Prefilled syringes are single dose drug delivery systems typically made from plastic and glass. Syringes are used in their billions by people all over the world!

People with diabetes use prefilled syringes to take (sometimes) multiple doses of insulin a day. To put this scale into perspective, a single insulin pen manufacturer, Novo Nordisk, produce 500 million insulin pens per year.

Therefore, making prefilled syringes more ‘environmentally friendly’ has a potentially huge impact for sustainability. However, we thought we should dig a little deeper into this subject, unravel some common misconceptions and look at what the industry is doing right now, to make the world a better place.

Sustainability can be commonly misunderstood to just cater for environmental factors. However, sustainability can be broken into 3 core elements, called the Triple Bottom Line: People, Planet, Profit (or, Social, Environmental & Economic).

At the moment, the environmental impact of medical devices and prefilled syringes is an area of much research.

It’s not just the case of less plastic = better for the environment, although that does help!

Having more plastic in a device maybe more beneficial from a sustainability perspective if the device is more effective in the administration of the drug, and/or if it results in a safer operation for the user.

ERICPD, a hierarchy of hazard control, states that it’s more beneficial to eliminate a risk, rather than rely on discipline. The same can be said for sustainability regarding the comparison of prefilled syringes vs vial and syringe methods, as the potential for the healthcare professional or user to administer the medication incorrectly or harm the user due to improper vial and syringe method / application, may be more environmentally damaging, than the manufacture and supply of the prefilled syringe. Prefilled syringes provide many other benefits too. They also reduce the risk of administration complexity, spillage, contamination, needle stick injuries, misidentification, dosage error, eliminate overfilling – as sometimes the drug substance itself may have a higher environmental impact than the delivery device.

Picture: The three pillars of John Elkington’s triple bottom line to sustainable business. Brundtland Commission. (2017, June 04). Retrieved June 09, 2017, from https://en.wikipedia.org/wiki/Brundtland_Commission

Environmental, or planet, costs typically are measured in tonnes of carbon dioxide equivalent emissions (tCO2e). Most, if not all healthcare activities expend energy and consequently, have a tCO2e cost. In the case of syringes, the manufacturing, transport, use and disposal of a syringe involves energy and the emission of greenhouse gases which impact on climate change.

The NHS have a target of a net zero by 2040, with an ambition to reach an 80% reduction in carbon emissions by 2028. Therefore, NHS procurement teams have the challenge of making purchasing decisions based upon triple bottom line concepts in order to achieve their net zero target. In 2013, The Royal Liverpool and Broadgreen University Hospitals NHS Trust performed an environmental analysis, exploring the impact of switching from BD Plastipak to BD Emerald syringes. They found that due to plastic weight alone, switching from Plastipak to Emerald would save about 21% or almost 5 tonnes of CO2e per year. Furthermore, BD reports that in the manufacture of the BD Emerald (in Fraga, Spain), 100% of the electricity used is from renewable sources!

Although it is difficult to apportion energy and material use to different products, it would be helpful to those making purchasing decisions to have environmental impact ratings at the level of the individual item, through the means of a universally adopted environmental impact score, similar to efficiency ratings for consumer products. However, this needs to consider not only the manufacture and use of the product, but also the sustainable cost of product end of life.

Appropriate end of life management for prefilled syringes is key to prevent these types of devices ending up being incinerated or, in landfill. Ensuring that devices are disposed of via the most environmentally friendly waste stream is essential. This can be assisted through design and/or through device labelling and instruction.

Most hospitals have waste bins and a structured waste management process set in place for appropriate device disposal, however there’s an emerging trend of home medication, especially for people with diabetes. Homes don’t have the luxury of fully trained waste management teams nor safe methods of breaking the components down from plastics, glass and metal. Therefore, manufacturers are taking innovative approaches to waste management solutions for the devices that they produce.

Novo conducted a pilot project whereby they collected the devices back from users, separated the materials, collected plastic from their devices and produced 1 chair from 120 insulin pens, and converted the glass into lamps.

It’s clear that the most effective strategy relies around creative partnerships. It’s difficult to think about how your waste stream may be useful to you, but as they saying goes, “one man’s trash is another man’s treasure”.

Also using the Design Thinking process, at HD we not only develop injection pen systems, but we’re always thinking, “Is the pen the best form for drug delivery? Are there other ways that drugs can be delivered to patients in an effective and safe manner, all whilst being incredibly environmentally friendly, not having a negative effect, but to have a positive effect on restoring natural systems?”.

 

We offer a range of services with sustainability at the heart of which some activity includes:

 

• High level review of product development strategies to eliminate wasteful product development by reducing material waste and cost, and also to benefit users by reducing cost of purchase.

• Material selection and review to eliminate or minimise, where possible, costly precious materials. We consider different grades to ensure materials are fit for purpose, conform to best practice guidelines so can be easily recycled.

• We review not only the ease of assembly, but also disassembly of the products that we design, to assess whether or not a product can be easily stripped down by hand or autonomously, in trade back or right to repair initiatives to extract and reuse critical componentry or media.

• Advanced computer simulation software such as Finite Element Analysis (FEA) to ensure that products and medical devices are robust enough to last/exceed their expected product lifetimes and endure the typical battles of real-world conditions. Ensuring our devices and products are not over engineered but engineered for the actual use scenario.

• Computational Fluid Dynamics (CFD) to understand airflow or fluid dynamics where needed, i.e. to deliver the correct dosage of airborne particulates to patients through dry dose powder inhalers. This allows us to optimise the size of products and components to minimise waste.

• Process mapping for the manufacture for all major components to review their carbon footprint, and evaluate whether a conventionally sourced low cost part is more or less beneficial than a higher cost locally sourced part.

Will Morris 11 November 2021

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Get in Touch with Will Morris

Design Development Engineer

Will graduated from the University of Wolverhampton with a degree in Product Design. Prior to Haughton Design, Will worked for Renishaw, where he led the industrial design for the current and next generation metal Additive Manufacturing machines. Will has a strong interest in Design for Sustainability, and the Circular Economy, looking to reduce companies’ environmental impact and often teaches about design engineering at local STEM events. Outside of work, Will enjoys Formula 1, rugby and travelling with friends.

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