Royal London Hospital: Designed for operational effectiveness
The first phase of a £1 redevelopment and expansion of The Royal London Hospital officially opened in March this year culminating in one of the most complex hospital moves ever undertaken. The state-of-the-art hospital, globally recognized as a leader in pre-hospital and trauma care, boasts of advanced features including specialized ventilation systems to keep air 100% fresh, control infection and reduce noise. The move to the new, 17 storey hospital, which is located next door to the old hospital site accessed from Whitechapel Road or Stepney Way, involved moving 3,000 staff, patients and some 11,000 boxes.
Most exciting move ever made
It has been hailed as one of the most complex hospital moves ever undertaken. Chief Executive Peter Morris said, “This move into our new hospital, which for the first time brings our clinical teams together under one roof, gives us a once-in-a-generation opportunity to provide a health legacy to a community with some of the most challenging health needs anywhere in the developed world.” Mr. Morris also said, “I am incredibly proud of what our staff has achieved in reaching today’s milestone, which marks a new and exciting chapter in the Royal London’s history.” The new hospital has replaced a number of now demolished old buildings with a coherent structure, purpose-built to support the delivery of 21st century clinical care.
The architecture of the new hospital building
The world’s most acclaimed architectural design company HOK was selected as the architect for the project by Skansa. The new hospital features a cluster of inter-connected contemporary glass buildings, including two 18 storey towers and one 10 storey tower. The 727-bed hospital has 6,000 rooms, 52,000 pieces of new furniture, loose equipment, 28,000 towels, 3,000 pillows and 12,000 keys. The tallest part of the building is 284 sq ft, the same height as Big Ben. The building has used 7,000 km of metal reinforcement (the distance between London and Miami), and 175,000 tonne of concrete. Royal London Hospital is a completely sealed building and the windows do not open. The building is completely ventilated with 100% fresh air as a way to reduce noise and control infection. The 17-storey building took about five years to complete at a cost of £650 million. It has been designed with inputs from nurses and doctors to provide the best healing environment for patients.
World-class services and facilities offered at the Royal London Hospital
The new hospital has been designed to best manage patient, visitor and staff foot traffic. The hospital has been recognized worldwide as a leader in pre-hospital and trauma care. The new hospital programme is replacing many of the current ageing buildings with state-of-the-art healthcare facilities. The Royal London Hospital provides emergency care with a resident Emergency Department consultant available 24 hours a day. It also offers renal and urology services, and maternity facilities. Maxillofacial surgery is the Trust’s major specialties. The hospital’s eight maxillofacial consultants can now practice this surgery in state-of-the-art operating theatres.
Glance into the history of the hospital
Royal London Hospital is a part of the Barts Health NHS Trust. It was founded in September 1940, and was initially named The London Infirmary. In the year 1748, the name was changed to The London Hospital. Again on its 250th anniversary in the year 1990, its name was again changed to The Royal London Hospital. In May 1741the hospital was moved to Prescott Street and remained there until 1757.
The Royal London Hospital enjoys the best reputation and is successfully well-known for its expertise in clinical areas.
Driving sustainability in medical device production
Environmental protection and stewardship are rapidly rising to the top of the corporate agenda and medical device businesses are no exception. The healthcare sectors of the United States, Australia, Canada, and England combined emit an estimated 748 million metric tons of greenhouse gases each year, an output greater than the carbon emissions of all but six nations worldwide. In order to curb this situation various European standards have been introduced.
The Waste Electrical and Electronic Equipment (WEEE); Restriction on Hazardous Substances (RoHS); Registration, Evaluation, and Authorisation of Chemicals (REACH) and the Energy Using Products (EuP) regulations have all significantly altered manufacturing processes, specific labelling, compliance with disposal restrictions, and creation of instructions for end-of-life management and recycling.
At the moment many medical devices are currently exempt from these regulations but several directives, including RoHS and WEEE, are in the process of being reviewed and could be applicable in future. This is especially relevant for devices that are ‘connected’ and have a digital monitoring component which then brings them under the regulatory purview of authorities that govern devices with electronic components.
Safety, Usability and Sustainability
While medical device manufacturers have been working to respond to increasing demand for environmental sustainability from the market, they also have to contend with a key element of their mission: to ensure safety and usability to healthcare workers and patients. Parenteral and other invasive devices are strictly regulated to help reduce the risk of Healthcare Acquired Infection which typically runs as high as 5% and 8% in most developed countries, according to the European Centre for Disease Prevention and Control. As a result, they typically contain disposable single-use plastic elements.
