How do you redesign a medical device to be both circular and nurse-friendly?

Nine Industrial Design Engineering (IDE) students from the TU Delft took on the challenge! They redesigned the urine meter with a focus on circularity, as part of the Product Futures course during the last semester. This project was carried out in collaboration with the Intensive Care Unit (ICU) of Erasmus MC.

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We need the whole system in the room – To get there – Together

On Wednesday June 4, Prof. Dr. Ir Erik van Raaij, board member of ESCH-R and WP4 lead, delivered his inaugural lecture as new chair “Sustainable Procurement in Health Care” at Erasmus School of Health Policy & Management (ESHPM) and Rotterdam School of Management, Erasmus University.

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PhD webinar ESCH-R PI Nicole Hunfeld

The Green ICU: How can we make impact together?

On Wednesday, the 28th of May, Nicole Hunfeld (Principal Investigator ESCH-R) presented about: “The Green ICU: How can we make impact together?”.

Intensive Care Units (ICU) are among the largest polluters within Dutch hospitals. According to the 2023 Lancet Countdown report on health and climate change, the healthcare sector in the Netherlands is responsible for 7% of national CO₂ emissions – with ICU’s being the second largest emitters within hospitals. The Operating Rooms (OR) come in first place, as being the biggest emitters.

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From infusion to tablet: the paracetamol challenge is a real win-win-win

You can’t avoid it in many hospitals: a giant paracetamol rolling through the corridors. This giant pill is part of the ‘paracetamol challenge’, started by hospital pharmacist Nicole Hunfeld at Erasmus MC. In this video, Hunfeld tells more about the challenge: “Tablets are cheaper, save time for the nurse and reduce waste.

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Recap of the ESCH-R PhD Day at UMC Utrecht

On May 26th, the ESCH-R PhD community came together at UMC Utrecht for an inspiring and hands-on PhD Day focused on co-creation and circularity in healthcare.

Morning Session: Co-Creation Workshop
Led by Jotte de Koning and Ayşegül Özçelik, the morning kicked off with an interactive co-creation workshop designed to explore how our ESCH-R PhD researchers can apply co-creation in their own scientific work and also the importance of co-creation in the development of products and services used in healthcare settings. The PhD’s developed practical co-creation plans by answering key questions: What is your goal? Who do you want to involve? What setting works best?

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ESCH-R presents research progress to a delegation of top-level managers and cardiologists from healthcare institutions from Poland

On Monday, May 19th, Jasper Klasen, PhD student in WP5 for the ESCH-R project, had the honour of presenting the ESCH-R initiative to a delegation of top-level managers and cardiologists from healthcare institutions from Poland. This insightful meeting was organized by the Ministry of Health, Welfare and Sport (VWS).

The session provided a platform to delve into the Green Deal and showcase the initial research outcomes from ESCH-R. Jasper shared key findings, including his first  published paper as an ESCH-R PhD and the ongoing waste audit conducted with waste coming from the department of interventional cardiology of the Erasmus MC. Part of the presentation was also dedicated to an engaging discussion on the differences and similarities between the Polish and Dutch contexts regarding sustainability in healthcare.

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ESCH-R Work Package 4 at the TU Eindhoven campus

On May 13, Work Package 4 took the next step in defining the circular healthcare ecosystem through a co-creation process. Building on the key stakeholders identified during the session of 11 February, they explored their roles, activities, and characteristics, as well as what they would need to successfully transition to a circular ecosystem.

A particular focus was placed on the issue of data exchange, such as the importance of being able to track product usage throughout their lifecycle, along with their environmental impacts across all stakeholders in the hospital supply chain. This traceability would not only enhance transparency but also empower stakeholders to make more responsible and informed decisions.

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ESCH-R Podcast EP3 with Harald Tepper from Philips!

Our third ESCH-R Podcast! A circular approach for medical devices in action: Ecodesign with Philips 🏥🌍 Join us as we explore the challenges and opportunities in transitioning healthcare towards a more circular future! 

This episode features Harald Tepper from Philips, discussing Ecodesign: what is it, and how does Philips use this circular design principle when developing new products? And how do companies like Philips and hospitals such as Erasmus MC and UMC Utrecht collaborate within a public-private consortium to drive innovation in healthcare through circular design and sustainable product development?

Each episode will be in Dutch with some interviews in English.

