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Environmentally Sustainable Management of Used Personal

Protective Equipment
Narendra Singh, Yuanyuan Tang, and Oladele A. Ogunseitan*

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period either, with an estimated compound annual growth of

20% in facial and surgical masks supply from 2020 to 2025.2
The sustainable management of PPE is a key challenge. The
lack of a coordinated international strategy to manage the PPE
Downloaded via 152.57.192.39 on August 26, 2021 at 17:56:10 (UTC).

production and waste lifecycle threatens to impact progress

toward achieving key components of the United Nation’s
Sustainable Development Goals (SDGs), including SDG 3
good health and wellbeing, SDG 6 clean water and sanitation,
SDG 8 decent work and economic growth, SDG 12
responsible consumption and production and SDG 13 climate
action.4 We propose product lifecycle strategies that should be
integrated into solutions based on public-private partnerships.
The increase in PPE manufacture and distribution is
generating an equivalent increase in the waste stream,
compounded by health and environmental risks along the
waste management chain, especially in countries with an
underdeveloped infrastructure. China produced approximately
240 tons of medical waste daily at the peak of pandemic in
Wuhan, amounting to six times higher than before the disease
outbreak (Figure 1). Therefore, the local waste management
agency deployed mobile incinerators in the city to dispose of
the unprecedented quantities of discarded face masks, gloves,

P ersonal protective equipment (PPE) such as face masks,

gloves, goggles, gowns, and aprons are essential items to
help protect individuals from exposure to pathogens and
and other contaminated single-use protective gear.1 Similar
increases in discarded face masks, hand gloves, and protective
goggles have been observed worldwide. For example, more
contaminants. Traditionally, PPE use against pathogens was than 7 million residents of Hong Kong wear single-use masks
predominantly in the hospital environment. However, the daily. There are published reports of discarded masks in the
COVID-19 global pandemic necessitated that PPE is now ocean and on Hong Kong’s beaches and nature trails.5
widely used in domestic situations, leading to shortages in the The pandemic has impacted how solid-waste management
supply chain, and a rapid accumulation of potentially infectious activities are performed. The waste management and resource
PPE in domestic solid waste streams.1 The unprecedented recycling sectors were not regarded as essential services and
domestic demand for PPE in response to the pandemic has were placed under lock down. This disruption of routine waste
also impacted other industries reliant on PPE, including management services has been documented worldwide, further
manufacturing, construction, oil and gas energy, transportation, exacerbated by China’s earlier restrictions imposed in 2019 on
firefighting, and food production. Since the COVID-19 the importation of “recyclable” solid waste. In response,
outbreak, increased production of plastic-based PPE equip- impromptu procedures for collection and recycling of used
ment has been rapid. For example, between 2016 and 2020, PPE has been underway in some countries, a practice that may
the compound annual rate of increase in the global market for
PPE was 6.5%, from approximately $40 Billion to $58 Billion.2
In contrast, the World Health Organization projected that PPE Received: May 11, 2020
supplies must increase by 40% monthly to deal effectively the Published: June 29, 2020
COVID-19 pandemic. The essential PPE includes an estimated
89 million medical masks, 76 million pairs of medical gloves,
and 1.6 million pairs of goggles.3 The demand for PPE is not
expected to decline substantially during the postpandemic

© 2020 American Chemical Society https://dx.doi.org/10.1021/acs.est.0c03022

8500 Environ. Sci. Technol. 2020, 54, 8500−8502
Environmental Science & Technology pubs.acs.org/est Viewpoint

Figure 1. Medical waste generation and compositions in China. The quantity of waste is expected to increase by more than 25% in 2020.7,11 In the
U.S., there is no national database on medical waste generation because the Medical Waste Tracking Act (MWTA) of 1988 expired in 1991 and the
U.S. Environmental Protection Agency has not had the authority, specifically for medical waste, since then.

