Replacement of mercury thermometers and sphygmomanometers in health careTechnical guidance

This short guide is designed to provide step-by-step instructions for the safe substitution of non-mercury thermometers and sphygmomanometers in health-care settings. It identifies the resources available to provide confidence that the substituted products will provide equivalent accuracy and comparable clinical utility, while protecting health-care workers and the environment. It is designed for professionals responsible for institutions or ministries desiring to switch to safer non-polluting technologies in health care.

This guide is also an output of a global mercury-free health-care initiative in which the World Health Organization is engaged. This global initiative aims to promote the substitution of mercury-based medical devices with safe, affordable, accurate alternatives around the world. The global mercury-free health-care initiative has documented mercury substitution in dozens of countries. It has also produced a series of additional resources for health professionals, health system managers and government officials that can be useful in developing and implementing policy and strategies for mercury substitution in the health sector.

Replacement of mercury thermometers and

sphygmomanometers in health care

Technical guidance

Edited by: Jo Anna M Shimek, Jorge Emmanuel, Peter Orris and Yves Chartier

4102 WHO Mercury Replacement Guidelines.indd 1 23/05/11 10:25 AM

Replacement of mercury thermometers and sphygmomanometers in health care

Replacement of mercury thermometers and sphygmomanometers

in health care

Technical guidance

Edited by: Jo Anna M Shimek, Jorge Emmanuel, Peter Orris

and Yves Chartier

‹„”ƒ”›ƒ–ƒŽ‘‰—‹‰Ǧ‹Ǧ—„Ž‹…ƒ–‹‘ƒ–ƒ

Replacement of mercury thermometers and sphygmomanometers in health care: technical guidanceȀ

‡†‹–‡†„›‘ƒŠ‹‡ǥȏ‡–ƒŽȐǤ

ͳǤ ’Š›‰‘ƒ‘‡–‡”• Ȅ •–ƒ†ƒ”†•Ǥ ʹǤ Š‡”‘‡–‡”• Ȅ •–ƒ†ƒ”†•Ǥ ͵Ǥ ‡”…—”› Ȅ ƒ†˜‡”•‡ ‡ˆˆ‡…–•Ǥ ͶǤ‘‹–‘”‹‰ǡ Š›•‹‘Ž‘‰‹… Ȅ ‹•–”—‡–ƒ–‹‘Ǥ ͷǤ ˜‹”‘‡–ƒŽ ‡š’‘•—”‡Ǥ ͸Ǥ ƒ—ƒŽ•Ǥ Ǥ Š‹‡ǡ ‘

ƒǤƒ—‡Žǡ‘”‰‡Ǥ””‹•ǡ‡–‡”ǤŠƒ”–‹‡”ǡ˜‡•Ǥ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘Ǥ

ͻ͹ͺͻʹͶͳͷͶͺͳͺʹ ȋ…Žƒ••‹ˆ‹…ƒ–‹‘ǣʹͻ͵Ȍ

©WorldHealthOrganization2011

ŽŽ”‹‰Š–•”‡•‡”˜‡†Ǥ—„Ž‹…ƒ–‹‘•‘ˆ–Š‡‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ƒ”‡ƒ˜ƒ‹Žƒ„Ž‡‘–Š‡™‡„•‹–‡

ȋŠ––’ǣȀȀ™™™Ǥ™Š‘Ǥ‹–Ȍ ‘” …ƒ „‡ ’—”…Šƒ•‡† ˆ”‘ ”‡••ǡ ‘”Ž† ‡ƒŽ–Š ”‰ƒ‹œƒ–‹‘ǡ ʹͲ ˜‡—‡

’’‹ƒǡ ͳʹͳͳ ‡‡˜ƒ ʹ͹ǡ ™‹–œ‡”Žƒ† ȋ–‡ŽǤǣ ΪͶͳ ʹʹ ͹ͻͳ ͵ʹ͸ͶǢ ˆƒšǣ ΪͶͳ ʹʹ ͹ͻͳ Ͷͺͷ͹Ǣ ‡Ǧƒ‹Žǣ

„‘‘‘”†‡”•̷™Š‘Ǥ‹–ȌǤ

‡“—‡•–• ˆ‘” ’‡”‹••‹‘ –‘ ”‡’”‘†—…‡ ‘” –”ƒ•Žƒ–‡ ’—„Ž‹…ƒ–‹‘• Ȃ ™Š‡–Š‡” ˆ‘” •ƒŽ‡ ‘” ˆ‘”

‘…‘‡”…‹ƒŽ †‹•–”‹„—–‹‘ Ȃ •Š‘—Ž† „‡ ƒ††”‡••‡† –‘ ”‡•• –Š”‘—‰Š –Š‡ ™‡„ •‹–‡

ȋŠ––’ǣȀȀ™™™Ǥ™Š‘Ǥ‹–Ȁƒ„‘—–ȀŽ‹…‡•‹‰Ȁ…‘’›”‹‰Š–̴ˆ‘”Ȁ‡Ȁ‹†‡šǤŠ–ŽȌǤ

Š‡†‡•‹‰ƒ–‹‘•‡’Ž‘›‡†ƒ†–Š‡’”‡•‡–ƒ–‹‘ ‘ˆ–Š‡ƒ–‡”‹ƒŽ‹–Š‹• ’—„Ž‹…ƒ–‹‘†‘‘–‹’Ž›–Š‡

‡š’”‡••‹‘‘ˆƒ›‘’‹‹‘™Šƒ–•‘‡˜‡”‘–Š‡’ƒ”–‘ˆ–Š‡‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘…‘…‡”‹‰–Š‡Ž‡‰ƒŽ

•–ƒ–—•‘ˆƒ›…‘—–”›ǡ–‡””‹–‘”›ǡ…‹–›‘”ƒ”‡ƒ‘”‘ˆ‹–•ƒ—–Š‘”‹–‹‡•ǡ‘”…‘…‡”‹‰–Š‡†‡Ž‹‹–ƒ–‹‘‘ˆ‹–•

ˆ”‘–‹‡”•‘”„‘—†ƒ”‹‡•Ǥ‘––‡†Ž‹‡•‘ƒ’•”‡’”‡•‡–ƒ’’”‘š‹ƒ–‡„‘”†‡”Ž‹‡•ˆ‘”™Š‹…Š–Š‡”‡ƒ›

‘–›‡–„‡ˆ—ŽŽƒ‰”‡‡‡–Ǥ

Š‡‡–‹‘‘ˆ•’‡…‹ˆ‹……‘’ƒ‹‡•‘”‘ˆ…‡”–ƒ‹ƒ—ˆƒ…–—”‡”•ǯ’”‘†—…–•†‘‡•‘–‹’Ž›–Šƒ––Š‡›ƒ”‡

‡†‘”•‡†‘””‡…‘‡†‡†„›–Š‡‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘‹’”‡ˆ‡”‡…‡–‘‘–Š‡”•‘ˆƒ•‹‹Žƒ”ƒ–—”‡

–Šƒ– ƒ”‡ ‘– ‡–‹‘‡†Ǥ ””‘”• ƒ† ‘‹••‹‘• ‡š…‡’–‡†ǡ –Š‡ ƒ‡• ‘ˆ ’”‘’”‹‡–ƒ”› ’”‘†—…–• ƒ”‡

†‹•–‹‰—‹•Š‡†„›‹‹–‹ƒŽ…ƒ’‹–ƒŽŽ‡––‡”•Ǥ

ŽŽ”‡ƒ•‘ƒ„Ž‡’”‡…ƒ—–‹‘•Šƒ˜‡„‡‡–ƒ‡„›–Š‡‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘–‘˜‡”‹ˆ›–Š‡‹ˆ‘”ƒ–‹‘

…‘–ƒ‹‡†‹–Š‹•’—„Ž‹…ƒ–‹‘Ǥ‘™‡˜‡”ǡ–Š‡’—„Ž‹•Š‡†ƒ–‡”‹ƒŽ‹•„‡‹‰†‹•–”‹„—–‡†™‹–Š‘—–™ƒ””ƒ–›‘ˆ

ƒ›‹†ǡ‡‹–Š‡”‡š’”‡••‡†‘”‹’Ž‹‡†ǤŠ‡”‡•’‘•‹„‹Ž‹–›ˆ‘”–Š‡‹–‡”’”‡–ƒ–‹‘ƒ†—•‡‘ˆ–Š‡ƒ–‡”‹ƒŽ

Ž‹‡•™‹–Š–Š‡”‡ƒ†‡”Ǥ‘‡˜‡–•ŠƒŽŽ–Š‡‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘„‡Ž‹ƒ„Ž‡ˆ‘”†ƒƒ‰‡•ƒ”‹•‹‰ˆ”‘

‹–•—•‡Ǥ

Š‡ƒ‡†ƒ—–Š‘”•ƒŽ‘‡ƒ”‡”‡•’‘•‹„Ž‡ˆ‘”–Š‡˜‹‡™•‡š’”‡••‡†‹–Š‹•’—„Ž‹…ƒ–‹‘Ǥ

”‹–‡†‹ ”ƒ…‡

‘˜‡” ’Š‘–‘‰”ƒ’Š• ȋ–‘’ –‘ „‘––‘Ȍǣ ‘Žƒ” Ȅ‘”Ž† ‡ƒŽ–Š ”‰ƒ‹œƒ–‹‘Ǣ ‡ƒŽ–Š ƒ”‡ ‹–Š‘—–

ƒ”ȋ’Š‘–‘•ʹȂͷȌǢ‡–‡”””‹•Ǥ

‘˜‡”†‡•‹‰‡†„›ǣ‡•‹‰‡ǡƒ„‡””ƒǡ—•–”ƒŽ‹ƒ

”‘†—…–‹‘ƒ††‡•‹‰„›ǣ‹‘–‡š–ǡƒ„‡””ƒǡ—•–”ƒŽ‹ƒ

MERC-17-FINAL(18May11).pdf 2

MERC-17-FINAL(18May11).pdf 2 23/05/2011 10:32:49 AM23/05/2011 10:32:49 AM

iii

C o n t e n ts

Foreword...v

Acknowledgements...vii

I. WHOpolicy...1

II. Purposeofthisguide...3

III. Background...5

ƒǤ Š‡‹•–”›ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͷ „Ǥ š’‘•—”‡ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͷ …Ǥ —ƒ‡š’‘•—”‡ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ͸ †Ǥ ‘•–•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ͹ IV. Thermometers...9

ƒǤ ‹•–‘”›ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͻ „Ǥ ’‡”ƒ–‹‘‘ˆ‡”…—”›–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͻ …Ǥ ……—”ƒ…›‘ˆ‡”…—”›–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͲ †Ǥ ‡”…—”›Ǧˆ”‡‡–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͲ ‡Ǥ ……—”ƒ…›‘ˆ‡”…—”›Ǧˆ”‡‡–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͳ ˆǤ ‘•–…‘•‹†‡”ƒ–‹‘•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͳ ‰Ǥ ‡”…—”›–Š‡”‘‡–‡””‡’Žƒ…‡‡–ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳʹ V. Sphygmomanometers...17

ƒǤ ‹•–‘”›ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳ͹

„Ǥ ’‡”ƒ–‹‘‘ˆƒƒ—ƒŽ•’Š›‰‘ƒ‘‡–‡”ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳ͹

…Ǥ ……—”ƒ…›‘ˆ‡”…—”›•’Š›‰‘ƒ‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͺ

iv Replacement of mercury themometers and sphygmomanometers in health care

†Ǥ ‡”…—”›Ǧˆ”‡‡•’Š›‰‘ƒ‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͺ

‡Ǥ ……—”ƒ…›‘ˆ‡”…—”›Ǧˆ”‡‡

•’Š›‰‘ƒ‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͻ

ˆǤ ƒŽ‹„”ƒ–‹‘ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͳͻ

‰Ǥ ƒŽ‹†ƒ–‹‘ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤʹͲ

ŠǤ ‘•–…‘•‹†‡”ƒ–‹‘•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤʹͳ

‹Ǥ ‡’Žƒ…‡‡–‘ˆ‡”…—”›Ǧ…‘–ƒ‹‹‰

•’Š›‰‘ƒ‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤʹͳ

VI. Conclusion...25

Annex1...27

Annex2...39

References...45

Tables

ƒ„Ž‡ͷǤͳ ”‹–‹•Š›’‡”–‡•‹‘‘…‹‡–›‰”ƒ†‹‰…”‹–‡”‹ƒǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤʹͲ

ƒ„Ž‡ͳǤͳ‡“—‹”‡‡–•ˆ‘”†‹‰‹–ƒŽ–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤʹ͹

ƒ„Ž‡ͳǤʹ‡“—‹”‡‡–•ˆ‘”’Šƒ•‡Ǧ…Šƒ‰‡–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ͵ͷ

ƒ„Ž‡ͳǤ͵‡“—‹”‡‡–•ˆ‘”–›’ƒ‹…‹ˆ”ƒ”‡†–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤ͵͸

ƒ„Ž‡ͳǤͶ‡“—‹”‡‡–•ˆ‘”–‡’‘”ƒŽƒ”–‡”›‹ˆ”ƒ”‡†

–Š‡”‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ͵ͺ

ƒ„Ž‡ʹǤͳ‡“—‹”‡‡–•ˆ‘”ƒ‡”‘‹†•’Š›‰‘ƒ‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤ͵ͻ

ƒ„Ž‡ʹǤʹ‡“—‹”‡‡–•ˆ‘”ƒ—–‘ƒ–‡†

•’Š›‰‘ƒ‘‡–‡”•ǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͶʹ

ƒ„Ž‡ʹǤ͵—ƒ”›‘ˆ”‡“—‹”‡‡–•‹ȀȀ

ͺͳͲ͸ͲǦʹǣʹͲͲͻȋ47ȌǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤǤͶͶ

MERC-17-FINAL(18May11).pdf 4

MERC-17-FINAL(18May11).pdf 4 23/05/2011 10:32:49 AM23/05/2011 10:32:49 AM

v

F o r e w o r d

Ž‡‡–ƒŽ ‡”…—”› Šƒ• „‡‡ —•‡† ˆ‘” †‡…ƒ†‡• ‹ –Š‡”‘‡–‡”• ƒ†

•’Š›‰‘ƒ‘‡–‡”• ‹ –Š‡ Š‡ƒŽ–ŠǦ…ƒ”‡ •‡––‹‰Ǥ ‡”…—”›ǡ ƒ–—”ƒŽŽ›

‘……—””‹‰‹–Š‡‡ƒ”–Šǯ•…”—•–ǡ‹•”‡Ž‡ƒ•‡††—”‹‰˜‘Ž…ƒ‹…‡”—’–‹‘•ƒ†

ƒ• ƒ „›Ǧ’”‘†—…– ‘ˆ Š—ƒ ƒ…–‹˜‹–‹‡• •—…Š ƒ• –Š‡ „—”‹‰ ‘ˆ …‘ƒŽǡ ‘”

‹‹‰ƒ†”‡ˆ‹‹‰‘ˆ‡–ƒŽ•Ǥ

…‡ ”‡Ž‡ƒ•‡†ǡ ‡”…—”› ƒ› –”ƒ˜‡Ž ‰”‡ƒ– †‹•–ƒ…‡• „‡ˆ‘”‡ †‡’‘•‹–‹‰

‘ Žƒ† ƒ† ™ƒ–‡”ǡ ™Š‡”‡ ‹– ”‡ƒ…–• ™‹–Š ‘”‰ƒ‹… ƒ–‡”‹ƒŽ• –‘ ˆ‘”

