According to an analysis by the World Health Organization, plastic production has more than doubled since the start of the COVID-19 pandemic. Increased patient loads from the pandemic also reduced the number of health care workers to manage that doubled burden of plastic waste in the medical market.
Disposable systems in health care, while cheap and convenient, have increased the volume of plastic waste from health care activities.
That waste "has been exacerbated during the pandemic [to] protect workers … and protect patients," Gregory Keoleian, director of the University of Michigan's Center for Sustainable Systems, told PN. Even in 2022, hospitals are still facing "major challenges in terms of managing operations and managing cost and staff."
That continued pressure on the health care system "doesn't favor a circular economy," Keoleian said.
Unfortunately, a true understanding of the excess plastic waste created by the pandemic is limited due to a lack of data. The WHO was only able to track health care waste volumes through data from the United Nations COVID-19 Supply Portal, which represents a small fraction of global procurement. The analysis didn't even consider the "substantially larger amounts" of COVID-19-related products that were procured outside of the U.N. system or pandemic-related waste generated by the public.
According to an assessment by the United Nations Development Programme, the pandemic increased the amount of hazardous health care waste by approximately 10 times more than the average volume of hazardous waste.
Many health care facilities also mistakenly classified 100 percent of COVID-19 health care waste as hazardous. According to WHO, about 85 percent of waste generated by health care activities is nonhazardous. The other 15 percent of health care waste is considered hazardous that may be infectious, toxic or radioactive.
"A lot of nonhazardous material ends up in hazardous waste streams because [health care workers] have to separate out those toxic and infectious products, things that were contaminated with blood," Keoleian said.
"Hospitals have an opportunity to do a better job of separating those with how they set up their systems, to set in place collection containers for recyclables," he said. "But that's time and space … and if the [recycling] markets aren't that strong, that's going to be difficult."
About three out of 10 health care facilities globally lack systems to segregate waste, the WHO analysis said.
The impact of poor waste management and climate change — of which the health care sector is a substantial contributor, accounting for approximately 4-5 percent of global greenhouse gas emissions — is felt disproportionately by impoverished communities that lack quality health care systems, it added.
Hospitals' priority is always "going to be the care of the patient at a low cost," Keoleian said. "These disposable products still meet their requirements to be sterile, deal with infection and being low-cost and convenient."
"The hospitals need to put in place recovery systems," he said. "But that's only going to happen if there's a market for those materials and the markets aren't strong.
"Virgin plastics feedstocks are still relatively inexpensive in terms of cost, and the end-of-life management cost for landfill disposal is also relatively low, while the costs of recycling are high," Keoleian said. "You're fighting the relatively low cost of the virgin resins, compared to recycled. It's not going to happen unless there's a driver."
The only way consumers could affect the medical market, Herrild said, is by targeting other tiers in the supply chain, like large medical device companies, with inquires forcing the companies to explain why they aren't allowing the use of reprocessed materials in their packaging "as a place to start."
Teel Plastics manufactures medical disposable components, including packaging parts, like endoscopic tool packaging, catheter needle sheets, needle protectors and functional components such as swab sticks, endoscopic surgery handles or retractors. The company doesn't receive any external reprocessed materials to incorporate in medical packaging, but it is using internally generated regrind with some customers, Herrild said.
Consumer-visible waste in health care is just part of the problem, he said.
"The part consumers aren't even aware of [is] perfectly clean, usable material … from the manufacturing process," he said. "[This is] material we can handle before it leaves the plant floor, but even in that instance, sometimes a medical device company will not allow it to go back into the product.
"There's a school of thought [in the medical device industry] that you can't get a sufficiently high-quality device or there's some kind of quality hit that you're going to take if you open the door for use of any type of internal or externally generated reprocessed material as a primary component or as part of a blend of components," Herrild said.
There is some validity to that thought process, he added.
"If you take a material and you extrude or injection mold it, grind it and then you do physical testing to failure … you see minor decreases in some values [like tensile elongation or modulus]," Herrild said. "But the reality is you shouldn't be designing anything where it has to operate at its functional limits in order for the device to be good. There's usually a pretty significant safety margin built in so if the tensile is 5 percent less, it shouldn't matter if you've engineered the device correctly."
Use of regrind "depends on how critical the device is to sustaining life and how easily the material handles being reprocessed, because some materials see bigger effects than others depending on how you handle it," he said.
It "doesn't make sense" to use reprocessed materials or regrind in implants or items that have body contact greater than three days, Herrild said. "Use of internally generated regrind for packaging and noncritical [components] are going to be a place to start, and it's going to have to be something people get comfortable with.
"For packaging, especially secondary or tertiary packaging that's not even touching the device, there really isn't a good reason to not use some amount of regrind where it can be demonstrated that it's handled well and that you have good-quality controls and there's no effect on the safety of the end device," he said.