Biodegradable Alternatives to Plastic in Medical Equipment: Current State, Challenges, and the Future

Abstract

The use of plastic products or components in medical equipment and supplies results in challenges in terms of environmental sustainability and waste management for disposable, non-recyclable, and non-biodegradable materials. Medical plastic waste includes items ranging from syringes, tubing, intravenous (IV) bags, packaging, and more. Developing biodegradable replacements to petroleum-based plastics in medical equipment has not yet become an urgent priority, but it is an important endeavor. Examining alternatives involves several key themes, including material selection, testing, validation, and regulatory approval. To date, research includes studies on biodegradable polymers, composite materials, surface modifications, bacterial cellulose, three-dimensional (3D) printing with biodegradable materials, clinical trials and testing, collaboration with industry, regulatory considerations, sustainable packaging for medical devices, and life cycle analysis. The incorporation of bio-based and biodegradable plastics in the healthcare industry holds immense potential for reducing the environmental impact of medical plastic waste. The literature suggests that researchers and industry professionals are actively working towards finding sustainable alternatives that meet the stringent requirements of the medical industry. This paper reviews the efforts made so far to develop biodegradable and sustainable alternatives to plastic in medical equipment using a meta-analysis of resources, which include relevant papers published in English until June 2024. A total of 116 documents were found and screened by three reviewers for relevance. The literature reviewed indicated that various medical uses require plastics due to their unique properties, such as having strength and flexibility; being lightweight; and being able to prevent bacterial contamination. Among the alternatives, polycaprolactone (PCL), polylactic-co-glycolic acid (PLGA), starch-based acid, and polybutyric acid (PBS) have demonstrated favourable outcomes in terms of biocompatibility, safety, and efficacy. Additionally, a set of approaches to overcome these barriers and strategies is discussed alongside potential future solutions. This review aims to catalyze discussions and actions toward a more environmentally sustainable future in the medical industry by providing a comprehensive analysis of the current state, challenges, and prospects of this domain.

1. Introduction

The use of plastic in medical supplies results in numerous environmental problems, amplifying the overarching environmental footprint linked to healthcare. In 2023, the global plastics market was valued at USD 712 billion. The plastics market is projected to grow in the coming years to reach a value of more than USD 1050 billion by 2033, registering a compound annual growth rate (CAGR) of four percent during the forecast period of 2023 to 2033 [1]. Traditional petroleum-based plastics currently used in medical equipment are often non-biodegradable, contributing to long-term environmental pollution. For example, degradation of thin films or soft plastics like bags tends to occur over 10–20 years, while harder plastics take 500–1000 years. Plastic bottles are reported to take over 70 years and up to 450 years to degrade. Some media have reported that “plastics” do not degrade at all [2,3]. The vast majority of produced plastics originate from fossil feedstocks [2]. Disposal of these plastics can lead to accumulation in landfills and oceans. The production of plastics relies on the extraction of fossil fuels, contributing to resource depletion and environmental degradation.

Healthcare facilities generate a significant amount of medical plastic-based waste. Proper disposal and management of hazardous medical waste poses challenges. Many medical devices are single-use or undergo rigorous sterilization processes, making recycling more complex and adding to the overall waste volume. Chemical exposure is another challenge in using plastics for medical equipment since certain plastics inherently contain harmful chemicals that can leach into the environment or interact with the contents of the devices, posing potential health risks [3]. On the other hand, the degradation of plastics over time can lead to the formation of micro- and nano-plastics, which have been found in various environments, including water sources and organisms [4].

The production of plastics in general involves energy-intensive processes which contribute to carbon emissions. The transportation of raw materials and finished products also contributes to the overall carbon footprint associated with plastic medical equipment.

Despite these challenges, there is a notable gap in the literature about the specific application of biodegradable alternatives in medical contexts. Existing studies largely focus on the environmental impact of plastics and general approaches to sustainability yet fail to address how these alternatives can be effectively integrated into medical applications. In response to these challenges, researchers and manufacturers are exploring biodegradable alternatives to mitigate the environmental impacts associated with medical waste [5,6,7]. The process of exploring alternatives involves critical steps, including material selection, testing, validation, and obtaining regulatory approval [8]. Biodegradable plastics (BPs) offer an alternative to traditional plastics, yet not all BPs undergo complete degradation in the natural environment. Instead, depending on the structure of the polymer chains, some BPs may degrade into micro/nano-plastics more rapidly than conventional plastics, thereby introducing an extra risk to all ecosystems [9]. These BP materials can be sourced from a variety of origins, including biomass such as plant-based feedstocks, agricultural remnants, and microorganisms [10]. BPs are polymers that can be degraded into CO₂, H₂O, CH₄, and biomass by enzymes and microorganisms [11]. BPs can be categorized into natural polymers and synthetic polymers based on their natural or laboratory-derived starting materials [9]. BPs are a subset of bioplastics, which are plastics that are biodegradable or derived from renewable resources, which are often confused [9]. Some bioplastics like bio polyethylene (Bio-PE) and bio polyvinyl chloride (Bio-PVC) are not biodegradable but are synthesized from renewable materials. Similarly, bioplastics like fossil-based polycaprolactone (PCL) are not derived from biological sources but are biodegradable. Nevertheless, notable bioplastics in recent years, such as starch blends, polylactic acid (PLA), and polyhydroxyalkanoate (PHA), primarily rely on microorganisms for their raw processing, which presents challenges in scaling up production and ensuring cost-effectiveness. These bioplastics encounter limitations in terms of recycling, as their recycling needs require specialized facilities and processing capabilities to biodegrade. Concerns persist regarding the sustainability of bioplastics, particularly if they compete for land use with food sources.

This work explores the published literature on biodegradable alternatives to plastics for use in medical equipment and supplies. This paper provides a comprehensive analysis of the current challenges with medical plastics, the significance of biodegradable alternatives, and the market potential and possible adoption of these alternatives in medical contexts. Through a systematic methodology involving keyword compilation and data retrieval from relevant databases, this study investigates the current state, challenges, and prospects of biodegradable materials in medical applications. Material innovation and development are scrutinized, with in-depth analyses of various biodegradable alternatives including PHA, PLA, PGA, PCL, PLGA, starch-based, and PBS-based materials. Finally, barriers and strategies are discussed alongside potential solutions. Through a comprehensive review of the literature, this paper aims to catalyze discussions and actions toward a more environmentally sustainable future for material use in the medical industry.

