In 1997, an EPA study found that medical waste incinerators were the fourth largest source of man-made mercury emissions. For many health professionals concerned with the environment, that was a wake-up call. I’m glad to report that things have changed.

Mercury is a potent neurotoxin and a persistent bioaccumulative toxin (PBT). Exposure can damage the brain, spinal cord, kidneys and liver. Mercury easily crosses the placenta, and impacts fetal neurological development. A July 2000 National Academy of Sciences (NAS) report (www.nyas.org) indicates that more than 60,000 children may be exposed to methyl mercury in utero annually. According to the Centers for Diseases Control and Prevention, 1 in 8 women in the US has a blood mercury level high enough to impact fetal development.

There can be up to 50 times more mercury in medical waste than in municipal waste. According to 1990 data, medical waste incinerators emitted 50 tons of mercury per year. Hospitals contribute about 5% of the total wastewater mercury load in some areas, and mercury thermometers contributed about 17 tons of mercury to solid waste landfills annually. Scary numbers!

Hospitals for a Healthy Environment (H2E), the organization for which I work, was formed in 1998, when the EPA and the American Hospital Association (AHA) signed a Memorandum of Understanding to address health care’s contribution to mercury pollution, and other serious environmental issues. H2E is now a collaborative effort between EPA, AHA, the American Nurses Association, and the nonprofit coalition Health Care Without Harm (www.noharm.org).

The Memorandum called for hospitals to voluntarily eliminate mercury-containing waste from the waste stream; reduce the overall volume of waste (both regulated and non-regulated) by 50% by 2010; and identify other toxic substances for future pollution prevention/waste reduction efforts.

I’m pleased to report that we’ve made major progress in achieving these goals. H2E has worked with more than 4,400 facilities nationwide. Over 6,000 medical waste incinerators have closed. That, along with a phase-out of mercury-containing devices and improved waste management mean that today, health care is no longer a leading source of mercury emissions. Through concerted efforts, we’ve reduced overall emissions from medical waste incinerators by 99%. As of June 2004, there were just 110 medical waste incinerators left in the U.S. and only 96 were in use.

Laura Brannen, H2E’s Executive Director, summarized findings of a 2005 AHA survey on mercury elimination efforts. The survey showed 97% of hospital respondents across the country are aware of the mercury problem and have taken steps to address it. H2E’s work with group purchasing organizations (GPOs) to remove mercury products from hospital contracts has reduced the amount of mercury entering the health care sector.

Major sources of mercury, including sphygmomanometers and thermometers are being replaced with non-mercury devices. Many health care facility managers are also replacing mercury-containing switches and gauges. The AHA Survey indicates that 72% of responding facilities had inventoried all devices and labeled them as containing mercury where appropriate.

Fluorescent light bulbs also contain mercury, even energy efficient “green tip” bulbs. The current solution is to recycle them, and the survey shows 80% of respondents do recycle them. Clinics in multi-tenanted buildings must work with property management to ensure bulbs are not discarded in the regular garbage.

Chemicals, including pharmaceuticals, contain mercury, primarily as a preservative. Replacing mercury-containing chemicals is a challenge. The good news, according to the AHA survey, is that facility managers are making significant progress. Of survey respondents, almost 80% had replaced some or all mercury-containing lab chemicals; over 64% purchase mercury-free (i.e., thimerosal-free) pharmaceuticals, and 81% buy mercury-free cleaning chemicals.

Energy efficient buildings and devices reduce mercury emissions from coal-fired power plants. “Green” building design is increasingly embraced by the health care sector as both a cost-saver and health improvement measure. All in all, the ripple effects of health care’s shift away from mercury are enormous.

While we celebrate our advances, we’re also setting new goals and priorities, including continued outreach to facilities and their outpatient areas (including dental offices) that have not yet committed to mercury phase-out. We’re addressing issues such as mercury in chemicals and other devices. We also need to ensure that as mercury-containing items are removed from service in the US, they’re not exported to other countries, shifting the toxic burden globally.

Mercury in wastewater remains a problem. Health care facilities managers need to assess pharmaceuticals, lab chemicals, radiology chemicals and cleaning products to identify mercury-containing products and find alternatives.

Working collectively, the health care sector must continue to strive toward a mercury-free environment. By choosing and promoting safer, non-mercury alternatives, and by educating staff, patients and the broader community on mercury’s dangers, the health care industry demonstrates its leadership in promoting human health and the health of our environment.

Each year, H2E presents a “Making Medicine Mercury-Free” Award to hospitals and clinics that have successfully met the mercury challenge. Over the years, we’ve honored 91 facilities. The next awards will be presented on April 18, 2006, at the Cleanmed conference in Seattle (www.cleanmed.org). Want to learn more? Become a Partner of H2E and apply for the award. Registration is free, and can be done on the website at http://h2e-online.org/programs/partner/p_regform.cfm. To learn more about mercury and how you can get it out of your practice, read our full mercury report at http://h2e-online.org/pubs/mercuryreport.pdf.

Janet Brown is the Partner Coordinator for Hospitals for a Healthy Environment (H2E). The organization’s goals are to reduce the toxicity and volume of health care waste and to eliminate mercury from health care practice. Learn more about the organization at: www.h2e-online.org.