EARTH Thailand

Developing national strategies for phasing out mercury-containing thermometers and sphygmomanometers in health care, including in the context of the Minamata Convention on Mercury: key considerations and step-by-step guidance

World Health Organization, 2015

With the adoption of the Minamata Convention on Mercury in October 2013, clear time-bound targets were set for phasing out the manufacture, export or import of a number of mercury-added products specified in the Convention. For thermometers and sphygmomanometers that are included in a wider category of non-electronic medical devices regulated under Article 4 of the Convention, the phase-out date is 2020, with the possibility of Party-specific exemptions up to 2030. An open-ended exemption is also afforded to products for research, calibration of instrumentation, and for use as a reference standard.

The implications of the provisions of Article 4 are that Parties may not procure mercury-containing thermometers or sphygmomanometers after 2020 (or 2030 for Parties afforded the maximum exemptions) for routine use in health care settings. Replacement of these devices with mercury-free alternatives will thus become a necessity when they reach their end-of-service life.

Many mercury-free thermometers and sphygmomanometers are available which provide equivalent accuracy and comparable clinical utility.

Many examples of successful substitution programmes exist, demonstrating that it is possible and affordable to switch to mercury-free alternatives. Much of this work has been done in the context of movements driven by health-care-providers to promote mercury-free health care. For example, WHO and Health Care Without Harm collaborate in order to promote mercury-free health care, key aims being to raise awareness about environmental and health risks associated with the use of mercury-containing medical measuring devices, and to provide technical and policy guidance in support of the switch to mercury-free alternatives. These efforts have been critical in developing and documenting good practice examples and demonstrating the feasibility of implementing voluntary replacement (at end-of-service life) and substitution (prior to end-of-service life) programmes.

This publication was developed to guide health ministries in planning and leading the development of national strategies to phase out mercury-containing thermometers and sphygmomanometers in health care, including through substitution and replacement with alternatives.

It is recognized that the approach taken will need to be adapted to each country’s needs. Thus the measures suggested in this guidance are intended to inform health ministries and partners involved in these efforts about key considerations to be taken into account at each point in the process. Sample activities and objectives are highlighted, as are issues that may require more in-depth consideration. An indication of technical resources available and good practice examples are also provided.

The publication focuses primarily on national or country-wide strategies and programmes targeted to health care facilities and settings, both public and private. Some reference is made to sub-national and facility level considerations as relevant. While there are many potential sources of mercury in health care settings (for example, fluorescent lamps, cantor tubes, dilators, mercury switches, some button batteries and dental amalgam), this guide specifically addresses the phase out of mercury-containing thermometers and sphygmomanometers. By adopting the use of mercury-free thermometers and sphygmomanometers, health care facilities can make a significant contribution to reducing mercury emissions while simultaneously reducing exposure of patients and staff.

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