Climate change and resource scarcity are putting increasing pressure on healthcare systems, making it essential to reduce the sector’s environmental impact. In Dutch hospitals, particularly Intensive Care Units (ICUs), large volumes of unused but contaminated medical consumables are routinely disposed of as a precaution against the transmission of infections. This linear, single-use approach generates significant waste and emissions, challenging long-term sustainability goals. This thesis investigates whether ultraviolet germicidal irradiation (UVGI), specifically using UV-C radiation, can serve as a sustainable alternative to the disposal of unused medical consumables in the ICU of the Leiden University Medical Centre. The research assesses both the applicability and sustainability of UV-C disinfection. Applicability was evaluated through an inventory analysis of ICU bedside carts and a workflow analysis comparing current practices with the implementation of UV-C disinfection. The sustainability was assessed using a Life Cycle Assessment (LCA) to compare the environmental impacts between UV-C disinfection and disposal.
A bedside cart inventory contains medical consumables of which approximately 75% are considered manufacturer-proven or literature-supported suitable for UV-C disinfection with a value of €323. The operational disinfection costs are €23 per bedside cart. Assuming 30-50% inventory levels combined with the patient data of 2023 and 2024 (22 and 33 bedside carts), the total avoided costs are estimated to be between €680-2,000 and €1,670-3,650 respectively, including capital expenditure. The disinfection time of a bedside cart including preparatory steps is estimated to be 65 minutes but may be shortened by, for instance, colour-coding the bedside cart compartments. No previous LCA study on UV-C disinfection of medical consumables had been conducted. The results indicate that UV-C disinfection as an infection prevention method has fewer environmental impacts compared to disposal. Across all assessed impact categories, including climate change, water use, and material use, reductions of 46% to 50% were observed.
Integrating UVGI within hospital settings can reduce environmental burdens and support circularity in healthcare supply chains. UV-C disinfection of medical consumables is best suited for hospitals with large ICU departments, as smaller ICU departments may not generate enough contaminated medical consumables to justify the investments, making financial factors critical to its feasibility. This study contributes to ongoing efforts within the Dutch Green Deal for Sustainable Healthcare and provides actionable insights for hospitals, UV-C device manufacturers, medical consumable manufacturers, and policymakers seeking to improve environmental performance in clinical settings.

The healthcare sector contributes significantly to global emissions, accounting for more than 4% worldwide and up to 10% in some high-income countries. Hemodialysis (HD), a life-sustaining treatment for kidney failure, is among the most resource-intensive therapies due to its heavy use of energy, water, and single-use materials. In high-income countries, aging populations are increasing the prevalence of kidney disease, while in low-income settings, limited access to transplants often makes HD the only treatment. Reducing its environmental burden is therefore a global priority.
This thesis focuses on dialysate, the largest consumable in HD. The research begins by investigating current practices at UMC Utrecht and then evaluates two alternative technologies: (1) central delivery for concentrates and (2) forward osmosis (FO) for dialysate preparation.
The current system requires 41 tons of concentrates, 2.2 million liters of water, and 17 MWh of energy annually to treat 30 patients. Major environmental impacts arise from transport, packaging waste, and unused concentrate residues. In the water purification process, only about half of the input water becomes dialysate; the rest discharged as waste. Most of the energy is consumed by reverse osmosis (RO) pumps, which run continuously, even outside treatment hours. These inefficiencies result in 35 tons of CO₂-Eq emissions and €24,290 in annual environmental costs.
By transitioning to central concentrate delivery, UMC Utrecht reduced transport weight by 75%, plastic use by 95%, and acid concentrate-related emissions by 58%. Emissions were lowered by delivering dry powder instead of liquid and reusing packaging containers. The model performed well even over long distances, showing potential for global application.
FO, tested as an alternative to RO, achieved 90% water recovery and used only 4% of the energy. As a passive process, FO consumes far less energy than RO and shows strong promise for remote or resource-limited healthcare settings.
A future scenario combining both technologies was modeled, showing that carbon emissions could be cut to one-third of current levels and annual environmental costs halved to a €11,490. These outcomes align with Green Deal goals and highlight how circular strategies can reduce the environmental footprint of dialysis.
Importantly, many opportunities for improvement already exist without major technological investment. Hospitals are encouraged to reassess resource use. As seen at UMC Utrecht, turning off RO pumps outside treatment hours could already make a meaningful difference.
UMC Utrecht, as a leading academic hospital, is well positioned to drive this transition. Its example can inspire other institutions across Europe and globally. As demand for dialysis continues to grow, healthcare systems must rethink how essential treatments like HD are delivered. This thesis presents a clear, evidence-based approach to reduce environmental impact, increases resilience, and supports equitable access to treatment worldwide.

