The considerable use of personal protective equipment (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, a new analysis suggests.
Between February and August 2020, about 3bn items of PPE were utilised – generating over 106,000 tons of carbon dioxide equivalents, according to research conducted at Brighton and Sussex Medical School. This equates to 591 tons a day, which works out to roughly 27,000 times the average individual’s daily carbon footprint, the authors estimated in the Journal of the Royal Society of Medicine.
“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.
“It’s a colossal amount of greenhouse gases that were generated. 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,” she said.
“And while the NHS in 2020 pledged to meet net zero carbon by 2040, this is moving us in the wrong direction.”
In their analysis, the researchers included items such as gloves, aprons, face shields, gowns as well as respiratory and surgical masks. The environmental cost of the PPE 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 – disposed of by high-temperature hazardous incineration.
“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 Prof 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”
Study 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.
“We’re not suggesting that we should do anything that puts health and social care staff or patients at risk … we are suggesting is that there might be strategies that we should be using, which enables us to continue to provide the same level of protection whilst actually reducing the environmental impact,” Rizan said.
“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.”
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.
“At the time … UK policy mandated that gloves were used for close patient contact, despite the fact that we knew the transmission of coronavirus is mainly through the air. The UK guidance has actually since changed,” said Rizan.
“So, 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.”
The government has plans to expand domestic manufacturing with the ambition to meet about 70% of PPE demand, she noted, adding that the plans explicitly exclude gloves. “As gloves were responsible for almost half of the carbon footprint of PPE, perhaps the remit of this ambition should be expanded.”
In the first six months of the pandemic, a lot of gear 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.
“But importantly here, the reductions aren’t just because of reducing the overseas travel, it’s also because of the actual electricity mix. Because in the UK we’ve got a much higher proportion of renewables than some of these other countries, where we were originally getting our PPE supplies from,” said Rizan.
This paper highlights the key message of reduce, reuse, recycle – this hierarchy suggests recycling, is “the least best thing that you could be doing,” noted Rachel Stancliffe, founder of the Centre for Sustainable Healthcare.
“Reduce what we’re using in the first place, and that would be, for example, washing hands rather than gloves and where possible. Don’t use aprons unless it’s necessary to. And then, if you do have to use them, use ones that are reusable,” she said.
“We can save money by doing the right thing.”