Single-use plastic is widely used throughout hospitals for a number of reasons: not only is it cost-effective, but plastic can easily be sterilized, utilized during surgery, then thrown away. Undeniably, the introduction of single-use plastic to the OR was a large contributing factor to many of the advancements in surgery which have characterized the past few decades. Personal protective equipment and other barriers against microbe transmission have also been especially important during the COVID-19 pandemic and other disease outbreaks. However, as pointed out by a National Geographic article, there are huge environmental consequences that accompany both the production and disposal of single-use plastic.1 Knowing what we know now about the effect of greenhouse gases and microplastics in marine ecosystems, it is clear that the convenience of single-use plastic comes with very real long-term consequences. There is therefore a contradiction when it comes to the promise to “do no harm” when practicing medicine that generates such large amounts of waste and pollution. Innovation to improve environmental sustainability, especially in the operating room, is needed.
The conflict between optimization of patient care and preservation of the environment is both complex and highly nuanced. Ultimately, the priority remains getting patients the highest quality care possible. However, organizations such as Practice Greenhealth are committed to getting hospitals to at least take the first step towards greater environmental sustainability, some of which even have the potential to improve patient outcomes and safety in the operating room. For example, a single hysterectomy can produce up to 20 pounds of waste, most of which is plastic and therefore, not biodegradable.2 According to Practice Greenhealth, a lot of this waste is avoidable and could safely be replaced with reusable options: for example, metal sterilization containers to hold dirty instruments, instead of the usual polypropylene wrap which is tossed out after a single use. Another easy change could be moving from single-use sterilization pouches to newly-developed multi-use ones. Each “EnviroPouch” can replace up to 200 single-use plastic pouches.3 Not only are these pouches more sustainable, but their founder Barbara Knight argues they are also thicker and therefore safer for the storage of sharp instruments.
It has become commonplace to see single-use plastics as an integral part of modern healthcare practices. However, this hasn’t always been the case. Gary Cohen, president of Practice Greenhealth and Health Care Without Harm, argues that paranoia from the AIDs crisis motivated the integration of single-use practice into hospitals:
“[HIV/AIDS] was one of the drivers that helped to fuel the use of single-use devices and excessive packaging in the healthcare sector because there was such deep concern of the spread. It was an overreaction.”1
The origin of single-use plastic in the OR may be partially fueled by fear rather than strictly pragmatism. Recognizing this fact could be potentially helpful in normalizing a new, more sustainable approach to medicine.
While environmentalists admit that it is unlikely that single-use plastic could be completely eradicated within medical practice, there is much room for improvement. Moreover, with mounting global pressure to find more “eco-friendly” alternatives to common polluters, hospitals will likely be forced to respond. Yet it will still take a large, conscious effort and the work of many dedicated organizations to inspire significant change toward environmental sustainability in the operating room.
References
[1] Gibbens, S. (2021, May 03). Can medical care exist without plastic? Retrieved from https://www.nationalgeographic.com/science/article/can-medical-care-exist-without-plastic
2 Thiel, C. L., Eckelman, M., Guido, R., Huddleston, M., Landis, A. E., Sherman, J., Shrake, S. O., Copley-Woods, N., & Bilec, M. M. (2015). Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environmental Science & Technology, 49(3), 1779–1786. doi:10.1021/es504719g
3 EnviroPouch® Reusable Steam Sterilization Pouches. (2021). Retrieved from https://www.enviropouch.com/