Health care depends on plastic. It keeps medications sterile, is present in lifesaving devices and helps prevent infections. But as researchers uncover microplastics in the human brain, heart, liver and other organs, experts are asking whether medicine’s reliance on single-use plastics has created a new health challenge hiding in plain sight.
The Thursday session, “The Plastics Pandemic: What We Can Do About It,” explored the impact on human health as well as the environment.
Megan J. Wolff, PhD, MPH, executive director of the Physician and Scientist Network Addressing Plastics and Health (P-SNAP), set the stage, noting that 10 billion tons of plastics have been produced since 1950. “Most of it is still with us now. Very little of it is still in use,” she said.
Instead, some of it is showing up in the human body. Plastics break down into smaller parts, into microplastics and nanoplastics. Microplastics — which range in size from the size of a pencil point to a grain of salt — are inhalable but typically are expelled from the body. Nanoplastics are much smaller — and more difficult to expel.
“Plastic appears in the human body pretty much anywhere investigators look,” Dr. Wolff said. “The question isn’t just, ‘Where is the plastic?’ but, ‘What is it doing?’ Is it a bystander or driver of harm? The findings are not good.”
While a lot is left to research, one thing is certain: Most plastics are created from chemicals, many of which are known toxins.
“They are little trojan horses that get into tissues,” Dr. Wolff said. “The chemicals are going to leach into the tissue. As long as those plastics are present, they’re going to deliver toxins.”
The focus now is on the impact on the endocrine system, particularly among those most vulnerable. Phthalates make plastics soft, but exposure in the womb can lead to phthalate syndrome, resulting in male reproductive and genital malformation. It may lead to low sperm count and reproductive issues. In girls, phthalate exposure can lead to early puberty, irregular periods and polycystic ovary syndrome.
“We think of this as a hit-and-run,” Dr. Wolff said. “It does its impact, and you see it later on.”
Phthalates are found in IV bags and IV tubing, which can leach directly into the bloodstream of the person receiving a transfusion. Neonatal intensive care is one area where the most vulnerable see the biggest use. “Arguably, the plastics are saving their lives,” Dr. Wolff said. “But at what cost to them later?”
Still, she is not arguing for the complete elimination of plastic use. “There are necessary plastics. Plastics can be lifesaving.” Instead, she called for a reduction in unnecessary use and new ways of formulation.
Antimicrobial Stewardship, Infection Prevention and Sustainability
Pamela Lee, MD, an infectious diseases specialist at Harbor-UCLA Medical Center, addressed practical applications, particularly in antimicrobial stewardship and infection prevention and control.
One key factor: partnering with pharmacists. “Pharmaceuticals cause about 10% of health care-associated emissions,” Dr. Lee said. One approach is to use oral antibiotics instead of IV therapy when clinically appropriate.
Daptomycin dosing is weight based but is limited to standard vials. “The amount is taken out of the vial, and the rest is thrown away.” Offering more vial sizes of the drug resulted in less waste of daptomycin, lowered pharmaceutical waste and generated more than $7,000 per year in savings at one facility. “There are a lot of opportunities like this in the pharmacy world that we can reduce by talking to our pharmacy colleagues.”
Stewardship and sustainability can coexist, especially since both specialties are focused on taking actions now that impact the future. Infection prevention lives more in tension with sustainability, though Dr. Lee sees opportunities in “low-hanging fruit” like glove usage.
“This is an opportunity to improve hand hygiene and to make hand hygiene cool,” she said. “If you avoid that nonsterile glove, you are a hero, saving the planet.”
Waste sorting is another opportunity for linking infection prevention and sustainability. “A lot of things that are non-biohazardous are disposed improperly but must get processed as though they are hazardous. Count the savings along with the waste averted. By and large, interventions that improve sustainability reduce waste and save money.”
Health care myths should be explored, too, including whether behaviors are just ingrained in a facility culture or based on evidence. “The real harm of a health care myth isn’t just the single-use plastic,” Dr. Lee said. “But those myths may distract from higher-yield infection prevention methods.”
Photo: Megan J. Wolff, PhD, MPH, executive director of the Physician and Scientist Network Addressing Plastics and Health (P-SNAP), discussed the impact of microplastics and nanoplastics on human health at a Thursday session.