medical needles in a pile

Paper or Plastic: How would you like your IV fluids today?

The patient was a very pleasant 45-year-old woman who came into the emergency department with fever, headache and neck pain; all signs and symptoms concerning for meningitis or possibly encephalitis. Both are often an infectious, sometimes inflammatory diseases of either the meninges, the thin membrane that covers the brain, or the brain itself. The diagnosis is considered clinically, based on signs and symptoms as well as some clinical exam, and often confirmed by a lumbar puncture or spinal tap.

I discussed this with the patient and she agreed to the procedure. I had her positioned and had opened the prepackaged kit to get started. The kit is wrapped in plastic, a necessity to keep equipment sterile, especially for a procedure that will involve instrumenting a space that communicates with the central nervous system; the brain and spinal cord.

Off came the plastic, and into the trash. There are also some stickers for labeling the syringes used to inject the anesthetic, but I didn’t need those either, so they also went into the trash. There are extra plastic syringes that you don’t need, as well as a plastic straw to draw up the anesthetic if you choose to use that instead of a needle. Into the trash. There are several more items in the kit that are destined for the trash as well: a small circular piece of foam for sticking used needles into, as well as unused needles. By the end of the procedure, I had become a one-man wrecking ball of plastic waste.

Plastic Waste in the Hospital Setting

This is true of many of the other procedures that are done not only in the emergency department but hospital wide. Many suture kits are plastic trays wrapped in plastic. The operating room uses plastic drapes to keep patients sterile. Other procedure kits have an array of unused doodads, often plastic or foam. Plastic products are vital to the delivery of safe patient care, helping to ensure sterility as well as providing engineering that reduces patient harm. They are also less expensive and more versatile than alternative materials. At the same time, there is a great deal of plastic waste that hospitals are producing on a daily basis. Non-clinical areas produce a fair amount of waste as well, especially cafeterias where polystyrene containers are both efficient and cost-effective. Plastic straws have received a great deal of attention lately, but for patients with a swallowing disorder are a necessity and alternatives don’t often make fiscal sense. It’s somewhat of a Catch-22, with hospitals wanting to provide safe and effective healthcare, while considering cost and patient outcomes. Simply put, plastics are integral to healthcare delivery.

Where is the waste?

While a lot of attention has been focused on the disposal of medical waste, healthcare wastes that have the potential to spread infectious disease, there has been significantly less attention to the plastic waste hospitals are producing every day. The Medial Waste Tracking Act was passed in 1988 to evaluate the impact of medical waste and to investigate means to limit the harms of incinerating these materials. This act had a two-year expiration date, and then the responsibility of regulation was passed on to the individual states. This act did help to reduce the number of incinerators, a process that produces some significant environmental toxins, by instituting a number of alternative processes that reduce the infectious risk of these medical products. These methods have reduced incineration, and therefore the release of harmful chemicals into the environment. These products however are then often destined for landfills, which still has a significant environmental impact. The destiny of all of the other non-hazardous waste is the same, including all that plastic and polystyrene.

Going Green

All in all, hospitals account for over 850 million tons of plastic per year, representing approximately 25% of the total hospital waste stream. Fifty-percent of that waste is attributed to packaging. Some of this is unavoidable. Disposable plastic syringes are ubiquitous to healthcare and have lessened the risk of blood borne pathogens such as HIV ad Hepatitis C. Plastic intravenous bags and tubing carry the same considerations. There are alternatives however, and these alternatives carry not only a more environment-friendly impact, but also some cost-savings as well. The Mayo Clinic was at the forefront of the “going green” initiative, which included not only recycling plastics, but also initiatives to recycle cardboard, lightbulbs, computer parts and scrap metal. This has been further extended to sourcing food from local farms, and donating unused food to soup kitchens and shelters. Since starting this initiative in 2013, the Mayo Clinic has increased recycling by 78%. Many other hospitals have followed suit with an array of initiatives aimed at reducing not only plastic and polystyrene waste, but all sorts of other materials as well.

The medical plastics industry has made some efforts to reduce the impact of plastics as well, developing more environmentally friendly biodegradable plastics that have wide implications for medical use. There is a need for these manufacturers to work with healthcare systems to re-evaluate packaging alternatives, such as cardboard substitutes or other biodegradable alternatives for packaging. Corn-based polylactic acid could be one alternative to conventional packaging. A shift towards reducing polystyrene containers in hospital food-service is another step, and there needs to be an industry-wide effort towards a cost-effective substitute. Development of green committees and working with both industry as well as with policy makers can help drive these initiatives. Informing and pushing policy towards a greener operating system for hospitals is an imperative as well.

Hospitals and healthcare providers have a responsibility to ensure environmentally friendly healthcare delivery. This includes implementing alternatives to large-volume plastic waste and encouraging recycling and alternative, more eco-friendly materials. Evaluating healthcare savings can help to justify implementing these programs and can allow for shifting healthcare expenditures are the costs of waste disposal is reduced. Healthcare systems should be active in informing policy makers as well as driving policy with evidence-informed practice. Our goal in healthcare is to keep people healthy; keeping our planet healthy is just as important.



Stephen Wood

Stephen P. Wood, MS, ACNP is an acute care nurse practitioner practicing emergency medicine in Boston, Massachusetts, and a fellow in bioethics at the Center for Bioethics at Harvard Medical School in Boston.

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