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ESCH-R Waste Audit

At the beginning of April, Maurice Kloos, a student from Hogeschool Rotterdam, and Jasper Klasen, ESCH-R PhD student, began working on an ambitious task: mapping the complete material flow within the Interventional Cardiology department. To achieve this, Maurice and Jasper are conducting a detailed waste audit: collecting and analyzing surgical waste to identify which products are used, and in what quantities. This audit marks the beginning of a larger effort to map over 100 individual procedures!

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Focus group discussions at the Obstetrics Department Erasmus MC

On the 23rd and 24th of April, Ellen Bakker (WP6 lead of ESCH-R) accompanied Rienke de Jong, a nursing student from Rotterdam University of Applied Sciences and intern, in two focus group discussions with nurses, nursing students, and maternity care assistants at the Obstetrics Department of Erasmus MC. During these sessions, participants actively contributed ideas for making healthcare practices more circular and sustainable.

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Sensing a Sustainable Future – Graduation Master student Fiene Kuiper

On Friday April 25th, Fiene Kuiper, Master Student Integrated Product Design at the TU Delft, presented her graduation project called: “Sensing a Sustainable Future”. During her graduation project Fiene has analyzed and redesigned pulse oximeters from a circularity perspective in hospitals.

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Wittenburg Group visits ESCH-R Living Lab in Erasmus MC

Han Buck, master Industrial Design student at TU Delft, is researching how she could design a more sustainable version of the infusion bag for her master graduation project. Infusion bags are a large source of hospital waste and are currently not being recycled. 

Anne Traa (Vice Director) and Winfried Lange (Key Account Manager / Global Project Manager Medical Plastics) from Wittenburg Group visited the ESCH-R Living Lab at Erasmus MC, last April. Together with Jan Carel Diehl (WP5 lead), Jasper Klasen, and Han Buck, they discussed the progress of Han’s graduation project and explored potential directions for future research. For this project, Erasmus MC and TU Delft work closely together with ESCH-R consortium partner Wittenburg Group, because of their deep knowledge on plastic formulation.

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Circular material flow of medication in the intensive care unit

20 May, 2025
Published in: Critical Care
Authors: Jasper Klasen, Silke Rijcks, Diederik Gommers, Jan Carel Diehl & Nicole Hunfeld

Abstract

Background
Intensive care units (ICUs) contribute significantly to healthcare’s environmental footprint, with medications playing a major role. This study performed a comprehensive Material Flow Analysis (MFA) of medications in a large academic ICU to quantify material flows and identify opportunities for sustainability.

Methods
A single-center MFA was conducted at a 50-bed ICU, analyzing all medications delivered in 2023. Medication and packaging components were weighed and categorized by active pharmaceutical ingredients (APIs), excipients, and packaging type. Total annual mass as well as daily medication and packaging waste per patient were calculated.

Results
The annual medication inflow totaled 234,337 kg, including 194,411 kg of medication content (5287 kg APIs, 189,124 kg excipients) and 39,923 kg of packaging. APIs constituted only 2.3% of the total medication mass. On average, patients received 89.5 medication units daily, totaling 5.0 kg of medication and generating 1.7 kg of packaging waste. Waste outflow comprised 194,413 kg to the sewage system, 21,894 kg for incineration, and 18,030 kg recycled, consisting primarily of continuous renal replacement therapy (CRRT) bags.

Conclusions
This MFA highlights significant opportunities to enhance ICU medication sustainability by targeting CRRT-related waste, optimizing fluid formulations to reduce excipient use, and minimizing packaging. These findings support the development of targeted interventions to reduce the environmental footprint of critical care.

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ESCH-R Publication Procedure

We would like to remind you of the ESCH‑R publication procedure. Please make sure to fill in the publication template when planning a scientific publication.

The ESCH‑R project board has established this procedure to provide guidance and ensure transparency for all researchers and partners within the ESCH‑R consortium. By submitting your manuscript plan at an early stage, the project board can offer advice on potential collaborations, data availability and management, publication formats, license options to help avoid article processing charges (APCs), and the correct way to acknowledge ESCH‑R in your publication.

You can find both the explanatory document and the template in Teams.

If you have questions, feel free to reach out to Naomi: n.kakiailatu@erasmusmc.nl

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We are keen to post a bio of everyone involved in this project on the website and in the newsletter as well! 

Herewith the format:

• Who am I?
• What do I do?
• What am I up to during ESCH-R? Connected to which WP? Which cases do I work on?
• What do I expect to accomplish within ESCH-R?

