SUS TAINABL E HEALTHCARE
current problem is that there is a disconnect between frontline attitudes to sustainability and procurement decision making. In a survey, conducted with 156 healthcare workers across primary and secondary care, 90% believed it was important to replace plastic layers with sustainable biomaterials and 78% reacted positively to paying more for an equivalent surgical face mask that was manufactured with a lower carbon footprint.10
Involving
frontline users in procurement decision making can help ensure sustainability is prioritised and forms a greater part of the overall cost-benefit-analysis undertaken by those making decisions. This integrated approach can help the NHS deliver on its goal to be carbon neutral.
As COVID-19 is unlikely to be eradicated and attitudes towards infection control change, PPE is likely to play more of a role in healthcare than it did pre-COVID, both in the UK and internationally. The global demand for PPE is not expected to decline substantially during the post-pandemic period, with an estimated compound annual growth of 20% in facial and surgical masks supply from 2020 to 2025, making the environmentally sustainable management of used PPE crucial.11
If the use of protective
equipment is unlikely to return to pre-COVID levels, it’s even more essential that we consider how products are made and ensure we do everything possible to reduce the amount of plastic we use, improve product reusability and increase our reprocessing capabilities.
How can we make PPE more sustainable? We can’t eliminate all single use PPE, but we can innovate our way to making it more sustainable through the use of better materials12
and improved processes which could reduce the carbon footprint by 75%.13 Tecman focuses on manufacturing using low carbon footprint processes and using biomaterials to make PPE as sustainable as possible, while ensuring it still meets the required specifications. The mix of materials used in manufacture, including plastic and foam, can make sustainable
design challenging. We use as little plastic as possible in our disposable face shield and, through innovative processes, we are able to save over 10 tonnes of plastic per million units. In our reusable product, Optec, we use biomaterials made from sustainably forested trees and have made it two and a half times more efficient in terms of storage, to reduce packaging and transportation emissions. We believe manufacturers can achieve significant improvements through reviewing processes, improved material selection and better packaging choices. Secondly, there is a role for re-usable protective equipment. Not every item can be made reusable, but we should look to increase the longevity of a face shield or mask wherever possible. For example, reusable Optec face shields are designed to be processed through thermal disinfectors and can be wiped down with disinfecting wipes – extending product life. This means whole units do not need to be reordered. By manufacturing components separately, manufacturers can help healthcare organisations to minimise waste – particularly for components without a limited lifespan. Although consideration needs to be given to the washing and disinfection process, reusable products offer a more sustainable solution for some health settings. Klemes et al argue in their article: ‘Reusable PPE are highlighted as an option with lower energy consumption; however, a
In a survey, conducted with 156 healthcare workers across primary and secondary care, 90% believed it was important to replace plastic layers with sustainable biomaterials and 78% reacted positively to paying more for an equivalent surgical face mask that was manufactured with a lower carbon footprint.
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proper design standard, material selection and user guidelines are needed to ensure its effectiveness. [sic]’. The emphasis they place on design and material selection cannot be overstated – the NHS should be as stringent in assessing sustainability as it is when considering the safety and usability of products. Thirdly, improvements can be made by sourcing products in the UK, wherever possible, rather than importing them. In their article, Rizan et al point out the environmental benefits that sourcing PPE domestically can bring, estimating that UK manufacture would have reduced the carbon footprint by 12% over the study period. Headline figures about the amount of plastic used in a particular face shield often hide the impact the supply chain has, particularly when PPE is sourced from Asia via intermediaries that have little control or oversight of the supply chain.
Many UK based PPE suppliers, especially in the early stages of the crisis, were not manufacturers but instead agents for international suppliers. Having suppliers that manufacture their own products ensures secure supply lines that can source sustainable alternatives should a particular material be unavailable. Ultimately, there needs to be a global, co- ordinated strategy to manage PPE production and the waste life cycle if we are to make progress and avoid delays to achieving key components of the United Nation’s Sustainable Development Goals.14
Time to reset
The pandemic has led to record production and use of personal protective equipment to keep healthcare workers safe. While lives have been saved by using these vital products, they have left behind an unenviable environmental legacy. A lack of reprocessing facilities and insufficient emphasis on sustainability in NHS procurement guidelines means PPE is having a more detrimental impact than it might
SEPTEMBER 2021
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