George I’ons, head of product strategy and insights, Owen Mumford Pharmaceutical Services, explains how medical device manufacturers can make single-use device more environmentally friendly.
In England, the NHS is responsible for 4% of total carbon footprint, with a significantly higher percentage of plastic waste compared to other industries. Unlike other industries, healthcare waste may be infectious, resulting in only about 5% of NHS plastic waste is being recovered. The pandemic has helped to shine a light on this issue, due to the increased demand for Personal Protective Equipment (PPE). Since February 2020, the government has distributed over 11 billion items of PPE to health and social care services in England, compared to just over 2.4 billion in 2019 – representing a substantial increase in waste, and highlighting the urgency of taking action.
In tandem, there is wider public awareness of environmental issues, leading to greater pressure on healthcare procurement teams to use their purchasing power to address this – around 60% of the health service’s carbon footprint can be attributed to the procurement of goods and services. Proactive businesses are therefore likely to benefit commercially from establishing sustainability goals and objectives. The challenge for manufacturers of disposable medical devices is to reduce the overall impact in a way that is financially viable.
The need to control infection and to comply with strict safety regulations makes it difficult to avoid using certain single-use medical devices. The UK does not encourage reprocessing and reuse of single-use products while the EU’s Medical Device Regulation (MDR) introduces strict reprocessing guidelines. Taking the sterilisation route also has limitations. Sterilisation may be costly and require high levels of energy, cancelling out the sustainability benefits of reuse. Some sterilants may also have toxic properties. In the US, 50% of all sterile medical devices are sterilised with ethylene oxide as it is the only effective method for many devices but releases harmful emissions, causing the FDA to call for the development of new methods or technologies.
Rather than reusing a whole device, it may be possible to reuse some of the materials. The most widely used plastic for medical devices is Polyvinyl chloride (PVC) which can be recycled several times without losing its critical properties. In one UK take-back scheme, disposable and non-infectious PVC medical devices from over 30 participating hospitals, including oxygen masks, oxygen tubing and IV bags, are turned into products for the horticultural industry. In this way, useful plastics are kept in circulation rather than being incinerated with other healthcare waste. New technologies could further aid this process for plastics that are more difficult to recycle. For instance, the chemical recycling process of depolymerisation breaks down polymers into their original monomers.
Sustainability shouldn’t only be a consideration at the end of a product’s life cycle. Device designers can assess various methods of reducing plastic use right from the design planning phases, such as reducing the number of components or choosing alternative materials. One company is now making pregnancy tests with plant fibres, meaning they can be flushed and then biodegrade within ten weeks. There may be scope to reduce environmental footprint across multiple stages of the device manufacturing process, from minimising primary and secondary packaging, to choosing recyclable labelling.
The manufacturing site itself should undergo a sustainability review. Improving energy efficiency and opting for clean energy sources could also reduce overall costs. These savings can then be used to fund sustainability initiatives. Investments in process optimisation and new technologies may also support environmental efforts. For instance, additive manufacturing can reduce scrap waste by as much as 90% compared to conventional manufacturing. It can also speed up production of device prototypes, meaning that the product can be refined and tested in a more efficient manner.
As manufacturers explore possibilities of adding digital capabilities to devices, innovative approaches will be needed to maintain sustainability. Connected medical devices can reduce some of the burden on healthcare by facilitating remote patient monitoring and encouraging patient adherence. However, adding electronic elements to a disposable device presents a new obstacle to sustainability. One response is hybrid design, where reusable electronic components are coupled with disposable device components.
Many successful sustainability initiatives are already in place but need to be implemented on a much wider scale. The UK has been a leader in healthcare sustainability initiatives, setting up the Sustainable Development Unit in 2007. As we face new challenges, we must keep up the momentum to make a bigger impact. A pre-pandemic estimate suggested that one million tonnes per year of non-infectious medical plastics are available for recycling in the US, with equivalent amounts in Europe and Asia. Working together, the industry can start to make a dent in that figure.
