 patients per day. Regular
updates on mercury reduction are shared with employees at quarterly meetings. This keeps them
informed of the actions and policies of the laboratory. Employees are given the required Occupational
Safety and Health training, additional training in bloodborne pathogens, and are broken up into orisk
groups in relation to where they work and the chemicals that are handled. A formal chemical-hygiene
plan is also in effect for Quest Diagnostics Incorporated.
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Mercury Case Studies - Mayo Clinic Page 1 of 1
Preventing Mercury Pollution: Case Studies
I. MERCURY MANAGEMENT AT MAYO CLINIC

Contact Person: David H. Senjem
Environmental Safety Coordinator
(2/13/97)

Mayo's management of mercury in the medical environment has evolved over time. Historically,
elemental mercury from thermometers, blood pressure units, research apparatus, and other devices was
referred to Mayo's Pulmonary Laboratory for cleaning, redistillation, reuse, or sale. Mercury batteries
were first collected for referral to a California-based reprocessing center in 1978. A strong emphasis has
existed since the mid-1970's on collecting and commercially disposing of mercury-containing laboratory
wastes through Mayo's hazardous waste program. Specialized mercury vacuum cleaners were first
purchased in the 1970's to ensure than mercury spills were effectively and safely managed.

In more recent years, institutional interest in mercury management has led to even more aggressive
actions. Mercury thermometers have been removed from Mayo's 1500 outpatient examination rooms
and replaced with electronic devices. Similarly, mercury thermometers and sygnometers were removed
and replaced with electronic devices in all hospital areas. Mayo's Pulmonary Function Laboratory
discontinued the use of large quantities of mercury associated with their Haldane/VanSlyke devices in
favor of electronic instrumentation. Laboratory test procedures have been re-evaluated for mercury use
with an emphasis on substitution, whenever possible, and strict attention to disposal management when
substitution is not possible. Used mercury-containing fluorescent light bulbs are, of course, collected
and disposed of through a commercial vendor who recovers and recycles mercury.

Efforts continue to further investigate and reduce the presence of mercury in the Mayo environment.
Examples of such efforts include the incorporation of heavy metal analysis in certain product purchases
and similar evaluations in certain large components of Mayo's incinerated waste stream. Additionally,
we have strived through continuing educational efforts to sensitize staff on avoidance of the use of
mercury or mercury-containing materials, whenever possible, and especially when alternative choices
are available.
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Tracking Progress of Mercury Pollution Prevention
1. Oualification/Quantitation Approaches to Evaluate Mercury Use at Medical Facilities
2. A Checklist to Help You Verify Your Progress
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Qualification/Quantification Approaches to
Evaluate Mercury Use at Medical Facilities
The U.S. Environmental Protection Agency Region 5 has initiated a Medical Waste Mercury Reduction
Project to reduce the amount of mercury discharged into the environment. Mercury continues to be used
routinely at medical facilities.

Mercury's usefulness in the medical industry must be weighed against its hazards when released into the
environment through incineration or discharges from publicly owned treatment works. For example,
significant amounts of mercury in publicly owned treatment works (POTWs) waste streams can be
attributed to the disposal of dental amalgam down drains when fillings are removed at dental offices.
Mercury is also released into the environment through the incineration of mercury-containing materials
from hospital facilities that have been placed in infectious waste containers.

Because there are currently no federal regulations for medical facilities to limit the discharges of
mercury down the drain, voluntary programs must be implemented to encourage the medical industry to
reduce the use of mercury and its releases into the environment through product substitution, recycling,
and proper handling and disposal practices.

In an effort to track reductions in mercury from medical facilities, it is necessary to quantify the mercury
that is currently in use. The purpose of this section is to present the elements needed to qualify and
quantify the amount of mercury used in a medical facility.

A Use existing data or reporting requirements to estimate mercury use and release
B Develop and implement a survey
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rogress ofMercttr^PoilMon Prevention
There are several databases that include information on mercury use and/or release. These databases can
be accessed to determine the relative amounts of mercury products that have been purchased by a
facility. Examples of relevant databases include

1. Michigan Critical Materials Register Annual Wastewater Report
2. RCRA Biennial Report
3, Permit Compliance System
4. Toxic Release Inventory
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1. Michigan Critical Materials Register Annual Wastewater Report

Under Michigan's Pollution Control Act, facilities in Michigan are required to report the quantities of
mercury they use. The Act requires that commercial facilities file annual reports that list the materials
used directly or incidentally to produce a product or service including by-products and waste products.
The Act applies to materials on Michigan's Critical Materials Register, which includes metallic mercury
as well as several mercury compounds, some of which are used in pharmaceuticals (mercuric acetate,
mercuric chloride, mercuric nitrate, mercuric sulfide, and mercurous nitrate). All critical materials used,
manufactured, stored, discharged in wastewater, disposed of as waste materials (residuals) or transferred
off site must be reported each year. Separate forms and instructions are provided for reporting releases
to wastewater outfalls and critical materials used. Questions asked about critical material use cover:

• Amount that was or might have been discharged to wastewater and whether this amount was
measured or estimated
• How much was discharged to each outfall
• Amount of critical material that was or might have been contained in residuals (i.e., other waste
streams)
• Source of critical material in residuals (production, wastewater treatment, or combination)
• Physical state of critical material-containing residual (liquid, sludge, wet solid, dry solid)
• How critical material-containing residuals are stored before removal (metal drums, fiber drums,
above-ground tank, underground tank, stockpiled on ground, holding/pond lagoon, dumpster/roll-off
box, other [please specify]
• Disposal method for critical material-containing residuals (sanitary landfill, hazardous waste landfill,
own land, shipped out of state, incinerated, recycled, other [please specify]).