2. Materials and Methods

The study collected data from trustworthy sources using established review methods [12,13] as guidance, starting with the compilation of relevant keywords for searching databases to obtain materials. Acquired results were evaluated for inclusion. Scopus, PubMed, Engineering Village, iPortal, and Web of Science were searched by three researchers between April 2023 and June 2024 during the compilation stage. The search covered all articles published between 2008 and 2024 that were available in the five databases. The search terms used in the study were developed with the support of an engineering librarian and included the following: (TITLE–ABS–KEY (medical) OR (TITLE–ABS–KEY (“medical equipment”) OR (TITLE–ABS–KEY (“medical devices”) OR (TITLE–ABS–KEY (“medical tools”) AND TITLE–ABS–KEY (“single–use”) OR (TITLE–ABS–KEY (disposable) AND TITLE–ABS–KEY (biodegradable) OR TITLE–ABS–KEY (“environmentally friendly”) OR TITLE–ABS–KEY (“degradable plastics”) OR TITLE–ABS–KEY (“green alternatives”) OR TITLE–ABS–KEY (“plastic substitute”).

A total of 116 documents were found and screened by three reviewers for relevance. After restricting findings to English, there were 114 documents remaining. The number of documents dropped to 102 when the subject area was narrowed down to the pertinent fields, which included engineering, materials science, chemistry, sustainability, plastics, and medicine. The sample reduced to 91 when the keywords were limited to “disposable equipment”, “recycling”, “instrument sterilization”, “waste management”, “environmental impact”, “devices”, “COVID-19”, “sterilization”, “equipment reuse”, “hospital waste”, “disinfection”, “sustainable development”, “sustainability”, “single use”, “pandemic”, “medical waste”, “plastic”, “medical device contamination”, “equipment design”, “personal protective equipment”, “equipment contamination”, “medical device”, “infection control”, “cost control”, “surgical equipment”, and “environment”. The search results are schematically displayed in Figure 1. Materials science was the main subject area, accounting for 16.7% (33 documents). The majority of the publications (61.5%) were research articles, and the number of documents published annually increased over the years and reached 22 in 2023. In each section below, we summarize the results of the review in parts by Application, Strategies to Transition to Alternatives, Material Innovations, Biodegradable Alternatives, and Barriers to Transitioning.

3. Results Part 1: Application of Plastic in Medical Equipment

The literature reviewed indicated that various medical uses require plastics due to their unique properties, such as having strength and flexibility; being lightweight; and being able to prevent bacterial contamination. It is difficult to know the exact amount of medical plastic waste since the data vary from one place to another, especially in health facilities. A good percentage (probably 75–90%) of all plastic waste generated during treatments is not hazardous according to the World Health Organization (WHO) classification, since it depends on how the plastic was used [14]. Examples of plastic applications in the medical field are outlined in

Table 1. Some notable applications of plastic in medical tools and equipment [15,16,17,18].

Application	Description
Medical Devices	Implants: Certain plastics, such as polyethylene and polypropylene, are used in the manufacturing of orthopedic implants like hip and knee replacements. Catheters: Plastics like polyurethane and silicone are commonly used in the production of catheters for various medical procedures. Tubing: Flexible and sterile plastic tubing is widely used in medical applications, such as intravenous (IV) lines, blood transfusion, and respiratory tubing.
Packaging	Plastics are extensively used for packaging medical supplies, pharmaceuticals, and sterile instruments. They help protect the contents from contamination and ensure sterility.
Surgical Instruments	Some surgical instruments are made from high-performance plastics like polyetheretherketone (PEEK) due to their biocompatibility, resistance to chemicals, and radiolucency.
Dental Applications	Plastics are commonly used in dentistry for items such as dental implants, dentures, crowns, and various orthodontic devices.
Drug Delivery Systems	Plastics are used in the development of drug delivery systems, such as polymer-based nanoparticles and microparticles, which can be tailored to release drugs in a controlled manner. These polymer carriers, while effective in medicine, also contribute to pollution due to their persistence in the environment.
Diagnostic Equipment	Many diagnostic devices and equipment components are made from plastics. For example, parts of X-ray machines, CT scanners, and MRI machines often incorporate plastic materials due to their radiolucency.
Prosthetics and Orthotics	Plastics are used in the fabrication of prosthetic limbs and orthotic devices due to their lightweight nature and ability to be molded into complex shapes.
Disposable Medical Products	Many single-use medical products, such as syringes, gloves, and surgical drapes, are made from plastics to ensure sterility and prevent the spread of infections.
Medical Imaging	Plastics are used in the construction of components for medical imaging devices like computed tomography (CT) and magnetic resonance imaging (MRI) machines. Plastics are chosen for their electrical insulation properties and ability to withstand the harsh conditions inside these machines.

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In larger Canadian cities where healthcare waste management systems are in place, medical waste can be disposed of in compliance with waste regulations; in remote and rural communities, the medical waste is sent to the local landfills or incinerated. In contrast, low-income countries may not have the facilities to properly dispose of medical devices, which leads to inappropriate management practices, as shown in Figure 2.

