5 Minute Healthtech Jargon Buster: Sustainability in Healthcare

As healthcare systems strive to meet growing demands, there is an urgent need to enhance sustainability and reduce environmental impact. Within a range of alternatives, there are specific opportunities to improve healthcare sustainability while maintaining efficiency and quality of care.

• Biodegradable plastics: In place of traditional plastics, biodegradable plastics (BPs) have been developed. BPs fully degrade into CO2, H2O, CH4, using microorganisms [3]. BPs can be either natural polymers, which are synthesised from renewable resources or synthetic polymers, which are made from non-renewable sources (Fan et al.). Traditional plastics are detrimental to the environment, often not degrading at all and occupying landfills and oceans, negatively impacting ecosystems, thus biodegradable plastics offer an alternative source [4].

  
  

• Circular economy: This is an approach that aims to reduce waste, keeping materials in use as long as possible and regenerating natural resources [5]. The primary strategies are reuse, remanufacturing, and recycling, as highlighted by Figure 1. Currently in healthcare the circularity is limited, providing an opportunity to decrease waste production and excessive energy use [5]. A circular approach could apply to medical devices via refusing technologies which are unsustainable, reduce energy consumption and offering multiple uses to one device. [5]

  
  

• Artificial intelligence (AI): This is the simulation of human intelligence through, computer programs (“models”), which typically learn from large sets of exemplar data. Training these models requires high consumption of fossil fuels and subsequent high carbon emissions. Addressing this issue would help healthcare systems that rely increasingly on AI to improve their environmental impact.

Innovative approaches are emerging to enhance sustainability in healthcare while maintaining safety and effectiveness. These strategies demonstrate the potential for integrating sustainability without compromising medical quality or patient care.

• Polylactic acid (PLA) as surgical sutures and meshes: PLA is synthesised from corn starch or sugarcane, with similar properties to traditional plastics.  The naturally occurring materials allows for safer use in medical implants, for the natural and safe degradation in the body. Medical uses include surgical suturing and surgical meshes as shown in panel D of Figure 2. 

  
  

• poly Hydroxy-alkanoates (PHA): These have a wide range of uses. PHA can be used in dressings for wound healing, post-surgical ulcer care, as carries for medication delivery, and as bio-absorbable sutures. The added medicinal and nutritional properties of PHA add to its value when using in wound care for better healing [4].

  
  

• Cellulose based dressings: Created from plant cell walls, cellulose can be used as a material for dressings. Cellulose prevents biofilms, containing bacteria, from forming in the wound. Additionally, its absorption capacity allows the removal of fluids from the wound to decrease the risk of infection [7]. 

  
  

• PGA in tissue engineering: PGAs are used to a provide a framework for cell growth. PGA can be formed into scaffolds to create a three-dimensional shape for increased cell growth of bone, cartilage and skin [4].

  
  

• Redesign of medical devices: Redesign to improve suitability for multiple cleaning methods including, heat, chemical exposure, and water exposure, without decreasing the safety is a key strategy. This can also extend the lifespan of plastics, reducing the need for replacements [5].

  
  

• 3D printing using bioabsorbable materials: These materials are suitable for use in orthopaedic implants to improve sustainability. This reduces waste in production of the implants whilst using less overall material [6]. 

   

• Reprocessing of equipment: The reprocessing of face mask by steam sterilisation results in a reduced carbon footprint in comparison with single use masks [6].

   

• Improving AI efficiency: Techniques such as model compression reduce the size of AI models to improve speed and efficiency, specifically in low power environments. The process of pruning decreases the number of neural networks involved in AI, making it faster and less energy demanding. Lastly, quantisation lowers memory usage and computational costs by using smaller, less precise numbers. This saves battery and energy costs [15]. 

Ensuring the safety and effectiveness of sustainable healthcare solutions comes with several challenges. Addressing these challenges is essential for successfully integrating sustainability into healthcare without compromising patient safety or operational efficiency.

• High variability of natural polymers: Natural polymers have high variability in their production due to natural variability in the plants/animals’ resources used to synthesise them. One approach to mitigating the high variability of natural polymers is through tailored modifications, such as chemical functionalization and blending techniques, which enhance their structural consistency and performance for specific applications [8].

  
  

• Storage and infectious diseases: Natural polymers can carry infectious diseases, due to incorrect manufacturing, storage, and use [9]. However, sterilization techniques such as gamma irradiation, ethylene oxide treatment, and autoclaving have been shown to effectively eliminate microbial contamination in natural polymer-based materials, ensuring their safety for biomedical applications [10]. However, ethylene oxide (EtO) sterilization raises sustainability concerns due to its toxic emissions and classification as a human carcinogen. While effective, its environmental impact and health risks have prompted efforts to explore safer, more sustainable sterilization alternatives [11].

  
  

• Biocompatibility of synthetic polymers: As synthetic plastics are synthesised from non-renewable sources and man-made, their biocompatibility is less certain. For this reason, rigorous testing is needed to ensure safe degradation in the human body [9].

  
  

• Safety and contamination of single use products: Single use products are used to eliminate any risk of contamination and introducing reusable products thus raises concerns [5]. Correct handling of reusable medical devices is a health risk.  For example, if medical devices are improperly stored and dried, this could increase contamination risks [5].

  
  

• Linear to circular supply chain: A circular supply chain is not as widespread as a linear chain due to the ease and decreased complexity of the latter. Scalability problems can occur, as hospital systems are not designed for repurposing surgical equipment. This would require new tools and equipment [5] while regulatory compliance also needs to be considered [4].

Integrating sustainable practices into healthcare aligns with global and regulatory initiatives aimed at reducing environmental impact.

Overall, Improving sustainable healthcare practices would align with the 2030 United Nation (UN) goal of the agenda for sustainable development [12].

The Food and Drug Administration (FDA) requires biological evaluation of medical devices. Biodegradable materials often degrade in the body when used as sutures. This would require testing around the degradation byproducts, absorption rate and impact on surrounding tissues [13].

The Waste Framework Directive governs waste management systems and supports implementing circular economy practices [14].