Lessons learnt from the rapid implementation of reusable personal protective equipment for COVID-19 in Malawi


Fumbani Limani, David Garley, Derek Cocker, Priyanka Patel, Pratiksha Patel, Stephen Gordon, Mulinda Nyirenda, Servace Sakala, Luis A Gadama, Queen Dube, Feggie Bodole, Kwazizira Samson Mndolo, Kelvin Mponda, Bridget Freyne


The SARS-CoV-2 pandemic has challenged health systems and healthcare workers worldwide. Access to personal protective equipment (PPE) is essential to mitigate the risk of excess mortality in healthcare providers. In Malawi, the cost of PPE represents an additional drain on available resources. In the event of repeated waves of disease over several years, the development of sustainable systems of PPE is essential. We describe the development, early implementation and rapid scale up of a reusable gown service at a tertiary-level hospital in Blantyre, Malawi. Challenges included healthcare worker perceptions around the potential of reduced efficacy of cotton gowns, the need to plan for surge capacity and the need for ongoing training of laundry staff in safety and hygiene procedures. Benefits of the system included increased coverage, decreased cost and reduced waste disposal. The implementation of a reusable cotton gown service is feasible, acceptable and cost-effective in tertiary centres providing specialist COVID-19 care at the height of the pandemic. This innovation could be expanded beyond low-income settings.

Summary box

  • Components of reusable personal protective equipment (PPE) are recommended by the WHO where disposable items are not available or sustainable.

  • Programmes which implement reusable PPE need to be underpinned by reliable supply, ongoing monitoring and evaluation, and robust contingency planning.

  • Given the prospect of prolonged circulation of SARSCoV-2 in low and middle-income countries (LMICs), reusable PPE is a sustainable, environmentally friendly option which supports local business.

  • Studies are required to empirically prove the safety of reusable PPE and these findings may be generalisable beyond LMIC contexts.