This research investigates the implementation of sustainable alternatives to reduce the use of disposable absorbent pads in hospital care, focusing on the Obstetrics and Endoscopy departments of Reinier de Graaf Hospital. A mixed-methods approach was applied, combining literature review, stakeholder interviews, pilot studies, and clinically oriented absorption tests. Results from the absorption tests show that reusable products, such as washable pads and towels, can provide comparable performance to disposables when applied in a taskand context-specific manner. Pilot studies emphasized that successful implementation requires not only technically adequate and more sustainable alternatives, but also logistical integration, clear communication, and bottom-up staff involvement.
The application of the COM-B model demonstrated that psychological capability is a major barrier, as healthcare staff had limited knowledge of sustainability. Physical opportunity also played a role, with high workload limiting the time available for behavioural change. The Behaviour Change Wheel indicated that these barriers can be addressed through education and environmental restructuring, increasing awareness and supporting adaptation via integration into existing logistical workflows. The Consolidated Framework for Implementation Research highlighted the role of opinion leaders and implementation facilitators in bridging the gap between Green Teams and the sustainability coordinator.
Overall, this study concludes that reducing disposable absorbent pad use is both feasible and desirable, provided that product performance, workflow integration, and organisational support are combined with behavioural interventions and hospital-wide awareness. These findings contribute to the development of practical strategies for sustainable healthcare implementation.

Background This report presents the design and initial validation of the Delft Car Pack (DCP), a mobile chest X-ray device developed for tuberculosis (TB) screening in rural areas of Africa, classified as a low and middle-income region (LMIC). TB screening in LMICs, particularly in remote areas, poses significant challenges due to limited infrastructure, a shortage of trained radiologists, and a lack of reliable, portable screening equipment. To address these specific barriers, the DCP was developed, a pick-up-mounted X-ray system that combines mobility with Delft Imaging’s (DI) AI-powered detection software, CAD4TB. This integration enables dependable TB screening without requiring a radiologist. The DCP bridges the gap between Delft Imaging’s two primary transportable X-ray solutions: the Delft Light (DL) and the Mobile Clinic (MC). The DL is an ultra-portable, backpack-based X-ray unit, while the MC is a truck mounted system offering enhanced safety and image quality at a significantly higher cost. Although highly mobile, the DL presents challenges in safety, power consumption, image quality, and usability. Conversely, the MC addresses these limitations but is approximately ten times more expensive and cannot reach many hard-to-access locations. The DCP is designed to offer a balanced alternative, combining the affordability and mobility of the DL with the improved safety, usability, and image quality of the MC.
Method The design process was guided by the following core values: radiation safety, power consumption, X-ray image quality, usability, cost, and spatial fitting. These values were identified through field research that included qualitative interviews and Likert-scale surveys with experienced DL/MC users. Based on this user input, the values were translated into a set of design requirements, which were subsequently validated through conceptual analysis, radiation safety testing, and CAD modelling.
Results The key results are as follows. Radiation safety was assessed using a test setup, which showed that the radiographer receives a dose of 0.015 μSv per X-ray. This results in an annual exposure approximately three times lower than the 1 mSv safety threshold, assuming 200 X-rays are taken per day, five days per week. For power, the recommended daily battery capacity, including a 30% degradation margin, was determined to be approximately 956 Wh. To increase the X-ray quality in comparison to the DL, the DCP features a 110 kV X-ray tube (DL: 90 kV) connected to a digital detector by a rigid X-frame (source-to-image distance 1.25 m). The load-bearing capacity of this frame still requires testing. To enhance usability, the DCP includes a fixed lead barrier, supports simultaneous charging of the tube and detector during operation, and minimises user interaction to a single power cable. The estimated purchase price is expected to fall between that of the Delft Light and the Mobile Clinic. Finally, CAD models confirm that the DCP fits within a Toyota Hilux Double Cab and accommodates participant heights ranging from 1.45 to 1.90 m.
Conclusion This report outlines the initial design and validation phase of the Delft Car Pack (DCP). The system was assessed against the core values described earlier. Preliminary results show that radiation safety and power requirements have been successfully validated through empirical measurements. The validation of cost, spatial fitting, and usability appears promising, although usability still requires confirmation through field testing. Finally, the robustness requirements have yet to be verified through structural analysis and real-world evaluation. The prototype has already progressed to the development phase, reflecting Delft Imaging’s confidence in the DCP’s practical utility and potential impact. Continued development represents a crucial step toward increasing access to high-quality TB screening in remote and underserved 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.

