Decentralized Reuse-system for healthcare. Towards a more mindful use of material resources in the healthcare industry.
Climate change poses a significant crisis for healthcare. It drives an increase in chronic and infectious diseases due to declining air quality and extreme temperature shifts, placing immense pressure on health services. Paradoxically, current healthcare, while saving lives, heavily relies on energy and material resources, contributing to environmental harm, and further worsening the climate crisis.
The transition to a mindful health system holds the potential to realize this vision by reimagining waste management, ensuring prolonged product, and more mindful relations with prevention and cleaning standards.
How can Erasmus Medical Center (EMC) initiate its path toward circularity, especially in the face of its daunting annual waste generation of 50,000 kg?
I collected insights with a specific focus on the Intensive Care Unit (not only intensive in its name but also in its use of materials due to strict cross-contamination regulations), with a specific focus on one of the most regular and material-intensive operations they realize, intubation. I collected insights into the complex factors entrenching unsustainable practices in healthcare institutions and, secondly, proposed two decentralized reuse pilots.
Reflection
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Sustainability and individual patient safety values create tensions within current hospital structures, as the liability of hospitals leds them to reduce to its maximum the potential of cross-contamination, making reuse or mindful use of diposable a almost imposible mission.
Individual patient safety-centered design limits the radical changes needed to make healthcare sustainable.This is paramount to mitigate far larger health risks associated with climate change.
Current hospital risk management focuses exclusively on individual patient safety, leading to an excessive avoidance of specific risks, at the wider expense of unsustainable practices. As such, to catalyze systemic change in health care, a reframing of risk management is needed.
Reuse results in decreased environmental impact, but may slightly increase infection risks. Even if the infection risk is low and compliant to regulation, tensions arise that can be leading us to the core of health wastefulness.
Changes in our healthcare consumption as a society are required. Circular healthcare would provide higher value even if the patients individually might be exposed to slighly increased infection risk.
Furthermore, with sustainability acting on spatio-temporal scales that are not directly apparent, it becomes challenging to make decisions now that may have directly visible drawbacks (increased risk), while only offering invisible future benefits (mitgated climate change). Healthcare cannot be free of risks, and a better understanding of the value of sustainable health by organizations and society would allow for innovations toward a circular future.
Results
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A set of challenges were synthesized from the research and used to ideate on different system directions which could improve sustainability at the ICU. It was decided to detail further a system allowing the reuse of devices. This system was articulated around a specific product, the video laryngoscope. This device 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. Reusing devices in the healthcare environment, also called reprocessing, does not come without challenges. It requires different steps depending on the criticality of the product, meaning the product’s level of contact with the patient. According to regulations, different reprocessing techniques can be used depending on the product criticality.
Each additional reprocessing step implies additional environmental impact. The ecological implications also vastly differ depending on the technology used.
Ideation on a system enabling safe and hassle-free reuse of the video laryngoscope at the ICU with a lower environmental impact was done. The pilot considered three levels: product, reprocessing and procedures.
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 removeable polyethylene plastic cover to the device enables reuse of the device. By not bringing the device in direct contact with the patient, fewer reprocessing steps are required.
The second proposal, reuse, offers the complete reuse of a modular video laryngoscope. Similar to the first proposal, the main body would be reprocessed without having been in contact with the patient. A redesigned polycarbonate hardcover would surround the product and allow reuse, as well as 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 device availability. The use of a novel reprocessing technique, UV-C radiations, is also proposed. Compared to current reprocessing techniques, it consumes less water, electricity, and space.
In addition, UV-C reprocessing allows a high level of automation of the process, increasing its safety and reducing the hassle for ICU workers.
Methodology
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A participatory design approach was used for the research part of this project. Through observations of the doctors and nurses in their work environment, a set of overviews were put together collaboratively of the products used.
The project emailed to understand the systemic reasons behind the use of disposables. Interviews were organized with people from different backgrounds within the organization (for instance, procurement) as well as healthcare experts from within the industry.
Visualization was also a core part of this project, used to synthesize the current system and user journeys as well as depict how the speculative pilot could look.
