Towards Circular ICUs

Abstract

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.