Most of the PPE used in Canada is made of plastic – much of it disposable – and the research’s focus was opportunities for reduction and reuse in the health system. Reusable, safe and Infection Prevention and Control Canada-(IPAC) approved PPE gowns were identified as offering the greatest opportunity to reduce greenhouse gas (GHGs) emissions. Given a broad adoption of reusable gowns in Canada, medical glove use generated the most significant waste quantities. “It was important to consider the question of reusability of PPE as a strategy to address both waste plastics and GHG emissions, while also enabling a secure supply of safe, IPAC-approved PPE products,” said Dr Myles Sergeant, Executive Director of the Canadian Coalition for Green Health Care (pictured).
The project, entitled ‘A circular economy model for hospital-generated PPE and medical single-use plastic waste: Demonstrating opportunities for reduction and reuse’, was funded by Environment and Climate Change Canada (ECCC). It also explored ‘the many synergies with other government and health system priorities that would enhance opportunities and support for a reusable PPE system’. The Coalition says other government priorities – such as reduction of GHGs from the health system, and promoting circular economy approaches to resolve resource and waste issues, could also be supported through this approach.
“We can prevent plastic pollution, reduce plastic waste, and implement a circular economy in all sectors, by valuing innovation, said the Honourable Steven Guilbeault, Canada’s Minister for the Environment and Climate Change. “We can, for example, find new ways of making personal protective equipment reusable and recyclable, or look for other environmentally-friendly solutions. Reducing plastic pollution will not only help combat climate change and protect biodiversity, but also support the creation of good jobs,”
Access to PPE in Canada, especially during the initial stages of the pandemic, was poor, due to global supply chain challenges, the Coalition says. “Disruptions to the healthcare supply chain, whether through a pandemic, or climate change-related events, can affect the quantity and quality of PPE or other medical supplies, and impact the safety of both patients and healthcare workers,” said Dr Fiona Miller, Professor of Health Policy at the University of Toronto, and an advisor to the project, who argues for development of strategies ‘to ensure 100% continuous access to essential healthcare products’.
The Canadian Coalition for Green Health Care says a ‘comprehensive reusable PPE health system’, which includes reusable products, local infrastructure for reprocessing, sanitising and disinfecting, with associated transport and tracking systems, should be explored ‘as a strategy to ensure 100% access for some PPE, and for the many environmental, social, and economic co-benefits of such a system’. “It is a lot easier to scale up your reuse cycles such as laundering gowns or replacing the filters in your reusable respirators than it is to remanufacture more of something, and of course it creates less pollution,” said Dr Andrea MacNeill, Medical Director of Planetary Health, Vancouver Coastal Health, British Columbia, one of the project hospital partners. “Our healthcare laundry partner, K-Bro, was able to easily scale up laundering of reusable gowns and keep up with our needs. In some of our BC hospitals the reusable gown use ranges from 80-100% now.”
Altaf Stationwala, CEO of Mackenzie Health in Ontario, also supports switching to reusable gowns. He said: “Converting to reusable gowns immediately introduced a predictable supply of product for the foreseeable future. The fact that it also reduced our environmental footprint was an added benefit.” Mackenzie Health has now converted all the isolation gowns used in its ICU to reusables.
This thought was echoed by project partner, University Health Network (UHN) in Ontario. Joanne Bridle, Executive director, FM-PRO Operations, at UHN, explained: “Early in the pandemic, UHN and Ecotex, our healthcare linen services partner, collaborated on the development of a high-volume reusable isolation gown programme. This process was quickly scalable, enabling Ecotex to launder and return clean reusable isolation gowns up to three times a day during the peaks of the COVID-19 pandemic, when reusable isolation gown use had more than tripled to 120,000 gowns per week. Through this creative and sustainable local initiative, TeamUHN was consistently provided with high quality reusable isolation gowns during this very challenging time. Today, over 99% of the isolation gowns used at UHN are reusable.”
Cost savings were also reported by hospitals using reusable gowns. For example, UHN reported ‘significant cost savings’ where reusable isolation gowns were 60% of the cost of disposables, and Toronto area hospitals that used reusable isolation gowns saved an estimated $70 m dollars over the first two years of the pandemic. In British Columbia,, Surrey Memorial Hospital reported that reusable isolation gowns were nine times cheaper per use than disposable gowns.
Healthcare laundry services providers are an integral part of the reuse infrastructure, reaffirms Randy Bartsch, Executive Chairman of Ecotex Healthcare Linen Service, and the incoming Chair of the Washington DC-based Textile Rental Services Association (TRSA). He said: “Healthcare laundry processing facilities are critically important support infrastructure, and were invaluable in ensuring Canadian healthcare workers had IPAC-approved, reusable PPE barrier gowns throughout the pandemic and beyond. Our TRSA member operators partnered with the hospitals they serve to assure an uninterrupted supply of reusable PPE gowns, reprocessed, and sanitised locally, at accredited and certified laundry facilities across the country, while saving the health systems money, and reducing the massive environmental waste impacts of single-use disposables. Our TRSA members process more than 80% of all the healthcare laundry at hospitals in Canada, and are key suppliers of reusable PPE gowns and other protective medical garments and textiles.”
For more information, visit the Coalition’s project webpage at: https://greenhealthcare.ca/ppe-msup/