Plastics in the health sector

Asia and the Pacific region

Issue: South West Healthcare is focusing on replacing single-use plastics with biodegradable and compostable products to reduce landfill waste.
Solution: Compostable straws, injection trays, kidney dishes, denture pots and lids and anesthetic trays were targeted for substitution. This included purchasing already available items and providing feedback to a supplier supporting the development of fully compostable anesthetic trays.
Outcome: In one year, South West Healthcare avoided sending 328,000 pieces of plastic medical waste to landfills. This included plastic straws, injection trays, kidney dishes, denture pots and lids, and anesthetic trays. South West Healthcare plans to continue partnering with suppliers of compostable clinical consumable items. They are currently helping to support EcoAid's development of a sustainable urinary catheter insertion pack.
Cost savings: N/A.
Link with details: Case study available on GGHH Connect.

Issue: The hospital noticed that straws were provided, by default, with every cold beverage—up to six per day for some patients. They set out to eliminate unnecessary use of single-use plastic straws,
Solution: The hospital worked with suppliers and undertook product testing to identify the best paper and flexible bioplastic alternatives.
Outcome: The hospital minimized plastic straw use and switched to an alternative paper product where possible. A small number of flexible plastic straws are issued by clinical staff for patients with specific needs. They avoided the use of 422,000 straws (84% reduction) per year, and reduced waste to landfill by 177 kilograms
Cost savings: 3,420 US Dollars in cost savings (68% reduction) per year
Link: Case study available on GGHH Connect

Issue: China has been developing green public procurement policies since approximately 2004, largely through the labeling of energy-efficient and environmentally friendly products, including detoxifying and reducing plastic products.
Solution: In order to create a systematic tool to guide and evaluate Chinese healthcare institutions’ sustainable procurement, Rock Environment and Energy Institute (REEI) collaborated with the China Environmental United Certification Center (CEC) to develop a Sustainable Procurement Evaluation Guidance for Healthcare Institutions in 2019.
Outcome: Since 2020, the Guidance, including Guidance text and an evaluation form, was launched. The Guidance has been shared with groups working on sustainable health care during domestic meetings.
Cost savings: N/A
Link: Sustainable Procurement Evaluation Guidance (2020).

Issue: The Maria Reyna-Xavier University Hospital Waste Management Team undertook a series of projects to reduce plastic use and plastic waste at the facility.
Solution and outcome: On the guard podium at the hospital entrance there is a sign “styrofoam packaging not allowed” posted. In addition to styrofoam, administrators are also taking steps to minimize the use of single-use disposable plastics. Hospital dietary staff eliminated clear plastic cling film and instead, they are using reusable plastic basket covers for food. The dietary team also asks the staff to bring their own spoons, cups, and other eating utensils to the cafeteria. The hospital has a linen repair area where hospital linens are repaired. If they are not usable, they are transformed into pillowcases or washing rags. Waste segregation systems for maximization of recyclability have been created. The hospital has a materials recovery facility that manages some of the waste the hospital generates. Sharps containers are being used as building blocks by pouring cement inside of them.
Cost savings: From July 2011 to May 2012, income from the Materials Recovery Facility of the hospital totaled 201,526 Philippine pesos (approximately 4,798 US Dollars)
Link: Waste Minimization and Segregation to be Good Business (2013)

Issue: During the COVID-19 pandemic, the hospital developed a project to improve the rationale for and efficient use of personal protective equipment (PPE).
Solution: Strategies included dispensing, controlling, and forecasting PPE; training staff on proper PPE use, waste management, and disposal; and management and reprocessing of PPE in accordance with the World Health Organization (WHO) guidance, and use of alternative products.
Outcome: Hazardous waste was reduced by over 10 tons (10,821kg), and resources were used more efficiently.
Cost savings: These actions resulted in savings of almost $220,000 US Dollars.
Link: Optimization of Personal Protective Equipment: Reducing the Impact of Healthcare Waste Amidst Pandemic.

Issue: Every year, the Philippines produces 2.15 million tons of plastic waste, more than a third of which leaks into the open environment, while another third is thrown into landfills. Health care contributes significantly to the flood of plastic waste, largely through an increase in single-use plastic. All of this single-use plastic is costly as well. The problem worsened during COVID-19, as single-use plastic waste increased dramatically, particularly at the expense of PPE.
Solution: St. Paul Hospital in Iloilo asked its Linen Department to research and develop reusable PPE to adequately protect frontline workers without creating significant amounts of waste.
Outcome: A significant amount of waste was avoided as a result of the intervention.
Cost savings: From April to December 2020, St. Paul’s saved 65 million Philippine Pesos by switching to disposable PPE. Between January and November that year, the hospital also reduced waste expenses by 33.7% through recycling.
Link: Article | Plastic waste from hospitals: An emergency case (2022)