In low-resource settings such as refugee camps, inadequate sanitation and poor hygiene contribute to the spread of infectious diseases. Without improved sanitation, hygiene education, and clean water access, these preventable diseases will continue to threaten public health in these areas.
The SaniSecure project was developed to address critical sanitation challenges in the Imvepi refugee settlement, where unlined pit latrines contribute to groundwater contamination, disease transmission, and environmental degradation.
The research for this project was conducted using a human-centered approach, incorporating field visits, in-depth interviews, and direct engagement with settlement inhabitants, latrine emptying groups, and sanitation experts. Through which, key challenges were identified. Most latrines were poorly maintained, often structurally compromised due to flooding and material degradation. The lack of handwashing facilities and cleaning agents further increased disease risks. Additionally, latrines were not designed for elderly or disabled individuals, creating barriers to safe and dignified sanitation. These challenges, however, presented opportunities for a new Product-Service System (PSS) that integrates a safe toilet design with an effective emptying service.
By proposing the SaniSecure System, multiple levels of complexity were tackled on product, system, & human interaction, while taking into account environmental, financial, cultural and human factors, such as renewable cooking fuel, a self-sustaining business model, and inhabitant latrine habits.
The SaniSecure Toilet was developed to directly address these issues. It features a sealed sludge container that prevents groundwater contamination, a robust and flood-resistant structure, and an inclusive design that accommodates users with mobility challenges. The introduction of the toilet resolves multiple health and environmental problems by ensuring safe containment and hygiene maintenance, while also improving user experience through better privacy, cleanliness, and security.
The SaniSecure Service complements the toilet by providing scheduled emptying, maintenance, and user education. This service, run by a trained Service Group, utilizes the Pupu Pump and motorized tricycles to ensure hygienic and efficient sludge transport. Beyond emptying, the Service Group plays a key role in educating users about WASH practices and providing access to cleaning supplies. The integration of this service ensures the long-term functionality and sustainability of the sanitation system.

To validate the SaniSecure System’s impact, a phased implementation strategy has been designed. A pilot test involving 40 toilets will be conducted, allowing for real-world evaluation of system effectiveness. The testing phase will gather data on user behavior, sludge quality, and system efficiency to refine the design before full-scale deployment. Financial sustainability is achieved through a dual revenue model: biogas sales from treated sludge and fees for public latrine emptying.

In conclusion, the SaniSecure project presents a scalable, community-driven solution that addresses sanitation challenges through an integrated design approach. By combining improved toilet infrastructure with a reliable service, the system enhances public health, environmental protection, and economic resilience within the Imvepi settlement. The pilot phase will serve as a foundation for future expansion, demonstrating the viability of the SaniSecure model in low-resource settings.

Project Overview
The healthcare industry is responsible for 6-7% of the Netherlands' national carbon footprint, with Intensive Care Units (ICUs) having three times the environmental impact of general hospital care. At Erasmus Medical Center (EMC), each ICU patient generates 17kg of waste daily, translating to 12kg CO2-equivalent emissions. This project addresses the challenge of reducing the ICU's environmental footprint through a data-driven approach to meet EMC's sustainability targets of 55% CO2 reduction and a 100% circular ICU by 2030.

Problem
The Erasmus MC ICU needs to reduce its environmental footprint but lacks the data insights to effectively measure, monitor, and improve its impact. Current sustainability data is fragmented across departments, making it difficult for the ICU Green Team to execute their established workflow of identifying hotspots, setting goals, and implementing interventions.

By bridging the gap between environmental data and clinical practice, GERDA demonstrates how data-driven approaches can effectively support sustainability progress in healthcare settings while respecting clinical priorities.

This project, Women in Transit: Considerations for Kitchen Design for Formal Settlements in Bangladesh, explores the challenges and key factors in designing kitchens for women in informal settlements. The focus is on women who have migrated from rural to urban areas, driven by rapid urbanization due to climate change and economic factors. As a result of this, informal settlements are increasing in Bangladesh.

The goal of this project is to enhance awareness among NGOs regarding key factors that need to be considered when designing homes for women who are currently residing in urban informal settlements. The central focus is food preparation and cooking, which play a vital role in the daily lives of these women.

Therefore, through interviews, field research, and a literature review, the report explores the cultural, social, economic, and practical aspects of kitchen design. It examines how women in rural areas often cook on open fires in private spaces, and how this changes when they move to urban areas, where kitchens are usually shared and gas stoves are used. The shift from rural to urban living brings both challenges and opportunities as women adapt to new cooking methods, environments, and social settings.

