There are many non-PVC materials available, suitable for a wide variety of medical applications, which do not require phthalates or other softeners. The potential hazards posed by phthalates leaching from equipment and being carried into the patient can therefore be avoided.

Furthermore, since the alternatives are not made from PVC, they can be more easily recycled, eliminating the problems associated with disposal of PVC medical equipment.

Availability of Alternatives

Contrary to what many people might think, medical device manufacturers in Europe generally offer both PVC and PVC-free versions of the same device. The price premium is not always as drastic as is often assumed.

• Bags: PVC-free bags made of ethylene vinyl acetate (EVA), multilayer polyethylene or polypropylene are cost-effective and technically competitive with PVC bags. PVC-free intravenous and other bags are available for all but one product, packed red blood cells.
• Tubing: PVC-free tubing from silicone or polyurethane is on the market for most medical applications.
• Gloves: Alternatives made from nitrile for disposable gloves are readily available.

From the products for which alternatives are available, hospitals tend to prioritise intravenous, enteral feeding and respiratory therapy devices for substitution.

Plasticisers: Alternatives to DEHP

PVC products softened with plasticisers other than DEHP are also available on the market. Citrates, adipates, trimellitates and Hexamol DINCH are all used in PVC medical devices as alternative softeners.

Many are like DEHP, in that they can all leach out of devices and into patients. The potential health risks of DEHP alternatives are largely unknown, due to the lack of toxicological data publicly available on these softeners.

Nor does using alternative softeners eliminate the environmental problems associated with the manufacture and disposal of PVC.

Is Price a Problem?

A common concern with PVC substitution is the higher cost of using alternatives. Although not always the case, there can be a significant difference between the price of PVC products and the non-PVC alternatives.

How large a price difference, if any, depends greatly on national markets and the individual contracts between hospitals and suppliers. Hospitals can lower per-unit costs by purchasing in large volumes: here price differences can be negotiated down to a minimum, especially in the case of bags.

There are often material benefits to alternatives. For example, PVC-free IV bags won't stiffen with use, as softeners are not removed from the plastic by the bag contents. And while nitrile gloves are more costly than PVC (although there has been a significant cost reduction in recent years) they are also more durable.

The benefits to health can ultimately outweigh higher costs, especially when considering the long-term benefits for society at large.

New regulatory initiatives could also soon ban DEHP use in treating high-risk populations, opening the market and driving development of PVC-free alternatives.

PVC-free Devices Available in Europe

This brief survey of PVC-free devices being offered in Europe shows that alternatives are far more readily available than might be assumed.

A History of Availability

The Glanzing Clinic of the Vienna Hospital Association became the world's first clinic to eliminate all invasive use of PVC — in 2003.

HCWH is now aware of over 80 hospitals which have begun taking steps to eliminate PVC, from countries well-known for environmental programmes such as Sweden, all the way to the Czech Republic and Slovakia.