To think single-use PPE is terrible for the environment

[Lycidas]

Apparently 55,000 items of PPE will only last eight hours in the UK...with this situation due to continue for many months at least. Is there really no alternative that’s not as wasteful and environmentally damaging?

Dentistry has been using single use items for 20 years or more
We have to.- there are incredibly strict rules about cross contamination I imagine it’s very much the same in hospitals
Is it terrible for the environment- yes
Do we have a choice - no.

It all usually gets incinerated

We are cleaning and reusing goggles and visors.
Some of us are using the industrial masks as we've failed mask fit testing and there are only a few hoods available.
What we don't know is how long the filters last in this situation.It would probably be cheaper to give everyone one of these as the sourcing a disposable mask that fits is a nightmare,we have had 4 different types supplied and trying to fit test everyone for all of them is a nightmare.

Years ago a lot of things would have been washed and sterilised for re-use (and the NHS was geared up to do that) but then there was the discovery that various "germs/viruses/bacteria" etc were still not destroyed by the process.

I think you are having a very hard time here, OP - you weren’t suggesting that medical staff reuse the current PPE equipment that they have, but as a wider debate about looking at potentially different materials for future use.

Just because we have gone from launderable, but inadequate by modern standards, gowns etc, to single use disposable for general use as well as this specific problem , doesn’t mean that there cannot be a middle way to be considered with the ever changing possibilities of materials science.

A PP linked to an accidental finding that the materials used for air bags has the right properties of fluid containment with wash ability for reuse. This may be just one tiny example that could be explored when we are not in a crisis .

It’s not even just about the cost to the environment- it’s about having at least a back up under local control, rather than being at the mercy of uneven supply.

Yes I understand what you mean. Sometimes I wonder, considering how easily and devastatingly quickly the virus has spread, how the world wasn't better prepared?? Surely there has always been a risk of this happening? Anyhow, on a personal note my wheelie bins are only half full of waste and recyclables..down to shopping at local grocers/butchers so not as heavily packaged, and making food go further using leftovers, not using car so much etc.

The OP hasn't suggested she wants people reusing single use PPE, she hasn't suggested she wants more people to die.

She has asked if there could be a better option which doesn't involve tonnes of single use items.

It's a reasonable question.

^ absolutely.

Balancing effective PPE with reducing avoidable waste is just one, single topical aspect of broader questions about medical waste, recycling, energy use and so on and how the environmental impact of the NHS could be mitigated. This has been in the agenda for years and hasn’t been tackled substantially.

BMJ article from 2009 www.bmj.com/bmj/section-pdf/186173?path=/bmj/338/7697/Analysis.full.pdf

This think tank blog sets out some of the big reasons why the environmental agenda has not been able to be addressed by the NHS in recent years: which are politically-led reasons: the reorganisation of the system by David Cameron’s (Andrew Lansley’s) Health and Social Care Act in 2012, the financial tension of the Coalition’s/Conservative policy of austerity and then most recently, Brexit preparation.

www.kingsfund.org.uk/blog/2019/04/nhs-climate-change

No-ones saying that now in the middle of a pandemic crisis is the time to solve this question. But given that research shows that the fundamental changes to healthcare that will be needed to make it less environmentally damaging are also linked to changes needed to improve quality of patient care and to support the overall financial sustainability of the NHS.. then avoiding this topic doesn’t look sustainable in the long run if we also care about the financial future of the NHS or about quality of care.

....or about the planet

Disposable single use PPE is currently the best option for infection control. It’s not the best option for the environment. But medical care cannot be compromised and avoidable breaches of cross infection control are not acceptable. That’s not to say we shouldn’t be aiming to produce materials that can be reused, but currently the medical world will not accept a second best option for patient care which prioritises environmental factors. PPE needs to protect against everything, not just COVID. Any patient currently in hospital could have TB/hepatitis/herpes/suppressed immune system etc... and PPE must protect the wearer and all subsequent patients. How well does dried blood wash out of fabrics? A surgeon wearing a bloodstained (albeit laundered) gown would be pretty terrifying!

It was said upthread that most hospitals had combined heat/waste incinerators. Interesting to know if the chimney gas is entirely free of fine particles and dioxins? If so, maybe it's an untapped income resource, as incinerators are in demand.

Also upthread, was mention of dental incineration. Some of the plastic is necessary, but by no means all. Sterile packaging need not be plastic. Single use sachets of all kinds are a massive pollutant, and virtually never need to be plastic.

. Cotton buds should simply be banned from manufacture. The public use them for obscure rituals with makeup, or, mostly, to stick in their ears. Bad plan. (Audiologists won't hear of it. Joke) A bit of sterile cotton wool does not require a stick of plastic to function .

It’s not the packaging itself that makes it non recyclable, but what’s potentially on the packaging. Anything that’s been used in a clinical environment could/will potentially have blood/other bodily fluids/infectious microbes on it so must be treated as clinical waste which is a biohazard. If a practitioner has to change into clean gloves each time they need to open a new packet to keep it clean, then to recycle one paper packet, two latex/nitrile gloves will be disposed of.

