The paradox of plastic in healthcare
Never has the need to reduce the use of plastics been more apparent and more pervasive. As world leaders, scientists and environmentalists convene to discuss climate change, media and social media platforms are littered with images of sea life choking on polythene bags, cotton swabs, disposable wipes and other plastic waste.
Closer to home, the government is consulting on proposals to ban the distribution and/or sale of plastic straws, plastic-stemmed cotton swabs and plastic drink stirrers in England. This is a move in the right direction but is a drop in the ocean when put into the perspective of what is required to mitigate against climate change, to clean up our oceans and to protect our health and our wildlife.
The UK is the second highest consumer of plastic straws, plastic-stemmed cotton buds and drinks stirrers in Europe and it is estimated that plastic waste generated in the UK in 2018 will reach 5.2 million tonnes, up by 300,000 tonnes from 4.9 million in 2014. These disposable items contribute significantly to the overall plastic pollution problem, and there are also other significant sources of plastic pollution that also require addressing such as plastic packaging, cups and water bottles.
Although, biodegradable plastics can be made, non-biodegradable, petroleum derived plastics are currently the most commonly used. Our use — and increasing over-use — of these plastics presents problems to the environment and human and animal health for multiple reasons.
Plastics manufacturing processes require a lot of energy, much of which is derived from the burning of fossil fuels which creates carbon emissions. Furthermore these processes themselves, which turn petroleum oils into plastics, create carbon by-products too. This two-dimensional insult of carbon emissions into the environment contributes to climate change and to air pollution. It is thought by experts that in thirty years or so, if the current trends continue, some 20% of global oil consumption and 15% of global carbon emissions will be associated with the production of plastics.
Disposal of plastics presents the next tranche of problems. The three main methods of disposal of non-biodegradable plastics are land-filling, incineration and recycling, although it is thought that most plastic waste actually doesn’t get reused or recycled. With some 50% of plastics believed to be single-use, that is a lot plastic going to landfill or being incinerated.
Incineration can cause dangerous substances such as dioxins and polychlorinated-biphenyls (PCBs) to be released into the environment. These persist in the environment and accumulate in the food chain, in animal fat, making them a public health concern and an area of ongoing research.
Many lightweight plastic items like plastic bags and straws can also end up being blown into drains, rivers and the sea, particularly where landfill sites are poorly managed. Tragically, 90% of marine litter is now comprised of plastic where it can harm and kill marine animals when they get trapped or smothered by it or mistakenly consume it. Tiny bits of plastic eaten by fish and shellfish are themselves toxic and can absorb toxic elements from the sea-water. This toxicity accumulates when the smaller fish are eaten by larger fish, which can then enter the human food chain.
It is not yet fully understood how inadvertent consumption of plastics affects the human body, but we do know that chemicals contained within plastics can cause significant human health problems.
As plastics decompose in water and in landfills, they can leak pollutants such as phthalates and bisphenol A into the soil and surrounding environment. These compounds are endocrine disruptors which can mimic male and female sex hormones, and studies suggest can result in human health effects if absorbed for example by occupational or environmental exposure, and are thought to be most dangerous to the development of unborn and new-born babies when their organs and nervous systems are developing.
Many plastics can be recycled. This should be the most effective way to deal with the tonnes of plastic waste we generate, but is depended on public awareness and the implementation of infrastructures such as the provision and availability of recycling bins and collection services to make recycling viable, popular and economically efficient.
As health professionals, we use and dispose of significant amounts of plastic in our day-to-day work. Within the NHS, there is a prolific use of single based plastics. Figures from the Press Association earlier in 2018 showed that NHS trusts in England have purchased around 600 million disposable cups since 2013 — the equivalent of more than 300,000 per day.
There are many other single use plastics being used in our health service, from plastic syringes and infusion devices, to products with plastics integrated into their fabric such as disinfectant wipes. This creates a sad juxtaposition, in which we are contributing to the negative health effects created by the manufacture and disposal of plastics while delivering care to our patients.
We would therefore urge the government to ensure that within the new NHS procurement model and Category Tower sustainability strategies, a clear ambition is put in place to be transparent about plastics use in the delivery of health and care. For the category towers this should start with an assessment of all plastic-containing products used by the NHS and consideration, as part of clinical evaluation as to firstly whether plastic is necessary for the product, and secondly whether any current single-use item needs to be single-use in the future.
While there are clearly times when single-use items (such as disposable syringes and needles) are required to prevent contamination and disease transmission, single use variations of some medical devices have been made available relatively recently, replacing models that were previously sterilised and reused repeatedly. There are many reasons for this, ranging from lower production costs to resistance to wear and complex or unsuitable manufacturing guidance on decontamination, but the fact remains that non-plastic alternatives were and are available and a life-cycle and cost review of current procurement and product alternatives based on re-use where appropriate is now due.
While plastics pollution is a problem for the environment and to health, tackling it should come alongside action to mitigate climate and other environmental change. The latest Intergovernmental Panel on Climate Change (IPCC) report made clearer than ever before the scale of the challenge we face. It warned that we have just 12 years to reduce our greenhouse gas emissions by 45% if we are to stay within the critical limit of 1.5 degrees of warming.
We know that going above this threshold is likely to be extremely damaging for public health. If we are to be the first generation to leave the environment in a better state than we inherited it, plastics pollution is an area that needs bold action to meet the IPCC recommendations.
It is time to call on government and the Environment Agency to examine where there is variation in medical single-use plastic across the UK health sector, learn from best practices and consider returning to some older ones where they are beneficial in the long term to our public’s health.
Dr Claire McLoughlin, UK Health Alliance on Climate Change
Rose Gallagher MBE, Royal College of Nursing
