Andreea Zotinca from Health Care Without Harm Europe discusses the impact of healthcare’s reliance on single-use plastic, and how it can be reduced.
Plastic is ubiquitous in all our lives, and though many industries and individuals are making great strides in reducing their reliance on plastic, the amount of waste produced as a result of single-use plastics in healthcare is having an alarming impact on the environment. In the UK alone, the NHS disposes of approximately 133,000 tonnes of plastic every year with a mere 5% of this being recovered. Likewise, according to the HCWH Global’s 2019 report, if the global healthcare sector were a country, it would be the world’s fifth-largest emitter of greenhouse gases.
From gloves to surgical devices, plastic has been revolutionary for the healthcare industry, offering a low-cost and adaptable option for the production of a myriad of products. While in many areas of care single-use plastic is necessary for infection prevention and control, there are opportunities to reduce its use, and to introduce more reusable alternatives. More and more strategies to support this are being launched.
Following the launch of the ‘Towards plastic-free healthcare in Europe’ project, we spoke with Health Care Without Harm Europe’s Circular Healthcare Project Officer, Andreea Zotinca, about the effect single-use plastic in healthcare is having on human and environmental health, as well as the challenges in plastic recycling and where there are opportunities for improvement.
What makes plastic an attractive material for the production of healthcare products and packaging?
Plastic is a very useful material for the healthcare industry, it is cheap to produce and can be moulded to make a range of healthcare products. The problem is that there is just too much of it, and it is not always necessary, nor reused where it could be.
There are misconceptions around single-use and multiple-use plastic, for instance, that everything should be used once and thrown away because it is safer. That is not true; sometimes there is no risk or a very small risk which does not justify single use.
Differences in culture, from one country to another, and awareness of the actual risk associated with procedures can also impact plastic use. Many hospitals are doing great work in reducing plastic use and we know that solutions are available, which is encouraging.
On your website you mention that single-use plastic products and packaging are overused, often in situations where they are not needed, can you give some examples of this?
Regarding single-use plastic items which are more damaging to the environment and society, we found that some hospitals use single-use curtains to separate patient beds. I would assume that in most European hospitals reusable curtains are being used, and this has been the practice for a long time, but some are making the switch towards single use. This is a waste of useful resources and is more expensive.
There are many opportunities to reduce single-use gloves and there is a project called ‘Gloves Are Off!’ run by Great Ormond Street Hospital in the UK which aimed to reduce the unnecessary use of non-sterile gloves. They managed to reduce glove orders from 11.1 million to 6.8 million, saving more than £100,000. It turned out that staff were overusing gloves thinking that they were protecting the patient when actually, gloves posed a greater risk of cross-contamination because instead of hand washing, staff were simply using gloves. The team also continued the awareness-raising campaign during COVID showing again that gloves are not necessary for every healthcare situation. There is so much potential in a project like this because we know from our research that gloves are perhaps the plastic item used in the largest quantities in healthcare.
We had one hospital participating in our ‘Towards plastic-free healthcare in Europe’ project and they told us after doing some procurement data analysis, that gloves represented almost 18% of their total plastic use.
There are many other examples including custom packs which contain specific items that are needed for a procedure. But sometimes, some items are not needed and once the pack is open, everything is thrown away. Imagine all the resources and processes that went into creating and transporting those items, then they are simply thrown away. This is just mindless waste.
We know that plastic can be detrimental to the environment, how much is known about its impact on human health?
There was a great report by CIEL about this in 2019 – Plastic & Health: The Hidden Costs of a Plastic Planet – and we are seeing more and more research on this topic. There have been reports on microplastics found in the lungs, blood, and placenta; we know that plastic is present in our bodies. It is hard for scientists to make claims about the impact of plastic on human health, research is hard to do and there are ethical implications to consider. We know that there can be risks with microplastics and the harmful chemicals they contain, and judging by how much the scientists are warning us about these risks, I think it is smart to think about prevention and not just wait until we have to do research to prove the extent of the problem.
Plastic contains many additives and chemicals and there are many studies on the harmful impact of these chemicals on human health. These chemicals can leach, through food containers for instance, or liquids. This is relevant to healthcare, not just because of the health effects but because these chemicals – such as endocrine disrupting chemicals – are present in many medical devices including tubes and IV bags.