Cervical cancer remains a major global health challenge and is one of the most frequently diagnosed cancers in women worldwide. Brachytherapy plays a central role in its treatment, particularly in locally advanced stages. Brachytherapy enables the precise delivery of high radiation doses directly to the tumour while limiting exposure to surrounding healthy tissues, making it a widely adopted and effective modality. To support the development and evaluation of brachytherapy procedures, anatomically realistic and mechanically representative pelvic phantoms are essential. These phantoms provide a safe and repeatable environment for testing needle insertion, assessing imaging compatibility, and exploring strategies for dose distribution, all without risk to patients. By replicating pelvic anatomy and enabling validation through CT and MRI guidance, such phantoms contribute to improved clinical accuracy and innovation in treatment planning.

This thesis presents the design and validation of a modular, anatomically accurate female pelvic phantom intended for research in gynaecological brachytherapy. The phantom was developed to support needle insertion and compatibility with computed tomography (CT), magnetic resonance imaging (MRI), and electromagnetic tracking (EMT).
The phantom includes soft-tissue components representing the vaginal canal, cervix, and surrounding support structures, cast from a silicone–cornstarch mixture and suspended within a rigid 3D-printed pelvic frame. An interchangeable tumour insert and surrounding tissue volume were incorporated to provide imaging contrast and enable clinical variation. Material testing guided the selection of suitable silicone mixtures for different tissue regions. To validate the usability of the phantom, ten interstitial needles were inserted and recorded using both CT and EMT. Custom registration using rigid and affine transformations was implemented to align needle trajectories from CT and EMT, enabling quantitative comparison of tip positions and insertion angles. This resulted in a median deviation in tip position and insertion angle of 11.06 mm and 8.04°, respectively. MRI scans further confirmed that the phantom produces sufficient contrast between different elements in the phantom.

In conclusion, the phantom was compatible with clinical tools and imaging modalities such as MRI, and enabled comparison of needle trajectories across CT and EMT. Although the validation was limited in scope, the results confirm that the phantom design is usable in the brachytherapy context. Opportunities for phantom improvement are discussed. With further development, the phantom can serve as a valuable platform for both validation and training in gynaecological brachytherapy.

Capillary refill time (CRT) is a simple, non-invasive bedside test used to assess peripheral perfusion. In critical care, particularly in conditions like septic shock, early and effective resuscitation is essential for reducing mortality. While traditional hemodynamic monitoring techniques, such as central venous oxygen saturation and lactate clearance, provide valuable insights, they often require invasive procedures, limiting their accessibility in resource-constrained settings. Recent clinical studies, including the ANDROMEDA-SHOCK trial, have highlighted the potential of CRT as an alternative resuscitation target, showing that CRT-guided resuscitation may lead to lower mortality rates compared to lactate-guided strategies. However, traditional CRT assessment is subjective and prone to variability between clinicians, as it is typically performed manually through visual inspection and timing.

This thesis presents the development and validation of a novel CRT measuring device designed to measure CRT automatically. The system integrates an optical sensor, LEDs, and a signal processing algorithm to measure the reflected and transmitted light through the finger and calculate the time it takes for blood to return to the capillaries after pressure is applied. Five different light wavelengths were tested (reflected red (620 nm), green (520 nm), blue (465 nm) and transmitted red (620 nm), and infrared light (940 nm)) to determine the optimal wavelength for CRT measurement.

