This graduation project, focussed on the environmental impact of the ECG-lead sets used at Erasmus Medical Centre (EMC). It explores how circular design techniques can help create a more sustainable healthcare system. Although ECG-lead sets are crucial for cardiac monitoring and diagnostics, they are frequently single-patient use (SPU), this greatly increases CO2 emissions and medical waste. Although there are multi-patient-use (MPU) alternatives, hygienic concerns, cleaning workload, and regulatory limitations limit their wider adoption. The project set out to redesign ECG-lead sets using an evidence-based and context-specific methodology, in order to evaluate theoretical sustainability strategies and their actual implications.

The research phase consisted of an in-depth exploration of the current ECG-lead set used across multiple EMC departments. Through interviews, direct observations, user journey mapping, and stakeholder analysis. The environmental impact of both SPU and MPU sets was measured using a Life Cycle Assessment (LCA), which revealed that MPU options become more sustainable after just four use cycles. Cable tangling, unclear ownership resulting from multiple department transfers, and inconsistent cleaning procedures were among the main obstacles found. The need for system-level thinking was highlighted by the frequent conflicting stakeholder interests, which ranged from procurement logistics to patient safety.
With a focus on co-creation, the design phase adhered to the triple diamond process: explore, ideate, implement. The concept for a modular, reusable ECG system with enhanced usability, durability, and lifecycle transparency was influenced by three co-creation sessions and multiple expert interviews.

Digital traceability to track usage cycles and maintenance, visible cleanliness indicators, and easy-to-use cable management were among the possible design interventions. In order to address user experience and operational viability, core concepts were validated through prototyping and testing with nurses and technical staff.

A reusable ECG-lead set that minimizes environmental impact and fits in the EMC context is the end result. Implementing dry electrode technology in the design, it reduces valuable material waste from conventional electrodes and keeps these in the loop of the circular economy. Embedding RFID tags to allow traceability, and lifecycle monitoring. The design enables individual part replacement and greatly reduces material waste by supporting circular strategies like reuse, repair, and refurbishment. This design shows how circular principles can be effectively translated into workable, scalable medical device solutions through co-created and context-specific design.

According to the project's findings, systemic knowledge and stakeholder involvement are both necessary for future healthcare transformation. In addition to producing better design, the project is an example that offers a scalable framework for implementing circular design in other medical product industries, making it a validated case study.

According to the NFU (2024), pulse oximeters are the second most environmentally impactful disposable medical product in terms of CO₂-equivalent emissions. At Reinier de Graaf Gasthuis (RdGG), all departments have transitioned to reusable pulse oximeters, except for the pediatric units.
This graduation project, conducted in collaboration with RdGG, investigates the barriers to adopting reusable pediatric pulse oximeters and proposes a solution through product design.

Initial research revealed that fully reusable pulse oximeters face several barriers in pediatric care, primarily due to concerns around hygiene, usability, and child- friendliness. Among the alternatives explored, a hybrid pulse oximeter, combining a reusable sensor with disposable adhesive stickers, was identified as the most promising solution for the pediatric context.

The goal of this project was to develop a user-friendly, cleanable, and sustainable storage solution that encourages nurses to use the hybrid pediatric pulse oximeter while ensuring safe storage for a long sensor lifetime. This led to the creation of the SatuSavers, a family of three product variants.

Of the three, the pole-mounted version was fully developed and tested for implementation. Through interviews, observations, co-creation, and prototyping, the design was refined to meet the criteria.
A full transition to hybrid sensors supported by the SatuSavers could lead to a significant reduction of environmental impact, alongside a cost reduction of up to 70.2% compared to the current use of disposable sensors.

The SatuSavers offer a practical and context specific solution to facilitate a seamless transition towards more sustainable pediatric pulse oximetry.

Cervical cancer is a leading cause of death for women in low- and middle-income countries (LMICs) like Ethiopia, where barriers such as cost, distance, and a shortage of specialists prevent effective screening. Existing visual inspection methods in local clinics often lack the reliability needed for early detection, leading to preventable deaths. To address this, we have developed an integrated, low-cost (<€200) AI-assisted cervical imaging system. The device uses a novel cross-polarisation filter on an off-the-shelf endoscope to capture glare-free, high-quality images. A removable hardware guide ensures safe, repeatable positioning, while an AI model running on a portable Raspberry Pi provides real-time sharpness feedback and diagnostic classification support to non-specialist users. This system is designed to function as a "digital endoscope," empowering local healthcare workers to perform accurate screenings without expensive equipment. By enabling a "screen-and-treat" workflow, our solution aims to decentralise care, reduce the burden on overwhelmed referral hospitals, and provide women in remote communities with immediate access to life-saving diagnostics, transforming a multi-week ordeal into a single, confident clinical encounter.