‡–Š›Ž‡”…—”›Ǥ ‡–Š›Ž‡”…—”› „‹‘ƒ……——Žƒ–‡• ƒ† „‡…‘‡• ’ƒ”– ‘ˆ

–Š‡ ƒ“—ƒ–‹… ˆ‘‘† …Šƒ‹Ǥ Š‹• ‘”‰ƒ‹… ‡”…—”› ‹• ƒ ’‘–‡– ‡—”‘–‘š‹ǡ

‡•’‡…‹ƒŽŽ›ˆ‘”†‡˜‡Ž‘’‹‰ˆ‡–ƒŽƒ†…Š‹Ž†”‡ǯ•„”ƒ‹•Ǥ

 ƒ††‹–‹‘ǡ ‹ –Š‡ Š‡ƒŽ–ŠǦ…ƒ”‡ •‡––‹‰ǡ ‡Ž‡‡–ƒŽ ‡”…—”› ƒ› „‡

”‡Ž‡ƒ•‡†ƒ•ƒ”‡•—Ž–‘ˆ•’‹ŽŽƒ‰‡ˆ”‘„”‘‡–Š‡”‘‡–‡”•‘”Ž‡ƒ‹‰

‡“—‹’‡–ǤŠƒŽƒ–‹‘‘ˆ–Š‡•‡‡”…—”›˜ƒ’‘—”•ƒ›…ƒ—•‡†ƒƒ‰‡–‘

–Š‡Ž—‰•ǡ‹†‡›•ƒ†…‡–”ƒŽ‡”˜‘—••›•–‡Ǥ›’–‘•‘ˆ‡”…—”›

’‘‹•‘‹‰ ˆ”‘ …Š”‘‹… ‡š’‘•—”‡ ƒ› ‹…Ž—†‡ •Š‘”–‡•• ‘ˆ „”‡ƒ–Šǡ

†›•’‘‡ƒƒ†‹””‹–ƒ„‹Ž‹–›ǡ†‡’”‡••‹‘ƒ†–”‡‘”•Ǥ

Š‡ ’‘–‡–‹ƒŽ ‡˜‹”‘‡–ƒŽ †ƒƒ‰‡ǡ Š—ƒ –‘š‹…‹–› ƒ† †‹•’‘•ƒŽ

…‘•–• ‘ˆ ‡”…—”› Šƒ˜‡ Ž‡† –‘ ƒ ‰”‘™‹‰ †‡ƒ† ˆ‘” ‘Ǧ‡”…—”›Ǧ …‘–ƒ‹‹‰ †‡˜‹…‡• ‹ Š‡ƒŽ–Š …ƒ”‡Ǥ Š‹• ‰—‹†‡ ™‹ŽŽ †‡•…”‹„‡ ƒ˜ƒ‹Žƒ„Ž‡

ƒŽ–‡”ƒ–‹˜‡ ‘Ǧ‡”…—”›Ǧ…‘–ƒ‹‹‰ †‡˜‹…‡• ˆ‘” –Š‡”‘‡–‡”• ƒ†

•’Š›‰‘ƒ‘‡–‡”•ǡ ƒ† ’”‘˜‹†‡ ‰—‹†ƒ…‡ ‘ –Š‡ •‡Ž‡…–‹‘ ‘ˆ

ƒŽ–‡”ƒ–‹˜‡†‡˜‹…‡•Ǥ

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vii

A c k n o w l e d g e m e n ts

Š‹•’—„Ž‹…ƒ–‹‘™ƒ•™”‹––‡„›ǣ

‘ƒŠ‹‡ǡ‹˜‡”•‹–›‘ˆŽŽ‹‘‹•ǡ‹–‡†–ƒ–‡•‘ˆ‡”‹…ƒ

‘”‰‡ ƒ—‡Žǡ ‹–‡† ƒ–‹‘• ‡˜‡Ž‘’‡– ”‘‰”ƒ‡ȄŽ‘„ƒŽ

˜‹”‘‡– ƒ…‹Ž‹–›ǡŽ‘„ƒŽ‡ƒŽ–Š…ƒ”‡ƒ•–‡”‘Œ‡…–ǡ‹–‡†–ƒ–‡•‘ˆ

‡”‹…ƒ

‡–‡”””‹•ǡ‹˜‡”•‹–›‘ˆŽŽ‹‘‹•ǡ‹–‡†–ƒ–‡•‘ˆ‡”‹…ƒ

˜‡•Šƒ”–‹‡”ǡ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ǡ™‹–œ‡”Žƒ†

–™ƒ•’”‡’ƒ”‡†„›ǣ

Š‡ ”‡ƒ– ƒ‡• ‡–‡”• ˆ‘” ……—’ƒ–‹‘ƒŽ ƒ† ˜‹”‘‡–ƒŽ ƒˆ‡–›

ƒ† ‡ƒŽ–Š ‘ˆ –Š‡ ‹˜‡”•‹–› ‘ˆ ŽŽ‹‘‹• ƒ– Š‹…ƒ‰‘ǯ• …Š‘‘Ž ‘ˆ —„Ž‹…

‡ƒŽ–Šǣ ‘ŽŽƒ„‘”ƒ–‹‰ ‡–”‡ ‹ ……—’ƒ–‹‘ƒŽ ƒ†

˜‹”‘‡–ƒŽ‡ƒŽ–Š

…‘Œ—…–‹‘™‹–Šǣ

Š‡ Ž‘„ƒŽ ‡ƒŽ–Š…ƒ”‡ ƒ•–‡ ”‘Œ‡…–ǡ ˆ—†‡† „› –Š‡ ‹–‡† ƒ–‹‘•

‡˜‡Ž‘’‡– ”‘‰”ƒ‡ǯ• Ž‘„ƒŽ ˜‹”‘‡– ƒ…‹Ž‹–›ǡ ‹

…‘‘’‡”ƒ–‹‘ ™‹–Š –Š‡ ‘”Ž† ‡ƒŽ–Š ”‰ƒ‹œƒ–‹‘ ƒ† ‡ƒŽ–Š ƒ”‡

‹–Š‘—–ƒ”

Š‡ƒ—–Š‘”•™‹•Š–‘–Šƒ–Š‡ˆ‘ŽŽ‘™‹‰‡š’‡”–•ˆ‘”–Š‡‹””‡˜‹‡™•ƒ†

Š‡Ž’ˆ—Ž…‘‡–•ǣ

Œ‘” ƒŠŽ‰”‡ǡ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ǡ™‹–œ‡”Žƒ†

ƒ”‘Ž›‹…‡”•ǡ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ǡ™‹–œ‡”Žƒ†

‘•Šƒ”Ž‹‡”ǡ‡ƒŽ–Šƒ”‡‹–Š‘—–ƒ”ǡ‹–‡†–ƒ–‡•‘ˆ‡”‹…ƒ

Šƒ–Š‹‡†‹•ǡ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ǡ™‹–œ‡”Žƒ†

—•ƒ‹Ž„—”ǡ‘”Ž†‡ƒŽ–Š”‰ƒ‹œƒ–‹‘ǡ™‹–œ‡”Žƒ†

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1

I . W H O p o l i c y

Š‡ Š‡ƒŽ–ŠǦ…ƒ”‡ •‡…–‘”ǯ• …‘–”‹„—–‹‘ –‘ –Š‡ ‰Ž‘„ƒŽ ‡˜‹”‘‡–ƒŽ

”‡Ž‡ƒ•‡•‘ˆ‡”…—”›ƒ†–Š‡‹”ƒ••‘…‹ƒ–‡†Š‡ƒŽ–Š‹’ƒ…–•Šƒ•…‘‡ǡ‹

Žƒ”‰‡’ƒ”–ǡˆ”‘‡”…—”›–Š‡”‘‡–‡”•ƒ†•’Š›‰‘ƒ‘‡–‡”•Ǥƒ

ʹͲͲͷ ’‘Ž‹…› ’ƒ’‡”ǡ –Š‡ ‘”Ž† ‡ƒŽ–Š ”‰ƒ‹œƒ–‹‘ ȋȌ ‘–‡† –Šƒ–

Dz‘ˆƒŽŽ‡”…—”›‹•–”—‡–•—•‡†‹Š‡ƒŽ–Š…ƒ”‡ǡ–Š‡Žƒ”‰‡•–ƒ‘—–‘ˆ

‡”…—”›‹•—•‡†‹‡”…—”›•’Š›‰‘ƒ‘‡–‡”•ȋͺͲ–‘ͳͲͲ‰Ȁ—‹–Ȍǡ

ƒ† –Š‡‹” ™‹†‡•’”‡ƒ† —•‡ …‘ŽŽ‡…–‹˜‡Ž› ƒ‡ –Š‡ ‘‡ ‘ˆ –Š‡ Žƒ”‰‡•–

‡”…—”›”‡•‡”˜‘‹”•‹–Š‡ Š‡ƒŽ–ŠǦ…ƒ”‡ •‡––‹‰dzǤ…ƒŽŽ‹‰ˆ‘”ƒ’Šƒ•‡Ǧ

‘—–‘ˆ‡”…—”›‡ƒ•—”‹‰†‡˜‹…‡• ˆ”‘Š‡ƒŽ–Š…ƒ”‡ǡ‹–‡š’Žƒ‹‡†–Šƒ–

Dz„› …Š‘‘•‹‰ ƒ ‡”…—”›Ǧˆ”‡‡ ƒŽ–‡”ƒ–‹˜‡ǡ ƒ Š‡ƒŽ–ŠǦ…ƒ”‡ ‹•–‹–—–‹‘ …ƒ

ƒ‡ ƒ –”‡‡†‘—• ‹’ƒ…– ‹ ”‡†—…‹‰ –Š‡ ’‘–‡–‹ƒŽ ˆ‘” ‡”…—”›

‡š’‘•—”‡ –‘ ’ƒ–‹‡–•ǡ •–ƒˆˆ ƒ† –Š‡ ‡˜‹”‘‡–Ǥ – ‹• ‹’‘”–ƒ– –‘

”‡…‘‰‹œ‡ –Šƒ– ‘ ƒ––‡” ™Šƒ– –›’‡ ‘ˆ „Ž‘‘† ’”‡••—”‡ ‡ƒ•—”‡‡–

†‡˜‹…‡‹•—•‡†ǡ„‘–Šƒ‡”‘‹†ƒ†‡”…—”›•’Š›‰‘ƒ‘‡–‡”•—•–

„‡…Š‡…‡†”‡‰—Žƒ”Ž›‹‘”†‡”–‘ƒ˜‘‹†‡””‘”•dzȋ1ȌǤ

”‡…‘‰‹œ‡•–Šƒ–‘‡‘ˆ–Š‡ƒŒ‘”…ƒ—•‡•‘ˆ’‘‘”„Ž‘‘†’”‡••—”‡

…‘–”‘Ž‹Ž‘™Ǧ”‡•‘—”…‡•‡––‹‰•‹•–Š‡—ƒ˜ƒ‹Žƒ„‹Ž‹–›‘ˆ”‡Ž‹ƒ„Ž‡ǡ‡ƒ•‹Ž›

‘„–ƒ‹ƒ„Ž‡ ƒ† ƒˆˆ‘”†ƒ„Ž‡ †‡˜‹…‡• ˆ‘” „Ž‘‘† ’”‡••—”‡ ‡ƒ•—”‡‡–Ǥ

Šƒ•†”ƒ™—’–‡…Š‹…ƒŽ•’‡…‹ˆ‹…ƒ–‹‘•ˆ‘”‡”…—”›Ǧˆ”‡‡ǡƒ……—”ƒ–‡

ƒ† ƒˆˆ‘”†ƒ„Ž‡ „Ž‘‘† ’”‡••—”‡ ‡ƒ•—”‹‰ †‡˜‹…‡• ˆ‘” …Ž‹‹…ƒŽ —•‡ ȋ2ȌǤ

‘”‡ ”‡…‡–Ž›ǡ ’”‘˜‹†‡† –‡…Š‹…ƒŽ •—’’‘”– –‘ †‡˜‡Ž‘’ ƒ†

˜ƒŽ‹†ƒ–‡ ƒ ƒ……—”ƒ–‡ ƒ† ƒˆˆ‘”†ƒ„Ž‡ •‘Žƒ”Ǧ’‘™‡”‡† •‡‹Ǧƒ—–‘ƒ–‹…

„Ž‘‘† ’”‡••—”‡ ‡ƒ•—”‡‡– †‡˜‹…‡ ˆ‘” ”‡•‘—”…‡Ǧ…‘•–”ƒ‹‡†

•‡––‹‰•ȋ3ȌǤ

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3

I I . P u r p o s e o f t h i s g u i d e

Š‹• •Š‘”– ‰—‹†‡ ‹• †‡•‹‰‡† –‘ ’”‘˜‹†‡ •–‡’Ǧ„›Ǧ•–‡’ ‹•–”—…–‹‘• ˆ‘”

–Š‡ •ƒˆ‡ •—„•–‹–—–‹‘ ‘ˆ ‘Ǧ‡”…—”› –Š‡”‘‡–‡”• ƒ†

•’Š›‰‘ƒ‘‡–‡”• ‹ Š‡ƒŽ–ŠǦ…ƒ”‡ •‡––‹‰•Ǥ – ‹†‡–‹ˆ‹‡• ƒ˜ƒ‹Žƒ„Ž‡

”‡•‘—”…‡• –Šƒ– •—’’‘”– –Š‡ ‡“—‹˜ƒŽ‡– ƒ……—”ƒ…› ƒ† …‘’ƒ”ƒ„Ž‡

…Ž‹‹…ƒŽ—–‹Ž‹–›‘ˆ–Š‡•—„•–‹–—–‡†’”‘†—…–•ǡ™Š‹Ž‡’”‘–‡…–‹‰Š‡ƒŽ–ŠǦ…ƒ”‡

™‘” ‡”• ƒ† –Š‡ ‡˜‹”‘‡–Ǥ – ‹• †‡•‹‰‡† ˆ‘” ’”‘ˆ‡••‹‘ƒŽ•

”‡•’‘•‹„Ž‡ ˆ‘” ‹•–‹–—–‹‘• ‘” ‹‹•–”‹‡• †‡•‹”‹‰ –‘ •™‹–…Š –‘ •ƒˆ‡”