While the sampled literature noted that plastic has been a widely used material in medical equipment due to its versatility, durability, and cost-effectiveness, there are several disadvantages associated with its use. Key findings include, but are not limited to [20,21], the following:

• Non-Biodegradability: Traditional plastics used in medical equipment are generally non-biodegradable, contributing to long-lasting environmental pollution when not disposed of properly.
• Environmental Impact: The production of plastic involves the extraction of fossil fuels and energy-intensive manufacturing processes, contributing to carbon emissions and environmental degradation. The production of plastic requires the extraction of finite resources, contributing to resource depletion. The reliance on non-renewable resources raises concerns about sustainability.
• Waste Generation: Medical facilities generate a significant amount of plastic waste, particularly from single-use devices. Managing and disposing of this waste can be logistically challenging and may contribute to overall waste management issues, especially in remote and rural communities.
• Chemical Composition: Certain plastics used in medical devices may contain harmful chemicals, plasticizers, or additives. These substances can leach into the surrounding environment or interact with the contents of the devices, posing potential health risks.
• Single-Use Culture: Many medical devices are designed to be single-use due to infection control measures, contributing to a disposable culture that increases the demand for raw materials and generates more waste.
• Sterilization Challenges: Some plastics may not withstand certain sterilization methods, limiting their reusability. This can result in the need for single-use items, contributing to waste generation.
• Microplastics Formation: Over time, plastics can degrade into smaller particles known as microplastics (e.g., fragments less than 5 mm in length) and nano-plastics (e.g., size ranges between 1 nanometer and 1000 micrometer in length). These microplastics have been found in various environments and currently have unknown effects on ecosystems and human health.
• Incineration Issues: Incinerating plastic medical waste can release harmful pollutants into the air, posing environmental and health risks. Incineration is also associated with the generation of greenhouse gases.
• Regulatory Compliance: Meeting regulatory standards for certain medical devices made from plastic can be challenging. Strict safety and quality standards must be adhered to, and obtaining regulatory approval can be a complex and expensive process.
• End-of-Life Disposal: The disposal of plastic medical equipment at the end of its life cycle requires careful consideration. Improper disposal can lead to environmental pollution and may pose risks to human health.
• Public Perception: There is an increasing awareness of environmental issues associated with plastic use. The negative perception of plastics, especially in the context of healthcare, can impact the reputation of healthcare institutions.

Addressing these disadvantages has prompted research and development efforts to explore sustainable alternatives, including biodegradable materials and other eco-friendly solutions for use in medical equipment.

4. Results Part 2: Primary Strategies for Transitioning from Plastic to Sustainable Materials

As the environmental impact of plastic pollution becomes increasingly apparent, the literature has stressed the urgency to transition to sustainable alternatives. Through this review, a set of strategies was identified to transition from petroleum-based plastics to more sustainable alternatives. Authors noted that this shift requires a comprehensive approach that addresses not only material substitutions but also structural changes in production, consumption, and waste management. Here, the main strategies for transforming from plastic to sustainable replacements are outlined.

4.1. Material Innovation and Development

The literature sample gave evidence that research and development efforts are focused on discovering and refining sustainable materials that can replace traditional plastics [22,23]. These materials include biodegradable polymers derived from renewable sources, such as plant-based plastics (e.g., PLA), bio-based plastics, and compostable polymers [22]. Advancements in material science aim to improve the performance, durability, and cost-effectiveness of sustainable alternatives, ensuring they meet the functional requirements of various applications. Collaboration between scientists, engineers, and manufacturers is essential to accelerating the development and adoption of these materials.

4.2. Circular Economy Practices

Embracing circular economy principles involves designing products and packaging for reuse, recycling, and composting at the end of their life cycle. According to several works in the literature sample [23,24,25], this shift requires rethinking product design, material selection, and waste management processes [23]. Implementing extended producer responsibility (EPR) frameworks incentivizes manufacturers to take responsibility for the entire life cycle of their products, including collection, recycling, and disposal. Circular economy initiatives promote resource efficiency, reduce waste generation, and minimize the environmental footprint of plastic alternatives. However, the application of circular economy principles in the medical field presents unique challenges. Recycling materials for medical use is complex due to the stringent requirements regarding cleanliness, sterility, and safety. The main challenges include sterility and contamination risks, material integrity and composition, regulatory hurdles, and economic viability. To address these challenges and make circular economy practices viable in the medical field, the sampled articles noted that the following strategies can be considered: (i) Advanced sterilization techniques: Developing and implementing advanced sterilization methods that can effectively eliminate contaminants from recycled materials without degrading their properties is crucial. (ii) Material innovations: Research into new materials that are easier to recycle and which maintain their integrity and safety through multiple life cycles is essential. Innovations in polymer science, such as the development of medical-grade bioplastics and composites, could provide sustainable alternatives. (iii) Closed-loop systems: Establishing closed-loop recycling systems within the medical industry can help ensure that recycled materials meet the necessary standards. These systems would involve collecting used medical devices, processing them in controlled environments, and reusing the materials in new medical or other products and (iv) policy and incentives; governments and regulatory bodies can play a significant role by providing incentives for the use of recycled materials in medical devices. Policies that support research and development, subsidize the cost of recycling technologies, and streamline regulatory approval processes can encourage manufacturers to adopt circular economy practices.

4.3. Reduction and Elimination of Single-Use Plastics

Policies and regulations aimed at reducing single-use plastics, such as bans on plastic bags and straws, encourage or force consumers and businesses to seek alternative solutions [26]. Public awareness campaigns raise consciousness about the environmental impact of single-use plastics and promote behavioral change towards more sustainable alternatives. Businesses and industries are transitioning towards reusable and refillable packaging solutions, reducing reliance on disposable plastics. In the context of medical devices, the reduction and elimination of single-use plastics presents unique challenges and opportunities. The viability of these alternatives depends on the following critical factors: sterility and safety, material durability, design and functionality, economic and environmental impact, and regulatory approval. To make the reduction and elimination of single-use plastics in medical devices viable, the following series of pathways can be considered: development of advanced materials, improved sterilization techniques, life cycle analysis, and regulatory frameworks and incentives.

4.4. Collaboration and Partnerships

The reviewed articles noted that collaboration between governments, industries, non-governmental organizations (NGOs), and academia is crucial for driving systemic change and scaling up sustainable alternatives [27]. Public–private partnerships facilitate knowledge sharing, resource pooling, and collective action towards common sustainability goals. Joint research projects, innovation hubs, and technology transfer initiatives foster interdisciplinary collaboration and accelerate the development and adoption of sustainable solutions.

4.5. Consumer Education and Engagement

Educating consumers about the environmental consequences of plastic pollution and the benefits of sustainable substitutes empowers individuals to make informed choices. Promoting sustainable lifestyles and consumption habits, such as reducing waste, choosing eco-friendly products, and supporting responsible brands, encourages widespread adoption of sustainable alternatives [28]. Engaging with consumers through labeling, certification schemes, and awareness campaigns builds trust and transparency in the market for sustainable products.