Inflators play a crucial role in interventional radiology and cardiology to restore blood flow to obstructed veins. Given the high-risk nature of these procedures, inflators must be sterile. Consequently, they are designed for only single-use. This practice results in the annual incineration of around 100.000 inflators annually in the Netherlands, contributing to approximately 62500 kg of CO₂-eq emissions.
Our research, employing literature review, HotSpot and Disassembly maps, interviews and observations identified key barriers to reuse of the current inflators. These devices are designed for single-use, applying materials that cannot withstand decontamination and lacking the ability to be disassembled. In addition, parts are fixed together to reduce the chances of failure during the procedure.
This master’s thesis proposes a circular model for endovascular inflators, focusing on the reuse of valuable components within healthcare institutions while disposing of the rest. POMPA. POMPA is a circular redesign of the inflators. It aims to make inflators easy and safe to use, disassemble, decontaminate, reassemble and reuse. POMPA adopts materials suitable for decontamination and redesigns the architecture of inflators to achieve complete dis- or reassembly of the product in less than a minute without compromising its functions and performance.
The new system and product-level interventions enable the decontamination and reuse of key components for about 1000 patient procedures. POMPA has a lower environmental and economic impact than current single-use inflators after just nine uses.
In conclusion, POMPA offers a sustainable, convenient, and safe alternative to single-use inflators. This conceptual solution has many features that can be further explored and improved, but for now, it is intended to be a first step towards more circular inflators and to inspire similar innovation change in other medical devices.

Pulse oximetry is an essential part of modern patient monitoring, but the current widespread use of single-use pulse oximeters in hospitals results in significant environmental impact (Duffy et al., 2023). Although reusable alternatives exist, their adoption remains limited (Noort et al., 2024). This graduation project, in collaboration with the Erasmus Medical Center and Philips, investigates the barriers to reusable pulse oximeter use and proposes a solution through product and system redesign.

A mixed-method research approach was used to identify key obstacles on system and product level. Barriers included poor cleaning compliance, sensor loss during patient transfers, off-label use in low-perfusion patients, sensor instability, alarm fatigue and discomfort for patients. Through interviews, observational studies, and co-creation sessions with hospital stakeholders, these barriers were mapped.

Short-term solution directions, such as monthly sensor redistribution, clearer cleaning responsibilities, and market research into low-perfusion sensors, were identified through co-creation and can form interventions in the current system to create sustainable change now.

To address barriers through product redesign, the Philips Nova was developed (figure 1), a hybrid pulse oximeter consisting of a reusable sensor base and a single-use adhesive patch. The design supports reuse through cleaning, cable repair to extend product lifespan and critical material recovery through recycling, while improving patient comfort. An integrated tracking system, Philips Connect, enables lifecycle data collection, supports circular business models such as product-as-a-service, and helps prevent unnecessary sensor loss or repurchasing. The Philips Nova builds on the existing system, minimizing workflow disruption and allowing easy adoption.

Together, the product concept and system recommendations form a practical roadmap for sustainable pulse oximetry in Dutch hospitals, bringing it closer to achieving circularity.

This graduation project focuses on the redesign of the Chloe Gynaecological Training Model (GTM). The six-month project is being conducted on behalf of TU Delft and Chloe Company. The goal is to improve the first version of the GTM by enhancing usability, stability, and increasing the number of procedures that can be practiced on the model.

The development of the model is divided into three sprints. The first sprint focuses on improving the original model based on feedback from users in the Netherlands. The second sprint took place in Kenya, where, over a period of four weeks, the local context was explored and the model was tested with twenty medical professionals. In the third sprint, the feedback from Kenya was incorporated into the final design.

While hospitals play a central role in healing, it is contradictory that healthcare activities contribute to climate change, ultimately creating a less healthy world. To achieve the goals of reducing waste and climate impact established to address this issue, action must be taken. Medication is responsible for a large share of Erasmus MC's emissions. However, research into the environmental impact of medication is still in its early stages. In particular, the impact of medication packaging remains largely unexplored and must first be mapped. For this purpose a Material Flow Analysis (MFA) was executed at the Intensive Care Unit (ICU) of Erasmus MC to assess its current environmental impact and to identify environmental hotspots (for potential reductions).
 
Patient care in the ICU is highly specialised and personalised, and medication plays a critical role in this. Medication packaging is composed of several components. The components included in this MFA study are primary packaging, secondary packaging, leaflets and accessories. All components come in many different shapes.
 
For all medications prescribed more than 250 times in 2023 within the ICU, the components of the packaging were assessed by weight. The three major hotspots in terms of material are plastic, glass and paper. A significant finding in terms of packaging was the share of dialysis bag boxes. These boxes alone account for 20% of the waste in the ICU.
 
In the second part of this study a redesign of the dialysis bag boxes was proposed. To redesign the dialysis bag boxes, their packaging was first examined and the surrounding system was mapped. The redesign process utilised the Circular R-strategies from Metabolic’s Value Hill to reduce waste and the environmental impact of the packaging. During the ideation phase, two strategies were prioritised: reducing the paper content of the packaging and introducing reusable packaging. A cost analysis revealed that reusable packaging is both more sustainable and more cost-effective over time compared to single-use paper boxes. Existing reusable systems in healthcare and other industries, such as the fruit and vegetable sector, were also explored for inspiration.
 