‘Ǧ’‘ŽŽ—–‹‰–‡…Š‘Ž‘‰‹‡•‹Š‡ƒŽ–Š…ƒ”‡Ǥ

Š‹• ‰—‹†‡ ‹• ƒŽ•‘ ƒ ‘—–’—– ‘ˆ ƒ ‰Ž‘„ƒŽ ‡”…—”›Ǧˆ”‡‡ Š‡ƒŽ–ŠǦ…ƒ”‡

‹‹–‹ƒ–‹˜‡ ‹ ™Š‹…Š ‹• ‡‰ƒ‰‡†Ǥ Š‹• ‰Ž‘„ƒŽ ‹‹–‹ƒ–‹˜‡ ƒ‹• –‘

’”‘‘–‡–Š‡•—„•–‹–—–‹‘‘ˆ‡”…—”›Ǧ„ƒ•‡†‡†‹…ƒŽ†‡˜‹…‡•™‹–Š•ƒˆ‡ǡ

ƒˆˆ‘”†ƒ„Ž‡ǡ ƒ……—”ƒ–‡ ƒŽ–‡”ƒ–‹˜‡• ƒ”‘—† –Š‡ ™‘”Ž†Ǥ Š‡ ‰Ž‘„ƒŽ

‡”…—”›Ǧˆ”‡‡ Š‡ƒŽ–ŠǦ…ƒ”‡ ‹‹–‹ƒ–‹˜‡ Šƒ• †‘…—‡–‡† ‡”…—”›

•—„•–‹–—–‹‘‹†‘œ‡•‘ˆ…‘—–”‹‡•ȋ4ȌǤ–Šƒ•ƒŽ•‘’”‘†—…‡†ƒ•‡”‹‡•‘ˆ

ƒ††‹–‹‘ƒŽ”‡•‘—”…‡•ˆ‘”Š‡ƒŽ–Š’”‘ˆ‡••‹‘ƒŽ•ǡŠ‡ƒŽ–ŠǦ•›•–‡ƒƒ‰‡”•

ƒ† ‰‘˜‡”‡– ‘ˆˆ‹…‹ƒŽ• –Šƒ– …ƒ „‡ —•‡ˆ—Ž ‹ †‡˜‡Ž‘’‹‰ ƒ†

‹’Ž‡‡–‹‰ ’‘Ž‹…› ƒ† •–”ƒ–‡‰‹‡• ˆ‘” ‡”…—”› •—„•–‹–—–‹‘ ‹ –Š‡

Š‡ƒŽ–Š•‡…–‘”ȋ5ȌǤ

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5

I I I . B a c k g r o u n d

a. Chemistry

‡’‡”ƒ–—”‡ ƒ† „Ž‘‘† ’”‡••—”‡ ƒ”‡ –™‘  ‡› …‘’‘‡–• ‹ –Š‡

‡˜ƒŽ—ƒ–‹‘‘ˆ–Š‡Š‡ƒŽ–Š‘ˆƒ’ƒ–‹‡–ǤŠ‡‡”…—”›–Š‡”‘‡–‡”ƒ†–Š‡

‡”…—”› •’Š›‰‘ƒ‘‡–‡” Šƒ˜‡ „‡‡ —•‡† –‘ ’”‘˜‹†‡ –Š‹•

‹ˆ‘”ƒ–‹‘ˆ‘”‘”‡–ŠƒͳͲͲ›‡ƒ”•Ǥ‡”…—”›‹•ƒƒ–—”ƒŽŽ›‘……—””‹‰

‡Ž‡‡–™‹–Š‹–•‰”‡ƒ–‡•–•–‘”‡•™‹–Š‹–Š‡‡ƒ”–Šǯ•…”—•–Ǥ–‹•ƒ—‹“—‡

‡–ƒŽ –Šƒ– ‹• ƒ Ž‹“—‹† ƒ– ”‘‘ –‡’‡”ƒ–—”‡Ǥ ‡”…—”› Šƒ• ƒ ˆ”‡‡œ‹‰

’‘‹–‘ˆȂ͵ͻιǡƒ„‘‹Ž‹‰’‘‹–‘ˆ͵ͷ͹郐††‘‡•‘–„—”ǡƒ‹‰‹–ƒ

—•‡ˆ—Žƒ–‡”‹ƒŽˆ‘”ƒ™‹†‡”ƒ‰‡‘ˆƒ’’Ž‹…ƒ–‹‘•Ǥ

‡”…—”›‹•”‡Ž‡ƒ•‡†„›˜‘Ž…ƒ‹…‡”—’–‹‘•ǡ‘ˆ–‡‹–Š‡ˆ‘”‘ˆ‡”…—”›

•ƒŽ–• •—…Š ƒ• ‡”…—”› •—Žˆ‹†‡ǡ ƒ† ƒ• ƒ „›Ǧ’”‘†—…– ‹ ƒ› Š—ƒ

ƒ…–‹˜‹–‹‡••—…Šƒ•„—”‹‰…‘ƒŽǡƒ†‹‹‰ƒ†”‡ˆ‹‹‰‘ˆ‡–ƒŽ••—…Š

ƒ• …‘’’‡”ǡ ‰‘Ž†ǡ Ž‡ƒ† ƒ† œ‹…Ǥ Š‡ Žƒ”‰‡•– ’”‡•‡– ‹–‡–‹‘ƒŽ —•‡ ‘ˆ

‡”…—”› ‹• „› ƒ”–‹•ƒƒŽ ƒ† •ƒŽŽǦ•…ƒŽ‡ ‰‘Ž† ‹‡”•Ǥ ‡”…—”›

…‘’‘—†• ƒ”‡ —•‡† ‹ …Š‡‹…ƒŽ ƒ—ˆƒ…–—”‹‰ǡ –Š‡ ’”‘†—…–‹‘ ‘ˆ

…‡‡– ƒ† ‘–Š‡” ‹†—•–”‹ƒŽ ’”‘…‡••‡•ǡ ƒ† ƒ”‡ …‘–ƒ‹‡† ‹ ƒ›

…‘•—‡”ƒ†‹†—•–”‹ƒŽ’”‘†—…–•ȋ6ȌǤ

b. Exposure

Š‡‡˜‡”’‡‘’Ž‡‹–‡–‹‘ƒŽŽ›’”‘†—…‡ƒ†—•‡‡”…—”›ǡ—…Š‘ˆ–Šƒ–

‡”…—”›™‹ŽŽ‡˜‡–—ƒŽŽ›˜‘Žƒ–‹Ž‹œ‡‹–‘–Š‡ƒ–‘•’Š‡”‡Ǥ–‹•‡•–‹ƒ–‡†

–Šƒ–ƒ’’”‘š‹ƒ–‡Ž›‘‡Ǧ–Š‹”†‘ˆ–Š‡ ‡”…—”›…‹”…—Žƒ–‹‰‹–Š‡ ‰Ž‘„ƒŽ

‡˜‹”‘‡–‹•ƒ–—”ƒŽŽ›‘……—””‹‰ǡƒ†ƒ’’”‘š‹ƒ–‡Ž›–™‘Ǧ–Š‹”†•‹•ƒ

”‡•—Ž– ‘ˆ ‹†—•–”‹ƒŽ ƒ† ‘–Š‡” Š—ƒ ƒ…–‹˜‹–‹‡• ȋ7ȌǤ Š‡ ƒ‘—– ‘ˆ

‡”…—”› –Šƒ– ‹• …‹”…—Žƒ–‹‰ ‹ –Š‡ ™‘”Ž†ǯ• ƒ–‘•’Š‡”‡ǡ •‘‹Ž•ǡ Žƒ‡•ǡ

•–”‡ƒ•ƒ†‘…‡ƒ•Šƒ•‹…”‡ƒ•‡†„›ƒˆƒ…–‘”‘ˆ„‡–™‡‡–™‘ƒ†ˆ‘—”

•‹…‡–Š‡•–ƒ”–‘ˆ–Š‡‹†—•–”‹ƒŽ‡”ƒȋ8ȌǤ

ˆ–‡”‡”…—”›˜ƒ’‘—”‹•”‡Ž‡ƒ•‡†ǡ†‡’‡†‹‰—’‘ƒ‹”…—””‡–•ǡ‹–ƒ›

–”ƒ˜‡Ž•Š‘”–‘”Ž‘‰†‹•–ƒ…‡•„‡ˆ‘”‡ˆƒŽŽ‹‰„ƒ…–‘‡ƒ”–ŠǤ’‘”–‹‘‘ˆ

–Š‡ ‡”…—”› –Šƒ– ˆƒŽŽ• ‹–‘ –Š‡ ‘…‡ƒ ‘” ‘–‘ –Š‡ Žƒ† ™‹ŽŽ ƒ‰ƒ‹

˜‘Žƒ–‹Ž‹œ‡ ƒ† –”ƒ˜‡Ž •–‹ŽŽ ˆ—”–Š‡”Ǥ Š‡ ”‡•‹†—ƒŽ ‡”…—”› –Šƒ– ˆƒŽŽ• ‘

Žƒ† ™‹ŽŽ Ž‹‡Ž› „‹† –‘ ‘”‰ƒ‹… ƒ–‡”‹ƒŽ ‹ –Š‡ •‘‹ŽǤ Š‹• ‡˜‡–—ƒŽŽ›

†”ƒ‹• ‹–‘ •–”‡ƒ• ƒ† ”‹˜‡”•ǡ ƒ† –Š‡ –‘ Žƒ‡• ƒ† ‘…‡ƒ•Ǥ  –Š‡

ƒ“—ƒ–‹…‡˜‹”‘‡–ǡ—…Š‘ˆ–Š‡‡Ž‡‡–ƒŽ‡”…—”›„‡…‘‡•„‘—†

–‘ •‡†‹‡– ƒ† –Š‡ ”‡•– ‹• …ƒ””‹‡† „› –Š‡ …—””‡–•Ǥ  –Š‡•‡ ƒ“—ƒ–‹…

‡˜‹”‘‡–•ǡ ‹…”‘‘”‰ƒ‹•• ‡–ƒ„‘Ž‹œ‡ ‡”…—”› ‹–‘

‡–Š›Ž‡”…—”›ǡ ƒ ‘”‰ƒ‘‡–ƒŽŽ‹… …‘’‘—†Ǥ ‡–Š›Ž‡”…—”›

6 Replacement of mercury themometers and sphygmomanometers in health care

„‡…‘‡• ’ƒ”– ‘ˆ –Š‡ ƒ“—ƒ–‹… ˆ‘‘† …Šƒ‹Ǣ ‹– „‹‘ƒ……——Žƒ–‡• ƒ†

„‹‘ƒ‰‹ˆ‹‡•ǡ ƒ†Ȅ‘ ‘……ƒ•‹‘Ȅ‹• –”ƒ•’‘”–‡† ‡˜‡ ˆ—”–Š‡” „›

‹‰”ƒ–‘”›ˆ‹•ŠǤ

 Š‡ƒŽ–ŠǦ…ƒ”‡ •‡––‹‰•ǡ –Š‡ …‘‘ „”‡ƒƒ‰‡ ‘ˆ ‡”…—”›Ǧ…‘–ƒ‹‹‰

†‡˜‹…‡•ǡ •’‹ŽŽ‹‰ ‘ˆ ‡”…—”› ƒ† ‹…‹‡”ƒ–‹‘ ‘ˆ ‡”…—”›Ǧ…‘–ƒ‹‹‰

‡†‹…ƒŽ ™ƒ•–‡ …‘–”‹„—–‡ –‘ „‘–Š ‹†‘‘” ƒ† ‘—–†‘‘” ‡‹••‹‘•Ǥ  ʹͲͲ͹ǡ ƒ •—”˜‡› ‹ —‡‘• ‹”‡• ‘–‡† –Šƒ– ‘”‡ –Šƒ

ͶͲͲͲͲ–Š‡”‘‡–‡”• ™‡”‡ Ž‘•– ’‡” ›‡ƒ”ǡ ‘•– –‘ „”‡ƒƒ‰‡ǡ ‹ –Š‡‹”

͵͵’—„Ž‹…Š‘•’‹–ƒŽ•ƒ†͵ͺ…Ž‹‹…•ǡƒ†‹‡š‹…‘ƒƒ–‹‘ƒŽ’ƒ‡†‹ƒ–”‹…

–‡ƒ…Š‹‰ Š‘•’‹–ƒŽ „”‘‡ ƒ ƒ˜‡”ƒ‰‡ ‘ˆ ͵ͺͷ –Š‡”‘‡–‡”• ’‡” ‘–Š

ȋ9ȌǤͳͻͻ͸ǡ„‡ˆ‘”‡ƒ•‹‰‹ˆ‹…ƒ–—„‡”‘ˆŠ‘•’‹–ƒŽǦ„ƒ•‡†‹…‹‡”ƒ–‘”•

™‡”‡ …Ž‘•‡†ǡ –Š‡ ‹–‡† –ƒ–‡• ˜‹”‘‡–ƒŽ ”‘–‡…–‹‘ ‰‡…›

†‡•‹‰ƒ–‡†–Š‡„—”‹‰‘ˆ‡†‹…ƒŽ™ƒ•–‡ƒ•–Š‡ˆ‘—”–ŠǦŽƒ”‰‡•–‡”…—”›

‡‹••‹‘•‘—”…‡‹–Š‡‹–‡†–ƒ–‡•ȋ10ȌǤ

c. Human exposure

—‡–‘‹–•Š‹‰Š•—”ˆƒ…‡–‡•‹‘ƒ†˜‘Žƒ–‹Ž‹–›ǡ‡Ž‡‡–ƒŽ‡”…—”›ˆ‘”•

•ƒŽŽ †”‘’• ™Š‡ •’‹ŽŽ‡† ƒ† ˜ƒ’‘”‹œ‡• ”ƒ’‹†Ž› ‹–‘ –Š‡ ƒ‹”Ǥ †‘‘”•ǡ

‡”…—”› •’‹ŽŽ• „‡…‘‡ ƒ ‹ŠƒŽƒ–‹‘ Šƒœƒ”† ȋ11ȌǤ ƒ”‰‡– ‘”‰ƒ• ‘ˆ

‡Ž‡‡–ƒŽ ‡”…—”› ˜ƒ’‘—” ‹ŠƒŽƒ–‹‘ ‹…Ž—†‡ –Š‡ Ž—‰ǡ ‹†‡› ƒ†

…‡–”ƒŽ ‡”˜‘—• •›•–‡Ǥ ›’–‘• ‘ˆ ‡”…—”› ’‘‹•‘‹‰ ‹…Ž—†‡

•Š‘”–‡••‘ˆ„”‡ƒ–Šǡ†›•’‘‡ƒƒ†…‘—‰Š™‹–Šƒ…—–‡‡š’‘•—”‡Ǣ…Š”‘‹…

‡š’‘•—”‡ –‘ Ž‘™‡” †‘•‡• ‰‡‡”ƒŽŽ› Ž‡ƒ†• –‘ ‹””‹–ƒ„‹Ž‹–›ǡ †‡’”‡••‹‘ǡ

–”‡‘”•ƒ†•Ž—””‡†•’‡‡…Šȋ11ȌǤ

Š‡ ‰‡‡”ƒŽ ’‘’—Žƒ–‹‘ ‹• ‡š’‘•‡† –‘ –Š‡ ‡”…—”› ”‡Ž‡ƒ•‡† ‹–‘ –Š‡

‡˜‹”‘‡––Š”‘—‰Šƒ†‹‡–…‘–ƒ‹‹‰ˆ‹•ŠǤŠ‹•‡š’‘•—”‡‹•‘ˆ ‘•–

…‘…‡”™‹–Š”‡•’‡…––‘…Š‹Ž†”‡„‡ˆ‘”‡„‹”–Šƒ†‹‹ˆƒ…›ǤʹͲͲͲǡ

–Š‡ƒ–‹‘ƒŽ‡•‡ƒ”…Š‘—…‹Ž‘ˆ–Š‡‹–‡†–ƒ–‡•ƒ–‹‘ƒŽ…ƒ†‡›

‘ˆ …‹‡…‡• ˆ‘—† –Šƒ– –Š‡ ’‘’—Žƒ–‹‘ ƒ– Š‹‰Š‡•– ”‹• ˆ‘”

