Cindy,

You have to approach this from three directions.

The pathologists are reluctant to change because

1) they aren't convinced the replacement fixed tissue slides look as
"good" as the B-5 fixed tissue.

2) They have no idea, or don't care, how dangerous mercury is, both to
the environment and to the lab workers.

3) They are clueless as to what it costs to dispose of
mercury-contaminated reagents.

First, do a blinded study in which several cases are fixed using all the
fixatives and then present the slides to the pathologists, without any
indication of which was fixed with which fixative, and have them tell
you which prep is not good enough for the purpose. This should prove
that a B-5 replacement is at least as good a B-5.

Second, have your institution's risk control officer do an inservice on
the problem of mercury in the environment, and it's effect on lab
workers. Pathologists are required to attend, of course.

Third, have your waste control people do an in service on waste disposal
and the cost of disposing of all the types of waste you produce,
emphasising the out-of- proportion cost of mercury disposal. Be sure to
include all waste contaminated by mercury - which is any chemical
down-stream from the place where the mercury reagent is.

If, after all that, they are still reluctant to switch, quit the job and
find a place where intelligent people are in charge!

Tim Morken, B.S., EMT(MSA), HTL(ASCP)
Infectious Disease Pathology
Centers for Disease Control
MS-G32
1600 Clifton Rd.
Atlanta, GA 30333
USA

email: tim9@cdc.gov
       timcdc@hotmail.com

FAX:  (404)639-3043



----Original Message Follows----
Date: Thu, 01 Oct 1998 14:33:01 -0500
From: Cindy Higgerson <chiggerson@memhosp.com>
Subject: B-5 Fixative Substitutes
To: HistoNet@Pathology.swmed.edu

Hi Histonetters!

I need help from those of you lucky enough to have convinced your
pathologists to get rid of B-5 and use a substitute instead. We are
still using B-5 and would like to eliminate it. We have obtained several
samples of B-5 substitutes from different companies and have given our
Pathologists lymph node slides using these fixatives to evaluate.  The
slides look great, however they are still reluctant to eliminate the
B-5.

I would like to hear what fixatives are being used, how you convinced
them to eliminate B-5, any pros or cons to any of the fixatives, and any
problems you have had with any of the substitutes. Any information would
be greatly appreciated.

The substitutes we have tried are AZF by Newcomer, Zinc chloride by
Newcomer, Z-5 by Anatech, Zinc chloride by Polyscientific, and Zinc
Formalin by Stephens Scientific.

Cindy Higgerson HTL (ASCP)
Pathology Supervisor
Memorial Hospital
Belleville, Illinois








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