Nineteen hospitals reported mercury use or release in the 1991 Critical Materials Registry Annual
Wastewater Report. Additional information or retrievals from the Michigan Critical Materials Registry
Annual Wastewater Report data base can be requested from Christopher Hull at the Michigan
Department of Natural resources in Lansing (517) 335-4199.
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2. RCRA Biennial Report

The RCRA Biennial Report System (BRS) tracks information on hazardous waste generated and
managed by large quantity generators and permitted treatment, storage, and disposal facilities. Several of
the codes used in the BRS are used to identify the presence of mercury in a waste stream or discarded
product. Eighteen health services facilities reported mercury-bearing wastes in the RCRA Biennial
Report System in 1991 out of a total of 572 facilities reporting mercury overall in the Great Lakes states.
Sixteen of the 18 health care facilities were general medical and surgical hospitals, the other two
consisted of one medical clinic and one medical laboratory. No dental clinics reported RCRA waste
generation.

Commonly reported sources of mercury in hospital waste streams are laboratory wastes (most common
among Great Lakes states health care facilities), discarded out-of-date products or chemicals, filter or
battery replacement, and wastewater treatment or pollution control wastewater treatment processes.

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3, Permit Compliance System

The Permit Compliance System (PCS) contains information on wastewater discharges for permitted
dischargers. These data are based on monitoring data supplied by the facilities. Few hospitals are
represented in the PCS database as having NPDES permit limits for mercury.
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4. Toxic Release Inventory

The Toxic Release Inventory (TRI) is not a good source of information on health care facilities because
it only covers the manufacturing facilities (SIC codes 20-39). The reporting thresholds for TRI are so
high relative to the amounts that could impact the Great Lakes that they are not useful for tracking
mercury releases.
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Develop and Implement a Survey
1. Approaches to Develop a Survey
2. Information Needed to Qualify or Quantify Mercury Use
3. EPA's Medical Facility Mercury Use Survey
4. Mercury Reduction Survey Worksheets
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Approaches to Developing a Survey
There are two basic approaches: look at what is coming into the healthcare facility with orders of
supplies, shipments, patients, etc. ("supply side" approach) or look at what is going out in the waste
streams ("waste stream" approach). The advantage of looking at what is coming in is that more detailed
records might be available for procurements than for discards of unwanted materials. The supply side to
the hospital is also directly linked with the purchasing behavior that healthcare facilities should examine
and change. A difficulty with the supply side approach is that hospital personnel might not know which
products contain mercury or how much mercury they contain. Some sources might be missed by the
supply side approach that would not be missed if the waste stream were analyzed as in the waste stream
approach. The waste stream approach, however, might require more "detective work" to trace mercury
in waste streams back to the actual source of mercury in the healthcare facility. Use of this later
approach requires information on both the concentration of mercury in the waste stream and the quantity
of waste generated. A combination of both approaches could be used to fill information gaps.
To Develop and Implement a Survey
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Information Needed to Qualify or Quantify Mercury Use
Mercury use primarily centers around the use of products and equipment. A list of products and supplies
containing mercury that might be used at hospitals is needed to form the basis of a questionnaire on use
patterns and disposal practices. The section Mercury in Medical Facilities provides a list of mercury-
containing products and supplies the might be found at a medical facility.

The hospital purchasing manager can be asked to identify products on the list that the hospital uses and
how much is normally ordered in a year. Another list of hospital equipment and appliances that contain
mercury can be compiled to address issues related to equipment use. Issues to explore might include
how unwanted equipment is disposed and whether mercury is removed from equipment prior to disposal
by hospital personnel, service contractors or the vendor.

For example, a survey might ask the hospital administrator to check which supplies or equipment are
used and in a column at the left of each item checked write in information to calculate how much is
used, how items are disposed, and how they are stored before disposal pick-up.

It is important to state up front that the survey is confidential so that their answers will be as honest as
possible and the respondents won't be inclined to give the "right" answer. Always include a self-
addressed stamped envelope for them to return the survey.

The range of medical facilities surveyed in terms of size and geography should be broad. The larger
hospital facilities may have already substituted products that don't contain mercury, while smaller
hospitals, nursing homes, and clinics, might not have the resources to upgrade their equipment.

The recipients of the survey should also include a broad range of personnel to determine if the entire
facility follows similar procedures. Particularly at smaller facilities, procedures and practices for
mercury use may not be standardize.

An EPA survey draft is presented in the next section using the above-mentioned questions to help
personnel in the medical industry quantify the amount of mercury in use at their facilities and to
determine their current disposal practices.
To Develop and Implement a Survey
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EPA's Medical Facility Mercury Use Survey
The United States Environmental Protection Agency, Region 5, would appreciate your participation in
this survey to determine the sources and disposal practices of products containing mercury in your
medical facility.

We hope through this survey and other efforts, that we can help control the amount of mercury released
into the environment. The information you provide is confidential. Thank you for your time.

1. Facility
2. City
3. Zip Code
4. Which of the following best describes your role in the medical industry?
_Purchasing manager
Physician
_Nurse
Laboratory technician
_Custodian
_Administration personnel
Other
5. Does your healthcare facility have any written policies or procedures to control mercury use? If
yes, please explain.

