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“The U.S. health care system is responsible for an estimated 10 percent of national greenhouse gas emissions, which cause extreme weather events and contribute to worse health outcomes.” This is the sobering start to the U.S. House of Representatives Ways and Means Committee report, “Health care and the climate crisis: preparing America’s health care infrastructure,” issued in September this year.
The medical textile and product sectors have been grappling with the additional challenge posed by the nature of their materials and products, indicating that full circularity may never prove possible in some instances. Emerging now are a range of sustainable strategies, including design focus, laundering, and movement away from single use to reusable products.
A case study
While medical textiles play a very visible role in many applications such as PPE, textiles also play an important role in many medical devices. At IFAI Expo 2022, ResMed’s Holly Harris gave a presentation that focused on the Australian company’s work in addressing sustainability for their Sleep apnea devices.
Sleep apnea is a disorder in which the muscles in the throat relax to the point of collapse, restricting airflow. This results in shallow breathing, or even stopped breathing for seconds or minutes at a time. This can lead to disrupted sleep patterns, which can cause significant fatigue and elevate the risk for serious health problems.
The role of the textile is to hold the mask in place as unobtrusively as possible, without causing too much pressure, while restricting leakage. Materials used need to adhere to biocompatibility and toxicity requirements. Acknowledging that it is not currently possible to replace a material with a more sustainable “like” material, the company is taking a more holistic approach towards its ESG (environmental, social and governance) goals to design products for circularity by 2027.
Design strategies are central to this by choosing textiles with a lower carbon footprint, considering design for disassembly, or enabling a reduced number of manufacturing steps, energy consumed and water produced. Part of this is material development and specification, such as looking at natural (rather than chemical) wellness compounds and moving from a hybrid, layered cushioning material to a mono-material.
Energy and material including packaging reduction is also a focus area, as is engagement with the consumer to make participation in recycling and repurposing simple and easy to do. Smart labeling offers significant potential for engagement in this as well as reducing the need for multi-lingual printed matter. What is significant about this approach are the milestones that ResMed has put in place that take account of material, design and consumer readiness, as they move towards their full circularity goal.
Meeting medical demands
Michigan-based medical technologies company, Stryker, is a manufacturer of medical and surgical equipment, including inflatables. These are designed for very specific activities such as the inflatable lift that is placed under the patient in the ambulance or on arrival at the hospital. It is then moved with the patient into the operating room (OR) or in the intensive care unit (ICU) to reduce the risk of further injury during the transfer.
Woven and nonwoven fabrics are typically used with polyester fillers making it a hybrid construction not easy to disassemble. Calf cushions, knee pads and inflatable heel protectors are also produced by the company. These are likewise designed to reduce the risk of heel pressure injuries in OR and ICU.
Another product, the Prevalon II, is a heel-protector to prevent pressure injuries where the foot is immobile for long periods of time. In some instances, these products can be taken back by Stryker to be cleaned, sanitized and reused. Excessive bleeding or damage to the fabric can mean these are not reusable and because of the biohazard risk they are disposed of in a landfill.
The full patient lift product has a limited use even if fully cleanable because of the risk of weakened material through use and the laundry process. There cannot be any risk posed to the patient, so these products are taken out of use before an equivalent in other industries.
Stryker has been looking at sustainable materials such as a recycled nylon 6.6; however, much of what is available is 15-20 percent recycled content to achieve the strength needed. In other recycled materials they are looking for ways to trace and verify the content. Verifying content, strength and price points acceptable to the consumer are all issues that come before looking for FDA approval.
Finding support in partnerships
In a Small Business Research Initiative (SBRI) Healthcare-funded project in the U.K., Revolution-Zero, in partnership with the Royal Cornwall Hospitals NHS Trust, are looking at ways to reduce the government-estimated 88,000 tons of single-use medical device textiles utilized by the National Health Service (NHS) on an annual basis.
They have been developing a certified reusable fluid-resistant surgical mask displacing more than three million single-use items and saving more than 36,000 kilograms in CO2e emissions in a twelve-month period, according to Charlie Preece, the partnership director.
Indicative of the unique challenges faced, Preece points to challenges beyond textiles when looking to move from a single-use product, including factors such as design, health system infrastructures, procurement policies, workflow and work culture.
In this first stage of introduction the partnership has concentrated on developing the systems and demonstrating the feasibility of replacing single-use textiles in operating theatre environments. The next stage in planning will be a larger scale rollout over four orthopaedic operating theatres utilizing a ZERO-DECON net zero focused decontamination and sterilization hub.
This is part of a wider program directed at achieving a more sustainable medical industry that will deliver economic and social benefits as well. NHS Circular Textiles Net Zero Road Map for Wales to 2030 is being delivered in partnership with the University of Exeter Circular Economy Hub. This looks to establish targets to deliver environmental, social and economic sustainability benefits. Within this is the Revolution-ZERO circular systems design that focuses on achieving a multiple cycle of reuse that is then followed by repurposing and ultimately recycling into medical textiles or other products.
There are considerable challenges being faced by the medical textile and device sector in reducing their environmental impacts. Maintaining patient safety is the key factor, so solutions will have to focus on this. The approaches outlined here are not complete solutions; they cannot be at this time. What they do offer are examples of how creative thinking around problem can make a difference, and, crucially, the importance of engaging with the user and healthcare providers as part of this process.
Dr. Marie O’Mahony is an industry consultant specializing in smart and advanced textile technology and market trend reports for global clients. Based in London, she is a regular contributor to Textile Technology Source.