European region

Issue: In 1992 the Vienna City Council decided to phase out PVC from all city funded projects and institutions.
Solution: The Vienna Hospital Association, Austria, committed to phasing out PVC in 1992 including in packaging, building materials, and medical devices.
Outcome: After more than 15 years of this policy, the PVC share in medical devices has dropped from approximately 10% of total weight of medical waste in 1992, to 2.5% in 1995, to just 0.6% in 1999. The proportion of PVC packaging material was reduced from 3.6% to 0.04%. Two of the Vienna Hospital Association hospitals - Glanzing Paediatric Hospital and Preyer Paediatric Hospital - serve as examples of PVC and phthalate elimination. They have succeeded in becoming almost completely PVC-free. NICU’s in the Vienna General Hospital and Danube Hospital are also successfully phasing out PVC / DEHP containing devices based on the experiences gathered by the Glanzing Clinic. In addition to PVC-free medical devices, the Vienna Hospital Association strategy also involves construction work, where PVC has been avoided for flooring and window frames since 1990.
Cost savings: N/A.
Link:
- Vienna Hospital Association Phase Out Policy on PVC, page 16 (2004).
- PVC/DEHP phase-out is possible anywhere in Europe: Model hospitals show how to succeed, page 1 (2007).

Issue: Every year Belgian hospitals throw away millions of baby feeding bottles after a single use, creating more than 300 tonnes of high-quality plastic material which are then incinerated. The project aimed to recycle this material stream by identifying and solving the legal, technical, and logistical obstacles in the way.
Solution: An NGO and the hospital started the 'Baby Bottle Reborn' pilot project in 2013. Instead of incinerating plastic bottles after one use, the hospital is recycling the material.
Outcome: The disposable bottles are now sorted at the hospital before being recycled into new raw materials. From the experiences gathered in this project, it is hoped that the project can be rolled out to other hospitals.
Cost savings: N/A.
Link:
- Second life for baby bottles, page 100 (2014).
- Non toxic healthcare, page 32 (2019).

Issue: The goal was to eliminate PVC in hospital IV bags. The initiative came from the renal unit because dialysis patients are exposed to high levels of Di(2-ethylhexyl)phthalate (DEHP) due to long-term medical procedures. Patients on dialysis receive multiple treatments with intravenous liquids; therefore the exposure from these IV bags is significant.
Solution: Identify and purchase alternative IV bags that are not made of PVC. The alternative is made of multi-layer plastic from polyethylene (PE), polyamide (PA) and polypropylene (PP).
Outcome: The Czech Hospital Na Homolce has switched to PVC-free IV bags as of November 2003.
Cost savings: The initial costs of PVC-free bags were higher, however the hospital managed to negotiate a competitive price with one of the major IV bags suppliers. After 3 years, the hospital pharmacy - the central purchasing unit - completely switched to PVC-free IV bags.
Link: Preventing Harm from Phthalates, Avoiding PVC in Hospitals, page 17 (2004).

Issue: Hospitals produce large amounts of plastic packaging waste: many products used on a daily basis in a hospital are wrapped in plastic to ensure sterility and therefore patient safety. Sample tests at Aarhus University Hospital (AUH) indicated that 18 % of their solid waste is clean plastic packaging - approximately 400 tonnes annually. Many waste management facilities are reluctant to work with hospital plastic waste because of the complex and varied compositions of the plastic.
Solution: The Aarhus University Hospital decided to collaborate with suppliers to overcome the reluctance and concerns surrounding health care plastic recycling. Bottles used for irrigation fluids were chosen as a baseline product since they are used frequently everyday within hospitals and are a relatively simple product.
Outcome: AUH and the Central Denmark Region tested a set of generic criteria to support increased recyclability by applying these criteria to different tenders. They learned that introducing recyclability criteria in tenders does not lead to higher prices. AUH’s first test in a joint national tender showed that by setting recycling criteria, the Central Denmark Region actually achieved a 24% cost saving. It will take time to implement changes in any medical product in part because the European approval system process for medical products takes three years, and because tenders typically run for 3-4 years.
Cost savings: Central Denmark Region achieved a 24% cost saving compared to previous offers on the same product (bottles for irrigation fluid).
Link: Sustainable Health in Procurement Project (SHiPP) case study: Aarhus University Hospital, Denmark, page 6 (2019)

Issue: To reduce the waste associated with disposable diapers.
Solution: The maternity team at Center Hospitalier (CH) Angoulême (France), together with the management team and the hygiene team have engaged with suppliers to introduce washable reusable nappies in the maternity department.
Outcome: The hospitals switched from disposable to reusable cloth diapers that they designed. They also give parent workshops and information on ecological brand soaps for cleaning the diapers
Cost savings: Approximately 1,500 babies are born every year at CH Angoulême, and the maternity team has ordered 300 washable nappies at a cost of 8,000 euros. The anticipated maintenance costs are 3,500 euros per year (including the purchase of new stock). By washing the nappies at their own facility (at 60º and using eco-labelled detergents), they will reduce their waste management costs.
Link:
- Measuring and reducing plastics in the health care sector, page 56 (2021).
- Article (in French)https://www.jagispourreduire.com/initiative-locale/centre-hospitalier-de-girac/