‡–Š›Ž‡”…—”› ‡š’‘•—”‡ ‹• –Š‡ …Š‹Ž†”‡ ‘ˆ ™‘‡ ™Š‘ …‘•—‡†

Žƒ”‰‡ ƒ‘—–• ‘ˆ ˆ‹•Š ƒ† •‡ƒˆ‘‘† †—”‹‰ ‘” ‹‡†‹ƒ–‡Ž› ’”‹‘” –‘

’”‡‰ƒ…›Ǥ – ˆ‘—† –Šƒ– –Š‡ ”‹• –‘ –Š‹• ’‘’—Žƒ–‹‘ ‹• Ž‹ ‡Ž› –‘ „‡

•—ˆˆ‹…‹‡––‘”‡•—Ž–‹ƒ‹…”‡ƒ•‡‹–Š‡—„‡”‘ˆ…Š‹Ž†”‡™Š‘—•–

•–”—‰‰Ž‡–‘‡‡’—’‹•…Š‘‘Žƒ†™Š‘‹‰Š–”‡“—‹”‡”‡‡†‹ƒŽ…Žƒ••‡•

‘”•’‡…‹ƒŽ‡†—…ƒ–‹‘ȋ12ȌǤ

MERC-17-FINAL(18May11).pdf 14

MERC-17-FINAL(18May11).pdf 14 23/05/2011 10:32:50 AM23/05/2011 10:32:50 AM

Background 7

d. Costs

 ʹͲͲͷǡ ”ƒ•ƒ†‡ ‡– ƒŽǤǡ —•‹‰ „Ž‘‘† ‡”…—”› †ƒ–ƒ ˆ”‘ –Š‡ ‹–‡†

–ƒ–‡•‡–‡”•ˆ‘”‹•‡ƒ•‡‘–”‘Žƒ†”‡˜‡–‹‘ǡ‡•–‹ƒ–‡†–Šƒ––Š‡

Ž‘•• ‘ˆ ’”‘†—…–‹˜‹–› „ƒ•‡† ‘ –Š‡ ’”‡†‹…–‡† ‡—”‘–‘š‹…‹–› ‘ˆ ‡”…—”›

ƒ‘—–‡† –‘ „‡–™‡‡ ̈́ʹǤʹ ƒ† ̈́Ͷ͵Ǥͺ „‹ŽŽ‹‘ ƒ—ƒŽŽ› ˆ‘” –Š‡

‹–‡†–ƒ–‡•ˆ”‘…‘ƒŽǦ„—”‹‰’‘™‡”’Žƒ–•ƒŽ‘‡ȋ13ȌǤ‡‡•’‡…‹ˆ‹…

…‘•– …‘•‹†‡”ƒ–‹‘• ‹ –Š‡ …Šƒ’–‡”• ‘ –Š‡”‘‡–‡”• ƒ†

•’Š›‰‘ƒ‘‡–‡”•Ǥ

MERC-17-FINAL(18May11).pdf 16

MERC-17-FINAL(18May11).pdf 16 23/05/2011 10:32:50 AM23/05/2011 10:32:50 AM

9

I V. T h e r m o m e t e r s

a. History

 ͳ͸ͷͶǡ ‡”†‹ƒ†‘ †‡ǯ ‡†‹…‹ …”ƒˆ–‡† –Š‡ ˆ‹”•– ‘†‡”

–Š‡”‘‡–‡” „› †‡•‹‰‹‰ ƒ •‡ƒŽ‡† –—„‡ ’ƒ”–‹ƒŽŽ› ˆ‹ŽŽ‡† ™‹–Š ƒŽ…‘Š‘Ž

ƒ† ƒ ”‡•‡”˜‘‹” „—Ž„ǡ –Š‡”‡„› ‡Ž‹‹ƒ–‹‰ –Š‡ ‹–‡”ˆ‡”‡…‡ ‘ˆ

„ƒ”‘‡–”‹…’”‡••—”‡…‘‘‹’”‡˜‹‘—•‘†‡Ž•ȋ14ȌǤ

ƒ‹‡Žƒ„”‹‡Ž ƒŠ”‡Š‡‹–’”‘†—…‡†ƒ–Š‡”‘‡–‡”—•‹‰‡”…—”›‹

ͳ͹ʹͶ ƒ† ‡•–ƒ„Ž‹•Š‡† –Š‡ ƒŠ”‡Š‡‹– •…ƒŽ‡ ȋ͵ʹȂʹͳʹι ȌǤ ‡…ƒ—•‡ ‘ˆ

‡”…—”›ǯ• Š‹‰Š …‘‡ˆˆ‹…‹‡– ‘ˆ ‡š’ƒ•‹‘ǡ –Š‡ ”‡•—Ž–• ™‡”‡ Š‹‰ŠŽ›

”‡’”‘†—…‹„Ž‡Ǥ ‹‰Š–‡‡ ›‡ƒ”• Žƒ–‡”ǡ †‡”• ‡Ž•‹—• ’”‘’‘•‡† –Šƒ– ƒ

•…ƒŽ‡‘ˆœ‡”‘†‡‰”‡‡•ȋ‡Ž–‹‰’‘‹–‘ˆ™ƒ–‡”Ȍ–‘ͳͲͲ†‡‰”‡‡•ȋ„‘‹Ž‹‰

’‘‹–Ȍ ™ƒ• ‘”‡ ’”ƒ…–‹…ƒŽǤ ‘–Š •…ƒŽ‡• ƒ”‡ •–‹ŽŽ —•‡† –‘†ƒ›ǡ ƒ• ‹• –Š‡

‘”‹‰‹ƒŽ‡”…—”›•‡ƒŽ‡†Ǧ‰Žƒ••–Š‡”‘‡–‡”ȋ10ȌǤ

”ƒ‡•—””‹‡’‘’—Žƒ”‹œ‡†–Š‡—•‡‘ˆ–Š‡•‡‰Žƒ••–Š‡”‘‡–‡”•ˆ‘”

–Š‡‡ƒ•—”‡‡–‘ˆ’ƒ–‹‡––‡’‡”ƒ–—”‡•–‘™ƒ”†•–Š‡‡†‘ˆ–Š‡ͳͺ–Š

…‡–—”›Ǥ ‡ ’”ƒ…–‹•‡† ‹ ‹˜‡”’‘‘Ž ˆ”‘ ͳ͹ͺͲ –‘ ͳͺͲͷǡ ’—„Ž‹•Š‡† Š‹•

ˆ‹†‹‰•ƒ†–Š‡‘”‹‡•ǡƒ†…‘””‡•’‘†‡†™‹–Š–Š‡Ž‡ƒ†‹‰•…‹‡–‹•–•‘ˆ

–Š‡†ƒ›ȋ15ȌǤ

b. Operation of mercury thermometers

‡”…—”›Ǧ‹Ǧ‰Žƒ•• –Š‡”‘‡–‡”• Šƒ˜‡ –™‘ …‘’‘‡–•ǣ ƒ ”‡•‡”˜‘‹” ‘ˆ

‡”…—”›ǡ‘”ƒ„—Ž„ǡƒ––ƒ…Š‡†–‘ƒ‰Žƒ••–—„‡–Šƒ–Šƒ•ƒ•…ƒŽ‡–‘‡ƒ•—”‡

–Š‡ –‡’‡”ƒ–—”‡ …Šƒ‰‡Ǥ • –Š‡ –‡’‡”ƒ–—”‡ …Šƒ‰‡•ǡ –Š‡ ‡”…—”›

‘˜‡• —’ ‘” †‘™ –Š‡ –—„‡ǡ ƒ† –Š‡ …Šƒ‰‡ ‹• ”‡…‘”†‡†Ǥ

Š‡”‘‡–‡”• —•‡† ‹ Š‡ƒŽ–Š …ƒ”‡ ƒ”‡ †‡•‹‰‡† –‘ ”‡…‘”† –Š‡

ƒš‹—–‡’‡”ƒ–—”‡‘„–ƒ‹‡††—”‹‰–Š‡”‡…‘”†‹‰’‡”‹‘†„›—•‡‘ˆ

ƒ …‘•–”‹…–‹‘ ‹ –Š‡ ‡… ‘ˆ –Š‡ –Š‡”‘‡–‡” –Šƒ– ’”‡˜‡–• –Š‡

‡”…—”›ˆ”‘ˆƒŽŽ‹‰„ƒ…‹–‘–Š‡”‡•‡”˜‘‹”Ǥ…‡–Š‡–‡’‡”ƒ–—”‡‹•

”‡…‘”†‡†ǡ–Š‡–Š‡”‘‡–‡”—•–„‡Dz•Šƒ‡dz–‘”‡–—”–Š‡‡”…—”›–‘

–Š‡ ”‡•‡”˜‘‹”Ǥ Š‡ –Š‡”‘‡–‡” ‹• –Š‡ ”‡ƒ†› –‘ –ƒ‡ ƒ‘–Š‡”

”‡ƒ†‹‰ȋ10ȌǤ

10 Replacement of mercury themometers and sphygmomanometers in health care

c. Accuracy of mercury thermometers

Š‡ƒ……—”ƒ…›‘ˆ–Š‡‡”…—”›–Š‡”‘‡–‡”†‡’‡†•‘•‡˜‡”ƒŽˆƒ…–‘”•ǡ

‹…Ž—†‹‰’”‘’‡”’Žƒ…‡‡–ǡŽ‡‰–Š‘ˆ–‹‡‡’–ƒ–•‹–‡ǡ–‡…Š‹“—‡—•‡†

„› –Š‡ …Ž‹‹…‹ƒǡ ’ƒ–‹‡–ǯ• ƒ…–‹˜‹–‹‡• „‡ˆ‘”‡ ƒ† †—”‹‰ –Š‡

‡ƒ•—”‡‡–ǡ…Ž‘–Š‹‰ǡƒ„‹‡––‡’‡”ƒ–—”‡ƒ†Š—‹†‹–›Ǥ

Š‡‡”‹…ƒ‘…‹‡–›‘ˆ‡•–‹‰ƒ†ƒ–‡”‹ƒŽ•ȋȌŠƒ•‡•–ƒ„Ž‹•Š‡†

˜‘Ž—–ƒ”› ’‡”ˆ‘”ƒ…‡ •–ƒ†ƒ”†• ˆ‘” –Š‡”‘‡–‡”•ǡ ƒ†

–Š‡”‘‡–‡”• —•‡† ‹ Š‡ƒŽ–Š …ƒ”‡ ƒ”‡ –›’‹…ƒŽŽ› –‡•–‡† ƒ‰ƒ‹•– –Š‡•‡

•–ƒ†ƒ”†•Ǥ ……‘”†‹‰ –‘ –Š‡ ’‡”ˆ‘”ƒ…‡ •–ƒ†ƒ”†•ǡ ‡”…—”›

–Š‡”‘‡–‡”• —•– „‡ ƒ……—”ƒ–‡ –‘ άͲǤʹι „‡–™‡‡ ͻͺǤͲι ƒ†

ͳͲʹǤͲι ǡƒ†–‘άͲǤͶι ƒ––Š‡‡š–”‡‡•‘ˆδͻ͸ǤͶι ƒ†εͳͲ͸ι ȋ16ȌǤ

†Œ—•–‹‰ ˆ‘” Š—ƒ ‡””‘”ǡ ƒ ’”‘’‡”Ž› ˜ƒŽ‹†ƒ–‡†ǡ …ƒŽ‹„”ƒ–‡† ƒ†

ƒ‹–ƒ‹‡†‡”…—”›–Š‡”‘‡–‡”‡‡–‹‰–Š‡•–ƒ†ƒ”†™‹ŽŽ„‡

ƒ……—”ƒ–‡™‹–Š‹–Š‡ƒ„‘˜‡Ž‹‹–•ȋ12ȌǤ

d. Mercury-free thermometers

‘‡”…‹ƒŽŽ›ƒ˜ƒ‹Žƒ„Ž‡ƒŽ–‡”ƒ–‹˜‡•–‘‡”…—”›–Š‡”‘‡–‡”•‹…Ž—†‡

–Š‡”‹•–‘”Ǧ„ƒ•‡† †‹‰‹–ƒŽ –Š‡”‘‡–‡”•ǡ ‰ƒŽ‹•–ƒǦ‹Ǧ‰Žƒ••

–Š‡”‘‡–‡”•ǡ ƒŽ…‘Š‘ŽǦ†›‡ –Š‡”‘‡–‡”•ǡ –›’ƒ‹… ‹ˆ”ƒ”‡†

–Š‡”‘‡–‡”•ǡ–‡’‘”ƒŽƒ”–‡”›‹ˆ”ƒ”‡†–Š‡”‘‡–‡”•ǡ–Š‡”‘…‘—’Ž‡Ǧ

„ƒ•‡† –Š‡”‘‡–‡”•ǡ ’Šƒ•‡Ǧ…Šƒ‰‡ ȋ†‘–Ǧƒ–”‹šȌ –Š‡”‘‡–‡”• ƒ†

–Š‡”‘…Š”‘‹… ȋ…Š‘Ž‡•–‡”‹…Ȍ Ž‹“—‹† …”›•–ƒŽ –Š‡”‘‡–‡”• ȋ17ȌǤ Š‹•

‰—‹†‡ ˆ‘…—•‡• ’”‹ƒ”‹Ž› ‘ †‹‰‹–ƒŽǡ ’Šƒ•‡Ǧ…Šƒ‰‡ǡ –›’ƒ‹… ‹ˆ”ƒ”‡†

ƒ† –‡’‘”ƒŽ ƒ”–‡”› ‹ˆ”ƒ”‡† –Š‡”‘‡–‡”•ǡ ƒŽ–Š‘—‰Š •‘‡ ‘ˆ –Š‡

•’‡…‹ˆ‹…ƒ–‹‘• ƒ› ƒ’’Ž› –‘ ‘–Š‡” –›’‡• ‘ˆ ‘Ǧ‡”…—”› ‡ƒ•—”‹‰

†‡˜‹…‡•Ǥ

‹‰‹–ƒŽ–Š‡”‘‡–‡”•ǡ•‘…ƒŽŽ‡†„‡…ƒ—•‡–Š‡›†‹•’Žƒ›–Š‡–‡’‡”ƒ–—”‡

‹ †‹‰‹–ƒŽ ˆ‘”ƒ–ǡ ƒ”‡ ‡“—‹’’‡† ™‹–Š ‡‹–Š‡” ƒ ‡Ž‡…–”‘‹… •‡•‘”

ȋ”‡“—‹”‹‰„‘†›…‘–ƒ…–Ȍ‘”ƒ‹ˆ”ƒ”‡†•‡•‘”ȋˆ‘””‡‘–‡•‡•‹‰Ȍ–‘

ƒ•…‡”–ƒ‹–Š‡„‘†›–‡’‡”ƒ–—”‡Ǥ

Šƒ•‡Ǧ…Šƒ‰‡ –Š‡”‘‡–‡”• —•‡ ƒ ‰”‹† ‘ˆ †‘–• ƒ––ƒ…Š‡† –‘ ƒ –Š‹

’Žƒ•–‹…†‹•’‘•ƒ„Ž‡•–‹…–‘‹†‹…ƒ–‡–Š‡–‡’‡”ƒ–—”‡ǤŠ‡†‘–•ƒ”‡ƒ†‡

—’ ‘ˆ ƒ ‘Ǧ–‘š‹… …‘’‘—†ǡ ƒ† ‡ƒ…Š ”‘™ ‘ˆ †‘–• ”‡’”‡•‡–•

–‡’‡”ƒ–—”‡ ‹…”‡‡–•Ǥ Š‡ •–‹… ƒ› „‡ ’Žƒ…‡† —†‡” –Š‡ –‘‰—‡

ƒ†ǡƒ•–Š‡–‡’‡”ƒ–—”‡‹…”‡ƒ•‡•ǡ–Š‡†‘–•™‹ŽŽ…Šƒ‰‡…‘Ž‘—”ȋ—•—ƒŽŽ›

–‘ „Žƒ…Ȍǡ ™‹–Š –Š‡ –‡’‡”ƒ–—”‡ ‹†‹…ƒ–‡† „› –Š‡ Žƒ•– †‘– –‘ …Šƒ‰‡

…‘Ž‘—”Ǥ

›’ƒ‹… ‹ˆ”ƒ”‡† –Š‡”‘‡–‡”•ǡ ‘” ‡ƒ” –Š‡”‘‡–‡”•ǡ ƒ”‡ –›’‹…ƒŽŽ›

„ƒ––‡”›Ǧ‘’‡”ƒ–‡†—‹–•”‡•‡„Ž‹‰ƒ‘–‘•…‘’‡’”‘„‡ǤŠ‡’”‘„‡ǡ™‹–Š

MERC-17-FINAL(18May11).pdf 18

MERC-17-FINAL(18May11).pdf 18 23/05/2011 10:32:51 AM23/05/2011 10:32:51 AM

Thermometers 11

ƒ †‹•’‘•ƒ„Ž‡ ’Žƒ•–‹… …‘˜‡”ǡ ‹• ‹•‡”–‡† ‹–‘ –Š‡ ‘—–‡” ’ƒ”– ‘ˆ –Š‡ ‡ƒ”

