Flame retardants are all around health care. IV pumps, televisions/computers, hospital beds, waiting room chairs, and hospital privacy curtains all share the need to be fire resistant.  To meet fire safety standards, chemicals, known as "flame retardants," are added by manufacturers. Unfortunately many of these flame retardants do not remain fixed in the product, but slowly leak into our air, dust and water, and eventually enter our food and bodies. Evidence shows that a subset of these chemicals, called "brominated flame retardants" (BFRs), are likely to persist in our environment, bioaccumulate in the food chain and in our bodies, and cause adverse health effects in children. The breast milk of American women contains the highest levels of BFRs in human breast milk found anywhere in the world.

Recent studies have shown that BFRs do not remain bound to a product, but release and attach to dust particles. Scientists have measured significant BFR levels in common household dust, window film, and clothes dryer lint. Manufacture, use, and disposal of products containing BFRs also have resulted in contamination of the outdoor environment where scientists have found that BFRs rapidly accumulate in wildlife tissue. Similar to PCBs, concentrations of BFRs increase up each step of the food chain, indicating these chemicals are readily absorbed and not easily broken down by the body. Therefore, human exposure to BFRs is thought to occur through ingestion and inhalation of dust particles containing BFRs and through ingestion of food containing BFRs, including breast milk.

Toxicity:  Based on the available data, we know that BFRs are associated with several adverse health effects in animal studies, including developmental effects that include permanent changes in memory and learning, interference with normal thyroid function, and reproductive effects.  There is  evidence that some BFRs can cause immune suppression, endocrine disruption, and cancer. Measurements in humans are troubling because some levels are rapidly approaching those associated with adverse effects in rodent studies. The available literature on BFR toxicology is incomplete, so more studies are needed. However, based on the available data, Health Care Without Harm believes it is prudent to switch to safer available alternatives in the health care setting.

BFRs in health care: In the health care setting, BFRs are as pervasive as they are in our homes and offices. Patients' rooms, mattresses, foam pads and other bedding materials may contain BFRs. Other furniture and textiles in patient rooms may be treated with BFRs, including furniture cushions, lamp shades, cubicle curtains, privacy curtains, drapery, and window blinds. Electronic equipment such as televisions, pulse oximeters, monitors, ventilators, or IV pumps likely have BFRs in the plastic housing. At the nursing stations, BFRs may be in computers, printers, fax and copy machines, and assorted office furniture. In the cafeteria and other eating areas, BFRs may be in microwave ovens, refrigerators, and other appliances. In nearly every area of the hospital - from shipping and receiving to the operating rooms - foam packaging is found that can contain BFRs.

Many products which do not contain BFRs are available, effective, and affordable.  Health care institutions can make efforts to reduce the use of products and materials containing BFRs.  In purchasing practices, institutions can choose products, when available, that meet flame retardancy standards without any added flame retardants – products that are inherently flame resistant such as wool or Kevlar.  To help learn more about the flame retardants used in products, hospitals can require disclosure of the name and CAS number (the chemical abstracts service registry number) of all added flame retardants used in the products purchased.  Moreover, hospitals can express a preference for products that do not contain toxic, persistent, bioaccumulative toxicants and alert vendors that, as more information on flame retardants becomes available, you will choose products with flame retardants that have been comprehensively tested for health and safety.

Key Resources

What Health Care Purchasers Can Do To Reduce Flame Retardants (pdf)

Flame Retardants: Alarming Increases in Humans and the Environment (pdf) 

Brominated Flame Retardants: Rising Levels of Concern (pdf)