Polyvinyl chloride, known as PVC or vinyl, is the single most used plastic for disposable medical devices and the standard base material for pharmaceutical blister packaging. While recycling efforts, such as those led by VinylPlus Med® and VinylPlus® PharmPack, are expanding, non-recyclable medical vinyl waste remains a key aspect of healthcare sustainability.
Energy Recovery: A Necessary Component of Medical Waste Management
Most vinyl-based medical devices are single-use products designed for hygienic and patient safety reasons. As a result, non-recyclable medical vinyl waste in Europe is primarily disposed of via incineration, often in waste-to-energy plants where permitted. This ensures the safe destruction of contaminants while significantly reducing waste volume. In many cases, the thermal energy produced from incineration is recovered for electricity and district heating.
Advances in Hospital Waste Incineration
Over the past decades, hospital waste management has seen significant improvements in sustainability and efficiency. Modern incinerators operate under strict regulations to minimise emissions, and extensive flue gas cleaning technologies ensure that harmful substances are effectively removed. As a result, incineration remains a highly effective method for managing medical vinyl waste while reducing the overall environmental impact.
Addressing Emissions Concerns
Concerns have been raised about the potential emissions from incinerating vinyl waste, particularly hydrochloric acid (HCl), dioxins, and furans. However, modern, well-regulated incineration facilities are equipped with advanced flue gas cleaning technologies that effectively neutralise HCl and other byproducts, ensuring compliance with stringent EU environmental standards. According to the European Chemicals Agency (ECHA), European incinerators can generally handle waste containing up to 2% PVC without issues related to smoke cleaning or corrosion.
Studies have also shown that the formation of dioxins and furans is mainly dependent on incineration conditions, and removing vinyl from the waste stream would not eliminate their production (ECHA, 2023, Swedish Environmental Protection Agency, 1999, Themelis, 2010).
The Challenges of Low-Temperature Incineration, Open Burning, and Landfilling in the Global South
While high-temperature incineration effectively mitigates harmful emissions, low-temperature incineration remains a major issue in parts of the Global South, where medical waste is often burned in poorly regulated facilities. Many small-scale incinerators operate at suboptimal temperatures, leading to incomplete combustion and increased emissions of dioxins, furans, and toxic gases, regardless of the material being burned.
Beyond formal incineration, open burning and uncontrolled landfilling of medical plastics and other plastic fractions present additional challenges. In regions with inadequate waste infrastructure, medical waste, including PVC-free alternatives, is often discarded in unregulated dumpsites or burned in the open, releasing hazardous emissions.
Simply removing vinyl from medical applications does not address these broader waste management issues. Instead, investment in controlled disposal methods, improved infrastructure, and scaling up medical plastic recycling is necessary to mitigate the environmental and health risks associated with poor waste handling practices.
Misconceptions Around PVC-Free Alternatives
There is a perception that so-called PVC-free alternatives are inherently safer for waste management. However, other plastics such as polyethylene (PE), polypropylene (PP), polyurethane (PU or PUR), polystyrene (PS), polyethylene terephthalate (PET), low-density polyethylene (LDPE), and high-density polyethylene (HDPE) each present significant environmental and health challenges.
Research indicates that burning PE, PP, PS, PET, and HDPE at low temperatures or under open-fire conditions releases volatile organic compounds (VOCs), aldehydes, polycyclic aromatic hydrocarbons (PAHs), and persistent free radicals, some of which are carcinogenic or toxic. Additionally, PU alternatives may emit highly toxic substances such as isocyanates when incinerated under controlled conditions. When burned openly or at low temperatures, PU can release other extremely hazardous gases, including hydrogen cyanide and phosgene.
Replacing vinyl with other plastics does not eliminate environmental concerns and may introduce new challenges for health and environment. According to the ECHA and the European Commission’s Directorate-General for Environment (DG-ENV), some PVC-free alternatives have technical drawbacks that could compromise patient safety, while their life cycle impacts remain largely unknown. With increasing scrutiny on chemicals in all plastics, material safety should be assessed based on scientific evidence rather than assumptions, ensuring patient safety and performance remain the top priorities.
Instead of calling for PVC-free alternatives, efforts should support and expand initiatives already led by VinylPlus, focused on increased collection, novel sorting technologies, and advancements in recycling to further enhance the sustainability of medical vinyl. Physical recycling methods like dissolution can recover high-quality vinyl from complex waste streams, while chemical recycling techniques, including pyrolysis, hold potential for converting vinyl waste into valuable raw materials, even when mixed with other plastics.
Recycling Initiatives for Medical Vinyl
While incineration remains a necessary method for handling non-recyclable medical waste, significant efforts are underway to increase the recycling of vinyl medical devices. VinylPlus Med and VinylPlus PharmPack are pioneering initiatives focused on collecting and recycling medical vinyl waste in Europe. These programmes enhance circularity by transforming used medical devices and pharmaceutical blister packs into new, high-quality products, ultimately reducing reliance on incineration.
Comparable programmes are in place in a growing number of countries, such as Australia, New Zealand, South Africa, Canada, and the US.