A qualitative study exploring single-use plastics and environmental sustainability in orthodontics

Background: The World Health Organisation labelled climate change ‘the single biggest health threat facing humanity’. Healthcare has significant adverse effects on the environment. Single-use plastics (SUP) are one aspect of environmental sustainability that we must address to reduce our impact on the environment. Plastics used in medical equipment are not easily sterilised for re-use, or recyclable, meaning that the majority of healthcare plastic waste goes to incineration or landfill. Orthodontic treatment uses myriad SUP items whilst reusable alternatives exist.
Aim: To explore how the orthodontic community and orthodontic industry in the UK, use and perceive SUP, to understand current practice and identify barriers or facilitators to changing SUP use.
Methods: This qualitative study involved a document review to understand the policies and guidelines that influence the use of SUP in orthodontics that helped to develop topic guides for interviews with orthodontic industry and focus groups with the orthodontic community. These were conducted online, to understand different stakeholders’ perspectives and barriers and facilitators surrounding a change in SUP use in orthodontic practice. Data analysis was phenomenological, grounded in the experience of the participants and coded thematically, according to Braun and Clarke (2006). Three focus groups (13 participants) and three interviews were carried out with the UK orthodontic community and company representatives.
Results: Orthodontic industry and the orthodontic community had similar viewpoints. Both interview and focus group participants felt that change is needed and welcomed, but that barriers included infection prevention control, cost and confusion regarding recycling. Participants felt changes must be made at all levels.
Conclusions: This study highlights the complexities associated with transitioning to more sustainable ways of working. These complexities include the need for multiple stakeholders (trade, regulators, clinicians and patients) to accommodate more sustainable practice through improved policies, systems, workflows and education while minimising any negative financial impacts.