Issue: Maternity ward staff at Angoulême Hospital Center (FR) wanted to reduce vulnerable patients’ exposure to harmful substances by reducing plastics in the maternity services.
Solution: They replaced food containers and cutlery with reusable porcelain and stainless steel alternatives, purchased and served products in bulk, e.g. jam and cereals, purchased fruit juice and served water in glass containers.
Outcome: Exposure to plastic products was reduced for patients.
Cost savings: N/A.
Link: Sustainable food contact materials in the European healthcare sector, page 15 (2021)

Issue: To address the issue of supply chain disruptions for disposable surgical and isolation gowns during the pandemic, and to address waste issues.
Solution: The hospital began using two models of reusable gowns: one for high-level protection in high-risk processes and one for regular procedures. The general-use gowns are used in greater quantities; for this product, they purchased polypropylene (PP) fabric and contracted a factory to manufacture their own design.
Outcome: The hospital discovered that they could reuse their general-use disposable gowns at least 20 times and dramatically reduce gown use for high-level protection.
Cost savings: That reusable high-level protection gown saved the hospital 30-60%. They also discovered they could safely reuse their general-use gowns at least 20 times, which saved approximately 67%.
Link: Measuring and reducing plastics in the health care sector, page 55 (2021).

Issue: To reduce plastic use and waste in the maternity ward.
Solution: The Maternity Unit at Clinical University Hospital Virgen de la Arrixaca uses reusable glass bottles to give breast milk to neonates.
Outcome: The bottles are washed and sterilized in their own facilities. In addition, the majority of artificial baby milk (infant formula) is purchased in glass containers. The unit’s human milk bank only uses glass containers for pasteurization and storage of milk. In addition to being reusable, the containers are produced locally and also support the local economy.
Cost savings: N/A.
Link: Sustainable food contact materials in the European healthcare sector, page 17 (2021)

Issue: To reduce food service waste.
Solution: The hospital banned disposable dishes from all their cafeterias and instead introduced reusable food containers using a deposit return system, through reCIRCLE.
Outcome: More than 4,300 kg of plastic waste will be avoided every year, corresponding to approximately 22 tonnes of CO₂ emissions.
Cost savings: Every year, 44,000 Swiss Francs (approximately 40,800 Euros) are saved thanks to this change.
Link: Sustainable Development Annual Report (2019).

Issue: The Stockholm County Council passed a resolution to phase out PVC in 1997.
Solution: PVC was identified as a priority to be avoided in the procurement of new products as part of a sustainable purchasing policy.
Outcome: The program prohibits the use of PVC unless a very strong, written explanation for its purchase and use is provided as part of the purchasing process. In many disposable medical products, PVC has been avoided, with a few exceptions such as tubing and blood transfusion bags. At 32 neonatology units in the country, feeding tubes used for the long-term treatment of babies are made of non-PVC materials. PVC gloves softened with phthalates were substituted with nitrile gloves.
Cost savings: N/A.
Link: Preventing Harm from Phthalates, Avoiding PVC in Hospitals (2004).

Issue: A consultant analyzed the plastic waste stream from OVLG hospital in Amsterdam. The analysis concluded that disposable packaging makes up over 50% of plastic waste and is composed of nearly 15 different types of plastic materials.
Outcome: The largest estimated plastic type used in disposables packaging based on weight were Polypropylene (PP), followed by Polyethylene Terephthalate (PET), Mixed High Density Polyethylene (HDPE) with Coated Medical Grade Paper, and Polyvinyl chloride (PVC).195 In addition, 45% of plastic products were not labeled and nearly 20% of the plastic waste was composed of mixed materials either (different kinds of plastic or plastic combined with other materials such as paper and aluminum).
Link: Non-toxic healthcare, page 32 (2019)

Issue: To address the over-use of non-sterile gloves, and the resulting waste and GHG emissions.
Solution: Developed an educational awareness programme for staff. Guidelines were updated and training and resources developed for multiple staff groups which included a risk assessment matrix for glove use when administering medications.
Outcome: The central venous line (CVL) catheter infection rate remains within normal parameters. Per week, 36,608 fewer gloves have been ordered. In 10 months, 21 tonnes of plastic has been reduced.The central venous line (CVL) catheter infection rate remains within normal parameters. 36,608 fewer gloves were ordered per week. In 10 months, 21 tonnes of plastic was reduced. There has been a reduction in staff-reported occupational health issues for hand or skin-related problems.
Cost savings: In 10 months, 90,000 Pounds were saved.
Link:
- Case Study: The Gloves are Off! (2019)
- Video: Great Ormond Street Hospital – reducing single use plastics case study (2019)

