Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic

  1. Chantelle Rizan
  2. Malcolm Reed
  3. Mahmood F Bhutta

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Abstract

To quantify the environmental impact of personal protective equipment (PPE) distributed for use by the health and social care system to control the spread of SARS-CoV-2 in England, and model strategies for mitigating the environmental impact.

Design

Life cycle assessment was used to determine environmental impacts of PPE distributed to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use and disposed of via clinical waste. Scenario modelling was used to determine the effect of environmental mitigation strategies: (1) eliminating international travel during supply; (2) eliminating glove use; (3) reusing gowns and face shields; and (4) maximal recycling.

Setting

Royal Sussex County Hospital, Brighton, UK.

Main outcome measures

The carbon footprint of PPE distributed during the study period totalled 106,478 tonnes CO 2 e, with greatest contributions from gloves, aprons, face shields and Type IIR surgical masks. The estimated damage to human health was 239 DALYs (disability-adjusted life years), impact on ecosystems was 0.47 species.year (loss of local species per year), and impact on resource depletion was costed at US $12.7m (GBP £9.3m). Scenario modelling indicated UK manufacture would have reduced the carbon footprint by 12%, eliminating gloves by 45%, reusing gowns and gloves by 10% and maximal recycling by 35%.

Results

A combination of strategies may have reduced the carbon footprint by 75% compared with the base scenario, and saved an estimated 183 DALYS, 0.34 species.year and US $7.4m (GBP £5.4m) due to resource depletion.

Conclusion

The environmental impact of PPE is large and could be reduced through domestic manufacture, rationalising glove use, using reusables where possible and optimising waste management.

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  3. Version published to 10.1177/01410768211001583
  4. ScreenIT

    SciScore for 10.1101/2020.09.21.20198911: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Parameters for Life Cycle Assessment: A LCA was conducted in accordance with ISO 14044 Guidelines,(6) and modelled using SimaPro Version 9.10 (PRé Sustainability, Amersfort, Netherlands), with additional analysis using Microsoft Excel for Mac Version 16.25 (Microsoft Corp, Washington, US).
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We estimate the carbon footprint of PPE distributed for use by health and social care services in England during the first six months of the COVID-19 pandemic to be 106,478 tonnes CO2e, which is equivalent to 0.8 % of the entire carbon footprint of health and social care in England during six months of normal activity (estimated at 27 million tonnes CO2e per annum in 2018).(20) Per day this equates to a mean of 591 tonnes CO2e, equivalent to 27,000 times the average individual’s carbon footprint, or around 244 return flights from London to New York.(21) There are some caveats in interpretation of these data. Around 3 billion items of PPE were used in the six-month period analysed, but data from 2019 (prior to the pandemic) suggest that around 1.2 billion items would normally be consumed in the NHS in a six-month period,(5) hence the excess in this period was in fact 1.8 billion items. However, 70-80% of elective care in the NHS stopped during the first few months of the pandemic, and emergency attendances decreased by 30-40%,(22) meaning PPE use related to normal (non-pandemic) NHS activity would have fallen by a comparable amount. The backlog of pending elective activity means that the PPE required to deliver elective care has been deferred rather than abolished, and as elective activity resumes, current requirements for enhanced protection mean that use of PPE will likely be even higher than before. The large environmental impact of PPE, and the probability that we will con...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  5. Version published to 10.1101/2020.09.21.20198911v3 on medRxiv
  6. Version published to 10.1101/2020.09.21.20198911v2 on medRxiv
  7. Version published to 10.1101/2020.09.21.20198911v1 on medRxiv