The “Gloves-Off” project is reducing unnecessary PPE waste by educating and empowering healthcare workers to decide what’s necessary, benefiting both the environment and patient safety.

The COVID-19 pandemic, which started in 2019, brought about a new era in healthcare, marked by an unprecedented reliance on Personal Protective Equipment (PPE), notably gloves, to shield frontline workers from the virus. While PPE was essential for safety during the height of the pandemic, concerns have emerged regarding its continued overuse in hospitals in the years following the peak.

A high reliance on non-sterile gloves causes cross-contamination and, therefore, a vast increase in waste. But another way is possible. A 2018 project at Great Ormond Street Hospital (GOSH) educated staff on the appropriate use of gloves, reducing use by a third without compromising clinical care.

Today, critical care nurse Lauren Bryant is adapting the GOSH research and bringing “Gloves-Off” to the Royal Sussex County Hospital (RSCH) intensive care unit (ICU) in Brighton. Bryant describes the project as “an attempt to reduce [our] unnecessary use of gloves by educating staff and empowering [staff] to make decisions about when it is appropriate to use them”.

The surge in PPE

The increase in PPE use during and after the pandemic was due to the virus’s contagiousness. The speed at which the virus spread throughout the world, understandably, meant infection control was the top priority for healthcare officials. COVID-19 causes coughing, resulting in droplets of the virus flying through the air. PPE such as gloves and masks serve as a barrier to prevent direct contact with the virus.

Additionally, the shortage of PPE supplies initially experienced in the UK led to heightened awareness regarding its importance and, therefore, a stockpiling mentality. The government rushed to obtain contracts with PPE providers to fill the gaps in availability for the National Health Service (NHS), whose guidelines stressed the need for protective equipment. All told, government contractors supplied more than 30 billion items of PPE during the initial COVID response.

This heightened awareness, coupled with the psychology of having a physical barrier to protect, has continued to exist among healthcare professionals. Bryant states that the use of PPE is “an emotive issue for some people, as the pandemic has brought a lot of fear into working in healthcare and workers, understandably, seek to protect themselves”.

Clinical and environmental impact

Gloves are some of the most widely used items of PPE; NHS hospitals used 1.8 billion of them in the first six months of the pandemic, according to a life cycle assessment by researchers at the RSCH. This number continued to rise in the months following the assessment, despite a decrease in COVID-19 cases.

It has been observed that gloves can cause a false sense of security, which can lead to cross-contamination. Prolonged glove use can result in increased moisture and warmth, creating an ideal environment for the growth of bacteria on the hands. This can potentially increase the risk of infection for both healthcare workers and patients.

Due to the initial panic, the government contracts given to PPE suppliers in many cases did not meet NHS requirements, and therefore £4 billion of non-standard PPE had to be disposed of. Often, PPE is non-biodegradable, and therefore disposal methods such as burning and landfilling are used, which are detrimental to the environment.

Healthcare contributes 4% of global greenhouse gas emissions, and a significant portion of this is PPE waste. Gloves make up 45% of the PPE carbon footprint and are formed from fossil fuels, which produce emissions during production and disposal.

Gloves-off: empowerment and education

Bryant discussed the benefits of reducing glove use by using the “triple bottom line” theory of planet, profit and people. “Reducing unnecessary (glove) use benefits, firstly, the environment by reducing oil demand, water demand, and landfill/incineration; secondly, the cost to the NHS as all items used come with a price tag; and thirdly, the social benefit of reduced infection risk for our patients.”

When asked how this project is going to be implemented within the hospital, Bryant said that “the project will only work through education and time. Habits are really hard to overcome, and many healthcare workers have deeply ingrained ways of working. ” 

Bryant continued that the key will be to “find out what motivates someone to make a change — whether environmental concern, a passion for patient safety or human rights”. The hope is that through face-to-face teaching, presentations and posters the initiative will make people confident in their decision-making and help to manage the fear that COVID-19 left so prevalent.

One of the measures has been to set up a Green Team in the local trust and work closely with them to make improvements. Bryant concluded by saying that she has “great faith that we can enact some big changes over the next year”.