Why is this important?
Plastics have become an integral part of medical care and support activities, and the use of single-use plastic items has been dramatically rising over the last few decades (1). Single-use plastic items comprise of, for example, syringes, IV bags, tubing, catheters, surgical gloves, face masks and shields, disposable gowns, pipettes and petri dishes, sample containers and surgical instruments, packaging and wrapping, etc. In addition, healthcare facilities use single-use plastic items in non-medical activities, e.g. catering, personal care products, cleaning, laundry, cafeterias, administration.
Whilst single-use plastics are essential for healthcare delivery in some cases, they are linked to significant negative impacts on the environment and human health at each stage of their life cycle. 98% of plastics are derived from fossil fuels, and global plastic production contributes to an estimated 3.7% of global greenhouse gas production (2) During resource extraction, refining and manufacturing, toxic chemicals are used and released. When using plastics, humans can be exposed to hazardous additives present in plastics. At their end-of-life, plastic incineration releases toxic chemicals, and when left in the environment, plastics break down into micro-plastics and nano-plastics, entering the food chain and water systems (3).
Single-use items make up a large share of the waste production in medical facilities. It is estimated that 25% of healthcare waste in the US is plastic (4). Already prior to the Covid-19 pandemic, the NHS produced 11,300 tonnes of waste each day, of which about 23% was plastic (5). Currently, less than 5% of the plastic waste from the UKs healthcare industry is recycled, even though 64% of the total plastic waste is recyclable (6).
What's the solution?
Reducing the use of single-use plastic items in medical facilities involves strategies in line with the principles of a circular economy. One approach is to cut down on unnecessary consumption by changing protocols and by educating healthcare professionals on the correct use of single-use items. Additionally, rethinking the composition of medical kits can significantly reduce waste, as it was found that disposable items in pre-packaged kits are often unnecessary (7). Switching to reusable products, whether made of metal, cloth, glass, can further decrease waste and pollution linked to single-use items.
In addition, it is crucial to avoid harmful chemicals present in plastics, as these substances pose significant health and environmental risks during their production, use of the plastic item and during incineration. Ensuring proper waste management practices and increasing recycling rates by improving the collection and sorting of waste are key in reducing harm from plastic waste and promoting a more sustainable, circular approach in healthcare facilities.
Key actions
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#1 Reduce unnecessary use and over consumption
Evaluate the need for certain interventions and educate healthcare professionals on correct use of single-use items (15). See success stories on reducing unnecessary cannulation and reducing overconsumption of gloves.
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#2 Reduce the disposable plastic content within medical kits
Reevaluate the content of medical kits. Studies have shown that 12 out of 40 disposable items in prepackaged surgical kits for tonsil surgery were unnecessary (16). Additionally, the packaging for these kits should be reconsidered as a single sterile wrap for sterile items poses no greater risk of contamination than a double wrap, which generates more plastic waste (17).
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#3 Switch to reusable products
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#4 Avoid harmful chemicals in plastics
Avoid hazardous chemicals in plastic items and devices, such as , phthalates (e.g. DEHP) or bisphenol A (BPA). They can migrate into the body, potentially causing health issues such as hormone disruption, developmental problems, and increased cancer risk. When incinerated, PVC releases chlorinated dioxins, considered among the world’s most toxic substances (20).
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#5 Strengthen plastic recycling measures
Increase the recycling rate of clean, non-hazardous plastic (e.g. gloves and syringes are considered infectious waste) by, if possible, switching to mono-materials, asking suppliers to properly label plastics to facilitate sorting and to put in place improved waste management practices (21). Educate staff. Consider joining a recycling network to generate sufficient volume for recyclers and encourage recycling by strategically placing collection containers in accessible areas throughout the facility.
To consider
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Potential co-benefits
- Cost savings: Transitioning to reusable items can lead to long-term cost savings.
- Enhanced reputation: Improves the facility’s public image.
- Staff motivation: Reduced waste increases staff motivation and retention.
- More efficient workflow
- Health benefits for patients and staff: Reducing harmful chemicals in plastics decreases exposure to health hazards.