Furthermore, based on this research, design guidelines have been developed to help NGOs understand the needs of women transitioning from informal to formal housing more effectively. These guidelines focus on creating kitchens that support women’s social connections, maintain their cooking traditions, and address practical needs.

The final result of this project is a booklet that tells the story of Sadia, a woman who moves from a rural area to an urban informal settlement and eventually to formal housing. Sadia’s journey highlights the challenges women face in cooking, adjusting to new social dynamics, and adapting to new living conditions, as well as the opportunities that open up for her.

The aim of the booklet is to help NGOs thoroughly understand and empathize with women like Sadia when designing formal housing. The booklet provides design ideas for kitchens that are culturally appropriate and support women in their roles of cooking and caregiving. This is achieved by offering design options for both low- and high-density housing, as well as different living environments that can influence how women cook and manage their daily tasks.

The healthcare sector, while dedicated to promoting human well-being, is also a major contributor to declining environmental conditions, paradoxically adversely affecting health through resource-intensive and waste-generating practices. Laparoscopic surgeries using single-use insufflation devices, or disposables, exemplify the tension between healthcare delivery and sustainability. This graduation project addresses these challenges by exploring and proposing circular strategies to mitigate the environmental impacts of disposables inside a insufflation system through strategic design.

The research follows the Double Diamond Design Framework, beginning with an in-depth context analysis of the environmental impacts of an average laparoscopic patient journey and an extensive literature review on circular economy principles. Empirical studies, incorporating semi-structured interviews with relevant stakeholders, provide insight from the hospital perspective. Intermediate findings are combined into a design scope, guiding subsequent work. Environmental hotspots are identified by combining a self-executed fast-track life cycle analysis with insights from existing studies. Finally, conceptual circular interventions are developed to address identified hotspots and improve the environmental sustainability of the insufflation system.

This results in a strategic sustainability plan designed to help the client, a medical start-up, integrate sustainability and create a truly “future-proof” insufflation system. This plan includes company level strategies offering recommendations for actionable steps, commitments, and documentation, potentially leading to a competitive advantage in hospital procurement processes and product level circular strategies. These include redesigning devices to reduce material use, introducing reusable or hybrid devices, and exploring recycling opportunities. Applying strategic design thinking, the proposed strategies balance sustainability ambitions and both the complexity and practical constraints of healthcare systems and medical start-ups, offering a roadmap for implementing more circular and sustainable medical practices.

In conclusion, this project demonstrates the potential for applying circular strategies to complex healthcare settings. By integrating circular economy principles, it exemplifies how sustainable healthcare practices can reduce CO₂ emissions and waste from single-use devices. Ultimately, this thesis underscores the growing need for healthcare to adopt circularity, enabling it to continue improving human well-being while respecting the planet.

The large environmental impact (EI) of healthcare is of growing concern, especially given the increasing negative health effects of environmental deterioration.1,2 Paediatric intensive care units (PICU) are major contributors to this EI, partly due to the use of consumables and electricity.3–5 Environmental hotspots in clinical pathways (CP) must be identified to guide practical and effective interventions to lower the EI.5,6 Life cycle assessment (LCA) is currently the golden standard for EI assessment. However, LCA is time-consuming and highly complex. Thus, execution of LCAs on a large scale to analyse full CPs is not feasible in healthcare settings. Furthermore, the required data are often not available. Financial costs may be used as a proxy (spend-based LCA), but their representativeness is questionable.6,7 Furthermore, the CPs of patients in the PICU differ highly and cannot be represented by a single standard CP. Therefore, this research aimed to develop a process-based framework for environmental hotspot identification that requires less time and expertise compared to LCA and accounts for differences between patients, using a case study of six PICU post-cardiac surgery patients. Modules were designed as building blocks to represent medical events in the CP with the flexibility to deal with interpatient variation. Associated consumable and electricity use were allocated to each module based on medical protocols and discussions with clinical staff. From this iterative process, a set of allocation rules was established. The material composition of each product was analysed and recorded in a database. Per module, the median frequency of occurrence was calculated in the patient cohort data. The carbon emissions (kg CO2-equivalent) associated with each module per occurrence were calculated based on impact factors from an open-source database.8 The total of each module was defined as the EI per module occurrence (in kg material and in kg CO2-equivalent) multiplied by the median module frequency. This research was a first step towards an accurate and flexible approach to environmental hotspot identification within CPs related to consumable weight and bedside electricity consumption. The modules and the data analysis algorithm can be reused and expanded for other CPs, saving time and effort in future analyses. The allocation rules ensure standardised allocation of consumables and electricity across the current modules and when new modules are added. Challenges in this approach lie in the availability of product information from manufacturers and reliable, open-source impact factors, especially for pharmaceuticals.

