6. Selecting Alternative Mercury-Free Products

Mercury-free product alternatives are available throughout the medical facility - in housekeeping and engineering, in patient areas, and in clinical laboratories. See that the decision makers in your community are guided by the best available technical, economic, and environmental assessments of mercury products and substitutes.

Encourage your facility to buy products that do not contain mercury. There are several products on the market that can be used as substitutes for mercury. By ordering mercury-free products, hospitals, nursing homes, clinics, and laboratories will encourage manufacturers to provide ecologically sound products. Medical professionals must ultimately balance the advantages of selecting products that contain mercury against the risks that mercury poses to the environment. The following table highlights some alternatives.

Products	Alternatives
Batteries Defibrillators Hearing aids Pacemakers	Lithium, zinc-air, alkaline
Dental amalgams	Gold, ceramics, porcelain and polymers
Electrical equipment	Fiber optics, solid state devices, mechanical switches
Esophageal devices Cantor tubes Miller Abbot tubes	Tungsten tubing (tungsten for weight)
Lamps Fluorescent, High intensity, and Ultraviolet	Ordinary glow lights; low sodium vapor tubes (yellow); opticals, high-energy, long-lasting lights
Sphygmomanometers	Electronic vacuum gage, expansion, aneroid
Thermometers	Electronic (digital), expansion, aneroid

Chemicals	Alternatives
Mercury (II) chloride Zenker's solution Histological fixatives	Zinc formalin Freeze drying
Staining solutions and preservatives: Thimerosal, Immu-sal, Carbol-fuchin stain, Gram iodine stain, Phenolic mercuric, Acetate, Alum, Hematoxylin "Solution A"	Replace with a variety of chemical compounds
Mercury (II) oxide	Copper catalyst
Mercury oxide	None identified
Mercury (II) chloride	Magnesium chloride/sulfuric acid
Mercury (II) sulfate	Silver nitrate/potassium sulfate/chromium-(III) sulfate
Mercury iodide	Phenate method
Mercury nitrate (for corrosion of copper alloys)	Ammonia/copper sulfate
Colorimetric chloride analysis	Ion-selective electrode method

There is no longer any need to manufacture mercury oxide and silver oxide batteries; the former are 25 to 35 % mercury by weight, the latter are 1 % mercury. Use alkaline, zinc-air, and lithium batteries instead. Collect all batteries containing mercury for special disposal or recycling. Any products that contain batteries should be collected for recycling.

Dental amalgams do not pose a health risk. However, their disposal is a potential source of mercury to the environment. Separate collection and recycling are recommended along with predetermined operating procedures and spill cleanup measures.

No effective substitute exists for high energy fluorescent tubes. Effective recycling systems should be in place. U.S. EPA's Green Lights Program is a good source of information about alternative applications in this area.

Mercury thermometers and manometers should be phased out since good substitutes exist. Old medical instruments should be collected and recycled.

Mercury's use in chemical analysis can be phased out in many cases, especially in Zenker's solution and histological fixatives. Purchasing contractors and users should ask to see material safety data sheets in all cases. Some substitutes, such as copper, tin, and chromium compounds also have some risk, but less than the risk associated with mercury. The total use of mercury remaining in such products as antiseptics, diuretics, a nd skin preparations is minimal; mercury should not be used in skin lightening soaps and creams.

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