Some talk of abrasions on their faces caused by having to pull masks too tight, others about having to roll up the sleeves of their fluid-repellent gowns. Some have been left barely able to see, while others have used micropore tape to seal gaps around their jawline. The thing they all have in common? They are trying to save lives – and they are women.
NHS professional bodies, experts and trade unions have warned that female healthcare workers’ lives are being put at risk because personal protective equipment is designed for men. As one frontline NHS worker put it: “PPE is designed for a 6 foot 3 inch bloke built like a rugby player.”
Dr Helen Fidler, the deputy chair of the British Medical Association (BMA) UK consultants committee, said: “Women’s lives are absolutely being put at risk because of ill-fitting PPE. We know that properly fitted PPE works, but masks are designed for a male template, with the irony being that 75% of workers in the NHS are female.”
Caroline Criado-Perez, whose book Invisible Women addresses the issue of ill-fitting PPE for women in one of its chapters, said she has been inundated with messages from healthcare workers who could not find protective equipment to fit them.
“Respiratory protective equipment is designed for a male face, and if it doesn’t fit it won’t protect,” she said. “Because of a dearth of sex disaggregated data we don’t know how many women are affected, but I am hearing on a daily basis from women in the NHS who say they can’t get their masks to fit.”
One intensive care nurse revealed that half the women on her unit had failed the fit test – a rigorous process which ensures health workers wear the right size mask, which does not leak – on both of the FFP3 masks available. “The only men I know of that have failed are either very small, or ones that refuse to shave their beards so don’t get a tight fit. Sexism is very much present here,” she said.
Another experienced critical care nurse had to be redeployed to work with less ill patients because her “head was too small for the mask to create the right seal around her mouth”. Collecting sex disaggregated data on the result of fit tests was vital to addressing the problem, Criado-Perez said.
Asked about the lack of PPE for women, the minister for women and equalities, Liz Truss, said “people need the same level of protection”, which Criado-Perez argues is currently impossible.
“People are dying and we should all be furious about that, it is an international scandal,” she said.
Knowledge of the lack of properly fitting PPE for women is not new. A 2016 survey conducted by the trade union Prospect, the TUC, and others found that just 29% of female respondents were using PPE designed for women, and 57% said their PPE hampered their work.
Frances O’Grady, general secretary of the Trades Union Congress (TUC), said frontline workers were being forced to risk their lives because they lacked proper PPE. “With women making up nearly eight in 10 of the NHS workforce, it’s a disgrace we don’t have protective uniforms in women’s sizes. Our workers deserve better,” she said.
Female nurses were routinely expected to work without adequate PPE or to use PPE that had not been produced to meet the required safety standards, said Rose Gallagher, the professional lead for infection prevention and control at the Royal College of Nursing.
“Nurses can find it very difficult to deliver care to patients if this equipment is so uncomfortable it bruises the skin and makes them feel hot and unwell,” she said.
Fiddler, also a consultant gastroenterologist at Lewisham and Greenwich NHS trust, said one colleague in intensive care had developed ulcers on her face after pulling a mask as tight as possible to protect herself. However, she said, there was still an unwillingness among female health workers to complain.
“It is seen as somehow just something you have to put up with, but is really not acceptable,” she said. “It shouldn’t have taken a global pandemic for people to realise that women are a different shape than men. The government has a moral, legal and ethical responsibility to sort this out, and quickly.”