From the ideation, four concepts were developed, and a final concept was selected: a dolly system combined with a box with a lid. This box can be sealed and is stackable and nestable, which is essential for transport and storage. Additionally, the reusable box is more user-friendly, saving nurses time and allowing them to focus more on critical patient care. By implementing this concept, 20% of the waste generated in the ICU can be eliminated.
 
This research primarily aims to highlight the challenges within the complex healthcare system and serves as an eye-opener for the industry to reconsider its strict regulations and environmentally harmful practices.

The circular economy is increasingly acknowledged worldwide, including in healthcare. It focuses on extending the lifespan and value of products and materials by ensuring their continuous use within the system. This approach is crucial as it shifts away from the prevalent "take-use-dispose" linear model. Given the rapid growth and mounting pressures on healthcare systems, adopting a circular economy is essential to improving sustainability and ensuring broader access to healthcare.

In healthcare, particularly in low-resource settings in Sub-Saharan Africa, circular economy principles can improve access to medical devices and overall healthcare. As the global awareness of health as a fundamental human right grows, there is an increasing push towards universal health access. However, this access is heavily dependent on the availability of medical equipment and qualified medical staff. Unfortunately, medical devices and healthcare technologies are often inaccessible in low-resource settings. Not only does this undermine healthcare delivery, but it sometimes also results in environmental issues, such as the improper disposal of non-functional devices and medical waste, which leads to the loss of valuable materials.

Recent trends in medical device design are shifting from a linear model towards a circular economy approach. This shift aims to ensure that devices are robust, durable, reusable and have an extended lifespan to provide healthcare for all. However, the full implications and complexities of integrating circular economy principles into medical device design in low-resource contexts, is poorly understood. This thesis addresses these through a series of studies focused on designing and implementing medical devices in low-resource settings while incorporating circular economy principles.

The first study is a foundational study which provides a literature review of how circular economy principles have been applied in designing medical devices for low resource settings in Sub-Saharan Africa. The study highlights existing practices such as durability, maintenance, and repair that enhance the longevity of medical devices. However, it also identifies a notable gap in the consideration of refurbishment, re-manufacturing, and recycling in these designs. Building on this, the second study utilises a practical framework to design a medical device from a circular economy perspective, examining the complexities and trade-offs involved. It introduces the Chloe Syringe Extension Device (Chloe SED®), designed to provide pain relief medication during gynaecological procedures in Kenya. The study identifies trade-offs between, on the one hand, material selection, cost price, durability, reprocessing methods and costs, and on the other hand environmental impact, highlighting the need for ongoing assessment to ensure the device remains accessible, affordable, and environmentally sustainable.

The third study assesses the implementation of Chloe SED® in routine care through a large-scale clinical trial. The findings show that the device performs comparably to standard care, integrates well into existing procedures, and has potential to enhance healthcare access. This study highlights the importance of aligning medical device design with local healthcare systems to ensure effective integration and impact. The fourth study explores the designer’s journey in creating and implementing Chloe SED®. This study highlights the diverse roles a designer must assume: collaborator, facilitator, knowledge broker, policy advocate, and entrepreneur, while recognising the need to shift between these roles. The study underscores the iterative nature of the design process and the necessity for ongoing stakeholder engagement to achieve successful adoption and integration of new devices into healthcare systems.

This thesis provides an in-depth analysis of designing and implementing medical devices for low-resource settings in Sub-Saharan Africa, focusing on circular economy principles. It highlights the significance of context-specific design, the challenges of integrating new devices into routine care, and the essential roles of designers in fostering innovation and driving societal change.

The global burden of schistosomiasis and soil-transmitted helminth (STH) infections is substantial, with millions at risk, particularly in sub-Saharan Africa. Traditional diagnostic methods using optical microscopy are labour intensive, operator dependent, and often inaccessible in remote areas. This thesis focuses on the development and validation of an AI-based digital microscope, the Schistoscope, designed to enhance the diagnosis of these infections, particularly in resource-limited settings. The aim is to bridge existing diagnostic gaps by developing an automated system that reduces reliance on skilled personnel, enhances diagnostic accuracy, and improves accessibility.

The research integrates innovations in hardware design, digital imaging, and artificial intelligence (AI) to create an affordable, efficient, and accurate diagnostic tool that addresses the limitations of traditional microscopy. The primary objectives include designing and developing cost-effective digital microscope prototypes, integrating AI algorithms for automated detection and classification of parasite eggs, and validating the diagnostic performance of the system through field studies. The development process began with two low-cost digital microscope prototypes: the Raspberry Pi-based Schistoscope and the smartphone-based Schistoscope. Both designs focused on affordability, portability, and ease of use, with key innovations such as the integration of 3D-printed components and locally sourced materials to ensure sustainability and ease of maintenance in endemic regions.