5. Results Part 3: Material Innovation and Development

A large part of the literature has focused on material innovation and development, reinforcing that materials play a pivotal role in the transition from conventional plastics to sustainable alternatives. This aspect involves the discovery, refinement, and optimization of materials that offer comparable functionality to plastics while mitigating environmental impacts.

5.1. Biodegradable Polymers

Biodegradable polymers represent a promising class of materials for sustainable alternatives to traditional plastics. These polymers can undergo decomposition through natural processes, reducing their persistence in the environment. One notable example is polylactic acid (PLA), derived from renewable resources such as corn starch or sugarcane. PLA exhibits properties similar to conventional plastics, making it suitable for a wide range of applications [29]. Figure 3 and Figure 4 show the global production capacities of BPs by polymer type and by market segment, respectively, in 2023.

The global bioplastic production capacity is set to increase significantly from around 2.18 million tons in 2023 to approximately 7.43 million tons in 2028, as shown in Figure 5 [30].

5.2. Bio-Based Plastics

Bio-based plastics are derived from renewable biomass sources, offering a sustainable alternative to petroleum-based plastics. These materials can be synthesized from various feedstocks, including agricultural residues, algae, and waste streams. Bio-based polyethylene (PE) and bio-based polyethylene terephthalate (PET) are examples of bio-based plastics used in packaging and other applications. Advancements in bio-based plastic production aims to improve scalability, cost-effectiveness, and environmental performance [31].

5.3. Natural Fiber Reinforcements

Natural fibers, such as bamboo, hemp, and kenaf, offer renewable and biodegradable alternatives to synthetic reinforcements in composite materials. These fibers exhibit excellent mechanical properties and can be incorporated into polymer matrices to enhance strength, stiffness, and durability. Fiber surface modification techniques and composite formulations are employed to optimize the compatibility and adhesion between natural fibers and polymer matrices, resulting in sustainable composite materials that are suitable for various applications [32].

5.4. Composite Materials from Waste Streams

Using waste streams as feedstocks for composite materials represents a sustainable approach to material innovation. Waste materials, such as agricultural residues, food waste, and recycled plastics, can be transformed into value-added products through composite fabrication processes. Composite materials derived from waste streams offer environmental benefits, resource efficiency, and economic opportunities. Research found in the sampled literature in this area focuses on developing cost-effective and environmentally friendly composite materials for diverse applications [33].

5.5. Three-Dimensional (3D) Printer Technology in Material Innovation

Three-dimensional (3D) printer technology offers unique opportunities for material innovation and development, enabling the fabrication of complex geometries and customized products using sustainable materials. Researchers are exploring the use of biodegradable polymers, bio-based plastics, and natural fibers as feedstocks for 3D printing applications. Advancements in material formulations, printing processes, and post-processing techniques contribute to the expansion of sustainable 3D printing materials and applications [34].

5.6. Challenges with the Addition of Secondary Sustainable Materials to Polymers

Studies have shown the addition of natural fibers and waste stream materials can be repurposed into new polymer composite materials [28,29]. For instance, a blend of polymers containing polycaprolactone (PC), polybutylene succinate (PBS), natural rubber (NR), PLA, and PBAT reinforced with grass fibers increased in tensile strength and modulus [29]. However, due to the need to guarantee cleanliness and sterility safety for medical uses, the current applications for these polymer composite materials exclude medical uses. One challenge is that these materials are not clean enough for medical grade devices. Medical devices must meet stringent safety standards to ensure they do not cause adverse reactions in patients. Natural materials can introduce impurities or allergens that pure synthetic or biobased polymers typically avoid [35]. Additionally, these materials may not withstand the rigorous sterilization processes required for medical devices [36].

6. Results Part 4: Biodegradable Alternatives to Plastics in Medical Equipment

Biodegradable plastics in medical equipment as described in the literature are designed to break down into natural components under specific environmental conditions, reducing long-term environmental impact. The sampled articles differentiated two different pathways to biodegradability. The first was biophysical degradation and the second was biochemical or microbial degradation (Figure 6). In the first step, polymers are broken down into smaller polymer fragments through abiotic reactions such as oxidation, photodegradation, and hydrolysis, or biotic reactions involving degradation by microorganisms [37,38,39]. Polymer constituents then undergo hydrolysis, ionization, or protonation, leading to the formation of oligomer fragments facilitated by the proliferation of biological cells while the overall molecular structure of the polymer remains unaltered. The second step involves the biological breakdown of polymer fragments followed by their mineralization [36,37]. Through the direct action of microorganisms or enzymes, the polymer undergoes decomposition or oxidative degradation into smaller molecules, ultimately resulting in the production of carbon dioxide (CO₂) and water (H₂O) through aerobic biodegradation or methane (CH₄) and carbon dioxide (CO₂) and water (H₂O) through anaerobic biodegradation.

BPs find application in a variety of medical uses, including medical equipment, gloves, and blood containers. Their inherent ability to biodegrade makes them suitable for applications in or on the human body, such as implants, where the plastic naturally breaks down and does not necessitate removal [37]. Additionally, these plastics are employed in cardiovascular devices, burn dressings, and wound dressings, as well as medication delivery devices and dental implants. Ongoing advancements in the biomedical use of biodegradable plastics contribute to the creation of innovative drug delivery systems and therapeutic devices for tissue engineering, such as implants and scaffolds [40]. Polymers play a crucial role in diverse medicinal and biological applications [41]. Cellulose, a primary green bioplastic, is particularly beneficial in these domains. Cellulose has undergone extensive research for applications in implants, tissue engineering, and neural engineering, owing to its non-toxicity, lack of mutagenicity, and biocompatibility in medical contexts [42]. Synthetic polymer-based fibers and suture threads are used in medicine. Replacing such fibers with natural cellulose fibers that have active antibacterial additives or using betulin, a constituent found in the bark of the birch tree which has antibacterial, anti-inflammatory, anti-cancer properties, are some examples of current trends in modern materials science [43].