To validate the system’s accuracy and determine which light wavelength is better for CRT measurements, experimental tests were conducted on 12 healthy volunteers. The experiments involved immersing the subject's hand in cold water to induce vasoconstriction and inflating a blood pressure cuff around the arm to temporarily stop blood flow, simulating peripheral perfusion failure. The results showed that all tested wavelengths were able to detect the peripheral perfusion changes, with findings suggesting that transmitted red (620 nm) and infrared (940 nm) light provide the most reliable measurements. Further research is needed, but this automated device has the potential to improve the objectivity and reliability of CRT measurements and contribute to its standardization.

Purpose. Patient-tailored cervical cancer brachytherapy applicators may improve treatment outcomes over clinical applicators. There is a need for automated design and treatment planning as this is a complex, time consuming process. The ARCHITECT project has developed fully automated 3D printed personalised applicators, matching and improving conventional treatment. However, small postprocessing modifications may often be needed as it is difficult to quantify all criteria used during treatment planning. Current treatment planning systems allow physicians to adjust dwell times, but do not support modifications to automated needle configurations. This work presents an approach for real-time needle replanning in patient-tailored applicators demonstrated through a graphical user interface. Methods. Our approach to perform real-time replanning consists of a heuristic convex-decomposition step followed by quadratic optimisation. Safe flight corridors (SFCs) were generated by inflating a symmetric ellipsoid around automated trajectories and iteratively selecting tangent planes to form a convex volume. Needle trajectories were represented by Bézier curves and optimised considering the boundary volume constraints. Replanning could be done by the user by modifying the interstitial part of the needles through a graphical user interface developed in MATLAB. The algorithm was tested with a database of 20 patients, a dosimetric study was carried out with 5 of those patients and the GUI was evaluated with a usability study involving 8 participants. Results. Replanning of individual needles could be performed in <1.0 s with optimisation times of ~0.01 s followed by a feasibility check of 0.5 s. SFC generation and trajectory optimisation were tested with 99 needle channels (20 patients) showing an error rate of 17%. Replanning in a case study to demonstrate dosimetric benefits in 5 patients was feasible, however, did not lead to clear improvements in dose conformity. The interface received a usability score of 73 (min=57.5, max=92.5) from participants. Conclusions. The algorithm and interface were validated and used successfully. However, their use in a clinical setting requires improvements or exploration of alternative approaches to increase robustness.

Needle Stick Injuries (NSIs) are a significant occupational hazard for healthcare workers, exposing them to life-threatening pathogens such as HIV and Hepatitis B and C. Although safety-engineered devices have successfully reduced NSI rates in high-income countries, their high costs, limited adaptability, and environmental impact hinder their adoption in low- and middle-income countries.

This thesis addresses the need for a cost-effective, sustainable, and user-friendly needle safety system applicable to low- and middle-income countries, particularly in Nepal. The objective is to explore the solution space and propose an optimal blueprint for a needle safety system for this context, in order to provide the foundation for a novel needle safety system.

To achieve this, multiple design phases and a field trip are performed. The exploration of the solution space is guided through the elimination by aspects decision-making strategy through multiple design phases. The first started with conceptual strategies ought to solve the composed design brief; the remaining two strategies were translated into concepts that were ultimately developed into MVPs. Within this process, concepts were discontinued on the basis of the elimination by aspects method. This resulted in one efficient strategy. From this process, two effective devices employing the strategy are identified.

Validation trials in six Nepali hospitals demonstrated their effectiveness, usability, and acceptance among healthcare workers, emphasizing their potential to address the challenges faced. In addition, the field trip validated the problem analyses and underscored the need for such solutions. Both systems can meet the design requirements described and perform well in the performance metrics. The concepts provide a foundation for future development, marking a step toward safer, more affordable, and sustainable needle practices.

