“It’s estimated that it could take 450 years to completely decompose a surgical mask.”

Personal protective equipment (PPE) is critically important for health care workers; however, use of PPE is also contributing to environmental disaster. The COVID-19 pandemic and the monkeypox outbreak underscore how crucial protecting frontline workers is for their health and for public health at large. What is yet unclear are the environmental implications of our extensive PPE use during the pandemic. Nurses must have prominent voices at the table when discussing the future of PPE and how to deal with waste.

In the United Kingdom alone it was reported that over a period of just 53 days, 748 million PPE items were used in hospitals. In 2020, over 6.76 billion PPE items were distributed in England, three times the usual amount. Several countries reported over a 350% increase in medical waste during the height of the pandemic. During two years of the pandemic, it’s estimated that over 900 million tons of plastic waste was generated.

This ‘plastic pandemic,’ which is now a global threat that has been exacerbated by the COVID-19 pandemic, began in the 1850s when early forms of plastic began replacing natural materials. Despite recycling efforts, over 60% of plastics are estimated to remain in the environment. Plastics can be found in remote corners of every continent and in all water systems.

Environmental threats posed by single-use face masks.

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Given the extent of our use of face masks, it’s critical to understand what single-use face masks are made of. Single-use face masks can include microfibers made from polypropylene, polyethylene polymers, polyamide/nylon, polyethylene terephthalate, polyurethane, polyacrylonitrile, and polystyrene. Face masks exposed to water can release heavy metals such as lead, cadmium, and antimony. Face masks that are tossed on the ground or thrown into lakes, rivers, or landfills can leach these harmful chemicals, thus affecting human and animal life.

We have all seen face mask litter on the ground. These masks can end up blocking sewage systems and affecting our waste water management systems. It’s estimated that it could take 450 years to completely decompose a surgical mask.

In addition, face masks, gloves, and other plastic-based PPE will degrade into microplastics. Microplastics are plastic fragments less than 5 mm wide, can be ingested by marine and other animals, and can harbor viruses. It’s been pointed out that, ironically, the PPE we use to keep ourselves safe from COVID-19 results in plastic pollution can facilitate the grown of viruses and bacteria.

Reducing PPE waste.

Unfortunately, standard recycling efforts are not the solution for face masks, surgical gloves, or disinfectant wipes. Not only are these items flimsy and could clog machinery, but they could spread disease in recycling plants. Fortunately, there are efforts underway to clean and repurpose single-use items while limiting environmental damage.

There are companies that are exploring safe ways to recycle and repurpose PPE. Other suggestions to reduce the amount of PPE wastage include minimizing reliance on single-use PPE when possible, buying in bulk to avoid smaller plastic containers and wraps, and using a recyclable product when possible. Other strategies include cutting mask ear loops to reduce wildlife entanglements and using recyclable masks (e.g., multilayered cloth masks) when possible. In addition, nurses can advocate for changing from fuel-based plastics to biobased plastics.

What can nurses do in the workplace?

Nurses working in health care systems can advocate for the exploration of ways to support environmentally friendly purchasing efforts, such as masks and gowns that can safely and effectively be cleaned and reused, and the update of policies and procedures to consider environmental impacts of waste management practices.

While reliance on single-use face masks has decreased somewhat with the lifting of mask mandates, the issue of achieving the use of safe and effective PPE that does not cause irreparable environmental harm continues to be urgent. It is critical that nurses are active in discussions, proposal developments, and implementation of safe recyclable and reusable products.

By Barbara Polivka, PhD, RN, FAAN, is an associate dean of research and a professor at the University of Kansas, Kansas City.