This design thesis explored the possibilities of recycling medical waste from the Intensive Care Unit of the Erasmus MC Hospital in the transition towards Circular ICUs. Through a combination of qualitative research methods, such as observations, interviews and waste audit, the medical context and the waste composition were explored. By selecting the most promising waste types for recycling, proposals for their collection and following parts of the waste journey were prepared.

In close collaboration with the main stakeholders and several sessions with the nurses, two directions for the final design were defined. Both solutions bring part of the waste stream upwards in the hospital waste hierarchy, ensuring better environmental scenarios in the short term. The first part of the design provides a process for separately collecting the packaging of special infusions bags used for dialysis. This process is aided by several physical and graphical tools which help the waste generating group, the nurses, to integrate the separation into their practices easily and correctly. The second part of the design promotes the correct usage of existing waste shredders through simplified rules and aided decision making.

By implementing the proposed solutions, nearly 10.000 kg of plastic waste can be derailed from incineration towards mechanical recycling, and 2000 kg of infectious waste can be saved from high intensity hazardous waste incineration. The overall environmental impact of the design is calculated to reach a reduction of 26.000 kg CO2 yearly and more importantly, poses an example to other hospitals, that recycling of their waste is a possible scenario.

Background
The healthcare sector is one of the most polluting sectors in the Netherlands. To limit the environmental impact of the medical sector, Erasmus MC collaborated with Metabolic to conduct a Material Flow Analysis (MFA) and Impact Assessment for the Intensive Care Unit (ICU). The research revealed the hotspots of the ICU, contributing to this polluting sector. Based on the hotspots The Convergence, a cooperation between the Erasmus University, Erasmus MC, and TU Delft have set up the first three design projects.
Project aim
This graduation project aimed to make a start towards greener ICUs. In the ICU care is delivered to critically ill patients. The number of gloves used is high because of the intensity of care and high standards. Due to its resource-intensive production and frequency of use, the use of nitrile disposable gloves was found as a hotspot. The question to be answered was; How could the environmental impact of gloves in the ICU be reduced, while remaining quality of care? Research
Extensive research is done with different focuses; product-centred, human-centred and material centred. Furthermore, the waste from the PICU was analysed for one week. The research revealed the importance of the procurement department and the Unit Infection Prevention.
Design direction
Together with the nursing staff, it was decided to go for the design direction of reducing the number of unused gloves. The scope was set to the current situation in the ICU and the idea should be implementable in the short term. The research resulted in five building blocks for the design that need to be incorporated; (1) infection prevention, (2) zero-risk, (3) ease of use, (4) efficiency and (5) technology.
Ideation
Ideation was done by involving people in creative sessions. Restrictions were excluded in the creative sessions, to come up with a wide range of ideas. Three ideas were chosen based on their short-term implementation possibility and incorporation of the building blocks. The ideas were presented to the Green Team of the ICU and it was decided to go on with an addition of the current box and applying a different way of dispensing gloves.
Prototyping and testing
Prototypes were made to quickly verify the functioning of the ideas. While testing the prototypes, iterations were applied. A user evaluation was performed and resulted in a preference for the vertical dispensing design.
Final design
The final design is GloVe, a vertical dispense system. By incorporating the five building blocks, the design can provide benefits for multiple stakeholders. It reduces the environmental impact of gloves in the ICU by dispensing one glove at a time. Furthermore, the gloves are dispensed at the cuff, which comes in little contact with the patient. The vertical movement is pleasant to the user. The use of colour for different sizes makes it clear to the care assistant which box should go in which holder. Also, nurses will see at a glance, which size gloves they are dispensing. The small V-shaped opening makes the undesirable behaviour, of placing gloves back, almost impossible.
Transformation towards greener ICUs The design thinking approach has yielded a design, insights, and recommendations for subsequent projects. Furthermore, the project has drawn a lot of attention to making healthcare more sustainable. The project has been a necessary start towards more sustainable ICUs.

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.