Subsequent iterations led to the development of the Schistoscope 5.0, which featured significant improvements in imaging quality, automation, and user interface. The device incorporates a whole slide imaging system with an advanced autofocusing algorithm, enhancing image clarity and diagnostic accuracy. A cornerstone of the thesis is the integration of AI for automated detection and quantification of Schistosoma haematobium and intestinal helminth eggs. The diagnostic framework employs deep learning models, particularly convolutional neural networks (CNNs), to perform semantic segmentation and object detection. Key components include the DeepLabV3 with a MobileNetV3 backbone, used for semantic segmentation of Schistosoma haematobium eggs, effectively distinguishing eggs from background artifacts, and the EfficientDet model, applied for the detection of intestinal helminth eggs, including Ascaris lumbricoides, Trichuris trichiura, hookworm, and Schistosoma mansoni.

The models were trained on robust datasets collected from field samples, with extensive image annotation to ensure accuracy. The diagnostic system demonstrated high sensitivity and specificity, meeting the World Health Organisation's target product profiles for schistosomiasis and STH control programs. Comprehensive field validation studies were conducted in Nigeria and Gabon to assess the real-world performance of the Schistoscope. These studies compared the device's diagnostic accuracy with conventional microscopy and composite reference standards incorporating real-time PCR and UCP-LF CAA. In Nigeria, the study also focused on the usability and acceptability of the Schistoscope among healthcare workers, demonstrating high acceptance rate of both the semi- and fully automated modes. In Gabon, the diagnostic performance was assessed on fresh and banked urine samples, with the Schistoscope demonstrating comparable accuracy to traditional microscopy, alongside the added benefits of automation and reduced diagnostic time.

Key findings highlight improved diagnostic accuracy, with the Schistoscope achieving high precision and sensitivity in detecting schistosomiasis and STH infections. The integration of AI reduced the need for skilled personnel, thereby enhancing automation and efficiency. The device's cost-effectiveness is underscored by the use of affordable materials and open-source hardware/software, making it accessible for low-resource settings. Field readiness was confirmed through validation under real-world conditions, attesting to the device's robustness and reliability.

Despite these advancements, the research identified several challenges and limitations. Some images were affected by sub-optimal autofocusing, impacting diagnostic accuracy in certain cases. The AI models require further training on more diverse datasets to improve generalisation across different environmental conditions. Additionally, operational challenges such as mechanical issues in the autofocusing mechanism were noted, necessitating further hardware refinements.

Building on these successes and lessons learned, future research will focus on hardware and software refinement to improve mechanical stability and AI model robustness. The Schistoscope will be adapted for the diagnosis of other parasitic diseases, with enhanced field validation through extensive trials in diverse settings. Sustainable deployment strategies will explore local manufacturing options to reduce costs and improve accessibility. Furthermore, the development of cloud-based data storage and analysis systems will support large-scale public health initiatives.

In conclusion, this thesis demonstrates that the integration of AI with digital microscopy can revolutionise the diagnosis of schistosomiasis and STH infections. The Schistoscope not only matches traditional microscopy in diagnostic accuracy but also offers significant advantages in terms of automation, cost-effectiveness, and field applicability. By addressing key challenges in parasitic disease diagnostics, this research contributes to global efforts in controlling and eliminating neglected tropical diseases (NTD), with the potential to improve health outcomes in some of the world's most vulnerable populations. Therefore, accelerating the achievement of the elimination targets as enshrined in the WHO’s NTD Road Map, 2021-2030 in resource-limited settings.

This master’s thesis presents a comprehensive redesign of the vaginal speculum, an essential yet historically problematic device used in women’s healthcare. The project focuses on addressing three main issues: enhancing patient comfort, fulfilling physician needs, and ensuring environmental sustainability. This work aims to resolve the persistent discomfort and anxiety associated with pelvic exams, which are exacerbated by the current design of the speculum, while also considering the environmental impact of the healthcare sector.

The vaginal speculum has seen little change since its invention in 1845, despite its controversial history and the discomfort it causes to patients. Traditionally, its design prioritized the needs of healthcare providers, often neglecting the experience of the patient. The discomfort caused by the device has been a significant deterrent for women undergoing gynecological examinations, contributing to delays in the diagnosis and treatment of various health conditions. While some modern adjustments have been made—such as the shift from reusable metal speculums to single-use plastic versions—these changes have increased the environmental burden of healthcare, particularly in the context of global greenhouse gas emissions.

The project followed the three diamond design method, encompassing the phases of Discover, Define, Ideate, Conceptualize, Develop, and Deliver, to create a new speculum design. The process began with an in-depth exploration of the needs of three primary stakeholders: patients, healthcare providers, and the environment. This included literature reviews, hands-on explorations, and interviews to understand the diverse perspectives and challenges faced by each group.

