Eu Mercury phase out in Measuring and Control Equipment - EEB

REPORT FROM THE CONFERENCE “EU MERCURY PHASE OUT IN MEASURING AND CONTROL EQUIPMENT”Early Clinical Experience:In Sweden they converted over in the late 1980s and early 1990s. On a survey approach of theirhospitals: clinics found no problems with diagnosis or clinical care by using the aneroids. To clarifyaneroid devices can be used for people with arrhythmias and other special medical conditions. Thismay not be true for oscilloscopic devices because they do the calculation of the diastolic andsystolic pressure but it is true for the aneroids. Aneroids are good for all of these special medicalconditions if they are calibrated and if they are maintained. Published experiences, such as from theMayo Clinic in Rochester, confirm this.When observing in Brazil or developing countries it was discovered that there were slight underreadingsof the aneroid instruments (hypertension prevalence 30%, compared with 32% for digitaland mercury). However, aneroid devices were preferred because they were easily used in clinicalsettings in the fields.Electronic devices have to be calibrated as well. One study showed that 21% of patients weremisdiagnosed with uncontrolled hypertension due to the lack of consistency and surveillance ofcalibration. In another study aneroid sphygmomanometers were less accurate than mercury basedsphygmomanometers but again only in settings in which they were not adequately calibrated andmaintained.The next problem is that most of these products that are on the market are not externally validatedby independent sources. Further, when models were tested they did not live up to the manufacturerspromises.The WHO 2005 position paper, on review of the literature, said that both mercury and aneroidsphygmomanometers have been in use for 100 years and when working properly either givesaccurate results. Aneroid sphygmomanometers provide accurate pressure measurements when aproper maintenance protocol is followed (as is also true for the mercury devices).In the short term the WHO is planning to develop a mercury cleanup and storage procedure. TheWHO says that before final replacement has taken place, and to ensure that new devices conformwith recommended validation protocols, health-care facilities will need to keep mercury as the“gold” standard to ensure proper calibration of sphygmomanometers. That was in 2005 and it isclear that this needs to be re-evaluated because this is no longer true given these electronic pressurestandards.In medium and long term, hospitals should begin to phase out mercury and assess their inventory.They should increase efforts to reduce the amount of unnecessary mercury equipment in general.And finally in the long term, they should look to ban mercury containing devices and promote theuse of mercury-free alternatives.The British Hypertension Society and others do some independent evaluation of the various models.There has been an explosion of reporting and materials in the literature both on the variousmanufacturers’ models, the various trade names as well as the overall group and types. In 2008 theWorld Medical Association urged the elimination of mercury containing products for physicians intheir offices as well as the larger clinics.38