Yes
No
6. What precautions or other measures are taken when handling mercury or cleaning, servicing, or
disposing of mercury-containing equipment or materials?
7. Who is responsible for implementing policies and procedures?
8. Who sees that mercury is removed from unwanted equipment prior to disposal?
9. What are the best ways for you to learn the proper use and disposal of mercury-containing
products? (check top three).

printed matter (newsletters, brochures, fact sheets)
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MERCURY IN MEDICAL FACILITIES
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11.
_onsite visits
Jnforniation hotline
_seminars
_speakers at medical meetings
other
10. What specific factors would help change the current practices towards addressing mercury in
medical facilities? (check top three).

economic benefits
_concern for environment
_ease of disposal
_concern for government enforcement
_concern for public image
_concern for liability
pick up/drop off services for waste
concern for human health
increased awareness
concise disposal guidelines
other
If you would like to receive more information about mercury reduction in medical facilities please
complete the following:

Name
Organization
Address
Products containing
mercury
Amalgam
Fluorescent lamps
High intensity
mercury lamps
Miller Abbott tube
Pagers
Sequential multiple
analyzers
Sphygmomanometer
Thermometers
Thermostats
Check here
if used at
your
facility
|

1
1

i
i
i
Quantity
used or
ordered per
year

Average
mercury
content per
unit measure

How
disposed
o

1
1
1
How stored
while waiting
for disposal ^

9 Choice for how disposed might include: sewer, hazardous waste, municipal solid waste,
infectious waste, or recycle.
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Page 3 of3
9 Choice for how stored while waiting for disposal might include: drum, dumpster, laboratory
hood, waste receptacle, etc.
Laboratory
materials
containing
mercury
Alum hematoxilin
Cajal's stain
Cameo
Carbol-Gentian
violet stain
Formol-Zenker's
stain
Golgi's stain
Millon's reagent
Mercuric chloride
Nessler's solution |
Takata's reagent ]
Check here
if used at
your facility
|
|

Quantity used
or ordered
per year

Average
mercury
content per unit
measure

1 1
1

1
How
disposed
9

\ |
| |
1 1
How stored
while waiting
for disposal ®

® Choice for how disposed might include: sewer, hazardous waste, municipal solid waste,
infectious waste, or recycle.

® Choice for how stored while waiting for disposal might include: drum, dumpster, laboratory
hood, waste receptacle, etc.
I To Develop and Implement a Survey
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Mercury Reduction Survey Worksheets
Worksheet 1: Survey Scope
Worksheet 2: List of Survey Team Members
Worksheet 3: Information Sources
Worksheet 4: Raw Material Summary/Equipment Survey
Worksheet 5: Source / Waste Reduction Alternatives
To Develop and Implement a Survey
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Worksheet I: Survey Scape
Hospital Name:

Address:

Area to be included in the survey:

Department(s):

Specific work area:

Specific chemical(s):

Specific waste(s):

Specific instrument(s)/equipment(s):

Report prepared by:

Date:
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Worksheet 2; List of Survey Team Members
Hospital Name:

Address:

Occupational health & safety rep.:

Hazardous materials rep.:

Nursing department rep.:

Microbiological lab. rep.:

Pathology lab. rep.:

Purchase manager:

Maintenance engineer:

Power plant (incinerator) engineer:

Rep. from doctors offices:

Others:
Team leader:
I To Mercury Reduction Survey Worksheets
© Copyright
http://www.epa.gov/grtlakes/seahome/mercury/src/wrksht2.htm
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MERCURY IN MEDICAL FACILITIES
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Worksheet 3: Information Sources
Information Sources & Reports
(Use all that apply)
Facility Layout:
Area Description:
List of Waste Sources:
Waste Description: .
MSDS:
Operational Manuals:
[Maintenance Records:
|Purchasing Records:
Inventory Records:
Process Description:
Instrument Diagram:
Equipment Specification:
SARA III, Section 313 Submittal:
Waste Manifest:
Waste Management Contacts:
Solid/Liquid/Emission
Characterization Data:
|Other Information Sources:
Exist
(Y/N)
1
1
1
1

|
|
| |
| 1
|
1
|
|

Complete
(Y/N)

J
|
I 1
J

1
1
Last
Revision

|_
|

|_ j
|_
L
|_
L

Permanent Storage
Location of
Information

1
i
Reported by:

Date:
To Mercury Reduction Survey Worksheets
©Copyright
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Worksheet 4; Raw Material Summary/Equipment Survey
HOSPITAL NAME:
ADDRESS:

DEPARTMENT/LAB:

Material Name:

Material Use:

Specifications:

Material Form (Sol/Liq/Gas):

Consumption (Vol/Time):

Purchase Price:

Minimum Inventory required:

Maximum Inventory Required:

Container Type:

End Use (Process):

Delivery Method on Site:

On Site Storage Method:

On Site Distribution Method:

Disposal Form:

Cost of Disposal:

Cost of Replacement:

Requesting Personnel:

Mercury Concentration (% or ug/1):

Leak/Spill Handling Method:

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MERCURY IN MEDICAL FACILITIES

Reported by:

Date:
Page 2 of2
To Mercury Reduction Survey Worksheets
© Copyright
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MERCURY IN MEDICAL FACILITIES
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Worksheet 5; Source/Waste Reduction Alternatives
HOSPITAL NAME:
ADDRESS:
Source/Waste/Process/Analytical Method Type:
Waste Stream:

Description:

SUGGESTED ALTERNATIVES/COMMENTS
|| SUGGESTED BY:
II
II
II
1 II
II

To Mercury Reduction Survey Worksheets
© Copyright
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MERCURY IN MEDICAL FACILITIES
Page 1 of 1
A Checklist to Help You Verify Your Progress
I. Have you estimated the extent of the mercury uses in your facility? (if yes, record these estimates
and proceed to question 2),

2. Have you measured the volume of mercury contained in your equipment and supplies? (if yes,
record these figures and proceed to question 3).

3. Have you begun a recycling program? (if yes, briefly describe this program and record the volume
of mercury recovered in this process).

4. Have you computed the amount of mercury and money saved each time an alternative product is
substituted for a mercury-containing product? (if yes, briefly describe the original product, the
alternative, and the process you used to discover the alternative).