Future research should explore the market need for the proposed one-handed and handheld solutions. Finally, the proposed solutions can be optimized to lower force requirements and must be refined for large-scale production and ensure compliance with medical standards.

The focus of oxygen therapy in preterm infants is to strike a balance between the need for additional oxygen and preventing damage due to oxygen free radicals. Beyond merely providing extra oxygen, therapy should encompass the transportation, delivery, and extraction of oxygen tailored to the organs and tissue needs. This thesis explores the challenges that are related to optimizing oxygen therapy, and some of the advancements in automated control and non-invasive measurement techniques that could be used to improve the optimization...

Breast cancer is the most common cancer in women globally, and breast-conserving surgery (BCS), or lumpectomy, is the primary treatment for early-stage patients. However, achieving clear margins—when the tumor is fully removed—remains a challenge, often requiring re-excision surgeries or additional treatments. Surgeons rely on preoperative images and palpation to estimate the tumor’s borders, but these methods are not always accurate, with incomplete resections occurring in 10% to 50% of cases. In this thesis, we explore the integration of Diffuse Reflectance Spectroscopy (DRS), an optical tissue-sensing technology, into an electrosurgical knife to create a smart electrosurgical knife that addresses this issue. DRS helps to distinguish between cancerous and healthy tissues in real-time by analyzing optical properties, offering a potential solution to ensure clear margins during surgery. Researchers have shown that DRS can differentiate tissues based on their unique optical fingerprints, such as the Fat/Waterratio, which helps determine tumor borders.

We began by identifying the main challenges in combining DRS with an electrosurgical knife. Initial tests on porcine tissue examined the impact of electrosurgery on the optical fibers and their ability to distinguish between tissues (Chapter 2). Microscopic analyses revealed changes in the optical fibers and the formation of debris during electrosurgery, which could interfere with accurate tissue sensing. The chapter concludes with an assessment of the fibers' performance in delivering light and capturing DRS readouts before and after electrosurgery, highlighting the complexities of using this technology in a surgical environment and the need for design modifications to protect the optical fibers from the effects of electrosurgery.

To further investigate design iterations and verify the technology, we describe in Chapter 3 the developed tissue-mimicking phantom materials that replicate the optical properties of human breast tissue. Since breast tissue consists of multiple layers with varying optical characteristics, simulating these complexities was crucial to test the smart electrosurgical knife. These phantom materials mimic both healthy and cancerous tissues, providing a controlled environment to evaluate the knife’s ability to differentiate between tissue types. The results from this chapter helped refine both the design and testing methodology of the knife.

In Chapter 4, we focus on the continued development of the smart electrosurgical knife to ensure it can withstand the demands of prolonged surgery. Several designs were tested on porcine tissue to identify the most effective configuration for integrating DRS. These designs were evaluated for their ability to maintain accurate DRS readings while performing electrosurgery, which involves high temperatures and tissue coagulation. Further experiments using tissue-mimicking materials demonstrated the knife’s ability to identify distinct tissue layers in real-time during electrosurgery.

In Chapter 5, we continued to enhance the design process by incorporating feedback from clinicians. In the first part, the best-performing design from previous experiments was refined based on suggestions from surgeons who tested the device. Various design concepts were produced to optimize the knife's electrosurgical and cutting performance while ensuring the integration of DRS technology. In the second part, the knife's performance was evaluated during a simulated lumpectomy on a tumor-containing phantom. Surgeons performed the surgery four times—twice with a traditional electrosurgical knife relying on preoperative images, and twice with the smart electrosurgical knife providing real-time tissue sensing. The results showed that using the smart knife led to better surgical outcomes, highlighting its potential as an intraoperative tool for margin assessment and its promise for improving the precision and safety of breast cancer surgeries.

