What is needed to move away from "One Size Fits All" in Personal Protective Equipment?

Women in Health and PPE: Does one size fit all? 

Female workers make up 70% of the global health workforce and 90% of nurses, but historically, Personal Protective Equipment (PPE) has generally been designed around the size and shape of an average European or U.S. man’s face and body.  If PPE does not adequately fit, it cannot protect the primary workforce at the front lines of the COVID-19 pandemic.  

We were pleased to co-host a webinar on November 23, together with Women in Global Health (WGH) under the IFC's Women's Leadership in Private Healthcare Global Working Group initiative, to explore the specific challenges women face and what can be done for PPE to protect all healthcare workers, regardless of body type and size. (You can watch the webinar here).  

 Among those who joined were @DuPont – a globally leading manufacturer of protective gear, @Global Fund, which procures PPE on behalf of governments around the world, and @ASTM International, an organization that sets technical standards on quality and safety for a wide range of products, including PPE. We invited health professionals from #Africa and #India to share their personal experiences. According to Valarie Dkhar, a nurse at Nehru Memorial State Dispensary: "PPE often comes in a unisex design. Even small sizes are too big for women. It makes us very uncomfortable and it is not safe." 

A few things stood out from the conversation:

First, COVID-19 and the media coverage on healthcare workers has brought greater global awareness of the issue. WGH's latest report, #FitForWomen: Improving Personal Protective Equipment (PPE) for women health & care workers, surveyed more than 1,000 health care workers and points to the increased health risks, including mental distress for female healthcare workers: only 25% of women reported having an adequate supply of PPE all the time. The University of Bath (UK), which surveyed 250 healthcare workers in the UK on PPE fit during COVID-19, found that women are less likely than men to feel safe carrying out their roles, with only 30.5% of women and 53.3% of men stating that they felt safe all of the time.

Second: manufacturers recognize the critical need to provide more sizes – but the demand for a broad range of sizes, in particular during COVID-19, was limited. "We are proposing more sizes and additional design, but they don't get purchased. The buyer tries to minimize the number of selling units and maximize the stock of the three most common sizes (L, XL and XXL). […] Order forecasting would help so we can produce to meet the demand in time," says Valerie Pierret, Global Business Developer Protective Apparel at DuPont.  

Third: the main challenge is inadequate communication between those procuring PPE – governments, medical distributors, and healthcare providers - and the healthcare workers themselves. "Take medical gloves for example: 95% of demand we received from countries was for size M, with only 2% for S, and another 3% for L and XL,” according to Roger Li, Head of Strategic Sourcing at The Global Fund.

To respond more effectively to the demand on the ground, procurement of PPE should consider the feedback from end-users, along with quality, standards and cost considerations.

The good news is that things are starting to change. ASTM International, a global technical standards organization, recently launched a Global Collaboration Forum bringing together experts from around the world to discuss new standards for PPE, including how PPE should fit different body types. Interested stakeholders are invited to join this effort.

ASTM is actively inviting diverse voices, including women, on their Technical Standards Committees so standards can better reflect specific needs. "A lot of the work is a revision of existing standards that will focus on the requirements of fit and size. […] We hope this work can be completed in the next 6 months, as long as there is consensus," says Dan Smith, Vice President of Technical Committee Operations at ASTM International.

Our main take away? More is urgently needed to move away from “One Size Fits All” in PPE. The webinar has put a spotlight on the issue and brought a variety of groups together in the ongoing discussions. New standards are already work in progress. Enabling stronger feedback between end-users and those responsible for purchasing PPE should now be the critical focus area to make the supply chain work better.