Project Title: Mercury Reduction in Hospitals
Intern:
Facility:
Mary Caddle
10 Roberta Drive
New Hampshire Department of Environmental Services
6 Hazen Drive, P.O. Box 95
Concord NH 03302-0095
Home Phone: (603) 749-2273
Dover NH 03820
E-mail: mccaddle@hopper.unh.edu m_caddle@des.state.nh.us
Contact Person: Stephanie D’Agostino 271-6398
Pollution Prevention Coordinator, NHDES
Sara Johnson 271-6460
Pollution Prevention Program Specialist, NHDES
Executive Summary
The New Hampshire Department of Environmental Services (DES) Pollution Prevention
Program (NHPPP) is spearheading this project to reduce mercury use and wastes in hospitals. By using non-mercury alternatives for equipment and products that have traditionally contained the toxic substance, hospitals can cut pollution at its source.
There are two main components of this project thus far. The first is the NH Mercury
Baseline Survey. This has been created with the intention of assessing the state of mercury use and policies at all the hospitals. The survey has undergone several revisions and been used and evaluated at the two test sites for this project. It is now completed and will soon be sent out to all acute care facilities in New Hampshire. This will enable DES to determine the needs of all the hospitals and seek areas of potential improvement.
The second portion of this initiative is education and outreach at the hospitals. Efforts such as bulletin boards, newsletter items, lunchtime lectures, literature distributions, and press releases help to pass information about mercury and its dangers on to the community. In addition, a web page design has been completed and will be linked to the NHPPP web page once revisions are complete.
Future steps will be determined by the results of the baseline survey. The information from the hospitals will show if education is an area of need and for what products alternative items are not being used. Work on this project has progressed significantly in the last two months, and experience from the two pilot hospitals will be invaluable during the next phase.

Introduction/Background
The goal of the Pollution Prevention Program is to reduce environmental damage by changing practices that use hazardous or polluting materials. Mercury is one substance receiving a substantial amount of attention in this regard. It is extremely harmful to humans, claiming neurological damage and reproductive damage as two of its possible effects. Since it is bioaccumulative, the mercury is retained in living organisms and is passed on to anything that consumes the polluted species, thus amplifying the effects to animals higher in the food chain.
Since mercury pollution is a serious problem affecting this state, all contributing sources must be carefully assessed and plans formulated to significantly reduce this contamination. In many cases, alternatives to mercury use can be found; in others, a careful recycling program can prevent the waste from being passed along with non-hazardous waste to incinerators or landfills, where it has a potential to escape into the environment.
The medical field is one area in which there has historically been significant mercury use.
Mercury is used in thermometers, manometers, vacuum gauges, switches, thermostats, batteries, blood pressure cuffs, internal tube devices, laboratory reagents, and more. In fact, DES has estimated that for the state of New Hampshire in 1997, approximately 9% of mercury emissions was as a result of medical waste incineration.
Goals/Objectives
The objective of this project is to aid the process of phasing out mercury containing devices and products from New Hampshire hospitals. The initial project will select two facilities that will receive direct assistance in their initiatives to eliminate mercury usage. In addition, another major objective is the completion of a “mercury survey” by all hospitals in the state. This will enable
DES to assess the areas of concern and how to best address them.
Approach/Methodology
This project involved several steps. First, a draft survey was created through modification and combination of existing surveys. This survey includes all pertinent data relating to the use and disposal of mercury. Topics covered include mercury purchasing and spill policies, recycling information, equipment lists, and spill history. These surveys are intended to be completed before reduction efforts are begun. As such, they will be used to create a baseline for the initiative.
The initial draft was sent to members of the Hospital Workgroup, which includes representatives from DES, U.S. Environmental Protection Agency (EPA), New Hampshire Hospital
Association (NHHA), WasteCap of New Hampshire, University of New Hampshire, Concord
Hospital, and Dartmouth-Hitchcock Medical Center. At this point, the survey has undergone multiple revisions.
Concord Hospital and Dartmouth-Hitchcock Medical Center are serving as “model” hospitals for this project due to the work that they have already completed on mercury reduction and education. One step in this project was the review of the items used and the procedures in place at these sites in order to determine some of the success factors which have enabled them to fully implement valuable environmental programs. In conjunction with this step of the process,

