This project aims to reduce the environmental impact of the Intensive Care Unit (ICU), the department which provides constant care to critical patients. One of the most common and wasteful ICU procedures is intubation. Intubation is needed when patients cannot breathe by themselves. Can we design a circular intubation procedure as a catalyser for systemic change towards circular ICUs? This project aims to design a pilot system to initiate the transition towards circular intubations.

Research was done to understand better the current waste created by the ICU. A set of challenges derived from the research were used to ideate on different systems which could improve the ICU sustainability. It was decided to further detail a system that allows reuse of intubation devices, articulating the first pilot around a specific product, the video laryngoscope. This video laryngoscope is used to intubate patients. It is composed of various plastics and electronics and has a relatively high procurement cost. Nevertheless, it is a single-use device, disposed of and incinerated after a few minutes of use.

Ideation on a system enabling a safe and hassle-free reuse of the video laryngoscope at the ICU with a lower environmental impact was done. Two pilot systems were proposed: 

The first proposal, reduce, enables Erasmus MC to reuse the current video laryngoscope in use at the ICU. Adding a removable plastic cover to the device enables reuse of the device. By not binging the device in direct contact with the patient, fewer reprocessing steps will be required since fewer microorganisms will get in contact with the video laryngoscope. The second proposal, reuse, offers the complete reuse of a modular video laryngoscope. The main body would be, likewise the first proposal, reprocessed after not having been in contact with the patient. A hardcover would surround the product and would be redesigned to allow reuse and traceability of the number of reprocessing cycles it has gone through. Reprocessing in both proposals could be done at the ICU. Not relying on the sterilization department allows the ICU to be resilient and to increase devices availability.The use of a novel reprocessing technique, UVC radiations, is proposed. Compared to current reprocessing techniques, it consumes less water, electricity, and space. In addition, UVC reprocessing allows a high level of automation of the process, increasing its safety and reducing the hassle for ICU workers. 
Outcomes

A better understanding of the healthcare complexity and impact has been achieved. An action plan towards a pilot system is proposed, with which CO2 emissions, amount of waste and costs for the hospital would be reduced compared to the current single-use system. Future scale-up of the reuse system to other devices is envisioned, as well as replicating it into other Erasmus MC departments. Next to this pilot focusing on reuse, a set of complementary opportunities areas to introduce circularity to the ICU are summarized in a booklet.

Over the past years, electric vehicle charging company EVBox has, in collaboration with design agency VanBerlo made the first steps in becoming more circular. Within this project further steps have been explored on both strategic- and product level of EVBox’s commercial AC chargers. First, an analysis on the EV context led to the conclusion that there are many stakeholders involved that need to be included in the value retention process and that EVBox could strengthen its market position by differentiating by becoming circular rather than just sustainable. Secondly, through a method dubbed reverse logistics mapping the economic viability of implementing maintenance and repair-, remanufacturing-, recycling- and component harvesting strategies was explored. A cascading strategy where all benefits of the aforementioned strategies can be added up, was chosen as the most fruitful. Thirdly, by disassembling two chargers Disassembly Maps (De Fazio, 2018) could be made where areas of improvement were found. The EVBox Iqon was chosen as the focus product and redesigns were proposed based on the areas of improvement and priority components, namely the charger cables, side panels and kWh-meter. Through Disassembly Map-guided brainstorm sessions multiple redesign proposals were developed within the solution spaces of a redesigned installerbox that allows for the harvesting of the kWh-meter; mechanical fastening of the PMMA plates to completely liberate the side panels for reconditioning; and a modified stopper mechanism to allow easier replacement of the cables. The chosen redesign is a custom installerbox which allows for a decrease of disassembly time of 76% compared to the original design. Furthermore, this project has proven that the Disassembly Map is a suitable tool to evaluate and guide redesign sessions for EV chargers. This project resulted in a proposal for EVBox’s future approach to circular design: Standard definitions of circular jargon have to be implemented throughout the whole company to facilitate communication and avoid miscommunication on the topic. The tools used in this project, namely the Disassembly Map and Reverse Logistics Mapping can be used to guide future circular design activities. The tools can be used on other products within the portfolio or to develop the focus strategy and product further. It is preferable to take circularity into account from the earliest stages of development, as it is difficult to optimise a product for circularity that is already on the market. When optimising a product for circularity that is already on the market, it is advised to focus on optimising 1 area of the product per time. The actual implementation of circular strategies goes much further than calculations and redesigns; the structure of a company has to be adapted too. If EVBox manages to successfully implement a cascading strategy both in- and outside the company, it can become one of the sustainable frontrunners in the EVSE market. In the long term it might be worthwhile to change to a subscription model, also known as ‘charging as a service’.