Do No Harm
Manufacturers are producing safer alternatives in IV bags and tubing.
The sustainability movement in hospital settings is branching into the operating room, bringing with it enormous potential for safer practices and cost savings. Tubing and intravenous (IV) bags—traditionally made with industrial chemicals now known to be unsafe to people and the environment—are being manufactured from alternative sources, and more hospitals are taking notice and action.
The chemicals in question, polyvinyl chloride (PVC) and di(2ethylhexyl) phthalate (DEHP), have been used for decades. PVC is the most widely used plastic in medical products. A rigid material, PVC requires the addition of materials called phthalates, which are used as plasticizers to make PVC softer and more flexible. DEHP is the most commonly used plasticizer in PVC-based bags and tubes; IV tubing may contain up to 80 percent DEHP by weight. (DEHP has been banned in Europe in the production of toys and cosmetics.)
When PVC is manufactured or incinerated, it creates dioxin, a known carcinogen and a bioaccumulative, toxic material that is harmful to humans and animals, even at extremely low doses. According to the World Health Organization, “experiments have shown [dioxins] affect a number of organs and systems.” Because of their chemical stability and the fact that they are absorbed by fat tissue, dioxins stay in the body for a long time, with a half-life estimated to be seven to 11 years.Dioxins tend to accumulate in the food chain. There also is concern about the use of chlorine and other organic compounds in PVC’s production.
DEHP exposure can harm the developing male reproductive system with permanent deformities and decreased fertility. DEHP may also affect the liver, kidneys, and lungs, as well as heart rate and blood pressure. When DEHP is added to PVC, it is not bound chemically to the plastic and can leach into surrounding fluid, or through lipids or heat, exposing patients to the chemical. Research shows that the DEHP levels in some IV solutions are more than 800 times higher than the levels permitted in U.S. drinking water.
Kaiser Permanente, one of the largest health care providers in the country, made news last winter when the company announced it would switch to more eco-friendly intravenous alternatives. The provider’s new IV bags and tubing are 100 percent free of PVC and DEHP. Kaiser annually purchases almost five million IV tubing sets a year and more than nine million solution bags—accounting for nearly 100 tons of medical equipment.
Manufacturers are responding. One is RAUMEDIC, an international firm based in Germany that is manufacturing DEHP-free products, including tubing. Another is Hospira, a manufacturer of hospital products headquartered in Lake Forest, Illinois, which includes DEHP-free IV containers (or bags) and IV sets.
Hospira supplied PVC- and DEHP-free equipment to Abington Memorial Hospital, a teaching hospital in Abington, Pennsylvania, after the hospital launched a green initiative several years ago. One of the initiative’s goals was to make the hospital 100 percent DEHP-free. But the Abington hospital has discovered other benefits, including waste reduction and a more efficient IV process.
Hospira’s VisIV equipment is a positive solution in a variety of ways, says Dan Rosenberg in Hospira Public Affairs. “The VisIV container provides the thermal stability, moisture barrier properties, and inertness required for IV medications,” Rosenberg says. “Hospira is dedicated to helping hospitals progressively advance health care and wellness for patients, care providers, and the global environment.”
Conservation of Natural Resources
When purchasing IV products, there are several environmental factors to consider:
IV bags and tubing are currently not made with postconsumer recycled material (current regulatory requirements prevent manufacturers from using postconsumer plastics in those products).
Some manufacturers are minimizing package waste by eliminating the plastic overwrap and incorporating the moisture barrier into the underlying material. Manufacturers also are reducing plastic through the redesign of IV bags and offering IV products with a longer shelf life.
A 2002 report entitled “PVC and Sustainability” offers still-relevant insight into several major challenges to make PVC a more sustainable material. These challenges include reducing energy emissions, increasing recycling potential during manufacturing and end of life, eliminating toxic byproducts, substituting toxic additives, and securing an industry-wide commitment to a long-term transformation process. Several firms that manufacture PVC and its component chemicals have been working since then to “design out” unsustainable production aspects throughout the lifecycle, although much progress remains to be made.
Due to the purpose and disposable nature of IV bags and tubes, reuse is not currently a consideration.
There are several obstacles to recycling IV bags and tubes, making it uncommon in most health care facilities to recycle them. However, manufacturers, health care providers, and recyclers are exploring ways to overcome the obstacles.
Biobased Plastics and Plasticizers
As research around biobased plastics continues, manufacturers may be able to incorporate either biobased plasticizers (to soften the PVC and make it flexible), while still using PVC as the core component, or biobased alternatives to the PVC plastic itself. (The safety and quality of biobased plastics in IV products are still being investigated.) Biobased plasticizers are also being explored by several research and development organizations as alternatives to traditional petroleum-based plasticizers used to soften PVC. However, selecting products with biobased plasticizers does not address concerns about the production and incineration of PVC, which releases dioxin.