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Success conditions
- Staff training: Training and education to ensure compliance with new practice and facilitate a change in culture.
- Supporting regulatory frameworks: Legislation can accelerate a change in practice.
- Adequate recycling infrastructure: Availability of recycling facilities.
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Prerequisites & specificities
- Waste audit: A waste audit helps to understand material flows and to set a baseline.
- Assessment of current usage of single use items: Identifying opportunities for change in practices.
- Infrastructure: Adequate infrastructure for cleaning, sterilising and storing reusable items.
- Clear policies: Updating protocols and training staff to ensure proper implementation.
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Potential risks
- Infection control: Inadequate cleaning and sterilisation processes could increase infection risks.
- Operational disruptions: Temporary disruptions in workflow if transition to new practices is not properly managed.
- Change management: Pushback from practitioners and patients.
Tools and good practices
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Climate Action Accelerator webinar, How to reduce single-use medical items?, 2024
This webinar discusses the current state of efforts to reduce the use of single-use medical items in the medical and the humanitarian aid sector. It will provide actionable insights on how to reduce single use medical items by switching to alternative items, changing practices, and by sensitising staff to reduce overconsumption.
Find out more -
Health Care Without Harm, Plastics toolkit for hospitals, 2019
A comprehensive toolkit on how hospitals can reduce their plastic use. It includes guidance on implementing long and short term solutions and alternatives by providing life cycle hazards of different polymers, a how-to guide on a simplified plastics audit, and case studies in Southeast Asia.
Find out more -
Health Care Without Harm, Measuring and reducing plastics in the healthcare sector, 2021
This toolkit breaks down the environmental and health risks associated with plastic use in healthcare while also providing case studies and guidance on how sustainability managers and healthcare professionals can reduce plastic use.
Find out more -
Healthcare Plastics Recycling Council, Resources for hospitals
The Healthcare Plastics Recycling Council offers a toolkit for hospitals looking to improve their recycling programme.
Find out more -
Health Care Without Harm, Towards PVC-Free Healthcare, 2023
This paper provides a comprehensive overview of plastic use and patient exposure to Polyvinyl Chloride (PVC) while highlighting the environmental concern and steps healthcare providers can take to reduce PVS use.
Find out more -
Green theatre checklist, 2022
Provides support for surgical teams to change their department and is divided into four sections. One on Anaesthetic care, second on preparation for surgery, and the last two on intra operative practices and post operative measures.
Find out more -
Health Care Without Harm, Sustainable Food Contact Materials, 2021
This factsheet provides scalable actions healthcare food providers, procurers, and consumers can make to reduce plastic use and encourage circular economy. It provides insight through case studies in hospital canteens, patient catering, and the maternity ward.
Find out more
Further reading
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Systematic review of the impacts when switching from single-use to reusable medical items
The authors performed a systematic review of comparative cradle-to-grave life-cycle assessments (LCAs) of single-use and reusable healthcare products. It was found that all environmental impacts were reduced when using reusable items, expect water use.
Explore here -
MF Bhutta, Our over-reliance on single-use equipment in the operating theatre is misguided, irrational and harming our planet, 2021
This article discusses the environmental impact of single-use medical equipment in surgeries, advocating for reusable items by highlighting the significant waste generated by operating theatres and the myths surrounding infection risks with reusable equipment
Explore here -
Life cycle assessment of reusable and disposable isolation gowns, 2018
This article explores the life cycle analysis of reusable isolation gowns and single use gowns. It finds that reusable gowns use less energy, greenhouse gas emissions, water consumption, and waste generation in healthcare settings.
Explore here -
Life cycle assessment of reusable and single-use sharps containers, 2023
Outlines the life cycle analysis of the switch to reusable sharps containers and unpacks the net zero efforts by NHS.
Explore here -
CAHA, Campaign to reduce single use plastic in healthcare, 2021
Short one page factsheet on how to reduce plastic in health care with action points to make it happen.
Explore here -
WHO, Glove use information leaflet, 2009
Information leaflet on the correct use of gloves, noting that the unnecessary and inappropriate glove use results in a waste of resources and may increase the risk of germ transmission.