background: To decrease health care’s emissions, the reacquiring of rare earth metals from a complex single use medical device was researched. For a complex single use device (SUD), a cardiac catheter was used, which has electrodes in its tip made of platinum, iridium and palladium. methods: A patent study was done to gain insight into the design and assembly of the catheters, which resulted in the identification of the plastics present. Depending on the electrode type, polyether etherketone (PEEK) or polyamide 12 (PA12) were dominant plastics surrounding the electrode. 5 concepts were developed, all involving a chemical or thermal treatment, which were assessed on their ability to structurally remove these plastics. The treatments used were: nitric acid treatment, sulphuric acid treatment, pyrolysis treatment, toluene treatment and phenol treatment. Treatment removal ability and the purity of the acquired electrodes, were assessed through the use of mass fractions and SEM analyses. Practical aspects, which will be relevant for scale up, such as risk indications, waste created and costs were briefly assessed as well. results: The only treatment that was able to structurally remove all plastics without compromising electrode’s purity, was the sulphuric acid treatment. It is in line with literature that sulphuric acid is the only agent able to structurally remove PEEK at room temperature. Pyrolysis could remove the plastics, but the electrodes were charred. Nitric acid and phenol could only dissolve PA12 but left PEEK structurally present, whereas toluene left all plastics structurally present. conclusion: Reacquiring the electrodes chemically is possible through the use of sulphuric acid. If the spent sulphuric acid can be regenerated, this would be a great benefit since no constant replenishment of acid is required. Pyrolysis could also be investigated further, but a separate cleaning step would be required.

The healthcare sector in the Netherlands is responsible for about 7% of the CO2 emissions. The Erasmus Medical Center (EMC) has committed to enhancing its environmental sustainability efforts by signing the Green Deal 3.0. This agreement sets ambitious targets for the EMC, including a 55% reduction in CO2 emissions by 2030 compared to the 2018 Green Deal Samen Werken Aan Duurzame Zorg (Green Deal 3.0) | Greendeals, n.d.). These targets are ambitious and call for immediate action.
The endoscopy department is found as the third highest largest contributor to hospital waste (Siau et al., 2021). This highlights the importance of improving the sustainability of the endoscopy department to meet the set targets.

This project set three main goals:
1. Creating an overview of all the consumables within the workflow of HCPs used in colonoscopy procedures at the Erasmus Medical Center.
2. Identifying and addressing the environmental impact hotspots of colonoscopy procedures.
3. Enhancing the sustainability of the reusable colonoscope with a redesign.

To achieve the first goal, the Product Journey Map method is used. Data on waste streams and the human interactions during the use of the colonoscope are gathered through observations and interviews conducted at the endoscopy department at the EMC.

After visualizing the Product Journey of the colonoscope in the EMC, it was easier to identify the environmental impact hotspots. The Value Hill model with the R-strategies was used to design sustainable interventions, to reduce the environmental impact of the hotspots. The identification of the environmental impact hotspots and the design of sustainable interventions are also carried out in a co-creation session with HCPs. Mapping out the colonoscopy procedure in a visual, including waste streams and human interactions, accelerated the ideation process with HCPs.

Furthermore, the focus of this project was on redesigning the colonoscope to enhance its sustainability. To achieve this, the literature was first explored to compare single-use with reusable colonoscopes. It became clear that implementing single-use colonoscopes would result in a 40% increase in net waste mass compared to reusable colonoscopes (Baddeley et al., 2022). However, one of the advantages of single-use colonoscopes was that they were easy to use. This was as an inspiration for the redesign of the reusable colonoscope which detects maintenance on time and prevents the damage that can occur during the use of it.

Finally, all the designed sustainable interventions and the redesign of the colonoscope are compiled into a revised Product Journey map. This revised PJM compares the new ideas with the practices, illustrating how the environmental impact of colonoscopy procedures can be reduced.

Cervical cancer poses a huge challenge to global health (Sung et al., 2021). To provide access to cervical-cancer care to women in Low Resource Settings (LRS), the startup GIC Space is developing the C-Spec and GICMED application. With these innovations the company aims to offer remote Cervical Cancer Screening (CCS) and diagnosis, and a more comfortable experience than with a regular speculum. With the implementation of Artificial Intelligence (AI) algorithms, diagnoses will partly be automated and this requires a new workflow for the app.