5. Have you set up a procedure to report mercury spills? (if yes, document the number of reported
mercury spills).

6. Have you displayed your emergency procedures prominently and communicated all facets of your
program to all members of your staff? (if yes, prepare a file of your communication pieces to
share with other facilities).
To Tracking Progress of Mercury Pollution Prevention
© Copyright
http://www.epa.gov/grtlakes/seahome/mercury/src/cheklist.htm
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MERCURY IN MEDICAL FACILITIES
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EPA & State Agencies
Federal: Environmental Protection Agency
o Mission Statement
o Role
o Structure
o Regional Contact Map

State Agencies
o State Contact Map
To Table of Contents
© Copyright
EPA's Mission Statement

The U.S. Environmental Protection Agency is charged by Congress to protect the Nation's land, air, and
water systems. Under a mandate of national environmental laws, the Agency strives to formulate and
implement actions that lead to a compatible balance between human activities and the ability of natural
systems to support and nurture life.

The Agency's priorities include emphasizing flexibility and innovation, working in partnerships with
private and government groups, and encouraging sound science and engineering. For example, under the
"Common Sense Initiative" the Agency looks at pollution industry-by-industry, rather than by using the
pollutant-by-pollutant approach of the past. Everyone concerned with a given industry—from
manufacturers to community organizations—works together to fashion new strategies to emphasize
preventing pollution.

EPA works in partnership with state, county, municipal, and tribal governments to carry out its mission.
State and local standards may exceed federal standards, but they cannot be less stringent. EPA works
with states and municipalities so they can cany out federal standards consistently but flexibly. The
Agency also makes extensive efforts to involve the public in environmental protection. Some laws
specifically invite public monitoring; others allow individuals to sue polluters or to notify environmental
agencies of violations.

Through research, development, and technical assistance, EPA generates and disseminates sound
science and engineering to support its missions. These efforts provide the data that the Agency needs to
set and address priorities in identifying, assessing, and managing serious risks to public health and the
environment. EPA's research combines the in-house expertise of Agency scientists and engineers with
complementary research by universities and nonprofit organizations under a competitive, peer-review
extramural program. EPA operates a large website at: http://www.epa.gov

Up to Programs Menu
EPAfs Role
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MERCURY IN MEDICAL FACILITIES Page 2 of 3
EPA administers 11 comprehensive environmental protection laws. These are explained in summary
form at the website: http://www.epa.gov/epaliome/iaws.htni
1. the Clean Air Act
2. the Clean Water Act
3. the Safe Drinking Water Act
4. the Comprehensive Environmental Response, Compensation, and Liability Act ("Superfund")
5. the Resource Conservation and Recovery Act
6. the Federal Insecticide, Fungicide, and Rodenticide Act
7. the Toxic Substances Control Act
8. the Uranium Mill Tailings Radiation Control Act
9. the Lead Contamination Control Act
10. the Ocean Dumping Ban Act
11. the National Environmental Education Act
The text of the laws and the regulations based upon them are accessible at the website:
http://www.epa.gov/epahome/ruies.html

iM Up to Programs Menu
EPAfs Structure

The Agency is directed by an Administrator and a Deputy Administrator, both appointed by the
President with the advice and consent of the Senate. Nine Assistant Administrators, the Agency's
General Counsel, and its Inspector General, also are named by the President and are subject to Senate
confirmation.

The nine Assistant Administrators manage specific programs, such as those protecting the air, water, and
land of Americans, or direct other Agency functions, such as enforcement of environmental laws.

Three Associate Administrators are named by the Administrator to carry out programs for public affairs,
congressional and legislative relations, and regional, state, and local relations. Ten Regional
Administrators work closely with state and local governments to carry out the Agency mission.

The EPA is divided into twelve offices, most of which offer websites containing large amounts of
information and publications in downloadable format:

1. Office of Water: http://www.epa.gov/QW/ This is the entry point to large water submenus for all
10 EPA regions, and a large publications catalog.
2. Office of Air and Radiation: http://www.epa.gov/oar/oarhome.html This contains many air and
pollution prevention publications in downloadable formats.
3. Office of Solid Waste and Emergency Response: http://www.epa.gov/epaoswer/ This contains
many publications in downloadable format listed under the component programs.
4. Office of Pollution Prevention, Pesticides, and Toxic Substances:
http://www.epa.gov/interneiyoppts/ This offers large publications catalogs listed under
"Consumer Information."
5. Office of Enforcement and Compliance Assurance: http://www.epa.gov/oecaerth/index.html
6. Office of Research and Development: http://www.epa.gov/ORD/
7. Office of Policy, Planning, and Evaluation: http://www.epa.gov/oppe/oppe.htm]
8. Office of Administration and Resources Management:
http://vywvv.epa.gov/epahome/OARM.html This includes the very large "Envirofacts" database of
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articles
9. Office of International Activities
10. Office of Communications, Education, and Public Affairs:
http://wvyw.epa.gov/docs/OCEPAterms This is not a full website, but contains the large and
extremely useful "Terms of Environment" glossary.
11. Office of Congressional and Legislative Affairs
12. Office of Regional Operations and State/Local Relations: http://www.epa.gov/regional/
Up to Programs Menu
Copyright
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Page 1 of 20
Glossary
Either select a word from the Word List or scroll through this file.
To Table of Contents
© Copyright
Word List
A abiotic
alkalinity
anthropogenic
atmosphere
-— ^ base
|j bioaccumulation
bioconversion
biomagnification
biota
C calorie
chlorophyll
condensation
-— ^ DDT (dichlordiphenvltrichloroethane")
nJ degreaser
E ecosystem
environmental release
excretion
F fauna
fertilizer
food chain
fungi
G gingivitis
H half life
humic
hydrologic cycle
-— - igneous
M. insecticide

