|LETTER TO THE EDITOR
|Year : 2011 | Volume
| Issue : 1 | Page : 52-53
A mercury free health care organization: A must
Ritesh Singh, Neeti Rustagi
Senior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
|Date of Web Publication||30-Jun-2011|
Senior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh R, Rustagi N. A mercury free health care organization: A must. Indian J Public Health 2011;55:52-3
Mercury (Hg), a heavy silvery-white metal that is found in liquid state at room temperature, is toxic and hazardous. Methyl-mercury is a dangerous compound that is widely found as a pollutant in water bodies and streams.  Mercury gets released into environment either by volcanic eruptions or human generated. It may be fatal if inhaled and harmful if absorbed through the skin. Around 80% of the inhaled mercury vapor is absorbed in the blood through the lungs. Mercury can cause both chronic and acute poisoning. It may cause harmful effects to the nervous, digestive, respiratory, immune systems, kidneys, and lung. Adverse health effects from mercury exposure can be tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, developmental deficits during fetal development, and attention deficit and developmental delays during childhood. Studies have shown effects such as tremors, impaired cognitive skills, and sleep disturbance in workers with chronic exposure to mercury vapor even at low concentrations in the range of 0.7 to 42 μg/cu mt.
Healthcare facilities are one of the main sources of mercury release into the atmosphere because of emissions from the incineration of medical waste. In some places, it is as much as fourth largest source of mercury in the environment. In the United States, according to US Environmental Protection Agency (EPA) in a 1997 report, medical waste incinerators were responsible for as much as 10% of all mercury air releases. Dental amalgam is the most commonly used dental filling material. In 1991, the World Health Organization confirmed that mercury contained in dental amalgam is the greatest source of mercury vapor in nonindustrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and for air.  A variety of studies demonstrate that mercury-containing healthcare equipment will invariably break. Small spills of elemental mercury on a smooth, nonporous surface can be safely and easily cleaned up with proper techniques. However, beads of mercury can settle into cracks or cling to porous materials like carpet, fabric, or wood, making the mercury extremely difficult to remove. Spilled mercury can also be tracked on footwear. Inadequate cleaning and disposal may expose already compromised patients and healthcare staff to potentially dangerous exposures. An average sized hospital in India releases around 3 kg of elemental mercury in the environment in a year. With very conservative estimates, a city like Delhi would be releasing around 51 kg of mercury each year through dental practices alone. 
Though there are instruments which are alternative to the mercury-containing equipments, their use was never widespread. Both mercury and aneroid sphygmomanometers have been in use for many years. The thinking that aneroid sphygmomanometer does not give accurate reading has no base. By choosing a mercury-free alternative, a healthcare institution can make a tremendous impact in reducing the potential for mercury exposure to patients, staff, and the environment. Aneroid sphygmomanometers provide accurate pressure measurements when a proper maintenance protocol is followed. 
The World Health Organization issued a policy paper in 2005 calling for short-, medium-, and long-term measures to substitute mercury-based medical devices with safer alternatives. The World Medical Association passed a resolution in 2008 calling for the substitution of mercury-based medical devices with safer alternatives.
Many cities in the world are moving toward mercury-free health centers In Argentina, more than 70 hospitals have replaced or are on the path to replacing mercury-free thermometers and blood pressure devices. In Sao Paulo, Brazil, more than 100 hospitals have eliminated mercury-based thermometers and sphygmomanometers.
There are many hospitals in India which are mercury free. The Department of Health and Family Welfare, Government of NCT Delhi, drafted and circulated a written policy to all the government hospitals, which asks the hospitals to curb the use of mercury equipment. All government hospitals in Delhi have stopped purchase of mercury equipment and are in the process of phasing it out. A non-mercury product replaces any broken mercury instrument. Some of the private hospitals in Delhi had started mercury phase out as early as 2003 when mercury was included in the training programs conducted for medical waste management.
| References|| |
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|2.||Ngim CH, Foo SC, Boey KW, Jeyaratnam J. Chronic neurobehavioural effects of elemental mercury in dentists. Br J Ind Med 1992;49:782-90. |
|3.||Concise International Chemical Assessment Document 50. Elemental mercury and inorganic mercury compounds: Human health aspects. Available from: http://www.who.int/ipcs/publications/cicad/en/cicad50.pdf. [last accessed on 2010 Aug 9]. |
|4.||Agrawal A. Moving towards mercury-free health care: Substituting mercury-based medical devices in India. Toxics Link, India 2009. Available from: http://www.mercuryfreehealthcare.org/reporthgTL.pdf. [last accessed on 2010 Aug 9]. |
|5.||Mercury in health care. Policy paper. World Health Organization. Available from: http://www.who.int/water_sanitation_health/mercurypolpaper.pdf. [last accessed on 2010 Aug 9]. |