The structural organization of cellulose fibers, consisting of fibrils with cell widths of 10 nm, is orchestrated in a macroscopically organized manner. Bacterial cellulose is specifically harnessed for the creation of cellulosic membranes utilized in scopes related to tissue healing. These membranes contain pores with diameters ranging from 60 to 300 μm. There has also been exploration into bacterial nano-networks and modified cellulose matrices [44].

Some research shared in the literature focused on the realm of green plastics for manufacturing medical implants to be used in the fields of dentistry, orthopedics, or biomedicine [44,45,46,47]. These alternatives rely heavily on nanocellulose and its composites. Recent investigations are also focusing on the development of 3D printing and magnetically sensitive nanocellulose-based materials [45]. Another noteworthy application is found in nanocellulosic membranes used for wound dressing. These membranes offer various advantages, including accelerated epithelialization, reduced wound pain, decreased risk of infection, and enhanced extruding retention. Examples of patented products in this category currently available on the market include Bioprocess^®, XCell^®, and Biofll^® [44]. Additionally, the biocompatibility of PHAs is advantageous, making them suitable for diverse medical applications such as cancer detection and therapy, wound healing dressing, post-surgical ulcer care, and bone tissue engineering [40]. PHA finds extensive use across various industries, serving diverse applications. It is employed in the production of medical implant materials, carriers for medication delivery, and even surface proteins for granules. To meet specific objectives, PHA has been synthesized into different structures such as polyhydroxybutyrate (PHB), polyhydroxybutyrate-co-valerate (PHBV), poly-4-hydroxybutyrate (P4HB), and poly-3-hydroxyoctanoate (P3HO). Ongoing research explores applications like sutures, patches for repair, devices for tendon repair, artificial esophagus, and wound dressings. Furthermore, investigations have revealed that PHA oligomers possess both nutritional and medicinal properties [46]. Success has been achieved in using polylactic acid (PLA) and its copolymers to fabricate recyclable sutures and matrices for drug delivery [47].

Table 2. Biodegradable alternatives to plastics commonly used in medical applications and their relevant advantages and disadvantages.

Biodegradable Material	Applications in Medicine	Advantages	Disadvantages
Polyhydroxyalkanoates (PHA)	Medical implant materials, medication delivery carriers, sutures, repair devices, repair patches, tendon repair devices, artificial esophagus, wound dressings	Favorable biocompatibility and degradability [9].	Poor thermal stability, fragility, and challenges in processing [48].
Polylactic Acid (PLA)	Surgical implants, drug delivery systems, sutures, orthopedic devices	Favorable thermomechanical characteristics include a high tensile modulus, strong mechanical strength, excellent workability, and transparency.	Brittleness and elevated moisture uptake [48,49].
Polyglycolic Acid (PGA)	Surgical sutures, drug delivery systems, tissue engineering scaffolds	Biodegradability, high strength, compatibility, versatility.	Rapid degradation, processing challenges, brittleness, and high cost.
Polycaprolactone (PCL)	Drug delivery systems, tissue engineering scaffolds, implants	Favorable ductility and thermal stability [9].	High crystallinity and low melting point [48].
Poly (lactic-co-glycolic acid) (PLGA)	Drug delivery systems, tissue engineering, sutures, implants	Biocompatibility, tunable degradation rate, versatility, drug delivery capabilities, favourable mechanical properties.	Hydrophobicity, acidic degradation products, and processing challenges.
Starch-based Bioplastics	Packaging materials, controlled drug release systems	Readily accessible, inexpensive, and completely biodegradable without leaving behind any harmful residues [48,49].	Inadequate mechanical characteristics and a tendency towards hydrophilicity, alongside diminished thermal stability.
Polybutylene Succinate (PBS)	Medical packaging, drug delivery systems, sutures	Effective biocompatibility and bioabsorbability, alongside cost-efficient production, a high melting point, commendable mechanical properties, resistance to heat, and favourable dyeing characteristics.	PBS exhibits a low molar mass, minimal long branching in its molecular structure, low melt viscosity, reduced melt strength, and its crystallinity mitigates the impact of degrading enzymes [9].

highlights biodegradable alternatives to plastics discussed in the literature sample and commonly used in medical equipment.

6.1. PHA-Based Medical Equipment

PHAs represent a class of biodegradable polymers synthesized by microorganisms as intracellular carbon and energy storage compounds. These polymers have gained significant attention as sustainable alternatives to conventional plastics due to their biocompatibility, biodegradability, and thermoplastic properties. PHAs can be classified into the following two main categories: natural-based PHAs and synthetic-based PHAs. While most devices and pharmaceuticals are derived from PHAs and have historically been manufactured from synthetic sources, there are now several products using natural-based PHAs that have been developed and are currently in use, as shown in Figure 7 [47].

6.1.1. Natur-Based PHAs

Natural PHAs are produced from a diverse range of microorganisms, such as Ralstonia eutropha [48,49] and Pseudomonas putida [50], in various environmental niches, including soil, water, and the gastrointestinal tracts of animals. Some sampled literature characterized these polymers as serving as carbon and energy storage compounds for microorganisms under conditions of nutrient limitation. Natural PHAs exhibit structural diversity and can differ in monomer composition, chain length, and physical properties depending on the producing organism and growth conditions. While natural PHAs are less well characterized than their synthetic counterparts, they offer potential advantages in terms of sustainability and biocompatibility. Research into natural PHAs focuses on understanding microbial synthesis pathways, optimizing production processes, and exploring novel applications [51].

6.1.2. Synthetic-Based PHAs

Synthetic PHAs are produced through the bacterial fermentation of renewable carbon sources such as sugars or plant oils. These polymers offer tunable properties, allowing for the customization of material characteristics to suit specific applications. Various monomers can be incorporated into the PHA backbone to modulate properties such as flexibility, crystallinity, and degradation rate. Synthetic PHAs have been utilized in a wide range of applications, including packaging, biomedical devices, and agricultural materials [52].

6.2. PLA-Based Medical Equipment

Polylactic acid (PLA) stands out in the literature as a user-friendly, biocompatible, and biodegradable polymer [48,49,50,51,52,53]. It is a versatile material derived from renewable sources like cornstarch or sugarcane, as shown in Figure 8. This eco-friendly characteristic makes it a preferred choice for various applications, including medical implants such as stents and implantable drug dispensers, which are engineered to gradually break down in the human body over time. PLA also finds utility in food packaging and disposable cutlery and can even be spun into fibers for clothing.

