General introduction of the problem

If you want to contribute to our hospitals fitting better in a sustainable world, then this project needs you! Current clinical care pathways are optimized to deliver high quality healthcare. However, the clinical procedures and the use of the various devices often require substantial resources (energy, water, fossil plastics, (rare) metals, etc.). One of the most extreme in this is dialysis: the environmental load of treating patients here is about 18 times higher than for the average hospital patient. Main contributors are the high demand for electrical energy, water, and plastic materials.

There exist several ideas for making haemodialysis more sustainable and bringing it closer to circularity. Examples are using the excess of heat of machines for heating up the dialysate, reusing the spent water for other purposes, regenerating the dialysate for reuse, extracting the constituents of dialysate as a source of hydrogen (energy) and fertilizer (N, P, K), or recycling of used materials without introducing any form of biohazard into the old or new chain. Besides, it is unclear what the long term consequences are for costs and benefits.

The student is asked to investigate the environmental load (by performing a Life Cycle Analysis (LCA)) of current dialysis and of new (possibly more sustainable) alternatives. 

The internship will include the following

• Training on performing a 4-factor LCA capturing social, environmental, health, and financial impacts
• Map different patient pathways for kidney failure
• Collect data for the LCA at the dialysis department of UMCU and Dianet (dialysis clinic)
• Perform a 4-factor LCA on different dialysis modalities in the center and at home and compare the impacts
• Support publication of the results (possibly as co-author)

Derived insights into hotspots will be used to design the new Haemodialysis Department of the University Medical Centre Utrecht which is going to be rebuilt in near future.

Background to the project

An important theme within UMC Utrecht is the transition towards a circular safe hospital by developing and implementing systemic transdisciplinary circular (ánd safe) strategies, and scalable solutions to minimize the ecological footprint and negative effects of the sector on global health, so in line with the Green Deal Sustainable Healthcare.

The healthcare sector is one of the most carbon-intensive sectors, contributing to 7% of the emissions in the Netherlands and responsible for 13% of the national footprint of material extraction. This is why the Dutch government has called for more environmentally sustainable healthcare and requested the sector – and hospitals in particular – to reduce their impact, and become fully circular by 2050. The materials and manufactured products should be used as long as possible, typically through sharing, leasing, reusing, repairing, and refurbishing. Waste is reduced to a minimum. When products can no longer be used or repaired, recycling will keep the materials within the economy. Clinical care pathways are optimized to deliver high quality healthcare. However, the clinical procedures and the production of used devices often require substantial resources (energy, water, plastics, (rare) metals, etc.). Moreover, the use of disposables has increased in recent years as they are low cost, have low infection risk, are labour extensive and easy to use, and (previously) always available. However, this increase of single-use products is at odds with the objective of making healthcare circular. While for many disposables a reusable variant is available, for others a safe reusable alternative should be developed. Economic, logistic, regulatory, and behavioural barriers need to be resolved.

Usefull links and literature

• EWUU: https://ewuu.nl/en/
• Final Report_Research_Disposable medical products used at UMCU
• Previous LCA analyses (e.g. Impactanalyse MVI UMC Utrecht – September 2018; Eénmalig of herbruikbare partusset? – Juli ‘21)
• Barraclough, K.A., Agar, J.W.M. Green nephrology. Nat Rev Nephrol 16, 257–268 (2020). https://doi.org/10.1038/s41581-019-0245-1
• Vanholder, R. et al. The European Green Deal and nephrology: a call for action by the European Kidney Health Alliance. Nephrology Dialysis Transplantation, 2022. https://doi.org/10.1093/ndt/gfac160

Contact: If you have any questions or are interested in this project, do not hesitate to send an e-mail to: k.g.f.gerritsen@umcutrecht.nl