Hospitals replace a type of plastic

By Tom Avril

Inquirer Staff Writer

As Jeanette Vergis peered through the window of the intensive-care unit last year at her newborn son, William, she could see Doylestown Hospital's nurses were keeping close tabs on the fluids entering his body through intravenous tubes.

Little did she know that the hospital recently had begun paying close attention to the tubes themselves.

Three years ago, Doylestown started buying IV tubes, catheters and other products made from plastics that may be safer for patients and better for the environment.

The old plastic contains a chemical called DEHP, which can harm the reproductive systems of male lab animals. There is no proof of this effect in humans.

Yet Doylestown is one of at least nine area hospitals to take a precautionary approach, switching to different plastics for some or all procedures, even though some of the replacement materials cost more than twice as much.

"Why risk it?" said Glenn Kaplan, head of neonatology for Main Line Health, which includes Bryn Mawr, Lankenau and Paoli Hospitals and has switched plastics for some devices.

Patient health may be at stake, and there is also "the medical liability issue that clouds us in everything we do," he said.

The change at some hospitals was prompted by a July 2002 advisory from the U.S. Food and Drug Administration, which recommended that hospitals consider switching plastics for certain procedures on premature boys, mothers of male fetuses, and boys in puberty.

In a broader sense, the change is part of growing movement toward "green" hospitals, highlighted in Philadelphia last month at a health-care conference called CleanMed. The idea is that in a building devoted to the delivery of health care, the environment ought to be as healthy as possible.

At Doylestown, for example, officials have switched to less-toxic cleaning detergents and have eliminated thermometers and blood-pressure readers that contain mercury, a toxic metal that can escape if a device breaks. And by 2006, the hospital will have phased out fluorescent lights that contain mercury, said director of risk and safety Pauline Rondeau.

The DEHP-free plastics cost more money, Rondeau said. She said she did not know how much more, but said some of the increase has since been recovered through renegotiation with suppliers.

Vergis, whose son was born in August, knew nothing about the plastic switch at the time. All she knew was that while her baby was born full-term, he was suffering from respiratory stress, breathing so fast that he could not eat. He received nutrients and other vital fluids through tubes inserted into his belly button and his foot.

"I had no idea what they were using," she said of the tubes and bags holding the fluids. "I just knew... he was getting everything he needed to survive."

The old kind of plastic is polyvinyl chloride (PVC), the same material used to make white plastic pipes for plumbing. Often simply called vinyl, the material can be made soft and pliable by adding plasticizers, or phthalates, such as DEHP, which stands for di(2-ethylhexyl)phthalate.

First developed for military applications in World War II, vinyl eventually became the material of choice in many medical applications. Vinyl IV bags do not break, unlike their glass predecessors, and vinyl does not kink or stretch, guaranteeing consistent dosage of medicine and nutrients.

Vinyl manufacturers say they see no lack of demand from medical device makers. And a representative of companies that make plasticizers warned against switching to alternatives that are less tested.

"Our view is, it's taking an extreme precautionary approach to try to remove something from the market that's very useful," said Marian Stanley, a senior director at the American Chemistry Council and manager of the Phthalate Esters Panel.

Though the effect of DEHP on people is unproven, the market for alternatives is growing. B. Braun, a German medical-device maker whose North American headquarters is in Bethlehem, Pa., estimates that it sells more than $200 million of DEHP-free items each year in this country.

An early leader in the field, B. Braun has been making such items since the mid-1980s. More recently, health-care giants Abbott Laboratories and Baxter International also entered the field. (Last month, Abbott's hospital products unit was spun off as a separate business, called Hospira Inc.)

A chief area of concern is when vinyl bags and tubes are used to administer nutrients that are high in fats, which can cause DEHP to leach into the feeding solution. There is little or no concern with saline solutions, according to the FDA advisory.

Premature babies are of special concern because they are hooked up to plastic feeding tubes for weeks at a time, and because in the case of boys, their reproductive systems are still developing.

Some of the local neonatal intensive-care units that have made full or partial switches to alternative plastics are the Hospital of the University of Pennsylvania, Pennsylvania Hospital, Hahnemann University Hospital, and Frankford Hospital. Children's Hospital of Philadelphia has so far made a switch that a spokeswoman called "limited." In New Jersey, Virtua Health, which has a neonatal unit in Voorhees, said it uses alternatives where they are available.

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Contact staff writer Tom Avril at 215-854-2430 or tavril@phillynews.com.