31 DECEMBER 2007

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FOR SURE local healthcare professionals have long been aware — however vaguely — of the risks posed by materials and products that use mercury. But concerns about these dangers were apparently put in the backburner by most; it took a groundbreaking conference on mercury last year and a particularly nasty incident involving the substance at a Parañaque school for members of the healthcare community to finally take a more careful look at the dangers in their midst.

Ironically, officials at the Philippine Heart Center — where the mercury conference was held in January 2006 — took even longer than that. Four months after the conference (organized by HCWH in association with UNEP, and with the support of DOH, DENR, and the Heart Center itself), the hospital’s Waste Management Committee invited Rivera as a resource person for one of its regular meetings. Admits Ester Borja, head of the committee and chief of the Heart Center’s Auxiliary Services Department: "It was through Engineer Rivera's account of her personal experience that we learned about the gravity of the St. Andrew's School mercury spill. This made me and the rest of the committee to seriously consider a phaseout of all mercury devices."



A PHC staff shows beads of mercury from broken thermometers collected using a tongue depressor. [photo by Mira Mendoza]
St. Andrew’s was the Parañaque school where early last year at least 24 students, mostly aged 13, wound up in the hospital as confirmed cases of mercury poisoning. Investigation showed that the students were poisoned after they were allowed to play with 50 grams of mercury intended for a science experiment. The school had to remain closed for months while local and international experts cleaned up and decontaminated it.

Rivera herself notes an increase in reports of mercury spills in healthcare facilities following the release of the DOH memorandum on how to clean up after mercury accidents, indicating a rise in awareness and concern about the substance’s possible effects. On average, the health department receives at least two calls per month requesting for assistance on handling mercury spills. But Rivera says that in a monitoring exercise conducted by the DOH last May on four government hospitals, the results were ominously “significant.”

She explains that this can only mean a history of spills that have not been cleaned up properly in these facilities (which she declines to name). Rivera points out that mercury is a persistent element — and becomes even more so in an airconditioned enclosure. She says that simple cleaning using a broom or worse, a vacuum cleaner, could only aid in spreading the contamination.

Absorbed by carpet, or trapped in floor cracks and crevices, elemental mercury can easily volatilize into mercury vapor, contaminating indoor air. Inhalation of mercury vapor in the short term will not readily manifest symptoms. Generally, a month or more is needed to produce symptoms.

The hospitals that were monitored have since been advised on how to reduce their indoor mercury levels to safe standards (0.2 micrograms per cubic meter). Rivera also reports that the raised awareness regarding mercury’s dangers has led to hospital workers themselves clamoring for the release of the health department’s AO on mercury.

PRESSED TO issue a memo banning the purchase of mercury thermometers by all hospitals by 2008 while the AO remains in limbo, the DOH has instead offered to have all government-regulated hospitals in Metro Manila put any mercury thermometer bought for 2008 on hold while those that have yet to place an order for such would be told not to proceed.

Many hospitals, however, are already taking it upon themselves to move toward mercury-free healthcare — with or without an AO, memo or no memo. HCWH even says there are more than 50 such hospitals. Ferrer also says these are currently developing policies or guidelines on evaluating safe alternatives to devices containing mercury and even testing some of options to the mercury thermometer and sphygmomanometer (the more formal name for the blood-pressure monitoring contraption). Some have also gone on to purchasing digital thermometers, albeit only for select wards.

Although HCWH has yet to name the hospitals that it says are bent on becoming mercury-free, two facilities are already recognized as pioneers in effectively accomplishing a complete phaseout of mercury thermometers and blood-pressure monitors. Both hospitals have removed these devices even in their respective purchasing policies.

Making your own mercury spill kit

THE following are some common household articles that could be used to construct an in-home mercury cleanup kit:

• eye dropper
• goggles
• paper towel
• plastic container with lid
• plastic sheeting
• powdered zinc*
• rubber squeegee
• tape: wide, duct, or masking
• tray or box
• flashlight
• napkins
• plastic bags with zipper seal
• plastic dust pan
• powdered sulfur**
• rubber gloves
• syringe without needle
• trash bags
• wide mouth container

* visualizes mercury by turning from yellow to brown and forms mercuric sulfide; dusting the area with this powder also reduces mercury vapors

** amalgamates (bonds with) mercury

Note: Used items are to be double-bagged and disposed of in accordance with DENR requirements.

Source: DOH

The Manila Adventist Medical Center, a 150-bed private hospital, decided to switch to mercury-free alternatives after the January 2006 mercury conference. By mid-2006, it had successfully replaced all its mercury thermometers and sphygmomanometers.

The other hospital is actually the Heart Center, where the board approved Borja’s recommendation for a phaseout of mercury devices soon after Rivera’s talk. The Center’s Products Standards Committee was then assigned to evaluate and present criteria for non-mercury alternatives.

Meanwhile, the hospital’s Waste Management Committee started its mercury spill management training for its staff. Mercury spill kits were distributed to each nursing unit. Spills were no longer ignored, but were reported. According to Borja, this was how they found out that between February to June 2007, there were 32 thermometer breakages in the hospital.

A thermometer contains about a gram of mercury. The HCWH says, “Thermometer breakages on a case-to-case basis pose some harm to patients, nurses, and other healthcare providers when mercury is absorbed through the skin or mercury vapor is inhaled.”

Borja relates how the Waste Management Committee’s insistence for the nurses to personally do the cleanup (within a five-minute deadline) eliminated any resistance to the use of digital alternatives. By last July, the Heart Center had purchased its first batch of digital thermometers — partially financing the transition by passing on the cost to patients. This has led to some resentment from patients who rue the huge leap in price (almost P200). But Borja says the nurses have been very successful in convincing patients that the added cost would go a long way in ensuring a healthier environment for all.

Similar efforts are being undertaken in other DOH-retained hospitals, such as the National Kidney and Transplant Institute and the Philippine Children’s Medical Center, both in Quezon City. Rivera is also proud to say that although the San Lazaro Hospital in the DOH compound in Manila has not completely gone mercury-free yet, its staff have “a strong awareness and knowledge of healthcare waste management.” One proof of this, she says, is its own initiative to phase out dental amalgam.

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