Today, medicine is responsible for approximately 4.5% of global greenhouse emissions, which, somewhat ironically, contribute to a lower standard of health and living globally. The key contributor to this figure is the volume of waste produced by the medical field, both in the form of hazardous (infectious) and non-hazardous (‘offensive’ and municipal) waste1. In England, a total of 185,233 tonnes of medical waste was recorded for the period 2015/16. But akin to many climate challenges, this drastic figure is a recent problem. Looking back at the history of medicine, we can identify the events that led to this and consider how we might address it in the future.

Much of medicine’s waste problem comes from a reasonable concern for sanitation and hygiene; discarding of soiled products reduces the chances of infection. But such concerns did not gain traction until the 19th century, with the simple notion that poor conditions and general dirtiness in hospital environments was causing patients to become sicker. In the latter half of the 1800s, germ theory became widely accepted. This was – and is – the theory that imperceptible microorganisms (aka pathogens or ‘germs’) are the culprits in the spread of disease. Joseph Lister introduced antiseptic surgery, a method in which germs were killed by creating a chemical barrier around an open wound – for this he used carbolic acid – and also by washing the instruments and hands of the surgical team with a carbolic acid solution. This led to the practices of aseptic surgery in the 1890s, in which a sterile environment is created using a combination of hygienic measures and antisepsis, i.e. sterilised surgical equipment, gowns, masks, and so on.

William Stewart Halsted in 1922. Photo: John H. Stocksdale, Public domain, via Wikimedia Commons

These developments in understanding led to further efforts to keep the medical environment as sterile as possible. Today we are all too familiar with the presence of disposable face masks and rubber gloves, and it is almost innate in our knowledge that disposable equipment is best when it comes to sanitation. This is not wrong – but this is where our waste dilemma lies. Single-use devices (SUD) are “items designated by the manufacturer as being suitable for one use only on an individual patient only then discarded” (NHS, 2018). Today they span every area of medicine, from surgery to general practice and the pharmacy.

Looking back over the timeline of SUDs, there are many noteworthy examples of innovation that informed the progression of a single-use world. The first use of rubber gloves, for example, can be traced to Caroline Hampton in 1894, scrub nurse to one Doctor Halsted (who, as a side, described her as “an unusually efficient woman”). Use of antiseptic and aseptic techniques had become routine but the chemical solutions used to sterilise caused her much irritation to her hands. Not wanting to forgo Hampton’s efficiency, Doctor Halsted gave the matter some thought. He concluded in requesting the Goodyear Rubber Company to make an experimental pair of thin rubber gloves with gauntlets. These proved to be so satisfactory that after a time the assistants became more accustomed to working with gloves than without. Some 70 years later, the first modern disposable rubber glove was invented by Angel Rubber co. in 1965. Now it is not only an accepted method of protecting the hands, but a staple of functional asepsis for patient and practitioner alike.

Disposable plastic syringe by Harry Whillis and Charles Rothauser. Museum of Applied Arts & Sciences.

Not all SUD innovations stemmed from the pursuit of best hygiene. In 1949, Charles Rothauser invented the first disposable2 syringe. This was not in an effort to improve sanitation, but practical use. By this time, most bacterial infections were treated with an injection of penicillin using a glass syringe. This created a problem when penicillin showed a tendency to clog up glass syringes, making them exponentially difficult to clean. This problem was solved by Rothauser in his Adelaide factory (an original syringe is now displayed in the Museum of Applied Arts & Sciences in Sydney, Australia). By 1951 he had produced injection-moulded syringes made of polypropylene, a plastic capable of being heat sterilised, and millions were produced for Australian and export markets.

The pertinent thing to notice is not so much to do with the products themselves but the materials they are made of. Since the 1960s, plastics have been the main material used in all SUDs. It’s not that medical practitioners and patients of the past were simply too frugal to throw anything away, but rather that the items disposed of were far kinder to the ecosystem than modern plastics. For example, cloth bandages would be used to dress wounds, and pharmaceuticals were packaged in paper or glass. In medical devices, glass, metal, or wood were mostly used, and said devices were re-used. Plastics are now favoured for their cost, durability, and flexibility. Overall, it really is a great material for this use.

In 2000, the MHRA issued advice warning against the re-use of single-use devices as it may compromise them and potentially encourage the spread of infection. Still, there is a debate as to the possibility, with some arguing that proper sterilisation would be as efficient as single use in achieving asepsis. But it is true that we cannot return to old methods of general practice and surgery as an antidote to medical waste without massively compromising human health and quality of life. Yet there are still things we can learn from their ingenuity.

While efforts are being made in the research and development of alternative materials for use in SUDs (among other things), there are some more simple proposed solutions. These include a reduction in mass production, i.e. only producing what is needed to save both material and energy, as well as local sourcing, the aforementioned re-use of devices where plausible, and, most pertinently, encouraging a healthy lifestyle in the general populous, thereby reducing the need for medical intervention. Conclusively, the objective should be for meaningful interaction between the necessity for SUDs and the prospect of a more symbiotic medical domain.

1. Municipal waste: everyday waste, e.g. food, packaging, recycling.
Offensive waste: waste that is soiled but not likely to cause infection, e.g. bloodied gauze, gloves etc. from a non-infectious source/patient.
Infectious waste: waste that is liable to cause infection, e.g. soiled SUDs, bedding.
Interestingly, significantly more waste from medical establishments is considered infectious than offensive.

2. I would like to side-track here a minute and talk about the reification of the word ‘disposable’. Truly, anything is disposable if you are willing to throw it away – your cutlery, your shoes, loved one’s ashes, whatever. Since around the 1950s, ‘disposable’ has been termed to mean flimsy products that you are only going to use once because they are not very good. But really this just means something you can move to a secondary location once you are done with it. I would argue that, logically, ‘disposable’ should be redefined to mean something that is by its nature compostable and will in essence cease to exist after its main use, i.e. been wholly disposed of.

References

Ansells History Ansell Available at: https://www.ansell.com/us/en/about-us/our-history

Barnett, R (2015) Crucial Interventions: An Illustrated Treatise on the Principles & Practice of Nineteenth-Century Surgery London: Thames & Hudson

‘Cambridgeshire and Peterborough Clinical Commissioning Group’ (2018) Single-use Medical Devices Cambridgeshire: NHS 

Disposable plastic syringe by Harry Whillis and Charles Rothauser 2021, Museum of Applied Arts & Sciences Available at: https://collection.maas.museum/object/142882

Joseph Lister’s antisepsis system 2018, Science Museum Available at: https://www.sciencemuseum.org.uk/objects-and-stories/medicine/listers-antisepsis-system

Lathan, R (2017) ‘Caroline Hampton Halsted: The First to Use Rubber Gloves in the Operating Room’ Taylor Francis Online Available at: https://www.tandfonline.com/doi/abs/10.1080/08998280.2010.11928658

Unknown (2017) ‘A brief history of medical waste disposal’ AEG Environmental Available at: https://www.aegenviro.com/blog/brief-history-medical-waste-disposal/

(2021) [2018] Freedom of Information Follow up Report on Management of Waste in the NHS London: RCN

Unknown (2006) ‘The implications of reusing single-use medical devices’ Nursing Times Available at: https://www.nursingtimes.net/roles/nurse-managers/the-implications-of-reusing-single-use-medical-devices-07-12-2006/

About the author

May Prothero is currently volunteering at the Old Operating Theatre Museum & Herb Garret as a welcome host and research assistant. May is a London based designer and artist with a vested interest in anatomy and the history of medicine; her work focuses primarily on environmental and social issues.

Environment and Single-use Devices in Medicine
Tagged on: