Mercurial hospital waste: management, becoming and recommendations

In hospitals, the use of medical instruments and products containing mercury and the management of mercury waste (MW) collected are regulated in developed countries. In Tunisia, MW end up in landfill and no strategy has so far been adopted. The objective of this study was to quantify MW in two university hospitals in Tunis and to indicate the elimination pathways used and to propose certain recommendations. This was a descriptive retrospective study conducted from February to August 2016 and quantifying the MWs from medical products and instruments used by two university hospitals in Tunis during 2015. Semi-structured interviews and focus groups enabled the collection of informations on MW management methods for these products and instruments and their waste and to identify the weaknesses of this management. In 2015, 2,443 mercury thermometers were used by Habib Thameur hospital (HHT) and 7,439 by La Rabta hospital (HLR), releasing 19,764 g of mercury. For dental amalgams, 1,440 g were used at HHT. Their residues (320.4 g) were stored in the original capsules. At HLR, 1,320 g were used but residues, estimated at one-third of the total amount (440g), were discharged into the cuspidor. The total amount released from the amalgams was 380.2g, knowing that half of the volume was mercury. The broken tensiometers (26 at HHT and 113 at HLR) released 183.5g of mercury, the roasted fluorescent lamps (1,627 at HHT and 1,722 at the HLR) 167.4g, Harris Hematoxylin (15 liters at HHT and 18 liters at HLR) 82.5g and used batteries (1,258 at the HHT and 914 at the HLR) 54,3g. In total, with the exception of mercury vapors, the amount of mercury released in 2015 at the two hospitals was approximately 20,632 g. These MW have borrowed the household waste stream (51% of HHT MW and 47% of HLR MW), waste from infectious care activities (47% HHT and 46% of the HLR MW), electrical and electronic waste (1% of HHT and HLR MW), and sewage (1% of HHT MW and 6% of the HLR MW). The main supplier of hospital MW is the mercury thermometer (95.8%). The managerial authorities would benefit from the promulgation of a regulatory framework, like the European law of 1998, prohibiting their use on a territorial scale and, by subsidies, replace them with electronic thermometers.