…ƒƒŽ –‘ ‡ƒ•—”‡ –Š‡ –Š‡”ƒŽ ”ƒ†‹ƒ–‹‘ ‘ˆ –Š‡ –›’ƒ‹… ‡„”ƒ‡Ǥ

Š‡ •‹‰ƒŽ ˆ”‘ –Š‡ ‹ˆ”ƒ”‡† •‡•‘” ‹• …‘˜‡”–‡† –‘ ƒ †‹‰‹–ƒŽ

–‡’‡”ƒ–—”‡†‹•’Žƒ›Ǥ

–‡’‘”ƒŽƒ”–‡”›‹ˆ”ƒ”‡†–Š‡”‘‡–‡”ǡ•‘‡–‹‡•…ƒŽŽ‡†ƒˆ‘”‡Š‡ƒ†

–Š‡”‘‡–‡”ǡ–ƒ‡•–Š‡„‘†›–‡’‡”ƒ–—”‡ƒ•–Š‡—•‡”•Ž‹†‡•–Š‡’”‘„‡

•‡•‘”ƒ…”‘••–Š‡’ƒ–‹‡–ǯ•ˆ‘”‡Š‡ƒ†ǡ…”‘••‹‰‘˜‡”–Š‡–‡’‘”ƒŽƒ”–‡”›Ǥ

 †‘‹‰ •‘ǡ –Š‡ •‡•‘” ‡ƒ•—”‡• –Š‡ –Š‡”ƒŽ ”ƒ†‹ƒ–‹‘ ‘ˆ –Š‡ • ‹

•—”ˆƒ…‡‘˜‡”–Š‡–‡’‘”ƒŽƒ”–‡”›ƒ†…‘’—–‡•–Š‡„‘†›–‡’‡”ƒ–—”‡Ǥ

‡’‘”ƒŽ ƒ”–‡”› –Š‡”‘‡–‡”• ƒ”‡ ‰‡‡”ƒŽŽ› ’‘”–ƒ„Ž‡ǡ „ƒ––‡”›Ǧ

‘’‡”ƒ–‡†‡Ž‡…–”‘‹…†‡˜‹…‡•™‹–Šƒ†‹‰‹–ƒŽ†‹•’Žƒ›•…”‡‡Ǥ

e. Accuracy of mercury-free thermometers

ƒ†œ‹Ž‡–ƒŽǤȋ18Ȍ…‘†—…–‡†ƒ•–—†›ƒ––Š‡‹˜‡”•‹–›‘ˆƒŽƒ›ƒ‡†‹…ƒŽ

‡–”‡ …‘’ƒ”‹‰ ˆ‘—” †‹ˆˆ‡”‡– –‡’‡”ƒ–—”‡Ǧ‡ƒ•—”‹‰ †‡˜‹…‡•ǣ

‡”…—”›Ǧ‹Ǧ‰Žƒ••–Š‡”‘‡–‡”ǡ†‹‰‹–ƒŽ‘”ƒŽ–Š‡”‘‡–‡”ǡŽ‹“—‹†…”›•–ƒŽ

ˆ‘”‡Š‡ƒ†–Š‡”‘‡–‡”ƒ††‹‰‹–ƒŽ–›’ƒ‹…‹ˆ”ƒ”‡†–Š‡”‘‡–‡”ǤŽŽ

ˆ‘—” ‡ƒ•—”‡‡–• ™‡”‡ …‘†—…–‡† •‹—Ž–ƒ‡‘—•Ž› ˆ‘” ʹͲ͹ ’ƒ–‹‡–•Ǥ

Š‡ ‡ƒ• ƒ† •–ƒ†ƒ”† †‡˜‹ƒ–‹‘• ˆ‘” –Š‡ ˆ‘—” ‡–Š‘†• ™‡”‡

”‡’‘”–‡† ƒ• ˆ‘ŽŽ‘™•ǣ ‡”…—”›Ǧ‹Ǧ‰Žƒ••ǡ ‡ƒ ͵͸Ǥ͹ͻͷιǡ •–ƒ†ƒ”†

†‡˜‹ƒ–‹‘ͲǤ͸ͻͷǢ†‹‰‹–ƒŽ‘”ƒŽǡ‡ƒ͵͸ǤͺͶͷιǡ•–ƒ†ƒ”††‡˜‹ƒ–‹‘ͲǤ͸͵ʹǢ

Ž‹“—‹†…”›•–ƒŽˆ‘”‡Š‡ƒ†ǡ‡ƒ͵͸Ǥ͹ͳͺιǡ•–ƒ†ƒ”††‡˜‹ƒ–‹‘ͲǤ͹ʹ͵Ǣƒ†

†‹‰‹–ƒŽ –›’ƒ‹… ‹ˆ”ƒ”‡†ǡ ‡ƒ ͵͸Ǥ͹ͺιǡ •–ƒ†ƒ”† †‡˜‹ƒ–‹‘ ͲǤ͹ͳ͹Ǥ

Ž–Š‘—‰Š ƒŽŽ –Š”‡‡ ƒŽ–‡”ƒ–‡• ™‡”‡ …‘’ƒ”ƒ„Ž‡ –‘ –Š‡ ‡”…—”›

–Š‡”‘‡–‡”ǡ –Š‡ ƒ—–Š‘”• ˆƒ˜‘—”‡† –Š‡ †‹‰‹–ƒŽ –Š‡”‘‡–‡” ˆ‘”

‰‡‡”ƒŽ —•‡ǡ –Š‡ –›’ƒ‹… ‘†‡Ž ˆ‘” —…‘‘’‡”ƒ–‹˜‡ ’ƒ–‹‡–• ƒ† –Š‡

Ž‹“—‹†…”›•–ƒŽˆ‘”‡Š‡ƒ†‡–Š‘†ˆ‘”Š‘‡—•‡ȋ13ȌǤƒ›‘–Š‡”•…‹‡–‹ˆ‹…

’ƒ’‡”• …‘’ƒ”‡ –Š‡ ƒ……—”ƒ…› ƒ† •—‹–ƒ„‹Ž‹–› ‘ˆ †‹ˆˆ‡”‡– –›’‡• ‘ˆ

–Š‡”‘‡–‡”•ǡƒ†–Š‡…‘…Ž—•‹‘•ƒ”‡•‘‡–‹‡•…‘–”ƒ†‹…–‘”›ȋ19ȌǤ

f. Cost considerations

Š‡’—”…Šƒ•‡’”‹…‡‘ˆ†‡˜‹…‡•ǡ™Š‹…Š˜ƒ”‹‡•ˆ”‘…‘—–”›–‘…‘—–”›ǡ

”‡ƒ‹• ƒ  ‡› ’‘‹– –‘ „‡ …‘•‹†‡”‡†Ǥ –Š‡” ˆƒ…–‘”• ‹ ƒ††‹–‹‘ –‘

’—”…Šƒ•‡ ’”‹…‡ ‡‡† –‘ „‡ …‘•‹†‡”‡† •—…Š ƒ•ǡ –Š‡ ”ƒ–‡ ‘ˆ —•‡ ‘ˆ

…‘•—ƒ„Ž‡‹–‡•Ž‹‡ƒŽ…‘Š‘Ž™‹’‡•ǡ„ƒ––‡”‹‡•ǡ…—ˆˆ•ƒ†‘–Š‡”’ƒ”–•ǡ

ƒ†”‡’ƒ‹”ƒ†…ƒŽ‹„”ƒ–‹‘…‘•–•ƒŽŽ‡‡†–‘„‡…‘•‹†‡”‡†Ǥ™‘ˆƒ…–‘”•

‘ˆ–‡ ‘˜‡”Ž‘‘‡† ƒ”‡ –Š‡ …‘•–• ‘ˆ †‹•’‘•ƒŽ ‘ˆ –Š‡ ‡”…—”›Ǧ…‘–ƒ‹‹‰

—‹–•ƒ†–Š‡‡†—…ƒ–‹‘‘ˆ•–ƒˆˆ‘–Š‡’”‘’‡”‘’‡”ƒ–‹‘‘ˆ–Š‡—‹–•Ǥ

 ʹͲͲͷǡ ”ƒ™ˆ‘”† ‡– ƒŽǤ ȋ20Ȍ ‘†‡ŽŽ‡† …‘’ƒ”ƒ„Ž‡ …‘•–• ‹ ƒ Žƒ”‰‡

–‡ƒ…Š‹‰Š‘•’‹–ƒŽ‘ˆʹʹͲͷ„‡†•‹–Š‡‹–‡†‹‰†‘‘˜‡”ƒͳͲǦ›‡ƒ”

’‡”‹‘†Ǥ Š‡› ‡•–‹ƒ–‡† –Šƒ– –Š‡ ‡”…—”› –Š‡”‘‡–‡” ™ƒ• –Š‡

12 Replacement of mercury themometers and sphygmomanometers in health care …Š‡ƒ’‡•– –Š‡”‘‡–‡” ƒŽ–‡”ƒ–‹˜‡ ƒ• ‘ „ƒ––‡”‹‡•ǡ …‘˜‡”•ǡ ”‡’ƒ‹”• ‘”

…ƒŽ‹„”ƒ–‹‘ ™‡”‡ ”‡“—‹”‡†Ǥ Š‹• …ƒŽ…—Žƒ–‹‘ ™ƒ• „ƒ•‡† ‘ –Š‡

ƒ••—’–‹‘ ‘ˆ ƒ ͳͲΨ „”‡ƒƒ‰‡ ’‡” ›‡ƒ” ‘ˆ –Š‡•‡ ‰Žƒ•• †‡˜‹…‡• ƒ†

”‡’Žƒ…‹‰ ƒŽŽ ™‹–Š –Š‡ …‘’ƒ…– †‹‰‹–ƒŽ —‹–•Ǥ  ”‡ƒŽ‹–›ǡ ƒ• †‹•…—••‡†

ƒ„‘˜‡ǡ –Š‡ ”ƒ–‡ ‘ˆ „”‡ƒƒ‰‡ ‹• —…Š Š‹‰Š‡”Ǥ ˆ –Š‡ –Š‡”‘‡–‡”

„”‡ƒƒ‰‡”ƒ–‡ˆ‘”–Š‡‡š‹…ƒ’‡†‹ƒ–”‹…Š‘•’‹–ƒŽȋ•‡‡ƒ„‘˜‡Ȍ™‹–Šʹͳʹ

„‡†•‹•‡š–”ƒ’‘Žƒ–‡†–‘–Š‹•ʹʹͲͷǦ„‡†•‡––‹‰ǡ–Š‡”ƒ–‡™‘—Ž†„‡…Ž‘•‡”

–‘ʹͲͲΨǤ

—”–Š‡”ǡ ƒ ‘‡Ǧˆ‘”Ǧ‘‡ ”‡’Žƒ…‡‡– ‹• ‘– ‡…‡••ƒ”› ‰‹˜‡ –Š‡

˜‡”•ƒ–‹Ž‹–› ƒ† ‰”‡ƒ–‡” †—”ƒ„‹Ž‹–› ‘ˆ –Š‡ †‹‰‹–ƒŽ †‡˜‹…‡Ǥ – ƒ Ž—š—”‹ƒ–

”‡’Žƒ…‡‡–”ƒ–‹‘‘ˆ‘‡†‹‰‹–ƒŽ†‡˜‹…‡ˆ‘”‡˜‡”›–™‘‰Žƒ••†‡˜‹…‡•ǡƒ

„”‡ƒƒ‰‡”ƒ–‡‘ˆ‘Ž›͵͵Ψ‘”ƒ„‘˜‡™‘—Ž†ƒ‡–Š‡…‘–ƒ…–ǡ…‘’ƒ…–

‡Ž‡…–”‘‹… †‡˜‹…‡• …Š‡ƒ’‡”ǡ ‡˜‡ ‹ˆ ƒŽŽ ‘–Š‡” ’”‹…‹‰ ƒ••—’–‹‘•

ȋͷǣͳ †‹ˆˆ‡”‡–‹ƒŽȌ ”‡ƒ‹‡† –Š‡ •ƒ‡Ǥ ‡”–ƒ‹Ž›ǡ ‡šƒ…– …‘•–• ™‹ŽŽ ˜ƒ”›

™‹–Š Ž‘…ƒ–‹‘ǡ ‘†‡Ž ƒ† —„‡” ‘ˆ —‹–• ’—”…Šƒ•‡†Ǥ ‘™‡˜‡”ǡ

Š‘•’‹–ƒŽ•–Šƒ–Šƒ˜‡•—„•–‹–—–‡†‡”…—”›–Š‡”‘‡–‡”•‹ƒ—„‡”‘ˆ

…‘—–”‹‡•Ȅ‹…Ž—†‹‰ ”‰‡–‹ƒǡ ‡š‹…‘ ƒ† –Š‡ Š‹Ž‹’’‹‡•Ȅ”‡’‘”–

…‘•–•ƒ˜‹‰•™‹–Š–Š‡†‹‰‹–ƒŽ†‡˜‹…‡•Ǥ

g. Mercury thermometer replacement

‰‡‡”ƒŽǡ•—……‡••ˆ—Ž‡”…—”›”‡’Žƒ…‡‡–’”‘‰”ƒ‡•‡–ƒ‹Žǣ Ȉ ‹˜‘Ž˜‹‰’ƒ”–‹…‹’ƒ–‘”›•–ƒ‡Š‘Ž†‡”•Ǣ

Ȉ …‘†—…–‹‰ ƒ ‹˜‡–‘”› –‘ ‹†‡–‹ˆ› –Š‡ —„‡”• ƒ† —•‡• ‘ˆ

‡”…—”›Ǧ…‘–ƒ‹‹‰ †‡˜‹…‡• ƒ† ƒ–‡”‹ƒŽ• ‹ –Š‡ Š‡ƒŽ–ŠǦ…ƒ”‡

ˆƒ…‹Ž‹–›Ǣ

Ȉ ‡˜ƒŽ—ƒ–‹‰ –Š‡ ˆ‡ƒ•‹„‹Ž‹–› ƒ† ƒ……‡’–ƒ„‹Ž‹–› ‘ˆ ‘Ǧ‡”…—”›

ƒŽ–‡”ƒ–‹˜‡•Ǣ

Ȉ ‹†‡–‹ˆ›‹‰ ˜‡†‘”•Ǣ ’Žƒ‹‰ –Š‡ ’Šƒ•‡Ǧ‘—– ‘ˆ ‡”…—”› ƒ† –Š‡

’Šƒ•‡Ǧ‹‘ˆ‘Ǧ‡”…—”›ƒŽ–‡”ƒ–‹˜‡•Ǣ

Ȉ †‡˜‡Ž‘’‹‰ƒ„—†‰‡–ƒ†’”‘…—”‡‡–’”‘…‡••Ǣ

Ȉ •ƒˆ‡Ž›”‡‘˜‹‰‘”†‹•’‘•‹‰‡”…—”›Ǧ‡ƒ•—”‹‰†‡˜‹…‡•Ǣ Ȉ ’”‡’ƒ”‹‰’”‘‰”ƒ••—…Šƒ••–ƒˆˆ‡†—…ƒ–‹‘Ǣ

Ȉ ’‡”‹‘†‹…ƒŽŽ›ƒ‹–ƒ‹‹‰ƒ†…ƒŽ‹„”ƒ–‹‰–Š‡‡“—‹’‡–ǡƒ•‡‡†‡†Ǣ Ȉ ‘‹–‘”‹‰–Š‡—•‡‘ˆ–Š‡‘Ǧ‡”…—”›ƒŽ–‡”ƒ–‹˜‡•–‘‡•—”‡–Š‡