present hazard due to improper decontamination.6 Improper worldwide and the lack of coordinated governmental policies
disposal or handling of contaminated waste can transmit viral that require minimum recycling content in new products will
pathogens to healthcare and recycling workers. For example, it likely lead to an increase in virgin plastic manufacturing in the
has been estimated that up to 30% of hepatitis B, 1−3% of postpandemic period. The U.S. plastics manufacturing
hepatitis C, and 0.3% of HIV rates have been communicated industries have requested more than $1 billion in emergency
from patients to healthcare workers due to improper disposal funds to deal with the extra demands attributed to COVID-19
of medical waste. Studies conducted in Pakistan, Greece, impacts.9 To ensure that increased plastic PPE production
Brazil, Iran, and India show that higher than normal prevalence does not lead to increased pollution, restrictions on the
of virus infection in solid waste collectors’ can be traced emergency funds are warranted to support investments in
directly to pathogens in contaminated wastes.7 research and development of used PPE collection, sorting, and
The United Nation’s Basel Convention on the Trans- recycling. Implementing a sustainable PPE waste management
boundary Movement of Hazardous Wastes and their Disposal system will benefit from public-private partnerships (PPPs). In
has recently urged member countries to treat waste manage- countries with economies in transition, the role of artisanal
ment amid COVID-19 as an urgent and essential public service solid waste collectors and recyclers is indispensable. Develop-
to minimize possible secondary impacts upon health and the ing safe and sustainable PPE management beyond the
environment. Therefore, safe and sustainable recovery and healthcare settings (hospitals and clinics) under emergency
treatment of PPEs should be intensified. It is important to conditions is complicated because it requires a clear under-
clarify the role of informal recyclers in developing countries, standing of best practices, monitoring, and enforcement of
where medical waste has not been adequately regulated. policies and regulations. In healthcare settings, thermal,
The PPE response to the COVID-19 pandemic has also chemical, irradiative, and biological processes can be
impacted plastic recovery and recycling and will increase implemented locally or scaled-up in regional facilities where
landfilling and environmental pollution. The material compo- collection and waste transportation are possible.
sition of PPE includes plastics as major constituents Single-use PPE is not a sustainable practice, and multi-
representing 20−25% by weight. Ultimately, if not recycled, disciplinary technical expertise, including biomedical sciences,
their disposal contributes substantially to hazardous environ- environmental science, public health, materials science, and
mental pollutants such as dioxins and toxic metals. Contrary to engineering is essential for tackling the PPE pollution problem.
recommendations from the World Health Organization, which New research since the beginning of the current pandemic
encourages safe practices that reduce the volume of wastes indicates that PPE disinfection and reuse is possible on a large
generated and that ensure proper waste segregation at origin,7 scale through methods such as infusion of hydrogen peroxide
plastic-based PPE discarded from households is mixed with vapor, ultraviolet or gamma-irradiation, ethylene oxide gas-
other domestic plastic wastes such as single-use plastic bags, ification, application of spray-on disinfectants, and infusion of
the use of which has multiplied rapidly since grocery stores base materials with antimicrobial nanoparticles.10 Many of the
disallowed customers to bring their own bags for fear of disinfection methods are in the preliminary stage, and they
additional virus transmission routes. Polypropylene is a must be calibrated to ensure that material degradation during
common constituent of PPEs such as N-95 masks, Tyvek each disinfection cycle does not compromise the primary
protective suits, gloves, and medical face shields. Polypropy- function of PPEs to prevent penetration of pathogens and
lene also represents a substantial proportion of the human exposure.
approximately 25 million tons of plastic materials that are The circular economy principle focusing on reducing,
disposed of in U.S. landfills annually, with recovery and reusing, and recycling resources should guide policy develop-
recycling accounting for only 3% of the polypropylene plastic ment for PPE management during and after the current
generated.8 pandemic. National policies should be designed to require that
The potential to recover polymers from mixed healthcare plastic manufacturers add minimum recycling content in new
waste including PPE is challenging. Recycling without risking products, and product pricing should reflect environmental and
infection of individuals working as recyclers in middle- and health externalities. Public education campaigns to promote
low-income countries is limited by the low proportion (15− appropriate PPE stewardship should be integrated into policy
25%) of healthcare waste that is not contaminated. implementation, monitoring, and enforcement. Development
Furthermore, the low recycling rates for plastic waste of infrastructure to ensure safety in informal waste collection
8501 https://dx.doi.org/10.1021/acs.est.0c03022
Environ. Sci. Technol. 2020, 54, 8500−8502
Environmental Science & Technology pubs.acs.org/est Viewpoint

