How can I reduce my use of plastic in healthcare?

Fossil fuel plastic causes death, disability, and disease at every stage of its lifecycle from the mining of feedstocks, fracking, cracking, manufacture, use and disposal. These impacts fall disproportionately on those from lower HDI countries, fence line communities, the vulnerable and extremes of age. Fossil fuel subsidies result in derived products being artificially cheap whilst the cost of harm is externalised to society and the healthcare sector. Whilst plastic healthcare products are procured and used with good intention, they come with an environmental and social footprint which cannot be ignored.

Single-use medical devices are an inevitable part of modern clinical practice. Whilst it is hoped in future, we will see increased adoption of re-useable products, more sustainable polymers used, fewer toxic additives and more options to recycle, we are at present dependent on existing materials and pathways. There are however steps all healthcare professionals can take to reduce their plastic footprint and collectively send a clear demand signal to industry that we are ready for change.

NHS England’s Standard Contract (item 18.3.3.2) states - we must take action to reduce avoidable use of single use plastic products - and for this to have maximum impact, it must be supported by all. Suppliers must avoid using the worst types of plastics and toxic additives whilst healthcare organisations and professionals must increase their level of understanding of what’s in the equipment they’re using. Choosing to procure and use the most sustainable products not only enables healthcare professionals to ‘first, do least harm’ but sends a clear signal that we want access to the most sustainable products and to accelerate change.

At CPDmatch, we actively seek out education and resources relating to healthcare plastic and have specific website categories assigned to materials, waste, and pollution. There is also clear overlap with climate change as plastic pollution does not just have an impact on planetary and human health, but the wider industry threatens our ability to reach net zero through greenhouse gas emissions and polluting natural systems which sequester CO₂ from the atmosphere.

Actions for all healthcare professionals can include:

• Support initiatives to keep yourself and others active and healthy. The least polluting healthcare plastic is that which does not need to be used.
• When healthcare intervention (e.g., surgery) is planned, ensure patients are as fit as possible to reduce the incidence of post-intervention complications and their additional (potentially avoidable) footprint.
• Understand healthcare decisions and actions are not benign: every piece of equipment used, every investigation done, and every treatment prescribed has an impact on the planet.
• Become educated in the different types of plastics, which additives are toxic and what to ask suppliers of healthcare products.
• Disseminate this knowledge in clinical meetings to ensure all staff are educated.
• Use personal-protective equipment appropriate to the clinical scenario and patients’ needs. A good example is the Intensive Care Society’s Gloves Off initiative.
• When appropriate and possible, use the oral route for fluids, electrolytes, and medication. There is an excess of plastic required for intravenous administration.
• Create a culture of only opening equipment when needed rather than ‘just in case’.
• Ask for healthcare products to be supplied in the minimum quantity of clearly labelled recyclable packaging.
• Reprocess equipment (e.g., cardiology and laparoscopic) whenever possible.
• Understand the distance your waste travels, how it is treated and whether processing creates energy. Segregate waste correctly and use the least harmful waste pathway.
• Identify if sustainable waste pathways are missing (e.g., blue medicinal waste bins) in your organisation and ask your waste manager to address. The plastic and net cost savings can be considerable.
• Utilize your buying power and collaborate with suppliers who are the forefront of reducing the impact of their products, packaging, and delivery method/miles on the environment.
• Learn how to communicate effectively with procurement teams, explaining the concept of first, do no harm applies to both patients and planet. Challenge if equipment with a lower environmental footprint (e.g., plastic mass) is not available (see below).
• Remove litter from the environment and dispose through standard domestic waste pathways. Most marine plastic stays close to shore so consider participating in beach cleans.
• Whatever you’re doing at home or at work, tell everyone why you’re doing it, inspire others and accelerate change.

It is possible for new and alternative healthcare products to reduce planetary harm in several ways:

• By reducing the mass of plastic used in their device.
• By using ‘less bad’ plastic. For example, polyethylene in place of PVC.
• By extending the life span of a disposable product. For example, a product which traditionally is used once only may be able to be used on the same patient multiple times without harm occurring.
• By ensuring that used products are disposed of in the least harmful waste streams. For example, giving sets attached to fluid bags which have been used to deliver medication can be disposed of through the blue medicinal waste stream rather than yellow sharp bins. This reduces the mass of plastic incinerated, enables electrical energy to be generated (Energy From Waste) and lowers organisational waste disposal costs. For more details, please contact me on the email address below.

When communicating with procurement teams, it is important to use the right language. The text below is an example of what we include when completing forms for trialling more sustainable equipment:

As healthcare professionals, we must first, do no harm and, since our health is inextricably linked to that of the climate and planet, we must extend this ethos beyond clinical care to the entire healthcare value chain. We know plastic is responsible for death, disability, and disease at every stage of its life cycle from mining and fracking through manufacturer, distribution, use and disposal and therefore, we have a responsibility to seek out, audition and where appropriate, use healthcare products which contain less fossil-fuel plastic.

<Product> contains x% less plastic than our existing product and is made from <material> rather than PVC which is widely recognised as a particular harmful polymer. Using <product> is one way that we, as healthcare professionals can reduce harm on the environment. We therefore have a duty to make <product> available within the Trust and specifically in areas of high-volume use. To not have <product> available forces us to cause avoidable planetary harm.

Procuring <product> ensures the Trust is supporting <supplier> who is taking action to reduce avoidable use of single use plastic products as required through the NHS Standard Contract 2023/24 (item 18.3.3.2). By sending a clear signal to all our suppliers that we are seeking out and auditioning more sustainable products, we will drive further positive action.

It is hoped the global plastics treaty will lead to all industries, including healthcare, to reduce the impact of the plastic they use with the 5^th meeting of the negotiating committee scheduled to meet in Korea; November 25^th to December 1^st, 2024. Regardless of the scope of recommendations made, as healthcare professionals we must continue to seek out actions we can deliver and reduce the amount of plastic we use in our working lives.

Richard Hixson, Consultant in Anaesthesia and Critical Care; Physician Environmentalist: richardhixson@nhs.net