‘The sector accounts for about seven per cent of CO2 emissions'

Each patient in Erasmus MC's intensive care unit (ICU) accounts for seven rubbish bags, or 17 kilos of waste per day. Throughout the hospital's ICU, 250,000 kilos of materials were used in 2019, most of which are not recyclable. This can and must change, according to intensivist Diederik Gommers and assistant professor, ICU pharmacist and sustainability project leader Nicole Hunfeld.

The amount of waste that passes through Erasmus MC‘s ICU in a day was only really noticed during the covid period. That is why head of ICU Diederik Gommers and ICU pharmacist Nicole Hunfeld wanted to investigate how things could be done differently and, above all, better. ‘You saw the medical staff walking in and out all day long with these big rubbish bags full of waste,’ says Diederik. ‘That felt so wrong.’ This awareness led to The Green Intensive Care project, which explores the possibilities of a circular and sustainable ICU. Aiming for a waste-free ICU with reusable resources. ‘We commissioned an analysis to find out how polluting our ICU is. When that report was available, we wrote a scientific paper on it. Because the analysis made the medical waste streams visible, the urgency was then felt in the rest of the organisation as well. When covid had settled down a bit, the board of directors thought we should pick up this gauntlet.’

Non-recyclable materials

The analysis maps how many materials and raw materials are used by the ICU and their impact on the environment. ‘Among other things, the ICU uses 108 disposable gloves, 57 gauzes and 34 infusion bags per day per patient,’ illustrates Nicole. ‘By visualising this with nice pictures and graphs, everyone could immediately see what the problem is.’ The analysis also revealed what raw materials and substances the medication and products such as plasters and needles are made of. For instance, an incontinence pad, eight of which pass through each ICU patient every day, contains various plastics and wood chips. ‘You cannot separate those materials and such a mat is therefore not recyclable,’ Nicole continues. ‘We have no choice but to throw away the used mats. The same goes for the disposable gloves, made of nitrile. But so are the plastic jackets and all the other protective gear we had to wear during covid. Now that we know which products are in our waste and which of them are most harmful to the environment, we started to investigate with TU Delft what it would take to change that in the supply chain. And what environmentally friendly alternatives are available for the materials we use.’

Too many materials

There has been a strong focus on infection prevention in recent years, resulting in excessive use of equipment. ‘Everything was focused on sterility and preventing infections,’ Diederik states. ‘We never asked ourselves whether we were not overdoing it. And what the effect of all those packaged materials is on sustainability. Now, with every product we take in our hands, we ask ourselves why it is packaged the way it is. Take a bag we use to dialyze patients. It has a plastic bag around it and that, in turn, comes in a box. As a healthcare sector, we produce 300,000 tonnes of waste a year in the Netherlands. That goes straight into the incinerator, because hospitals are legally not allowed to separate waste. In addition, the sector is responsible for about seven per cent of CO2 emissions. All hospitals in the Netherlands are as polluting as Tata Steel. All in all, this was an eye-opener for us, and we became convinced that sustainability should also be a part of healthcare.’

Green Teams

With a share of around seven per cent in national CO2 emissions, the healthcare sector actually has a negative impact on people’s health. ‘That’s very contradictory,’ Diederik acknowledges, ‘but it is true. For example, our waste goes to the incinerator, we do not yet use green electricity and many patients and staff come to the hospital in a fossil-fueled car. So we can already contribute to people’s health by being less polluting. For young doctors and nurses, this is becoming more and more a matter of course. We already have more than 30 Green Teams in house, for instance. In these teams, employees from all departments think along about what we can do together to become more sustainable. In this way, we hope to put Erasmus MC on the map and attract young people to come and work in the healthcare sector.’

Great collaborations

In 2021, Nicole won the Sustainability Award for The Green Intensive Care project. The award is a prize from Erasmus University Rotterdam (EUR) and is intended for initiatives that contribute to, among other things, embedding sustainability in the DNA of the organisation. ‘There were a lot of reactions to this, followed by great collaborations,’ she recalls. ‘With economists and buyers from the EUR, for example, and startups from TU Delft. We are bringing them all together in a big consortium to see if we can accelerate sustainability together. There is a lot of great energy involved. Everyone has the same goal and wants to think along. Rotterdam was one of the first municipalities in the Netherlands to form the Health Care Climate Table. This is where Rotterdam’s hospitals join forces to substantially reduce their CO2 emissions and environmental pollution. Apart from tackling wastage of raw materials, we are also looking at purchasing sustainable materials and energy. You have to be big to tackle this properly, to get manufacturers, suppliers and policymakers on board.’


According to Diederik, a green ICU and making healthcare as a whole more sustainable have been under consideration for a long time. ‘We are making small steps, but the topic is very much intertwined with what we do. It’s in care, in health, in attracting young people. We really needed this after covid. It makes us happy to talk about it, we laugh together and it also helps to get the positivity back in. Students are welcome with ideas and some really exciting experiments arise from that. It is a nice cross-pollination, which gives us all a lot of energy.’


This article is part of the magazine ‘Rotterdam Circulair’, produced by the collaborating parties of the Rotterdam brand alliance ‘Rotterdam. Make It Happen.” The stories from this magazine will be published weekly from mid-February 2023 on the websites of various brand alliance partners. Knowing more? Check out www.rotterdammakeithappen.nl. Have the stories inspired you and do you want to contribute to the development of Rotterdam’s circular economy? Send us an e-mail message. We are happy to connect you with the right people and organizations.

Photo accompanying this article: Lennaert Ruinen.

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