Why are we so reliant on "single use" PPE?

[Saracen999]

Obviously, cost. At least in the short term.

And sure, some "stuff", particularly from theatres, can be extremely dangerous, but that's a different issue.


But for all this "single use" PPE? Especially given a marked lack of security of supply.


I mean, hospitals seem to me to be chock-full of stuff that needs cleaning, from sheets to patient smocks.


More than that, well .... I had a finger operation recently (during the COVID situation) and it wouldn't stop bleeding during a dressing change. The blood soaked through pads, round plastic sheet, past all preventative steps and into one of the "treatment" couches. The nurses immediately took it out of use and marked it for "deep cleaning".

Hospitals are probably the type of facility more festooned with heavy-duty cleaning facilities, from autoclaves to washing machines.

So why do we rely so much on single-use PPE?

If nothing else, what about environmental impacts of all that "single use" plastics?


Whatever we do, and however we do it, this country needs to rethink what products need security of supply, and at least bring manufacturing back here, and also think long and hard about "single use" decisions.

[ik9000]

Quite. Couldn't agree more. It would give manufacturing jobs a boost too. It's all cost. China et al can manufacture in bulk so much cheaper than we can: lower wages, less environmental regulation, more spare land (outside of their cities) etc. Time was high-pressure steam cleansing and thorough washing were acceptable for many things. We've just become used to throwing a lot away. For a lot of things though disposable is essential. This side of aids etc people are much more reluctant to accept resterlisied needles for example.

[Saracen999]

Yeah, HIV/ Aids is a concern, but for that matter, so it Hep-C, etc. That's the "dangerous" stuff.

I s'pose all such risk can be eliminated with suitable cleaning, but single-use ensures no shortcuts / mistakes / simple human fallibity can cause a life-threateng/changing cockup.

Still ....we still need a long, hard look at our priorities. People > Cost, even if the direct implication is quite serious tax rises. Which it will be.

[Galant]

Convenience, I'd say, and cost.

I'm sure there are places, like those you've mentioned, where there is a real benefit in terms of hygiene. However, in general, 'throw-away' stuff doesn't have to be maintained or cleaned and is thus more convenient, and reduces costs in terms of that maintenance. Bring out the classic triangle. Quality - Cost - Speed: pick two. In this case, it's maybe Convenience - Financial Cost - Sustainability.

Where we, as a community, want more convenience, speed, or feels as though we are in competition, we'll always want cheaper and faster, never slower. However, COVID19 might be showing us that there are real benefits to slower and more spaced out. It's ultimately a cultural community issue. If we as individuals, and communities, decide to slow things down, space things out, and put up with less convenience in the short term in order to have a more sustainable, more maintainable way of life, we may well find things better.

By way of example - food. Assuming a fixed budget, someone could feel a strong impulse to always by the most or most voluminous products possible with the money. However, it may prove wiser and healthier to buy fewer and smaller products that are better quality. That might come like a shock at first and a move towards a 'poorer' lifestyle, but in the long run, eating better might lead to a 'richer' lifestyle.

[matts-uk]

Obviously, cost. At least in the short term.

No. Nothing to do with cost. Everything to do with clinical efficacy and 100 years of improving infection controls. Cross-contamination in a word but there is more to it.

But for all this "single use" PPE? Especially given a marked lack of security of supply.

Security of supply is very easy to achieve. You have a local manufacturing capacity and you protect it from market forces. It helps to protect the localised economy too but comes at the cost of bottom line (absolute) profit.

I mean, hospitals seem to me to be chock-full of stuff that needs cleaning, from sheets to patient smocks.

Hospitals are probably the type of facility more festooned with heavy-duty cleaning facilities, from autoclaves to washing machines.

Different infections are resistant to different cleaning measures. The cleaning regimen is based on the use case and the risk profile it presents.

So why do we rely so much on single-use PPE?

