2006-05-20-世界卫生组织-Mercury_in_health_care_2页_33kb

报告摘要

Mercury is a naturally occurring heavy metal, present as a silvery-white liquid at room temperature. It vaporizes easily and can persist in the atmosphere for up to a year.
Mercury accumulates in aquatic sediments, transforming into the highly toxic methyl mercury, which concentrates in fish tissue.
Mercury and its organic form, methyl mercury, are highly toxic, affecting the nervous, digestive, respiratory, immune, and kidney systems. Exposure can cause tremors, vision/hearing impairment, paralysis, insomnia, developmental deficits, and cognitive delays. No safe threshold has been established for adverse effects.

Health-care facilities are major sources of mercury emissions, particularly from:
- Medical Waste Incineration: Estimated to account for up to 10% of total air mercury releases globally (e.g., Canada, US).
- Untreated Wastewater: Estimated up to 5% of total mercury releases via wastewater; over one-third from dental practices.
Dental amalgam (a mixture of mercury and metals) is a significant source of mercury vapor, especially in non-industrialized settings, constituting about 80-100g of mercury per instrument.
Other sources include mercury spillage from thermometers and other devices, waste incineration, and crematoria. Data is lacking for many countries but releases are recognized.
Some countries restrict or ban mercury thermometers, and various entities encourage reducing mercury equipment use.

Occupational exposure primarily occurs through inhalation of mercury vapours (from spills -- e.g., thermometer breakage).
Mercury vapour is odorless and colourless, making exposure easy.
Improper cleanup of spills, especially into cracks or porous surfaces, and inadequate containment/storage can lead to dangerous workplace exposure for patients and staff.

Effective non-mercury alternatives exist (e.g., electronic and aneroid blood pressure monitors, digital thermometers). Studies suggest cost differences between mercury and non-mercury technologies are often minimal.
Mercury sphygmomanometers (blood pressure cuffs) are one of the largest mercury reservoirs in healthcare settings, but can be replaced by aneroid sphygmomanometers (with proper maintenance protocols).
All blood pressure measurement devices require regular calibration to accuracy standards.

UNEP Governing Council concluded global action is warranted due to significant adverse environmental impacts from mercury.
WHO proposes working with countries; no specific international mercury convention mentioned here, but UNEP has acknowledged the problem.

Short-term:
- Develop protocols for safe cleanup and emergency management of mercury spills and waste.
- Implement measures minimizing patient, staff, and community exposure (staff training, protective gear, proper storage/cleanup). Monitor existing and alternative devices.
Medium-term:
- Enhance efforts to reduce mercury equipment usage (inventory existing use; encourage recovery/recycling of replaced equipment).
- Discourage the import/sale of new mercury devices.
Long-term:
- Support national policies banning mercury devices and promoting mercury-free technologies.
- Support the development and implementation of national guidelines for healthcare mercury waste management, policies, and legislation.
- Encourage environmentally sound management of healthcare waste containing mercury (aligned with Basel Convention principles).