Literature revealed that the deployment of information systems (such as smartphones) is needed to offer professional support to medical personnel in LRS in performing and managing CCS. The objective of this master thesis was to redesign the existing GICMED application to enhance the interaction between patient and healthcare provider, and assist in keeping track of patient data more efficiently. GIC Space set the challenge to design for both highly trained medical professionals, like general practitioners and gynaecologists, and less trained healthcare providers such as nurses and midwives. By responding to medical practitioners' lack of expertise and experience to accurately diagnose cervical cancer, the GICMED application could increase screening reliability in LRS. In addition, allowing healthcare providers to have more time for patients, will enable them to better empathise with their client and will lead to better care.

The usability of the current application was inspected with a cognitive walkthrough. Insights about desirable features were gathered by means of a benchmark with competitors. Four User Journey Maps were created to explore design opportunities. To determine whether the concept would be viable, the Lean Startup Model was deployed to rapidly develop a Minimum Viable Product (MVP). The MVP was assessed through user testing in order to determine its desirability.

Since the redesign combines paper work and implements EMRs, patient data can be stored and accessed digitally, allowing personnel to work in a efficient manner and devote more time on providing care. EMRs enable exchange of patient data between healthcare facilities, which is particularly beneficial for reducing loss of follow-up. In order to establish an accurate diagnosis and management plan, AI should solely serve as a second opinion and still rely on the user's own judgement. To avoid AI’s diagnosis from simply being adopted, users should be requested to share their findings and diagnosis first, before AI hands over its conclusion.

During user tests, the redesigned application received an average score of 82.8 out of 100. Participants unanimously agreed that the app helps healthcare providers to keep track of patient data more efficiently and two out of three subjects agreed the app allows both user groups to devote more attention to patients and to express empathy.

This master thesis highlights that potential users are open to trust the result given by AI. Users will first provide their own judgment and then utilise AI’s findings to come to a final conclusion. This thesis thereby affirms the potential for the integration of AI to partly automate diagnosis for cervical cancer.

The prevalence of chronic and complex wounds is high in low- and middle-income countries (LMICs). Due to the lack of adequate treatment wound conditions are likely to worsen. Improving access to wound care in LMICs is crucial for enhancing the quality of life for the people living there. Vacuum- assisted closure (VAC) therapy is an effective treatment for chronic and complex wounds. By applying a negative pressure to the wound the healing process is promoted. However, due to the high cost of VAC devices, their availability in LMICs is limited. A. Knulst works as a biomedical engineer at GPH and recognized this problem. In GPH the AquaVAC, a converted aquarium pump, is used to be able provide VAC therapy to patients. The use of the AquaVAC is not meeting the users’ requirements. Recognizing this problem, A. Knulst initiated the WOCA project to develop a VAC device tailored for LMICs. Over the past three years, the project has progressed to creating three simple yet functional prototypes using locally available materials in GPH. Based on the findings of A. Knulst a suitable next step for the WOCA is determined to conduct a clinical trial to evaluate the WOCA’s effectiveness in wound healing.
Designing the goal of this graduation project; preparation of the WOCA for the performance of a clinical trial conducted in GPH. Based on analysation of this goal preparation of the WOCA consists of veri- fication, and validation of the design requirements, verification of the applicable ISO-criteria, and the performance of a risk assessment. By making a redesign the current WOCA at GPH will also be made compatible with these stated requirements.
By making a redesign during this graduation project the canister is implemented and the noise is re- duced for the WOCA. This new version of the WOCA is verified for its design requirements as well as validated, also the applicable ISO-norms are verified and a risk assessment is performed.
Based on this performed effort it is shown that the WOCA is exceeding the allowed noise level deter- mined to be reached before the WOCA can start the clinical trial. Furhtermore, recommendations have been given for additional validation and verification of the WOCA before conducting the clinical trial.
Steps have been taken during this graduation project to improve the access to wound care in LMICs by a contribution to the open-source-publication of the WOCA device, and the development of a study protocol for the performance of a clinical trial.

