{"id":49742,"date":"2021-03-09T14:32:34","date_gmt":"2021-03-09T13:32:34","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49742"},"modified":"2021-03-17T18:02:17","modified_gmt":"2021-03-17T17:02:17","slug":"personal-protective-equipment-is-sexist","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/09\/personal-protective-equipment-is-sexist\/","title":{"rendered":"Personal protective equipment is sexist"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Covid-19 has highlighted concerns around shortages of personal protective equipment, but a simple fact remains largely ignored; in our healthcare system, where 77% of staff are women, PPE does not protect female staff as well as their males colleagues.\u00a0<\/span><\/p>\n<p><b>PPE isn\u2019t a good fit for females\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400\">Female healthcare workers (HCWs) report that goggles slip, gowns are too long, face shields push against breasts, and respirators don\u2019t fit their faces. Those that fail fit tests may be forced to choose between wearing shared powered respirators (often in short supply and <a href=\"https:\/\/www.ajicjournal.org\/article\/S0196-6553(21)00061-4\/fulltext#%20\">inadequately cleaned<\/a>), or wearing ill-fitting items through an obligation to put the needs of patients\u2019 above their own right to safe PPE. Many female HCWs accept this as the norm, unaware that they fail fit tests because PPE is designed primarily for Caucasian men. Shape and size determine whether a person fits PPE, and therefore PPE may be less likely to fit HCWs of some ethnicities.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Women have reported problems with PPE in many industries including science, manufacturing, policing, <a href=\"https:\/\/carolinecriadoperez.com\/book\/invisible-women\/\">and the military<\/a>. Women are not small men. One-size-fits-all equipment designed on male body templates ignores the impact of biological features such as facial geometry and breasts. <a href=\"https:\/\/www.theguardian.com\/world\/2020\/apr\/24\/sexism-on-the-covid-19-frontline-ppe-is-made-for-a-6ft-3in-rugby-player\">The media<\/a> has presented anecdotal evidence regarding the inadequacy of PPE for females HCWs, supporting previously expressed views of <a href=\"https:\/\/www.tuc.org.uk\/sites\/default\/files\/PPEandwomenguidance.pdf\">trade unions<\/a> that, surprisingly, have remained quiet on this problem although it impacts the UK\u2019s biggest employer on a national scale.\u00a0<\/span><\/p>\n<p><b>Disaggregated data is crucial<\/b><\/p>\n<p><span style=\"font-weight: 400\"><a href=\"https:\/\/bjanaesthesia.org\/article\/S0007-0912(20)30851-5\/fulltext#%20\">Data analysis at our own institution<\/a> has provided empirical evidence that, although males HCWs also fail fit tests, female staff fail respirator fit tests significantly more often. Analysis was not easy as gender or sex weren\u2019t recorded. Nationally, disaggregated data is not collected during fit testing.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Disaggregated data on covid mortality shows that <a href=\"https:\/\/doi.org\/10.1111\/anae.15116\">men, and people from ethnic minority backgrounds<\/a>, are at higher risk, but data is emerging to suggest that <a href=\"https:\/\/doi.org\/10.1111\/anae.15116\">younger female UK HCWs<\/a> are more likely to die from covid-19 versus age-matched non-HCW contemporaries in the general public. Female staff that intubate the tracheas of patients may also be more likely to contract <a href=\"https:\/\/doi.org\/10.1111\/anae.15170\">covid-19 than males that intubate<\/a>. At the same time, there is increasing evidence supporting the spread of SARS-CoV-2 by aerosols generated by speaking and coughing.\u00a0\u00a0\u00a0<\/span><\/p>\n<p><b>An issue ignored<\/b><\/p>\n<p><span style=\"font-weight: 400\">Although <a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/910885\/COVID-19_Infection_prevention_and_control_guidance_FINAL_PDF_20082020.pdf\">Public Health England acknowledges<\/a> the role of fit testing in its national guidance, it seems to be unaware of the impact of sex on PPE. Guidance from advisory bodies such as the <a href=\"https:\/\/www.rcplondon.ac.uk\/projects\/outputs\/ppe-and-improving-safety\">Royal College of Physicians<\/a><\/span><span style=\"font-weight: 400\">, <\/span><span style=\"font-weight: 400\">the Intensive Care Society, and <a href=\"https:\/\/static1.squarespace.com\/static\/5e6613a1dc75b87df82b78e1\/t\/5f255aabbf557e3744b304d6\/1596283565617\/COVID-19+pandemic+personal+protective+equipment+%28PPE%29+Guidance+for+intensive+care+-1_8_20.pdf\">Faculty of Intensive Care Medicine<\/a> don\u2019t mention the impact of sex, and also fail to include the essential role of fit testing respirator masks to ensure staff safety. <\/span><span style=\"font-weight: 400\">We encourage medical institutions to urgently acknowledge these issues, thereby fulfilling their duty of care to protect both staff and patients.