UnEarth Magazine.

_{Writing by Rose Overton – Art by Nele Hubert}

For medical students at the University of St Andrews, the first clinical session of first year, even before lectures begin, is titled “patient safety”. This entails an hour dedicated to learning everything about Personal Protective Equipment (PPE): the disposable, non-sterile aprons, gloves and masks that prevent transmission of infections from patients to healthcare workers and vice versa on a daily basis. It’s something that we all became familiar with during the 2020 pandemic, but its daily use in healthcare might often be overlooked and as you move through medical school, the skills you learn in this session become automatic. Gloves on, take blood, gloves off, in the bin. Apron on, perform a urine dipstick test, apron off, in the bin. At this stage, it doesn’t matter that the blood is really just red food colouring, and the urine is just water. What matters is that students are learning how to keep themselves and their future patients safe, developing the habits that will stay with them throughout their careers. 

As a medical student, I am of course dedicated to ensuring I am working safely and effectively. On the other hand, I’m someone who takes care to methodically separate  weekly recycling, regularly takes teracycle waste to my local supermarket and avoids flying. When I think about the number of plastic aprons I have ripped from around my neck or the bright blue mountain of disposable gloves sitting in each clinical waste bin, I become quite uncomfortable. We’re a relatively small medical school, and so the issue only becomes greater when you appreciate the scale of the healthcare industry, and in particular the organisation I will one day work for, the NHS. 

In 2021, the UK Department of Health and Social Care allocated £6 billion to spend on disposable gloves contracts to cover the period to 2023 . They are typically made of nitrile, a synthetic rubber, and while specialised recycling projects exist for such products, such as the Kimtech Nitrile Glove Recycling Programme, these are not appropriate if the material is contaminated – as will be the case in most healthcare contexts. So, as the largest public sector employer, what is the NHS (both England and Scotland) doing to tackle such a clear yet complicated issue? 

Alas, it seems evident that despite medical innovation in recent decades, disposable gloves are still the most cost-effective, safe and efficient barrier that healthcare workers in the UK have against contact spread of infection. The current strategies employed to mitigate their environmental impact, therefore, focus on reducing consumption via education about appropriate use. An example of this that I’d like to highlight is the “Gloves Off” campaign, launched by NHS Grampian in September 2024. This was part of their Climate Emergency and Sustainability Strategy, which additionally estimated that the health board previously generated an annual carbon footprint of 889,190 kg CO2  from glove disposal alone. With a focus on directing practitioners to the National Infection and Prevention Control Manual to remind them of appropriate use and only using them when necessary and by working with their supply chains for the preceding year, NHS Grampian reported a reduction in glove use by 6.7% , a significant and inspirational change for minimal intervention. 

This was not without controversy, though. Unison, the largest union for UK NHS workers, warned that this move should not limit the availability of such resources for staff. While primarily cautioning against the influence of financial pressure on good practise, citing the costs saved, this attitude shows the difficulty of balancing such a fine line between environmental, safety and economic priorities. 

Of course, the Grampian initiative is not in isolation, with a similar “Gloves Off” campaign in 2023 run by University College Hospitals , and a Quality Improvement project recently launched by East London NHS Foundation Trust that aims to reduce “unnecessary glove use” on wards by 50% within a year. There is also innovation in the gloves themselves, with companies striving to produce biodegradable equivalents that require less energy to produce, while simultaneously provide the same degree of protection and durability. Whether or not this is something that can be achieved successfully on such a scale that it inspires a change in suppliers on a local or national scale remains to be seen, but it is reassuring to know that this is an issue with substantial discourse around it. 

On a personal level, it’s inspiring to see the impact that even local initiatives can have on clinical practise and the environment. It’s true that having economic justification for these actions is an added benefit to stimulating change, but education and campaigns can raise awareness of an issue that for so many people – students, healthcare staff and patients alike – is one that goes unnoticed and disregarded. Hopefully, in the years to come, change will be achieved on a more national level and I look forward to where scientific research will lead us on this issue.