The resulting design, named "Lilium," integrates patient-centered features such as improved ergonomics, reduced invasiveness, and enhanced aesthetics to alleviate patient discomfort. For healthcare providers, the design offers a more efficient and user-friendly tool that facilitates better access and visibility during examinations. In terms of sustainability, the Lilium speculum is designed for reusability, with a focus on materials that reduce environmental impact while maintaining high standards of hygiene and safety.

LAYCO Medical Devices BV needs a packaging solution for their new product, vela®, a
reusable vacuum extraction device aimed at replacing single-use devices in Dutch hospitals
by 2025. The challenge was to design packaging that not only meets stringent medical
and logistical requirements in the Netherlands, but also aligns with LAYCO’s commitment
to sustainability, reducing environmental impact while ensuring the device’s safety and
usability.

The proposed packaging solution is a compact box made of corrugated board. The use of
this material has a low environmental impact as it is renewable and easy to recycle. The
corrugated board cutout of the packaging is cunningly designed to fold into a rigid box with
designated placeholders for the product parts. The folding and unfolding of the packaging
is specifically designed to increase the ease of use.

The packaging solution accumulates 0.046 Grams of CO2eq. in its life cycle whilst competitor
packaging solutions are responsible for at least double this number. The design stimulates
correct disposal through its usecues. The solution is seamlessly implementable in the existing
systems in the healthcare ecosystem. The protective capabilities are validated in several
tests with extreme conditions.

The importance of this project lies in the fact that packaging solutions currently are all
designed to be disposed of. While the transition to a world without the need for disposable
packagnig is desired in order to sustain life on earth in the long run, smaller changes right
now can significantly decrease our impact on the environment. In this thesis it is explained
that by redesigning disposable packaging solutions, we can already half our impact today.

This research project explores opportunities for EcoWorld to expand their product portfolio beyond mere recycling. The initial goal was to investigate potential products that could improve the living conditions of local communities in Watamu, Kenya, using collected plastic waste. EcoWorld, a local non-profit organization, aims to ignite the plastic recycling economy in Watamu by creating dynamic value waste streams and empowering women and youth as drivers of this economy. However, they face challenges in moving from recycling to circular design practices and in identifying suitable products for the local communities.

The research begins by defining the local context and identifying key stakeholders. It reveals a significant plastic waste problem in Watamu and inadequate living conditions for the local communities. While there is a growing understanding of the potential of collecting and recycling plastic waste, a knowledge gap hinders progress towards more circular practices. The research clarifies what circular practices mean in the local context, centering on creating products from plastic waste that offer enhanced social benefits to end-users while managing the entire lifecycle of these products. It explores EcoWorld’s potential to build a business around this approach and develops a framework for integrating circular practices into local product production. Integrating local end-users into the design process emerged as a key opportunity to create value, understanding, and awareness, ensuring proper waste management and slowing down the resource loop.
A four-week field research in Watamu engaged these various stakeholders in the design process. Observations and interviews with EcoWorld employees highlighted the potential for new technologies to move beyond recycling and the openness to raising community awareness. Creative sessions with local communities provided insights into their perspectives on plastic pollution and their needs for improving their living conditions. While there was interest in using plastic waste materials, trust in these materials for structural improvements, like bricks for houses, was lacking. However, there was significant interest in improving household cleanliness through storage solutions.

Based on these insights, a cabinet design was developed during the design phase together with the local end users. The design focuses on practicality and simplicity to fit the local market, emphasizing functionality and ease of use. The production process was kept simple with minimal tool requirements to ensure feasibility for local production at EcoWorld. The design aligns with the established circular framework, ensuring proper handling of the product at its end-of-life, thereby slowing down the resource loop.

Finally, a transition model was created for EcoWorld’s future growth. An implementation plan for the current product includes the necessary tools and machines for successful production. The transition model is based on building trust among end-users as they become familiar with using plastic waste materials for products and actively participate in the emerging economy. This involvement will enable EcoWorld to expand their product portfolio further and focus on proper waste management in the future, creating jobs and income for women and youth in Watamu, igniting the local plastic recycling economy.

This Master's thesis describes the redesign of the HeartEye portable Electrocardiogram (ECG) device to enable home use for patients with coronary artery disease (CAD). The initiative aimed to transition the medical-grade 12-lead ECG from a clinical setting to a user-friendly, home-based application, maintaining the device’s diagnostic integrity while enhancing accessibility for non-expert users.

The project was done in collaboration with HeartEye, TU Delft, and NPK Design, applying the double diamond design framework that works with four key phases: Discover, Define, Develop, and Deliver.

