Over the last decade, many of us have been making the move to a more sustainable way of living. Small incremental steps that collectively add up. Think of the re-fillable coffee cups, tote bags, and widespread shunning of single-use plastic. Consider the food waste collections and compost heaps, household recycling; and the growing demand for ‘vintage’ and ‘pre-loved’ clothing, furniture, and all manner of reconditioned electronics. The mantra of reduce, reuse, recycle has crept into the mainstream.
But, what about within our hand therapy departments? The consumption of a lot of single-use plastics no longer sits well with many of us. The plastic dressings packs, oedema wraps, thermoplastics, Velcro and packaged prefabricated splints. How can we change this?
In the UK, the NHS procurement systems is a mystery of locally arranged deals, dictating which equipment suppliers can be used. This appears to be driven by cost, without clear ethical production and sustainability criteria. We can question this and ask for suppliers to be judged on ethical and environmental sustainability throughout their production and supply chain. Is the situation different elsewhere? It would be great to hear of successful models of negotiating for a greener agenda within hospital/clinic procurement.
We can consider switching to brands of thermoplastics that are home compostable, including X-Lite (Classic and Premium only) and Woodcast. It’s our role to prioritise the use of these materials and encourage patients to compost their splint when it’s no longer required – remembering that all strapping, padding, lining etc, still needs to be discarded. This is particularly important for splints that are expected to have a short period of use, for example after surgery or trauma. We could also start local initiatives to arrange for the collection and compost of biodegradable thermoplastic scraps, perhaps through partnerships with local gardening and allotment groups.
Moving to compostable splinting materials may require an adjustment period to become confident in handling and moulding these materials, but it is essential that we take these steps to drive healthcare towards a sustainable model.
As for the traditional thermoplastics, some suppliers offer a collection of scrap thermoplastic material for recycling. This offers another option for individual departments to explore and usually isn’t limited to the brands of plastic that suppliers provide. We also need hospital/clinic policies that allow thermoplastic scraps and other recyclable items to be diverted from the default clinical waste (incineration) bin. Another issue to flag-up and discuss.
A further area of waste is dressings packs and bandages, all packaged in non-recyclable cellophane. These materials are widely used throughout different hospital and clinic departments. It’s our role to call for change. Why are these items not packaged in biodegradable or recyclable materials?
![Lisa Newington (BSc, MSc, PhD, AHT[BAHT], MCSP)](https://environmentalphysio.com/wp-content/uploads/2021/08/Lisa-Newington-EPA-profile.jpg)
Lisa Newington (BSc, MSc, PhD, AHT[BAHT], MCSP)
Advanced Clinical Practice Hand Therapist, Guy’s and St Thomas’ NHS Foundation Trust and Postdoctoral Research Fellow, Imperial College London, UK
As a hand therapist, Lisa works in therapy-led trauma and post-operative clinics. Her research focuses on upper limb rehabilitation, and clinical academic careers for the healthcare professions outside medicine. Lisa is a member of the British Association of Hand Therapists Clinical Evidence Committee.
Zoë Thompson (BSc, MSc)
Senior Hand Therapist, Chelsea and Westminster Hospital NHS Foundation Trust, Co-Founder of the Green Hospital Project and NHS Clinical Entrepreneur
Specialising in hand therapy for 8 years, Zoë has an interest in the psychological impact of hand injuries and providing holistic treatment. Now part of the sustainability team at her Trust, she is establishing sustainability projects in Hand Therapy and beyond. Zoë is also a Co-Founder of The Green Hospital Project (The GHP on Twitter and Instagram)
Many hand therapists will remember when rehabilitation workshops were a key part of their department. This facility enabled patients to be guided with woodwork and other projects as part of their functional rehab. Over the years these workshops have been stopped due to cuts, the space being needed for something more pressing, or health and safety reasons. Hand therapy rehab options, in the UK at least, seem to have moved to the provision of limited-use home exercise equipment, such as plastic exercise sponges, therapy putty or theraband. Before giving patients these resource-intense short-lifecycle products, we can ask: what have you got at home that could be used for rehab exercises? It’s an opportunity to get creative with children’s toys, kitchen and home maintenance tools and repurpose functional tasks into rehab activities. Even better, explore access to local gyms, free outdoor equipment, and exercise groups (where available). Have a discussion with your patients about maintaining or increasing physical activity in general, while incorporating hand, wrist, upper limb rehab as a part of this.