Background: Bilateral tubal ligation (BTL) is the most common method of contraception worldwide because it is safe and effective. However, its accessibility remains unequal among women in rural India, in part due to a lack of laparoscopic equipment. Rural hospitals therefore resort to gas insufflation-less laparoscopic surgery (GILLS) because it requires less complex equipment. The pneumoperitoneum is replaced by an abdominal wall lift (AWL) device, but these devices suffer from limitations concerning visibility and working space.
Methods: Initiated by the identified medical needs in rural India, a novel AWL device with an integrated imaging system is designed based on methods from literature and input from local end-users. It is a stainless steel hollow circular hook housing an LED lighting system and a 5 MP camera module. It can be connected to any laptop with a USB-A port. The device substitutes for both the traditional AWL device and currently used laparoscopes. The design is exemplified by a fully functional aluminium prototype used for verification and validation.
Results: The selected camera module is the key technology of this design because it provides state-of-the-art imaging at an unmatched price point. The lighting system used for the prototype does not provide enough light, has an asymmetric illumination distribution, and generates too much heat. A structural strength test showed that the strength of the prototype exceeds the material-adjusted design load by 30%. Furthermore, the prototype is cost-effective, lightweight, compatible with current AWL systems, and has limited waterproofness. User tests with an expert rural surgeon confirmed that this design has the potential to improve surgical outcomes of BTL and other procedures, and can increase access to specialized medical care in rural India.
Conclusions: It is strongly recommended to continue the development of this AWL device. The focus points should be the shape and size of the loop (and related cost-effective production techniques), a new lighting system, and the waterproofness of the device. Collaboration with rural surgeons and local biomedical engineers is crucial for context-driven development and implementation.

This project addresses the subject of integrating Computerized Maintenance Management Systems (CMMS) into low-to-middle income healthcare contexts, with a specific focus on Nepal. CMMS play a prominent role in enabling Biomedical Equipment Technicians (BMETs) to monitor and optimize the performance of medical equipment (WHO, 2012), streamline operational processes, and facilitate intra-hospital communication and decision-making (Basiony, 2013). However, existing CMMS solutions designed for high-income environments, often fail to seamlessly integrate into the unique workflows and needs of low-to-middle income settings (Cohen et al., 2023).

The central problem identified in the Nepalese context is a misalignment between the workflow of BMETs and the CMMS interface. An overwhelming amount of information and functionalities within the system, making it challenging for the BMETs to identify tasks. Reinforced by, that the Nepalese context places less value on data creation and tend to operate more in accordance with tasks that can be observed physically.

To identify and address this problem, a comparative study was conducted between a Dutch hospital and two Nepalese hospitals. Data was gathered using the context-mapping method (Vissers et al., 2005), and a comprehensive understanding of the system’s interface was obtained through the streamlined cognitive walkthrough method (Spencer, 2000). The design goal was to create an inclusive interface for BMETs in Nepal through the visualization of medical device data. Norman and Draper’s design steps (1986) were used to generate an iterative approach for designing an CMMS interface. A mixed-method approach, including the System Usability Scale (Brooke, 1996), was used to evaluate the iterative prototypes and the final interface design.

The results of this study showed, by visualizing medical device data, a transition from a data-centric system to a task-oriented system. BMETs in Nepal confirmed through evaluation that the final design represents an improvement on the systems towards a task-oriented interface that aligns more with their daily workflow.

The project serves an inspiration for future designers to illustrate the importance of a human-centered approach when adapting software from one context to another. By highlighting the importance of considering the needs and workflows of a setting. Furthermore, this project can be a resource for companies and NGOs seeking to develop CMMS solutions from a human-centered perspective. In the Nepalese context, it provides building blocks for designing CMMS systems that better suit the work environment. In essence, this research represents a step towards a more inclusive CMMS system and the broader conversation on human-centered design in healthcare technology.

You will be reading a comprehensive study that examines the shortage of instruments for performing surgery in sub-Saharan Africa and the wastage of quality surgical instruments in the Netherlands. The report explores the potential solution of repositioning the excess instruments to sub-Saharan Africa, focusing on three product categories identified by Unifix Care as having the potential to make an impact. The thesis investigates the important elements that determine the value of these second-life products in Kenya. The conclusion reached is that none of the three product categories will have a significant impact in Kenya, leading to the recommendation for Unifix Care to discontinue this proposition.

In the next part of the thesis, the report takes a higher-level perspective and examines the decision-making process of Unifix Care when approaching and investigating expansion opportunities. It highlights the limitations of the current approach, which is deemed non-strategic and unsustainable in the long term. The section discusses the significance of making structured decisions and proposes a suggestion to proactively predict market potential to avoid investing time and resources into unprofitable opportunities. A recommendation is proposed to prevent this by implementing a quickscan that forecasts market conditions in advance. This approach aims to stay focused on the most important activities. Moreover, this thesis promotes the application of an effectual approach in conjunction with proactive prediction methodologies and theories that align with the causation paradigm.