These can pose risks to vulnerable patients including babies and children; these chemicals can affect their development. It is a huge problem and that is why in our programme, as well as advocating for reduced plastic use, we are also pushing for toxic-free healthcare. These products should not be there, especially in areas of the hospital where there are vulnerable groups. We should take a very precautionary approach to this matter.
On top of the use of plastic, there is also the production and disposal of plastic. Many harmful chemicals are being used in single-use plastic production; it is not good for the environment. We know that a lot of plastic is incinerated, even in waste to energy it is still incinerated, emitting toxic chemicals. The communities living next to incineration plants are typically already underprivileged, this inequality is widening, as they are the most affected by these production and disposal processes.
scientists are warning us about these risks, I think it is smart to think about prevention and not just wait until we have to do research
to prove the extent of the problem
Can you give an overview of the rate of plastic recycling in the healthcare sector? What are the key barriers to this?
It is hard to know the true recycling rates for plastic in healthcare and in general, there is so little transparency in the process. I would imagine the numbers vary across Europe and that the rates are very low in healthcare compared to general-use plastic.
Recently, there was an investigative report from Greenpeace UK that showed plastic placed in recycling bins in the UK was found in Turkey, just abandoned in open fields, or burned because people in the local communities did not know what to do with it. This was not healthcare plastic but if municipal waste plastic is treated in this way, with a total lack of transparency, and assuming it is easier to recycle than healthcare plastic, then it makes you wonder what happens to healthcare plastics from the recycling bins.
Lack of transparency is a big problem; we know that it is impossible to recycle all of the plastics we are using in Europe so that is why we are trying to focus more on prevention and reduce plastics to begin with. As an NGO, we know that there is a place for recycling as well, but we want to focus on the solutions that will bring the most impact.
which is a pity because 85% of the plastic in healthcare is nonhazardous
How is the use of plastic in healthcare being regulated?
There is some encouragement and a push for hospitals to recycle their single-use plastic and their waste in general, but they encounter many challenges. For example, recycling firms do not always accept plastic from healthcare which is a pity because 85% of the plastic in healthcare is non-hazardous, it is just like the general waste we would recycle at home. It is hard to know how different countries are managing this, but we know from our members that it is a problem that they encounter. But again, knowing that there is so little transparency in the recycling process, it is unclear what would happen to recycled plastics from healthcare if they were accepted.
In Nordic countries, there is a lot of effort to reduce single-use plastic waste and even more effort into reducing the use of toxic plastic material and harmful chemicals in plastics. Sometimes this effort is because of regulation but sometimes institutions join forces at the local level to make progressive change.
Can you tell me about the ‘Towards plastic-free healthcare in Europe’ project and your long-term vision for this?
It started two and a half years ago with the initial idea of transforming the use of plastic in healthcare, but now we have a concrete idea of what we want to see which is a reduction of unnecessary plastic use in healthcare. This means a reduction in unnecessary or unused items as well as a reduction in packaging. At the beginning of the project, we focused on research, carrying out waste audits, and gathering procurement data and we learned a lot and identified the use of key plastic items that could be addressed.
I was talking earlier with a student, and a doctor had told her that screws used for bone surgery used to be packaged together in one big bag now, each screw is packaged separately, in plastic. So again, if things were working beforehand and it was fine and safe, why do we need to change them?
There is a lot of debate on the choice between single-use plastic versus reusable items, and we have to look at it with a critical eye and assess whether there is a significant risk of infection or not. Sometimes the risk of infection is so small that we have to consider whether the risk warrants all these resources used for single-use items. As well as the reduction in unnecessary use we are also advocating switching to safe reusable items where possible so for medical textiles, for instance, there are many opportunities here. We must try and deter hospitals that are already using reusable items without risk from switching to single-use plastics. It is important that all these processes contribute towards toxic-free healthcare, even if products are reusable.
We want to provide a platform for people who work in healthcare across Europe to come together and talk because there are solutions available and sharing examples, challenges and experiences can be helpful. Although the project is called plastic-free healthcare, we know that there will still be single-use plastic in healthcare, even with reusable items but the idea is ultimately to reduce plastic use as much as possible.
Andreea Zotinca
Circular Healthcare Project Officer
Health Care Without Harm Europe
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This article is from issue 22 of Health Europa Quarterly. Click here to get your free subscription today.
