Purchasing for Pollution Prevention: Mercury-Free Medical and Surgical Supplies Fact Sheet

A wide variety of medical equipment can contain mercury, from thermometers and blood pressure equipment to diagnostic analyzers. Many hospitals are now buying only mercury-free products, and government agencies can easily follow suit by restricting mercury on their purchasing contracts. With INFORM’s technical assistance, Massachusetts changed its guidelines to allow the sale of mercury-containing products through its state contract only when no mercury-free substitutes are available. Since the contract's inception in the spring of 2001, no mercury-containing devices have been requested by state agencies.

• Performance of mercury-free substitutes
• Costs
• Recommended specification
• Actual specifications used by a state government
• For more information

Performance of mercury-free substitutes

• Blood pressure equipment. Peer-reviewed studies show that electronic and aneroid sphygmomanometers are accurate within acceptable clinical practice limits if calibrated regularly according to manufacturer directions.1 Mercury-free blood pressure measuring devices have been used by most major medical facilities and accepted by medical personnel for many years.



• Gastrointestinal/feeding tubes. Tungsten-weighted tubes can be used for x-ray viewing during use. Tubes filled with saline perform well but may work more slowly than mercury or tungsten devices.



• Clinical fever thermometers. All thermometers for medical use are typically tested to voluntary standards set by the American Society for Testing and Materials (ASTM). These standards dictate the maximum error allowed, so one can verify whether or not a non-mercury alternative is as accurate as a mercury thermometer in the critical temperature range. For more information on ensuring accuracy, see "Selecting Non-Mercury Thermometers". Alternatives include electronic, infrared, liquid crystal, and phase-change thermometers.



• Household fever thermometers. Mercury-free alternatives should be handed out to new mothers and other patients. Many types are available, including digital, infrared, and nonelectronic thermometers.

Costs

• Mercury and aneroid (mercury-free) blood pressure equipment are comparable in cost.



• Gastrointestinal/feeding tubes without mercury are usually comparable in cost.



• Clinical electronic thermometers can cost much more than mercury thermometers depending on the type, but are more durable. Electronic thermometers are sometimes offered free of charge if the facility also purchases probe covers from the same vendor.



• The costs of mercury-free household fever thermometers vary depending on volume and type. Digital thermometers can cost twice as much as mercury thermometers, but nonelectronic types can be cheaper or comparable in price to mercury thermometers.

Recommended specification

As part of [state's] efforts to reduce the use and disposal of mercury and mercury containing products, the [state] has determined that any contracts resulting from this solicitation must meet the following requirements:

• In their response, Bidders must offer mercury-free alternatives to all products which contain intentionally added mercury (mercury added products) where such alternatives exist.



• Should such alternatives not be available, bidders must submit with their response a list of products without mercury-free alternatives and an explanation of why alternatives are not available.



• Following a contract award, contractors must not sell any mercury added products, even if they have received a direct request from a contract user, unless they have submitted a written request and received written prior approval from the [procurement office].

Additionally, it is desirable that Bidders offer:

• A proposal for a collection system to ensure recycling or proper disposal of mercury for any product containing mercury offered for sale on this contract when no mercury-free alternative is available. This includes any mercury containing batteries (such as button batteries) that may be sold with equipment such as electronic thermometers.



• A proposal on the type of mercury reduction and/or elimination training for contract users that would be offered by the bidder.



• A description of any other efforts that the bidder would undertake as part of this contract to reduce/eliminate the sale and use of mercury containing products, as well as any mercury reduction efforts being undertaken or proposed by the bidder which are not related to this contract.



• Identification of products which contain mercury (when no mercury-free alternative are available) to contract users at the time of purchase and delivery. This language can also be adapted if other mercury-containing components are required.

The [purchasing office] reserves the right to remove products from this contract that have been deemed hazardous and/or unacceptable by federal/state/agency regulations and/or guidelines for their agencies or affiliate departments.

Actual specifications used by a state government

Massachusetts restricts the sale of mercury-containing products, allowing vendors to sell them only when no mercury-free substitute is available. Since spring 2001, no vendor has sold any mercury-containing product to the state. Note that in these specifications, "mercury-labeled" means "mercury-added."

• Actual specifications (mercury section on page 13): hsp16.rfr.pdf



• Other documents related to this contract: Comm-PASS



• Case Study: fsma.pdf

Wisconsin restricts the sale of mercury-containing thermometers and blood pressure equipment, and reserves the right to remove other mercury-containing items from the contract.

• Actual specifications (mercury section on page 2): 1432_2.doc



• Other information related to this contract: Contract Information for Prime Vendor Medical Supplies

For more information:

• Sustainable Hospitals Project



• California Guide to Mercury Assessment and Elimination in Health Care Facilities (PDF)



• Health Care Without Harm



• Hospitals for a Healthy Environment

Notes
1 N.D. Markandu et al., "The Mercury Sphygmomanometers Should Be Abandoned Before it is Proscribed," Journal of Human Hypertension (2000) 14, 31-36; Vincent J. Canzanello et al., "Are Aneroid Sphygmomanometers Accurate in Hospital and Clinic Settings?" Archives of Internal Medicine, March 12, 2001, 729-731.