Module 4 Mercury Use in Health Care Settings - For Health Care Workers -
Learning Objectives • Know how to identify and locate mercury containing products in the hospital • Be familiar with proper handling and clean up procedures for small mercury spills • Identify options to make your health care setting a safer place to work Module 4: Mercury Use in Hospitals and Dentistry
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Learning Objectives • Know why mercury is used by the dental industry • Promote good dental hygiene for patients with mercury amalgams
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Toxic Mercury • Mercury and its compounds are recognized as highly toxic substances • Mercury’s toxic effects include: – Harm to the central nervous system – Neurological and behavioral disorders – Kidney and thyroid problems
• Mercury is more likely to adversely affect children than adults Module 4: Mercury Use in Hospitals and Dentistry
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Why Does Mercury Matter? • Mercury is toxic to ourselves and to our environment • Yet, mercury is used in hospitals and dental offices all over the world • People are at risk when a mercury containing instrument breaks, leaks or spills Module 4: Mercury Use in Hospitals and Dentistry
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Mercury in Hospitals • Mercury is found in thermometers
• In sphygmomanometers
• In cantor tubes, esophageal dilators, feeding tubes and Miller Abbot tubes http://www.healthsystem.virginia.edu/internet/anesthesiologyelective/images/anesth0018.jpg
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Mercury in Hospitals
• And in some vaccines – Multi vs. single dose – No proven harm – Benefits vs. cost of vaccine
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Is Mercury in Medicine? • Mercury is sometimes found in herbal products, dietary supplements and other compounds • Some textbooks erroneously report that mercury can be “detoxified”
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What Are the Risks? • Mercury containing devices, especially thermometers, often break • Other times, mercury is spilled when devices, such as bogie tubes are filled • The mercury readily evaporates, posing a risk to everyone • Doctors, nurses and patients are at especially high risk Module 4: Mercury Use in Hospitals and Dentistry
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What Happens if There is a Mercury Spill? – Remove all people from the contaminated area – Keep the area below 20°C and ventilate if possible – Wear nitrile gloves and a mask during the clean-up – Use cardboard or folded paper to gather the mercury “beads” • Never use a broom or a vacuum cleaner
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What Happens if There is a Mercury Spill? – Place all contaminated materials into a sealable plastic bag – Seal the bag – Place this sealed plastic bag inside an impactresistant sealable container made of plastic or metal – Put the container holding the contaminated material in sturdy secondary containers
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Disposing of Mercury
Health Care Without Harm
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How is Mercury Best Stored? • Keep all mercury containers tightly closed when not in use • Store liquid mercury and mercury-containing waste in a cool place • Post clearly visible signs in the storage area • Limit access to the storage area • Monitor the quantity of mercury on hand
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Do Alternatives to Mercury Containing Devices Exist?
Health Care Without Harm
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How Can the Government Help? • To safeguard the public, governments can: – Require the labeling of all mercury-containing medicines – Regulate the import and export of mercury containing healthcare products – Educate the public and health care workers about the dangers of these products – Help purchase mercury free alternatives
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Health Care Without Harm
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Mercury in Dentistry
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How and Why Mercury is Used in Dentistry • In 2005 some 270 tonnes of mercury were used in dental amalgam worldwide • Dental amalgam is a cheap and easy method used by dentists to fill in cavities
Module 4: Mercury Use in Hospitals and Dentistry
www.ada.org
• The amalgam contains roughly 50% mercury
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What Are the Risks? • Mercury containing waste released from dental office damage the environment • Do not use mercury amalgams with patients with impaired kidney function
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What Are the Risks to the Patient? • The mercury in the amalgam slowly volatizes and erodes over time • Replacing the mercury amalgam may do more harm than good – Pieces of the amalgam may be inhaled or ingested
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Minimizing Mercury’s Toxic Effects • Promote good dental hygiene in patients • Follow steps to safely and properly dispose of mercury containing waste • Use alternatives to dental amalgams whenever possible
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Minimizing Mercury’s Toxic Effects • Use mercury detection devices in the office to protect against high levels of mercury vapor • Replace the mercury amalgam with mercury free alternatives
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Safely Removing Dental Amalgams • Remove amalgam in chunks rather than dust • Do not remove amalgam chunks with a suction device • Use a finer mesh to trap more of the mercury waste • Consider purchasing an amalgam separator to separate mercury from wastewater Module 4: Mercury Use in Hospitals and Dentistry
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Skills for Amalgam Waste Management • Train staff to minimize and to properly dispose of waste • Offices should collect, store and recycle as much of the amalgam waste as possible – i.e. amalgam capsules, excess amalgam, pump filters
• Professionals should read suggested practices found in “How does an institution properly dispose of mercury?” Module 4: Mercury Use in Hospitals and Dentistry
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What Are the Main Messages? • Prevent mercury spills and leaks whenever possible • For almost every mercury containing device in the hospital, a mercury free alternative exists • Dentists should take proper measures to safeguard staff, patients and the local water supply from mercury contamination Module 4: Mercury Use in Hospitals and Dentistry
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Additional Resources •
Healthcare Environmental Resource Center:
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Sustainable Hospitals Project: www.sustainablehospitals.org
www.hercenter.org •
Health Care Without Harm:
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Mercury in Health Care Fact Sheet: www.epha.org/a/2455
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World Federation of Dentists
www.noharm.org •
Patient Brochure www.fdiworldental.org www.mercurypoisoned.com
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Mercury in Vaccines: www.fda.gov/CBER/vaccine/thimerosal.htm
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Or contact
[email protected]
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