Consumer demand has little power in medical waste

There's a shared hope, both within and outside the plastics industry, that younger generations — millennials and Gen Z, specifically — will save the world from climate change by demanding sustainable practices from OEMs. But in the medical market — a major source of plastic consumption — consumers are disconnected from choosing the products used when they seek health care services.

"Health care is a space in which the end consumer of the device … the patients … have absolutely no say in what gets used," Christian Herrild, director of growth strategies at Teel Plastics Inc., told Plastics News.

When consumers require health care services, they can't go to a hospital and request it doesn't use a certain medical device OEM's product over pollution concerns, Herrild said.

"You can try to demand that and get the hospital to change the overall process," he said, "but at the end of the day, even if the hospital agrees with you and wants to make the change, if the [consumer's] insurance company won't pay more than 7.5 cents for a syringe, and the [OEM] is the only one that can meet that price point, it's not going to go very far.

"You end up with this screwy setup with how the market operates, compared to any other market," Herrild said. "There's a separation between the end user, the specifier and the people actually paying the bill."

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.

"Most things are overpackaged," Keoleian said, adding that there are significant opportunities to reduce virgin plastics in packaging for medical devices.

Source reduction or material substitution, he said, can "reduce the amount of plastic involved in certain products where possible. Use alternative materials that are more easily recycled."

Incorporating and increasing recycled content could differentiate suppliers to medical OEMs, but an incentive for companies to seek out sustainability is missing without direct consumer demand.

"A lot" of material goes into medical packaging, Herrild confirmed.

"If you have a syringe and do an injection, it might be that only the needle is technically contaminated waste, and the remaining syringe, which is a much higher quantity, could be recyclable," he said. "There are significant barriers there relative to infrastructure to actually segregate that and collect it back. … That issue really needs to be addressed before Teel or any other suppliers can take the material back and find a way to reuse it."

Another possible solution for more sustainable plastic use in health care is reusable systems, Keoleian said. Certain reusable systems could potentially be cheaper than current disposable systems, he said.

"But there [are] trade-offs," Keoleian said. "There are trays and things that could be reusable, but … it's a matter of time and convenience.

"We really need to return to reusable products," he said. "The proliferation of plastics is really problematic. It's a lost resource; it's taking space in landfills or we have plastics getting into the oceans and causing contamination there, impacting wildlife and marine systems.

"We know that certain systems like reuse for circularity; the advantages are very clear," Keoleian added. Medical devices or equipment "that are inherently circular and looking at a long service life … are going to reduce carbon emissions. There are tremendous benefits of plastics [in medical applications] in terms of their properties."

But the same physical, mechanical and thermal properties that make plastics great for health care applications "are constraints" that could limit recycling opportunities.

"Downcycling," by using recycled medical plastic waste in new market applications, might be a more functional solution, Keoleian added. But durable, reusable, plastic medical products have "the same challenge" at the end of an item's life cycle, he said.

Medical device companies design durable goods for functional use, not end-of-life recyclability, Bill Feldman, global commercial director at Americhem Engineered Compounds Inc., told PN. Americhem makes biocompatible resins and pigments for the medical industry, mostly in durable goods. It hasn't started developing materials used in durable medical devices for end-of-life circularity, Feldman said.

"You depend on [the materials] to be 100 percent perfect; that's a long cut to make that recyclable," Feldman said. "When you recycle, you're losing properties every time you heat it, and [medical devices] can't afford that.

"When a surgeon is cranking down on a device, you don't want it to bend," he added. "If this component fails in surgery, that patient is in trouble. High-temperate polymers with additives, low-friction additives, conducive additives [and] stiffening additives" complicate recycling at end of life.

Medical professionals want to "totally eliminate risk," he said. "A lot of surgical instruments are one-time use and they throw them away, and it's because they're so worried about contamination. They want it to be perfectly clean."

Since most of Americhem's compounds go into reusable devices, Feldman said, "we're not filling up the landfills. Well, we are, but it's very slow. … We still owe it to the business to figure out a way."

"On the specialty side, we see ourselves going there," he said, adding that he hopes the change starts with medical packaging and personal protective equipment.

A shift to circularity in the medical market would take an "alignment between technology, markets, policy and behavior," Keoleian said. Medical system staff at every level would "need to make behavior changes."

"Without some kind of regulation or shift in the market," Keoleian said he doesn't see an incentive for medical suppliers or OEMs to decrease disposable production.

"It's either going to make sense for the manufacturers that it's more economical to use recycled content or they need to seek out a customer base that wants to support a circular economy," he said.

"I'm not seeing any major innovations that are helping in regard to circularity" Keoleian said. "There are so many different resins. Theoretically, you could separate these with kinds of infrared systems, but the economics aren't working. … We really don't have strategies to recover those applications of plastic right now."

The plastics industry needs to take leadership in driving the market toward circularity, he added.

"I think we're going to see very slow progress until the industry itself recognizes that there needs to be a shift in their business model," Keoleian said. "The plastics industry wants to produce material — that's where their profit is. But it has to recognize they need to reduce production of virgin feedstock.

"It's got to come from secondary, recycled materials," he said. "The industry needs to be a part of that value chain. Without the industry making that shift, the markets aren't sending the signals to move from a linear economy to a circular economy."

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