Discover Phase: The redesign began with an examination of the existing HeartEye ECG device, assessing its design and functionality. Following research explored the opportunities in E-Health, highlighting trends and innovations that could inform HeartEye's integration into telemonitoring service centres. In-depth user group research was conducted to understand the specific needs, behaviours, and experiences of CAD patients, guiding the development of user personas. This phase also looked at the regulatory landscape to ensure that the redesigned device would comply with the most important medical device standards and to address potential future regulations related to AI and sustainability in healthcare. A quick dive into machine learning interpretability was completed. Additionally, market strategies were evaluated to discover if they would have an impact on the to be designed device. Gender-specific issues of heart disease and care were addressed as well. Lastly, a qualitative study enriched by direct patient feedback provided deeper insights into the personal impact of CAD.

Define Phase: Using the knowledge from the Discover phase, a start was made to discover potential use scenarios. A well evaluated choice was made to choose for the rehabilitation to rehabilitation period as the use scenario to be designed for. Once this was defined, we scoped down the design space to only encompass the physical design considerations and set up some boundaries to help make design decisions later on in the project. Lastly, we defined four determinants that determine what makes a good measurement based on expert feedback and research.

Develop Phase: Factors influencing measurement quality were developed, allowing for the exploration of a broad range of directions. Ideas were iteratively conceptualized, prototyped, and refined, with three main directions chosen for further development: housing geometry, feedback methods, and electrode material. These were prototyped and tested in a structured user test, consisting of four parts: quantitative evaluation of device geometries, qualitative interviews about user experiences, a card game to discuss feedback needs and methods, and an internal test on electrode material effects on contact resistance. The results informed design guidelines for the redesign.

Deliver Phase: This phase explored the practical implications of the developed design guidelines, by designing, optimizing, and evaluating a concept design. Moreover, some recommendations are given for the future implementation of the insights generated over the course of this project.

The resulting redesigned HeartEye portable ECG device could empower patients to monitor their cardiac health effectively at home, combining clinical-grade monitoring capabilities with an accessible, user-centric design to potentially reduce CAD-related mortality through timely and frequent monitoring.

Cervical cancer is the development of abnormal cell growth on a woman’s cervix. It is a highly preventable and highly curable disease if detected early. Notably, 22.5% of cervical cancer related deaths occur in Africa but, they have the lowest rate of cervical cancer prevention measures worldwide.

This project focuses on increasing women’s participation in cervical cancer screenings through redesigning the C Spec, a product that lowers the patient discomfort barrier associated with cervical cancer screenings.

The C Spec was developed by the startup company GIC Space. Its design utilizes a narrow body and an endoscopic camera to visualize the cervix via a live mobile phone feed, reducing the diameter needed to stretch the vaginal walls to view the cervix.

Although the original C Spec design improves patient comfort, healthcare professional ease of use was limited. This new C Spec design therefore utilizes a speculum style handle attached to the original C Spec main body to allow for intuitive use by healthcare professionals while maintaining patient comfort.

This research, part of the Master Integrated Product Design Engineering at Delft University
of Technology, is a collaboration between Red Cross Kenya, TUDelft, INSPiRED, the
MakerSpaces of I.O.Me 254 and its participating students.

Originating in the 2021 Advanced Embodiment Design course at TUDelft, the Eduscope
project aims to improve microscopy accessibility in Sub-Saharan African countries.
Leveraging accessible manufacturing technologies, such as 3D printing, and collaborating
with local MakerSpaces, it empowers communities by giving them control over the project
and enables the fabrication of low-cost digital microscopes.

The Eduscope project has focused on real-world testing at I.O.Me 254, serving as a crucial
testing ground and incubator. This research builds on this collaboration, starting with an
in-depth exploration of Eduscope V2 and the MakerSpace at I.O.Me 001 in Mombasa,
Kenya. Three categories, featural, structural & sourcing improvements, were identified, but
more essential four missing pieces between the I.O.Me 001 students and the projects’
success were unveiled. Continuing on the four missing pieces, Understanding, Curiosity,
Trial & Error and Independence the research goal of “Empowering the students at I.O.Me
001 to develop digital microscopes targeting low-resource secondary schools in Kenya" was
outlined. With this research goal three deliverables have been developed to ensure a holistic
approach.

The Eduscope Rig is an essential tool in initial recruitment of the students by fostering
curiosity and understanding. Next to the educational function, the Rig functions as an
essential design tool by boosting Trial & Error practices and reducing supply chain
independencies. The Eduscope STEM project is a series of workshops crucial to bringing
the students up to the level where they can make actual improvements to Eduscope
products. Lastly, the Eduscope V3 Prototype serves as tangible and visual presentation for
the three improvement categories, creating an updated reference point for the students and
boosting the development of the Eduscope V3.

In a collaborative effort spanning between the Netherlands and Kenya, this project aimed to enhance the livelihoods of smallholder farmers in the Meru region by designing a manual groundnut thresher. Recognising the importance of cultural context, I embarked on a journey guided by a cultural anthropological research approach, placing a strong emphasis on co-creation and iterative prototyping to ensure the tool’s effectiveness and usability.

