PPE: ‘one size fits all’ design is a fallacy that’s putting female health staff at risk

Women in healthcare don’t get the same protection against coronavirus as male colleagues

With healthcare workers bearing the brunt of the COVID-19 crisis, it is essential everyone has the right personal protective equipment (PPE) at the right time, with the right fit.

Only with the correct fit does PPE work effectively and help keep us safe while we care for our patients.

The male-female divide on correctly fitted PPE

The problem, which we have known for some time, is that PPE is usually designed for the male shape. According to data published by the Trades Union Congress (TUC) in 2017, only three in ten women in the UK have PPE designed for the female frame.

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Not only does this put female healthcare staff at significant risk, it makes it much harder for us to do our jobs properly. For this reason, correct-fitting PPE is not just a safety concern, but an equalities issue.

Not much has changed since the TUC published its data and women continue to put up with gowns we trip over, masks that are too big, and equipment designed for male hands.

But in the current COVID crisis, the problems for women working in healthcare are literally a matter of life and death. With 77% of NHS workers being female, we are the most exposed gender, and the precise fitting of filtering facepiece particle (FFP) masks has become essential.

This has thrown a spotlight on the problem for women, and some men, when equipment is designed without thought for gender and size.

What about staff who ‘fail’ the fit test?

Everyone should now be having FFP masks properly fit-tested before use.

Of course, some employers are not even doing this first step. But it is common for female colleagues to report they have ‘failed’ the fit test – the mask is just too big – and there is no alternative.

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This puts them in the invidious position of either refusing to work in high-risk environments or putting themselves in danger. Even small masks, when available, are actually designed for small men. And unisex really does mean unisex – male.

‘There are many things about the COVID-19 crisis we can’t change. Properly fitted PPE, designed for the needs of whole workforce, is not one of them’

One female friend of mine is 5ft 2in. She trips over her gown and has to tighten her FFP mask so much that at the end of a 12-hour shift she has pressure damage to her skin. The top of the mask presses on her lower eyelids and she can barely see. But with no other mask available, and with patients desperately needing her skills, she carries on.

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Another was called urgently to the intensive care unit to see a patient, but on arriving found the FFP mask was one she had failed the fit test for – it was too big and leaked around the edges.

She had to decide whether to see the unwell patient and put herself at risk, or refuse and have to accept she hadn’t been able to help.

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Without the right fit for PPE, we are risking our lives

We don’t send our children to school in shoes that don’t fit, I don’t buy the same size work clothes as my partner, and appropriate PPE is not a matter of having pink gowns with flowers on. If PPE doesn’t fit, we are risking our lives. Surely it's not too much to ask of the makers of PPE?

The NHS must urgently source suppliers and manufacturers that provide relevant sizes for men and women that are properly tested in real life. Of course, we don’t know how many women need smaller sizes or how many are putting themselves at risk – because we don’t bother to collect disaggregated data for women.

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But we do know it was a widespread problem before the COVID-19 outbreak. We have to close the gender data gap and find out what is happening with fit-testing for women and disaggregate all COVID-19 data by gender.

There are many things about the COVID crisis we can’t or don’t know how to change. Properly fitted PPE, available to all who need it, and designed appropriately for the needs of whole workforce, is not one of them.

View our COVID-19 resource centre

Further information

• BMA PPE survey

Helen Fidler is a consultant gastroenterologist and deputy chair of the British Medical Association (BMA) UK consultants committee