It does seem slightly undercut when some staff have to wash their uniforms at home though.

I think there does need to be a balance, and cradle-to-grave analysis done but a reserve stock of 500 gowns that can be safely boil washed/bleached 50 times with no loss of performance (and I can tell you that scientists are usually pretty conservative with those estimates) would give you 25,000 gowns if there were issues getting PPE.

Clean room industry tends to use reusable silicone masks with changeable filters, which could also be something that might work — the body of the mask can be cleaned with IPA.

We were talking about this last night. If the virus is going to come back in waves, and the whole world will be scrabbling for PPE again, the the development of a reusable version should be a priority. Sounds like someone in the NHS should be talking to Switzerland.

There’s a lot of short termism in the NHS because of the stupid way budgets work: spend it now from the consumables budget or lose it from next year’s budget, rather than invest more in a longer term solution.

And yes, I imagine there’s an awful lot of money made from single use items.

Clean room industry has different concerns and priorities to the medical industry, it's not comparable.

I work in the pharma industry, in my 20 year in the industry we have moved more and more to disposables for safety, sterility and disposal reasons. Reusable stainless steel equipment requires pressurised hot caustic washes to clean, producing tons of difficult to dispose of liquid waste at high pH (that needs high volumes of acid added to neutralise before disposal into the water system). In addition, there are safety issues, both due to inadequate sterilisation but also for the operators if caustic is sprayed over the clean room. Disposables are far far safer.

the body of the mask can be cleaned with IPA

IPA might be reasonably effective if used correctly against a coronavirus (an enveloped virus) but has no impact on fungal spores or prions.

I agree with you op. I’m an NHS nurse. We use a lot of single use plastic. Sadly at the moment there is no alternative but I would like to think that this is something that will be looked at in the future.

My experience was in pharma as well CountFosco, but not current I admit. It was more of an example of equipment that is available and used so could potentially have its suitability assessed.

We used IPA to clean them, but I presume material testing could be done (or already has been) to whether they'd survive the sort of treatment needed to sterilise them to meet spec. Or they could be risk assessed for use in only certain areas.

I understand the reason disposables are used, but it does create problems when there are supply chain issues, so testing and having safe reusable options (even only for some applications) would allow disposables to be diverted to where they're needed.

The resource side of it worries me as much, if not more, than the environmental side to be honest, because there are many points at which the balance does swing in favour of single-use items.

waterford-news.ie/2020/05/05/uhw-surgeon-develops-reusable-ppe-gown/#.XrLX4VMo-yP
This article reminded me of this thread. Some positive progress in the development of reusable PPE.

We are all being fitted for the Force8 industrial masks inourtrust andI know others are too.This saves money, they're reusable so we each have our own and Savesall the fitting for different masks.Maybe in future they'll consider doing ones for the70% of female healthworkers.But at least we're safe.
Visors,the public have been great,we have lots of 3d printed visors,home made ones that we can clean and reuse or discard if needed.
Gowns,awhile different issue.We have some non sterile disposable so ok for anaesthetists,ITU/theatre anaesthetic staff but since gowns have beeninshort supply(worldwide) management have bought lots of reusable,non sterile 'gowns'.Unfortunatly no one spoke to clinical staff.I can't show pictures of what they're like as it would be outing.
We used to use washable gowns and these would be ok for what we're doing'blood did wash out,but they could safely be used by the Nona subgroup.
Management also brought out hazmat suits,extra large mansized,we average females ,modelled a few and it's gone quiet.
In the NHS and care homes the lessons were learning will change things,hopefullyfor the better.Getting the right kit is a struggle for procurement teams and a worry for us if we know things are tight but with a little ingenuity we're getting by.
I have my own scrubs,they home in a bag,bag and scrubs go on a hot wash as soon as I get home,hot tumble drier and steam ironed.I don't think uniforms have ever been implicated in infection outbreaks,we are careful because our selves and families are dependant on it.
We need to push more onplastics though,some companies use moulded plastic to package glass vials,others manage with card.Puloed paper trays are used by some companies and other use plastic.The means are there for immediate reduction but the debate is not for now.

Bizarre what a hard time @Lycidas is being given on this thread. Why are people being so obtuse and dramatic? She's not suggesting we stop using - or start reusing - PPE right now under the current circumstances. She's asking whether there's a different approach that would help in the current situation and thereafter. As a pp says, the amount of waste of single-use items in the NHS is extraordinary, but there is much else in that isn't reused but instead is autoclaved or otherwise sterilised. There may well be new or transferable techniques that could be applied, or a more creative approach to procurement, use or reuse, but none of that is possible without a change of perspective at a political or bureaucratic level. It's a completely valid, and important, question to be asking.

Mumsnet is so weird. Sometimes you get publicly humiliated for being the only person in the world who doesn't wash your used sanitary products in the tears of baby chinchillas, and today apparently you get flayed alive for wondering if there might be a little less waste in the world.