Healthcare saves lives but also pollutes the environment. In terms of pollution, just 1 day of intensive care care at Erasmus MC is equivalent to driving 2000 km, clearing 200 m² of forest and using at least 15000 liters of water. Hospital pharmacist Nicole Hunfeld wants to make this IC the first circular IC in the world, without even 1 gram of waste. 12 meters of plastic hoses, 108 gloves, 57 compresses, 24 syringes, 16 insulating coats, 8 pads. Nicole Hunfeld, pharmacist in the ICU of Erasmus MC, sums up what she sees, pointing to a mountain of waste on an ICU bed. She has spent the past 24 hours collecting all the supplies needed to care for one patient. The bed is barely visible, because the packaging materials are also good for 7 full garbage bags. “The first time I saw this, I was shocked,” Hunfeld says. At the end of last year she took up the challenge to make her IC more sustainable. Goal: a fully circular department by 2030. 'Where we reuse all raw materials and equipment and where we no longer produce a gram of waste.' Confronting The ambitious plan arose in Covid time. The doctors and nurses temporarily collected the waste in bins in the hallway. Hunfeld: 'It was very confronting to see those bulging bins with protection and packaging materials together. I immediately thought: so many things that go to waste incineration, that really has to change.' Not only ICs, other care departments and institutions are also major polluters. In total, the Dutch healthcare sector is responsible for almost 7 percent of national greenhouse gas emissions. "It is mainly the production, transport and waste incineration of medical products that cause the emissions," says Diederik Gommers, head of IC at Erasmus MC and chairman of the Dutch Association for Intensive Care. Weigh everything On his own IC, the first step has now been completed. “To start with, we had to know exactly what will enter our IC in one year, what we will use and consume. And, of course, what goes off from our department. That's why we started weighing everything from needles to textiles and medicines. At the end, the counter stood at 250,000 kg of stuff," says Hunfeld. The company Metabolic, specialized in sustainability, was called in to analyze what happened to the products and what the impact is on the environment, together with Erasmus MC buyer Maarten Timmermann. For example, 172,000 of the 250,000 kg flows through the sewer and 50,000 kg is incinerated as hospital waste. Hunfeld: 'In terms of environmental impact, that is equivalent to driving 2000 km per day. For afforestation, we take 7.5 football fields of trees for the production of materials. And that production requires almost 4 million liters of water.” Do we really need 16 plastic aprons per day per patient? With this knowledge, the IC can take new steps. Can doctors and nurses, for example, be more aware of how they use the materials? ‘We hold sessions where they can think along. That's useful information. For example, it turned out that nurses also use pads, intended to collect urine from patients, for other things, for example to put on medical instruments. Now that they know how bad these mats are for the environment, they are looking for other solutions.' Or take the aprons, made of plastic. Do we really need 16 per day per patient? And do they have to go after 1 use? In terms of ecological footprint, throwing away 1 apron is equivalent to washing 20 times. So maybe we should just go back to the cloth jackets.” Bubbling with ideas Involving nurses and doctors in sustainability is extremely important, Gommers also notes. “In the end, they have to work with the products and they will soon be able to collect them separately. Moreover, they themselves are brimming with ideas and they really see it as a challenge to make the IC more sustainable.' In order to really become more sustainable, the suppliers must also participate. “We desperately need them to get products that have less of a burden on the environment. Now, for example, 1 patient needs 1 box of gloves per day. Its production costs an enormous amount of water. The material itself is also harmful to the environment. As a hospital and wholesaler, we can use our purchasing power to stimulate the demand for circular products.' Green Deal Making the IC more sustainable is part of the Green Deal Sustainable Care. In this, healthcare institutions, companies and governments have promised to reduce CO2 emissions by half by 2030 and to work climate neutral by 2050. ‘But we want to do things faster in the IC of the Erasmus MC,’ says Hunfeld. Hunfeld recently won an award for her ambitious approach. She uses this 'Sustainability award' to inspire others. ‘Many healthcare institutions are already working on sustainability, but do not know how to tackle it concretely and completely. I hope that our approach will encourage others to also opt for a circular working method. We are happy to share our knowledge, so that no one has to reinvent the wheel.' Products with the highest environmental impact -Packaging of liquid substances, such as infusions -Gloves, 108 per patient per day. If all IC beds in the Netherlands are occupied, there will be 108,000 -Disposable clothing, for example aprons. These are made of PP/PE woven fabric. -Incontinence mats, largely made of fluff pulp -Syringes, made from a mix of materials and therefore not easy to recycle -PVC hoses -Face masks. Its use has increased significantly due to the Covid-19 pandemic