Cross contamination has been the cause of so many infections that turned out to be worse than the primary disorder. WWI hospitals were just as dangerous as the battlefields. By the advent of WWII the electron microscope had been invented and infection control started to move forward. There was a backward step during the 1980s as clinicians gave way to hospital administrators (accountants) and it became financially convenient to take greater risks and treat the resulting infections with antibiotics. Then in the 00s MRSA came along and rendered many cross-infections untreatable.

The big step up in single use PPE was during the AIDS crisis, when infection control awareness came out of the hospitals and into all the front line services. Since then basic infection control has made it's way into food hygiene, work place and amateur activities training. I should point out I am talking about the UK. It's a bit different in the States due to the legal system.

Single use helps in forming simple use procedures that do not require a knowledge of the underlying scientific disciplines. For instance an economist would be familiar with the logistical growth curve function,
deltaN / deltaT = R * N * (N - K / K)
But it is unlikely a GP, nurse or policeman would.

One treatment = One mask, gloves, gown, goggles. It's easy to teach, easy to remember, easy to enforce in the workplace and most importantly, it has proven to be most effective.

If nothing else, what about environmental impacts of all that "single use" plastics?

I don't know how much of it is currently recyclable. When you remove the financial constraint people are very good at finding innovative reuses.

Whatever we do, and however we do it, this country needs to rethink what products need security of supply, and at least bring manufacturing back here, and also think long and hard about "single use" decisions.

The World, the democratic part of it at least, needs to re-think the global consumerist economy. It has turned out to be one big lie and has not delivered the benefits we were all promised. I used to think globalisation raised living standards in emerging economies but it turns out it damages the majority in impoverished nations the same as the developed nations.

Globalisation has allowed about 1 million people world wide to accrue sufficient assets to truly control their lives. That leaves 7.7 billion of us working ever harder for an increasingly precarious existence. We are working so hard to not be the less fortunate, we don't have time to join up the dots and realise we are all less fortunate by degree.

[DanceswithUnix]

I s'pose all such risk can be eliminated with suitable cleaning, but single-use ensures no shortcuts / mistakes / simple human fallibity can cause a life-threateng/changing cockup.

It makes it easier.

But for example, when you take off your breathing mask you untie it at the back and don't touch the front, or you just contaminated yourself. I gather there is a correct way of removing gloves so as not to touch their outside contaminated surface as well.

Environmental impact? I presume gloves and masks go into clinical waste for burning, or again you have to decide what you think could go into landfill and that can lead to mistakes.

I've just been bagging up some 3D printed face shield parts, which hopefully will get taken away and assembled into masks and soon be in use by some poor sod mixing with the infected public. They are made in PETG on the expectation that things are so bad the shields will probably be steam sterilised and the cheaper PLA will sag at those temperatures and not be re-usable. But in the making of those 40 shield sets I have consumed a few nitrile gloves, some isopropyl alcohol and bagged the frames in freezer bags to make sure what I make is clean and safe from anything I or the couriers might have.

https://www.3dcrowd.uk/

It is an interesting attempt to help, if there are 7000 of us printing we have to average 84 frames each to cover the initial request from doctors, hospitals, vets etc for 585000 units. I might manage 45, but I'm out of raw material and it is hard to buy more with a delivery schedule that is in any way helpful. Thankfully I think injection molded frames are starting to appear.

[Saracen999]

Excellent reply, Matts. Learned a lot.

On globalisation, there have been benefits, especially to worse off people. In my youth, minimum price for a pair of jeans was about £30-£35. A few years ago, due to overseas manufacture, that 2as about £3 (gone up some now, but still way under the 1970/80s price, with inflation adjustment. Apply that to shirts, underwear, suits, etc and the savings over years aren't trivial.

Of course, that's all little-picture stuff. It also doesn't reflect durabilty. I have some 20+ year-old good quality shirts that I still happily use. But they weren't cheap.

