FAQ about PVC in healthcare

Our FAQ has answers to frequently asked questions about PVC in healthcare.
1What is PVC?

PVC is short for polyvinyl chloride and is made from salt and oil or natural gas. PVC is also known as vinyl and is one of the most widely used plastics in the world with a wide range of applications such as window frames, water pipes, flooring, cables. In healthcare, PVC is used for a wide variety of disposable medical devices and for hygienic ceiling, flooring and wall covering for wet rooms, operation theatres, hospital rooms etc.

For more information about PVC—its history, how it is made, its physical properties and sustainable development of the industry—please visit pvc.org and vinylplus.eu.

2How is PVC made?
PVC is made from 57% chlorine and 43% carbon from oil or gas. The chlorine is derived from common salt, which is an inexhaustible resource. In a chemical process, the salt is split into caustic soda and chlorine. The caustic soda is used for detergents, glass, aluminum, cholesterol-lowering medications and many other applications. Aside from being used in PVC production, potable water and pool water is disinfected with chlorine. Chlorine is also used to manufacture polyurethane for insulation and packaging, as well as life-saving medicines, computers, batteries for hybrid cars, and a wide array of other products.
3Is PVC safe?

The plastic material PVC, also known as vinyl, has been used safely in healthcare applications for over 60 years. The material has been thoroughly tested by independent bodies, and regulatory agencies in many countries have approved PVC for use in medical devices and other critical areas such as pipes for potable water.

Importantly, disposable products made from medical PVC replaced multiple-use medical equipment made from rubber and other materials. PVC, which is affordable, extremely versatile, easy to sterilise and does not break when used inside the body, resulted in a revolution in healthcare. First, the clean PVC devices eliminated cross-contamination between patients when the material was introduced in the 1950s and 60s. Second, PVC has enabled development and production of an ever-growing range of life-saving medical equipment and made quality, affordable healthcare much more accessible. Read more about how plastics revolutionised healthcare.

Concerns have been raised over the substance DEHP, which is one of the so-called plasticisers that can be used to make medical devices flexible. Due to industry innovation, a range of new plasticisers have been developed. Four of these are now included in the European Pharmacopeia that sets the guidelines for medical devices in Europe and beyond.

4Why is PVC used in medical applications?

PVC combines unique technical properties such as flexibility, versatility, ease of processing, and chemical stability with low cost. This combination means that the polymer has become the material of choice for a wide range of medical applications and for hospital flooring, operation theatre walls and ceilings.

An example of the plastic’s advantages is medical tubing. If a medical tube kinks and stops the flow of medicines, it can mean it can trigger a life threatening situation for the patient. Because of unsurpassed flexibility, PVC-based medical tubing does not kink. See more reasons why PVC is used in medical applications.

Medical devices did exist before the polymer got its breakthrough in the middle of the 20th century. However, these devices were expensive and made from traditional materials such as rubber, glass or metal. The equipment thus had to be reused, causing cross-contamination between patients. The high price restricted access to healthcare, and the limited versatility of these materials meant that medical innovations were slow. A revolution in healthcare happened with the advent of affordable plastics that could be tailored to nearly any piece of medical equipment and mass-produced. Read about how plastics revolutionised healthcare.

5Are phthalates necessary to produce PVC-based medical devices?

Most PVC-based medical devices, such as tubing and flexible containers, are made from soft PVC. To make the product soft, a so-called plasticiser (US: plasticizer) is added to the PVC compound. Because of technical properties and low cost, the phthalate DEHP was in the past the main plasticiser for PVC medical applications. Yet DEHP has come under scrutiny by regulatory and medical authorities. Today, several alternative plasticisers are available for medical applications. These include TOTM, DEHT, DINCH and BTHC which are all approved by the European Pharmacopeia for medical applications. These new plasticisers allow healthcare professionals and patients to benefit from PVC’s unique properties such as softness without using phthalates of concern.

6Don’t PVC medical devices emit toxic acid gasses and dioxins when incinerated?

PVC is mainly a building and construction material for durable applications that are recycled after many years of service. However, the majority of PVC medical devices are short term, disposable products. For safety reasons, non-recyclable medical PVC waste and other hospital waste streams are generally managed through incineration with energy recovery. This is a highly effective waste management method. When incinerated, the waste is combusted at high temperatures that destroys contaminants and reduces the waste volume dramatically. Typically, the thermal energy can be used to generate electricity and in some instances district heating.

Hospital waste management processes have been improved over the last decades to make energy recovery sustainable and efficient. In addition, recent experiences show that recycling of medical waste has the potential to be successfully implemented in healthcare settings like hospitals.

Concerns have been raised about the potential emission of waste substances from PVC energy recovery. The production of waste substances depends on incineration conditions. In modern, well-run incinerators, these substances are appropriately managed on the basis of the strict procedures and standards set up under the EU legislation.

7Aren’t dioxins released when PVC is produced?

Dioxins emissions from industrial production in general have been nearly eradicated during the last decades. European PVC resin manufacturers committed already in 1995 to a charter to tightly limit dioxin emissions. Manufacturing is also tightly controlled by Best Available Techniques and EU regulations.

8PVC depends on chlorine. Isn’t that a problem?

Chlorine chemistry is key to our society. Besides being a raw material for polyvinyl chloride, chlorine is used to disinfect drinking water and treat waste water, in manufacturing of life-saving pharmaceuticals, computers, circuit boards, batteries for hybrid car, car tyres, smartphones, mattresses, shoe soles and a wide range of other products. Learn more about chlorine’s role in society.

In Europe, the chlor-alkali industry today uses membrane technology, which avoids using mercury and contributes to significant energy savings compared to other technologies.

9Is mercury still used in chlorine production?

During the last decades, the chlor-alkali industry has made a targeted effort to phase out mercury cell technology for chlorine production. In the EU chlorine production is now mercury-free as all plants have shifted to membrane technology. This technology is safe and contributes to significant energy savings. The same shift to mercury-free chlorine production is happening in the rest of the world through the Minamata Convention.

10Can PVC-based medical devices be recycled?

PVC is easily recyclable with more than 640.000 tonnes being recycled per year in Europe through the VinylPlus® programme. In several countries the healthcare sector is also partaking in recycling of PVC-based medical devices, which makes good sense: hospitals save money by diverting waste from expensive treatment processes for clinical waste and at the same time contribute to circular economy, reduce carbon emissions and help save energy. The collection and recycling are done without risk to hospital staff, patients or recyclers as the PVC medical devices have only been used on pre-screened patients and have not been in contact with bodily fluids or medicines. This practice can be likened to collection schemes for deposit bottles.

Recycling schemes for PVC-based medical devices exist in Australia, New Zealand, and the UK. In Australia and New Zealand more than 170 hospitals collect and recycle IV bags, face masks and oxygen tubing. The PVC recyclate is turned into new useful products such as mats, garden hose, and floor coverings. In the UK 14 hospitals are part of the VinylPlus®-funded RecoMed pilot programme. Additional pilot programmes are underway in other European countries.