| The Solution
Polyvinyl chloride (PVC) items are pervasive in health care, one quarter of all plastic medical products are made of it. These items include IV and blood bags, enteral feeding devices, tubing, endotracheal tubes, oxygen tents, mattress covers, packaging, basins, hemodialysis equipment, patient i.d. bracelets, bedpans, respiratory therapy products, catheters, thermal blankets, lab equipment and medical gloves. Non-medical hospital uses for PVC are found in office supplies and hospital building materials.
There are two areas of concern about the safety of PVC: (1) Manufacturing and incineration of PVC products can result in the formation of dioxin, dioxin is a group of persistent and very toxic chemicals that are the by-products of PVC incineration and production, they are released into the air in emissions from municipal solid waste and industrial incinerators, including hospital incinerators. When released into the air they may be transported long distances, even around the globe. Concentrations build up in the food chain, resulting in measurable levels in animals.
(2) PVC is very brittle, and unstable so plasticizers are added for the flexibility and softness necessary for products such as medical tubing and IV bags. However, the additives do not actually bond with the PVC polymer and are subject to leaching, or breaking free from the PVC. Di(2_ethylhexyl) phthalate (DEHP), is one of these plasticizers used in making PVC, it is from a family of chemicals called phthalates. DEHP can leach out of the PVC from which tubing and delivery bags are commonly made and into the IV fluids and enteral feeding products that enter the patients.
There are health effects linked with both dioxin and DEHP. Both have been identified by the EPA as probable carcinogens and possible endocrine disrupters. Depending on amount, route and timing of exposure, DEHP may affect various organ systems. There has been particular concern about the toxic effects on NICU patients exposed to DEHP, especially on the developing male reproductive tract. In animal studies, DEHP affects male sexual development (demasculinization). A recent study measured levels of phthalates in the urine of pregnant women and found that the baby boys of mothers who had the most phthalates were much more likely than other baby boys to have certain demasculinized traits (including undescended testes at birth, low sperm counts and benign testicular tumors later in life).
Besides acting as a carcinogen in humans as well as animals, dioxin disrupts multiple growth factors, and developmental processes. Dioxin has been shown to be toxic to the developing immune system in human and animal studies. Exposure to high concentrations of dioxins can cause skin lesions, rashes, discoloration and excessive body hair. Changes in blood and urine that may indicate liver damage also are seen in people. Other effects may include alterations in glucose metabolism and changes in hormonal levels.
The solution for the problem is to establish and implement PVC reduction programs in healthcare facilities. Below are resources to help with such a program. The document "Setting Healthcare's Environmental Agenda" (Web address to be found below under the HCWH resources) lists the steps involved in this process:
(1) establish a PVC reduction policy
(2) educate staff
(3) collect data
(4) identify PVC- and DEHP- free alternatives and
(5) develop and implement a PVC reduction plan.
Possible barriers and ways they might be addressed is also discussed.