In Chapter 6, we focus on simplifying the technology for broader surgical use. We proposed using LEDs and photodetectors instead of wide-band light sources and spectrometers, creating a compact, console-free design. An electronic board was developed to identify optimal wavelengths for breast tissue, and a proof-of-concept showed that this system could distinguish tissue-mimicking materials. We envision a handheld device integrating DRS into the electrosurgical knife, removing the need for bulky equipment and paving the way for a more accessible, user-friendly tool in clinical settings.

Finally, Chapter 7 reviews the key findings from the research and presents concluding remarks. The thesis demonstrates the potential of integrating DRS into surgical tools for real-time tissue identification, offering a valuable solution to the problem of incomplete tumor resection.

Introduction - Post Partum Heamorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, necessitating immediate and effective intervention. Manual external aortic compression is a recognized technique for temporarily managing PPH, but it poses challenges such as physical strain on healthcare providers and difficulty maintaining compression during patient transport. This graduation project aimed to develop a device capable of managing PPH through external aortic compression, providing continuous and adjustable pressure on the abdominal wall.

Method - Through the mechanical engineering design process, including problem definition, requirement analysis, conceptualization, and selection, CAD designs were developed for two device modules. When combined, these modules form one cohesive device. Subsequently, two functional prototypes were made for each device module and subjected to three studies: an evaluation on healthy volunteers, a user study with healthcare personnel, and mechanical testing to assess structural integrity under load.

Results - The comfort and fit study with healthy volunteers indicated positive assessments for both belt prototypes. The user study revealed that the Semi-Rigid Belt combined with a Tooth-lock module, outperformed the Vacuum Belt with a Scissor Press module, in achieving successful aortic compression on a manikin. Mechanical testing demonstrated that all prototypes maintained structural integrity under the maximum expected operational loads, although some design enhancements were identified as necessary.

Conclusion - This study successfully developed and evaluated prototypes for an external aortic compression device aimed at managing PPH. While initial results are promising, further research and development are required to enhance the mechanical design and improve and indicate the device’s stability and effectiveness.

Leprosy is a neglected tropical disease affecting people worldwide. Left untreated or starting therapy too late, the infection can cause permanent damage to the nerves, skin, eyes, and limbs of patients. While current standard diagnostic techniques generally detect the disease once symptoms have manifested, infrared thermography presents a potential tool for the early detection of leprosy-related neuropathy. A research initiative has been established to explore whether autonomic nerve impairment in the hands can be identified using infrared thermography, necessitating a new method for temperature evaluation. This work discusses the development of a semi-automatic temperature analysis method for twelve regions of interest on the hands. The approach utilises real-time landmark tracking based on an existing machine-learning model, adapted to the context of the application. After applying a cold impulse and recording the response with an infrared camera, the rewarming temperature and recovery values are determined within the regions. Results presented in this report indicate no significant improvement compared to the existing manual method. The success of the model outcomes highly depends on the accuracy of the machine-learning-based hand landmark detection, resulting in insufficiently reliable outcomes. The underlying explanations and the potential for future improvements are further discussed in this thesis, considering the evident potential and benefits of the automated approach.

The human eye is a very delicate yet highly intricate organ, and treatments such as cataract surgery call for meticulous precision. Ophthalmologists hone their skills over years of practice, which they initially acquired during their studies in medical schools. Basic skills such as globe fixation and capsulorhexis training have a very steep learning curve as they are fundamental, albeit very challenging from the get-go. There is a lack of training simulators that can combine both surgical techniques as effectively and economically as animal eye setups. In this respect, the present research work aims at designing a cataract surgery eye phantom for capsulorhexis and globe fixation, which can replicate the movement of the eyeball in the orbit coupled with the inherent passive stiffness. The project culminates in the design of a 2-degree-of-freedom anterior human eye phantom with anatomically similar features of the human eye needed for training the aforementioned surgical steps. A significant part of the prototype structure is 3D printed using Draft resin V2 on the Formlabs Form 3+ printer to create minute yet almost anatomically impeccable components. Mechanical analyses were performed to tune the passive stiffness of the compliant mechanisms, and materials such as PlatSil Gel-00, hydrogel, and eggshell membrane were chosen and utilized to replicate the interactions between the tools and various tissues in the human eye. Clinical evaluations were conducted by a surgeon performing capsulorhexis on the prototype in a wet lab environment and several validation tests by an academic trainer for the suitability and practicality of the prototype. In that context, the present research serves as the first step toward creating innovative designs for training phantoms in the field of eye surgery.

