PVC & Plasticizers: Steps to Safer Alternatives
The ubiquitous use of plastics around the globe is having enormous consequences on the environment and our health. Globally plastics cause disease and death with estimated health-related economic losses exceeding US$1·5 trillion annually.(1) It was estimated in 2018 that the total annual plastic-attributable disease burden in the US was $249 billion, or 1.22% GDP.(2) And yet the US healthcare system produces more than 1.7 million tons of plastic waste a year. (3) Here you will learn more about the ‘why’ and steps we can all take NOW to stop this harm.
‘PVC has no place in a non-toxic circular economy’
-Health Care Without Harm
PVC: Toxic & Ubiquitous
To highlight an egregious example of an environmentally damaging plastic- let's consider polyvinyl chloride (PVC)- one of the most toxic plastics from manufacture to discard and yet is one of the most commonly used in healthcare- accounting for 26% of medical device material. (4)
PVC products in healthcare include IV bags, pumps sets, tubing, catheters, some examination gloves, flooring, pipes, food packaging, and office supplies. PVC is widely available due to low production costs and diverse applications.
Harms Across the Lifecycle
Throughout the manufacturing process of PVC every step is inherently toxic; from the production of the chlorine - requiring mercury, asbestos, or PFAS, to its reaction with ethylene (generated from cracking a component of fossil fuel such as naphtha or natural gas), and resulting in toxic monomer production - vinyl chloride monomer (VCM), which is associated with acute toxicity and chronic carcinogenic risks. When incinerated, PVC produces dioxins and furans which are some of the most toxic substances on earth, being extreme carcinogens. PVC is also very challenging to recycle although there are now some breakthrough methods; however, such processing can pose public, occupational, and environmental risks. PVC cannot be generally recycled and is often considered a troublesome contaminant as it degrades the structural properties of other plastics in a polymer mix. (4) The EPA has formally designated vinyl chloride as a High-priority Substance and the risks of PVC in the environment have been clearly identified. (5)
Additives Exacerbate Harms
PVC is very brittle and requires plasticizers, heat stabilizers, fillers, pigments, and other additives to achieve the desired functionality of each product. Plasticizers are synthetic chemicals (and include phthalates such as DEHP, but also alternatives) added to PVC to soften and increase the flexibility of the material. They can leak into the body from medical devices, especially IV bags and IV tubing or be taken up from the environment. Up to 70% of a product by weight may be comprised of phthalates. These molecules are not bound to the PVC matrix and thus leach out into the body and/or environment. (4) They are also common in household items such as tablecloths, shower curtains, rainwear, garden hoses, furniture and children’s toys. Phthalates are androgen disruptors, may affect neurodevelopment, (6) and can promote chemotherapeutic drug resistance including colorectal, breast and other cancers. (6, 7) Due to the health risks of DEHP, alternative substitute non-DEHP plasticizers are now being added to PVC. Some are likely to disrupt thyroid function, with inadequate data yet compiled on many others to determine the level of risk. In addition, this does not address the PVC problem and the concerns over its lifecycle. (4)
Steps to Take NOW to Safer Alternatives
Request from your supplier PVC-free and DEHP-free products - there are many readily available and often at less or no extra cost. We do not endorse any particular product. The following is a selection that are currently available in the US and Canadian markets.
Vetivex IV bags from Dechra - containing no PVC or DEHP or other plasticizers
Fleboflex IV bags from Grifols - containing no PVC or DEHP or other plasticizers
IV pump sets and lines that are DEHP free. Many manufacturers; search for DEHP-free.
BBraun CARESAFE™ and Infusomat® plus Line PUR - both containing no PVC or DEHP
References
1. Landrigan, PJ et al. The Lancet Countdown on health and Plastics. Lancet 2025;406:1044-62.
2. Trasande L et al. Chemicals used in Plastic Materials: an estimate of the attributable disease burden and costs in the United States. J Endocr Soc. 2024;8:bvad163
3. Rizan, C et al. Plastics in healthcare: time for a re-evaluation. J R Soc Med. 2020;113:49-53
4. Health Care Without Harm: Towards PVC-Free Healthcare- reducing the environmental impact and exposure to harmful chemicals. 2023 https://global.noharm.org/sites/default/files/documents-files/7382/2023-05-Towards-PVC-free-healthcare_0.pdf
5. Kudzin, CH et al. Risks Associated with the Presence of Polyvinyl Chloride in the Environment and Methods for Its Disposal and Utilization. Materials (Basel). 2023;7:173.
6. Schettler T. Polyvinyl chloride in health care- a rational for choosing alternatives. Health Care Without Harm. 2020. https://us.noharm.org/media/4423/download?inline=1
7. Zhou, X et al. The role of di-(2-ethylhexyl)phthalate in cancer initiation and progression: Mechanisms and health implications. Sc Total Environ. 2025;959:178285
