Reducing the financial and environmental costs of PPE

The worldwide response to COVID-19 has come at significantly increased financial and environmental personal protective equipment (PPE) costs. Many healthcare providers are seeking solutions to these challenges. To do this, they are collaborating with other organisations, harnessing smart technologies in combinations not previously available.

A growing mountain of waste is a challenge worth solving

Aside from the heighted PPE needs of the pandemic, increased PPE consumption is here to stay, with infection control standards being raised permanently in many places. The related costs that were previously seen as bearable have been permanently exacerbated.

The costs of using disposable PPE for consultations that can last just 15 minutes can be significant when isolation controls are being upheld and single-use PPE is being disposed of prior to the next consultation. In the UK’s National Health Service (NHS) alone, 10 million or more PPE items are used each day.¹

The environmental burden is eye-watering. The NHS’s December 2020 ‘Net Zero’ report highlighted that the NHS is responsible for 4% of England’s total carbon footprint, with about 60% of their footprint coming from the procurement of goods and services, particularly in acute and primary care.²

PPE is typically derived from fossil fuels that are: shipped around the world for conversion to polymers; shipped again to manufacturers; and then shipped to customers — often back to the side of the world where the fossil fuels originated — often only to be disposed of after a single consultation.

The disposal process itself adds to the environmental impacts of single-use PPE, with infectious materials going through decontamination plants before being landfilled.

The challenge needs collaboration with new combinations of technologies

Old problems can be solved in innovative ways by bringing new technologies together. The health industry has been a great vantage point from which to see this in recent decades. It has happened time and again in fields like 3D-printed medical devices; next-generation sequencing and immunotherapies; the diverse medical applications of artificial intelligence, big (including social) data and virtual reality, biosensors and trackers; and in conveniently located/telehealth and point-of-care diagnostics.³

The cost and sustainability challenge of healthcare PPE can be addressed in a similar way. One of the biggest contributors to healthcare PPE waste has been disposable isolation gowns. Not only are they the second-most-used form of healthcare PPE after gloves,⁴ but they are also one of the largest.

Reusable gowns can offer a safe, cheaper⁵ and more environmentally friendly alternative to disposable gowns. A full life cycle evaluation has shown that reusable gown systems resulted in a 30% reduction in global warming potential and reduced solid waste generation at the healthcare facility by up to 99% compared with using disposable gowns.⁶ In the past they have been a relatively marginal call in terms of providing financial savings.⁷ In particular, even a low percentage loss/damage rate per cycle could significantly reduce the average net number of uses per gown. The exponential impact of even a 1% loss rate per usage cycle leaves just half of a set of gowns left after 75 cycles. Effective stock management that significantly reduces the loss rate is therefore critical to the attractiveness of reusable gowns.

A multi-stakeholder solution is emerging

Thanks to new smart and sustainable technologies, reusable isolation gowns now offer a more attractive alternative to disposable gowns.

Combining RFID tracking with gowns made from specially formulated materials and manufacturing processes can significantly extend their nominal and net lifespan, while also making stock management and end-of-life withdrawal much easier. Tracking the locations of each gown with RFID helps ensure that there is always sufficient stock available where required, and identifies when garments have reached the maximum number of laundry cycles. In addition, the use of RFID can bring the following benefits:

• Easy identification and removal of PPE to ensure staff are kept safe.
• Saving time by automating audits and eliminating manual stock counting.
• Monitoring subcontractor SLA compliance.
• Highlighting whether the correct number of gowns is sent to and from the laundry provider to reduce losses.
• Providing valuable historical usage data to inform purchase decisions.

How RFID works

At the point of manufacture, each garment is fitted with a specialist passive RFID tag designed to withstand the typical wash, sanitise and dry cycles. Handheld scanners and/or fixed readers are used at each location (healthcare site and laundry supplier) to scan garments and update PPE status.

With each gown uniquely identified and its full history of locations recorded, RFID systems can highlight when garments are near their disposal stage and provide an alert when they need to be removed from circulation. Location information is monitored continually, with the real-time inventory information triggering an alarm if stock is running low in specific care locations to ensure that healthcare staff can be protected, while avoiding delays in patient care.

With RFID reducing loss factors, investing in the extension of gown lifespans becomes worthwhile.

New materials and manufacturing processes are making this possible, and the combined technologies are currently being trialled across the globe. The targeted lifespan multiplication has potential to reduce the total cost and environmental impact of isolation gown usage significantly, and trial results to date are encouraging.

Smart, sustainable PPE solutions are on the way, and they’re worth investigating

Smart, sustainable developments are emerging in response to the PPE challenges of the current pandemic and beyond. We can be hopeful that long-term solutions are coming to the fore that will keep healthcare workers safe whilst significantly slowing the growth of the mountainous PPE waste flows we’ve all been witnessing since early 2020.

Brendon Rowse (left), Managing Director of Welspring, and Simon Dawkins (right), Lead RFID Consultant at RFiD Discovery.

References

1. “Healthcare is Still Hooked on Single-use Plastic PPE, but there are More Sustainable Options,” https://theconversation.com/healthcare-is-still-hooked-on-single-use-plastic-ppe-but-there-are-more-sustainable-options-143940. “Why a Billion Items of PPE is Not Enough,” https://www.bbc.com/news/business-52362707.
2. ‘Delivering a “Net Zero”,’ https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf, p. 7.
3. https://www2.deloitte.com/global/en/pages/life-sciences-and-healthcare/articles/top-10-health-care-innovations.html, 17 February 2021.
4. “A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties,” J Eng Fiber Fabr. 2015 September, 10(3): 180–190, p. 4.
5. “Disposable versus Reusable Medical Gowns: A Performance Comparison,” American Journal of Infection Control 000 (2020) 1−8.
6. “Vozzola E, Overcash M, Griffing E. Environmental considerations in the selection of isolation gowns: a life cycle assessment of reusable and disposable alternatives,” Am J Infect Control. 2018;46:881–886, p. 885. “Overcash M. A comparison of reusable and disposable perioperative textiles, Anesth Analg.” 2012;114:1055–1066.
7. “Disposables vs Reusables: Are we Missing the Wood for the Trees?” International Journal of Nursing Care. July-December, 2017, Vol. 5, No. 2.