Number

094-EN

Section

General Section

Use

Abstract

A guidance from the World Health Organisation WHO concludes that there are mercury-free alternatives to all applications of thermometers and sphyromanometers. The guidance list the different alternatives and assesses accuracy and cost.

Substituted substances

Reliability of information

Evidence of implementation: there is evidence that the solution was implemented and in use at time of publication
Evidence of assessment: there is evidence of an official (positive) assessment of the substitution

Reason substitution

CMR
ecotoxicity

Other type of alternative

Aneroid and oscillometric devices

Hazard Assessment

Substance to be substituted: Mercury is very toxic, is fatal if inhaled, may damage the unborn child may cause damage to organs through prolonged or repeated exposure. Furthermore, it is very toxic to aquatic life with long lasting effects. The substance is: 1A or 1B carcinogen (CLP Regulation), neurotoxic cat. 4 (Vela et al.) as listed in the Substance Database according to SUBSPORTplus Screening Criteria (SDSC). Alternative substance: Non-chemical alternative

Description of Substitution

The aim of the guidance is to give a step-by-step instruction for safe substitution of mercury thermometers and sphygmomanometers in health-care settings. For thermometers the following alternatives are in focus concerning operation (use), accuracy and cost: digital, phase-change, tympanic infrared and temporal artery infrared thermometers. Concerning mercury-free sphygmomanometers two alternatives are considered: aneroid and oscillometric devices. The aneroid devices uses mechanical parts to relay the blood pressure to the gauge. It contains no liquid. The oscillometric devices are operated by electronic means using a different technique by measuring the inflation and deflation. The overall conclusion of the guidance is: "Alternatives to mercury-containing thermometers and sphygmomanometers are available, and are practical in clinical settings. These alternatives should be considered when replacing or phasing out mercury units in health-care settings. The elimination of mercury, a potent neurotoxin, from these devices protects the health-care providers and their communities. In this way, it promotes good health for patients as well. This guide provides a step-by-step approach to phasing out mercury thermometers and sphygmomanometers. It emphasises the availability and cost considerations of alternative equipment, and their conformity with existing international or national standards with the understanding that they must be properly validated by the manufacturer and calibrated by the user. If this is kept in mind and if replacement equipment is phased-in as suggested in this document, the new devices will provide equivalent accuracy and comparable clinical utility."

Case/substitution evaluation

The non-chemical alternatives eliminate the risk from mercury containing devices. Therefore, this case study is a successful description of substitution.

Availability ofAlternative

Available

Producer/Provider

The guidance include information on suppliers in different parts of the world

Type of information supplier

Authority

Type of publication and availability

Freely available from link

Publication source: author, company, institute, year

Replacement of mercury thermometers and sphygmomanometers in health care. Technical guidance edited by: Jo Anna M Shimek, Jorge Emmanuel, Peter Orris and Yves Chartier. WHO 2011

Publication source

Type of publication and availability

http://whqlibdoc.who.int/publications/2011/9789241548182_eng.pdf

Date, reviewed

December 11, 2020