Making medical textiles circular

The COVID-19 pandemic brought the problem of medical textile waste into our homes and communities; who didn’t become accustomed to seeing disposable masks littering the streets? But the underlying issue – of how to supply equipment that meets the highest clinical standards without producing mountains of waste – has been around much longer.

In the UK alone, approximately 53,000 tonnes of single use regulated medical textiles are consumed annually, costing the NHS an estimated £436 million. Despite being highly vulnerable to supply chain disruptions, disposable solutions for the medical sector continue to dominate. The spikes in demand for medical textiles witnessed during COVID-19 (when three billion pieces of PPE were used in just six months at the start of the pandemic), and the personal protective equipment (PPE) shortages and procurement controversies which ensued highlight this vulnerability.

Fortunately, there is another way. A circular economy approach to medical textiles addresses not only the environmental waste produced by single use, but also has social and economic benefits, in addition to enabling a more resilient supply.

Benefits of a circular economy for medical textiles

From an environmental perspective, the reduction in waste is a clear benefit. Using UK government procurement figures, we have calculated that with reusable medical textiles (such as masks, gowns, and drapes), 10,000 tonnes of waste could have been saved from mask reuse, recycling and repurposing alone in the first two years of the pandemic. And while reusables require laundries to wash and decontaminate the products, the carbon intensity is still lower than with disposables. With the UCL Plastic Waste Innovation Hub for the NHS, we carried out a life cycle assessment to compare a reusable mask with three scenarios, based on single-use masks from China (air or sea freight) and Turkey (sea freight). The study found that the reusable mask, which can be used 40 times as compared to the single use alternatives, generated the least environmental impact, taking into consideration CO2e equivalents, land use and energy use.

Decreased transport and lower requirements for storage of stock also have a positive impact when compared to single-use alternatives across all forms of medical textiles. And like any product produced with circularity in mind, the ability to generate local return on investment and improve resilience of supply are key social, operational, and economic benefits.

Addressing the challenges

But accessing these benefits and pivoting our current medical textiles system to reusables will not be easy. The entire system is currently set up with linear solutions in mind. This encompasses everything from centrally controlled regulation and compliance standards, to procurement, estates, and waste systems. Behaviour patterns are also crucial and bringing about a change – when healthcare professionals are under mounting and well-documented pressure – is extremely challenging.

To navigate these challenges, we need feasible and proven alternatives at every stage. Rather than seeing the provision of medical textiles as a purely outsourced function of the NHS, we need to include clinicians in the design of the products they use on a day-to-day basis. We also need to acknowledge that the logistical and infrastructure characteristics of a circular model will be completely different than those of a linear one.

Take the example of a sterile surgical gown. During the design process, we need to consider not only reuse but further down the line, repurposing and recycling. At this stage, a lot of thought needs to be given to what features can be optimised for clinical use (which may differ from a linear alternative, where such features may not be cost effective). The gown will be processed multiple times so a high level of quality control needs to be carefully designed and managed, as well as tracked over the product’s life.

While in the reuse phase, there are key on-site and off-site processing considerations, and a need for high-standard decontamination units and laundries which are capable of coping with the reusable products. The location of these facilities is obviously crucial to keeping financial and environmental costs down; representing a key challenge and opportunity for healthcare sites.

Once the gown has reached the end of its functional clinical life as a surgical gown, it can be repurposed for other healthcare settings, such as endoscopies, or as a patient gown. Finally, the gown could be repurposed as outerwear, or at the end of wearable life sent for mechanical recycling, which is becoming an increasingly effective and efficient method of reprocessing.

Working with the NHS

In October 2020, the NHS became the first national healthcare system worldwide to set a carbon net zero goal, with an aim to reach net zero in direct emissions by 2040, and then in July 2022 the first to embed this target into legislation.

This creates the conditions for a rapid and large-scale shift towards circular medical textiles. But the complexity is staggering – the NHS and its supply chain accounts for 10 per cent of UK GDP and employs £1.4 million people. Even just within the area of medical textiles, a move from linear to circular requires new ways of thinking and operating from a huge range of people in different sectors and roles. This cross-sector collaboration is key and teams will increasingly need to mix clinical, industrial, commercial, scientific, and academic expertise.

The good news is that despite this complexity, NHS trusts are enthusiastic about engaging with circular economy alternatives. Since setting up Revolution-ZERO in 2020, we have had interest from 150 NHS Trusts and have so far supplied more than 15 Trusts with reusable products and services.

The global context

The NHS provides the most significant opportunity for a circular approach to medical textiles in line with its environmental commitments. However, the market - and this alternative model  - are inherently global. We know that in many parts of the world, circularity is not a novel concept but standard practice. Rather than introducing new methods we can instead learn from these environments.

Worldwide, healthcare contributes to around four to five per cent of global emissions, and circular economy medical textile solutions have the potential to help reduce this impact. These reusable solutions also provide associated benefits for waste reduction, alongside employment and supply chain resilience. The ‘sell’ of these benefits is the easy part – now we need to tackle the challenges and barriers at each stage, breaking down the silos and bringing healthcare organisations along on the journey. Thankfully, this is already happening with the help of advances in technical textiles, production methods, digital assurance systems and state of the art tracking systems, linked to both compliance and environmental impact reporting.