both hospitals were visited and the site contacts were able to share a great deal of information and display their techniques and tips.
Two pilot hospitals were selected as test sites for the survey and the first recipients of assistance in determining their mercury use and implementing educational programs. Franklin
Regional Hospital (FRH) in Franklin and Alice Peck Day Memorial Hospital (APD) in Lebanon were selected on the basis of their interest in the EPA’s Mercury Challenge program.
Representatives from DES and NHHA met with the site contacts at both of these facilities to discuss the object of the NH hospital initiative. At these meetings, the needs of the hospital were discussed and next steps planned. For FRH, it was decided that they would complete the survey while DES prepared possible educational materials. APD was not able to complete the survey right away, but also requested sample information and scheduled an on-site, at which DES was able to see different aspects of the hospital’s waste management processes.
Further work with FRH has included several educational efforts, including a newsletter article, bulletin board set-up, distribution of educational materials, and lunch-time lectures. These efforts are consistent with the needs of the Franklin community as the hospital has very little mercury remaining on site, yet is concerned with the lack of awareness about the issue.
Work with the pilot sites has also enabled completion of the baseline survey, as their suggestions were also incorporated. The survey is now in its final form and is soon to be distributed.
Chemical Usage/Equipment/Wastes
While no chemicals were handled or used during the course of this project, the focus of the effort is clearly mercury. This metal is silvery in color, liquid at room temperature, and highly toxic. Known for its high surface tension which creates the characteristic little balls, it is also volatilizes easily, making spills a hazard, particularly if they are not properly cleaned up.
Mercury’s classification as a persistent bioaccumulative toxic (PBT) has made it a priority as of late, both within New Hampshire and in the nation as a whole. It can be harmful to humans through inhalation, ingestion, or skin absorption, but it is most toxic in its organic form. When mercury contaminates surface water, either directly or as a result of air emissions, it can then be transformed by the bacteria in the water to methyl mercury. This is the form that accumulates in the muscle tissue of fish and the form that is ingested by humans and other animals through fish consumption.
Work Accomplished/Project Results
Several steps in this project have been completed (see Approach/Methodology ). In addition, many auxiliary tasks have been assigned and have now been finished. These include writing the survey cover letter, creating bulletin board materials, drafting a press release, writing an article for the FRH newsletter, giving informational lectures at FRH, and designing a web page to share facts about mercury and the project with the public.
Although this project has not yet been completed, significant progress has been made in the past few months. Feedback from FRH has been positive regarding the outreach efforts. Work at the pilot sites suggests that this type of work may be instrumental in achieving the goal of mercury

reduction (see Recommendations for Future Efforts ).
Pollution Prevention Benefits
Mercury contamination in New Hampshire and beyond is at a level that warrants extreme concern. Fish advisories have been issued in 40 states, and mercury deposition rates suggest that they are called for in even more. Medical facilities are a major source of this pollution, and one that has the potential to change its procedures drastically. Success in this area would mean considerable reduction in the anthropogenic releases of mercury that are constantly damaging the environment.
The primary object of this project is to reduce the use of mercury in the medical facilities.
This source reduction means that hazardous mercury waste will not be generated in the first place.
Another important goal is the corresponding education. As people come to understand the reasoning behind the removal of mercury-containing products, they will support the initiative, thus making it self-policing.
Recommendations for Future Efforts
At this time, the survey has been completed and will soon be mailed to all NH acute care facilities. The compilation of this information will be key in determining the focus of future efforts.
Assembling the information will be one important piece of the work to come. The aggregate results will be made available to the public on the web page, and specifically to the hospitals at a P2 conference with a special focus on health care.
One of the most important aspects of this program has been education, and this may continue to be so. While experience at the pilot sites suggests that many hospitals may have very little in the way of mercury on site, it also indicates that very few people have an understanding of the effects of mercury and the state of the problem in New Hampshire. While it is outside the realm of actual pollution prevention, it is important to continue to recommend the NH Health and Human
Services brochure describing the fish consumption advisory. Another possibility is to offer the materials from Franklin as a template with which other hospitals can begin their own education programs.
References
Healthcare Without Harm. www.noharm.org
Laura Brannen, Waste Minimization Coordinator/Safety and Environmental Programs.
Dartmouth-Hitchcock Medical Center
Judy Sharpe, BSN RNC, Green Team Representative. The Family Place at Concord Hospital
New Hampshire Mercury Reduction Strategy, October 1998. New Hampshire Department of
Environmental Services