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Sustainability in medical and healthcare applications

Q: Why is sustainability important in healthcare and medical applications?

Sustainability reduces the impact we have on our environment. The population of our planet is continually growing, so the demand for medical care will also increase. With the increase of this demand, the Earth's natural resources are being used up at an alarming rate. This will generate new problems such as polluted water sources and a lack of food sources.

Q: How much CO₂ is being emitted by the healthcare industry?

The Healthcare industry is one of the largest CO₂ emitters in the world, responsible for ca. 4,4% of total CO₂ emissions. It would rank as the 5th largest emitter if it were a country.

By: Jana Zietzling

The term sustainability dates to early 1700, created by the German Hans Carl von Carlowitz (1645-1741) for the long-term responsible use of natural forest resources. The concept of sustainability of course exists eternally but, while seen traditionally as “nice to have”, has recently become a first priority.

Many initiatives have been started to increase the sustainability of different industry segments. Recently, this topic has also arrived in the medical & healthcare market. In fact, the healthcare industry is estimated to be one of the biggest CO₂ emitters, responsible for ca. 4,4%^[1] of total CO₂ emissions globally. If it were a country, the healthcare sector would be the 5th largest greenhouse gas emitter in the world.

The aim, as well as the priority of applications in medical & healthcare, is to save lives, treat diseases and provide relief from pain. This industry is highly regulated with strict approval processes that avoid any comprise on the safety of human life or efficacy of the medical device. Accordingly, the development times of medical devices and pharmaceutical packaging can take many years up to almost a decade. This brings further complexity to incorporate sustainability in this industry.

How does IMCD approach sustainability?

At IMCD, we are on a mission to champion our partners’ journeys towards utilising sustainable solutions every day to make a positive impact on their organisation and the world. Our goals are to achieve a 15% reduction in GHG emissions per million-euro operating EBITDA by 2024 compared to 2019, as well as to be THE go-to distributor for sustainable products, value added services, expertise, and formulations globally. Recently, IMCD achieved Eco Vadis Gold status, established the community program IMCD Care and is publishing sustainability reports annually.

IMCD Advanced Materials provides sustainable solutions across markets.

Additionally, IMCD launched the Sustainable Solutions Framework, in which our experts provide a tool to de-complexify the different approaches to sustainability for our Advanced Material industry by breaking down the sustainable solutions into 8 categories: Biodegradable, CO₂ Reduction, Compostable, End-of-Life Enhancement, Recyclability, Renewable Source, Waste Reduction, Weight Reduction.

For medical & healthcare applications, we will only take a deep dive into the following 5 categories of our Sustainable Solutions Framework: Renewable Resources, Recyclability, End of Life Enhancement, Waste Reduction, and Weight Reduction.

Renewable resources for medical device applications

Approximately 99% of plastics are produced from chemicals which are connected to the refining and processing of fossil feedstocks extracted as oil or gas from land, or seabed. The estimates on the depletion year of fossil resources vary from 2050 to 2060^[2], providing that the demand is further increasing and no new reserves will be found. Not only the depletion of fossil resources but also the high CO₂ emission when fossil fuels are burnt is a big concern. Although only ca. 4-6%^[3] of oil and gas, estimated for Europe, are used in the production of polymers, the interest in considering renewable resources as an alternative to fossil resources is significant.

The feedstock of renewable resources can be derived, for example from agricultural products, starch, cellulose, and chitin. Renewable resource-based polymers might have different properties in comparison to traditional fossil-based polymers.

For medical device applications with strict regulatory requirements, a change in material would require recommencement of the time-consuming and costly approval process. Hence, drop-in solutions like polypropylene derived from used cooking oil could be an ideal option.

Similar to fossil oil, used cooking oil is broken down into its components on a molecular level. Due to this, PP derived from used cooking oil provides the same mechanical properties and maintains the same regulatory compliance as its fossil-based sibling. In order to track the whole supply chain of sustainable feedstock, IMCD is ISCC Plus certified and thus can carry out the mass-balance approach.