Within the medical realm, PLA finds utility in diverse areas including sutures, implants, drug delivery systems, and scaffolds for tissue engineering. In addition, bone fixation devices can be made from PLA, as shown in Figure 9. Its compatibility with living tissues and capability to break down naturally renders it suitable for various biomedical devices designed to interact with biological systems.

6.2.1. PLA Surgical Suturing Materials

PLA-based sutures are reportedly widely used in surgical procedures as they offer excellent biocompatibility and tensile strength comparable to traditional synthetic sutures [52,53]. These sutures gradually degrade in the body over time, eliminating the need for suture removal surgeries and reducing the risk of tissue trauma and infection [54]. PLA sutures have been used in various surgical specialties, including general surgery, orthopedics, and obstetrics.

6.2.2. PLA Surgical Meshes and Implants

PLA-based meshes and implants are employed in soft tissue reinforcement and hernia repair surgeries [55,56]. These devices provide mechanical support to weakened or damaged tissues while promoting tissue ingrowth and regeneration. PLA meshes gradually degrade in the body, allowing for the natural healing process to occur without the need for implant removal. PLA-based meshes have demonstrated favourable outcomes in terms of biocompatibility, safety, and efficacy.

Figure 9. (a) OSTEOTRANS MX (Takiron Co, Ltd., Osaka, Japan) composed of a forged unsintered hydroxyapatite/poly-L-lactide composite. Reproduced with permission from [52]. (b) PLA-based bone screw [57] (permission for reuse obtained from publisher).

Figure 9. (a) OSTEOTRANS MX (Takiron Co, Ltd., Osaka, Japan) composed of a forged unsintered hydroxyapatite/poly-L-lactide composite. Reproduced with permission from [52]. (b) PLA-based bone screw [57] (permission for reuse obtained from publisher).

6.2.3. PLA Drug Delivery Systems

PLA-based drug delivery systems are utilized for controlled release of therapeutic agents in various medical applications. PLA nanoparticles, microspheres, and implants offer advantages such as sustained drug release, improved bioavailability, and reduced side effects. These systems have been employed for delivering drugs, growth factors, and biomolecules to target tissues or cells, enhancing the efficacy and safety of pharmaceutical treatments [58].

6.3. PGA-Based Medical Equipment

Polyglycolide, also known as poly (glycolic acid) (PGA), represents a biodegradable thermoplastic polymer and is the simplest linear, aliphatic polyester available. It can be synthesized from glycolic acid through polycondensation or ring-opening polymerization methods. Despite being recognized as a robust fiber-forming polymer since 1954, PGA’s initial utilization was constrained due to its susceptibility to hydrolytic degradation [59]. Presently, polyglycolide and its copolymers, such as poly (lactic-co-glycolic acid) incorporating lactic acid, poly(glycolide-co-caprolactone) integrating ε-caprolactone, and poly (glycolide-co-trimethylene carbonate) including trimethylene carbonate, find extensive applications as materials for developing absorbable sutures and are under assessment within the biomedical domain [60]. Based on the current literature review survey, the primary uses of PGA in the medical realm can be outlined as follows:

6.3.1. PGA Surgical Sutures

The literature described how PGA is extensively used in the manufacturing of absorbable surgical sutures. These sutures are designed to degrade over time within the body, eliminating the need for suture removal surgeries (Figure 10). PGA sutures provide excellent tensile strength and knot security, facilitating wound closure during surgical procedures. Their biodegradability reduces the risk of tissue irritation or inflammation, promoting optimal wound healing [61].

6.3.2. PGA Tissue Engineering Scaffolds

PGA scaffolds are used in tissue engineering applications to support cell growth, proliferation, and differentiation, as shown in Figure 11. These scaffolds provide a temporary three-dimensional structure that mimics the extracellular matrix, facilitating tissue regeneration and integration [57,58,59,60,61,63]. PGA’s biocompatibility and biodegradability make it suitable for engineering various tissues such as bone, cartilage, and skin. Additionally, PGA scaffolds can be tailored to degrade at controlled rates, allowing for the synchronized replacement of the scaffold with newly formed tissue [63].

6.3.3. PGA Drug Delivery Systems

PGA-based microparticles and nanoparticles are employed as drug-delivery carriers for the controlled release of therapeutic agents. These drug delivery systems offer advantages such as high drug-loading capacity, tunable degradation kinetics, and localized drug delivery. PGA’s biodegradability ensures the gradual release of encapsulated drugs, enhancing therapeutic efficacy while minimizing systemic side effects. PGA-based drug delivery systems are utilized in various medical applications, including cancer therapy, tissue regeneration, and wound healing [65].

6.4. PCL-Based Medical Equipment

Polycaprolactone (PCL) was discussed as a distinctive biodegradable polymer within the aliphatic polyester category, featuring hexanoate repeat units. PCL has been extensively researched for its role in developing controlled drug delivery systems. However, its slow degradation rate (2–3 years), hydrophobic nature, and limited solubility render it more suitable for applications in tissue engineering, bone tissue regeneration, and tissue repair as implants or scaffold matrices [66,67]. To enhance its degradation properties, PCL has been modified by blending with other polymers such as polyethylene glycol (PEG) (Figure 12), polylactic-co-glycolic acid (PLGA), and polyethylene glycol (PEG) to form block copolymers. This modification introduces amphiphilic structures, thereby improving its degradation reactivity [68,69].

6.5. PLGA-Based Medical Equipment

Poly (lactic-co-glycolic acid) (PLGA) is widely recognized as a suitable polymer for manufacturing drug delivery devices and tissue engineering applications. Approved by the Food and Drug Administration [71], PLGA is a biodegradable polymer that has been extensively researched for its potential in developing controlled delivery devices for small molecule drugs, proteins [72], and other macromolecules, both in academic research and commercial ventures. Figure 13 exhibits a schematic illustration of PLGA bio nanoarchitectures and their applications.

