WATCHING: PLASTICS’ CONTRIBUTIONS TO HEALTHCARE · plastics market watch watching: plastics’ contributions to healthcare a series on economic-demographic-consumer & technology

PLASTICSMARKETWATCH

WATCHING: PLASTICS’ CONTRIBUTIONS TO HEALTHCARE A SERIES ON ECONOMIC-DEMOGRAPHIC-CONSUMER & TECHNOLOGY TRENDS IN SPECIFIC PLASTICS END MARKETS

B E T T E R I N D U S T RY. B E T T E R W O R L D.

Summer 2019

EXECUTIVE SUMMARY

19145PLAS_HealthcareMarketwatch_Inside_v8.indd 1 5/29/19 1:07 PM

Plastics Market Watch—Watching: Plastics’ Contribution to Healthcare 2

Executive SummaryThis summer, the Plastics Industry Association (PLASTICS) will release its complete Market Watch Report on Healthcare. It is fitting that this is just a summary on the role of plastics and polymers in healthcare as it forces PLASTICS and members to evaluate the whole value chain to capture how plastics improve the quality of life for patients, save and extend lives, combat infections, diseases and illnesses, save money, contribute to medical devices, and help protect medicine—and deliver them into the body.

Fully understanding healthcare plastics is complicated by the fact that the scope of healthcare is so expansive—as are the different roles plastics play and kinds of plastics used. Healthcare encompasses surgery and hospital care, pharmaceuticals and medicine, public health and disease control, medical devices and equipment—and it is also hearing, vision, and dental care. For example, 75% of American adults use plastics every day to see whether that’s using eyeglass frames, lenses and or contact lenses which are most commonly made of plastics. And at the beginning and end of every day, people clean their teeth with plastic brushes.

Plastics used in healthcare and medical grade plastics can be advanced polymer materials that comply with regulatory standards and are engineered and designed for medical usage, or they can be commonly found plastics used in packaging that still protect products and improve health. Plastics are used in healthcare because of the material’s versatility, sterilization qualities, enhanced safety for patients and providers, cost savings and effectiveness, ease of use, improved quality of life, and new applications and solutions.

Some plastic applications in healthcare may be overlooked as their use is so dominant (i.e. syringes and fluid bags) or simply accepted because they are commonly used in medical packaging. There are other applications, however, which are more advanced and unseen like joint replacements. When a patient walks toward a magnetic resonance imaging (MRI) machine, attention is likely drawn to it size and noises, but not the plastics found in and out of the machine that are vital to its operation. In fact, the telltale “knocking” sound of an MRI is due to the gradient coils made up of wires embedded in plastic tubes; the pulsing electric current in the coils causes a vibration inside the tubes.

The usage of plastics can also be misunderstood. In nearly every healthcare setting, from the dentist’s chair to a surgical suite, “blue wrap” is used to protect equipment; but why? The polypropylene-based material fights microbial contamination and resists liquids, which makes it critical given that healthcare providers rely on sterilization to protect equipment and patients.

The use of plastics in healthcare delivers benefits to providers and to the public. The protective clothing and equipment fight infections and the spread of deadly diseases, making plastics an integral material for medical equipment whether it is

“Plastics are used in healthcare

because of the material’s versatility,

sterilization qualities, enhanced

safety for patients and providers,

cost savings and effectiveness, ease

of use, improved quality of life, and

new applications and solutions.”



in the most advanced hospital surgical suite or a developing country combatting Ebola.

The diversity of plastics in healthcare is also significant. Some materials and applications, like bottling and packaging are consistent across industries, although protocols are in place to ensure products are safe and contaminant free. Other medical grade plastics with the U.S. Food and Drug Administration (FDA) oversight are used in hearts, knees, hips, limbs and pharmaceuticals that represent the leading edge of medicine and research. In listings of the top medical advances over the past several decades, the technologies or treatments may vary, but the presence of plastics in these advancements is consistent. Listed advancements like bionic prostheses, robotic and laser surgical equipment, artificial hearts, and MRI or Computed Tomography (CT) machines, all use plastic components and technologies.

Plastics are vital for healthcare today and will be for innovations tomorrow. This report digs into the industry’s role in improving human health and how medical developments will impact plastics in the future.

What kinds of plastics are used in healthcare?As with packaging and other plastics applications, some plastics in healthcare and medicine are used for their superior barrier properties, durability, transparency, impact-resistance, lightweight and low costs. For other areas, medical grade plastics are utilized for their sterility, biocompatibility, interoperability with other materials, and even degradability for temporary applications.

A wide range of plastics materials are used in healthcare and medical applications, including:

■ polyvinyl chloride (PVC) ■ polypropylene (PP) ■ polyethylene (PE) ■ polystyrene (PS) ■ nylons ■ polyethylene terephthalate (PET) ■ polyamide (PA) ■ polycarbonate (PC) ■ acrylonitrile butadiene styrene (ABS) ■ polyetheretherketone (PEEK) ■ polyurethane (PU)

The most widely-used plastic material in medical applications is PVC, followed by PE, PP, PS and PET. For single-use, pre-sterilized applications, like syringes, PVC is the leading material and can be found in medical applications in all healthcare environments.