This thesis proposes a method of detecting autonomic neuropathy in low-income countries using an infrared camera. Access to healthcare is often limited in low-income countries delaying the detection of neuropathy. If neuropathy can be detected in the earliest stage, often the autonomic state, damage to motor and sensory nerves can be prevented. To develop the method for detecting autonomic neuropathy, first the autonomic system was researched, followed by looking into the effects of neuropathy on the autonomic system to discover what physical properties might be measured with the detection device.
Four affected physical properties were determined through literature research: blood flow, blood pressure, skin resistance, and skin temperature. Of these properties, skin temperature was found to be the most promising based on a literature study, as it seemed to be both easily measurable and relatively independent of other bodily functions. Then the constraints of healthcare in low-income countries were examined and devices that work within these constraints were identified. Of these, the infrared camera showed the most promise, because of its ease of use and cost to accuracy ratio.
A single-subject study was performed to test the restorative capacity of the autonomous system by deliberately changing the temperature of the hand with a heating and cooling agent. Four locations were used on both hands, and both palmar and dorsal side of the hand, using different doses of the agents. The temperature change of the skin was measured using an InfraRed (IR) camera.
A large variation in results was found, but the results did show some evidence for structural differences in the temperature normalization between the affected and unaffected hand. The palmar side shows a stronger reaction than the dorsal side. The cooling agent seems to be more effective, but there are some caveats attached to its use. An interesting observation is that the most noticeable difference between left and right was measured in an area of low circulation. This gives some indication that this area has the most difficulty with returning to the neutral state.
Conclusion: This research shows that skin temperature variation as a result of applying heating or cooling agents to the skin can be measured using an infrared camera, suggesting that minor variations in skin temperature as a result of neuropathy can also be measured, further research with more test subjects should be done.

The availability of laparoscopy in low-income settings has been limited based on the requirements that have to be met to perform this type of abdominal surgery. At the same time, these regions and countries could stand to gain the most from it based on quicker recovery times and a lower chance of infections. Attempts have been made to solve this inaccessibility by minimizing the required components to perform this type of surgery at a substantially lower cost. None of these projects have resulted in a laparoscope that can compete with commercial laparoscopes regarding resolution, image quality, and critical design features such as viewing angle. Based on these shortcomings, this study aims to design a sub-500-dollar modular laparoscope for gas and gasless laparoscopy that adheres to state-of-the-art image quality and design features. The laparoscopes are designed following the 'Roadmap for Design of Surgical Equipment for Safe Surgery Worldwide”. Based on the roadmap requirements regarding the needs of patients, end-users, and stakeholders, were acquired focusing on cost, robustness, and reusability. Following the design process, two intermediate prototypes were developed, which were evaluated based on function and image quality by a laparoscopic surgeon to validate the requirements and receive design feedback. They resulted in a modular laparoscope that connects with USB to a laptop, which shares the image sensor, light source, electronics, and handle between the laparoscope for gas and gasless laparoscopy. The gasless laparoscope employs a flexible chip-on-the-tip design that can be straightened for entry through a trocar and released to set the tip angle at 30 degrees. The gasless laparoscope does not have to comply with the trocar and can enter straight through the abdominal entry point. Resulting in a chip-on-the-tip design, which is statically bent at an angle of 30 degrees. To validate the design, a laparoscopic surgeon evaluated the function and image quality, and additional tests were performed to validate the thermal and reprocessing capability. The study resulted in a modular sub-500-dollar laparoscope for gas and gasless laparoscopy, which shows great potential but requires future work to be certified and production-ready.