6.6. Starch-Based Medical Equipment

Some literature focused on starch, a naturally occurring storage polysaccharide in higher plants, which represents the predominant carbohydrate in both human and animal diets. It is distributed across various plant parts, including leaves, stems, seeds, fruits, roots, and tubers. Maize, wheat, potatoes, and cassava serve as the primary sources of starch for industrial use, with maize accounting for the majority at 82%, followed by wheat (8%), potatoes (5%), and cassava (5%) [74]. Starch is a material composed of anhydro-glucose units, which form two different polymers, namely amylose and amylopectin [75]. It has found utility as a biomaterial across various applications, encompassing tissue engineering scaffolds, substrates for cell seeding, drug delivery systems, bone replacement implants, wound dressings, and more (Figure 14). The properties of the starch-based BPs depend on the source of starch. When subjected to appropriate levels of water and heat, starch can undergo processing to become a thermoplastic material. Its well-documented biodegradability, widespread availability, and economic feasibility make it suitable for diverse applications.

6.7. PBS-Based Medical Equipment

Polybutylene succinate (PBS) is described as a biodegradable polyester with potential applications in medical equipment [79]. PBS is characterized by good processability [79,80]. According to the literature, composites composed of natural fibers and PBS demonstrate complete biodegradability and exhibit favourable mechanical properties [80,81]. The biodegradability of PBS presents an appealing characteristic of this polymer, providing it with a competitive edge in single-use applications. This material can rapidly degrade within a brief timeframe and has additionally been certified as compostable [82]. Figure 15 depicts the biodegradation process of PBS nonwoven in comparison to polypropylene masks and cotton (100%) [79]. As was observed, after 24 weeks, the biodegradation level of the developed nonwoven PBS averaged 91.4% ± 0.35. In comparison, the reference material (100% cotton) achieved complete biodegradation (100%) within the same 24-week period, validating the accuracy of the process. Meanwhile, the polypropylene facemask exhibited 0% ± 0.0 biodegradability during the assessment. There are both bio-based and oil-based PBS polymers. Bio-PBS refers to polybutylene succinate (PBS) that is derived from renewable biomass sources, such as plant-based feedstocks. It can be produced through the fermentation of biomass-derived sugars, followed by polymerization of the resulting succinic acid and 1,4–butanediol monomers [83]. Oil-based PBS, on the other hand, refers to PBS that is synthesized from petroleum-derived feedstocks. It is produced through the polymerization of succinic acid and 1,4–butanediol obtained from a crude oil refining processes [84]. While oil-based PBS shares similar properties with bio-based PBS, it relies on non-renewable resources and may have a higher environmental impact. In addition to their degradation characteristics, biomaterials must also demonstrate adequate biocompatibility within physiological environments to be effectively implanted within the body. According to Gigli et al. [85], PBS-based copolymers and composites exhibit favourable biocompatibility both in vivo and in vitro across a range of experimental conditions. They also demonstrated the promising capacity of PBS biopolymers in producing bone marrow stem cells. Their findings revealed that PBS exhibited superior capability and a greater propensity compared to PLA or polyvinyl chloride (PVC) polymers in promoting the growth of new tissue.

In addition to the numerous benefits of the PBS biopolymer in tissue engineering, it presents some challenges, such as susceptibility to bacterial infection and insufficient osteocompatibility post-implantation in the body [84]. As a result, addressing these issues requires surface treatment or modification. To tackle this challenge, Domínguez-Robles et al. [86] used a blend of lignin and PBS biopolymer, leveraging their antioxidant and antibacterial properties that are suitable for biomedical applications and infection prevention in the manufactured components. Notably, staphylococcus aureus is a prevalent infection associated with medical devices, and the PBS/lignin composite demonstrated a significant reduction in adherent bacteria, reaching up to 90%.

6.8. A Comparative Analysis between Different Biodegradable Materials and Their Effectiveness

To provide a clearer understanding of the relative advantages and limitations of the biodegradable materials reviewed in the literature, this subsection offers a comparative analysis. Each material has distinct advantages and limitations that impact its effectiveness in medical applications.

• PHA offers excellent biocompatibility and degradability, making this class suitable for medical implants and wound dressings. However, their poor thermal stability and fragility present challenges in processing and application [48].
• PLA is favored for its strong mechanical strength and transparency, suitable for surgical implants and drug delivery systems. Despite its advantageous thermomechanical properties, PLA is limited by its brittleness and elevated moisture uptake [48,49].
• PGA is known for its biodegradability, high strength, and versatility, particularly in surgical sutures and tissue engineering scaffolds. However, its rapid degradation, brittleness, and high cost are significant drawbacks [48].
• PCL provides favourable ductility and thermal stability, ideal for drug delivery systems and tissue engineering scaffolds. Its high crystallinity and low melting point can restrict its use in certain medical applications [48].
• PLGA is valued for its biocompatibility and tunable degradation rate, making it versatile for drug delivery and tissue engineering. Its hydrophobicity and the challenges of processing acidic degradation products can limit its effectiveness [48].
• Starch-based bioplastics are noted for their cost-effectiveness and complete biodegradability. However, they suffer from poor mechanical characteristics and reduced thermal stability [48,49].
• PBS exhibits effective biocompatibility, a high melting point, and good mechanical properties, making it suitable for medical packaging and drug delivery systems. Yet, its low molar mass and reduced melt strength impact its performance [9].