acid
alloy
anthropogenic mercury

benthic
biocide
biogeochemical cycle
biomass

carcinogenic
chronic toxicity
conductivity
degassing
discharge
effluent
erosion
felting process
flora
fossil
fungicide

heavy metalfo
humus
hydrosphere
incinerator
ion

acute toxicity
amalgam
emissions antifouling

benthos
bioconcentration
biohazard
biosphere

catalyst
combustion
crematory
degradation
ductility
emission
evaporation
fermentation
fluorescence
fossil fuel

herbicide
hydrograph
hydroxide
inorganic
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L lagoon
lethal dose 50% (LD5(ft
lithosphere
M manometer
mercury/ionic mercury
metal
N natural mercury emissions
nitrite fNC-21
O opacity
oxidation
P paralysis
PCB (polvchlorinated biphenyl)
pJl
photosynthesis
point-source pollution (PS)
porosity
predatory fish
R reduction
runoff
S salinity
sediment
soil moisture content (me")
T1CDD
threshold
turbidity
-f -y- uptake
u
— - jr valence
Wwastewater
X™
Zzooplankton

landfill
lethal dose (LD )
mantle
mercury/elemental mercury
methylmercury
neurotoxin
ores
pathogen
permeability
pharmaceutical
plankton
pollution prevention
parts per million (ppm)
prenatal
refuse
salt
smelting
solvent
teratogenic
toxic

volatilization

Page 2 of 20
latent heat
lime
mercury (Hg)
metabolism
nitrate (NO3^
organic
pathology
pesticide
photochemistry
poison
pollution reduction
precipitation (ppt)
preservative
root zone
saturated fat
sorb/sorption
storage
textile
toxicity

•

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Page 3 of 20
abiotic
a system characterized by the absence of life or living organisms.
Too of Glossary Page
acid
a sour substance , typically soluble in water, which neutralizes bases to form salts.. A compound
containing hydrogen atoms (H) which are capable of being replaced by a positive element or
radical. A substance which gives up H to another substance.
Top of Glossary Page
acute toxicity
any poisonous effect produced within a short time after exposure to the toxic compound, usually
within 24 to 96 hours
TOP of Glossary Page
alkalinity
the total measurable bases (OH. HCQ3. C03^ in a volume of water; a measure of a material's
capacity to neutralize acids.
alloy
a substance composed of two or more metals
TOP of Glossary Page
amalgam
an alloy that consists chiefly of silver mixed with mercury and variable amounts of other metals
and is used as dental filling.
TOP of Glossary Page
anthropogenic
man-made
anthropogenic mercury emissions
the atmospheric emission of geologically bound mercury by human activity (e.g. emission of
mercury in fossil fuels such as coal)
Top of Glossary Page
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antifouling
a coating process or the like that prevents the accumulation of aquatic animals and plants
Top of Glossary Page
atmosphere
the gaseous layer that surrounds the earth (air)
base
I TOP of Glossary Page
a substance which neutralizes an acid. A substance which furnishes hydroxyl (OH) ions and a
positive ion, usually a metal. An ion which will combine with hydrogen ions. An alkali.
Top of Glossary JPage
benthic
of or pertaining to the benthos
benthos
the bottom of the sea or of any body of water.
JH Top of Glossary Page
bioaccumulation
the uptake and retention of substances by an organism from its food and its
surrounding environment. Chemicals that bioaccumulate become more
concentrated at each successively higher level of the food chain.

Bioaccumulative chemicals can be toxic to organisms at the upper end of a food
chain, such as predatory fish, loons, eagles, otters, or humans that eat fish
TOD of Glossary Page
biocide
any chemical that destroys life by poisoning.
TOP of Glossary Page
bioconcentration
a specific bioaccumulation process by which the concentration of a chemical in an organism
becomes higher than its concentration in the air or water around the organism. Although the
process is the same for both natural and manmade chemicals, the term bioconcentration usually
refers to chemicals foreign to the organism.
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TOP of Glossary Page
byconversion
the conversion ofbiomass to usable energy, as by burning solid fuel for heat, by fermenting plant
matter to produce fuel, as ethanol, or by bacterial decomposition of organic waste to produce
methanol.

Top of Glossary Page

biogeochemical cycle
a cycle dealing with the relationship between the chemical changes of the earth's crust of a given
region and its flora and fauna, including the circulation of such elements as carbon, and nitrogen
between the environment of the cells of living organisms.
I Top of Glossary Page
biohazard
the health risk posed by the possible release of a pathogen into the environment.
I Top of Glossary Page
Biohazard
biomagnification
it describes a process that results in the accumulation of a chemical in an organism
at higher levels than are found in its food. It occurs when a chemical becomes more and more
concentrated as it moves up through a food chain. At the top of the food chain an animal, through
its regular diet, may accumulate a much greater concentration of chemical than was present in
organism lower in the food chain.
Too of Glossary Page
biomass
the amount of living matter in a given habitat.

!• Top of Glossary Page

biosphere
all living organisms (plant and animal life)
I Top of Glossary Page
biota
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living organisms.

IB Top of Glossary Page

calorie
the amount of heat required to raise the temperature of one gram of water by one degree
centigrade

IH Top of Glossary Page

carcinogenic
event, condition or effect that produces cancer.

IH Top of Glossary Page

catalyst
a substance or agent which alters the velocity of a chemical reaction but is not itself changed in
the process. An enzyme is an example of a catalyst.

Top of Glossary Page

chlorophyll
one of a number of green pigments present in plant cells which are essential in the utilization of
light energy in photosynthesis.

IH^Tpp of Glossary Page

chronic toxicity
any poisonous effect having long duration, usually months or years.

Top of Glossary Page

combustion
the act or process of burning.

OH Top of Glossary Page

condensation
the process in which water vapor is cooled to the liquid phase. The water film produced is reffered
to as condensate.