Through research, several challenges faced by smallholder farmers in Meru were uncovered. Handpicking groundnuts is labour-intensive and time-consuming, limiting productivity and income generation. Additionally, there is a lack of tools available to aid in the harvest of groundnuts, and the options found in other regions, such as Asia, were prohibitively expensive or unsafe.

This project fostered a collaborative environment where stakeholders from diverse backgrounds actively participated in the design process. Farmers, engineers, and students from a local technical institute worked together to co-create solutions tailored to the specific needs and preferences of the community. This inclusive approach ensured that the final product addressed the real challenges faced by farmers on the ground.

Prototyping played a prominent role in refining the design concepts and iterating towards the final prototype. We experimented with various mechanisms and configurations to optimise the thresher’s performance and usability. Continuous feedback loops enabled us to make iterative improvements, ensuring that the final product met the standards of quality and functionality.

After multiple iterations and rigorous testing, we developed a working final prototype: the Manual Groundnut Harvester. This innovative tool streamlines the harvesting process, reducing the time and labour required to thresh groundnuts. Its design allows for easy operation by farmers of all skill levels, empowering them to increase their productivity and income. Additionally, the thresher’s cultural sensitivity ensures seamless integration into the local farming practices, further enhancing its adoption and impact.

Looking ahead, the project holds promising prospects for the future. The Manual Groundnut Harvester and its redesign have the potential to significantly improve groundnut farming in Meru, offering a sustainable solution to enhance productivity and livelihoods. Moreover, the collaborative approach serves as a model for future design projects, emphasising the importance of co-creation and cultural sensitivity in addressing complex socio-economic challenges.

In conclusion, this journey to design and develop the Manual Groundnut Harvester exemplifies the power of inclusive design and collaborative innovation. By leveraging local knowledge, expertise, and resources, we have created a solution that not only improves agricultural practices but also fosters economic empowerment and community resilience in the Meru region.

This graduation project consists of the journey of developing a context-specific training system for nurses to administer a paracervical block (PCB) using the medical Chloe Syringe Extension Device (SED). This six-month during project is being carried out on behalf of TU Delft and Chloe Company. The aim of the project is to enable nurses in sub-Saharan Africa (SSA) in low-resource settings (LRS) to competently use the Chloe device for pain management during Manual Vacuum Aspiration (MVA). The outcome of this project is a two-component training system: a job aid and a demonstration device designed to enhance the training experience and guidance for use.

The project approach was implemented using a context-driven design approach, consisting of Research & Analysis, Ideation, Conceptualisation and Evaluation. Literature research on the topic and its context is carried out, while further knowledge is gathered through contacts with sixteen Dutch and Kenyan medical professionals. In addition to individual interviews, two studies are conducted in the Dutch and Kenyan contexts. A six-week field trip to Kisumu, Kenya, during which ten medical professionals in three hospitals were visited, made it possible to ensure that the design truly fits its context. These medical professionals provided valuable input to the iterative design process and helped to shape the final concept design of the training system.

Further designing is enabled through prototyping, the use of decision-making methods and continuous iteration. This allowed new ideas to be generated, tested, and therefore new improvements to be made. Ultimately, new requirements could be identified, providing the opportunity to create even more valuable designs.

Future research should focus on further developing these designs, giving them an embodiment, and creating the possibility of actually implementing the training system in its intended context.

Healthcare is a major contributor to the negative effects on the environment, leading to adverse effects on the physical and mental health of people globally (IPCC, AR6). The Dutch healthcare sector alone is responsible for 7-8% of the national carbon footprint, 4,2% of total waste and 13% of raw material extraction (Steenmeijer et al. 2022).
This project was set up in three main parts to identifying opportunities for sustainable interventions in colonoscopy procedures for the EMC gastroenterology department. Throughout the project, a human-centered design approach was maintained. Research was done in literature on sustainability in healthcare and environmental impact of endoscopy, empirical context research and material flow analysis (MFA) in the form of a waste audit.

Based on circular strategies Reduce and Recycle, the research outcomes were synthesized into an intervention that aligns to the EMC's policy statements for sustainability:
- reduce waste with 10%
- increase recycling with 20%

Waste audit data was used as an input for co-creating with endoscopy nurses, where the focus was put on retrieving plastics from GMW because of their significant contribution to total emissions when incinerated (López-Muñoz et al., 2023).

Ideation was done in co-creation sessions to solve the problem of integrating waste segregation inside the complex environment of a colonoscopy treatment room for current system boundaries.
Outcomes
While it is ideal to implement higher R-strategies for designing out waste early on in the process, waste cannot be ruled out completely. Therefore, implementing a waste segregation system in the endoscopy treatment room presents an opportunity to enhance waste management in EMC and align with sustainability goals.
The proposal is a demonstration rather than a product concept, to show small incremental changes within the current system boundaries can help achieve the EMC goals. The intervention was estimated to reduce the weight of incinerated GMW with at least 40% with segregation of plastic products, and additional 16% by disposing of absorbent products in TONTO. Additional research is needed to determine the true recyclability potential of the plastics.
With the foresight of the implementation of new products in the system and a circular model where materials of these products have to be kept in the loop, the endoscopy nurses will be equipped and trained to accomodate these changes, and maintain sustainable practices.