Issue: To reduce the waste associated with single use food service ware.
Solution: Newcastle replaced disposable plastic bowls, plates, straws, polystyrene boxes, stirrers, coffee cups and cutlery used in patient catering with reusable ceramic, wood, and stainless steel options in one of their hospitals.
Outcome: Removed over 1.9 million items from being disposed of annually, including 513,600 polypropylene bowls, 490,800 polypropylene lids for bowls, 312,000 polystyrene bowls, 371,000 plastic spoons, and 216,000 plastic knives.
Cost savings: Saved 68,000 Pounds in the first year. The initial cost was £12,000 (approximately €14,000), but annual savings of £80,000 (approximately €93,000) were achieved with a payback period of the initial investment of just two months.
Link: Case study available on GGHH Connect.

Issue: To remove avoidable single-use plastics from hospital's catering.
Solution: The hospital changed cups to reusable mugs and reintroduced china coffee cups. They switched plastic plates and cutlery for biodegradable options, and stopped giving out straws. They introduced a ‘latte levy’ and a discount for using reusable mugs.
Outcome: Percentage of reduction of cutlery (77.5%), plates (43.1%), and cups (66.7%).
Cost savings: N/A.
Link: Case study: Sheffield Teaching Hospitals (2017)

Issue: The Yorkshire Ambulance Service NHS Trust in the UK decided to make changes in their food service operations.
Solution: They conducted an audit to see where plastic was being used in their food services. They researched alternatives, opened a dialogue with suppliers, and included a specification for plastic-free packaging in new tenders.They also engaged staff. They replaced plastic milk bottles for glass ones that can be returned to the supplier and reused. They introduced a borrowable cup program for a refundable deposit of 1 Pound, replaced disposable plastic plates for reusable ones, replaced plastic cutlery for stainless steel alternatives, installed a water refill point to encourage use of staff’s own bottles. Single-use plastic condiment sachets of ketchup, vinegar, sugar, and salt were replaced with larger, refillable containers and they replaced cardboard packaging in their food deliveries with reusable crates that can be returned to the supplier.
Outcome: They removed approximately 206,000 single pieces of plastic a year from their canteen and reduced their waste by approximately 3.5 tonnes annually. They reduced the 104,000 disposable cups that were previously being used annually.
Cost savings: This reduction represents an annual saving of 12,000 Pounds (approximately 14,000 Euros) in procurement and disposal costs.
Link: Sustainable food contact materials in the European healthcare sector, page 22 (2021).

Issue: During the pandemic, mask use skyrocketed. Every day many hospitals are using between 10,000 and 100,000 facemasks, and ambulance services are using 10,000 to 20,000. The aim of this pilot was to ensure a sustainable way for the organization to continue to protect staff and the public through reducing reliance on single-use facemasks, specifically Type IIR facemasks. This project provides a blueprint for procurement in a Greener NHS.
Solution: Facemasks supplied by accredited and certified British manufacturers and suppliers were trialed. Some were face coverings working towards becoming Type IIR accredited, and others already have Type IIR accreditation. Some of the facemasks have a viral coating. Breathability, wearability, comfort, traceability, and washability were taken into account. Participants also assessed the circumstances under which they wore the masks, and how safe they felt in them, as well as their useability.
Outcome: As the pilot was developed, more Trusts and healthcare organizations wanted to get involved. During this pilot, over 60 healthcare organizations have been involved in trialing reusable facemasks across the UK.The carbon impact of reusable masks is dramatic, with transport to the UK being the highest source of emissions from single-use masks. The 1,250 facemasks used in this pilot trial replaced 41,920 single-use facemasks, or the equivalent of 1.467 tonnes of single-use facemasks, and saved up to 41 tonnes/CO2e of carbon emissions.
Cost savings: Savings were realized by not procuring the masks as well as reducing the cost of the waste disposal (between 400 and 1,000 Pounds per tonne) in addition to the reduction in ancillary staff time for bag removal.
Link: Reusable Facemasks Trial + direct link (2023).

Latin America and the Caribbean

Issue: Uniforms were going directly to the landfill after their useful life when they could be further recycled.
Solution: In 2020 they started a project to recycle used uniforms. First, they started with four units and then proceeded to add all 32 units that are part of the Brazilian UnitedHealth hospitals. They used the textiles to produce new threads to make bags, sheaths, etc.
Outcome: The organization avoided sending 261 tons of waste to landfills and emitting 343.31 tons of CO₂.
Cost savings: N/A.
Link: Hospitales que curan el planeta, page 175 (2023).

