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For Equine Vets Everywhere

Knowing the hidden environmental cost

Sustainability Tips for Practices Sustainability Tips for Everyone
06 Aug 2021 BEVA

Disposable materials and single use plastics are an intrinsic by-product of equine ambulatory practice and hospital activities. Although items like PPE, single use syringes and medical packaging are necessary for safety and sterility, their environmental impact has often been neglected.

In the past century, the healthcare sector turned to plastic because it is safe, cheap and effective (Gibbens 2019). Unfortunately, the wider environmental costs of plastic use were not considered, leaving the healthcare industry as a major contributor to environmental degradation.

To this end, the Life Cycle Assessment (LCA) is a fundamental tool that allows us to consider the products’ effects on the environment from their production to their disposal (Life Cycle Initiative 2020).

The Covid-19 pandemic has exacerbated the littering effect of common disposable medical items such as reusable gloves and facemasks, driving more attention to their environmental impacts. By applying a LCA assessment, it was calculated that a box of 100 nitrile gloves would produce the same amount of CO2 as driving a petrol car for 20 miles (Rizan et al., 2020)

With regards to face masks, the graph below illustrates how reusable and single use compare from a LCA perspective. Although a cotton facemask is initially associated with higher CO2 emissions, its impact equals that of disposable masks by the 13th use, and by the 30th the relative CO2 emission is halved (European Environment Agency 2021).

Transitioning to the adoption of reusable items can also be applied to surgical hats and theatre shoe covers, and dedicated suppliers have devoted their attention to providing these solutions (Greener Veterinary Practice 2021).

As already highlighted in our Sustainability Tip for Practices in June 2021, choosing reusable surgical gowns reduces the consumption of natural resources by 64%, the emission of greenhouse gases by 66% and production of solid waste by 88% (Vozzola et al., 2020).

Wasteful sterilization packs can also be assessed with the LCA approach. A study by Stiegler et al. (2016) measuring CO2 emission associated with the sterilization processes when using reusable hard cases vs polypropylene blue wraps, showed how blue wraps result in twice as much production of CO2 in the long term.

GHG emissions from blue wrap and hard cases from 1-10 years (Stiegler et al., 2016)


Companies such as Millpledge are tackling the environmental impact of sterilization envelopes by providing 100% recyclable items (Millpack 2021).

Other brands such as Terumo are cutting on the amount of plastic employed in the production of fluid bags, using less material and energy in the process. In addition, the transport and disposal of a 23% lighter bag will ease the impact connected to the commercial and disposal stages (Terumo Global 2021).

The possibility of substituting petrochemical plastics with plant-based ones, referred to as bioplastics, seems, from an environmental point of view, a tempting one. Sourcing bioplastic from plant fibres, such as corn, however, does not make them an automatic winner in this comparison. The diversion of agricultural resources to their production, soil and water contamination due to fertilizers, and their complex disposal, does not necessarily result in a better environmental performance (Gibbens 2018).

A study by Unger et al. (2017) using the LCA approach revealed how using biopolymer enriched disposable items for a selected surgical procedure, resulted in higher gas pollution by 900% and ozone depletion by 125%. Despite this environmental downside, biopolymers had positive outcomes for the health of patients e.g. lower carcinogenic impact and respiratory effects.

Reducing disposable materials and single use plastics is a complex objective that needs the contribution from both the supply and demand actors. Accounting for the environmental costs of plastic and disposable items can help addressing the choices made by individual practices and create more awareness within the medical supply industry.


Benefits of Life Cycle Approaches – Life Cycle Initiative, n.d. URL https://www.lifecycleinitiative.org/starting-life-cycle-thinking/benefits/ (accessed 8.1.21).

Greener Veterinary Practice Checklist [WWW Document], n.d. . Vet Sustain. URL https://vetsustain.org/resources/vet-practice-checklist (accessed 8.1.21).

Impacts of COVID-19 on single-use plastic in Europe’s environment — European Environment Agency [WWW Document], n.d. URL https://www.eea.europa.eu/publications/impacts-of-covid-19-on (accessed 8.1.21).

MillpackTM [WWW Document], n.d. . Millpledge. URL https://millpledge.com/shop/millpack-ss00520p (accessed 8.1.21).

Reducing Environmental Footprint | Highlights | Sustainability | Terumo Global [WWW Document], n.d. URL https://www.terumo.com/sustainability/environment/index.html (accessed 8.1.21).

Rizan, C., Reed, M., Bhutta, M.F., 2021. Environmental impact of Personal Protective Equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic. medRxiv 2020.09.21.20198911. https://doi.org/10.1101/2020.09.21.20198911

Gibbens, S., 2019. Can medical care exist without plastic? [WWW Document]. Science. URL https://www.nationalgeographic.com/science/article/can-medical-care-exist-without-plastic (accessed 8.1.21).

Gibbens, S., 2018. Bioplastics—are they truly better for the environment? [WWW Document]. Environment. URL https://www.nationalgeographic.com/environment/article/are-bioplastics-made-from-plants-better-for-environment-ocean-plastic (accessed 8.1.21).

Stiegler, K., Hill, J., Van den Berghe, A.J., Babcock, L., 2016. Life Cycle Assessment of Medical Sterilization Protection: Disposable Polypropylene Blue Wrap vs. Reusable Aluminum Hard Cases. n.d. URL https://practicegreenhealth.org/sites/default/files/upload-files/awards/resources/gor_rmw_reduction_clinical_plastic_recycling_mayo_clinic_rochester_2016.pdf (accessed 8.1.21)

Unger, S.R., Hottle, T.A., Hobbs, S.R., Thiel, C.L., Campion, N., Bilec, M.M., Landis, A.E., 2017. Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents? J Health Serv Res Policy 22, 218–225. https://doi.org/10.1177/1355819617705683

Vozzola, E., Overcash, M., Griffing, E., 2020. An Environmental Analysis of Reusable and Disposable Surgical Gowns. AORN Journal 111, 315–325. https://doi.org/10.1002/aorn.12885