Chemicals in healthcare
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By Dr Dorota Napierska (PhD, ERT)
Dorota Napierska is Chemicals Policy and Project Officer at Health Care Without Harm Europe.
Health Care Without Harm (HCWH) Europe brings the voice of healthcare professionals to the European policy debate about key environmental issues. HCWH Europe educates the healthcare sector to understand the importance of the environment and presses healthcare leaders and professionals to advocate for broader societal policies and changes.
In modern life, we find ourselves surrounded by chemicals that can have unintended consequences for health. These chemicals are found in a range of everyday products and materials, including some furniture, clothes, and plastics.
Human exposure to certain chemicals is strongly linked to increased incidence of illnesses such as reproductive and metabolic dysfunction, developmental or neurological disorders, and some cancers. Healthcare workers (and even some patients) are at greater risk because of continued exposure; addressing this must form a key part of healthcare sector’s core mission to do no harm.
Many chemicals are used by the healthcare sector in the course of safeguarding health and providing care. Often they are used for very specific purposes such as chemotherapy treatment or sterilisation. Furthermore, many specialist medical devices, exclusively used in healthcare settings, may pose an exposure risk for healthcare workers or patients owing to the invasive mode of employment.
Whilst medical devices play a crucial role in modern healthcare, often saving lives and improving quality of life, many are manufactured using plastics made from toxic materials. Devices such as intravenous tubing and blood bags made from Polyvinyl chloride (PVC) hold potential very real risks for patients. Flexible PVC often contains the plasticiser DEHP a hazardous chemical that can leach out of products and enter the bodies of patients. DEHP may damage fertility and is a known endocrine disruptor i.e. a chemical that affects the human hormone system and is also listed as possibly carcinogenic with links to some cancers. European Union authorities concluded that patients undergoing haemodialysis and premature babies and infants subjected to certain medical procedures are at high-risk of exposure to DEHP. Early chemical exposure during human development can have long-lasting health consequences; sometimes symptoms do not even appear until adulthood. The unborn and new-orns are therefore particularly vulnerable to hazardous chemical exposure.
With safer alternatives already available for many of those devices, PVC should be prioritised for elimination in healthcare settings to deliver direct health benefits for patients. A 2009 German study showed that incidence of liver problems (cholestasis) dropped from 50% to 13% when PVC-based infusion systems for newborn children were replaced with non-PVC ones. Even since 2007 some European hospitals began phasing out PVC medical devices to protect patients from unnecessary exposure to DEHP and other alternative plasticisers. Many hospitals, however, continue to use PVC medical devices that can leach DEHP.
Another source of exposure in hospitals comes from the day-to-day hospital operations: potent cleaners and disinfectants (biocides). Whilst the chemicals used to clean healthcare facilities play an important role in infection prevention and control they are also, ironically, a source of health and environmental hazards. Cleaning products have been identified as the most frequent cause of work-related asthma, allergies, and skin problems in healthcare workers. The practice of disinfection must also be addressed, as increasingly harmful bacteria are developing resistance to disinfectants, fuelling the emergence and spread of antimicrobial resistance – a threat to the efficacy of modern medicine.
Exposure to mixtures
Chemical exposure, even at incredibly small levels, can impact the human hormonal system and disrupt normal development. The Hazardous Chemicals in Health Care study found that all participants (doctors and nurses) had at least 24 individual synthetic chemicals in their body. Samples from participants detected BPA, phthalates, polybrominated diphenyl ethers, and perfluorinated compounds, all listed as known chemicals of concern. One of the doctors tested commented: “it is hard to deny, minimise, rationalise, or justify [the chemicals’] presence. It is disturbing to know the only body I have is permanently contaminated.”
Other human biomonitoring studies of European citizens show widespread exposure to phthalates in unborn children and infants, with children presenting higher levels than adults. Importantly, over 200 synthetic chemicals have been detected in umbilical cord blood, including pesticides, phthalates, and flame retardants. There is evidence that mixtures of these chemicals interact in an aggregated way with negative impacts to our health or exacerbate existing health problems. Chemical exposure during medical procedures can therefore contribute to continuous long-term exposure to a mixture of different hazardous chemicals, with adverse effects on human health.
First, do no harm
These are but a few examples of chemical exposure in healthcare, however, chemical production is rising, and the resulting waste is mounting. Healthcare must increase its efforts to minimise the risks posed by the toxic chemicals used in their procedures, particularly for vulnerable groups such as pregnant women, neonates, and chronically ill patients. A growing number of hospitals are already substituting some of the most hazardous substances with safer alternatives, safeguarding human health without sacrificing quality of patient care - a win-win situation.
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