Use of Only N95 Masks in Singapore Reduces PPE Waste and Costs: Study
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During the late stage of the COVID-19 pandemic in Singapore, restricting the use of personal protective equipment (PPE) to only N95 respirators in healthcare facilities effectively protected staff, reduced plastic waste, carbon emissions and related costs, according to a JAMA Network Open study. Limiting the use of PPE to N95 respirators resulted in an annual savings of 440,532 gowns, 398,681 kilograms of carbon dioxide equivalent emissions, 66,080 kg of plastic waste, and approximately $333,970 US in healthcare costs. The study highlighted the importance of reevaluating PPE recommendations in light of the widespread availability of effective vaccines, decent levels of herd immunity, and the generally milder illness associated with the currently circulating Omicron variants.
Singapore Hospitals Limit PPE use, Slash Waste and Costs during COVID-19
A JAMA Network Open study states that the limited use of personal protective equipment (PPE) to only N95 respirators in Singapore healthcare facilities during the latter part of the COVID-19 pandemic resulted in staff safety, reduced plastic waste, lower carbon emissions, and decreased costs.
The National Centre for Infectious Diseases in Singapore conducted the study to evaluate the usage of PPE and the rates of monthly COVID-19 among medical staff at Tan Tock Seng Hospital and in the community before and after PPE de-escalation.
Changes in PPE Usage Guidelines
During the onset of the pandemic, the World Health Organization (WHO) released PPE guidelines recommending protective gowns, face shields, gloves, and medical masks for healthcare personnel caring for patients with SARS-CoV-2 infections. However, after the WHO declared the end of the public health emergency, the Singapore Ministry of Health revised its national PPE recommendations, advising N95 respirators alone from September 27, 2022, onwards.
Despite this, guidelines from the US Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) continue to recommend the use of gowns, gloves, and eye protection.
Massive Reduction in Waste and Greenhouse Gas Emissions
The study found that limiting PPE to N95 respirators resulted in a one-year savings of 440,532 gowns, 398,681 kilograms (kg) of carbon dioxide equivalent (CO2e) in emissions, 66,080 kg of plastic waste, and approximately $453,748 in Singapore dollars ($333,970 US) in healthcare costs.
Moreover, after PPE de-escalation, the number of gowns used per patient-day significantly decreased in general wards, the intensive care unit, and overall.
COVID-19 and Rise of Healthcare Waste
The COVID-19 pandemic led to a steep increase in healthcare waste worldwide. For instance, in Wuhan, China, medical waste rose nearly 400%. Similarly, sterilization plants in Madrid, Spain, operated at full capacity handling 50 tons of waste per day. In Bangladesh, this figure was around 14,500 tons during the pandemic’s peak.
Further, the pandemic intensified environmental pollution with PPE disintegrating into microplastics and microfibers, which persist in the environment for years, accumulating in river waters and sediments.
Alternative Approaches to PPE Use
The researchers noted that over 4 million metric tons of PPE waste and microplastic byproducts have entered the environment since the onset of the pandemic. Hence, exploring alternatives to single-use plastic gowns, such as reusable gowns or those made from sustainable materials, is critical.
Moreover, eliminating unneeded PPE can improve interactions between healthcare personnel and patients and lessen the psychological effects on patients without increasing the risk of disease transmission. In a related commentary, experts support the idea of healthcare systems investing more in research into disease transmission dynamics and expanding the implementation of engineering controls.
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