Recyclability of the medical waste

Every day, several thousand tons of medical waste are being created. Most of this waste is landfilled or incinerated currently. Recycling medical waste seems to offer a good option for creating more sustainable solutions.

Per definition, products are recyclable if they can be collected, sorted, reprocessed, and finally re-used for producing another item.

For a product to be collected and recycled, the material selection is essential in the design stage taking also into account the intended use of this product. Choosing a mono-material solution can help to enable the sorting of the products. Especially for healthcare and pharmaceutical packaging, there is a trend towards these considerations, for instance by abandoning metallised plastics in blister or tube packaging and replacing this with PP, PE, COC or Copolyester material solutions.

While mechanical recycling of plastics involves the re-granulation of material and maintains the molecular structure of the material, these products are not suitable for medical and healthcare applications because they lack medical approvals. During chemical recycling through the pyrolysis process, plastics are split into building blocks at the monomer level and can be used as feedstock to produce, for instance PP and PE. These can be considered as sustainable drop-in solutions for medical and healthcare applications as they offer the same technical specifications and medical compliances as their standard counterparts.

In the medical segment, there is often concern about contamination of disposed products with infectious materials like blood. As not all plastic products which are disposed in a hospital are contagious, for instance syringe caps, establishing sorting infrastructure in hospitals could be one approach. But from the regulatory point of view, the risk evaluation as well as the corresponding risk classification systems must be addressed first.

Besides medical waste occurring in hospitals, there is also a considerable source of waste deriving from the used drug delivery devices of homecare solutions. GSK approached this topic from 2011 until 2020 by establishing a return-to-manufacturer scheme for their inhalers and other manufacturers are setting up new recycling schemes for their drug delivery devices, too.

End of life enhancement

Historically, medical devices were made of glass or metal and were made reusable by steam sterilisation. With the growth of the population, the higher demand for healthcare treatments and the increasing concerns regarding blood transmitted diseases – like hepatitis and HIV – the call for developing single-use devices (SUD) became inevitable. The development of more complex devices, minimally invasive procedures and the simultaneous discovery of new materials like plastics boosted the trend towards SUD.

During COVID-19, the demand for single use PPE (personal protective equipment) increased significantly in order to limit further infections. This resulted in a massive increase of several million tons of waste. Considering reducing single-use items by designing these for durability and reusability could be a viable solution for achieving more sustainability in certain medical and healthcare applications.

In order to be safely reusable, the medical device must be capable of being appropriately reprocessed to remove contamination of microorganisms. A reprocessing in the medical and healthcare context could be disinfection or sterilisation of the device. In our “Selecting materials for medical device sterilisation” article, we de-complexify the challenge of matching the device material with the different sterilisation techniques.

Although there are certain applications in which reusable medical devices are meaningful, there are many devices, especially those used in certain invasive procedures, which will likely stay disposable to maintain safety and hygiene as well as to comply with the strict regulatory controls. Other aspects to consider are costs and time as well as usage of resources like water, logistics, and electricity of reprocessing methods which also have an environmental impact.

Waste management in the medical and healthcare segment

The WHO World Health Organization has been addressing the subject of medical waste for several decades. Medical waste is generated not only in hospitals but also in laboratories, research centres, nursing homes for the elderly and at collection services. The type of waste and by-products are divided into the following categories by the WHO as quoted below:

Infectious waste: waste contaminated with blood and other bodily fluids (e.g., from discarded diagnostic samples), cultures and stocks of infectious agents from laboratory work (e.g. waste from autopsies and infected animals from laboratories), or waste from patients with infections (e.g. swabs, bandages and disposable medical devices);

Pathological waste: human tissues, organs or fluids, body parts and contaminated animal carcasses;

Sharps waste: syringes, needles, disposable scalpels and blades, etc.;