<\/span><\/p>\n<p><b>Change is needed<\/b><\/p>\n<p><span style=\"font-weight: 400\">Internationally, the type of respirators available for supply are designed and manufactured as a single, mainly \u201cmale\u201d sized mask. Manufacturers acknowledge that a range of different models of respirators should be available whilst fit-testing staff to match different face shapes and sizes, increasing the chance of a safe fit. Nevertheless, disposable respirators remain single size.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In the UK, hospitals do not have the ability to procure respirators and PPE for themselves, and have to work with what they are sent. Most institutions tend to have one or two models of respirator and are sent new models every few months as stock levels change. Cross border shortages of PPE remain, and supply lines are fragile. It is likely that the UK\u2019s exit from the European Union will have a negative impact.<\/span><\/p>\n<p><b>Solutions<\/b><\/p>\n<p><span style=\"font-weight: 400\">Action is urgently required to address this sex discrimination. Change is possible if it is committed to. <a href=\"https:\/\/toolkit.wisecampaign.org.uk\/apprenticeship-toolkit\/support\/personal-protective-equipment-for-women\">Transport for London<\/a> identified that ill-fitting PPE risked the safety of female employees, and amended ordering patterns to source equipment specially designed to fit females that fulfilled their safety specifications.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Acknowledgement from government bodies and regulators will influence manufacturers. Covid-19 has driven innovation at a speed we never thought was possible. Traditional industrial processes have been bypassed to design bespoke respirators and PPE through adaptive engineering. Innovative 3D printed personalised respirators from facial scans are already in development, driven by the need for safe respirators for <a href=\"https:\/\/www.bbc.co.uk\/news\/uk-wales-55060985\">female staff<\/a>. This <a href=\"https:\/\/www.nao.org.uk\/report\/supplying-the-nhs-and-adult-social-care-sector-with-personal-protective-equipment-ppe\/\">approach will cost<\/a>, but the government has already demonstrated willingness to pay large sums of money for <a href=\"https:\/\/www.bbc.co.uk\/news\/uk-54974373\">inadequate PPE at the taxpayers\u2019 expense<\/a>.<\/span><\/p>\n<p><b>Let\u2019s get our priorities right<\/b><\/p>\n<p><span style=\"font-weight: 400\">The health and wellbeing of healthcare workers must be our priority. As a society, industry, and profession, we need to decide what is acceptable. Are we happy to ignore a major health and safety issue that discriminates against female colleagues, putting 77% of the workforce at risk?\u00a0<\/span><\/p>\n<p><b><i>Abhijoy Chakladar <\/i><\/b><i><span style=\"font-weight: 400\">is a consultant anaesthetist at Brighton &amp; Sussex University Hospitals NHS Trust. <a href=\"https:\/\/twitter.com\/chakladar_a?lang=en\">@Chakladar_A<\/a><\/span><\/i><\/p>\n<p><b><i>Anna Ascott<\/i><\/b><i><span style=\"font-weight: 400\"> is an internal medicine trainee at Brighton &amp; Sussex University Hospitals NHS Trust<\/span><\/i><span style=\"font-weight: 400\">. <\/span><a href=\"https:\/\/twitter.com\/anna_ascott_\"><i><span style=\"font-weight: 400\">@Anna_Ascott_<\/span><\/i><\/a><\/p>\n<p><b><i>Competing interests<\/i><\/b><i><span style=\"font-weight: 400\">: None declared<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Covid-19 has highlighted concerns around shortages of personal protective equipment, but a simple fact remains largely ignored; in our healthcare system, where 77% of staff are women, PPE does not [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/03\/09\/personal-protective-equipment-is-sexist\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":48134,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-49742","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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