7. Results Part 5: Barriers and Strategies Regarding Development of Biodegradable Alternatives to Plastic in Medical Equipment

According to the literature, significant efforts have been dedicated to the advancement of biopolymers in medical applications in recent decades. In particular, the development of biodegradable polymers and their composites has garnered considerable attention, although it remains in its early stages. There is an undeniable need for new types of biodegradable materials. This is especially true as there is a growing demand for a wide range of sustainable products. However, challenges, such as those listed below, hinder their production compared to traditional synthetic polymers [87,88,89]:

• Biocompatibility and Sterilization: One of the primary challenges in developing biodegradable alternatives to medical equipment is ensuring biocompatibility and compatibility with sterilization methods. Biodegradable materials must meet stringent safety and regulatory requirements to ensure they do not cause adverse reactions when in contact with biological systems or compromise the sterility of medical devices and fields, promoting patient healing.
• Mechanical Properties and Durability: Medical equipment requires high mechanical strength, durability, and stability to withstand rigorous use and maintain functionality during procedures. Biodegradable materials may not always possess the necessary mechanical properties, leading to concerns about their structural integrity and performance in medical applications.
• Degradation Rate and Predictability: Controlling the degradation rate of biodegradable materials in medical equipment is crucial to ensuring device functionality and safety over the intended lifespan. However, achieving a balance between degradation kinetics and device longevity presents a significant challenge. Moreover, predicting the degradation behavior of biodegradable materials in complex physiological environments remains challenging.
• Regulatory Compliance: Regulatory requirements for medical devices are stringent, and introducing new biodegradable materials into medical applications necessitates extensive testing and validation to ensure compliance with regulatory standards. A lack of established guidelines specific to biodegradable materials can create regulatory hurdles and prolong the approval process.
• Cost and Scalability: Developing biodegradable alternatives to medical equipment can be cost-prohibitive, particularly in the initial stages of research and development. The scalability of production processes and the availability of cost-effective raw materials are key factors that influence the economic feasibility of biodegradable medical devices.
• Material Selection and Performance: Identifying suitable biodegradable materials with the necessary properties for specific medical applications is a critical challenge. Material selection involves balancing biodegradability, biocompatibility, mechanical strength, and other functional requirements to ensure optimal performance and safety in medical devices.

Renewed environmental regulations aimed at addressing ecological concerns have spurred progress in the development of modern polymeric materials and processes that prioritize environmental well-being [87,88]. Nevertheless, there is a pressing need to develop highly efficient biodegradable polymer products and harness the ecological, social, and industrial benefits they offer. In the foreseeable future, significant hurdles facing biodegradable polymers are likely to revolve around effectively managing raw material stocks, optimizing the performance of bio-based materials, mitigating production costs, and building systems that promote circularity such as cradle-to-cradle procurement practices [90]. Additionally, establishing commercial manufacturing processes poses another formidable challenge, particularly in the production of bio-derived monomers and polymers sourced from renewable materials. Setting up industrial facilities may prove challenging due to the lack of experience with emerging technologies and the need to assess stock/demand equilibrium. Despite advancements in industrial-scale production of new types of bio-derived polymers, numerous unresolved issues remain for ensuring the long-term viability of biodegradable polymers. Forecasts suggest that competition for feedstock may intensify as global demand for food and energy continues to rise [91].

The production of synthetic fabrics and clothing has effectively met global demand, while the utilization of medical equipment and single-use plastic instruments remains indispensable in critical scenarios such as surgeries, pandemics, and disease containment efforts. Therefore, advocating for a blanket ban on all plastics is not a pragmatic approach. Instead, the emphasis should be on progressively phasing out non-essential plastic items while incentivizing the development of new single-use materials that are eco-friendly and devoid of disposal challenges. Addressing this complex issue demands substantial economic investment, time, and concerted effort from governmental bodies, industry, and the scientific community, all alongside public engagement. The transition necessitates the resolution of socio-political and economic disparities among nations and regions.

8. Conclusions

In this study, a literature review was conducted on biodegradable alternatives to petroleum-based plastics in medical equipment. The study surveyed the current trends in biodegradable alternatives through articles published between 2008 and 2024. From the literature review, it was found that the transition from conventional plastics to biodegradable alternatives in medical equipment presents both challenges and opportunities. While traditional plastics have played important roles in healthcare, their environmental impact and sustainability concerns are serious. Biodegradable alternatives offer a promising solution to mitigate these issues, but significant barriers exist in their development and adoption. Key barriers discussed in the literature include ensuring biocompatibility and sterilization, addressing mechanical properties and durability, controlling degradation rates, navigating regulatory compliance, managing costs and scalability, and selecting appropriate materials with optimal performance. Overcoming these challenges requires collaborative efforts from stakeholders across various sectors, including researchers, manufacturers, policymakers, and the healthcare industry.

Considering these challenges, the future research should focus on several key areas, including the development of biocompatible and sterile biodegradable materials, optimization of mechanical properties and durability, cost reduction and scalability, regulatory and compliance frameworks, and circular economy integration. Future research should also explore economic models and funding strategies that support the large-scale production and adoption of these materials. Collaboration with industry stakeholders to create scalable manufacturing and distribution networks will be crucial. The growing awareness of environmental concerns and the drive toward sustainability provide momentum for innovation and progress in biodegradable alternatives. Material innovation and development, circular economy practices, reduction in single-use plastics, collaboration and partnerships, and consumer education are vital strategies in this transition.

Circular economy practices, particularly in the medical context, involve the reuse and recycling of plastics to create new medical or non-medical products. For instance, sterilized and processed plastics could be repurposed for medical devices that do not require high-grade material or for non-medical applications, such as hospital infrastructure materials. The reduction in single-use plastics in medical devices can be achieved by developing products with multiple uses. This requires innovation in materials that can withstand multiple sterilization cycles without degrading. Furthermore, redesigning medical procedures to minimize the need for single-use items and promoting the use of reusable alternatives where possible are crucial steps. Consumer education, including both patients and healthcare providers, can significantly influence the reduction in environmental impacts. Educating doctors and medical staff about the environmental benefits of biodegradable and reusable medical devices can drive adoption. Patients can be informed about the importance of sustainability in healthcare, promoting acceptance and support for eco-friendly medical practices. For example, a well-informed medical community can prioritize and advocate for sustainable practices, while educated patients may prefer healthcare providers who utilize environmentally responsible methods. Efforts to develop and implement biodegradable alternatives must be accompanied by comprehensive planning, robust regulatory frameworks, and investment in infrastructure and technology. Moreover, addressing social, political, and economic disparities is essential to ensure equitable access and adoption of sustainable solutions. Finding a balance between meeting healthcare needs and minimizing environmental impact requires a holistic approach and commitment from all stakeholders. In terms of practical applications, multiple strategies could be employed, including designing multi-use medical devices, redesigning procedures, promoting consumer and provider education, and investing in infrastructure. By overcoming barriers and embracing sustainable practices, the research community can help support a more environmentally responsible healthcare system.