[ik9000]

you don't have to go that far back Saracen. The decline in quality is really only in the last 20 years. I have next clothes I bought at university. Early 2000s. Still going strong and likely to last several more years to go. Stuff I have bought in the interim routinel rips, goes thread bare, distorts in the wash to such a degree it becomes unwearable etc. The rise in cotton price thanks to investment banks and the other shenanigans has led to poorer quality in an attempt to mask the price change. I'd rather have better quality back and pay double - particularly as it seems so wasteful throwing stuff out when it gets holes in before its time. That and I hate shopping.

[Saracen999]

I'd rather have quality too ... and it's still available. I don't mean poncy-priced designer stuff, but ... well, i pay about £20 for a Polo shirt, instead of £20 for 4, or 6, or whatever. They feel much better, much better material, properly stitched, etc. I don't buy much in supermarkrts anymore.

[CAT-THE-FIFTH]

Its down to time,quality and capacity. Some stuff can be autoclaved,but it needs to be be heat tolerant items. The stuff which cannot be heat treated needs chemical disinfection. Some of the chemical sterilisation agents are not very pleasant to handle - they release ozone or chlorine as their active agents,and you need to wear sufficient protection when handling them.

Sterilisation also needs to be done in different steps - chemical disinfection agents cover different spectrums of contaminants,so you might need to apply overlapping applications. This also means users need to be sufficiently well trained in decontamination etiquette. If not the re-used items will be contaminated. In certain instances,a combination of chemical and heat sterilisation is used.

This all takes time,and you need sufficient throughput of the sterilisation facilities to handle the load for a whole facility. Remember,if its a single use item,it will just go into the disposal bag which is then sealed when full.. If its to be re-used,there is a whole line of people who will be handling the items,until they are disinfected. So each person needs to have proper etiquette when handling the contaminated items. There are far less points of failure with single use items.

It also needs to be done properly and competently. Things like industrial autoclaves will break down if not maintained properly for example.By making items single use,its easier to have a giant factory churning out stuff in an automated manner to a high standard,and these can be disposed off via incineration. None of the single use items will be recycled due to potential contamination risks.

It also means you need less user training,ie,use the item and dispose of it. Especially for PPE in field conditions,this is far more practical.

[watercooled]

I don't want to delve too deeply into this debate but some pathogens aren't so easy to destroy, for example prions which will survive many typical sterilisation processes.

There's usually a happy mid-ground between re-using and single-use, e.g. making things from sustainable materials where possible. I'm thinking things like bioplastics?

[CAT-THE-FIFTH]

To put in context,why you need to have overlapping treatments to sterilise items:
https://interestingengineering.com/b...as-clean-rooms
https://academic.oup.com/cid/article/39/5/702/2022846
https://idhjournal.com/article/S2468...17)30045-7/pdf

Despite extensive sterilisation procedures,even stainless surgical instruments and NASA cleanrooms,can still have contamination. It was long thought stainless steel had a very long shelf life as it can be heat sterilised,but even that is being re-examined. This is because resistant biofilms can be formed on surfaces,and bacteria and fungi can form very resistant spores,so there is even a lower limit on how many times things can be re-used. Some micro-organisms now can actually metabolise sterlisation agents - people talk about antibiotic resistance,but its starting to apply to chemical disinfectants too.

So single use items do solve a fair number of these issues.

Edit!!

Even surgical gowns after being disinfected still have contamination:

https://www.plymouth.ac.uk/news/hosp...research-shows

Some of the PPE such as gloves,are actually not totally resistance,as the structure has tiny pores and these increase with more use. If you look at the manufacturers specifications they have tables which list barrier time per contaminant class. After that time has elapsed the glove does not actually protect you anymore. So this is why they have to be disposable,but also worn for short periods. People make the mistake of wearing the gloves for too long.

[fredwck]

I don't want to delve too deeply into this debate but some pathogens aren't so easy to destroy, for example prions which will survive many typical sterilisation processes.

There's usually a happy mid-ground between re-using and single-use, e.g. making things from sustainable materials where possible. I'm thinking things like bioplastics?

