Health care groups warn about IV
bags
By TOM ROBERTS
NCR Staff
A broad coalition of health care organizations has launched a
campaign to end the manufacture of what the group claims is a dangerous type of
plastic IV bags and tubing used to deliver medicine and fluids
intravenously.
The group issuing the warning, Health Care Without Harm, warns
that a chemical used in making the bags could cause cancer and other health
problems.
The organization claims 159 member organizations in six countries.
It specializes in environmental issues. Membership includes an array of
Catholic and other religious institutions that have joined in warning that bags
made of PVC (polyvinyl chloride), and used by most U.S. hospitals, contain a
chemical that can leach into blood or medication being administered into a
patients veins.
Health Care Without Harm will launch the campaign at a variety of
news conferences across the country scheduled for Feb. 23.
The danger, they say, comes from additives called phthalates
(pronounced thal-lates) that make the stiff plastic more flexible.
The chemical added to PVC, di-2-ethylhexylphthalate (DEHP),
has been identified by the United States Environmental Protection Agency as a
probable human carcinogen, according to a health alert issued by Health
Care Without Harm, based in Falls Church, Va.
The campaign calls for lobbying health care providers to use
PVC-free and DEHP-free IV bags and other medical equipment. Further information
can be obtained from the Health Care Without Harm Web site:
www.noharm.org
Charlotte Brody, co-coordinator of Health Care Without Harm, said
the organization was founded two and a half years ago in response to concerns
about hospital incineration of medical supplies containing PVC. At the time,
medical waste incineration was the leading source of highly toxic dioxins,
which is the result of chlorine combustion, said Brody.
The work of Health Care Without Harm initially was based on
our goal of minimizing dioxin exposure. We originally were concerned with
incineration of PVC bags.
But the organization soon became aware of the additional problem
of the leaching of phthalates -- often referred to as
plasticizers.
Similar concerns arose within Catholic Healthcare West, a
California-based hospital system, according to Sr. Susan Vickers, director of
advocacy for the system. She said Catholic Healthcare West had already
determined to reduce as much as possible, the use of PVC plast supplies in the
systems 48 hospitals when it hosted a presentation by Health Care Without
Harm. The system then approved joining the national effort to reduce the use of
PVC plastic supplies in hospitals.
Health Care Without Harm was alerted by a pharmacist in one of the
member hospitals who pointed out that certain drugs contain warnings against
using them in PVC bags because of possible leaching of DEHP.
According to those involved in the issue, there are three major
manufacturers of IV bags and tubing: Baxter Healthcare Corp., Deerfield, Ill.;
Abbott Laboratories in North Chicago, Ill.; B. Braun McGaw Inc., Irvine, Calif.
Of those, Baxter and Abbott are the largest providers of the supplies. The
major portion of IV bags they manufacture contain PVC. Only McGaw regularly
supplies non-PVC bags.
All three have bid on a massive contract to supply IV
solutions and sets -- bags containing medication and other fluids as well
as the tubing and needles used to administer the fluids -- for the 296 Catholic
hospitals and 138 Catholic nursing homes that are represented by Consorta
Inc.
Consorta was formed in May when two Catholic purchasing groups
merged to form the countrys sixth largest health care group purchasing
organization.
The value of the contract will be $480 million over eight
years, said John Strong, Consortas president and chief executive
officer.
The contract for IV bags was one of the first actions of the new
purchasing group, and that development attracted the attention of Health Care
Without Harm.
The activist group, said Strong, was instrumental in helping
us understand the issues around PVC.
Those concerned with the questions of environmental safety as well
as phthalate leaching from the bags would prefer to see McGaw land the
contract. However, other clinical and economic issues will be part of the
consideration, said Strong.
No matter which firm lands the contract, Health Care Without Harm
has significantly influenced the negotiations. If the contract goes to Baxter
or Abbott, said Strong, Consorta would include language in the agreement that
would provide for education on the PVC issue at member hospitals; information
on proper disposal techniques and an assurance that the manufacturer would work
toward reducing the amount of PVC in the supply chain over the course of the
contract.
He said Consorta expected to reach terms with one of the suppliers
within 60 to 90 days. One of the terms will spell out the suppliers
intention to move as quickly as possible toward non-PVC bags and tubing.
Some discount the dangers of DEHP because there has been little
evidence of significant adverse effects and because the amount of
DEHP that can leach from IV bags is too small to be associated with any health
effects.
Other medical experts respond, however, that even though there is
no conclusive proof of a cancer connection in humans, the evidence is strong
enough to warrant a ban on PVC plastic.
Health Care Without Harm contends that lack of significant
evidence of health damage in humans does not mean that there is significant
evidence that DEHP is safe. Thalidomide and DES were both used by millions of
pregnant women before researchers made the link between birth defects, cervical
cancer and the effects of these two drugs in utero.
James Huff, a toxicologist with the National Institute of
Environmental Health Sciences, said tests performed by the institute left
no doubt that DEHP causes cancer in laboratory animals, although
there is so far no evidence of cancer in humans caused by DEHP.
However, he said, In my opinion, any result in lab animals
that is positive in that direction is reason for caution in humans. He
thinks hospitals should use alternatives to PVC bags.
Dr. Ted Schettler of Boston, science director for Science and
Environmental Health Network, said that, based on the scientific evidence,
it would not be irresponsible to say that DEHP is not a human
carcinogen. The evidence shows that while DEHP quickly causes a reaction
in the liver of rodents, it does not do so in humans. But Schettler said that
the evidence would suggest a strongly cautionary approach to DEHP.
Schettler finds far more interesting and worrisome DEHPs
effect on reproductive organs, particularly testicles, and on the heart.
Recent evidence shows that the developing organs of fetus and
infant rodents were highly sensitive to even low level doses of DEHP, he said.
He added that further longer-term experiments on mammals showed that DEHP
affected lung function in children and, over a prolonged period of time, caused
liver changes in monkeys that researchers had found to occur more quickly in
rodents.
National Catholic Reporter, February 19,
1999
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