Original Investigation
Infectious Diseases
April 15, 2025
Plastic Waste and COVID-19 Incidence Among Hospital Staff After Deescalation in PPE Use
Stephanie Sutjipto, Aung Hein Aung, Margaret M. L. Soon, et al
JAMA Netw Open. 2025;8(4):e255264. doi:10.1001/jamanetworkopen.2025.5264
Question Following PPE deescalation in Singapore, what was the incidence of COVID-19 among staff and how did the amount of plastic waste change?
Findings This quality improvement study analyzed PPE usage and staff COVID-19 incidence before and after PPE deescalation. Staff-to-community COVID-19 rates were comparable with median community rates of 2.6 preimplementation and 1.5 postimplementation; the implementation was associated with a 12-month reduction of 440 532 gowns, 398 681.46 kg carbon dioxide equivalent in carbon footprint, 66 080 kg plastic waste, and approximately SGD 453 748 (approximately USD 333 970) in health care costs.
Meaning These findings suggest PPE deescalation to N95 respirators alone ensured staff safety, promoted environmental sustainability, and reduced associated costs.
Abstract
Importance In September 2023, the Singapore Ministry of Health revised the national personal protective equipment (PPE) guideline for health care personnel (HCP) attending to suspected or confirmed patients with COVID-19, recommending the use of N95 respirators alone. However, data on the associations between PPE deescalation, staff COVID-19 incidence, and sustainability outcomes are limited.
Objective To evaluate the associations between PPE deescalation guidelines on staff COVID-19 incidence and the environmental sustainability outcomes of the measure.
Design, Setting, and Participants This was a retrospective quality improvement study of hospital PPE usage using data from Tan Tock Seng Hospital and the National Centre for Infectious Diseases (NCID), analyzing monthly COVID-19 incidence rates among HCP (all medical staff, allied health care workers, ancillary staff, and administrative staff from the hospital campus) and in the community over 12 months before and after PPE deescalation measures (October 2021 to September 2022 and October 2022 to September 2023).
Main Outcomes and Measures COVID-19 incidence rates among HCP and in the community; economic and environmental outcomes of removing single-use gowns from routine COVID-19 care, including reductions in carbon footprint, plastic waste generation, and cost savings.
Results The mean (SD) monthly number of HCP was 10 774 (79) (range, 10 636-10 891) preimplementation and 11 099 (200) (range, 10 864-11 449) postimplementation. Our analysis revealed PPE deescalation was not associated with an increase in monthly COVID-19 infections among hospital staff, with the trends aligning with population infection rates. The median (IQR) staff COVID-19 infection rate relative to the community COVID-19 infection rate was 2.6 (1.9-3.6) preimplementation compared with 1.5 (0.9-3.1) postimplementation. An estimated 4 gowns per patient-day were saved, totaling 440 532 gowns over 12 months. This equated to an estimated reduction in health care costs by SGD 453 748 (approximately USD 333 970) and reductions of 398 681.46 kg carbon dioxide equivalent in carbon emissions and 66 080 kg of plastic waste.
Conclusions and Relevance This quality improvement study of hospital PPE usage observed that the national PPE deescalation guidelines corresponded with the reductions in protective gown use, associated costs, carbon footprint, and plastic waste generation with no apparent compromise to staff safety and health.
