Identifying potentially harmful plastics in the NICU

Three decades after research began on the potential health effects linked to the use of polyvinyl chloride (PVC) and di(2-ethylhexyl) phthalate (DEHP), these plastics are still found in products used in neonatal intensive care units (NICUs) across the United States. HealthTrust is helping member facilities identify clinically acceptable alternatives for these products and working with suppliers to offer options without PVC and DEHP.

PVC and DEHP are found in a wide array of products in the NICU that come in contact with premature and fragile newborns, including oxygen masks, nasal cannulas, and infusion and nutrition tubes. While these products help address the acute health problems in tiny patients, many studies show that the PVC and DEHP they contain can cause various health issues over the long term, including endocrine disruption. Products with the highest impact are respiratory, infusion and enteral. PVC and DEHP have been banned from items like baby toys, but not from medical products.

Kyle Tafuri
Kyle Tafuri

Kyle Tafuri, Director of Sustainability for Hackensack Meridian Health in New Jersey, points to many potential items containing PVC and DEHP in a typical NICU. But his health system, which has two Level 3 NICUs, has been steadily phasing out the use of such plastics over recent years. “These babies are the most vulnerable population, and some are in NICUs for extended periods with exposure from many products. It adds up,” Tafuri says. “We have a commitment to provide the healthiest environment for our patients. It’s the right thing to do.”

Conversion challenges

Transitioning to a PVC- and DEHP-free NICU environment isn’t easy. The task involves a rigorous audit of what’s being used and a change in suppliers for some items, among other efforts, shares Zoë Beck, Sustainability Manager at HealthTrust.

“In respiratory and enteral feeding tubes, there are more PVC- and DEHP-free options. Many hospitals have done pretty well in those categories because suppliers have proactively switched,” Beck says. “IV bags and tubing are a different story. These are complicated contract categories, in that hospitals are usually using one supplier’s products, and converting to another supplier is a huge undertaking.”

Zoe Beck
Zoë Beck

The ask of suppliers is that they find new, safer materials that maintain the performance of these products—products that are integral in the care of NICU patients and help keep them alive. Changing out these materials is not a simple task.

The European Union has regulated PVC, DEHP and other phthalates, but the U.S. Food and Drug Administration has not yet followed suit, Beck adds. Because the chemicals aren’t regulated, tracking how many U.S. hospitals have transitioned away from these chemicals is challenging.

“The existence of and potential issues with these chemicals are not necessarily common knowledge,” she says. “While some individual hospitals may be working to remove PVC and DEHP from their NICUs, there are likely not as many organizations working on this at a system level.”

One system’s consistent efforts

Hackensack Meridian Health’s efforts to move away from PVC and DEHP in its NICUs began years ago, with a focus on two categories. “The bulk of the exposure is typically in IV bags and tubing,” Tafuri says. “So being able to transition those out was the biggest win we had in our NICUs.” But of the 71 products inventoried at Hackensack Meridian Health after that effort, Tafuri says, about a dozen contained the plastics.

The work has continued piecemeal ever since, with a couple of additional products switched out as alternatives were identified. “When you’re looking at safer chemicals as a whole, you strike where it’s hot—where there are known alternatives. We reached out to manufacturers and stated that we hoped to see a PVC-/DEHP-free product. Where there wasn’t an alternative, we put it on the back burner,” Tafuri recounts.

Not all alternatives have cost more than the items they replaced. In some cases Hackensack Meridian Health has saved money. “Typical to any product switch, there were instances where something cost a bit more, where it was a wash or where it saved money,” Tafuri adds. “It’s a mix. Our biggest challenge in doing this is when there isn’t an alternative; you’re kind of stuck. You hope those companies move forward to switch materials, but for some products there may be only one or two options, or it’s a product that’s unique and there aren’t any alternatives.”

Bold support

Over the past year, in particular, HealthTrust has amped up efforts to educate member facilities about the presence of PVC and DEHP in products used in NICUs and ways to streamline moving toward options that do not contain these chemicals. HealthTrust has also been gathering and analyzing data from members that have undertaken such efforts, Beck says. “We can show members where they stand today and where they can do better. It gives them something to measure so they can make changes where they choose,” she explains. “Additionally, when we collect information from suppliers, we can go back to those suppliers and say, ‘Comparatively, here’s where you stand in the marketplace in terms of these chemicals; here is where you have opportunity.’ The data serves an educational purpose for both the product end users and the manufacturers.”

Tafuri says Hackensack Meridian Health is well supported by HealthTrust in its NICU product transition efforts, simplifying the process and saving the health system time. “HealthTrust has been helpful in obtaining information from suppliers and providing us a forum to bring questions forward,” he says. “Instead of one member asking a supplier about PVC- and DEHP-free options, HealthTrust can make the ask on behalf of its entire membership. It’s a lot of purchasing power.”

Beck shares that HealthTrust has initiated conversations with member facilities about PVC and DEHP in the NICU. “HealthTrust is working on education to make sure health systems understand why we’re looking at these chemicals,” she says. “NICU technology has advanced tremendously, and now that we know more about the harmful effects of these chemicals, we need to help our member facilities evolve.”

For more information on the NICU project and analyzing products for the existence of PVC and DEHP, email Zoë Beck at

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