Researchers are calling for a fresh approach to the use of personal protective equipment (PPE) across health and social care settings after a study revealed a 1% increase in the NHS’s carbon footprint at the height of the Coronavirus pandemic.

Writing in the Journal of the Royal Society of Medicine, researchers from Brighton and Sussex Medical School revealed that the increased

use of PPE in health and social care services in England during the first six months of the pandemic added an additional 1% to the carbon burden.

Between February and August 2020, the team estimate that three billion items of PPE were utilised – generating over 106,000 tons of carbon dioxide equivalents. 

Making an impact

This equates to 591 tons a day, roughly 27,000 times the average individual’s daily carbon footprint.

In their analysis, the researchers included items such as gloves, aprons, face shields, gowns as well as respiratory and surgical masks. And the environmental cost was calculated on the basis of raw material extraction, manufacture, transport and under the assumption that each item was used only once, and – in accordance with UK guidance – was disposed of by high-temperature hazardous incineration.

“We could see on the ground that we were using a lot of PPE within healthcare and that the impact was likely to be large, but it was even bigger than we expected,” said lead author, Chantelle Rizan, an NHS doctor and sustainable surgery fellow at the Centre for Sustainable Healthcare in Oxford.

“We were able also to compare that to normal activity within the NHS over a normal six-month period, and we found that PPE was responsible for an additional 1% carbon burden.

“While the NHS in 2020 pledged to meet net-zero carbon by 2040; this is moving us in the wrong direction.”

A change of focus

To address the issue, the  researchers modelled that while maintaining safe levels of protection for staff and patients, it was theoretically possible to reduce the environmental cost by 75% through a combination of strategies – including rationalising glove use, domestic manufacturing, using reusables where possible, and optimising waste management.

“The NHS’s first priority had to be to protect patients and staff from the virus through the use of personal protective equipment (PPE),” said Professor Neil Mortensen, president of the Royal College of Surgeons of England. 

“However, we cannot ignore the damaging environmental impact of such vast use of disposable gloves and aprons … the findings of this new study are sobering”

Rizan added: “We’re not suggesting that we should do anything that puts health and social care staff or patients at risk. 

“What we are suggesting is that there might be strategies that we should be using, which enable us to continue to provide the same level of protection while actually reducing the environmental impact. For example, switching to reusable items and developing our capability to actually recycle these things. 

“At the moment much of our PPE is disposed of as clinical waste and is sent for high-temperature incineration, which has huge environmental impacts.”

A sensible approach

From the initial analysis, the researchers found that the biggest contributor to the carbon footprint was glove use – responsible for 1.8 billion items, or roughly 45% of the total PPE use, over the six-month period.

Rizan said: “We do need to essentially be a little a bit more sensible in terms of our glove use and to reduce their use where it is safe to do so, for example where there is minimal contact with low-risk patients.”

And she called on the Government to reconsider its plans to expand domestic manufacturing with the ambition to meet about 70% of PPE demand as the current proposal explicitly excludes gloves. 

“As gloves were responsible for almost half of the carbon footprint of PPE, perhaps the remit of this ambition should be expanded,” she said.

In the first six months of the pandemic, a lot of PPE was shipped from countries such as China, Thailand and Malaysia. If that manufacturing had been done domestically, the researchers modelled a 12% reduction in the carbon footprint.

And the paper highlights the key message of reduce, reuse, recycle where possible.