Greening our operating rooms

At a recent meeting I attended, a slide depicting two water bottles crawling out of a primordial sea entitled: “A Million Years From Now” gave me pause to consider the future of plastics. Canada has the world’s longest coastline, and we should be concerned about the pollution of our oceans, particularly as we recycle less than 10% of our plastics. In June 2019, Prime Minister Trudeau announced that Canada would ban single-use plastics by 2021. This was in response to the growing global movement to phase out the bottles, straws, and plastic bags clogging the world’s oceans. As well, microplastics, the result of clothing and other product manufacturing, are now found in our food chain because these tiny bits of plastic waste also end up in our oceans. Long term health consequences from consuming them are unknown, yet their production continues.  

Our provincial government recently completed a Plastics Action Plan consultation with British Columbians to determine our feedback on a path forward to reduce plastic pollution. I hope we see something substantive soon.

In BC, I would say we are adjusting well to the use of paper straws and reusable water bottles. I personally feel guilty when I get to the airport, and realize I forgot my bottle. Yet, in our practice of modern medicine large volumes of plastics remain a necessary part — particularly in the operating room.

Over the last few decades, the use of plastics in medicine has steadily increased. Many revolutionary interventional and innovative medical procedures evolved because of plastics, and we remain dependent on them. It would be hard to imagine practicing without surgical gloves, plastic disposable syringes, other deliverable devices (sheaths, IV fluid bags, catheters, arterial grafts, heart valves, pre-filled syringes), tubing, or MRI machines.

Plastic packaging is central to maintaining the cleanliness and sterility of our equipment, and the supplies we use, helping to prevent patient infections when they are undergoing medical treatment. Artificial limbs and joints are lighter, and more flexible, due to plastic. Plastics use in 3D-printed prosthetics and other objects is an ever-growing area. Single use plastics are a necessity for persons with disabilities and marginalized groups as a result of their decreased cost, increased portability, easy use at home, etc. 

So where do we start? Can we somehow translate Canada’s ban on plastics into a greener OR? We could start by increasing the recycling of plastic materials we use in the OR, although this alone will not be enough. Could we explore the concept of glass packaging of materials, or increased use of re-purposable products? The reality is that there are few products that would easily make the transition. Many procedures and lifesaving techniques are simply not possible without the use of flexible plastic catheters or lines. If we are unable to eliminate single-use plastics in our current healthcare system, we should at least be trying to explore other options moving forward. 

I am very glad to see governments at all levels, across our country, and around the world implementing bans and creating alternatives to single-use plastics. Perhaps we can rely on these measures to allow medicine to remain a high level consumer for the foreseeable future. 

In the meantime, closely inspect your personal plastic use. Try to visualize your used products laying to rest in your driveway, street, local lake, flower bed, or garden. I am committed to cleaning up my personal act and will do my best to reduce what I use as I go about delivering care to my patients. 

- Dr Kathleen Ross