Nurses: Taking Precautionary Action on a Pediatric Environmental Exposure: DEHP

Anna Gilmore Hall


Pediatr Nurs. 2006;32(1):91-93. 

In This Article

Alternatives: What's Already Been Done

Cost effective alternatives to DEHP-containing medical devices are available for most uses in health care. With the weight of the evidence suggesting that exposure to this reproductive toxicant should be eliminated where possible, many hospitals and health systems have successfully transitioned away from use of DEHP, particularly in neonatal intensive care units (NICUs).

June 9, 2005, San Francisco Chronicle, Toxic agent found in treated newborns is linked to plastic: "Kaiser Permanente, Alta Bates Summit Medical Center, Catholic Healthcare West and the John Muir Medical Center in Walnut Creek, among others, already are buying mostly DEHP-free plastic devices, and pressuring manufacturers and suppliers to produce safe alternatives, according to representatives."

John Muir Medical Center in Walnut Creek, CA, first considered eliminating DEHP from its NICU when a resident pediatrician brought the issue to the attention of the intensive care nursery (ICN) staff. The information he provided, as well as the 2002 FDA public health notification, prompted the ICN staff to look closely at ways to reduce the potential risks of DEHP. They evaluated the NICU's product list and identified which products contained DEHP and which were DEHP-free. Once this step was accomplished, the hospital's clinical nurse specialist led the DEHP reduction effort, working together with the medical and nursing staff to develop a short- and long-term DEHP reduction plan. John Muir was able to announce a virtually DEHP-free NICU within 6 months of beginning this effort (Health Care Without Harm [HCWH], 2003a).

A similar DEHP elimination story on a much larger scale comes from Kaiser Permanente, the nation's largest nonprofit health plan that operates 29 medical centers in 9 states and the District of Columbia. Beginning in July 2001, after learning of the potential hazards to neonatal patients from DEHP exposure, Kaiser Permanente staff underwent a process to identify DEHP-containing medical devices used in NICUs and to evaluate alternatives. Staff used a risk-management process to target products and began a series of clinical trials to test alternatives. Based on their results, the health system chose to switch to non-DEHP products for three commonly used NICU devices: umbilical vessel catheters, PICC lines, and enteral feeding products (HCWH, 2003b).

At Miller Children's Hospital in Long Beach, CA, a patient safety approach framed their DEHP elimination efforts. Because numerous scientific studies show that TPN bags and tubing pose the highest risk of DEHP exposure to neonates, this was their first priority product to eliminate, followed by IV sets. With help from the pediatric department's medical staff, clinical products committee, central supply products manager, and the hospital's risk management attorney, Miller Children's Hospital attained its target of 100% DEHP elimination in IV and TPN products in December 2002 (HCWH, 2003c).


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