‡ˆˆ‡…–‹˜‡‡••‘ˆ–Š‡”‡’Žƒ…‡‡–’”‘‰”ƒ‡Ǥ

MERC-17-FINAL(18May11).pdf 20

MERC-17-FINAL(18May11).pdf 20 23/05/2011 10:32:51 AM23/05/2011 10:32:51 AM

Thermometers 13

 ‡šƒ’Ž‡ ‘ˆ –Š‹• ƒ’’”‘ƒ…Š ‹• ‘—–Ž‹‡† ‹ –Š‡ •–‡’• „‡Ž‘™Ǥ

Step1 ˜‘Ž˜‡•–ƒ‡Š‘Ž†‡”•‹–Š‡ˆƒ…‹Ž‹–›Ȅ•—…Šƒ•–Š‡‡†‹…ƒŽƒ†

—”•‹‰ •–ƒˆˆǡ Š‡ƒ†• ‘ˆ †‡’ƒ”–‡–• ™Š‡”‡ ‡”…—”›

–Š‡”‘‡–‡”• ƒ”‡ …‘‘Ž› —•‡†ǡ ƒ† –Š‡ †‡’ƒ”–‡–•

‹˜‘Ž˜‡†‹„—†‰‡–‹‰ƒ†’—”…Šƒ•‹‰Ȅ‹–Š‡’Žƒ‹‰ƒ†

‹’Ž‡‡–ƒ–‹‘ ‘ˆ –Š‡ ’Šƒ•‡Ǧ‘—– ‘ˆ ‡”…—”›Ǥ ”‘—Ž‰ƒ–‡

‹•–‹–—–‹‘ƒŽ’‘Ž‹…‹‡•”‡‰ƒ”†‹‰–Š‡’Šƒ•‡Ǧ‘—–‘ˆ‡”…—”›ǡƒ•

ƒ’’”‘’”‹ƒ–‡Ǥ

Step2 ‘†—…–ƒ‹˜‡–‘”›–‘†‡–‡”‹‡–Š‡–›’‡•ǡŽ‘…ƒ–‹‘•ǡ—•‡•

ƒ†“—ƒ–‹–‹‡•‘ˆ‡”…—”›Ǧ…‘–ƒ‹‹‰†‡˜‹…‡•‹–Š‡ˆƒ…‹Ž‹–›ǡ

ƒ•™‡ŽŽƒ•†‹•’‘•ƒŽ’”ƒ…–‹…‡•Ǥ

Step3 ’Ž‡‡– ’”‘’‡” …Ž‡ƒǦ—’ ƒ† •–‘”ƒ‰‡ ’”‘…‡†—”‡• ˆ‘”

‡”…—”›Ǧ…‘–ƒ‹‹‰†‡˜‹…‡•ƒ†‡”…—”›™ƒ•–‡Ǥ•—”‡–Šƒ–

‡”…—”› ™ƒ•–‡ ‹• ’Žƒ…‡† ‹ •‡ƒŽ‡† ’”‹ƒ”› ƒ† •‡…‘†ƒ”›

…‘–ƒ‹‡”•ǡ ƒ† –Šƒ– –Š‡ •–‘”ƒ‰‡ ƒ”‡ƒ ‹• •‡…—”‡ǡ ’”‘’‡”Ž›

ƒ”‡†ƒ†˜‡–‡†–‘–Š‡‘—–•‹†‡ȋ21ȌǤ

Step4 ‡–‡”‹‡™Š‹…Š–Š‡”‘‡–‡”‹•”‹‰Š–ˆ‘”›‘—”ƒ’’Ž‹…ƒ–‹‘Ǥ

ƒ› ƒ•’‡…–• Šƒ˜‡ –‘ „‡ …‘•‹†‡”‡† ™Š‡ •‡Ž‡…–‹‰ –Š‡ –›’‡ ‘ˆ ‘Ǧ

‡”…—”›–Š‡”‘‡–‡”•Ǥ‘•—Ž–ƒ–‹‘™‹–ŠŠ‡ƒŽ–ŠǦ…ƒ”‡’”‘˜‹†‡”•ƒ„‘—–

™Š‹…Š –›’‡• ‘ˆ ‘Ǧ‡”…—”› –Š‡”‘‡–‡” ƒ”‡ ƒ’’”‘’”‹ƒ–‡ –‘

ƒ……‘‘†ƒ–‡–Š‡ƒ‰‡‘ˆ–Š‡’ƒ–‹‡–•ƒ†–Š‡‹”‡†‹…ƒŽ…‘†‹–‹‘•ǡ–Š‡

‹•–‹–—–‹‘ƒŽ •‡––‹‰ǡ ’‘”–ƒ„‹Ž‹–›ǡ –Š‡ •–‡”‹Ž‹œƒ–‹‘ ’”‘…‡••ǡ ‡ƒ•‡ ‘ˆ —•‡ǡ

•ƒˆ‡–› ƒ† ’ƒ–‹‡– …‘ˆ‘”– ‹• ‹’‘”–ƒ–Ǥ ‘•–•ǡ –‹‡ •’‡– ˆ‘”

–‡’‡”ƒ–—”‡ ‡ƒ•—”‡‡–ǡ •–‘”ƒ‰‡ ”‡“—‹”‡‡–• ƒ† —‹ˆ‘”‹–› ƒ”‡

ƒŽ•‘‹’‘”–ƒ–•›•–‡‘”‹•–‹–—–‹‘ƒŽ…‘•‹†‡”ƒ–‹‘•Ǥ

‹‰‹–ƒŽ…Ž‹‹…ƒŽ–Š‡”‘‡–‡”••Š‘—Ž†‡‡––Š‡”‡“—‹”‡‡–•‘ˆ‡‹–Š‡”

—”‘’‡ƒ ‘” ͳʹͶ͹ͲǦ͵ǣʹͲͲͲΪͳǣʹͲͲͻ ȋ22Ȍ ‘” ͳͳͳʹǦͲͲ ȋ23ȌǤ Šƒ•‡Ǧ…Šƒ‰‡ ȋ†‘–Ǧƒ–”‹šȌ –Š‡”‘‡–‡”• •Š‘—Ž† ‡‡– –Š‡

”‡“—‹”‡‡–• ‘ˆ ͺʹͷǦͻͺ ȋ24ȌǤ ›’ƒ‹… ‹ˆ”ƒ”‡† ȋ‡ƒ”Ȍ

–Š‡”‘‡–‡”••Š‘—Ž†‡‡––Š‡”‡“—‹”‡‡–•‘ˆͳʹͶ͹ͲǦͷǣʹͲͲ͵ȋ25Ȍ

‘” ͳͻ͸ͷǦͻͺ ȋʹͲͲͻȌ ȋ26ȌǤ ‡’‘”ƒŽ ƒ”–‡”› ‹ˆ”ƒ”‡†

–Š‡”‘‡–‡”••Š‘—Ž†‡‡––Š‡”‡“—‹”‡‡–••’‡…‹ˆ‹…–‘•‹‹ˆ”ƒ”‡†

–Š‡”‘‡–‡”• ‹ ͳͻ͸ͷǦͻͺ ȋʹͲͲͻȌ ȋ26ȌǤ  ‰‡‡”ƒŽǡ †‹‰‹–ƒŽ

–Š‡”‘‡–‡”•ǡ –›’ƒ‹… ‹ˆ”ƒ”‡† –Š‡”‘‡–‡”• ƒ† –‡’‘”ƒŽ ƒ”–‡”›

‹ˆ”ƒ”‡†–Š‡”‘‡–‡”••Š‘—Ž†…‘ˆ‘”–‘͸Ͳ͸ͲͳǦͳǡ–Š‡„ƒ•‹…•ƒˆ‡–›

•–ƒ†ƒ”† ˆ‘” ‡†‹…ƒŽ ‡Ž‡…–”‹…ƒŽ †‡˜‹…‡• ȋ27ȌǤ ‡‡ ‡š ͳ ˆ‘” ‘”‡

‹ˆ‘”ƒ–‹‘Ǥ

14 Replacement of mercury themometers and sphygmomanometers in health care

Step5 †‡–‹ˆ›˜‡†‘”•–Šƒ–…ƒ’”‘˜‹†‡–Š‡…Š‘•‡–Š‡”‘‡–‡”

–›’‡Ǥˆ†‡•‹”‡†ǡƒ•–Š‡˜‡†‘”ȋ•Ȍˆ‘”•‡˜‡”ƒŽ–”‹ƒŽ—‹–•ƒ†

‡˜ƒŽ—ƒ–‡ –Š‡ ‹ –Š‡ ƒ”‡ƒ• ™Š‡”‡ –Š‡› ™‹ŽŽ „‡ —•‡†Ǥ ˆ–‡”

”‡…‡‹˜‹‰ˆ‡‡†„ƒ…ˆ”‘–Š‡—•‡”•‘ˆ–Š‡—‹–•ǡ‹†‡–‹ˆ›–Š‡

†‡•‹”‡†–›’‡ˆ‘”’—”…Šƒ•‡Ǥ

Mercury-free product listings¹

 ƒ—ƒ”› ʹͲͲͷǡ –Š‡ ”‡’‘”–MHRA 04144 Thermometer review: UK market survey 2005 ‘ˆ –Š‡ ‡†‹…‹‡• ƒ† ‡ƒŽ–Š…ƒ”‡ ’”‘†—…–•

‡‰—Žƒ–‘”› ‰‡…› ™ƒ• ”‡Ž‡ƒ•‡† ƒ† …‘–ƒ‹‡† ƒ Ž‹•–‹‰ ‘ˆ ’”‘†—…–•

ƒ˜ƒ‹Žƒ„Ž‡ƒ––Šƒ––‹‡‘–Š‡ƒ”‡–‹–Š‡‹–‡†‹‰†‘ǣ

Š––’ǣȀȀ™™™Ǥ™ƒŽ‡•ǤŠ•Ǥ—Ȁ•‹–‡•͵Ȁ†‘…‡–ƒ†ƒ–ƒǤ…ˆǫ‘”‰‹†αͶͶ͵Ƭ‹†αͷͶ ͳ͹͵

’ƒ”–‹ƒŽŽ‹•–‹‰‘ˆ’”‘†—…–•ƒ˜ƒ‹Žƒ„Ž‡‹–Š‡Š‹Ž‹’’‹‡•‹•…‘–ƒ‹‡†‹

Guide to alternatives for healthcare personnelǡ ‡ƒŽ–Š ƒ”‡ ‹–Š‘—–

ƒ”ǡ‘—–Š‡ƒ•–•‹ƒǡ’—„Ž‹•Š‡†‹ʹͲͲ͹ǣ

Š––’ǣȀȀ™™™Ǥ‘Šƒ”Ǥ‘”‰ȀŽ‹„Ȁ†‘™Ž‘ƒ†•Ȁ‡”…—”›Ȁ‡”…—”›Ǧ ”‡‡̴—‹†‡̴–‘̴Ž–‡”ƒ–‹˜‡•Ǥ’†ˆ

‘” ’”‘†—…–• •‘Ž† ‹ –Š‡ ‹–‡† –ƒ–‡•ǡ –Š‡ ‘‘† ƒ† ”—‰

†‹‹•–”ƒ–‹‘ ȋ Ȍ ƒ‹–ƒ‹• ƒ Ž‹•–‹‰ ‘ˆ ƒŽŽ ƒ’’”‘˜‡† ‡†‹…ƒŽ

†‡˜‹…‡• ‹…Ž—†‹‰ –Š‡”‘‡–‡”•Ǥ Š‡•‡ …ƒ „‡ •‡ƒ”…Š‡† „›

ƒ—ˆƒ…–—”‡”ǯ•ƒ‡ǡ’”‘†—…–ƒ‡‘”ͷͳͲ—„‡”ȋ ƒ’’Ž‹…ƒ–‹‘

…‘†‡ȌǤŠ‡•‡ƒ”…Šˆ‘”‹•ˆ‘—†ƒ–ǣ

Š––’ǣȀȀ™™™Ǥƒ……‡••†ƒ–ƒǤˆ†ƒǤ‰‘˜Ȁ•…”‹’–•Ȁ…†”ŠȀ…ˆ†‘…•Ȁ…ˆ’Ȁ’Ǥ…ˆ

Step6 ‡–‡”‹‡ –Š‡ ’Šƒ•‡Ǧ‹ •…Š‡†—Ž‡ ˆ‘” –Š‡ ‡™ —‹–•Ǥ

‘•‹†‡”ƒ–‹‘•Š‘—Ž†„‡‰‹˜‡–‘–Š‡–‹‡‡‡†‡†–‘‹•–ƒŽŽ

‘””‡’Žƒ…‡–Š‡—‹–•ǡ…ƒŽ‹„”ƒ–‹‘‘ˆ–Š‡—‹–•ȋ‹ˆ‡‡†‡†Ȍƒ†ƒ

•–ƒˆˆ‡†—…ƒ–‹‘ƒŽ’”‘‰”ƒ‡Ǥ

Step7 ‡˜‡Ž‘’ƒ„—†‰‡–ˆ‘”–Š‡”‡’Žƒ…‡‡–’”‘‰”ƒ‡ǡ‹…Ž—†‹‰

–Š‡ ’—”…Šƒ•‡ ‘ˆ –Š‡ —‹–• ƒ† ƒ……‡••‘”‹‡• ȋ•—…Š ƒ• ’”‘„‡

…‘˜‡”•‘”•Š‡ƒ–Š•Ȍǡ‹•–ƒŽŽƒ–‹‘ƒ•‡‡†‡†ǡ•–ƒˆˆ‡†—…ƒ–‹‘‘

–Š‡ —•‡ ‘ˆ –Š‡ ‡™ †‡˜‹…‡•ǡ …ƒŽ‹„”ƒ–‹‘ ƒ† ƒ‹–‡ƒ…‡

•…Š‡†—Ž‡•ǡ ”‡‘˜ƒŽ ƒ† •–‘”ƒ‰‡ ‘ˆ –Š‡ ‡”…—”›Ǧ…‘–ƒ‹‹‰

—‹–• ƒ† ’—”…Šƒ•‡ ‘ˆ ƒ› …‘•—ƒ„Ž‡• ‡‡†‡† ‘ ƒ

‘‰‘‹‰„ƒ•‹•Ǥ

1

These product listings are examples. Other listings are also available.

