What are the risks in reusing single-use personal protection equipment and how could this be done safely? It is an issue that engineers in the United Kingdom have been studying, as the second wave of COVID-19 infection looms, with critical shortages once again lurking on the horizon.
A paper published by the National Engineering Policy Centre recommends giving serious consideration to decontaminating and reusing some types of PPE in order to maintain supplies and reduce waste, provided it can be safely reprocessed and suitable quality assurance procedures established.
The paper is the outcome of international consultation with engineers and manufacturers in other countries where various methods of reprocessing have been tested and evaluated.
Over 2 billion items of PPE were delivered to the health and social care system in England alone between March and July 2020, including more than 400 million masks, 300 million aprons, 4 million gowns and half a billion pairs of gloves.
The U.K. has rapidly scaled domestic PPE manufacturing capability, with U.K.-based supply anticipated to meet 70 percent of forecast demand in December for all categories of PPE, excluding gloves—by far the biggest component of PPE by number.
The potential decontamination methods detailed in the paper have been studied and trialed in the U.S., China, Finland, Japan and Germany, including treatment with hydrogen peroxide vapor, ultraviolet light, moist heat, dry heat and irradiation. The method of decontamination chosen would determine which items of PPE were applicable, necessary validations, potential risks and how many times the PPE could be reprocessed. Adopting a standardized approach across the U.K. would be beneficial.
"As the pandemic continues, we think there should be more emphasis on decontamination methods, which if properly used could enable more sustainable use of PPE that is specifically designed for reuse and reprocessing," said Professor David Delpy, a fellow of the Royal Academy of Engineering.
"We need to be conscious of the environmental impact of using and disposing of so much plastic waste, particularly when much of it has to be incinerated after use."
Implementation would require quality management records for any decontamination methods adopted alongside robust health and safety protocols to assess and manage risk assessments. Rigorous validation and verification would be required of any approach to the reprocessing of single-use PPE to ensure that the PPE decontamination process was effective and did not introduce other risks.
Care would have to be taken to ensure soiled or damaged PPE is disposed of appropriately; reprocessed PPE must be tracked to ensure that reuse does not exceed the recommended number of cycles.
Also, health care professionals would need to fully understand risks of reprocessing PPE. Any process deployed should be validated locally but remain under review as scientific evidence continues to emerge.
"It is vital to ensure that critical care workers have access to PPE if there is another sustained period of high COVID-19 transmission, and emergency reprocessing of single-use PPE should not be seen as an alternative to increasing the supply of vital protective clothing and equipment for our frontline staff," Delpy said.