Chemical waste: for example, solvents and reagents used for laboratory preparations, disinfectants, sterilants and heavy metals contained in medical devices (e.g. mercury in broken thermometers) and batteries;

Pharmaceutical waste: expired, unused and contaminated drugs and vaccines;

Cytotoxic waste: waste containing substances with genotoxic properties (i.e., highly hazardous substances that are mutagenic, teratogenic or carcinogenic), such as cytotoxic drugs used in cancer treatment and their metabolites;

Radioactive waste: such as products contaminated by radionuclides, including radioactive diagnostic material or radiotherapeutic materials; and

Non-hazardous or general waste: waste that does not pose any particular biological, chemical, radioactive or physical hazard.

Managing waste is a big challenge for the medical and healthcare industry. In addition to the aforementioned options of closing the loop by recycling as well as designing medical devices for reusability, the industry also investigates another aspect:

With the increase of vaccinations and the further developments of parenteral drugs, the usage of PFS (prefilled syringes) is becoming more popular. Traditionally, glass vials were the first choice for providing drug products, but these are usually overfilled to make sure the full dose will be administered to the patient. Prefilled syringes can be made of COC, are easier and faster to handle, reduced in risk and have improved dose control so that they help reduce drug product waste.

Reducing the carbon footprint with weight reduction

The idea of light weighting has been developed in the automotive industry to achieve a reduction in fuel consumption and improved car handling without making any compromises of function as well as passenger safety. This light weighting concept could be transferred to the medical and healthcare segment. Often, making medical devices less heavy comes with additional benefits like being more ergonomic and more user-friendly, which could have a positive impact on rehabilitation times and patient comfort.

Light weighting can be achieved by reducing the material in use. For instance, certain medical grades of PP, PMMA, or Copolyesters are available, which can be converted into devices with very thin walls due to their improved processability and flowability. At the same time, less energy is consumed, which further decreases the carbon footprint.

What should we do to build a sustainable future?

Plastic materials became indispensable in the medical and healthcare industry and are the base for developing and producing medical devices in order to save and improve patients’ lives.

It is a highly regulated market segment in which patient safety, hygiene, and infection control play a decisive role. Additional complexity arrives with the many players involved in this market often dependent on reimbursement schemes from healthcare insurance companies. This makes it difficult to find a one-fits-all solution in terms of the sustainability approach for medical and healthcare applications. However, one thing is for sure: a stand-alone approach of a single market player will likely not make the difference; it will require joint forces across the industry to achieve a “greener” segment!

With our sustainability approach, our broad product portfolio as well as our global reach, we are set up to help build this future. Please involve us early during your design phase in your considerations of evaluating the various aspects of sustainability in medical.

Sustainable future in medical and healthcare applications

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Fast facts

How does sustainability relate to healthcare and medical applications?

Healthcare and medical applications have a major impact on the environment. This is because they are resource-intensive and in almost constant use. As such, any potential improvements in sustainability can have a positive effect on the world.

Why is sustainability important in healthcare and medical applications?

How much CO₂ is being emitted by the healthcare industry?

Disclaimer: The information contained herein is to the best of our knowledge and belief. No warranty or guarantee is expressed or implied regarding the accuracy of information.

References:
1. Fletcher, Elaine Ruth (10/09/2019). Health care climate footprint is 4.4% of global emissions; larger than Japan or Brazil. Health Policy Watch.
2. Howarth, Jackson (02/12/2019). When will fossil fuels run out? Octopus Energy
3. Oil consumption. (21/05/2019). British Plastics Federation.

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About Jana Zietzling

Based in Hamburg / Germany, Jana Zietzling is the Head of Product Management Medical at IMCD. She has spent the last decade dedicated to the sales and marketing of medical polymers in Europe. Every day, she is passionate about saving and improving patient lives by supporting our customers in developing and producing various medical devices.