1. Kennedy, Maureen Shawn MA, RN

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A new study has documented for the first time that di(2-ethylhexyl) phthalate (DEHP), a chemical used to soften and strengthen plastic, specifically polyvinyl chloride (PVC), can leach into blood, as well as other lipid-containing solutions. Used in numerous medical products-including IV tubing, bags used for IV solutions and blood, nasogastric tubes, umbilical catheters, respiratory masks, and examination gloves-DEHP has been shown to produce developmental, reproductive, and hepatic toxicity in laboratory animals. Recent studies have also established a link between exposure to DEHP and adverse effects on the reproductive development of male infants.


Researchers at Harvard School of Public Health and Harvard Medical School examined the urine specimens of 54 patients on the neonatal intensive care unit (NICU) over three days ( On the basis of the amount of plastic (and, hence, DEHP) used in each infant's care, the researchers divided the neonates into three groups: low, medium, and high exposure. Results showed that the level of a particular DEHP metabolite present in the infants' urine varied according to their exposure to the chemical-the greater the exposure, the higher the level of toxins-thus raising concerns regarding the effects of these toxins on infants' reproductive development. The researchers recommend additional studies to follow the babies' health over many years.


The Food and Drug Administration (FDA) had already issued a public health notification in 2002 outlining the potential risks of extended or frequent exposure to DEHP-particularly for such high-risk patients as neonates; prepubescent boys; pregnant or lactating women undergoing hemodialysis; and adults receiving enteral nutrition or undergoing heart transplantation or coronary artery bypass graft surgery, and those being given vast quantities of blood. The FDA also recommended that hospitals use DEHP-free products whenever possible; this study confirms the need to do so. For a list of alternatives to PVC and DEHP, see Going Green: A Resource Kit for Pollution Prevention in Health Care at


One hospital that heeded the FDA's advice is John Muir Medical Center in Walnut Creek, California, which managed to rid its NICU of nearly all DEHP-based products. The switch to DEHP alternatives took less than six months, thanks to the efforts of Valerie Briscoe, a clinical nurse specialist in the hospital's NICU, who worked with the purchasing department to identify products that contained DEHP, researched alternatives, and together with the medical and nursing staff, was able to devise a plan to diminish the use of plastic supplies containing DEHP. "The switch actually helped the hospital save $15,000 per year," says Briscoe, who, since the program's implementation in July 2002, continues to monitor the supply room. "People sometimes ask me if this is my full-time job," she says. "It's really fairly simple. Larger hospitals may have a harder time, because the purchasing departments of various units all have to be committed to making the switch. But someone has to champion the cause and get it done."-Dalia Sofer

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Green R, et al. Environ Health Perspect 2005; in press.