The World Health Organization states that “Climate change is the greatest threat to global health…” and that healthcare itself has a significant environmental impact. In fact, “if the health-sector were a country, it would be the fifth-largest global carbon emitter on the planet” (Health Care Without Harm, 2019). Its major contribution to carbon emissions are energy consumption, procurement of pharmaceuticals and equipment, and travel (WHO, 2017). This article discusses the use of plastics in healthcare, which make up approximately 30 percent of medical waste (Rizan et al., 2020). Single-use plastics are a sustainability focus at home and are topical with recent increases in personal protective equipment (PPE) use.
Modern medicine has been transformed by the advent of plastics. Their material properties have allowed invaluable equipment to be developed: from the intravenous catheter and infusion bags to silicone surgical drains and PPE. Single use is driven by convenience and infection control; however, good aseptic technique may sometimes be sufficient or superior (Royal College of Nursing, 2019). Polypropylene surgical gowns and drapes are used in place of traditional reusable textiles (Delisser et al., 2012); however, impermeability is not always necessary, eg if minimal blood/fluid contamination is anticipated (Tobias, 2020). A rational use of reusable textiles will reduce lifecycle ecologic impacts, with no current evidence for increased infection rates, although permeability may be affected during repeated washing (Vansanthakumar, 2019). Outside the operating theatre, single-use PPE for handling infectious patients, contaminated materials (cytotoxic/cytostatic and offensive substances) or those with antimicrobial-resistant bacterial infection is commonplace (Hall, 2020). The vital human healthcare demand for PPE during the COVID-19 pandemic led to concerns about resilience of emergency veterinary healthcare (Today’s Veterinary Business, 2020). There is no doubt that plastics play an invaluable role in healthcare; however, we need to rethink and rationalise their use (Rizan et al., 2020).
Most plastics are a product from the petrochemical industry (8 percent of the world’s oil becomes plastic (Parker, 2018)). This is highly energy intensive, using fossil fuels for manufacturing resource and energy. Bioplastics are polymers made of at least 20 percent renewable materials (eg polyethylene from sugar cane). However, whilst an improvement, they are not without environmental impact in production (land use, fertilisers) and disposal; some may still create problematic microplastics (Cho, 2017). Bioplastics are typically suitable for packaging or domestic applications (eg food containers, cups, bed pans, sick bowls, plant-based PPE), but not where they contact the patient, infusion fluids or pharmaceuticals. Whilst ongoing research hopes to find a biodegradable and biocompatible solution for all indications, currently the disposal or decomposition is complex and typically requires very specific conditions (Prakash, 2020).
Currently plastics are used in a linear economy model – production, use and disposal – typically without use of plastic waste. Clinical waste is disposed of by incineration, high temperature sterilisation, landfill or recycling. Less than 5 percent of medical plastics are recycled (Rizan et al., 2020); however, studies report that 40 to 64 percent of operating theatre plastics are not contaminated and could be recycled (McGain et al., 2009, 2015). Recycling can have an 85 percent lower energy requirement than using virgin product (Vorster et al., 2015). Some licensed PVC recycling schemes are in operation for plastic that has contacted the patient (eg NHS oxygen masks made into tree-ties); however, regulations dictate that retrieved stock must be downgraded, rather than used to manufacture a medical product (Vorster et al., 2015). Optimal waste segregation at source reduces contamination, increases recycling and reduces waste sent for incineration, therefore reducing emissions, costs and generation of respiratory toxins (such as dioxins from PVC) (West et al., 2020).
It is unknown how much medical plastic/microplastic ends up in the ocean globally. Correct disposal should avoid this; however, the waste sector does face challenges. The Ellen MacArthur Foundation drives campaigns and research to address the devastating issue of ocean plastic and proposes a fundamental change to our plastic use: “circular economy considers every stage of a product’s journey, before and after it reaches the customer” (Ellen MacArthur Foundation, 2017). Waste is actually a valuable resource. The development of a circular economy model for plastics in healthcare would be revolutionary (Vorster et al., 2015; Voudrias, 2018).
A rigorous approach to sustainability creates optimal business resilience and will ensure evidence-based provision of outstanding veterinary care into the future. Whilst the medical benefits afforded by plastic are clear, the use of plastics should be reduced and rationalised wherever possible. The UK National Health Service has committed to reduce use of single-use plastics in the Long Term Plan (Rizan et al., 2020). We have to start somewhere: there are many uses of plastics within veterinary healthcare that can be avoided or adjusted to a non-plastic alternative or a different eco-friendlier plastic, and we await new technologic advances in medical bioplastics. Plastics are visible and at the forefront of our minds when considering our impact on the planet. Embracing sustainability within the workplace has been shown to improve team mental well-being and increase recruitment and retention (Darlington et al., n.d.). We need to make any changes we can for global health, alongside resilience of the veterinary sector.
Further information and resources can be found at vetsustain.org.