Dr Ameera Patel, CEO of TidalSense, an AI respiratory healthtech pioneer for COPD and asthma solutions, questions whether our healthcare systems have become too reliant on disposable medical devices, and argues that it’s possible to encourage more sustainable practices without increasing the risk of patient infection.
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In recent months, I’ve had to field a growing number of questions from NHS representatives – on both a local and national level – about the sustainability of TidalSense’s medical devices.
These aren’t difficult to answer; like many mission-driven healthtech startups, sustainability is something we’ve been focused on from day one. But it’s indicative of a broader shift in NHS procurement policy and net zero agenda that, over the next few years, could force other medical device manufacturers to change their approach to device sustainability.
Brilliant for healthcare, but plastic carries a hefty environmental cost
Western healthcare is currently far too reliant on single-use disposable plastic medical devices. It’s one of the main reasons why the sector consumes around 15 million tonnes of plastic globally every year.
The logic behind the shift away from reusable metal and washable items towards plastic is understandable. These devices are cheap to produce, and using new devices for each patient helps minimise the risk of infection, something which has been top of mind within healthcare environments since the pandemic. But while there can be little doubt as to the efficacy of this approach from a patient safety perspective, the downside is that it drastically increases the volume of devices required. Across Europe, more than one third of healthcare waste is plastics, and almost half of this waste is incinerated.
It’s over-simplistic to lay the blame at the door of clinicians and practitioners. The reality is that current medical device standards – in the UK, US and across Europe – prioritise patient safety and risk aversion and say nothing about sustainable usage. Indirectly, they’re encouraging device manufacturers such as ourselves to produce single-use disposables which, of course, can be sold in far greater quantities than reusables.
It’s time to challenge core assumptions about medical device safety
There is nothing ill-advised about promoting a safety-first message to manufacturers. But given that reusable medical devices are plainly better for the environment than single-use disposables destined for the incinerator, we should at least be asking the question: what exactly is the difference in cross-infection risk?
For example, we recently carried out analysis of the quantity of microorganisms that are found in one of the disposable plastic components, used as a breath tube, that fits inside our N-Tidal device. We found that the component in question, which is made from medical-grade plastic, receives either no or very low levels of microorganisms per use. In 100 uses over a period of a month, the total level of microorganisms is still at a level that would be acceptable from a newly manufactured and packaged item. The study then confirmed that with a simple cleaning process, it was possible to reduce this low level by four orders of magnitude, almost entirely removing the risk of cross-infection. Implementing this cleaning step allows component use to be increased from single-use to hundreds of uses.
As we continue our investigations, it may well be that we identify clear limits around frequency and longevity. But by using scientific analysis to challenge a core assumption about just one of our components, we’ve instantly made our devices far more sustainable, at no extra cost, within the current regulatory framework, and with no impact to patient safety, providing the consumable is cleaned as specified.
Changing procurement requirements up the ante on carbon reduction
The stated aim of the NHS is to achieve Net Zero by 2040 for direct emissions, and 2050 for the emissions it influences. And, to that end, from April 2024 it will ask all suppliers to declare their current carbon emissions and outline clear carbon reduction plans as a standard part of every procurement pathway.
We’re yet to discover just how stringent and exacting the NHS will be when it comes to assessing or verifying suppliers’ carbon reduction efforts. And as yet, there is little guidance for suppliers on what the NHS would like to see included in these plans. Nevertheless, it marks the start of several sweeping changes that will be made to NHS procurement over the coming years.
In 2027, for example, all suppliers will be required to publicly report their Scope 1, 2 and 3 emissions targets. Perhaps most notable of all, in 2028, reporting will be extended to cover product-level emissions in addition to company-level emissions - meaning that every product supplied to the NHS will have to have its own carbon footprint mapped out, accompanied by a carbon reduction plan.
Device manufacturers must drive the sustainability agenda
Rather than waiting until their hand is forced, it’s time that manufacturers took up the sustainability mantle and acted as the agents of change.
As our recent study shows, it’s perfectly possible to improve device sustainability without adding to production costs. And as sustainability is incorporated into more and more healthcare procurement pathways globally, manufacturers could soon find themselves in a situation whereby a proactive commitment to sustainability is a prerequisite of getting a new contract. The new NHS’s Net Zero strategy may feel like a burden at first, but sustainability also represents a business opportunity, and the possibility to reduce carbon footprints through medical device design decisions.
A broader sector-wide conversation about sustainability
The tide is turning, and an unwillingness amongst device manufacturers to rethink their approach towards reusability could put them at a significant competitive disadvantage in the years to come.
However, we should not forget that sustainability within healthcare is multi-faceted and needs to be considered holistically, rather than purely in terms of what can and cannot be reused and recycled.
We need joined up thinking, so that well-intentioned regulatory directives (i.e. prioritising patient safety when developing medical devices) don’t inadvertently compromise Net Zero targets, or vice versa. It’s time for the sector at large to acknowledge that safety and sustainability are not mutually exclusive, and begin to rebuild more sustainable working practices within day-to-day healthcare provision.