Hamilton, Ontario: December 21, 2023 – Research led by the Canadian Coalition for Green Health Care on personal protective equipment (PPE), intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, was conducted to identify prospects to reduce plastic PPE waste focusing on opportunities for reduction and reuse in the health system. Most of the PPE used in Canada is made of plastic, and much of it was disposable.
Reusable, safe and Infection Prevention and Control Canada- (IPAC) approved PPE gowns were identified as 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,” says Dr Myles Sergeant, Executive Director of the Canadian Coalition for Green Health Care.
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), also explored the many synergies with other government and health system priorities that would enhance opportunities and support for a reusable PPE system. 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. 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, it will also support the creation of good jobs,” says the Honourable Steven Guilbeault, Minister for the Environment and Climate Change.
Access to PPE, especially during the initial stages of the pandemic, was poor due to challenges in the global supply chain. “Disruptions to the health care supply chain, whether it is through a pandemic or through climate change-related events, can affect the quantity and quality of PPE or other medical supplies and can impact the safety of both patients and health care workers. Development of strategies to ensure 100% continuous access to essential health care products is needed,” suggests Dr. Fiona Miller, Professor of Health Policy at the University of Toronto, and an advisor to the project.
A comprehensive reusable PPE health system, which includes reusable products, local infrastructure for reprocessing, sanitizing 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. 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,” declares Dr. Andrea MacNeill, Medical Director of Planetary Health, Vancouver Coastal Health, British Columbia, one of the project hospital partners.
Timely access to PPE was reported by numerous hospitals as the primary motivator to secure reusable PPE such as reusable gowns.
Altaf Stationwala, CEO, Mackenzie Health in Ontario also firmly supports switching to reusable gowns saying, “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.” Adding, “Mackenzie Health has now converted all of the isolation gowns used in the ICU to reusables.”
This thought was echoed by project partner University Health Network (UHN) in Ontario. According to Joanne Bridle, Executive Director, FM-PRO Operations, UHN, “Early in the pandemic, UHN and Ecotex, our health care linen services partner, collaborated on the development of a high-volume reusable isolation gown program. 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 to continue caring for patients safely 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 million dollars over the first two years of the pandemic. In BC, Surrey Memorial Hospital reported that reusable isolation gowns were nine times cheaper per use than disposable gowns.
Organizations that provide health care laundry services 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). “Health care laundry processing facilities are critically important support infrastructure and were invaluable in ensuring that Canadian health care workers had IPAC approved, reusable PPE barrier gowns throughout the COVID pandemic and beyond. Our TRSA member operators partnered with the hospitals they serve to assure an uninterrupted supply of reusable PPE gowns, reprocessed, and sanitized 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 health care laundry at hospitals in Canada, and are key suppliers of reusable PPE gowns and other protective medical garments and textiles.”
For more information, including knowledge mobilization tools such as PPE reduction and reuse stories in our case studies map, our video featuring interviews with key health care leaders supporting reuse systems, infographics and a checklist for implementing reusable PPE initiatives at health care facilities, please visit the Coalition’s project webpage at https://greenhealthcare.ca/ppe-msup/. A copy of our paper entitled Reusable personal protective equipment in Canadian healthcare: Safe, secure, and sustainable is available in Healthcare Management Forum, volume 36(4), 2023.
Contact: Kent Waddington, Communications Director, CCGHC at Kent@kentwaddington.com