This project delivers:
A study on the adoption of excessive Western second-life surgical instruments in Kenya, analyzing the potential impact by means of a triple constraint analysis.
A recommendation for Unifix Care to enhance decision-making effectiveness and adopt a more strategic approach for future opportunities.
A decision support model that facilitates strategic decision-making for Unifix Care.
A strategic opportunity framework that aids Unifix Care in prioritizing its actions based on opportunity landscapes.

Rural India faces many challenges in providing adequate health care for all. Health awareness among the Indian population is low due to poor functional literacy and low emphasis on education within the health sector.

Minimally Invasive Surgery (MIS), such as laparoscopy, offers many advantages, including smaller incisions, less tissue damage and faster recovery for patients compared to traditional open surgery. The use of laparoscopy in low- and middle-income countries (LMICs) is particularly influential because it can minimise the morbidity associated with laparotomies and provide benefits such as fewer postoperative infections and faster return to work. The laparoscopic instruments must be carefully cleaned and sterilised after each use to prevent infection. In any surgery, there is a risk of infection. Postoperative wound infections (POWIs) occur after surgery on the part of the body being operated on. Globally, the rate of POWIs varies between 0.5 and 15 per cent, while in India, rates between 23 and 38 per cent are consistently measured (Arora et al., 2018). These complications lead to revision surgery, delayed wound healing, increased use of antibiotics and longer hospital stay, all of which have a significant impact on patients and healthcare costs. Antimicrobial resistance (AMR) is one of the greatest threats to human health we face worldwide. (World Health Organisation, 2012a, 2012b).

This project focuses on making minimally invasive surgery such as laparoscopy safely applicable in low- and middle-income countries through a medical washer. It aims to find a research-based solution to improve the reprocessing of laparoscopic instruments to reduce POWIs and the need for antibiotics. The current method of reprocessing in hospitals in rural India does not result in sterile laparoscopic instruments and is harmful to patient, nurse and all other staff present in the OR. Instruments are also damaged during the cleaning process. These problems mainly stem from lack of training of nurses, time pressure and due to lack of cleaning equipment.

The project approach was implemented using the Double Diamond Design Model. In the final phase, a prototype was built and this prototype was evaluated in the context of rural India. The aim of this study was to investigate the medical washer loading system for laparoscopic instruments in rural hospitals and to understand how the loading system is used by nurses without any prior explanation. We also investigated how the concept of the medical washing machine is perceived by the end user.

The medical washer for laparoscopic instruments for the context of rural India has been developed can improve current reprocessing practices. By automating the cleaning process, the medical washer reduces the risk of human error and ensures that instruments are thoroughly cleaned. The inclusion of a loading system that can be used without extensive training ensures that the system can be used safely and correctly by all healthcare workers. With the combination of these systems in an integrated design, the medical washer can additionally provide value by reducing cleaning time and allowing nurses to take rest breaks or do other tasks.

This graduation project explored how the circular economy could be implemented for single-use surgical devices like the endocutter. Design for reprocessing appears to be the best strategy, but modular solutions should be considered when reprocessing the entire device is not feasible. The project followed a transition management approach; a sustainable future is envisioned for the industry, and through backcasting a radical but short-term feasible solution is designed which could help us move towards this future. Conceptual service design “MedFlo” helps healthcare facilities overcome barriers in the implementation of modular devices into their workflow and logistics, by providing access to a safe and complete inventory of devices. MedFlo can help decrease the environmental and waste footprint of medical devices, create more resilient supply chains, stimulate circular design initiatives and serves as an example of how the circular economy can be implemented in the MedTech industry.

Abstract—Introduction: Surgical instruments are stored, transported, cleaned, disinfected, and sterilized in instrument sets. These instrument sets have a predetermined fixed size, which means they cannot be stored or transported efficiently when empty or used efficiently for different types of instruments. This report presents the design of an instrument set that is adaptable in shape for efficient storage and transport. Method: Based on a questionnaire completed by various departments that come into contact with instrument sets, such as the CSSD, logistics and repair and fixation, the context, the requirements and wishes of van Straten Medical. B.V. and CSA Services B.V., 15 requirements and criteria have been established. Five concepts were developed based on a morphological chart, after which a Harris profile showed that stacki is the best concept. Result: Stacki was further developed and designed using the 3D CAD software SolidWorks. 3 prototypes were created using water/laser cutting and 3D printing. To evaluate the prototypes and identify critical points, 3 tests were carried out regarding completion, ease of use, and strength. These tests have shown that the prototype is promising, but that the corner needs to be redesigned to make the prototype even better. Discussion: Of the requirements, 7 requirements have been met, and 6 requirements were not tested. For further research, these remaining requirements can be tested by applying the points of improvement. Conclusion: A prototype with perforations made from the final materials could be made and this new prototype could be tested for cleaning, disinfection, and sterilization. Finally, the idea with two half sides instead of one long side can also be further developed and tested. Overall, the instrument set is promising for further development, with this design as a starting point.

