Delivering sustainable healthcare has been on the sector’s agenda for many years following a report from Brundtland in 1987, that urged the industry to use resources wisely in order to preserve the environment and habitats that future generations need for survival. Yet it was the COVID-19 pandemic that finally brought widespread attention to the truly harmful repercussions of wasteful healthcare resources and wider environmental challenges that are having direct and immediate health consequences for society as a whole.
The recent discussions during COP26 also highlighted the need for a more sustainable healthcare approach globally. For example, a group of 50 countries have committed to developing climate-resilient and low-carbon health systems in response to growing evidence of the impact of climate change on people’s health.
In addition, NHS England has committed to becoming net-zero by 2045. However, with global health systems accounting for around 5% of total greenhouse gas emissions, this will not be an easy ask and will require the coming together of many parties to achieve one goal.
Encouraging sustainable approaches to PPE in a throw away culture
The notion of a ‘throw away culture’ has been prevalent for decades. Where economic growth saw both increased production and increased product waste from the beginning of the 1900s, single-use items have become ingrained in our modern day culture and society. So much so, that over the last ten years we have produced more plastic than during the whole of the last century.
Due to the nature of healthcare, medical devices are often used on an individual patient during a single procedure and then discarded immediately. And with good reason. Take COVID-19 or any other highly transmissible airborne virus – it only takes the slightest slip for contamination.
Personal protective equipment (PPE) and respiratory protective equipment (RPE) have multiplied in demand in healthcare applications ever since the pandemic emerged in March 2020. In fact, it is estimated that NHS and social care segments spent roughly £500 million on disposable RPE in 2020. Disposable RPE creates a major environmental challenge, with each item containing significant amounts of single-use and non-recyclable plastic materials. Recent research has discovered that the carbon footprint of PPE totalled over 100,000 tonnes CO2e, with greatest contributions from gloves, aprons, face shields, Type IIR surgical masks and FFP3 respirators. A sustainable approach to PPE going forwards is therefore a huge priority.
Current barriers to adopting reusable processes
For the highest risk environments, the currently recommended RPE is the tight fitting FFP3 grade respirators, which work by creating a tight seal between the user’s face and the mask to avoid transmission of airborne viruses. However, each disposable mask – regardless of whether it is tight fitting or loose fitting – has to be discarded as infectious waste requiring incineration.
Until now, the healthcare industry has lacked practical processes to effectively decontaminate items in between use. While disposable masks have a significant negative impact on the environment, ensuring the safest possible standards for patients remains the priority for health staff. And so it should. Any solution that provides reusable equipment would require guaranteed disinfection as well as complete traceability of the process. It would need to be able to eliminate any level of scepticism surrounding the ability to completely disinfect items. However, funding and investment into new technology that facilitates that has always presented an obstacle. There has always been a genuine concern over whether a reusable solution will reliably protect both health workers and patients. However, reliable, sustainable solutions are now possible, and those fears can be alleviated.
Creating a holistic RPE ecosystem
There are reusable solutions already on the market, with more being launched, that are more effective than the disposable FFP3 respirators currently recommended. For example, there are products which offer both inhale and exhale protection, and when tested, achieved a fit factor of over 6000. That’s more than 99.9% reduction in infectious particles, more than an order of magnitude better than typical FFP3 performance. New innovations such as UV-C respirators are also now in the approval process which can offer further orders of magnitude protection for the highest risk activities.
It is the need for a complete ecosystem – a collection of solutions that can work together – that will be the enabler for change throughout the healthcare sector. A virtuous cycle that feeds into one sustainable solution where wearables can be disinfected, traced and then re-entered into circulation, together with complementary solutions that improve the user experience when wearing the equipment. For instance, decontamination solutions, voice enhancement tools, standard operating procedures, storage and traceability of RPE are all separate areas that can come together so that reusable RPE is both accessible and affordable for mass adoption across healthcare segments.
Being able to reliably trace and disinfect PPE allows the health sector to make long term use of these items in a highly sustainable manner, with full knowledge that each piece of equipment is safe to use repeatedly. This will allow single-use plastic-based disposable RPE, and other items of single-use PPE, to be removed from regular use, eliminating a major source of harm to the environment. Solutions that seamlessly integrate with wearables have launched in the market with many to follow. For example, through UV-C disinfection chambers or point of use plasma units that provide automated decontamination, repeatable with evidence, as well as traceability abilities, allows health staff to have complete control and visibility over their PPE.
Looking to the future
The negative effects of healthcare processes on the environment are undeniable. The need for health related institutions to make the switch to reusable PPE over the coming years is paramount and reusable respirators and masks offer the potential to address both the environmental and economic challenges. To support this change, it is vital for more segments to adopt a new mindset and build an ecosystem of technology and processes so that new innovations can work together to provide a sustainable solution.