Towards a Circular ICU: How to implement reusable video laryngoscopes at the ICU

Abstract

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.