{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T16:39:18Z","timestamp":1780677558962,"version":"3.54.1"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>In September 2023, the Singapore Ministry of Health revised the national personal protective equipment (PPE) guideline for health care personnel (HCP) attending to suspected or confirmed patients with COVID-19, recommending the use of N95 respirators alone. However, data on the associations between PPE deescalation, staff COVID-19 incidence, and sustainability outcomes are limited.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the associations between PPE deescalation guidelines on staff COVID-19 incidence and the environmental sustainability outcomes of the measure.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a retrospective quality improvement study of hospital PPE usage using data from Tan Tock Seng Hospital and the National Centre for Infectious Diseases (NCID), analyzing monthly COVID-19 incidence rates among HCP (all medical staff, allied health care workers, ancillary staff, and administrative staff from the hospital campus) and in the community over 12 months before and after PPE deescalation measures (October 2021 to September 2022 and October 2022 to September 2023).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>COVID-19 incidence rates among HCP and in the community; economic and environmental outcomes of removing single-use gowns from routine COVID-19 care, including reductions in carbon footprint, plastic waste generation, and cost savings.<\/jats:p><\/jats:sec>Results<\/jats:title>The mean (SD) monthly number of HCP was 10\u202f774 (79) (range, 10\u202f636-10\u202f891) preimplementation and 11\u202f099 (200) (range, 10\u202f864-11\u202f449) postimplementation. Our analysis revealed PPE deescalation was not associated with an increase in monthly COVID-19 infections among hospital staff, with the trends aligning with population infection rates. The median (IQR) staff COVID-19 infection rate relative to the community COVID-19 infection rate was 2.6 (1.9-3.6) preimplementation compared with 1.5 (0.9-3.1) postimplementation. An estimated 4 gowns per patient-day were saved, totaling 440\u202f532 gowns over 12 months. This equated to an estimated reduction in health care costs by SGD 453\u202f748 (approximately USD 333\u202f970) and reductions of 398\u202f681.46 kg carbon dioxide equivalent in carbon emissions and 66\u202f080 kg of plastic waste.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This quality improvement study of hospital PPE usage observed that the national PPE deescalation guidelines corresponded with the reductions in protective gown use, associated costs, carbon footprint, and plastic waste generation with no apparent compromise to staff safety and health.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.5264","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T15:00:52Z","timestamp":1744729252000},"page":"e255264","source":"Crossref","is-referenced-by-count":4,"title":["Plastic Waste and COVID-19 Incidence Among Hospital Staff After Deescalation in PPE Use"],"prefix":"10.1001","volume":"8","author":[{"given":"Stephanie","family":"Sutjipto","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aung Hein","family":"Aung","sequence":"additional","affiliation":[{"name":"Department of Prevention and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret M. L.","family":"Soon","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda S. P.","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"},{"name":"Department of Infection Control, Tan Tock Seng Hospital, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"},{"name":"Yong Loo Lin School of Medicine, The National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sapna P.","family":"Sadarangani","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai Wei","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oon Tek","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"},{"name":"Yong Loo Lin School of Medicine, The National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalisvar","family":"Marimuthu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"},{"name":"Yong Loo Lin School of Medicine, The National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Yen","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Prevention and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Prevention and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Vasoo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The National Centre for Infectious Diseases, Singapore"},{"name":"Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"},{"name":"Yong Loo Lin School of Medicine, The National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"issue":"5","key":"zoi250222r7","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1017\/ice.2020.91","article-title":"Absence of contamination of personal protective equipment (PPE) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).","volume":"41","author":"Ong","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"key":"zoi250222r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.resconrec.2020.105071","article-title":"COVID-19 waste management: effective and successful measures in Wuhan, 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