Top of Glossary Page

conductivity
the property of conducting heat, electricity, or sound.

IH TOP of Glossary Page
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crematory
a place where a dead body is reduced to ashes by fire.

IB! Top of Glossary Page

DDT (dichlordiphenyltrichloroethane)
a white, water-insoluble solid used as an insecticide, and whose agriculture use was prohibited in
the U.S. in 1973.
Top of Glossary Page
degassing
to free from gases.

I Top of Glossary Page

degradation
to wear down, reduce to lower quality, by erosion or reduce the complexity of a chemical
compound
TOP of Glossary Page
degreaser
solutions that remove grease

I Top of Glossary Page

discharge
(1) the flow of surface water in a stream or canal or the outflow of groundwater from a well, ditch,
or spring

(2) the release of wastewater through a pipe outlet or similar apparatus to a discharge point such
as a ditch or storage lagoon
IH Tnp of Glossary Page

ductility
malleable. Able of undergoing change of form without breaking.
TOD of Glossary Page
ecosystem
an ecological system, a natural unit of living and nonliving components which interact to form a
stable system in which a cyclic interchange of materials takes place between living and nonliving
units, as in a balanced aquarium or in a large lake or forest.
TOP of Glossary Page
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effluent
the discharge of a pollutant in a liquid form from a containing space.

Top of Glossary Page

emission
the act of sending forth, to emanate.

IH Top of Glossary Page

environmental release
the introduction of a pollutant into the environment through waste-water discharge, air emission,
or volatilization or leaching from soil, landfill, or other contaminated site

Top of Glossary Page

erosion
the wearing away of the land surface by running water, wind, ice, or other geological agents,
including such processes as gravitational creep. Geological erosion is natural occurring erosion
over long periods of time. Accelerated erosion is more rapid than normal erosion and results
primarily from man's activities. Erosion is further classified by the amount and pattern of soil
removal and transport as gully, intertill, rill, sheet, and splash or raindrop erosion.

tH Top of Glossary Page

evaporation
the process in which liquid water is transferred into the atmosphere.

Top of Glossary Page

excretion
the elimination or discharge of waste products or substances present in excess from the body.

IH Top of Glossary Page

fauna
the animal life of a locality or a region
I Top of Glossary Page

felting process
process where nonwoven fabrics of wool, fur, or hair are matted together by heat, moisture, and
great pressure.
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TOD of Glossary Page
fermentation
a change which converts grape sugar into ethyl alcohol.
!• Top of Glossary Page

fertilizer
any substance, like manure, used to enrich the soil.
Top of Glossary Page
flora
the plant life of an area or locality.
Top of Glossary Page
fluorescence
the property of absorbing light of a particular wave length and
then emitting light of a different color and wave length.
IH Top of Glossary Page

food chain
a group of organisms involved in the transfer of energy from its primary source, plants, as algae,
insects, small fishes, larger fishes, fish-eating birds or mammals.
I Top of Glossary Page
fossil
any remains, impression, cast, or trace of an animal or plant of a past geological period. The term
is generally restricted to parts which have been petrified or converted to stone.
TOP of Glossary Page
fossil fuel
any combustible organic material as oil, coal, or natural gas, derived from fossils.
I TOP of Glossary Page
fungi
any of a large group of simple plants characterized by lack of chlorophyll as the mold, mildews,
mushrooms, rusts, and smuts. Most have a filamentous body and subsist on organic matter.
Top of Glossary Page
fungicide
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an agent which kills or inhibits the growth of fungi

IB Top of Glossary Page

gingivitis
swollen of the oral cavity gums.

Top of Glossary Page

half life
the time it takes certain materials, such as mercury, to become chemically altered

Top of Glossary Page

heavy metal(s)
any metal with a density of 5.0 or greater, especially one that is toxic to organisms, as lead,
mercury, copper, and cadmium.

Top of Glossary Page

herbicide
chemicals used to kill undesirable vegetation

IH Top of Glossary Page

humic
of or pertaining to the humus

IH Top of Glossary Page

humus
dark material in the soil consisting principally of organic matter.

IB Top of Glossary Page

hydrograph
a graph which illustrates hydrologic measurements over a period of time, such as water level,
discharge or velocity

)f Glossary Page

hydrologic cycle
the circulation of water in and on the earth and through earth's atmosphere through evaporation,
condensation, precipitation, runoff, groundwater storage and seepage, and re-evaporation into the
atmosphere

• TOP of Glossary Page
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MERCURY IN MEDICAL FACILITIES
Page 11 of 20
hydrosphere
water held in oceans, rivers, lakes, glaciers, groundwater, plants, animals, soil, and air.
!• Top of Glossary Page

hydroxide
a compound formed by the union of a metal or a radical with one or more hydroxyl (OH) groups,
as sodium hydroxide (NaOH).
TOP of Glossary Page
igneous
produced under conditions involving intense heat, as rocks of volcanic origin.
Top of Glossary Page
incinerator
a crematory instrument for the combustion (incineration) of organic material, leaving only ash.

IH Top of Glossary Page
inorganic
not containing carbon or compounds of carbon. Not of plant or animal origin.
TOP of Glossary Page
insecticide
chemicals used to control undesirable insects
ion
Top of Glossary Page
an electrically charged atom or group of atoms formed by the loss of one or more electrons, as a
cation (positive ion), which is created by an electron loss, or as an anion (negative ion), which is
crated by an electron gain.
Top of Glossary Page
lagoon
water impoundment in which organic wastes are stored or stabilized or both
landfill
a low area of land that is built up from deposits of solid refuse in layers covered by soil.
Top of Glossary Page
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latent heat
the heat (energy) absorbed or released as water changes between the gas (water vapor), the liquid
(water droplets), and the solid (ice) states

IB Top nf Glossary Page

lethal dose 50% (LD50)
the dosage of a toxic substance required to kill one half of the organisms under study in a given
period of time

fH Tnp nf Glossary Page

lethal dose (LD)
the amount of a toxic substance required to cause death of an organism under study in a given
period of time
I Top of Glossary Page

lime
calcium oxide (CaO) or quicklime, prepared by heating calcium carbonate thus driving off carbon
dioxide.