Last year, PLASTICS and the industry lost one of its leaders and greatest advocates, Bill Carteaux, to cancer. His courageous fight was well known to many—and his support for plastics never wavered. Plastic News editor Steve Toloken captured Bill’s unique fight against cancer and advocacy for plastics, “The energetic Carteaux had consistently chronicled the role of plastics in helping to treat his cancer, posting pictures of plastic components like Hickman central intravenous lines for administering drugs. His family wrote over the weekend that he would ask questions like which company had made the plastic masks used in his BiPap, or Bilevel Positive Airway Pressure, treatment.”

The plastics value chain has a remarkable story to tell about its contributions to healthcare; Bill advocated for this Market Watch and for everyone in plastics to support the material and its vital role in healthcare and other sectors.



Innovations and advancements in plastics materials, however, continue to be made. For pharmaceutical applications, plastics are not only used for containers, but are also used for plastic pill casings made with tartaric acid-based polymers that gradually break down in the patient, releasing the medication over a specified time period. The time-release of a medication can be paramount to a drug’s success in treating patients. So plastics can not only protect medications in blisterpacks or bottles, but also deliver the medicine in the patient.

The flexibility of uses for plastics in healthcare is one of its greatest assets—one polymer can have multiple, diverse applications. One of the most common surgeries in the U.S. and Europe—hip replacements—used metal-on-metal sockets for years. Today, new hip socket designs are made with carbon fiber-reinforced polyetheretherketone (PEEK) plastic that have demonstrated greater strength, wear resistance, and compatibility with other parts to mimic the joint and function of the human hip. PEEK is also used in a polymer capsule—the size of a grain of rice—to transmit a cobalt salt solution into patients to enhance the images and contracts of MRI scans. PEEK was selected for the application because of its performance when exposed to radiation.

On the cutting edge of medicine, plastics are an integral part of applications that need high-barrier properties or high moisture permeability. For new monitoring devices and sensors worn or embedded in patients, plastics are very often part of the application. 3D printing using polymers is making inroads into the prosthetic and implant markets as well as dentistry, making it possible for products to be personalized for an individual fit.

Fast Facts – Fighting InfectionsApproximately five to 10% of hospital patients acquire hospital-related infections in the U.S.; most common post-operative infections are urinary tract infections, surgical site infections (SSIs) and pneumonia. Infections extend a patients’ hospital stay up to five days, and dramatically drive up the cost of care. It is estimated that 30% of these infections are preventable.

Plastics combat infections in a number of ways—like helping with sterilization and in protective clothing. Additionally, plastics are being made with antimicrobial materials that repel or even kill bacteria; current generation antimicrobial plastics can reduce bacteria by up to 99.99%. Antimicrobial material with plastics can be used for equipment like catheters, wound dressings and hospital surfaces like doorknobs and countertops, to fight against bacteria.

The flexibility of uses for plastics in healthcare

is one of its greatest assets—one polymer can

have multiple, diverse applications. ”



Economic Trends One of the biggest achievements of mankind in the 20th century was longer life expectancy: in the U.S., average male life expectancy increased more than 27 years and female life expectancy increased more than 31 years. Advancements in medicine and health have resulted in lower infant mortality rates. New medical devices have contributed to early medical diagnoses. New and improved medical supplies led to the reduction of the spread of infectious diseases. In all instances, plastics has been key to making these developments possible.

With an aging population, U.S. healthcare spending is expected to increase. In the past, healthcare spending as a percent of GDP has been stable (see chart 1) but still rising. Last year, the U.S. population was estimated at 327.2 million. The 65 and older population accounted for 15.6% of that. By 2035, there will be 78.0 million people who are 65 years and older, as projected by the U.S. Census.

U.S. Health Care Spending(Source: PLASTICS Analysis of BEA Data)

% o

f GD

P

2002 2004 2006 2008 2010 2012 2014 2016 2018

9.5

10.0

10.5

11.0

11.5

12.0

12.5

Healthcare spending in the U.S. and other developed countries, as well as advances in healthcare in developing nations, will impact the healthcare plastics market. An example of the sector’s strength is demonstrated by the $3.30 billion in U.S. medical devices exports last year.

The PLASTICS Watching: Plastics’ Contributions to Healthcare report will analyze the key factors in healthcare that impact plastics and their future contributions to the vital, growing sector in the U.S. and around the world.



Plastics’ Healthcare Innovation and Technological Advancements Plastics are at the forefront of innovation in a wide range of medical specialties. But even before scientists and material engineers develop healthcare applications, the plastics value chain is making innovations in manufacturing and supplying plastics—from the simple to the complex—that transform how patients are treated and live their lives.

Medical plastics machinery produces high tolerance, high precision plastic applications efficiently with minimal waste or downtime. Plastics equipment manufacturers are collaborating with their customers and even assist with the extensive FDA approval process in delivering new applications.

