Eu Mercury phase out in Measuring and Control Equipment - EEB

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REPORT FROM THE CONFERENCE “EU MERCURY PHASE OUT IN MEASURING AND CONTROL EQUIPMENT”with regard to the viability of mercury free sphygmomanometers. The questions that continue toarise are: Can mercury sphygmomanometers be completely eliminated from professional use, and ifso, is the health care system actually ready for such a transition? As input to these questions,interviews were carried out with hospitals and clinicians in 8 countries (Czech Republic, France,Germany, Greece, Hungary, Italy, Spain and the UK). In total 37 persons were interviewed. Theinterviews with health care professionals are categorized as in the table below.Position at hospitalNumber of personsinterviewedSenior administrator 3Administrator 3Doctor 7Nursing director 7Nurse 8Biomedical or tech. specialist 7Other (cleaning, security) 2Total 37Table: Positions of healthcare professionals and numbers of people interviewedIn total, information was obtained for 55 hospitals representing a capacity of 38,000 beds. A roughestimation of sphygmomanometers in use in these 55 hospitals was close to 10,000, of which about15% were mercury sphygmomanometers and the rest mercury-free. It can therefore be seen thatthere is clearly a movement in the direction of mercury-free. Whether the movement is faster orslower seems to depend on the country in question.Hospitals with only mercury-free sphygmomanometers represented 75% of the total interviewed -but it would be more like 50% of the hospitals if Germany were to be removed from thatcalculation. Worthy of note is that the number of hospital beds per sphygmomanometer variesgreatly in the countries examined: from something like one sphygmomanometer for 3 hospital bedsin the UK, to one sphygmomanometer for 14 hospital beds in Hungary. In some countries likeGreece, up to two-thirds of the sphygmomanometers that were found were mercury-containingones; in Italy about half, whereas, in Denmark, Spain and France, zero or almost zero.The main concerns that were voiced by the interviewees were that the aneroid sphygmomanometersare too fragile and are subject to shock. People have had bad experiences with some sphygs so theylacked confidence in the reliability of the mercury-free sphygmomanometers. Further, intervieweesnoted that by looking at the sphygmomanometer, it is impossible to know whether the calibrationhas shifted or how stable it is.There is also a fair amount of confusion between calibration and validation. Some people wanted tosee the CE-label on the sphygmomanometer to know that it was a valid instrument; others knewthat calibration should be carried out but some hospitals did not necessarily follow the properprocedure because of cost reasons or a lack of awareness of the person who is responsible for it.There is also a large lack of awareness. Many interviewees were not aware that there are shockresistant models of aneroid sphygmomanometers and they were not aware of the limitations of the23
REPORT FROM THE CONFERENCE “EU MERCURY PHASE OUT IN MEASURING AND CONTROL EQUIPMENT”mercury ones or the difference in quality available among electronic and aneroidsphygmomanometers. Further, many people were not at all aware of the importance of routinecalibration.Cost issues were also a major factor in many hospitals. In some places the nurse is required topurchase his or her own sphygmomanometer. In that case, especially in the lower income countries,people were looking for the cheapest sphygmomanometer they could buy with the expectation thatif the instrument was on the market the quality would be at least at a certain minimum level. In thehospital it was discovered that – because the purchasing budget is frequently separate from themaintenance budget, hospitals would also purchase inexpensive and sometimes lower qualitysphygmomanometers – therefore contributing to the attitude among some of the professionals thatthey could not rely on the mercury-free sphygmomanometers that they were working with. Thespeaker underlined that an awareness raising process in the hospitals would be necessary, also aspart of the legislative process we are currently undergoing.Traditional mercury sphygmomanometerIn terms of waste, it was not a surprise that all hospital have a rigorous way of dealing with hospitalwaste in dividing waste among hazardous waste, infectious waste and municipal waste. However,when it comes to dealing with a mercury spill, the people dealing with the waste are not necessarilyaware of the adequate procedure. In a number of interviews there were people who have seenmercury disposed as normal trash or - because they considered it as somewhat hazardous- put ittogether with the infectious waste or mixed with other waste in a special bin. However, it wastypically not at all separated from other sorts of waste or dealt with in a way that would beconsidered appropriate.Interviewees expressed various concerns about mercury sphygmomanometers such as frequentbreaks of rubber tubes, air leakage, the mercury was dirty, that it had oxidized and it was difficult toread the mercury column through dirt on the inside of the tube. This indicates that there is a certainamount of air getting into the mercury column in some way and if that is true, it could be assumedthat the mercury is also getting out in the ambient air in some manner. Various maintenance peoplealso stated that you have to top up the mercury column on a routine basis – even if this is once ayear – so something is happening to the mercury. A well maintained mercury column is quite a goodinstrument. However, it seems that in many of these hospitals they have not been maintained orcalibrated as they should be.24
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Eu Mercury phase out in Measuring and Control Equipment - EEB

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