Why Are Plastic Syringes Not Recycled?: An Opportunity for Anesthesiology

Allison R Thompson BS MPH, Elizabeth E Hansen MD PhD, Diane W. Gordon MD

Original article:

Greene JA, Stringer R. Why are plastic syringes not being recycled? Lancet. 2025 Jun 27:S0140-6736(25)01333-9. doi: 10.1016/S0140-6736(25)01333-9. Epub ahead of print. PMID: 40587982.

Background

The healthcare sector generates a significant amount of waste each year. While the exact volume of plastic waste generated in the United States is unknown, one analysis suggests that 0.6 tons of plastic medical waste is generated per bed in a hospital each year.[1] While the environmental impact of the healthcare system is becoming more acknowledged, applying the classic “reduce, reuse, recycle” to healthcare plastic waste is difficult. Efforts to reduce single use plastic products should continue, but healthcare will never return to reusable glass syringes. Reuse of syringes between patients is obviously not allowable, and more than 90% of plastic is not easily recycled.[2] Plastic syringes, however, are unique in that they are made of polypropylene or high-density polyethylene, which are two types of plastic that are easily and efficiently recycled. Plastics are rarely recycled into the same product they started as, but even “down-cycling” reduces the amount of virgin plastic that is created.

History of Plastic Syringes

Before the 1960s, healthcare used glass syringes that were washed, sterilized, and reused along with metal needles that had been cleaned and resharpened. Although disposable plastic syringes were initially eschewed (no one likes change!), once the transmission of emerging infectious diseases like hepatitis, HIV, and Ebola was linked to shared needles/syringes, healthcare in the developed world changed abruptly to disposable syringes. The “syringe tides” of the late 1980s cemented the public image of needles and syringes as “dangerous”, leading to sharps bins to collect these items and prevent their disposal into waste streams that could lead to illicit reuse. Current disposal methods for plastic syringes include incineration (in certified facilities), burning, or landfilling (with or without prior sterilization), depending on a country’s available resources. Burning medical waste (or incinerating without the proper scrubbing technology) releases dioxins and furans into the atmosphere while landfilling increases the risk of needlestick injuries.

Potential Solution

There is evidence that syringe recycling is not only feasible, but also safe. In Nepal, at the Tribhuvan University Teaching Hospital (TUTH), in collaboration with Healthcare Without Harm, the Health, Environment, and Climate Action Foundation (HECAF) 360, and WHO Nepal, several initiatives were implemented to improve the sustainability of waste management practices, including those focused on the recycling of plastic syringes.[3] A key first-step in their syringe recycling process is the removal of the needle from the syringe by means of needle cutters. Cutting the needles allows for them to be disposed of properly, prevents the ability of the syringe to be reused because the hub of the syringe is removed in the process as well, and allows the high-quality plastic of the syringe to be sterilized and then recycled. The practice of needle cutting not only reduces the number of needlesticks by those who handle medical waste, but also causes no increase in the number of needlesticks during the actual cutting or disposal.[4] As a result of the new system at TUTH, 40% of the waste generated was able to be recycled, the plastics (most of which were plastic syringes) that were recycled generated income of $270 per ton, and the number of needlestick incidents decreased.[3]

The Problem

Currently in the United States, the infrastructure in place for medical waste management does not facilitate recycling. Hospital waste recycling is complex because much of the waste requires proper disposal and separation, specialized transport, and sterilization before the actual recycling process can begin. We can all bear witness to the breakdown of the waste management process in the OR– trash is carelessly tossed in biohazard bins, sharps are inadvertently disposed of in pharmaceutical waste bins, etc. This missorting of waste makes future disposal management more complicated. Similarly, although the utilization of sharps containers is an effective solution for reducing the risk of needlesticks and illicit reuse, they reduce the potential for plastic syringe recycling because the syringe is often disposed of alongside its needle in the sharps container. Because the containers are designed to not be reopened, the opportunity to separate the recyclable plastic from the needles is lost. In order for plastic syringe recycling to be implemented in high-income countries, there will need to be significant changes to our current waste collection infrastructure and process.

Conclusion

Anesthesiologists are high utilizers of plastic syringes. We are very uniquely positioned to lead efforts to reduce the environmental impact of our specialty, which could include implementing a process for recycling plastic syringes. We have clear evidence from the program in Nepal at the TUTH that with the right infrastructure, plastic syringe recycling is feasible and would significantly reduce the amount of plastic waste sent to landfills or incinerated.

From Myron: Doesn’t it seem bizarre to you that our colleagues in Ghana and Nepal can do this and we cant? Send your thoughts and comments to me (myasterster@gmail.com) and I will post in a Friday Reader Response.

PS From Myron: Alli Thompson is a medical student at the University of Michigan and joined SPA’s sustainability special interest group. She’s applying for an anesthesiology residency so keep your eyes open for this rising star!

References

1. Lee BK, Ellenbecker MJ, Moure-Eraso R: Analyses of the recycling potential of medical plastic wastes. Waste Manag 2002, 22(5):461–470.

2. Geyer R, Jambeck JR, Law KL: Production, use, and fate of all plastics ever made. Sci Adv 2017, 3(7):e1700782.

3. Stringer R: Health care waste management towards the circular economy. In.: Institute for Global Environmental Strategies Centre Collaborating with UNEP on Environmental Technologies (CCET); 2021. Accessed 009/10/2025 https://www.iges.or.jp/en/publication_documents/pub/workingpaper/en/12035/Napal+case+study_web.pdf

4. Agbenu E, Chartier Y, Eleeza J, Antwi-Agyei KO, Diamenu S, Ronveaux O, Perea W: Use of hub cutters and the volume of sharp waste and occurrence of needle-stick injuries during 2011 mass immunization campaigns against yellow fever in Ghana: a cohort study. Int J Occup Environ Med 2014, 5(1):9–17.