IH Top of Glossary Page

iithosphere
a general term for the outer layer of the earth. A wind blown deposit of silty soil having little or no
stratification

Top of Glossary Page

manometer
a device for measuring the pressure exerted by gases or liquids. In its simplest form, it is a U-
shaped tube containing a fluid (water or mercury) against which the pressure of an unknown is
balanced.

Top of Glossary Page

mantle
a general term for the outer covering of earth material

Top of Glossary Page

mercury (Hg)
a silvery-colored metal, commonly called quicksilver. The term refers to any of the different
chemical forms that mercury can take, including elemental mercury, methylmercury, and ionic
mercury
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MERCURY IN MEDICAL FACILITIES
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TOP of Glossary Page
mercury (ionic)
Ionic mercury is water soluble and associates with particulates. Atmospheric deposition of
elemental mercury is relatively fast, either as dry deposition or in precipitation. Combustion
sources can emit both elemental mercury and ionic mercury. Ionic mercury can be produced in the
atmosphere by the oxidation of elemental mercury by ozone or other oxidants
!• Top of Glo§§ajry .IPage

mercury (elemental mercury)
The elemental form of mercury is familiar as the silvery liquid. Elemental mercury can volatilize
to the atmosphere at normal temperatures. Over 90% of mercury in the atmosphere is in the
elemental form, although other forms may be considerably higher than 10% near sources. Because
elemental mercury does not adsorb to particulates and is not very water soluble, it is removed
from the atmosphere very slowly with a half life in the atmosphere of about a year. Ingested
elemental mercury is not absorbed, but the vapor is readily absorbed by the lungs

Ifl Top of Glossary Page

metabolism
the chemical or energy changes which occur within a living organism or a part of it which are
involved in various life activities.
I Top of Glossary Page
metal
any of a class of elementary substances, as gold, silver, or copper, all of which are crystalline
when solid, and many of which are characterized by opacity, ductility, conductivity, and a unique
luster when freshly fractured. An element yielding positively charged ions in aqueous solution of
its salts
!• Top of Glossary Page

methylmercury
any of several extremely toxic compounds formed from metallic mercury by the action of
microorganisms and capable of entering the food chain.

Top of Glossary Page

natural mercury emissions
the atmospheric emission of geologically bound mercury through natural processes (e.g. emission
of mercury from volcanoes)

• Top of Glossary Page

neurotoxin
a poisonous substance which affects nervous system.
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MERCURY IN MEDICAL FACILITIES Page 14 of 20
iH Top of Glossary Page

nitrate (NO3)
an important plant nutrient and type of inorganic fertilizer (most highly oxidized phase in the
nitrogen cycle). In water, the major sources of nitrates are septic tanks, feed lots and fertilizers.

Top of Glossary Page

nitrite (NO2)
product in the first step of the two-step process of conversion of ammonium (NH4) to nitrate
(NO3)
opacity
the state or quality of being opaque.

I Top of Glossary Page

ores
a metal-bearing mineral or rock, or a native metal, that can be mined at profit. A mineral or
natural product serving as a source of some nonmetallic substance, as sulfur.

IH Top of GlossaryJPage

organic
compounds that contain carbon.

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oxidation
the removal of hydrogen from a compound. The loss of electron with an increase in positive
valence of an element.

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paralysis
loss of sensation or loss of muscular function usually due to an injury to a nerve or a lesion within
the central nervous system.

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pathogen
any disease-producing agent.

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pathology
the scientific study of disease, including causes, symptoms, signs, and various structural and
functional alteration which may occur in its course.

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PCB (polychlorinated biphenyl)
a family of highly toxic chemical compounds known to cause skin diseases and suspected of
causing birth defects and cancer.

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permeability
the capacity of a porous rock, sediment or soil to transmit a fluid such as water. The more fluid
that can be transferred, the more permeable the material.

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pesticide
a chemical substance used to kill or control pests such as weeds, insects, fungus, mites, algae,
rodents, and other undesirable agents
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pH
a numerical measure of acidity, or hydrogen ion activity used to express acidity or alkalinity;
neutral is pH 7.0, values below 7.0 are acid, and above 7.0 are alkaline.
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pharmaceutical
a chemical drug or medicine.
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photochemistry
the branch of chemistry that deals with the chemical action of light.
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photosynthesis
The process which occurs in the cells of green plants in which simple sugars are formed from
carbon dioxide and water in the presence of light and chlorophyll. The basic reaction by which
light or radiant energy is converted to chemical energy and stored in the molecules of
carbohydrates.
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plankton
aquatic organisms of fresh, brackish, or sea water which float passively or exhibit limited
locomotor activity.

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poison
a substance, which upon contact or being introduced into an organism, impairs or prevents normal
metabolic processes from taking place, thus altering the normal functioning of organs or tissues.

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point-source pollution (PS)
pollution of water from one place in a concentrated manner that is easy to identify. Ex. leaking
underground storage tank or discharge pipe from a sewage treatment plant.