and recycling in low-income countries is essential. To be (5) Reuters, Discarded coronavirus masks clutter Hong Kong’s
sustainable, PPE management policies need be integrated into beaches, trails. https://www.reuters.com/article/us-health-
economic models that promote the adoption of green coronavirus-hongkong-environme/discarded-coronavirus-masks-
technology and alternative assessments to identify and adopt clutter-hong-kongs-beaches-trails-idUSKBN20Z0PP. 2020 (accessed
2020/5/11).
safer processes based on comprehensive materials life cycle (6) Mallapur, C., Sanitation Workers At Risk From Discarded
assessments and consumer preferences. Medical Waste Related To COVID-19. https://www.indiaspend.
In summary, the COVID-19 pandemic has strained solid com/sanitation-workers-at-risk-from-discarded-medical-waste-related-
waste management globally, while also highlighting the to-covid-19/ (2020/5/11).
bottleneck supply chain challenges regarding PPE manufacture, (7) WHO, Health-care waste. https://www.who.int/news-room/
demand-supply, use, and disposal. PPEs will continue to be in fact-sheets/detail/health-care-waste. 2018 (accessed 2020/51).
high demand, and this is the time to invest in research and (8) U.S. Environmental Protection Agency. 2019. Facts and Figures
development for new PPE materials that reduce waste about Materials, Waste and Recycling - Plastics: Material-Specific
generation, and for improved strategies for safe and sustainable Data. https://www.epa.gov/facts-and-figures-about-materials-waste-
management of used PPE with policy guidance at the global and-recycling/plastics-material-specific-data (accessed 2020/5/8).
(9) Lerner, S., Big plastic asks for $1 billion coronavirus bailout. The
level.

■
Intercept. https://theintercept.com/2020/04/27/plastic-industry-
coronavirus-bailout/ (accessed 2020/5/11).
AUTHOR INFORMATION (10) Price, A. D.; Cui, Y.; Liao, L.; Xiao, W.; Yu, X.; Wang, H.; Zhao,
Corresponding Author M.; Wang, Q.; Chu, S.; Chu, L. F., Is the fit of N95 facial masks
effected by disinfection? A study of heat and UV disinfection methods
Oladele A. Ogunseitan − Department of Population Health & using the OSHA protocol fit test. medRxiv 2020.
Disease Prevention, University of California, Irvine, California (11) Statistics of China’s medical waste generation and market size
92697, United States; orcid.org/0000-0003-1317-6219; forecast. https://www.reportrc.com/article/20200506/6615.html (ac-
Email: [email protected] cessed 2020/6/8).
Authors
Narendra Singh − School of Environmental Science and
Engineering, Southern University of Science and Technology,
Shenzhen 518055, China; orcid.org/0000-0002-6519-
9722
Yuanyuan Tang − School of Environmental Science and
Engineering, Southern University of Science and Technology,
Shenzhen 518055, China; orcid.org/0000-0003-2710-
6967
Complete contact information is available at:
https://pubs.acs.org/10.1021/acs.est.0c03022

Notes
The authors declare no competing financial interest.

■ ACKNOWLEDGMENTS
Work by N.S. and Y.T. is supported by the National Science
Fund of China (41977329), and the Shenzhen Postdoctoral
Funding (29/K19297523), respectively. O.A.O. codirects the
Lincoln Dynamic Foundation’s World Institute for Sustainable
Development of Materials (WISDOM) at UC Irvine.

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