Absorbent mats, abundantly used in hospitals, are integral to maintaining hygiene and cleanliness by effectively collecting and retaining patient's bodily fluids. absorbent mats are available as disposable and reusable products. In the Netherlands, predominantly disposable products are used, and approximately 23 million absorbent mats are employed each year. The abundant use contributes to the Dutch healthcare sector’s substantial impact to the country’s greenhouse gas emissions, waste generation, material extraction, water consumption, and land use. Hospitals and policy makers within the healthcare sector striving to implement environmentally sustainable practices, require current data for informed decision-making. Yet, only two studies have determined the environmental impact of absorbent mats; however, critical environmental metrics are lacking and detail on the contributions of life cycle stages are insufficient. This study addresses these issues by conducting a comparative Life Cycle Assessment, examining eighteen environmental metrics of both disposable and reusable absorbent mats. The primary objective is to not only assess the environmental impact across all their life cycle stages but also to facilitate the redesign of these absorbent mats to reduce their environmental impact. An in-depth cradle-to-grave Life cycle Assessment, utilizing the ReCiPe impact assessment method, was conducted to compare and evaluate the environmental impact of three different disposable absorbent mats and one reusable absorbent mat. The identification of major contributors to their environmental impact, combined with the application of eco-design strategies, facilitated the sustainable absorbent mat redesign. The Life Cycle Assessment findings indicate that reusable absorbent mats are environmentally superior compared to their disposable counterparts, even if the impact of disposable absorbent mats is mitigated by sustainable product redesign. The reusable absorbent mat demonstrates a lower environmental impact score in fifteen out of eighteen environmental metrics when compared to the disposable absorbent mats. The environmental impact of absorbent mats is largest in the use stage for reusable absorbent mats, and in the material production and manufacturing stage for disposable absorbent mats. The redesigned disposable and reusable absorbent mat concepts exhibit a reduced environmental impact, among other factors, attributed to product recycling. Both concepts facilitate recycling by utilizing a single material for the entire absorbent mat, namely wood-derived materials for the disposable redesign and polyethylene terephthalate-derived materials for the reusable redesign. This study has demonstrated the versatility of Life Cycle Assessment in aiding informed decisions-making and providing valuable insights for sustainable product redesign. The outcomes of the Life Cycle Assessment suggest that hospitals should transition to the use of reusable absorbent mats. Furthermore, the redesign findings offer valuable insights into the environmental benefits achievable through the recycling of medical products.

Background: Existing videolaryngoscopes do not meet the needs, budgets, and cleaning protocols of low- and middle-income countries. To solve these problems, a new videolaryngoscope, the Goodscope, has been developed which is less expensive, reusable and easy to clean. The aim of this study was to evaluate the efficacy of the Goodscope compared with a commonly used videolaryngoscope, the GlideScope, when used by experienced anaesthetists and residents in anaesthesia in both a normal and difficult airway scenario. Methods: Participants randomly intubated the manikin four times using both the Goodscope and the GlideScope twice in a normal and a difficult airway scenario. The primary endpoint was time to successful intubation. Secondary endpoints were time to glottic view, time to ventilation, number of intubation attempts, successful intubation rate, and ease of intubation. Results: A total of 73 participants were included in this study. The primary endpoint, time to successful intubation, showed no statistically significant difference between the Goodscope and GlideScope in both the normal (median Goodscope 10.3 s, inter-quartile range (IQR) 8.5, 12.2 vs GlideScope 10.1 s, IQR 8.4, 13.6, P = 0.614), and difficult scenario (median Goodscope 18.5 s, IQR 14.3, 25.3 vs GlideScope 18.4 s, IQR 13.7, 24.2, P = 0.238). Similarly, no significant differences between the two videolaryngoscopes were identified for all secondary endpoints in both scenarios. Conclusion: The findings of this study suggest that the Goodscope is non-inferior to the GlideScope since no significant differences between the Goodscope and the GlideScope were identified for all primary and secondary endpoints. Therefore, this study contributes to proving the concept of an affordable reusable videolaryngoscope without compromising on quality.