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pollution prevention (P2)
Altering a process or use of materials to reduce environmental release of mercury. Examples of
pollution prevention include nonfossil-fuel energy production (e.g. wind energy), more efficient
use of fossil-fuel energy, use of low-mercury coal, and use of alternative products (e.g. digital
thermometers instead of mercury thermometers). According to the Federal Pollution Prevention
Act of 1990, pollution prevention is "any practice which reduces the amount of any hazardous
substance, pollutant, or contaminant entering the waste stream or otherwise released into the
environment prior to recycling, treatment, or disposal...". Pollution prevention is also called
"source reduction".
a

B Top of Glossary Page

pollution reduction
in this program, pollution reduction is the decrease in the use and environmental release of
mercury.

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porosity
the degree to which the total volume of soil, gravel, sediment or rock is permeated with pores or
cavities through which fluids (including air) can move

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parts per million (ppm)
a common basis for reporting water analysis. One ppm equals one unit of measurement per
million units of the same measurement. One ppm equals one milligram per litre. One ppm is
approximately the aspirin concentration formed when one aspirin tablet is dissolved in 100 gallons
of water.
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precipitation (ppt)
moisture falling from the atmosphere in the form of rain, snow, sleet or hail.
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predatory fish
a fish living by killing and eating other animals.
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prenatal
before birth.
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preservative
a chemical substance used to preserve food or other organic material from decomposition or
fermentation.
reduction
a chemical reaction in which one or more electrons are gain by the substance reduced. The
addition of hydrogen atoms or the loss of oxygen atoms.

IH TOD of Glossary Page
refuse
something that is discarded as worthless or useless; rubbish, trash, garbage.
Too of Glossary Page
root zone
the depth of soil penetrated by crop roots. Also called the vadose zone.

IB Top of Glossary Page

runoff
the flow of water from the land to oceans or interior basins by overland flow and stream channels.

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salinity
the concentration of dissolved salts in water.
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salt
a substance other than water resulting from the reaction between an acid and a ba§e.

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saturated fat
a type of single-bond animal or vegetable fat, as that found in butter, meat, egg yolks, and coconut
or palm oil, that in humans tends to increase cholesterol levels in the blood.

IH Top of Glossary Page

sediment
that which settles to the bottom, as in a lake or a river.

IH Top of Glossary Page

smelting
fusion or melting process in order to separate metals.

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sorb/sorption
to take up and hold (to sorb) either by absorption (to absorb) or adsorption (to adsorb).

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soil moisture content (me)
the portion of water in a soil that can be readily absorbed by plant roots. It is the amount of water
released between in situ field capacity (FC) and the permanent wilting point (WP).

IH Top of Glossary Page

solvent
a liquid in which a substance is dissolved.

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storage
the temporary deposit of a chemical in body tissue or in an organ. Storage is just one facet of
chemical bioaccumulation. The term also applies to other natural processes, sues as the storage of
fat in hibernating animals or the storage of starch in seeds.
I Top of Glossary Page

TCDD

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a by-product of pesticide manufacture; a toxic compound that is carcinogenic and teratogenic in
certain animals.

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teratogenic
capable of interfering with the development of a fetus, causing birth defects.
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textile
any cloth or goods produced by weaving, knitting, or felting
threshold
the lowest limit at which a certain phenomenon will occur.
toxic
of, pertaining to, affected with, or caused by a poison.
I Top of Glossary Page
toxicity
the quality, relative degree, or specific degree of being toxic or poisonous.
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turbidity
a measure of water cloudiness caused by suspended solids.

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uptake
it describes the entrance of a chemical into an organism ~ such as by breathing, swallowing, or
absorbing it through the skin ~ without regard to its subsequent storage, metabolism, and
excretion by that organism.

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valence
the combining power of an atom; its capacity to combine with other atoms to form a molecule,
expressed in terms of the number of hydrogen atoms or their equivalent with which any atom may
combine.
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volatilization
loss of a substance through evaporation or sublimation. When manure is spread on a field,
ammonia-nitrogen in the manure may volatize quickly and be lost as fertilizer unless it is
incorporated into the soil.

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wastewater
water that has been used in washing, flushing, manufacturing, etc.; sewage

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x-rays
also know as Roentgen rays. Radiant energy of short wave length produced by high speed electron
striking a metal target in a vacuum.
[H Top of Glossary Page

zooplankton
the animals of plankton

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Bibliography
1. The case against mercury: Rx for pollution prevention. U.S. Environmental Protection Agency,
Region 5, Chicago, IL. 1995.

2. MERC Concern: Mercury awareness for Michigan citizens. Michigan Department of Natural
Resources. 1993.

3. Sources of mercury in the hospitals. Mr. Ketan Desai, Industrial Waste Control Division. Detroit,
MI.

4. Mercury sources in health care business. Detroit Water and Sewerage Department, Detroit, MI.
1995.

5. Mercury: Myths, truths, and disposal methods. U.S. Environmental Protection Agency, R'egion 6.
Dallas, TX.

6. Medical waste pollution prevention. Keep mercury out of the wastewater stream. U.S.
Environmental Protection Agency, Region 5. Chicago, IL.

7. Mercury. Western Lake Superior Sanitary District. Duluth, MN.

8. Mercury in Michigan's environment: Environmental and human health concerns. Michigan
Environmental Science Board, Lansing, MI. 1993.

9. Mercury, a fact sheet for health professionals.

10. Strategies for mercury control in Minnesota. Minnesota Pollution Control Agency, St. Paul, MN.
1994.

11. Hazardous Laboratory Chemicals. CRC press, Boca Raton, Florida. 1991.

12. Qualification/Quantitation Approaches to Evaluate Mercury Use at Medical Facilities. U.S. EPA,
Regions. 1995.

13. Steen, KB. Dictionary of Biology. Barnes and Noble Books, New York, N.Y. 1971.

14. Bioaccumulation 1973. Extension Toxicology Network (EXTOXNET). A pesticide information
project of cooperative extension offices at Cornell University, Michigan State University, Oregon
State University, and University of California at Davis.
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