Explore here
Acknowledgments
Last updated 4 September 2024
Share your success stories, suggestions, and comments with us! contact@climateactionaccelerator.org
Sources
(1) Healthcare without Harm, “Measuring and reducing plastics in the healthcare sector”, 2021, Read here, (accessed 19 August 2024).
(2) M. Smith, “Infection Prevention, Planetary Health, and Single-Use Plastics”, Jama Network, 2023, Read here, (accessed 21 August 2024).
(3) M. Smith, “Infection Prevention, Planetary Health, and Single-Use Plastics”, Jama Network, 2023, Read here, (accessed 21 August 2024).
(4) S. Gibbens, “Can medical care exits without plastic”, National Geographic, 2019, Read here, (accessed 15 July 2024).
(5) Health Care Without Harm, “Measuring and reducing plastics in the healthcare sector.”, 2021, Read here, (accessed 15 July 2024).
(6) C. Rizan, F. Mortimer, R. Stancliffe et al., “Plastics in healthcare: time for a re-evaluation”, Journal of the Royal Society of Medicine, 2020, 49–53. (accessed 5 September 2024).
(7) C. Rizan, F. Mortimer, R. Stancliffe et al., “Plastics in healthcare: time for a re-evaluation”, Journal of the Royal Society of Medicine, 2020, 49–53. (accessed 5 September 2024).
(8) S. Gibbens, “Can medical care exits without plastic”, National Geographic, 2019, Read here, (accessed 15 July 2024).
(9) S. Gibbens, ‘Can medical care exits without plastic’, National Geographic, 2019, Read here, (accessed 15 July 2024).
(10) C. Rizan, F. Mortimer, R. Stancliffe et al., “Plastics in healthcare: time for a re-evaluation”, Journal of the Royal Society of Medicine, 2020, 49–53. (accessed 5 September 2024).
(11) A. Gamba et al., “Measuring and reducing Plastics”, Health Care Without Harm 2021, Read here, (accessed 21 August 2024).
(12) MSF, “Tackling MSF OCG’s environmental footprint”, 2024, Read here, (accessed 27 August 2024).
(13) A. Gamba et al., “Measuring and reducing Plastics”, Health Care Without Harm 2021, Read here, (accessed 21 August 2024).
(14) P. Collinson and J Villar, “Susqi Project Report Glove use awareness campaign”, Green Team Competition, Centre for Sustainable Healthcare, NHS, Read here, (accessed 15 July 2024)
(15) WHO, “Glove Use Information Leaflet”, Read here, (accessed 15 July 2024)
(16) C. Rizan, F. Mortimer, R. Stancliffe et al., “Plastics in healthcare: time for a re-evaluation”, Journal of the Royal Society of Medicine, 2020, 49–53. (accessed 5 September 2024).
(17) J. Webster, E. Radke, N. George et al., ‘Barrier properties and cost implications of a single versus a double wrap for storing sterile instrument packs’, American journal of infection control, 2005, p. 348–52, (accessed 15 July 2024).
(18) R. Bromley-Dulfano et al., “Switching from disposable to reusable PPE”, BMJ, 2024, Read here , (accessed 1 July 2024).
(19) Vozzola, Eric, Overcash, Michael, and Griffing, Evan, “Environmental considerations in the selection of isolation gowns: A life cycle assessment of reusable and disposable alternatives”, American Journal of Infection Control, 2018, p. 881–6, Read here, (accessed 15 Jul 2024).
(20) Healthcare Without Harm, “Towards pvc-free healthcare”, 2023, Read here, (accessed 27 August 2024).
(21) Healthcare Plastics Recycling Council, “Barriers to Recycling Healthcare Plastics”, 2022, Read here, (accessed 15 Jul 2024).
(22) C. Kent, “Making sustainable medical devices: five top tips”, Medical Device Network, 2022, Read here, (accessed 15 July 2024).
(23) S. Gibbens, “Can medical care exits without plastic”, National Geographic, 2019, Read here, (accessed 15 July 2024).
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