PPE could be safely decontaminated and reused

order to maintain supplies and reduce waste, provided it can be safely reprocessed and suitable quality assurance procedures established, according to a paper published today by the National Engineering Policy Centre.

The paper, following the government’s publication of its PPE Strategy for England, was drawn up following international consultation with engineers and manufacturers in other countries where various methods of reprocessing have been tested and evaluated.

With a winter surge in Covid-19 cases looming across the UK, the NHS should consider developing appropriate reprocessing facilities, the paper says. This would need to be done in consultation with experts across the delivery pipeline to ensure all the component parts including validated reprocessing facilities, logistics, and the provision of skilled personnel can scale simultaneously to meet potential demand.

Over 2 billion items of PPE were delivered to the health and social care system in England alone between March and July 2020, including over 400 million masks, 300 million aprons, 4 million gowns and half a billion pairs of gloves. The UK has rapidly scaled domestic PPE manufacturing capability, with UK-based supply anticipated to meet 70% of forecasted demand in December for all categories of PPE, excluding gloves – by far the biggest component of PPE by number. However, this may be tested by the challenges of winter if there are sustained periods of high transmission rates and increased hospital admissions or supply disruptions due to adverse weather events and the end of the EU transition period. The paper outlines how reprocessing could help to reduce pressure on supplies.

The potential decontamination methods detailed in the paper have been studied and trialled in the US, China, Finland, Japan and Germany, including treatment with hydrogen peroxide vapour, 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 standardised approach across the UK would be beneficial.

Quality management records for any decontamination methods adopted would be critical to ensure good practice, traceability, and auditability 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. This would include assessments to ensure the elimination of Sars-CoV-2 and other micro-organisms, quantitative fit tests and performance tests.  Any soiled or damaged PPE has to be disposed of appropriately and reprocessed PPE must be tracked to ensure that that reuse does not exceed the recommended number of cycles.

Healthcare professionals would need to be consulted to ensure that the risks of reprocessing PPE are fully understood and any process deployed should be validated locally but remain under review as scientific evidence continues to emerge.

Professor David Delpy CBE FREng FRS FMedSci, a Fellow of the Royal Academy of Engineering, said: “We welcome the government’s PPE strategy, which outlines how it aims to move away from disposable by default and assess new types of PPE that are designed for reuse from the outset. Some UK pilot studies are now in progress.

“However, 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. 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.

“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.”

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