Cataract surgeries using phacoemulsification (phaco) are standard practice, accounting for the large majority of all cataract surgeries. Reliance on sterilization processes has significant environmental implications, giving its energy and resource intensive nature.

This thesis introduces a novel hybrid phaco handpiece design, eliminating the need for sterilization by adding a disposable to facilitate sterile use, combined with a reusable as driver of ultrasound. This product is the first step towards a proposed fully circular system. This project has a focus on reducing impact, while maintaining phaco functionality; it does so by testing for phaco ultrasound characteristics and functioning fluidics while addressing the challenges associated with sterilization. The design emphasizes quick, secure, and sterile assembly in the operating room (OR) while maintaining cost-effectiveness and minimizing environmental impact.

The hybrid phaco handpiece achieves its functional design by carefully managing the components responsible for ultrasound and fluidics. The internal sonotrode, driving ultrasound, is split between the disposable and reusable components, connected securely through a threaded interface. Fluidics are managed by splitting off before reaching the reusable part, employing a simple yet effective O-ring design in the disposable product.

Maintaining sterility in the OR is a critical aspect of the hybrid phaco handpiece design. Mechanical seals in O-rings provide internal sterile barriers, and a blister pack facilitates sterile interaction between non-sterile and sterile components. The contact-free assembly of the disposable into the reusable ensures a tight connection, validated by a torque ridge that breaks at a specified torque, offering a visual cue for successful connection. This usability design, validated with healthcare professionals, adds safety and fits the quick nature of cataract procedures.

The innovative sterile handover method is implemented through the packaging itself, acting as a sterile barrier between different nurses handling the disposable and reusable components. During handover, a pre-attached sterile tube sleeve is unrolled over the non-sterile component. This ensures a seamless and sterile transition during assembly, minimizing the risk of contamination.

A comprehensive functional analysis validates the hybrid design, ensuring it meets specifications. Insights gained from this analysis guide further mechanical tuning, particularly in aspects influencing ultrasound characteristics. Beyond functionality, the hybrid phaco handpiece design has environmental implications. By eliminating the need for energy-intensive sterilization procedures and reducing waste from disposable wraps, the design reduces its climate impact by 67% over the entire life cycle.

This hybrid phaco handpiece design represents a step towards a circular system in the field of cataract surgeries. Balancing functionality, sterility, and environmental impact, this novel approach not only provides new insight into sustainable phacoemulsification procedures, but also shows the potential of hybrid reusable and disposable products in healthcare.

The healthcare sector is one of the major contributors to negative effects on the environment. The healthcare sector is responsible for 7% of the total CO2 emission in the Netherlands (Milieuvoetafdruk rapportage, n.d.), 4% of waste, and 13% of use of resources (Green Deal Duurzame Zorg, n.d.). The emissions produced in, amongst others, the healthcare industry have a negative effect on the public health of the Dutch population. This paradox shows the growing need to make the healthcare sector more environmentally sustainable.

Project goal
This project aims to have a positive impact on the sustainability of the Interventional Cardiology department at Erasmus Medical Centre. The goal of the project is to:

“ Design a co-creation tool that provides a general approach for making medical products or protheses used at the Interventional Cardiology at Erasmus MC more environmentally sustainable. ”


Based on literature research and context research, multiple barriers and opportunties for co-creation of sustainable initiatives were found. These barriers were translated into opportunties for the design of the co-creation tool.
In the ideation phase, brainstorming sessies were held, and how-to questions were answered to find concepts for elements of the co-creation tool. The concepts were evaluated in multiple test sessions with people that work in the medical field and stakeholders from the Interventional Cardiology department. Iterations were made based on the insights from these test sessions.

Outcomes
A co-creation tool was designed for healthcare workers at the Interventional Cardiology department.
The tool consist of two different elements: The Sustainability Space, and the Co-creation toolkit.

The Sustainability Space serves as a basis for sustainability by raising awarenes and increasing the motivation for environmental sustainability amongst stakeholder at the Interventional Cardiology department. The Project Board provides a physical space for sustainabilty that attract attention, hereby raising awareness about the sustainability initiatives. The transparent presentation of the planned, active, and completed sustainability projects might help reduce the resistance to change, as this might be a consequence of unawareness of the need for sustainable improvements.

The co-creation toolkit provides a general approach for the initiation of sustainability projects. The steps in the proces help to establish or strengthen the relationships between stakeholders by creating mutual understanding. The collaborative goal setting activity helps to create goals that aim to align with the values and requirements of all stakeholders. This can create the feeling of a shared responsibility and ownership of the sustainability projects. Defining the goal (with a time-bound element) will improve the change of a succesful completion of the project.