Can the shortage of Personal Protective Equipment (PPE) be alleviated if more PPE such as gowns and aprons were to be decontaminated, cleaned and reused, rather than binned and destroyed after a single use in relation to a single patient.
THE PPE SHORTAGE
The supply chain of the NHS which has to bring PPE to hospitals and a multitude of other establishments such as care homes, evidently and unsurprisingly, has been unable to cope with demand caused by the sudden Covid-19 (CV) epidemic. Its normal distribution systems and resources are not fit for this task. A fact not fault, but the management in charge of the supply needs to learn from experience and change. There are stockpiles which have diminished very quickly. Much PPE has to be sourced from abroad, including ironically a lot from China, and with every nation competing for finite resources of PPE, availability is suffering. It will also be more expensive. Another lesson for future consideration. However, this is not a momentary problem but will continue and will re-emerge even after this crisis, when the next pandemic occurs.
PPE IS MOSTLY SINGLE USE
But why does so much new PPE get used so quickly. The answer partly lies in the fact that, at least in the UK, all PPE, with limited exceptions, is disposable after a single use. For example, an apron or gown gets used when there is , broadly , a risk assessed to exist of contact with a bodily substance (e.g. blood or mucus) and once used in relation to a single patient or sometimes a short session, it must be discarded and binned never to be used again. However, goggles for example are often decontaminated and reused. The relevant Standard Infection Control Procedures (SICPS) are clear as to single use only. But why do the SICPS not have more flexibility, as circumstances of use must vary considerably. Also, CV is not classified as a high consequence infectious disease (that is, it is not extremely deadly unlike Ebola, for example).
CAN PPE BE DECONTAMINATED AND REUSED?
If the apron or gown were to be washed and decontaminated in many situations, could they not be reused? No doubt disposal is the Rolls Royce standard for cleanliness and may be vital in some circumstances. The Rolls Royce is obscenely expensive, and more often than not a Mercedes might do, even in the world of healthcare. It must be questioned whether a blanket policy of disposal is really necessary. In the EU disinfecting of gowns and aprons seems to be contemplated in relation to CV. Goggles and certain other kit gets decontaminated and reused. In the NHS is not bed linen generally washed, maybe disinfected, and reused: and bed linen no doubt gets touched by body products. Also, cutlery gets washed and reused. The WHO does not seem to demand that all PPE is destroyed after exposure to a single patient. If in fact it is technically not possible safely to clean and decontaminate gowns and aprons and other single use PPE, perhaps urgent research is needed to solve any impediments so that it can be reused.
It is reasonable too to ask why the NHS disposes of perhaps all or nearly all sharps and other items used for or opened for a single patient. Is there no way to sterilise or otherwise clean thoroughly more things and recycle and reuse them safely?
There is an evergreen money tree available to the NHS it seems, and that makes it easy to adopt a policy of perfection, irrespective of cost. The perfect as the enemy of the good is an expression quite common these days. As the splendid efforts of NHS workers are rightly applauded now, its systems and practices should always be tested and, if possible, improved. If in fact more PPE can be properly cleaned, decontaminated, and so reused, then that might mitigate and prevent constant recurrence of the shortages and herculean distribution task presently experienced.
Uniquely, if anyone reading this knows the answer why more PPE cannot be decontaminated and used again, please email sherbhert@nautidev7.uk
