Replacing mercury-column sphygmomanometers

Mercury-based devices have a long history of use in the healthcare setting. However, mercury poses a significant occupational and environmental exposure hazard. In recognition of this hazard, the American Hospital Association and the U.S. Environmental Protection Agency have set a goal to eliminate mercury in healthcare by 2005. As a result, healthcare facilities are now under increasing pressure to replace mercury-based equipment. Thermometers and sphygmomanometer columns are the most prevalent sources of metallic mercury in the healthcare setting. Many hospitals have already swapped mercury thermometers for electronic devices. Replacing mercury sphygmomanometers, however, has been more problematic, as concerns have been raised about the accuracy of the alternatives. Despite these concerns, some hospitals have been able to eliminate or significantly reduce the presence of mercury sphygmomanometers. In this Guidance Article, we describe factors that healthcare facilities should consider when choosing from among the available blood pressure measurement methods, and we provide practical advice for facilities trying to make the switch from mercury sphygmomanometers to alternative methods.