Please share your bio and picture with maaike@esch-r.org.

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Who am I?
I’m Naomi Kakiailatu, project manager of ESCH-R. I have a background in the biomedical field, with a bachelor in Bio-Pharmaceutical Sciences and a master in Biomedical Sciences. I’ve done my PhD at the Department of Clinical Genetics at Erasmus MC, where I studied Hirschsprung disease and I’m very excited to defend my thesis in September. In April, I joined the Project Management team at the Research Development Office at the Erasmus MC. I enjoy bringing people together, organizing projects, and making sure things get done. I was born and raised in Rotterdam and have Moluccan roots. Outside of work, I love to travel, go for walks in the forest, train for HYROX, and spend time with family and friends.

What do I do?
As a project manager, I help coordinate the overall progress of ESCH-R. I support the work package leads, monitor timelines and deliverables, facilitate communication between partners, and ensure we stay aligned with the project goals and reporting requirements.

What do I expect to accomplish within ESCH-R? 
My goal is to ensure that the project runs smoothly and efficiently, and that all work packages are well-supported in achieving their aims. I hope to contribute to a strong collaboration across partners and help make ESCH-R a success both in terms of scientific output and societal impact.

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Who am I?
I am Behrang Manouchehrabadi, a Postdoc, at the Erasmus School of Economics to join the ESCH-R consortium.  I did an MS and PhD at Rotterdam School of Management. My area of research is business sustainability, contracts and governance structure and behavioral science. I live in Rotterdam. Prior to joining the team, I worked as a researcher at the Wageningen Economic Research for several years.

What do I do?
I am a quantitative researcher applying mathematical tools to tackle sustainability problems especially business models and supply chain governance . I also use econometric methods such as forecasting and causal analysis to provide insight into policy design problems. In addition, I am familiar with behavioral economics and combine insights from behavioral economics to analyze and design interventions. I am mainly connected to WP4, but will contribute to WP2 and WP3 as well.

What do I expect to accomplish within ESCH-R?
I expect to be good and pleasant team worker and build lasting relationship with the rest of the team. Next, I expect to contribute to the development of business models that enhance circularity within the healthcare system. This implies analysis of procurement and supply chain relationships in the healthcare domain. I would also like to further develop my understanding of LCA methods and contribute to the application of LCA methods for WP2. Last but least, I intend to contribute to the design of interventions that enhance circularity in the Dutch healthcare system.

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Concentrated Impact – Rethinking Dialysate Delivery

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ESCH-R Online Communication Session

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PAC Meeting

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ESCH-R PhD and Postdoc visit to PreZero

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ESCH-R Community of practice for Nurses and Educators

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Lof der Geneeskunst

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ESCH-R PhD and Postdoc visit to DORC

Have you attended a conference and presented your research about ESCH-R? We would love to feature your insights!

Please share:

• A short text about your experience: key takeaways, the research you presented, and any relevant highlights.
• Photos of your presentation, poster, or the event.

We will use your contribution for our website, newsletter, and possibly social media!

Please share your text and photos via info@esch-r.org

If you post on social media yourself, feel free to use these hashtags:
#circularhealthcare #circularity #ESCH-R #circularhospital #sustainability #research #greenhealthcare

Are you presenting soon and need a research poster template or Powerpoint template?
Download the ESCH-R Poster template and Powerpoint template via the button below.

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Would you like to share your ESCH-R news? Whether it’s vacancies, new PhDs, student achievements, research updates, publications, tweets, media appearances, or anything else, we’d love to hear from you! 

When sharing your news, please make sure to attach your photos/images or figures and always make sure when people are visible, you have their permission to use the pictures.

Below the format you can use to share your news with us:

• What is the purpose of your news? 
• What title can we use?
• Who attended (names, roles, if related to INDICATE meetings/events)?
• What were the main topics discussed or key findings?
• Were any follow-up actions or appointments agreed upon?
• Is there anything special or noteworthy?

Share your updates with us via info@esch-r.org, and we’ll include them in our next newsletter!

Have you been approached by a journalist for an interview or article about ESCH-R? Please let us know! We coordinate PR efforts to ensure clear and consistent messaging.

Before responding, reach out to Maaike and Nicole so we can align and provide any necessary support.

Thank you!

ESCH-R 

Email adress: info@esch-r.org
Email adress: ESCH-R@erasmusmc.nl
Website: www.esch-r.org