At the same time, many hospitals and purchasing organisations have started to recognise that sustainable purchasing practices play a pivotal role in reducing costs over time. Many GPOs have appointed and empowered Senior Directors of Environmentally Preferred Sourcing who are successfully implementing the sustainable purchasing business case. In addition global pharmaceutical companies are increasingly creating senior positions with sustainability objectives as key to the role.
Medical device disposal is a particularly burning issue; generally carried out through incineration in the EU, it typically releases nitrous oxide, as well as known carcinogens including polychlorinated biphenyls, furans and dioxins. Some of the strategies trialled by manufacturers to reduce waste matter destined to incineration include sterilisation and reprocessing.
Sterilisation, however, falls short on the environmental front, and may consume more energy and produce more emissions than incineration itself. In the United States for example, 50% of all sterile medical devices are sterilised with ethylene oxide but since this method releases harmful emissions, the US Food and Drug Administration is now encouraging the development of new methods or technologies. Many other established sterilisation methods use glutaraldehyde that is not only harmful to the environment but also tends to be regulated by strict usage and disposal rules such as COSSH guidelines.
Focus on Recycling
The outlook on recycling is changing significantly thanks to new research and technologies enabling, for example, monomer extraction. Recycled polymers can be broken down to their constituent monomers promoting an almost limitless recyclability of some polymers. In addition to this, Polyvinyl chloride (PVC), renewable polyethylene and polyethylene terephthalate (PET) can be recycled several times without losing critical properties.
Reducing the impact of packaging can also significantly reduce the materials that need to be dealt with through either waste or recycling. Packaging manufacturers are decreasing packaging volume by favouring sealed trays instead of pouches, laser-etching instructions directly on to the tray where regulation permits it, or reducing the number of components required overall. In addition to this, for recycling plans to be successful it important to have a full understanding of the practices surrounding device use and to establish, where possible, closed loop recycling systems that recover the waste materials from hospitals or patients and bring them back into the recycling process.
Sustainable Manufacturing: Technology and Research
Greater employment of fast degrading plastics or material from other sources is a key strategy to reduce harmful pollutants both at production and disposal stage. Bio-based materials can in fact offset the carbon emitted during processing as the monomer source grows, and a growing range of sources for bio based monomers -such as wood pulp or sugar cane- is available. However, when assessing the most suitable material for a part, the entire lifecycle of the product needs to be considered. For example: bio-degradable polymers can contaminate a recycling stream and emit methane when incinerated.
The use of environmentally friendly materials should also be supported by an increase in clean renewable energy sources. Lower energy consumption means fewer carbon emissions but also financial savings, making this an appealing measure for manufacturers. New technologies are proving a major gamechanger on this front, helping manufacturers marry their environmental stewardship with cost savings and efficiency. 3D printing, for example, can help develop optimum product moulds more quickly, refining production parameters to minimise raw materials volumes and maximising output productivity.
Similarly, ‘digital twin’ production software uses inline sensors to create a virtual, real-time mirror of the production environment to enable inline refinements. The objective is to achieve “zero defect”, waste-free manufacturing. In addition to this, LEAN manufacturing methodologies are already helping to optimise inventory management and reduce overproduction.
Sustainability by Design
It is increasingly clear that effective environmental sustainability in the medical device sector cannot exist without a full view of the product life cycle from concept development, material selection, design and engineering to manufacturing, packaging, transportation, sales, use, and end-of-life disposal. These evaluations are typically made for factors such as manufacturing efficiency, time to market, or safety and regulatory compliance, packaging and transportation costs, but should be extended to energy efficiency and environmental impact by means such as life cycle analysis.
In addition to this, with devices rapidly becoming more digitally connected, developers need to be aware that the costs of disposable electronics would simply not be viable, or indeed acceptable in the light of electronics disposal regulations. Design therefore should focus on creating a simple, repeatable interface between the two component sections so as not to impair the functionality or efficacy. As reducing waste and harmful emissions continues to exert businesses and governments globally, the medical devices industry cannot stand by. The environmental but also commercial implications of inaction are too serious and the array of solutions now available is exciting and diverse.