Issue: To address generated waste generated and the space required to manage the volume of serum containers, and other plastic containers used at the facility
Solution: The facility contacted a local recycling company that was able to handle the materials generated by the facility and meet their needs.
Outcome: In the first month alone, they collected 146 kg of plastic waste.
Cost savings: N/A.
Link: Case study available on GGHH Connect.

Issue: To reduce the use of disposable sharps containers.
Solution: The hospital worked with a company that helped them install special high-density plastic containers in areas of sharp waste. When full, the containers are treated with a sanitization and disinfection process and returned for reuse.
Outcome: Disposable rigid sharps containers were replaced with reusable plastic containers. Containers may be used up to 600 times. In three months they reduced their use of 304 rigid disposable containers.
Cost savings: N/A.
Link: Hospitales que curan el planeta, page 26 (2022).

Issue: To goal was to reduce the use of disposable PVC single-use breathing masks. The process of replacing the disposable face masks began in 2015 when the Maintenance and Environment Department noted that large amounts of single-use face masks were discarded as biohazardous waste. The department also highlighted that these masks were made from polyvinyl chloride (PVC), a material that needs to be prioritized for replacement due to its composition and environmental impact when treated as waste.
Solution: Switch from single-use PVC Bag-Valve-Mask (BVM) Ventilation to reusable silicon alternatives.
Outcome: 13 tons of avoided PVC per year.
Cost savings: 200,000 US Dollars in savings per year.
Link: Chemicals of concern for the health sector, page 13 (2020).

Issue: To reduce the use of unnecessary single-use trocars.
Solution: Switch from single-use plastic trocars to reusable metal trocars.
Outcome: Worked with health professionals to ease concerns about the switch and eventually won widespread adoption of reusable trocars.
Cost savings: $660,000 US Dollars in savings per year.
Link: Plastic in Healthcare Reduction & Elimination (2024)

Issue: To eliminate unnecessary plastic bags used for internal delivery of pharmaceuticals and reduce waste.
Solution: Acquired delivery carts to use instead of plastic bags.
Outcome: Significant plastic bag reduction as a result of the intervention.
Cost savings: Annual savings of 1,840 US Dollars from not buying plastic bags.
Link: Hospitales que curan el planeta, page 106 (2023).

Issue: In 2018, the Ministry of Environment and Sustainable Development of Colombia and a private company invited the Fundación to participate in a pilot project called “Remanufacturing of used catheters.” The Fundación was the first Colombian health institution to experiment with this strategy.
Solution: Catheters are sent to the United States for reprocessing. Colombian regulations do not allow them to be used in Colombia.
Outcome: Since 2018, 670 catheters of different sizes, equivalent to 1,100 kilograms of biomedical waste, have been diverted from landfills (after sterilization treatment), which is the equivalent of reducing emissions of 1,565.71 kg of CO₂e and 62.6 kg of CH₄. The facility also received national recognition for environmental responsibility and innovation.
Cost savings: The Fundación earns 10 to 15 US dollars for selling each catheter to the remanufacturing company. Reduced disposal costs also benefit the Fundación, which translates into annual savings of 1,084 US Dollars, based on the money that was not paid for treatment and final disposal.
Link: Hospitales que curan el planeta, page 166 (2022).

Issue: To address the unnecessary use of single-use plastic bags and to reduce the toxicity of the bags they use, the sustainability committee worked to identify alternatives.
Solution: Since 2021, the pharmacy has stopped using plastic bags for internal medicine distribution.
Outcome: Before this they used 450 roles of plastic bags per year. Since 2022, the pharmacy area has been working with different providers of drugs, services, and other materials, looking for the one that offers the best PVC and phthalate-free materials.
Cost savings: $1,840 US Dollars saved per year as a result of not purchasing plastic bags.
Link: Hospitales que curan el planeta, page 105 (2023)

Issue: The hospital identified an opportunity to reduce its waste in plastic bags.The hospital bought approximately 455 kilos of plastic bags in different sizes annually. These bags were used to distribute special feeding formulas (milk, enteral formulas, etc.) and pharmaceutical products to families. They were also used for patients with ostomies.
Solution: The hospital designed reusable cloth bags and asked the patients to sign an agreement to use them on their next visits.
Outcome: The hospital was able to gradually reduce the consumption of plastic bags, in accordance with a hospital directive issued by the executive president, which requires that alternatives for single-use plastics be investigated.
Cost savings: N/A.
Link: Hospitales que curan el planeta, page 106 (2022).