MERC-17-FINAL(18May11).pdf 22

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Thermometers 15

Step8

‡˜‡Ž‘’ ƒ „‹† •’‡…‹ˆ‹…ƒ–‹‘ ˆ‘” –Š‡ ’—”…Šƒ•‡ ‘ˆ –Š‡

”‡’Žƒ…‡‡–—‹–•ƒ†‹…Ž—†‡–Š‡—„‡”‘ˆ—‹–•–Šƒ–™‹ŽŽ

„‡ ”‡“—‹”‡†Ǥ ’‡…‹ˆ› …‘ˆ‘”‹–› ™‹–Š –Š‡ ƒ’’”‘’”‹ƒ–‡

•–ƒ†ƒ”†ǡ™ƒ””ƒ–›”‡“—‹”‡‡–•ǡ†‡•‹”‡†‘’–‹‘ƒŽˆ‡ƒ–—”‡•

ƒ† ƒ› ‘–Š‡” Ž‘…ƒŽ …‘•‹†‡”ƒ–‹‘•Ǥ ‘ŽŽ‘™ –Š‡ •–ƒ†ƒ”†

’”‘…‡†—”‡• ˆ‘” …‘’‡–‹–‹˜‡ „‹††‹‰ ‘” ‘–Š‡” ’”‘…—”‡‡–

‡–Š‘†Ǥ‘’ƒ”‡–Š‡˜‡†‘”’ƒ…ƒ‰‡•ˆ‘”…‘’Ž‹ƒ…‡™‹–Š

–Š‡ ƒ’’”‘’”‹ƒ–‡ •–ƒ†ƒ”† ƒ† ‘–Š‡” •’‡…‹ˆ‹…ƒ–‹‘•Ǥ ‡“—‹”‡

…‡”–‹ˆ‹…ƒ–‹‘ ‘” ’”‘‘ˆ ‘ˆ …‘’Ž‹ƒ…‡ ™‹–Š –Š‡ •–ƒ†ƒ”†ǡ

‡•’‡…‹ƒŽŽ› ˆ”‘ ‡™ ˜‡†‘”• ‘” ˜‡†‘”• ‘– Ž‹•–‡† ‹

ƒ–‹‘ƒŽ‘”‹–‡”ƒ–‹‘ƒŽ…‡”–‹ˆ‹‡†’”‘†—…–Ž‹•–‹‰•Ǥ‘•‹†‡”

–Š‡ƒ„‹Ž‹–›‘ˆ–Š‡˜‡†‘”–‘’”‘˜‹†‡–Š‡”‡“—‹”‡†—„‡”‘ˆ

—‹–•‹ƒ–‹‡Ž›ˆƒ•Š‹‘•‘ƒ•–‘ˆ‹––Š‡’Šƒ•‡Ǧ‹•…Š‡†—Ž‡Ǥ

‡Ž‡…––Š‡˜‡†‘”ˆ‘”–Š‡’”‘Œ‡…–Ǥ

Step9 ‡˜‹‡™ –Š‡ •‡Ž‡…–‡† ˜‡†‘”ǯ• ”‡“—‹”‡‡–• ˆ‘” …ƒŽ‹„”ƒ–‹‘

ƒ† ƒ‹–‡ƒ…‡ ‘ˆ –Š‡ –Š‡”‘‡–‡”ǡ ƒ† ‘„–ƒ‹ ƒ›

‡‡†‡†‡“—‹’‡–Ǥ‡–‡”‹‡™Š‘™‹ŽŽ„‡ƒ••‹‰‡†–Š‡–ƒ•

‘ˆ…‘†—…–‹‰–Š‡”‡“—‹”‡†…ƒŽ‹„”ƒ–‹‘ƒ†ƒ‹–‡ƒ…‡ǡƒ†

‘ ™Šƒ– •…Š‡†—Ž‡Ǥ ‘Ž‹…‹– –Š‡ ˜‡†‘”ǯ• ƒ‹† ‹ ’Žƒ‹‰ ˆ‘”

‡†—…ƒ–‹‘ƒ†…‘–‹—‹‰‡†—…ƒ–‹‘ǡ‹ˆ‡…‡••ƒ”›Ǥ

Step10 ”‡’ƒ”‡ –Š‡ ‹–‡”‹ •–‘”ƒ‰‡ •‹–‡ ˆ‘” ’Šƒ•‡†Ǧ‘—– ‡”…—”›

‡ƒ•—”‹‰ †‡˜‹…‡•Ǥ ˆ ƒ’’”‘˜‡† ‡”…—”›Ǧ†‹•’‘•ƒŽ ˆƒ…‹Ž‹–‹‡•

ƒ”‡ƒ˜ƒ‹Žƒ„Ž‡‹–Š‡…‘—–”›ǡ‹†‡–‹ˆ›–Š‡™ƒ•–‡˜‡†‘”–Šƒ–

™‹ŽŽ „‡ ”‡•’‘•‹„Ž‡ ˆ‘” †‹•’‘•ƒŽ ‘ˆ –Š‡ ‡”…—”›Ǧ…‘–ƒ‹‹‰

—‹–•ƒ††‡˜‡Ž‘’’”‘…‡†—”‡•–Šƒ–™‹ŽŽ„‡ˆ‘ŽŽ‘™‡†ˆ‘”–Š‡‹”

”‡‘˜ƒŽƒ†–”ƒ•ˆ‡”Ǥ

Step11 —”…Šƒ•‡–Š‡—‹–•ƒ……‘”†‹‰–‘–Š‡’Šƒ•‡Ǧ‹•…Š‡†—Ž‡Ǥ

Step12 ‡”ˆ‘” ƒ› ‹‹–‹ƒŽ –‡•–• ‘” …ƒŽ‹„”ƒ–‹‘ ƒ• ’‡” –Š‡

ƒ—ˆƒ…–—”‡”ǯ••’‡…‹ˆ‹…ƒ–‹‘•Ǥ

Step13 ‘†—…––Š‡’Žƒ‡†•–ƒˆˆ‡†—…ƒ–‹‘ƒŽƒ…–‹˜‹–›”‡Žƒ–‡†–‘–Š‡

‘’‡”ƒ–‹‘ƒ†ƒ‹–‡ƒ…‡‘ˆ–Š‡‡™†‡˜‹…‡•Ǥ

Step14 ‹•–”‹„—–‡ ‘” ‹•–ƒŽŽ ‡™ †‡˜‹…‡• ‹ ‡š…Šƒ‰‡ ˆ‘” ‘Ž†

‡”…—”›–Š‡”‘‡–‡”•Ǥ‡‘˜‡ƒ†–”ƒ•ˆ‡”–Š‡‡”…—”›Ǧ …‘–ƒ‹‹‰—‹–•–‘ƒ†‡•‹‰ƒ–‡†•–‘”ƒ‰‡ƒ”‡ƒǤˆ–Š‡…‘—–”›

Šƒ• ƒ’’”‘˜‡† ‡”…—”›Ǧ†‹•’‘•ƒŽ ˆƒ…‹Ž‹–‹‡•ǡ –”ƒ•’‘”– ƒ†

†‹•’‘•‡ ‘ˆ –Š‡ ‡”…—”›Ǧ…‘–ƒ‹‹‰ —‹–• ƒ– ƒ ƒ’’”‘˜‡†

†‹•’‘•ƒŽ•‹–‡ƒ……‘”†‹‰–‘Ž‘…ƒŽŠƒœƒ”†‘—•™ƒ•–‡”‡‰—Žƒ–‹‘•Ǥ

16 Replacement of mercury themometers and sphygmomanometers in health care

Step15

‘‹–‘”ƒ†‡•—”‡–Šƒ––Š‡‘Ǧ‡”…—”›–Š‡”‘‡–‡”•ƒ”‡

’”‘’‡”Ž›—•‡†ƒ†ƒ‹–ƒ‹‡†ǡƒ†–Šƒ–ƒ›™ƒ•–‡ǡ‹…Ž—†‹‰

‡†Ǧ‘ˆǦŽ‹ˆ‡ ™ƒ•–‡ǡ ‹• ƒƒ‰‡† ‹ ƒ ‡˜‹”‘‡–ƒŽŽ› •‘—†

ƒ‡”Ǥ

MERC-17-FINAL(18May11).pdf 24

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17

V. S p h y g m o m a n o m e t e r s

a. History

Š‡ •’Š›‰‘‰”ƒ’Šǡ ƒ †‡˜‹…‡ –Šƒ– ™ƒ• ƒ––ƒ…Š‡† –‘ –Š‡ ˆ‘”‡ƒ” ƒ†

”‡…‘”†‡† ƒ”–‡”‹ƒŽ ’—Ž•ƒ–‹‘• ‘ ƒ ‡š–‡”ƒŽ ‰”ƒ’Šǡ ™ƒ• †‡˜‡Ž‘’‡† ‹

ͳͺͷͷ „› ƒ”Ž ‹‡”‘”†–Ǥ Š‘•– ‘ˆ ‘–Š‡” •’Š›‰‘‡–‡”•ǡ †‡˜‹…‡• –Šƒ–

‡š–‡”ƒŽŽ› ‡ƒ•—”‡† ƒ”–‡”‹ƒŽ ’”‡••—”‡ „› †‹”‡…–Ž› …‘’”‡••‹‰ –Š‡

”ƒ†‹ƒŽƒ”–‡”›ǡˆ‘ŽŽ‘™‡†–Š”‘—‰Š–Š‡‡†‘ˆ–Š‡…‡–—”›ƒ†„‡›‘†Ǥ

˜‘ ƒ•…Š ‹–”‘†—…‡† –Š‡ ”—„„‡”ǡ Š‘ŽŽ‘™ „ƒŽŽ ˆ‹ŽŽ‡† ™‹–Š ™ƒ–‡” ‘”

‡”…—”› –‘ ‘„•–”—…– –Š‡ ƒ”–‡”›ǡ ƒ† …‘„‹‡† –Š‹• ™‹–Š ƒ ƒ‡”‘‹†

ƒ‘‡–‡” ‹ ͳͺͺͲǤ Š‡ ‡”…—”› •’Š›‰‘ƒ‘‡–‡”ǡ ƒ

•’Š›‰‘‡–‡” ™‹–Š ƒ •‡’ƒ”ƒ–‡ …‘’”‡••‹‘ †‡˜‹…‡ ˆ‘” –Š‡ ƒ”ǡ ™ƒ•

‹–”‘†—…‡†„›…‹’‹‘‡‹˜ƒǦ‘……‹‹ͳͺͻ͸Ǥ†‡’‡†‡–Ž›ǡ‹ͳͺͻ͹ǡ‹ŽŽ

ƒ†ƒ”ƒ”†‹–”‘†—…‡†ƒ•‹‹Žƒ”†‡˜‹…‡™‹–Šƒƒ‡”‘‹†ƒ‘‡–‡”

ȋ35ȌǤ

 ͳͻͲͷǡ ‹‘Ž‹ ‘”‘–‘ˆˆ ™ƒ• –Š‡ ˆ‹”•– –‘ •—‰‰‡•– Ž‹•–‡‹‰ –‘ ƒ”–‡”›

•‘—†•™Š‹Ž‡—•‹‰ƒ•–‡–Š‘•…‘’‡ǡ™Š‹…Š„›–Š‡™ƒ•‡ƒ”Ž›ƒ…‡–—”›

‘Ž†Ǥ Š‹• ƒ—•…—Ž–ƒ–‘”› ‡–Š‘† ™ƒ• ‘”‡ ”‡Ž‹ƒ„Ž‡ –Šƒ ’ƒŽ’ƒ–‹‘ ‹

‹†‡–‹ˆ›‹‰–Š‡†‹ƒ•–‘Ž‹…’”‡••—”‡ȋ27ȌǤ

b. Operation of a manual sphygmomanometer

ƒ—ƒŽ •’Š›‰‘ƒ‘‡–‡”ǯ• „ƒ•‹… …‘’‘‡–• ‹…Ž—†‡ ƒ

‹ˆŽƒ–ƒ„Ž‡ …—ˆˆ –‘ ’Žƒ…‡ ’”‡••—”‡ ‘ –Š‡ ƒ”–‡”›ǡ ƒ ’”‡••—”‡Ǧ‡ƒ•—”‹‰

•…ƒŽ‡ƒ†ƒ‹ˆŽƒ–‹‘„—Ž„–‘‹ˆŽƒ–‡–Š‡…—ˆˆǤ’Š›‰‘ƒ‘‡–‡”•ƒ”‡

—•‡† ™‹–Š ƒ •–‡–Š‘•…‘’‡ –‘ ‡ƒ•—”‡ –Š‡ •›•–‘Ž‹… ƒ† †‹ƒ•–‘Ž‹… „Ž‘‘†

’”‡••—”‡Ǥ ‘ ‡ƒ•—”‡ „Ž‘‘† ’”‡••—”‡ǡ –Š‡ ‹ˆŽƒ–ƒ„Ž‡ …—ˆˆ ‹• ’Žƒ…‡†

ƒ”‘—†–Š‡—’’‡”ƒ”ƒ†‹ˆŽƒ–‡†–‘ƒ’‘‹–™Š‡”‡–Š‡„Ž‘‘†ˆŽ‘™‹•

…—– ‘ˆˆǤ • –Š‡ …—ˆˆ ‹• ‹ˆŽƒ–‡†ǡ –Š‡ ‡‡†Ž‡ ‘ –Š‡ ƒ‡”‘‹† •…ƒŽ‡ ‘”

‡”…—”›‹–Š‡ƒ‘‡–‡””‹•‡•–Š”‘—‰Š–Š‡…‘Ž—ǡƒ†–Š‡”‡•—Ž–‹‰

’”‡••—”‡‹•†‹•’Žƒ›‡†‘–Š‡•…ƒŽ‡ǤŠ‡•–‡–Š‘•…‘’‡‹•’Žƒ…‡†‘˜‡”–Š‡

„”ƒ…Š‹ƒŽ ƒ”–‡”› ƒ– –Š‡ ‡Ž„‘™Ǥ Š‡ ’”‡••—”‡ ‹• •Ž‘™Ž› ”‡Ž‹‡˜‡† „›

†‡ˆŽƒ–‹‰ –Š‡ …—ˆˆ ƒ†ǡ ƒ• –Š‡ „Ž‘‘† •–ƒ”–• ˆŽ‘™‹‰ ƒ‰ƒ‹ǡ ƒ ’‘—†‹‰

•‘—†™‹ŽŽ„‡Š‡ƒ”†–Š”‘—‰Š–Š‡•–‡–Š‘•…‘’‡ǤŠ‹•—„‡”†‹•’Žƒ›‡†

‘ –Š‡ •…ƒŽ‡ ƒ– –Š‹• ’‘‹– ‹• –Š‡ •›•–‘Ž‹… „Ž‘‘† ’”‡••—”‡ǡ ™Š‹…Š

”‡’”‡•‡–•–Š‡ƒš‹—‘—–’—–’”‡••—”‡‘ˆ–Š‡Š‡ƒ”–Ǥ•–Š‡’”‡••—”‡

…‘–‹—‡• –‘ „‡ ”‡†—…‡†ǡ ƒ ’‘‹– ‹• ”‡ƒ…Š‡† ™Š‡”‡ –Š‡”‡ ‹• ‘ •‘—†

‹†‹…ƒ–‹‰ –Šƒ– –Š‡ Š‡ƒ”– ‹• ƒ– ”‡•–Ǥ Š‹• —„‡” ƒ• †‹•’Žƒ›‡† ‘ –Š‡

•…ƒŽ‡ ‹• ‘™ ƒ• –Š‡ †‹ƒ•–‘Ž‹… ’”‡••—”‡Ǥ ‡•’‹–‡ ƒŒ‘” ’”‘‰”‡•• ‹

‡†‹…ƒŽ†‡˜‹…‡•‘˜‡”–Š‡’ƒ•–…‡–—”›ǡ‘•–‘ˆ–Š‹•‡–Š‘†‘Ž‘‰›‹••–‹ŽŽ

–Š‡•ƒ‡ƒ•‹–Š‡‡ƒ”Ž›ʹͲ–Š…‡–—”›Ǥ

18 Replacement of mercury themometers and sphygmomanometers in health care

c. Accuracy of mercury sphygmomanometers

Ž–Š‘—‰Š –Š‡ ‡”…—”› –Š‡”‘‡–‡” ‹• ƒ ”‡Žƒ–‹˜‡Ž› •‹’Ž‡ †‡˜‹…‡ǡ –Š‡

ƒ—ƒŽ ‡”…—”› •’Š›‰‘ƒ‘‡–‡” ‹• ƒ ‘”‡ …‘’Ž‹…ƒ–‡† ’‹‡…‡ ‘ˆ

‡“—‹’‡–Ǥ‘™‡˜‡”ǡ‹ˆ’”‘’‡”Ž›˜ƒŽ‹†ƒ–‡†ǡ…ƒŽ‹„”ƒ–‡†ƒ†ƒ‹–ƒ‹‡†ǡ

‹– ™‹ŽŽ ’”‘˜‹†‡ ƒ……—”ƒ–‡ „Ž‘‘† ’”‡••—”‡ ”‡ƒ†‹‰•Ǥ ……—”ƒ…› ‹•

†‡’‡†‡–‘•‡˜‡”ƒŽŠ—ƒˆƒ…–‘”•ǡ•—…Šƒ•’”‘’‡”…—ˆˆ•‹œ‡ǡ’”‘’‡”

