The hospital in České Budějovice is the first facility of its kind in the South Czech (Jihočeský) region which, in cooperation with association Arnika, started systematic replacement of medical devices with the content of PVC (1) softened by phthalates (2). By the end of 2007, its neonatological department replaced 90% of medical devices with the content of PVC softened by phthalates by other products (3). „We have made a balance of the accomplished replacement of PVC products with phthalates by ecologically and medically safer alternatives after more than a year of intensive campaign 'Don'ṫ Play with PVC', and today we published an interactive list of Czech hospitals which have made a certain progress in the effort not to confront their patients with hazardous PVC (4),“ head of the campaign, Ing. Miroslava Jopkova, commented on the published balance.
Arnika launched the project of PVC substitution in hospitals in 2002 with the aim of making the hospitals aware of risks connected with the use of medical devices made of PVC (1) and to help them with their replacement. „At first we concentrated on nursing, neonatological and nephrologic departments, because prematurely born babies and patients, who are dependent on dialysis are the most endangered. Phthalate DEHP, often used in medical devices made of PVC, endangers reproductive functions, causes congenital malformations and increases possibility of newborn babies' death after the birth. This chemical can represent as much as 40% of the content of the medical device,“ Jopková added. Use of the same phthalate is banned in toys and other children products and in food packaging.
Usage of PVC in healthcare if often useless, Jopková said. „There are safer alternatives in most cases (5). The reason why such medical devices are so widely used in hospitals is in low purchase costs. But money should not be preferred to human health. Examples of hospital practices from the Czech Republic and other countries (6) prove that things can work even without PVC.“ But hospitals listed on map are not the only in the Czech Republic which stopped using the risky PVC devices. „We marked there only facilities that cooperated with us on the project. But there are also other hospitals dealing with this issue. For instance, phthalate-free dialysis sets are being used in hemodialysis center in INNEF center in Brno, in children dialysis department in University Hospital Ostrava, and in hemodialysis center in Jilemnice hospital,“ Jopková completed.
Within the projekt Arnika cooperated first of all with hospitals in regions Ústí nad Labem and South Czech (Jihočeský). The project is financed by NROS and finishes in mid June 2008. We would like to express our big thanks to all those who cooperated with us. Together we succeeded to reduce a share of hazardous chemicals in devices that are supposed to cure us,“ Jopková said.
(1) PVC, or polyvinylchlorid, is plastic material which had found a wide range of use in many kinds of human activities. Its whole life cycle – from production to liquidation – is connected with emissions of toxic chemicals. This fact also applies to the medical devices made of PVC – various bags and tubes. A big problem is that PVC is most frequently softened by di(2-ethylhexyl) phthalate (DEHP) which is toxic for the reproductive system, harms the liver and kidneys and can be related to increased occurrence of asthma in children. Use of this phthalate was already reduced because of its negative impacts in toys and other children products and in cosmetics. But there is no legal standard limiting its use in medical devices, even though this chemical can have 20 – 40 % share of weight of the substance which leaks gradually during the use of the product and easily gets to human body.
(2) Hospitals which minimized the use of risky PVC – phthalate containing medical devices in cooperation with Arnika: University Hospital Motol (Prague), Neonatological Department of hospital in České Budějovice. Gradual substitution of the hazardous devices takes place in following facilities: Hospital Nemocnice sv. Alžběty in Louny, Children Department in hospital in Havlíčkův Brod, Dialysis Department in Prague hospital Na Homolce which replaced risky infusion intravenous bags and intravenous sets already in 2003. Unfortunately, this progressive step in treatment was canceled when company B. Braun Avitum took over whole dialysis unit at the end of 2007.
(3) Alternatives: Health threats connected with the use of PVC can be reduced by replacing this material by another, less harmful polymer which would be comparable in terms of quality. Polymers (PE, PP, PS, latex) are plastic materials without content of chlorine and additives in such quantity like PVC. They are accessible and utilizable in the same extent which means they represent POSSIBLE ALTERNATIVE TO PVC. PVC-free medical products, eventually products made of PVC but without the content of reprotoxic phthalate DEHP, are also present on the Czech market. Database of possible alternatives to the PVC medical devices in available HERE.
(4) Map of hospitals which reduced use of hazardous medical devices in cooperation with Arnika, is available here.
(5) Couple of examples of PVC-free medical practices from abroad:
Denmark - Grenaa Central Hospital withdrew and replaced 95% of medical devices containing PVC.
Austria – Vienna Hospitals Association, which runs 18 hospitals, convalescent hospitals and center for care of seniors, tends to a gradual phasing out of PVC. The association approved policy aiming to remove PVC from packages, building materials and medical devices.
USA - Kaiser Permanente is the largest nonprofit healthcare provider in the U.S. A. It has been working on the reduction of risky devices made of PVC since 2001. Another U. S. healthcare provider - – Catholic Healthcare West – closed contract in 2005 with German producer B Braun for a purchase of PVC-free infusion sets worth 70 million USD for 40 American hospitals.
Slovakia – neonatological department in private hospital in Košice- Šaca started with the gradual replacement of PVC made devices in 2007.
(6) Coalition for PVC Substitution is informal association of companies, civic associations, municipalities and authorities connected by effort to reduce practical usage of PVC in all possible areas, resp. In areas where there is environmentally more friendly alternative. The coalition was founded on Arnika's impulse on 17 April 2008.