IT’S A SOBERING statement: “The U.S. health care system is responsible for an estimated 10%of national greenhouse gas emissions, which cause extreme weather events and contribute to worse health outcomes.” That’s the start of 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 2022.
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 personal protective equipment (PPE), textiles also play an important role in many medical devices. At IFAI EXPO 2022, ResMed senior textile engineer Holly Harris gave a presentation that focused on the Australian company’s work in addressing sustainability for its 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, which can lead to disrupted sleep patterns, causing significant fatigue and elevating the risk for serious health problems.
Sleep apnea is frequently treated with continuous positive airway pressure (CPAP) therapy. The role of the textile is to hold the CPAP 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 toward 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.
The reduction of energy and material, including packaging, 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 and reduces the need for multilingual printed matter. What is significant about this approach are the milestones that ResMed has put in place that consider the material, design and consumer readiness, as the company moves toward its full circularity goal.
Meeting medical demands
The Michigan-based medical technology 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 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 these a hybrid construction not easy to disassemble.
Stryker also produces calf cushions, knee pads and inflatable heel protectors. These are likewise designed to reduce the risk of heel pressure injuries in the OR and ICU. The company’s Prevalon® Heel Protector II prevents 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, but excessive bleeding or damage to the fabric can mean the products are not reusable and because of the biohazard risk they are disposed 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% to 20% recycled content to achieve the strength needed. In other recycled materials, the company has been looking for ways to trace and verify the content. Verifying content, strength and price points acceptable to the consumer are all issues that require attention before requesting 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, is investigating ways to reduce the government-estimated 88,000 tons of single-use medical device textiles utilized by the National Health Service (NHS) annually.
The partnership has developed a certified reusable, fluid-resistant surgical mask displacing more than 3 million single-use items and saving more than 36,000 kilograms in CO2 emissions in a 12-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 theater environments. The next stage in planning will be a larger scale rollout over four orthopedic operating theaters 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.
The medical textile and device sectors face considerable challenges 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 problems can make a difference and, crucially, the importance of engaging with the user and health care 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. She is based in London.