Providing adequate healthcare in low- and middle-income countries (LMICs) faces significant challenges due to the frequent failure of medical devices, including hospital beds. These failures arise from environmental stressors, resource limitations, and design mismatches that fail to address the specific needs of LMIC settings. This thesis examines these challenges and develops a robust and modular solution tailored to these contexts, focusing on designing an appropriate backrest movement mechanism as a foundational component of a Universal Modular Hospital Bed.

Hospital beds are essential medical devices that provide quality patient care, comfort, and safety. However, existing designs often need to be more suitable for the harsh environmental conditions and resource constraints of LMICs, leading to high failure rates, compromised patient safety, and increased operational costs. This research addressed these gaps by designing a backrest movement mechanism that prioritizes durability, affordability, and contextual adaptability while laying the groundwork for a Universal Modular Hospital Bed suitable for diverse healthcare environments.

The study employs a comprehensive methodology integrating a systematic literature review, fieldwork, and a structured design process. The literature review identified key causes of medical device failures in low- and middle-income countries (LMICs), including environmental challenges, maintenance issues, and inadequate design considerations, which also apply to hospital beds. Fieldwork in Nepal, Suriname, and the Netherlands assessed hospital bed performance in different contexts. Drawing from these insights, a structured design process was used to generate, evaluate, and refine several concepts for a backrest movement mechanism. The chosen concept was then validated through prototyping and testing to ensure it met performance criteria, including robustness, safety, and ease of maintenance.

The research revealed that hospital beds in LMICs frequently fail due to high humidity, fluctuating temperatures, and unreliable infrastructure, compounded by limited access to spare parts and maintenance expertise. These challenges necessitate a context-sensitive design approach. The designed solution for the backrest movement mechanism employs a counterweight-based system that is manually operated, minimizing dependency on electricity and ensuring usability in resource-constrained settings. The design's modularity allows for easy maintenance, scalability, and integration with more advanced features, making it suitable for LMICs and high-income countries (HICs).

The backrest movement mechanism developed in this study addresses the critical challenges of hospital bed performance in LMICs. Its modular design ensures adaptability and compatibility with various healthcare settings, while its robust construction enhances durability and reduces maintenance costs. By focusing on local manufacturing and cost-effective materials, the design promotes accessibility and sustainability.

Future research should focus on scaling the modular design to incorporate additional features such as height adjustment and lateral movement systems. Collaborations with local manufacturers and healthcare providers are recommended to facilitate adoption and implementation. Long-term field testing will further validate the design’s efficacy and provide insights for continuous improvement. This study contributes significantly to developing medical devices that are both contextually appropriate and globally adaptable, addressing a critical gap in healthcare infrastructure in LMICs.

This study investigates surgical stainless steels 304, 410, and 420 corrosion susceptibility under manual reprocessing conditions typical of low- and middle-income countries (LMICs). Cleaning protocols using sodium hypochlorite and the enzymatic agent Sanizyme were compared alongside an accelerated Salt Mist Test to explore predictive value for corrosion. Results show that sodium hypochlorite causes rapid corrosion across all steel types. In contrast, Sanizyme significantly delays corrosion onset and reduces the affected surface area, with stainless steel 304 demonstrating the most outstanding resilience. Minor differences between 410 and 420 were observed, with no significant performance distinction.
Including 2-hour rest periods, intended to activate stainless steel’s self-healing properties, did not significantly impact corrosion resistance. Additionally, the Salt Mist Test showed limited correlation with corrosion development observed under manual reprocessing conditions, indicating the need for refined predictive methods. These findings suggest that gentler enzymatic cleaning protocols enhance the longevity of surgical instruments in LMIC contexts, while accelerated corrosion tests may require adjustments to simulate clinical reprocessing better.