This graduation project focused on reducing the environmental impact of syringes on the Intensive Care Unit (ICU) of Erasmus University Medical Centre (MC) by designing solutions based on circular economy.

The ICU of Erasmus MC produces an excessive amount of waste and initiated the transition towards a circular ICU. Syringes and their packaging are defined as an impact hotspot product at the ICU, due to the product properties, extensive use (24 per patient per day), and the fact that it is a single-use disposable product. The underlying problem of the high environmental impact of syringes is the current linear life cycle. This needs to be transformed into a more circular system by design, to limit the amount of waste and to reduce the use of natural resources.

The goal of this project was therefore to redesign the syringes, their packaging and their use, according to circular design strategies suitable for medical products, to decrease the environmental impact. The use of syringes should remain convenient and safe for the healthcare staff and patients.

Research was executed to understand the context. This consisted of literature, user and product research. Furthermore, a waste audit and a life cycle analysis were performed. It showed that decreasing the impact of syringes is not only about the product itself. Manufacturing, preparing, using and disposing of all contribute to the environmental impact of the syringe. Various possible interventions were derived from this research.
Firstly, adapting the infection prevention protocol and behaviour of the staff could lead to a decrease in unused disposed syringes.
Secondly, separating infectious waste from general hospital waste properly could result in opportunities for recycling.
Thirdly, the syringe itself can be redesigned to reduce the impact by changing the material to a sustainable alternative and redesigning the shape for (partial) reuse.
Lastly, the impact of the filling process could be reduced. It was concluded from research that prefilled sterilised syringes (PFSS) are more environmentally friendly than manually filled syringes because they are produced in large batches and, therefore, have fewer by-products per syringe. However, a life cycle analysis of the filling process of PFSS showed various impact hotspots in this filling process, such as the sterilisation phase, materials used, and left-over medication.

The final design is a process optimisation for batch-produced PFSS, based on circular strategies such as reduce, reuse, rethink and repurpose. Interventions include: eliminating the first sterilisation phase, reduce left-over medication and change from steam to gamma sterilisation. The proposed interventions have been evaluated by discussion.

In the end, the environmental impact of syringes is reduced by optimising the filling process, which resulted in decreasing the amount of waste, material, energy and water usage, while remaining safe and without increasing the workload of the staff of the ICU.

The healthcare sector uses a lot of on single use medical products, causing large amounts of CO₂ emissions and excessive amounts of waste. This project contributes to a circular Intensive Care Unit (ICU) by investigating the barriers and possible solutions for a transition from single use video laryngoscopes (VL) to (partly) reusable ones, in order to develop guidelines and best practice for the transition of other single use medical products to reusables.

To produce single-use products, raw materials are extracted, products are manufactured, used, and disposed of after using the product just one time. This is known as the linear economy or the ‘take-make-waste’ system, having a devastating effect on the environment. However, reusing medical products comes with organisational challenges. Concerns with patient safety, liability, the costs, and complexity of developing and maintaining in-house reprocessing infrastructure and logistics have left hospitals with a complex organisational challenge.

The research question for this project is: How can the ICU become more sustainable through overcoming organisational challenges hindering the implementation of reusable video laryngoscopes? With the sub-questions: 1. What are the barriers and enablers for implementing the reuse of video laryngoscopes in the ICU? 2. How can the reuse of video laryngoscopes be implemented at the Erasmus MC? 3. What could be the next step in transitioning similar products (to the video laryngoscope) from single use to reusable?
This design project was structured through three phases: Exploration, Analysis and Conceptualisation phase. Three product journeys were analysed: a single use VL, semi-reusable VL and a completely reusable VL. This project concludes, contrary to the original hypothesis, that barriers to for the implementation of reusable VL’s are minimal. The semi-reusable VL seems to require the least change from the organisation, but the fully reusable VL contributes better to the end goal of a fully circular ICU in 2030, notwithstanding its higher up-front cost.
For the implementation of the reusable VL it is essential to spark the actual implementation of the reusable VL and communicate with and facilitate stakeholders. The implementation processes need to be kickstarted through the set-up of a tender, followed by a pilot, pilot evaluation and expansion of the pilot in order to ensure proper implementation. After implementing the VL three other medical devices were identified to follow in the footsteps of the reusable VL: Laryngoscope blades, bronchoscopes, and scissors. Laryngoscope blades and bronchoscopes can be collected in the same place since the use-case of them is very similar to the VL. Scissors will require further research but follow a similar journey to and from the CSD.

This report brings value to the ICU of the Erasmus MC through identifying that the Erasmus MC has the resources and capabilities to implement the reusable VL’s, as well as presenting recommendations for the implementation process.