Contributor: Kristin Six, BSN, RN, CWOCN
Earth Day 2023 – Saturday, April 22

Every day, nurses strive to work in line with the nursing profession’s principle of beneficence, or working to do good. But our nursing practice often directly violates another of nursing’s core ethical principles, nonmaleficence, more commonly known as “do no harm.” Single use disposable items have proliferated within healthcare in the pursuit of infection prevention, cost savings, or both. Disposable stethoscopes, disposable medication cups, disposable bedpans–this disposable everything is directly causing harm both to the environment and to people around the world. Nurses can do better. We must do better.

Only nine percent of plastic waste gets recycled. The rest ends up either in landfills domestically, or shipped overseas to dumping sites in poor countries. There, illegal “recycling” operations incinerate this plastic waste, releasing toxic chemicals (in addition to carbon dioxide) into the air and directly causing respiratory illness, rashes, and other harms to the families who live there. When the plastic is not incinerated, it accumulates into mountains of refuse, littering local neighborhoods and playgrounds, and clogging local waterways before eventually reaching the ocean, where it breaks into smaller pieces (“microplastics”) which accumulate in the stomachs of marine wildlife. Plastic production and incineration are leading drivers of greenhouse gas emissions and climate change.

Sometimes, a single-use disposable product truly is necessary for the patient. Critical devices, as identified by the Spaulding classification system, are those devices that come into contact with the sterile insides of the body–think surgical instruments–and must be sterile to avoid introducing infection. Similarly, semicritical devices are those that come into contact with mucous membranes or open skin–think endoscopes used for colonoscopies. These devices do not require sterilization, but can be disinfected for reuse following strict FDA guidelines for “high level disinfectants.” In some cases, sterilizing or disinfecting these devices for reuse proves challenging; in these cases the use of single-use devices can be justified against the environmental harms.

The greatest opportunity for sustainable change from within nursing lies in the third Spaulding classification of devices, the noncritical devices. These are the devices bedside nurses use most often. They come into contact with patients’ intact skin, pose low infection risk, and are appropriate for “low level disinfection” at the site of use, meaning they can be cleaned with simple rubbing alcohol or another similarly ubiquitous cleaning product.

Some disposable noncritical devices, including blood pressure cuffs and pulse oximetry probes, can be collected for reprocessing by a manufacturer and subsequent reuse. But healthcare is riddled with noncritical devices that have been designed as single-use. And because they are designed to be disposable, they must be disposed of–the rigors of cleaning, if the device is cleanable at all, could render it ineffective or even dangerous.

It hasn’t always been this way. When I graduated from nursing school, a family friend with a unique sense of humor gifted me with an antique enameled steel bedpan. This bedpan was a thing of beauty, sparkling clean yet durable, round with a deep bowl, designed to be cleaned and used over and over again in the time honored tradition of nurses regulating their patients’ bowel patterns. By contrast, the bedpans in hospitals today are made of thin plastic, with acute interior angles and narrow plastic buttresses that serve to increase the product’s strength while also creating cozy crevices for pathogens to hide. Today’s bedpans, like so many other noncritical devices, are intended for a single use. They are disposable. They certainly are not meant to be cleaned and reused.

Certainly, cleaning devices rather than tossing them creates more work for the already overworked nursing staff. But disposable products are not the solution for this problem. The solution is paying healthcare workers what they are worth for the demanding, sometimes grueling, work, and hiring sufficient staff so that the workload is manageable. And for those concerned about infection risk, the CDC has guidelines for safe low-level disinfection of noncritical devices and surfaces.

Disposable, single-use devices cause demonstrable harm to the environment and to people living near dumping sites; use of these devices directly violates the Nursing Code of Ethics. Nurses must use our voices to demand medical device manufacturers build a circular economy where waste is minimized if not eliminated, and we must demand our healthcare institutions purchase the sustainable, reusable alternative whenever it is available. While disposable medical devices are but one component of a larger waste stream, we are a profession promoting health for all, and we must lead by example.

Related Resources

1. What is the Nursing Code of Ethics?
2. Organisation for Economic Co-operation and Development (OECD)  information on global plastic waste.
3. BBC February 13, 2019: Plastic pollution: One town smothered by 17,000 tonnes of rubbish
4. Natural Resources Defense Council (NRDC), January 9, 2020: Single-Use Plastics 101
5. Center for International Environmental Law (CIEL) Plastic & Climate: The Hidden Costs of a Plastic Planet
6. CDC (Center for Disease Control & Prevention) – A Rational Approach to Disinfection and Sterilization
7. CDC (Center for Disease Control & Prevention) – Reuse of Single-Use Medical Devices
8. CDC (Center for Disease Control & Prevention)- Recommendations for Disinfection and Sterilization in Healthcare Facilities
9. Eleanor MacArthur Foundation – What is a Circular Economy?

About Kristin Six

Kristin Six practices as a wound & ostomy nurse in Lexington, KY.