Employers have the duty to provide personal protective equipment (PPE) to their employees, as this will protect an individual against health or safety risks in the workplace, according to the Health and Safety Executive, a website dedicated to information about health and safety at work.
These risks may include breathing in contaminated air, extreme heat or cold, flying particles of corrosive liquids, contact with corrosive materials, and more. PPEs include gloves, safety helmets, eye protection, high-visibility clothing, respiratory protective equipment (RPE), safety footwear, and safety harness.
The type of PPE used depends on the setting or the task, said Carly Fletcher of The Conversation, a news and analysis website. For example, nurses working in a COVID-19 ward are advised to wear an apron, a gown, a respirator and face protection, and disposable gloves. Community-based carers, meanwhile, are advised to wear aprons, gowns, and masks. PPEs are used onlyonce, so what happens when they are discarded?
Surveys Reveal Shortages of PPE In Healthcare
The Royal College of Surgeons of England, an independent professional body, found in their latest survey that 32.8% of surgeons and trainees did not believe they had an adequate supply of PPE in their Trust to help them do their jobs safely. Regarding the items of PPE they had personally seen shortages of in the previous two weeks, 34.1% said full, long-sleeved, fluid repellent surgical gowns or fluid repellant coveralls. 30.5% said FFP2 or FFP3 respirator masks and 28.8% mentioned full face visors.
35.2% stated that there had been no shortages of PPE in their workplace over the last two weeks. Over the same time period, 26.6% said they were not confident that the PPE they had been provided was FIT-tested to an adequate standard to help them do their job as safely as possible. 14.9% of surgeons and trainees stated they had been put under pressure to undertake procedures on COVID-19 positive or suspected COVID-19 positive patients without an appropriate level of properly fitted PPE.
A survey by organization APIC (Association for Professionals In Infection Control and Epidemiology) involving 11,922 US-based infection preventionist members showed that 69.59% (versus 30.31% of those who said no) were responding on behalf of a healthcare system rather an individual healthcare facility. The primary health setting the respondents work in were in a hospital (42.69%), ambulatory care/outpatient (17.39%), long-term care (15.22%), critical access hospital (8.76%), inpatient rehabilitation (4.22%), urgent care (4.02%), dialysis (2.70%), and other (5.01%).
With regard to PPE and other medical supplies, 17% of respondents said they had a sufficient supply of respirators (versus 33% of those who said it was running a bit low). 13% (38%) and 22% (38%) said they had a sufficient amount of face shields and goggles, respectively. 56% and 54% of respondents said they had a sufficient supply of hand soap (versus 28%) and gloves (versus 32%), respectively.
28% said they had a sufficient quantity of gowns (versus 44%) while 19% said they had enough supply of masks (versus 48%). Only 27% said they had enough supply of hand sanitizers (versus 43%). 20% said they had no respirators, along with face shields (13%) and goggles (11%). When asked how the respondents accessed supplemental PPE, 12.25% said federal resources like Strategic National Stockpile, 29.35% said state resources or local resources, and 24.5% mentioned private/community donations. 17.20% said do-it-yourself efforts like sewing and 5.63% said they don’t know or they were unsure. Only 6.57% and 4.46% said not applicable and other, respectively.
Disposing of PPEs
The National Health Service in England labels waste as either “infectious” (contaminated with bodily fluids), “offensive” (contaminated but not infectious), or “municipal” (similar to household waste). Used PPE is either “offensive” or “infectious,” meaning it needs to be disposed of to curb the spread of the disease.
One way to do that effectively is to burn the PPE in high temperatures to destroy the virus. In the UK, infectious wastes are sent to hazardous incineration plants. However, incineration draws controversy as it is known for releasing unwanted gases during the burning process. In modern waste plants, greenhouse gases are eliminated through gas cleaning technologies. Other types of used PPE can be sent to a landfill or burnt in non-hazardous facilities. Some are also recycled.
PPE Waste Is Expected to Rise
In England, the best option it has so far is incineration. We can expect the demand for disposing of used PPE to rise. Hence, we have to ensure that existing facilities can handle such demands. In the UK, those who are responsible for hazardous incinerators said there is currently enough space, but the Environment Agency has loosened its roles with regard to allowing COVID-19-infected waste to be burned in energy from waste incinerators.
Outside of the UK, Italy launched extra safe procedures for the disposal of PPE by sealing it in multiple containers, storing it away from others in the hospital, and moving it via dedicated corridors and elevators. On the other hand, China built a new medical waste plan and 46 mobile treatment facilities to deal with excess waste. But for other countries, PPE waste disposal is more complicated. For example, India has been known for violating government rules such as illegal dumping and mixing clinical and general waste. Since the pandemic, large quantities of used PPE have been dumped in open spaces of New Delhi. Volumes of PPE were also stored by workers in the informal sector to resell them.
What the Future Holds for PPE
Governments will have to reflect on current waste management systems and practices and whether alternatives can be introduced once the pandemic is over. Replacing single-use with reusable PPE can reduce the amount of waste since it is cleaned between uses. However, using chemical cleaning may pose a risk to the environment.
Introducing technology that sterilizes wastes and incorporates separation techniques that reduce the need for mixing infectious waste and general waste could minimize our risk of infection. More recycling would be available as more waste are classified as non-infectious. These options should be considered after the pandemic since new waste management systems or recycling options require new systems and infrastructures and extra staffing.
The aftermath of the COVID-19 pandemic may prompt countries to think of innovative waste management or recycling options to dispose of used PPE sustainably. Reusable PPE may be explored, but the environmental impacts of chemical cleaning should also be taken into consideration.