Issue: To reduce single-use plastic food service ware to eliminate waste. In 2022, the hospital decided to address the increased use of expanded polystyrene and polypropylene products in the food service. This increase came from the use of single-use plates, cups, and cutlery for patient and workers' food.
Solution: Replace single-use cups, plates, and spoons used in catering services for patients and hospital workers with reusable melamine cups, plates, and spoons.
Outcome: In the first year, they bought 6,400 reusable plates, 8,800 cups, and 17,000 spoons that were before discarded as waste.
Cost savings: Each year they have saved more than 63,000 pesos (3,827 US Dollars).
Link: Case study available on GGHH Connect

North American region (US & Canada)

Issue: To eliminate the use of disposable sequential compression devices due to cost and waste.
Solution: Switched to reusable sequential compression devices from disposable. Took the opportunity at the end of a contract in 2019 to approve the vendor to reprocess used sequential compression devices to assist Vancouver Coastal Health to make the switch.
Outcome: 60,000 devices diverted from landfills yearly, and the workload for nursing staff was reduced.
Cost savings: 6.3 million US Dollars in cost savings over seven years.
Link: Circulating change link and Webinar link at 41.50 minutes (2024)

Issue: To address the shortage of PPE during the pandemic, A research project at Allegheny Health Network aims to facilitate the widespread use of elastomeric masks.
Solution: The hospital switched from disposable N95 facemasks to industrial style elastomeric P100 masks and is conducting an ongoing study. Elastomeric masks with disposable P100 filters were found to be superior to disposable N95s for the protection of health care workers.
Outcome: Within one month, the Network was able to reduce the number of N95s needed by 95%,
Cost savings: The cost was 10 times less per month than disinfecting and reusing N95 masks, which are intended for only one use.
Link: Industrial masks tested at Allegheny Health Network hospitals (2021).

Issue: To eliminate the use of single-use plastic trocars for laparoscopic surgeries.
Solution: New lightweight, low profile reusable trocars made of stainless steel were substituted for disposable trocars.
Outcome: Waste diverted in 2012: 470 pounds of regulated medical waste.
Cost savings: Estimated annual cost savings: over 275,000 US Dollars.
Link: Case study: Reusable Trocars case study (2013).

Issue: Children’s sought to align two aspects of its mission: supply chain reliability and reducing Chemicals of High Concern (CoHC) in the pediatric population. Over the years, the hospital faced challenges in attempting to convert intravenous fluid (IVF) bags to polyvinyl chloride (PVC)- and phthalate-free versions due to supply issues related to natural disasters, contractual challenges, and the availability of products that do not contain chemicals of high concern (CoHC) that have been proven to be harmful to pediatric patients.
Solution: The organization used a standardized methodology to evaluate the new products and engage stakeholders, including those with clinical, operational, financial, and sustainability impacts.
Outcome: Children’s was able to utilize its GPO agreement to convert to a new IVF bag supplier that provides products that do not have CoHC, achieved cost savings, and manufactures these products within the continental US.
Cost savings: The hospital realized 276,000 US Dollars in annual savings.
Link: Protecting High-Risk Patients From Unsafe Chemicals: IVF Bag Conversion (2023).

Issue: To address the waste and cost associated with single-use trocars.
Solution: In 2011, a medical device manufacturer developed a new lightweight, low profile reusable trocar made of stainless steel rather than single-use plastic. The supplier’s reusable trocar provides a cost-effective alternative to traditional, single-use, disposable trocars.
Outcome: Waste diverted in 2012: 470 pounds of regulated medical waste. Many of the younger doctors gravitated toward using the reusable version while more experienced surgeons preferred to stick with the disposable suggesting culture change is important in implementation.
Cost savings: Estimated annual cost savings was over 275,000 US Dollars per year.
Link: Case study: Reusable trocar (2013).

Issue: To eliminate dialysis patient exposure to plasticizers in medical products.
Solution: Identify PVC and DEHP-free alternatives.
Outcome: Replaced PVC and DEHP containing split tip catheters with alternatives that did not contain PVC and DEHP.
Cost savings: 43% annual cost savings.
Link: Case study: PVC-free and DEHP-free split-tip chronic dialysis catheters (2010).

Issue: Kaiser Permanente, one of the US's largest nonprofit health systems, has prioritized healthy flooring for more than 15 years. They sought to eliminate worst-in-class plastics like PVC and other chemicals and materials of concern from flooring.
Solution: Choose flooring based on criteria that select products without chemicals and materials of concern, like worst-in-class plastics. These criteria became standards that have since been integrated into the Kaiser Permanente national design and purchasing criteria holistically.
Outcome: More than 50% of Kaiser flooring meets the criteria. According to Kaiser, healthy flooring will:
- Decrease patient, staff, and visitor exposures to harmful chemicals that have links to asthma, cancer, and developmental impacts, among other health effects;
- eliminate the need for toxic floor strippers and finishes;
- reduce maintenance costs and time;
- decrease the total cost of ownership; and
- drive greater transparency in the flooring materials market.
Cost savings: N/A.
Link: Article: Flooring free of toxic chemicals (2019).

