Date: June 12, 2026 | Nurse: Julie Jacobson Vann PhD, MS, RN
Title & Position: Professor and Planetary Health Director, University of North Carolina at Chapel Hill
Initiative Overview:
North Carolina’s Toxic-Free Medical Devices Act (HB 592) proposed to ban DEHP from hospital intravenous (IV) bags by 2030 and tubing materials by 2035. ANHE member from North Carolina, Dr. Julie Jacobson Vann, was an integral part of advocating for this health protective measure. North Carolina is one of only two states that have banned this chemical in certain medical devices. Di-(2-ethylhexyl) phthalate (DEHP) is a chemical that makes plastics more flexible and is also a known endocrine-disrupting compound (Citation #1). Despite 20 years of research showing that exposure to phthalates such as DEHP can increase reproductive and developmental risks, and other endocrine abnormalities (Citation #2), DEHP is still found in IV bags and tubing and remains legal in 48 states.
Two years ago in May, Dr. Jacobson Vann didn’t set out to work on eliminating DEHP. She attended the North Carolina Nurses Association Nurses’ Night at the Legislature with a goal, not to advocate for any legislation, but to promote the concept of greening of health care. She was passing out 200 magnetized metal pins stating “Let’s Green Health Care” to nurses and legislators in attendance. While Dr. Jacobson Vann was waiting to speak with Representative Reeder from Greenville, an Emergency Department Physician and a legislator, Dr Jacobson Vann struck up a conversation around environmental health with Rhonda Reeder, Representative Reeder’s wife and a registered nurse. Rhonda noted that California had recently filed a bill to ban DEHP in IV bags and tubing and asked if Dr. Jacobson Vann would be interested in getting involved in advancing similar work in North Carolina. The idea for the North Carolina DEHP bill was born. Dr. Jacobson Vann heard from Rhonda the next day and followed up with her periodically via Zoom over the next 9 months.
Project Implementation:
Dr. Jacobson Vann didn’t have a lot of knowledge on DEHP at the time, so she took on doing an analysis and did a deep dive on the research, developing an advocacy plan with scientific evidence to back up the bill. Based on her research, Dr. Jacobson Vann suggested two changes to the California bill: first, the bill should prioritize neonates and reduce the use of DEHP in neonatal nasal cannulas – “based on evidence this is some of the biggest risk” she noted; and second, nurses should prioritize decreasing DEHP products among people receiving cancer treatment.
Nine months after first speaking with Rhonda, North Carolina’s Toxic-Free Medical Devices Act (HB 592) was filed in March 2025. While the bill did not include the recommendations Dr. Jacobson Vann suggested, she continued to provide valuable education and insight as the bill began to move, sending summaries of the legislation to many legislators that she had met over the years. “Once the bill was introduced – I had been doing a lot of heavy lifting reviewing everything for 9 months – but all of a sudden everyone else did the heavy lifting… contacting their members, everybody was calling and meeting, I was calling legislators and emailing them but all of a sudden it became this massive team effort where everybody pitched in.”
Collaborators:
Those who advocated for the bill included health and environmental advocacy groups from across the state along with individual nurses who Dr. Jacobson Vann had reached out to during her research on the topic.
When she first started working on DEHP, Dr. Jacobson Vann also sought out interest from the UNC School of Nursing Graduate Students. Graduate nursing student Brianna Christianson wrote a parallel paper to Dr. Jacobson Vann’s policy advocacy paper. Dr. Jacobson Vann also reached out to Duke School of Nursing; and Graduate nursing student Christeanna Richardson wrote up a policy analysis with Dr. AnnMarie Walton, Dr. Valerie Sabol, and Dr. Malinda Teague.
The North Carolina Nurses Association got involved once the bill was filed along with Carolina Advocates for Climate Health and Equity, of which Dr. Jacobson Vann sits on the Board of Directors. Other supporters included Breast Cancer Prevention Partners, the North Carolina Conservation Network, and of course the Alliance of Nurses for Healthy Environments.
Challenges and Solutions:
Dr. Jacobson Vann notes that she didn’t really encounter any pushback or barriers in her work on this bill, attributing this to two factors. First, the bill had a bipartisan nature from the beginning. “It was introduced by Representative Reeder and another legislator who is a pharmacist and a legislator…. There was bipartisan support.” The other thing – “it was never talked about as an environmental bill – it was a health bill. Because of those two things, it was one of these bills that just kind of flew through quite easily.”
The main obstacle Dr. Jacobson Vann noted was keeping everyone on the same page. Dr. Jacobson Vann noted that some groups wanted to include more in the legislation, like polyvinyl chloride (PVC). Yet, she notes,“It’s important that bills are relatively incremental. We don’t want to make it so huge that it doesn’t get passed.”
It was also challenging that the nasal cannulas for neonates and reducing DEHP use for patients with cancer did not make it into the bill. Dr. Jacobson Vann notes that there were two studies conducted in NICUs that measured exposures, and “some of the biggest exposures were neonatal cannulas.” However, even if a change does not occur through policy, actions like reducing DEHP can be achieved through nursing education or at the clinical level. Further, the bill could maybe be amended in the future to include a broader scope,“Even as vendors, the suppliers get pressured into doing more DEHP-free products, hopefully they will start to change their business model.”
Results and Impact:
The DEHP portion of North Carolina’s Toxic-Free Medical Devices Act (HB 592) was eventually incorporated into SB 600 with a provision in SB 600 including DEHP protections for North Carolinians banning the use of IV bags and tubing containing DEHP. SB 600 passed the legislature and was signed by North Carolina’s Governor in July 2025. North Carolina is one of only two states that has successfully banned this chemical in certain medical devices, although a number of states have run similar legislation.
Brianne Christensen, RN along with Dr. Jacobson Vann published an article in Policy, Politics and Nursing Practice in early 2026. This policy advocacy paper teaches nurses to develop their own policy advocacy plan, step by step, – “I even use it as an example in my policy class. … Hopefully people can use it.”
Advice for Nurses Starting Similar Initiatives:
When asked for her advice to nurses interested in putting a similar action together she said, “My advice would be to sit down and write a bulleted outline and then really look at the scientific evidence. … There is a great Public Health Advocacy Guidebook and Toolkit, by the Association of Public Health Nurses. Use a toolkit like that, find a framework, and do your groundwork to really find evidence to support what you are doing. … You really need to have scientific evidence but you need to have something that brings home the message locally … really make it personal for an individual and bring in other people and definitely engage lots of organizations.” Dr. Jacobson Vann suggested coming up with a case example if possible, “just thinking about just one baby in the NICU, describe all the different products with DEHP that one person is exposed to.”
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You can check out an article featuring Dr. Jacobson Vann here:
North Carolina bans plasticizer chemical in some hospital equipment
Making IV bags and tubing without DEHP is entirely possible and cost-effective, and three of four major IV bag manufacturers already have large portfolios of U.S. Food and Drug Administration–approved DEHP-free IV bags. For more information see Breast Cancer Prevention Partners Report Toxic Free IV.
Citation 1: Agency for Toxic Substances and Disease Registry Toxicological profile for di(2-ethylhexyl)phthalate (DEHP). (January 2022). https://wwwn.cdc.gov/TSP/ToxProfiles/ToxProfiles.aspx?id=684&tid=65
Citation 2: Bernard, L., Masse, M., Boeuf, B. …, ARMED Study Group. (2023). Medical devices used in NICU: The main source of plasticisers’ exposure of newborns. Science of the Total Environment. 858(3). Article 159994 https://doi.org/10.1016/j.scitotenv.2022.159994
