Mercury spillage in health care settings

Mercury is a metal found naturally in the environment. It comes is a few forms. Elemental (metallic) mercury is the shiny, silver-gray metal found in thermometers, barometers, thermostats, and other electrical switches.

Mercury can break into droplets when spilled. The droplets spread easily and can build up in tiny cracks and spaces wherever it is spilled.
Mercury can vaporize (evaporate) into the air. The vapor cannot be seen or smelled.
Breathing in mercury vapors is the most common way to get mercury poisoning – and also the most dangerous.
Mercury can be toxic to the nervous system, lungs, and kidneys.

1. ” Mercury Spillage” in Health Care Settings Dr. Sujnanendra Mishra

2. Commercial products containing mercury Wiring Devices & Industrial Measuring Devices Medical Devices Pharmaceuticals & Personal Care Products Batteries, Thermostats, Barometers, Manometers, Temperature & Pressure Gauges, Certain Switches, and Light Bulbs.

3. Pesticides and Fertilizer Explosives/Weapons Dyes/Vermilion

4. Mercury Facts Mercury is the most toxic non-radioactive element on earth A silver colored mercury amalgam dental filling normally contains 52% mercury. The typical adult carries ten amalgam fillings containing about 5 grams of mercury 1/2 gram of mercury in a ten acre lake would warrant issuance of a fish advisory for the lake !

5. Dangers of Mercury The presence of raised mercury levels, in itself, does not necessarily cause pathologic reactions - the levels have to exceed a person’s threshold level.

6. Toxicity effects on humans Methyl mercury from fish consumption (highly toxic) or breathing vaporous mercury (bodies are more adapted to reducing toxic effects) Methyl mercury affects central nervous system and irreversible brain damage

7. Dangers, continued Exposure in the range of 25 to 80 m g/m 3 increases the incidence of: Defects in psychomotor performance Objectively detectable tremors Evidence of impaired nerve conduction Fatigue Irritability Loss of appetite Proteinuria

8. Occupational Exposure Occupational exposure to 25 m g Hg / m 3 air would correspond to a daily dose of somewhere about 100-200 m g / day (8 h / day, 5 days / week, 48 weeks / year, breathing of 1-2 m 3 of air per hour containing 25 (80) m g Hg / m 3 of which 80% is absorbed in the lung alveoli's).

9. Concentrated Exposure Mercury can: Selectively inhibit protein and amino acid absorption into brain tissue. Induce the thyroid gland to absorb an increasing amount of nuclear radiation from the environment. Impair the adrenal and testicular steroid hormone secretions. Selectively inhibit protein and amino acid absorption into brain tissue. Induce the thyroid gland to absorb an increasing amount of nuclear radiation from the environment. Impair the adrenal and testicular steroid hormone secretions.

10. Exposure, continued Cause chromosomal aberrations and alter the cellular genetic code Induce chromosomal breakage Alter cellular mitosis Cause a drop in t-cell production Kill white blood cells. Contribute to intelligence disturbances, speech difficulties, limb deformity, and hyperkinesia (hyperactivity resulting from brain damage) Studies have been done that suggest elevated levels of mercury can trigger auto-immune disorders (MS, ALS, Alzheimer’s)

11. !! Cleaning It Up immediately Mercury Spill Management

12. Suggested items for Mercury Spill Management Four to five zip-lock bags Waste bags (2 to 6 mm thick) Plastic container with lid that seals.(35 mm film canister for example) Nitrile or latex gloves Paper towels Cardboard strips (index cards for example) Eyedropper or syringe (without needle) Face mask Duct or other sticky tape (30 cm or so) Flashlight Powdered sulphur or zinc (this can easily be obtained at a pharmacy) Set of instructions with waste collection and disposal protocols.

13. Mercury Spill management STEPS 1. Evacuate area Remove everyone from the area that has been contaminated and shut The door. Turn off interior ventilation system to avoid dispersing mercury vapor throughout the facility. 2. Put on face mask In order to prevent breathing of mercury vapour , wear a protective face mask. 3. Put on old clothes Change into old clothes and shoes that can be discarded if they become contaminated. 4. Remove jewellery Remove all jewellery or else mercury will combine (amalgamate) with the precious metals.

14. 5. Wear gloves Put on rubber or latex gloves. If there are any broken pieces of glass or sharp objects, pick them up with care. Place all broken objects on a paper towel. Fold the paper towel and place in a zip lock bag. Secure the bag and label it as containing items contaminated with mercury. 6. Identify surface Wood, linoleum, tile and any other like surfaces can easily be cleaned. Carpet, curtains or other such surfaces cannot. ( For carpets, only the affected portion needs to be cut out and removed.)

15. 7. Locate mercury beads Locate all mercury beads, then carefully use the cardboard to gather them together. Use slow sweeping motions to prevent accidentally spreading the mercury. Small and hard-to-see beads can be located with the flashlight: Low angle beam, close to the floor in a darkened room can spot glistening beads of mercury that may be sticking to the surface or have gathered in small cracks in the surface. !!! Mercury can move a surprisingly long distance on hard and flat surfaces: be sure to carefully inspect the entire room.

16. 8. Use eyedropper and sticky tape Use an eyedropper or syringe (without a needle) to draw up the mercury beads . Slowly and carefully transfer the mercury into an unbreakable plastic container with an airtight lid. Place the container in a zip-lock bag. Label the bag as containing items contaminated with mercury. After you remove larger beads, use sticky tape to collect smaller hard-to-see beads. Place the sticky tape in a zip lock bag and secure . Powdered Sulphur or zinc stains mercury a darker colour and can make smaller beads easier to see. Be careful not to breathe the powder, as it can be mildly toxic.

17. The EPA (Environmental Protection Agency ), US has very strict restrictions on how to dispose of mercury. DON’T THROW IT IN THE TRASH OR DOWN THE DRAIN!!!

18. DISPOSAL Pour in to Leak-Proof Bag Place all materials used during the cleanup, including gloves, into a leak-proof plastic bag or container. Seal and label it as -- MERCURY “Danger: Do Not Touch.” . Final disposal Contact your local hospital manager responsible for toxic clean up and proper disposal to ensure that all mercury contaminated waste now secured in labelled bags is dealt with in accordance with prevailing Guideline. Ventilation Keep the affected area ventilated to the outside (with windows open and ventilation running) for at least 24 hours after your successful cleanup. If sickness occurs, seek medical attention immediately.

19. Six things you should NEVER do: Never use a vacuum cleaner to clean up mercury: the vacuum cleaner will vaporise the mercury and drastically increase exposure in the area. Never use a broom to clean up mercury: it breaks up the mercury droplets and moves them around, making it harder to decontaminate the area. Never pour mercury down the drain: it can lodge in the plumbing, and contaminate the septic tank and sludge in sewage treatment plants. Never wash mercury-contaminated items in a washing machine: mercury can contaminate the sewage system and the washing machine. Never continue wearing shoes and clothing that might have been contaminated in the mercury spill: this increases the wearer's exposure and helps spread contamination. Never burn shoes, clothing, fabric or anything that has been contaminated with mercury: this puts mercury into the atmosphere.

20. ”Do not use a vacuum cleaner to clean up a mercury spill .” Need to have a Mercury Audit and Follow-Up Checklist