Issue: In 2007, the National Product Council and the IV Sourcing and Standards Team decided to transition from the a new IV administration sets product line because clinical trials demonstrated that the new products were easier to use, and the new platform offered a DEHP-free alternative.
Solution: Transition product lines with the same manufacturer in order to improve performance and eliminate DEHP. This is a transition of over 3,000 miles of tubing per year.
Outcome: At the end of 2008, Kaiser Permanente’s California and Hawaii regions had converted approximately 85% of their IV admin sets to DEHP-free.
Cost savings: N/A.
Link: Case study: DEHP Minimization in Intravenous (IV) Administration Sets – California and Hawaii Regions (2008).

Issue: To eliminate PVC plastic in patient identification bands.
Solution: Identify new patient identification bands made with high-density polyethylene (HDPE).
Outcome: They reduced exposure to life cycle concerns with the material PVC.
Cost savings: The realized cost savings of 1.6% over the two year life of contract.
Link: Case study: PVC/DEHP-free patient identification bands (2009).

Issue: Reduce the use of PVC in signage throughout the health system. Kaiser Permanente decided to take action on the material and illumination of their wayfinding signage.
Solution: They switched from PVC lettering to all digital printing for interior signs, and switched from neon to LED lighting on large illuminated exterior signs for 12 sites.
Outcome: Eliminates consumption of 800 cubic feet of vinyl per year for signage lettering and 86 percent energy savings from LED exterior signage lighting.
Cost savings: Over 46% savings in total cost of ownership and energy reduction. LED uses 14% of the energy required for neon signs and lasts 12 years before servicing is required when compared to. neon lighting, which must be serviced every 18 months.
Link: Case study Reducing Energy and PVC Consumption (2011).

Issue: To reduce vulnerable patient and employee exposure to harmful chemicals that are known to pose health risks. Chief among these is reducing DEHP exposure to our most vulnerable patients, those in neonatal and pediatric intensive care units.
Solution: A standard sourcing effort was undertaken with an emphasis on identifying alternative suppliers and products that are PVC and DEHP-free for plastic items in the neonatal intensive care unit / pediatric intensive care unit (NICU/PICU). The supplier community has yet to prioritize the elimination of DEHP from products, but there are high-quality clinically acceptable product options available, but they are limited in depth and scope.
Outcome: The hospital increased its usage of DEHP-free products in the NICU/PICU environment from zero to 36% of respiratory therapy sub-categories. Subcategories that are DEHP-free are: filtered isolation valve kits, infant nasal continuous positive airway pressure (CPAP) system and cannula, nebulizer adaptors, and water traps.
Cost savings: The selected vendor offered 23% cost savings over the old vendor.
Link: Case study: Reduction of Di-2 ethylhexyl phthalate (DEHP) in respiratory therapy products (2011).

Issue: Use of blue sterile wrap for sterilization.
Solution: Substitution to rigid metal containers. They transitioned 66% of surgical instrumentation to reusable rigid containers in the OR.
Outcome: The solution increased workflow and utilization, reduced waste volume in the OR, and 5,606 lbs of disposable blue wrap in 2010 was avoided.
Cost savings: Estimated 29,843 US Dollars in avoided blue wrap purchase and avoided waste disposal fees.
Link: Case study: Rigid sterilization containers for surgical instrumentation (2010).

Issue: The OR staff had experienced problems with the previous fluid management system and wanted to find a safer way to manage fluid waste in the OR.
Solution: They purchased a new fluid management system for the hospital’s 6 ORs. The equipment is a closed fluid waste management system.
Outcome: The new system has not only addressed the safety concerns of the organization, but it has also reduced waste. The system uses an integrated canister that never has to be replaced.
Cost savings: Compared to disposable suction canisters that need to be replaced for each surgery, the integrated canisters save the hospital on the cost of supplies.
Link: Case study: North Suburban Medical Center: Fluid Management in the OR (2011).

Issue: At Ronald Reagan UCLA Medical Center, on average approximately 6,000 gowns were being used per day (2.2 million gowns per year). The reusable gowns offer more comfort and better protection than their disposable counterparts, and can be laundered and reused 75-100 times. The facility set out to reduce waste associated with these single-use isolation gowns.
Solution: Custom reusable isolation gowns were designed through an intensive and collaborative process involving nursing staff, unit directors, two competing gown vendors, infection control staff, and the vendors that process the product.
Outcome: After a six-month trial, the final gown design included snaps instead of tie-downs, smaller cuffs, and was comprised of 99% polyester and one percent carbon fiber to reduce static. The gowns are reversible which saves time for laundering.
In 3 years, a total of 297 tons of waste has been diverted from landfills.
Cost savings: In 3 years, over 1.1 million US Dollars have been saved just from procurement.
Link: Case study: Reusable isolation gown project (2013).