The wide diversity of plastics—and their properties—make them such an attractive material for medical devices and uses. A growing opportunity for plastics are resorbable polymers used for non-permanent implant devices, stents, or drug-delivery products and sensors that dissolve after use. Plastic polylactic acid screws that are biocompatible and biodegradable are being used as screws in lieu of titanium. In addition to not requiring a second surgery (with associated costs), the polylactic acid screws can be combined with other composite materials to promote bone growth near the surgery.

Plastic foams are being developed for trauma situations where patients suffer from major blood loss and organ damage; injectable plastic foams are being tested to stop bleeding and give patients more time to be transported to hospitals. Plastics are also being used with sensors and monitoring devices that are embedded or worn by patients to continuously monitor their health and symptoms.

Medical device and healthcare innovations do not come cheap; regulatory proceedings and approvals are lengthy, complex and expensive. The medical device marketplace has eight industry sectors that regulate everything from tongue depressors (which can be made with metal, wood or plastic) to implants like coronary stents (which again can be made of metal or polymers and can be dissolvable).

Research into medical device development has garnered significant investment, peaking in 2007 at $3.7 billion—and now averaging around $3 billion.

Curbing Plastic Healthcare Waste & Recycling Safely Healthcare recycling—of all materials—has lagged other industries, in part for health-related issues. It was widely thought that the lack of recycling was linked to the prioritization of sterility and safety. But that thinking is not the current mindset of health care providers, hospitals and their suppliers, including the plastics value chain.

About 85% of hospital waste is noninfectious, according to the World Health Organization, and a bulk of that is recyclable; yet most of these materials have traditionally been landfilled or burned—and some haulers are reluctant to take some medical materials.

About 85% of hospital waste is noninfectious, according to the World

Health Organization, and a bulk of that is

recyclable; yet most of these materials have

traditionally been landfilled or burned—and some haulers are

reluctant to take some medical materials. ”



From a disposal perspective there are three types of plastics found in the healthcare environment:

■ Pre-patient plastics, which are plastics that have not been biologically contaminated and can safely be disposed of through recycling or landfill channels.

■ Biohazardous waste, which is any waste that is contaminated by bodily fluids and should be disposed of through sterilization or incineration.

■ Plastics that are functional parts of durable goods.

Each of these plastics serve an important job in the safe delivery of healthcare. While reduction efforts need to be balanced with patient and provider safety, there are real efforts to improve landfill diversion of plastic medical wastes.

The drive to develop best practices and models to enhance recycling rates have come from concerted efforts throughout healthcare. For instance, in 2017, Cleveland Clinic facilities recycled 33% of their waste—from plastics to linens and batteries. The Cleveland Clinic recycled 194 tons of plastic.

PLASTICS is working with the Healthcare Plastics Recycling Coun.cil (HPRC) to improve recycling rates of non-infectious plastic packaging and products collected from clinical areas of the hospitals. One HPRC study helped identify the relative quantities of material types found in clinical settings and the complexity healthcare providers and staff faced in sorting the plastics after usage. The highest volume of material collected in the study was sterilization wrap; other plastics included film plastics and rigid plastic packaging.

HPRC has reported that identifying common materials and establishing strategies for hospitals and processing techniques provides a solid foundation for increasing recycling activities across healthcare. An additional challenge in the waste stream from hospitals is the quality and quantity of the material being sent to a recycler—ensuring that the material generated by the recycler is consistent and marketable will be important to the success of any widespread effort to increase plastics recovery from the healthcare environment. Aligning the supply chain, from hospitals, the recycler and buyers, is a challenge when other, more established streams are competing for similar buyers of recycled material.

Contact Perc Pineda, PhD, PLASTICS’ Chief Economist, at [email protected] if you want access to the complete Market Watch report on healthcare or to learn more about the plastics value chain. For media inquiries, contact Elleni Almandrez, PLASTICS’ Associate Director, Communications, at [email protected].

Visit plasticsmarketwatch.org to learn about other Market Watch reports.

HPRC estimates U.S. healthcare facilities generate an estimated 14,000 tons of waste per day and 25% (3.5 tons) of that is plastic packaging and products. Approximately 1 million tons of clean, non-infectious healthcare plastics could be safely recycled without threatening public health and patient safety.


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Phone 202.974.5200

plasticsindustry.org

The Plastics Industry Association (PLASTICS) sends special thanks to PLASTICS’ Pharmaceutical and Medical Device Applications Committee (PMDAC) for their input on this Healthcare Market Watch Report.

Materials were compiled, written and edited by Bill Mashek and Perc Pineda, PhD.

©Copyright 2019, Plastics Industry Association, Inc. (PLASTICS). All rights reserved.

This report is offered in good faith and is believed to be accurate at the time of its preparation, but is offered without warranty of any kind, either express or implied as to merchantability, fitness for a particular purpose, or any other matter. PLASTICS does not endorse any products

or third parties that may be mentioned in the report and accept no responsibility for any loss or damage arising from its use. We strongly recommend that you seek separate counsel for guidance to the accuracy and appropriateness of the report.


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WATCHING: PLASTICS’ CONTRIBUTIONS TO HEALTHCARE · plastics market watch watching: plastics’ contributions to healthcare a series on economic-demographic-consumer & technology