Yes, definitely sterilisation (the guarantee of). Even though SARS-CoV-2 is relatively easy to inactivate compared to the other aforementioned pathogens but because it is so infectious you don't need that many surviving particles to infect. Given this and the current "no vaccine yet" worry as well as turn over time of sterilisation, "use-once" is the most practical.

[matts-uk]

Excellent reply, Matts. Learned a lot.

Thank you.

On globalisation, there have been benefits, especially to worse off people. In my youth, minimum price for a pair of jeans was about £30-£35. A few years ago, due to overseas manufacture, that 2as about £3 (gone up some now, but still way under the 1970/80s price, with inflation adjustment. Apply that to shirts, underwear, suits, etc and the savings over years aren't trivial.

If you could see the terrible working conditions of the people who made those jeans. If you were aware most of the profit went towards the sweatshop owner's lavish lifestyle and to bribe a corrupt politician with a similar lavish lifestyle. If you were aware of the cost of 'fast fashion' to the environment (it is enormous). Would you still consider your £3 jeans good value?

Globalisation allows corporations to offshore the sharp practice, exploitation and corruption we stamped out in UK at great cost - It took us two World Wars to do it. The best chance children in the UK ever had of improving on their parents quality of life was in 1973. The same year OPEC started attacking Western economies with an artificial oil crisis. The much maligned Winter of Discontent was the most equal the UK has ever been and it has all been downhill from there. I will be the first to agree the Unions had become too strong by the 1970s and an adjustment was needed. What we got was a whole new, made in America, economic model. Taking the brakes off capitalism very quickly reversed the UK trend towards wealth equality.



Look who lost out and loses out, the most. It is the most vulnerable, the worse off, at the bottom of society and it is inevitable when everyone is being forced to compete.

Globalisation extends the playing field overseas. The Daily Mail would have us believe UK blue collar workers can not compete globally because they are lazy and inefficient. Complete tosh! The cost base of a UK worker is mainly their home. The £27 difference in the cost of your trousers represents the relatively high cost of land in the UK.

[CAT-THE-FIFTH]

Globalisation extends the playing field overseas. The Daily Mail would have us believe UK blue collar workers can not compete globally because they are lazy and inefficient. Complete tosh! The cost base of a UK worker is mainly their home. The £27 difference in the cost of your trousers represents the relatively high cost of land in the UK.

The speculative nature of the stock market is what is driving all of this though. Its not that you cannot make something here profitably in the UK,its just not profitable enough for the stock market,and the people who are involved in pulling the strings. The absolute profits and margins are not even important anymore,its the relative year on year increase,and nothing else now.

Year on year companies who are traded on the stock market are held to hostage by the same lot who have caused the last few decades of speculative crashes. A company "has" to make "X margins" and "Y profits" next year. Nobody questions how they come up with these numbers.

Look at the 1980s stock market crash,2000s dotcom bubble and the subprime crash. If you look back far enough it was the excessive speculation which caused the 1929 stock market crash. The US for example moved off the Gold standard entirely in 1971,and we have mostly moved to a Fiat money system which is not actually linked to physical goods,which means its getting worse.All these happened because the numbers were being fudged and it took only a slight nudge somewhere for the whole pack of cards to collapse,and who pays for all of this?? The average person.

Even Apple which had record margins/profits one quarter,had its shares go down,as they slightly missed the analysts figures. People have had their pay frozen,work benefits cut,etc even if the company they worked for,was doing well. Why? Because they missed the figures analysts expected,and the companies share price had to be shored up. Jobs being moved abroad happens because of this.

As the greed gets worse,they pull out higher and higher numbers. The problem is also the production costs can only go down so far,and prices only so far upwards until another crash. Boom and bust is inherent to the system and IMHO the time between cycles is getting shorter and shorter.

As long as the financial analysts old boys club can pull whatever numbers they want,most people are still going to get screwed over.

[Zak33]

@matts-uk

that was a superb history time line.. that was one of the finest, clearest, most concise things I have read for ages