Issue: In 2007, the University of Maryland Medical Center (UMMC) performed a waste audit and found that the facility produced 10 million pounds of waste annually, and was spending 1.35 million US dollars on waste disposal. They targeted single-use surgical gowns, drapes, stainless steel cups, basins, and bowls for reuse.
Solution: UMMC has been using reusable gowns and basins in their operating rooms (OR) for 15 years. UMMC uses a company which provides reusable products and supplies to healthcare facilities and sterilizes and repackages the products at a local plant. The company provides UMMC with surgical gowns, drapes, stainless steel cups, basins, and bowls. Each year, UMMC staff review the OR packs to ensure that all items in the packs are being used. If items are not being used, they work with the company to remove the unnecessary items and streamline the kits.
Outcome: 138,748 pounds of waste diverted in 2010 and 1.5 million pounds of waste diverted since 2000.
Cost savings: Estimated savings of 38,800 US Dollars in avoided waste costs in 2010. Estimated savings of 722,250 US Dollars in avoided waste disposal costs since 2000. Average of 39,000 dollars US Dollars in returned instruments per year.
Link: Case study: The University of Maryland Medical Center: Reusable Textiles in the OR (2010).

Reduce everything where possible!

Eliminate	Reuse/ redesign for reuse/ reduced toxicity	Recycle/ redesign for recycling
Plastics drinks bottles	Diapers/nappies	Syringes
Plates cups bowls	Surgical gowns	Medical packaging
Plastic drinks straws & stirrers	Surgical masks	Toothbrushes, & other toiletry products
Plastic toiletry sachets	Eye shields	IV tubing and accessories
Plastic bags	Other PPE	Blood and other medical bags
Black plastic packaging trays	Packaging trays	IV bottles & other sterile liquid bottles
	Toiletry bottles	Dialysers
	Toothpaste tubes	Rapid test kits
		Blister packs
		Other sanitary products
		Gloves

Asia and the Pacific region

Australia - South West Healthcare

Australia - Wesley Hospital

China - Environmental United Certification Center

Indonesia - Cahaya Qalbu Clinic in West Java

Philippines - Maria Reyna-Xavier University Hospital in Cagayan de Oro City

Philippines - Mary Johnston Hospital

Philippines - St. Paul Hospital in Iloilo

European region

European region best practices by hospital department

Austria - Vienna Hospital Association and pediatric centers

Belgium - University Hospital of Leuven

Czech Republic (Czechia) - Na Homolce

Denmark - Aarhus University Hospital

Finland - Helsinki University Hospital

France - Center Hospitalier (CH) Angoulême (Disposable diapers)

France Center Hospitalier (CH) Angoulême (Plastics in matermity services)

Spain - University Clinical Hospital Virgen de la Arrixaca (Supply chain disruptions)

Spain - University Clinical Hospital Virgen de la Arrixaca (Glass baby bottles)

Switzerland - Centre hospitalier universitaire vaudois, CHUV (Lausanne University Hospital)

Sweden - Stockholm County Council

The Netherlands - Onze Lieve Vrouwe Gasthuis (OLVG) Hospital in Amsterdam

United Kingdom - Great Ormond Street Hospital NHS Foundation Trust

United Kingdom - Newcastle Upon Tyne Hospitals NHS Foundation Trust

United Kingdom - Sheffield Teaching Hospitals

United Kingdom - Yorkshire Ambulance Service NHS Trust (food service operations)

United Kingdom - Yorkshire Ambulance Service NHS Trust (use of facemasks)

Latin America and the Caribbean

Brazil - Brazilian UnitedHealth Hospitals

Chile - Hospital Las Higueras

Chile - Hospital Penco Lirquén

Colombia - Fundación Valle del Lili (Breathing masks)

Colombia - Fundación Valle del Lili (Sterilization wraps)

Colombia - Fundación Valle del Lili (Trocars)

Colombia - Hospital Departamental San Antonio de Pitalito

Colombia - Hospital Fundación Clínica Shaio

Colombia - San Antonio de Pitalito

Costa Rica - Hospital Nacional de Niños Dr. Carlos Sáenz Herrera

Mexico - Salvatierra Hospital

North American region (US & Canada)

Canada - Vancouver Coastal Health

United States - Allegheny Health Network

United States - Beaumont Health System’s Royal Oak Hospital

United States - Children’s Hospital

United States - Corewell Health Beaumont Troy Hospital, Michigan

United States - Kaiser Permanente (dialysis catheters)

United States - Kaiser Permanente (floorings)

United States - Kaiser Permanente (IV sets)

United States . Kaiser Permanente (patient's identification bands)

United States - Kaiser Permanente (PVC in signage)

United States - Kaiser Permanente (respiratory therapy products)

United States - MetroWest Medical Center, Massachusetts

United States - North Suburban Medical Center, Colorado

United States - Ronald Reagan UCLA Medical Center

United States - The University of Maryland Medical Center, Maryland

Reduce everything where possible!