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At the time of
writing (Jan 2012) there are no
official plans to restrict the use of
Mercury in the U.K merely suggested "best
practice" guidelines. The health and safety
issues of restricting the use of Mercury in
Hospitals and Doctors Surgeries has been
highlighted in a number of well publicized
cases and now has priority within a number
of Trusts.
Background
In April 1997, The French Ministry of Labour
and Social Affairs sent a letter (DOS/DH
97/305) to the UK Department of Health. This
document "reminded health professionals of
the risks associated with the use of mercury
thermometers".
The principle thrust of this advice was that
"the purchase of instruments for measuring
temperature, which do not contain mercury,
should be promoted" and, "the use of mercury
thermometers in the near future should he
prohibited". The rationale for this advice
was both to try and reduce the discharge of
mercury of medical origin into the
environment, which could conceivably end up
in the food chain, and, to promote proper
recovery and recycling of mercury. -
Contact with mercury may occur when a
Mercury-in-glass clinical thermometer
breaks. Although the quantity of mercury
released with each breakage may he small,
failure to contain and dispose of each
spillage effectively, may lead to an
accumulation of spilt mercury in ward areas.
Nursing staff need to have ready access to
spillage kits, and be trained in their use.
The use of carpet floor covering in clinical
areas may reduce the number of breakages.
However, if spillage onto carpet is not
adsorbed, they may be sucked into vacuum
cleaners, which may in turn, cause
widespread dissemination of micro-droplets
and vapour.
Contact with mercury may also occur during
the servicing of the mercury column in
sphygmomanometers. There has been at least
one clinical report of toxicity arising from
this source (BMJ 1986;7.116A). However, in
1996, the UK Health and Safety Executive (HSE)
recommended that servicing of mercury
containing devices took place in a fume
cupboard, with a filter fitted to the
exhaust.
To help validate COSHH assessments, in 1996
the HSE set maximum exposure limits to
mercury vapour, as 0.025mg/m', as an 8-hr
Time Weighted Average (F~H40/1996).
A move to the purchase of non mercury
containing measuring devices to measure
blood pressure and clinical temperature is
becoming widespread, and reflects the
emphasis device manufacturers and
distributors are placing on the apparent
benefits offered by "new technology'
products, since apart from eliminating the
need to consider mercury-associated risks,
this technology offers added features for
the user, e.g. the storage and timing of
readings.
Additional incentives may hasten the change.
Since the disposal of mercury from
decommissioned sphygmomanometers is becoming
expensive.
The Health and Safety Executive (HSE) first
issued the Regulations for the Control of
Substances Hazardous to Health COSHH in 1988
(last updated in 1999). They have also
produced several guidance documents in order
to protect personnel and limit the amount of
mercury reaching the environment (EH 17 & MS
12). Occupational Exposure Limits are now
contained within EH40199.
The COSHH Regulations provide a
comprehensive and systematic approach to the
control of hazardous substances at work and
require employers to: (a) assess risks to
health arising from exposure to hazardous
substances; (b) prevent or adequately
control exposure; (c) ensure control
measures are used, maintained, examined and
tested; (d) in some instances monitor
exposure and carry out appropriate health
surveillance; (e) inform, instruct and train
employees.
Blood Pressure Measurement
In order to eliminate mercury a number of
hospitals have recently decided to change
their wholesale purchasing of
sphygmomanometers from the mercury column to
aneroid or digital type.
Cheap aneroid sphygmomanometers can be less
robust than the mercury column type. This is
not the case with ERKA or A&D but for peace
of mind they can be easily checked with a
P.M.S pressure tester. Users should be aware
of the limitation of the mechanical design,
and must routinely check that the position
of the pointer is within the zero tolerance
zone, before taking a measurement.
Summary
Before purchasing replacements for Mercury
an assessment should he made to check
accuracy of readings, and of robustness of
construction and after sales support which
as an ISO9000 2000 quality assured company
established for over 30 years P.M.S provide.
Running costs are also an important
consideration. Unlike some makes all A&D
digital monitors can use rechargeable
batteries and come with a two year warranty.
For medical devices containing mercury the
question needs to be asked, “are these
products needed?" If the answer is yes, then
control measures should be implemented and
staff should be trained to ensure safe
handling: 1 During normal use and storage; 2
in the event of a mercury spillage; 3 during
maintenance of mercury sphygmomanometers, if
performed in-house; 4 in the event of
mercury disposal or when a complete
instrument is discarded. This can result in
extra costs associated with the use of
devices containing mercury, when compared
with non-mercury types. In a particular
example a hospital's maintenance laboratory
was closed after a safety check revealed
that the mercury vapour present exceeded the
occupational exposure limit of 0.025 mglm3 (EH40199).
This resulted in a decision being made to
replace mercury sphygmomanometers throughout
the hospital
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