Information for Health Care Providers

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Medical facilities use a large variety of mercury-containing equipment and products. This page provides resources relating to issues of particular concern to people who work in the health care industry, including the medical uses of mercury, programs to reduce the use of mercury, health effects of mercury, workplace safety, how to handle mercury spills, and proper disposal and treatment of mercury waste.

Mercury and Health Effects
Mercury Management
Best Management Practices for
     Health Care Facilities
     Medical Waste Disposal
     Dental Offices
Skin-Lightening Creams
Thermometers
Use of Thimerosal in Lab Reagents and Vaccines

Mercury and Health Effects

Dental Amalgam - Links to U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) information about the status of classifying amalgam as a medical device with special controls.

Fish Consumption Advisories - Some fish may contain methylmercury and other harmful chemicals. This page provides links to advisories issued by state and local governments when fish are unsafe to eat.

Health Effects - General information on health problems caused by mercury plus links to a variety of resources on specific health-related issues and data including children’s health.

Mercury Management

Great Lakes Regional Pollution Prevention Roundtable (GLRPPR) Mercury Health Care Hub - This Web site provides a brief summary of resources, on-line tools and other information about mercury and the health care industry.

Pollution Prevention Resource Exchange (P2Rx)- Links to information and resources about mercury in health care, dentistry, and thermometers (home, medical, and industrial use). This page provides resources for establishments providing health care including hospitals, dental offices, doctor’s offices, and clinics.

Spills - Information on what to do in the case of a mercury spill.

Best Management Practices for Health Care Facilities

Sustainablehospitals.org is a project of the Lowell Center for Sustainable Production, which develops, studies, and promotes environmentally sound systems of production, healthy work environments, and economically viable work organizations. The Center is associated with the Department of Work Environment and the Toxics Use Reduction Institute at the University of Massachusetts, Lowell. Sustainablehospitals.org offers:

State Mercury Medical/Dental Waste Programs - A description of state legislation and programs that focus on mercury in medical facilities, including mercury management and reduction strategies, recycling mercury and mercury-containing products/devices, and training programs.

Health Care Without Harm is an international coalition of 437 organizations in 52 countries working to transform the health care industry so it is no longer a source of harm to people and the environment.

Hospitals for a Healthy Environment (H2E)- Hospitals for a Healthy Environment (H2E) is a voluntary program designed to help hospitals enhance work place safety, reduce waste and waste disposal costs and become better environmental stewards and neighbors. The primary goal of the H2E effort, a collaborative effort of the EPA, the American Hospital Association and other health organizations, is to educate health care professionals about pollution prevention opportunities in hospitals and healthcare systems.

Reducing Mercury Use in Health Care (PDF) (28 pp, 699K) -- This 1996 document presents information on how to start a mercury pollution prevention program in a hospital; how to monitor the program, educate staff and measure success; alternatives for mercury-containing products; and best management practices for handling,recycling and disposing of mercury-containing products still in use.

Best Management Practices for Medical Waste Disposal

Hospital/Medical/Infectious Waste Incinerators - Information about EPA's air emission regulations for Hospital/Medical/Infectious Waste Incinerators (HMIWI) and related web sites.

Mercury Reduction in Florida's Medical Facilities: Improving the Management of Mercury-Bearing Waste (PDF) (101 pp, 281K)- This 1998 report describes on-site technical assistance provided to Florida hospitals wanting to reduce the amount of mercury in their facilities and to improve their management of mercury and mercury-containing products. The report includes case studies and explains revisions made to hospital best management practices.

Memorandum of Understanding between EPA and the American Hospital Association - In 1998, the American Hospital Association (AHA) and EPA signed an agreement identifying goals to reduce the impact of health care facilities on the environment. Under the terms of the agreement, EPA would transfer technical information on pollution prevention opportunities that exist with respect to waste generated by the health care industry.

Best Management Practices for Dental Offices

The Quicksilver Caucus of the Environmental Council of the States has published a Dental Mercury Amalgam Waste Management White Paper (PDF) (96K, 24 pp.) to share information about state and local government programs that address dental mercury amalgam.

Dental Amalgam - NEWMOA, the Northeast Waste Management Officials' Association, provides a guide to information about the use of mercury in dental offices, including how dentists can dispose of dental amalgams that contain mercury and help prevent mercury pollution.

Dentistry - State Mercury Medical/Dental Waste Programs - A description of state legislation and programs that focus on mercury in medical facilities, including mercury management and reduction strategies, recycling mercury and mercury-containing products/devices, and training programs.

American Dental Association's "Best Management Practices (BMPs) for Amalgam Waste"- The American Dental Association encourages dentists to use the association's BMPs to help reduce the effects of amalgam waste on the environment. The BMPs are a series of amalgam waste handling and disposal practices that include but are not limited to initiating bulk mercury collection programs, using chair side traps and vacuum collection, inspecting and cleaning traps, and recycling or using a commercial waste disposal service to dispose of the amalgam collected.

Thermometers

Learn about mercury fever thermometers and their alternatives and about the phase-out of mercury thermometers used in industrial and laboratory settings.

NEWMOA, the Northeast Waste Management Officials' Association , provides information on using mercury in thermometers.

Use of Thimerosal in Lab Reagents and Vaccines

Lab reagents. Mercury is known to be used in some laboratory reagent kits. These kits contain thimerosal (chemical formula (C6H9HG02SNa)), a stabilizer; thimerosal contains mercury. We do not know of any new regulations governing the use of the reagent kits; however, under the Resource Conservation and Recovery Act (RCRA), EPA regulates any waste (i.e., solid, semi-solid, liquid and/or contained gas) from a reagent kit as D009 hazardous waste under 40 CFR 261.24 if the waste contains more than 0.5% solids and if, after using the kit in accordance with manufacturer's assay kit instructions, a representative sample of the waste contains concentrations of mercury equal to or greater than 0.2 mg/L.

Note that not all reagent kit manufacturers provide a Material Safety Data Sheets (MSDS) for their kits, so the amount of mercury in those kits is not known. In addition, EPA cannot certify the accuracy of information presented on MSDSs about the amount of mercury in the Thimerasol, or about the amount of Thimerasol in the kit.

The University of Minnesota Technical Assistance Program provides more information about the use of mercury in health care lab reagents.

Vaccines. To learn more about the use of thimerosal in vaccines, please see the Food and Drug Administration's (FDA) list of medicines that contain mercury and fact sheet on thimerosal in vaccines, and information from the Centers for Disease Control and Prevention on thimerosal. CDC also provides questions and answers about thimerosal in seasonal influenza vaccines.