Conservation Practices for Personal Protective Equipment: A Systematic Review with Focus on Lower-Income Countries

Cassandra L. Thiel, Pallavi Sreedhar, Genevieve S. Silva, Hannah C. Greene, Meenakshi Seetharaman, Meghan Durr, Timothy Roberts, Rajesh Vedanthan, Paul H. Lee, Gizely Andrade, Omar El-Shahawy, Sarah E. Hochman

Research output: Contribution to journalReview articlepeer-review


During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.

Original languageEnglish (US)
Article number2575
JournalInternational journal of environmental research and public health
Issue number3
StatePublished - Feb 2023


  • PPE
  • conservation
  • efficiency
  • resilience
  • sustainability
  • waste

ASJC Scopus subject areas

  • Pollution
  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis


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