’Žƒ…‡‡– ‘ˆ –Š‡ …—ˆˆ ‘ –Š‡ ƒ”ǡ ”‡…‘‰‹–‹‘ ‘ˆ ‡‡”‰‡…‡ ƒ†

†‹•ƒ’’‡ƒ”ƒ…‡‘ˆ–Š‡ƒ”–‡”‹ƒŽ•‘—†•ǡƒ……—”ƒ–‡”‡…‘”†‹‰‘ˆ–Š‡•›•–‘Ž‹…

ƒ††‹ƒ•–‘Ž‹…‡†’‘‹–•ǡƒ†–Š‡’ƒ–‹‡–ǯ•Ž‡˜‡Ž‘ˆƒš‹‡–›Ǥ

”‘’‡” ƒ‹–‡ƒ…‡ ‹…Ž—†‡• ƒ ˜‹•—ƒŽ ‹•’‡…–‹‘ ‘ˆ –Š‡ —‹– ƒ†

”‡‰—Žƒ”…ƒŽ‹„”ƒ–‹‘‘ˆƒ˜ƒŽ‹†ƒ–‡†—‹–Ǥ•–—†›„›ƒ”ƒ†—‡–ƒŽǤȋ36Ȍ

ƒ– ƒ Žƒ”‰‡ –‡ƒ…Š‹‰ Š‘•’‹–ƒŽ ‹ ‘†‘ –‡•–‡† Ͷ͸ͻ ‡”…—”›

•’Š›‰‘ƒ‘‡–‡”•ǡ ‘„•‡”˜‡† ‡†‹…ƒŽ ’”‘ˆ‡••‹‘ƒŽ• –ƒ‹‰ „Ž‘‘†

’”‡••—”‡”‡ƒ†‹‰•ƒ†”‡˜‹‡™‡†”‡•—Ž–•‘ˆƒ“—‡•–‹‘ƒ‹”‡…‘’Ž‡–‡†

„› –Š‡ ‡†‹…ƒŽ •–ƒˆˆǤ ™‡–›Ǧˆ‹˜‡ —‹–• ™‡”‡ ‡š…Ž—†‡† ˆ”‘

‡šƒ‹ƒ–‹‘ƒ•–Š‡›Šƒ†‹••‹‰…‘’‘‡–•ǤŠ‡’Š›•‹…ƒŽ‹•’‡…–‹‘

‘ˆ –Š‡ —‹–• ˆ‘—† ‘„•…—”‡ ‡”…—”› …‘Ž—• †—‡ –‘ †‹”– ‘” ‡”…—”›

‘š‹†ƒ–‹‘ ȋ͵ͺΨȌǢ •…ƒŽ‡• –Šƒ– Šƒ† ˆƒ†‡† ‘” …‘Ž—• –Šƒ– Šƒ† –—”‡†ǡ

Š‹†‡”‹‰ ”‡ƒ†‹‰• ‘ˆ –Š‡ ‡”…—”› ‡‹•…—• ȋͳͺΨȌǢ ‹…‘””‡…–

‘”‹‡–ƒ–‹‘‘ˆ–Š‡‡”…—”›…‘Ž—‹’‘”–ƒ„Ž‡—‹–•ȋʹͲΨȌǢƒ†˜‡”›

ˆ‡™ ™‹–Š ‘„•‡”˜‡† ‡”…—”› Ž‡ƒ • ȋͲǤ͹ΨȌǤ —ˆˆ• ƒ† –—„‹‰ Šƒ† ƒŽ•‘

†‡–‡”‹‘”ƒ–‡†‹ƒ›—‹–•ǤƒŽ‹†ƒ–‹‘”‡…‘”†•™‡”‡‘–”‡˜‹‡™‡†ƒ†

ƒ‹–‡ƒ…‡”‡…‘”†•™‡”‡ƒ˜ƒ‹Žƒ„Ž‡ˆ‘”‘Ž›ʹ͵‘ˆͶͶͶ—‹–•ȋ29ȌǤ

d. Mercury-free sphygmomanometers

Š‡”‡ ƒ”‡ –™‘ …‘‘ ƒŽ–‡”ƒ–‹˜‡• –‘ –Š‡ ‡”…—”›

•’Š›‰‘ƒ‘‡–‡”ǣ ƒ‡”‘‹† ƒ† ‘•…‹ŽŽ‘‡–”‹… †‡˜‹…‡•Ǥ ‡”‘‹†

†‡˜‹…‡•ƒ”‡Ž‹“—‹†Ǧˆ”‡‡†‡˜‹…‡•–Šƒ–—•‡‡…Šƒ‹…ƒŽ’ƒ”–•–‘”‡Žƒ›–Š‡

„Ž‘‘† ’”‡••—”‡ –‘ –Š‡ ‰ƒ—‰‡Ǥ Š‹• †‡˜‹…‡ —•‡• –Š‡ ‘”ƒŽ „Ž‘‘†

’”‡••—”‡ …—ˆˆ ƒ† •–‡–Š‘•…‘’‡ –‘ †‡–‡”‹‡ –Š‡ •›•–‘Ž‹… ƒ† †‹ƒ•–‘Ž‹…

’”‡••—”‡•Ǥ

Š‡ ‘•…‹ŽŽ‘‡–”‹… †‡˜‹…‡• ƒ”‡ ‘’‡”ƒ–‡† ƒ—–‘ƒ–‹…ƒŽŽ› ‘…‡ –Š‡ …—ˆˆ ‹•

’Žƒ…‡† ‘ –Š‡ —’’‡” ƒ”Ǥ ˆŽƒ–‹‘ ƒ† †‡ˆŽƒ–‹‘ ‘ˆ –Š‡ …—ˆˆ ƒ”‡

‘„–ƒ‹‡†„›‡Ž‡…–”‘‹…‡ƒ•Ǥ”‡••—”‡Ǧ™ƒ˜‡…Šƒ‰‡•ƒ”‡–”ƒ•‹––‡†

–‘–Š‡‘•…‹ŽŽƒ–‹‰†‡˜‹…‡ƒ†ƒƒŽ‰‘”‹–Šǡ‘ˆ–‡’”‘’”‹‡–ƒ”›ǡ‹•—•‡†–‘

…ƒŽ…—Žƒ–‡–Š‡•›•–‘Ž‹…ƒ††‹ƒ•–‘Ž‹…’”‡••—”‡•ǡ™Š‹…Šƒ”‡†‹•’Žƒ›‡†‘ƒ

†‹‰‹–ƒŽ ”‡ƒ†‘—–Ǥ ‹˜‡ –Š‡ ‹ƒ……—”ƒ…› ‘ˆ –Š‡ ƒ—•…—Ž–ƒ–‘”› –‡…Š‹“—‡ǡ

˜ƒŽ‹†ƒ–‡† ƒ† ƒˆˆ‘”†ƒ„Ž‡ ‡Ž‡…–”‘‹… †‡˜‹…‡• –Šƒ– Šƒ˜‡ –Š‡ ‘’–‹‘ –‘

•‡Ž‡…– ƒ—ƒŽ ”‡ƒ†‹‰• ƒ”‡ ’”‡ˆ‡””‡† ‘’–‹‘• ˆ‘” Ž‘™Ǧ”‡•‘—”…‡

•‡––‹‰•ȋ37ȌǤ

MERC-17-FINAL(18May11).pdf 26

MERC-17-FINAL(18May11).pdf 26 23/05/2011 10:32:51 AM23/05/2011 10:32:51 AM

Sphygmomanometers 19

 ƒ††‹–‹‘ǡ –Š‡”‡ ƒ”‡ ‘’’Ž‡”Ǧ„ƒ•‡† ’Ž‡–Š›•‘‰”ƒ’Š‹… ‘‹–‘”•ǡ

’Š‘–‘…‡ŽŽǦ„ƒ•‡† ‘‹–‘”• ƒ† •–”ƒ‹Ǧ‰ƒ—‰‡Ǧ„ƒ•‡† ‘‹–‘”•Ǥ Š‡•‡

†‡˜‹…‡•ƒ”‡ˆ‘”•’‡…‹ƒŽ–›’—”’‘•‡•ƒ†ƒ”‡‘–‹‰‡‡”ƒŽ—•‡ǤŠ‡›™‹ŽŽ

‘– „‡ …‘˜‡”‡† ‹ –Š‹• †‘…—‡–ǡ „—– –Š‡ •ƒ‡ ‰‡‡”ƒŽ ƒ’’”‘ƒ…Š‡•

ƒ’’Ž›–‘–Š‡‹”‹–”‘†—…–‹‘ƒ•–‘–Š‡ƒ‡”‘‹†ƒ†‘•…‹ŽŽ‘‡–”‹…†‡˜‹…‡•Ǥ

e. Accuracy of mercury-free sphygmomanometers

”‘’‡”Ž› ƒ‹–ƒ‹‡†ǡ …ƒŽ‹„”ƒ–‡† ƒ† ˜ƒŽ‹†ƒ–‡† ‡”…—”›Ǧˆ”‡‡

•’Š›‰‘ƒ‘‡–‡”• ™‹ŽŽ ’”‘˜‹†‡ …‘’ƒ”ƒ„Ž‡ ƒ……—”ƒ…› –‘ †‡˜‹…‡•

…‘–ƒ‹‹‰ ‡”…—”›Ǥ Š‡ ƒ……—”ƒ…› ‘ˆ –Š‡•‡ ƒŽ–‡”ƒ–‹˜‡

•’Š›‰‘ƒ‘‡–‡”•…ƒ„‡‡ƒ•—”‡†„›–Š‡ƒ„‹Ž‹–›‘ˆ–Š‡†‡˜‹…‡–‘

•ƒ–‹•ˆƒ…–‘”‹Ž›…‘’Ž‡–‡–Š‡˜ƒŽ‹†ƒ–‹‘’”‘–‘…‘ŽǤ”‘’‡”Ž›…ƒŽ‹„”ƒ–‡†ƒ†

ƒ‹–ƒ‹‡††‡˜‹…‡•‘’‡”ƒ–‡†ƒ……‘”†‹‰–‘ƒ—ˆƒ…–—”‡”•’‡…‹ˆ‹…ƒ–‹‘•

•Š‘—Ž†„‡ƒ„Ž‡‡‡––Š‡”‡“—‹”‡‡–•ȋ38ȌǤ•‡‹Ǧƒ—–‘ƒ–‡††‡˜‹…‡

–Šƒ– Šƒ• „‡‡ †‡•‹‰‡† –‘ ‡ƒ•—”‡ „Ž‘‘† ’”‡••—”‡ ‹ ”‡•‘—”…‡Ǧ …‘•–”ƒ‹‡† •‡––‹‰•ǡ •ƒ–‹•ˆ‹‡• –Š‡ …”‹–‡”‹ƒ †”ƒ™ —’ „› –Š‡ ‘”Ž†

‡ƒŽ–Š ”‰ƒ‹œƒ–‹‘ ȋȌ ƒ† ‹• ”‡ƒ•‘ƒ„Ž› ’”‹…‡† Šƒ• —†‡”‰‘‡

–‡…Š‹…ƒŽƒ†ˆ‹‡Ž†˜ƒŽ‹†ƒ–‹‘‹…‘ŽŽƒ„‘”ƒ–‹‘™‹–Šȋ11Ȍ.

f. Calibration

ƒŽ‹„”ƒ–‹‘‹•ƒ…‘’ƒ”‹•‘„‡–™‡‡–Š‡”‡ˆ‡”‡…‡˜ƒŽ—‡ƒ†–Š‡˜ƒŽ—‡

ˆ”‘ –Š‡ †‡˜‹…‡ „‡‹‰ –‡•–‡†Ǥ • ’ƒ”– ‘ˆ ‹–• ‰—‹†‡Ž‹‡• ‘ –Š‡

ƒƒ‰‡‡– ‘ˆ Š›’‡”–‡•‹‘ ȋ39Ȍǡ –Š‡ ”‹–‹•Š ›’‡”–‡•‹‘ ‘…‹‡–›

ȋȌ Šƒ• ’—„Ž‹•Š‡† ‰—‹†‡Ž‹‡• ‘ –Š‡ ’”‘’‡” —•‡ ‘ˆ ‘Ǧ‹˜ƒ•‹˜‡ǡ

•‡‹Ǧƒ—–‘ƒ–‡†•’Š›‰‘ƒ‘‡–‡”•ǤŠ‡’”‘–‘…‘Ž•ˆ‘”both‡”…—”›

ƒ† ‘Ǧ‡”…—”› ‡ƒ•—”‹‰ †‡˜‹…‡• ‹…Ž—†‡ ’”‘’‡” ƒ‹–‡ƒ…‡ǡ …ƒŽ‹„”ƒ–‹‘ƒ†˜ƒŽ‹†ƒ–‹‘Ǥ

Š‡ ‡”‹…ƒ ‡ƒ”– ••‘…‹ƒ–‹‘ǡ ‹ ‹–• ”‡…‘‡†ƒ–‹‘• ȋ40Ȍǡ ‘–‡•

–Šƒ–ƒŽŽƒ—ƒŽ†‡˜‹…‡•Ȅ‡”…—”›ƒ†ƒ‡”‘‹†•’Š›‰‘ƒ‘‡–‡”•Ȅ

•Š‘—Ž†„‡…Š‡…‡†ˆ‘”ƒ……—”ƒ…›‘ˆ–Š‡’”‡••—”‡”‡‰‹•–”ƒ–‹‘‡…Šƒ‹•

‘ƒ”‡‰—Žƒ”„ƒ•‹•Ǥ

Š‡ƒ‡”‘‹††‡˜‹…‡••Š‘—Ž†„‡…Š‡…‡†„›…‘‡…–‹‰–Š‡ƒ‘‡–‡”

–‘ƒ‡”…—”›…‘Ž—‘”ƒ‡Ž‡…–”‘‹…–‡•–‹‰†‡˜‹…‡™‹–ŠƒǦ–—„‡ǤŠ‡

‡‡†Ž‡ •Š‘—Ž† ”‡•– ƒ– –Š‡ œ‡”‘ ’‘‹– „‡ˆ‘”‡ –Š‡ …—ˆˆ ‹• ‹ˆŽƒ–‡† ƒ†

•Š‘—Ž†”‡‰‹•–‡”ƒ”‡ƒ†‹‰–Šƒ–‹•™‹–Š‹Ͷ‰‘ˆ–Š‡‡”…—”›…‘Ž—

™Š‡ –Š‡ …—ˆˆ ‹• ‹ˆŽƒ–‡† –‘ ’”‡••—”‡• ‘ˆ ͳͲͲ ƒ† ʹͲͲ ‰Ǥ Š‡

‡‡†Ž‡•Š‘—Ž†”‡–—”–‘œ‡”‘ƒˆ–‡”†‡ˆŽƒ–‹‘Ǥ

Ž–Š‘—‰Š ‘– ‹…Ž—†‡† ‹ –Š‡•‡ ”‡…‘‡†ƒ–‹‘•ǡ ‹– •Š‘—Ž† „‡ ‘–‡†

–Šƒ– —•‹‰ ƒ ‡Ž‡…–”‘‹… ’”‡••—”‡Ǧ‰‡‡”ƒ–‹‰ †‡˜‹…‡ ˆ‘” …‘’ƒ”‹•‘

’”‘˜‹†‡•ƒƒ……—”ƒ…›–Šƒ–‹•ƒ‘”†‡”‘ˆƒ‰‹–—†‡„‡––‡”–Šƒ–Šƒ–‘ˆƒ