Completely cutting out the use of rehab equipment may negatively impact on some patients’ recovery, but can we move to more sustainable models? For example, an equipment library where rehab products are loaned to patients for a month or two, or an informal rehab network based on the FreeCycle model with individuals handing on the rehab equipment they have finished using. Yes, everything will need washing, but this can be done with soap and water, saving all the plasticated wipes currently standard in our hospitals. Yet another procurement issue to flag-up and discuss.
Additionally, as therapists, we need to move away from the idea that an appointment is only valuable if we give the patient something, be it a paper exercise sheet, a new splint, or a resistance band. This is a culture change we need to support for both therapists and patients.
Healthcare professionals commonly feature among the top 10 most trusted professions. The public trusts us and listen to our voices. We need a collective voice calling for a shift in how we work. A broader vision not just of health today but for future generations and the planet.
As we understand the more pressing nature of the climate crisis, and our responsibilities to respond to this both in our personal and professional life, it’s time for change. There’s so much more to do, but no time like the present to start encouraging your department to move to a greener way of delivering hand therapy. Will you include this as part of your team goals this year? For those of you already making the journey to sustainable hand therapy provision, we’d love to hear your comments and suggestions.
Lisa Newington & Zoë Thompson
Lisa and Zoe,
I’m really excited by what I just read, thank you both. The Australian Hand Therapy Association following the urging of one member in particular has made the “greening” of hand therapy practice a priority. We will be giving this topic as much exposure as we can, and plan to work with local suppliers & therapists to reduce waste. Please let me know any way in which we can help more.
Hamish Anderson
President AHTA
Thanks Hamish,
Great to hear that the Australian Hand Therapy Assoc. have also identified these issues and are striving for greener hand therapy. Brilliant that this is coming from and organisational level, so many thanks to you! Would be great if the global hand therapy community could share all learning/progress in this area.
Very best wishes, Lisa
Hi Lisa and Zoe
That’s a very motivating read. I had thought that the compostable material is harder to mould but your photo shows that it can be done.
Christine
Thanks Christine,
There’s definitely a bit of a transition from traditional plastics to the woodcast splints, but it doesn’t take long to become familiar with this. I also find you need less material as the edges don’t need to be rolled (cf 1.8/2.4mm plastics). You have to remember to take the Velcro and straps off for composting! I hope you’re able to give it a go!
Thanks for your comment and very best wishes,
Lisa
This is such an important area to progress. Well done on helping motivate us to explore more environmental options. I would love to hear if anyone in Australia has found out how to recycle thermoplastic scraps.
Karen
Thanks Karen,
I’m not sure about scrap recycling in Australia, but please get in touch with your hand therapy association (see the first comment), as they’ve put environmental sustainability firmly on the agenda and may be able to liaise with suppliers at a national level?
Thanks for your comment and very best wishes,
Lisa
Hi Karen,
It may also be worth contact the reps who provide your thermoplastics. Here in the UK at least 2 companies were offering recycling of thermoplastic scraps pre-covid (unfortunately not used splints). This is on hold currently but if the reps know we want this service they may bring it back sooner!
KR,
Zoe
great blog Lisa and Zoe on a very important topic. We will need to push from the physiotherapy side to ensure that hospital administration goes with more environmentally friendly options. Only then we will see changes in industry and more options combined with lower cost for environmentally friendly products
Thanks Evangelos. Completely agree – we need to all argue that price alone is not a good reason for purchasing decisions. Environmental sustainability and fair/ethical manufacturing need to be factored in. Thanks for taking the time to read our post and for being a sustainability champion!
Very best wishes,
Lisa
I completely agree. I really think we can change the products that we use to become more environmentally friendly. Unfortunately, as hand therapists, I think we become creatures of habit – I know I’m guilty of that! We already have a date to re-visit woodcast next month. When we originally trialled it I don’t think the environmental issues were as high on the agenda as they are now. This article has also made me think about other products we use too. Thank you for highlighting this issue.
Hi Lisa and Zoe,
I attended the IFSHT in London and heard Zoe’s presentation about the environmental advantages of Woodcast. I have followed up with your work and now have read this excellent blog with so many creative ideas. I did go to the Woodcast exhibit at the meeting and am now doing some work with Michael Lindroos. Coincidentally, the Dassiet USA headquarters are in Denver, Colorado, where I live so we were able to meet up in person. I would love to be in touch with you more about your IFSHT presentation about Woodcast. I would like to share you work with therapists in the US–of course citing you and crediting you with anything you might be willing to share. I hope we can be in touch.
Hi Karen,
Sorry for the delay – I hope you have been able to get through to Zoe. We wrote the blog a while back now, so haven’t been looking at the comments. Please let me know if you would like to be linked up and I’ll put you in touch.
Very best wishes,
Lisa