Medical Design project of Design & Engineering course. Autumn semester 2013/2014

2. Abstract
“Handtlers is a new approach to
hand
hygiene, which meant to be
used in a hospital environment.
Highly effective and at the same time,
a natural way of cleaning hands...
Fast,
convenient
and
easily
integrated into the daily routine”

3. Introduction
Process and methods
What was our task?
Double Diamond design process model
This semester we faced with project to work in
cooperation with Regionaalhaigla.
The North Estonia Medical Centre is Estonia’s
foremost hospital.
The mission is to provide top-level patientfriendly healthcare and to promote the
development of medicine in Estonia. The
hospital is a higher level medical institution.
We were given a task to observe usual day in
a hospital and discover
areas which could be
improved from a perspective of dignity or privacy.
To explore
clinical spaces that are integrated
with their surroundings and are accessible and
responsive to patients’ needs.
The aim of the project is to give an experience of
participating in a practical conceptual development
process in a given topic.
Design
has
become
the
theoretical concept for what are
called
healing
environments.
1. Discover
2. Define
3. Develop
4. Deliver
1-5 weeks
6- 8 weeks
8-12 weeks
13-20 weeks
Methods:
Research for understanding
the problem and identifying
space of opportunity.
Data collection,
hospital visit, user scenarios.
Methods:
Defining goal and scope
of the project, narrowing
problem to solve
Methods:
mapping,
brainstorming,
design sketches,
mock-ups,
analyses of analogues,
user and specialist feedback.
Methods:
Detailing design and
sub-solutions, prototypes
and tests.

4. Team and tutors
Tutors:
Martin Pärn
Janno Nõu
Henrik Herranen
Estonian Academy of
Arts
Tallinn University of
Technology
Tallinn University of
Technology
Partners:
The North Estonia
Medical Centre
Envirolyte
Tallinn
Students:
Mohammad J.
Almutawa
Iuliia Vorobiova
Dima Malezki
I year D&E student
Bachelor of Architecture
II year D&E student
BSC Computer Science
I year D&E student
MSC Rocket Science

5. Research
Visiting hospital
In a society where understandings of health have
Forcing the inhabitants to adapt to a poorly
During the visit to hospital we came to the
expanded to encompass a holistic notion of
designed set of tools means that the tasks of daily
conclusion that hygiene is important part of a daily
mental and physical well-being, rather than a
living cannot be successfully completed’’
routine.
straightforward idea of a disease-free body, it is not
During our visit we tried to focus on items and
Now in the hospitals, doctors and nurses use several
surprising that hospitals are changing in form and
activities in the immediate environment observing
techniques to get their hands clean.
function.
social activities.
The time required for nurses to leave a patient’s
The environment as a collection of tools used to
bedside, go to a sink, and wash and dry their hands
support its inhabitants.
before checking the next patient is a deterrent to
.
frequent handwashing.
• More rapid access to hand hygiene materials could
help improve adherence.
• Alcohol-based hand rubs may be a better option
than traditional handwashing with plain soap and
water or antiseptic hand wash because they require
less time, act faster, and irritate hands less often.
Another issue is that the constant washing of hands
makes skin dry. As well there are some cases when
people have an allergy to chemicals which are
present in current solutions.

6. Defining problem
Where do hands go?
An observation noted as an effective method at
So Why All the Fuss About Hand Hygiene?
Pamela
28 years old
nurse
has an
experience
working in
Norwegian
and Serbian
hospitals.
Hand hygiene is a general term that applies to either
handwashing, antiseptic hand wash, alcohol-based
hand rub, or surgical hand hygiene/antisepsis.
Most common mode of transmission of
pathogens is via hands!
this stage of the project development. We decided
to keep a track of a personnel in a hospital and
think about possible scenarios and situations when
they need clean hands .
Healthcare workers should wash hands with soap
and water when hands are visibly soiled, and use an
alcohol-based hand rub when hands are not visibly
dirty.
“It’s not possible to forget about washing hands,
the system has very strict rules, if you forget doing
Negative factors:
-
that most likely you lose your job”
Handwashing agents cause irritation and
dryness
“Of course there is problem that chemicals which
- Sinks are inconveniently located/lack of sinks
are present in washing soap which damaging
- Lack of soap and paper towels
skin, but there is other more major problem: some
- Too busy/insufficient time
people have an allergy and they just cannot use it.”
More rapid access to hand
- Understaffing/overcrowding
- Patient needs take priority
“You have to wash hands before you touch patient
hygiene materials could
and after, you cannot touch anything
help improve adherence.
around in not sterile space”

7. Research
Inspiration from nature
Thinking about designing new product would
Equity.
Is the trading equitable and what
start with environmental aspects. During the last
is the impact on the local and global community?
century, environmental problems were often seen
What about employee conditions of work?
as local problems due to the impact from the certain
Technology. Optimise the extraction of raw
product. In the world with limited recourses we
materials, production, lifetime and quality and
obliged change our life style into more sustainable.
functionality of the product.
But now it’s just obvious that the problems much
Ecology.
more complex and occur all the phases in a product’s
minimize the environmental impact.
Eliminate emissions and waste and
life cycle.
Criteria for the future product:
As a lot of factors are taken into account from the
Material.
begging its makes the rest of the work the most
Minimise the material use and energy
consumption and try to use renewable materials,
sufficient.
avoid toxic materials, etc.
Economy.
Product and service must be cost
efficient and comparable with similar products.
Consider the total cost during the life cycle including
the cost for restoring environmental impacts.
Design.
Design for the environment and
the product user as well as for recycling and
transporting.
Market.
Develop products and design them
according to the needs from the specific market
and target group.
Achieving excellence design evaluation toolkit

8. Market research
Hand-in-Scan Hand Hygiene Control System
Plasma Sanitizer
Self-Sanitizing Doorknobs
Wristband
Hand-in-Scan’s utility is plentiful: integrated into
Instead of scrubbing, the workers would put their
This clever door handle idea uses UV light to
An RFID-reading, motion-sensing wristband buzzes
medical institutions, it can protect both the patients
hands into a small box that bathes them with
disinfect itself. It uses an interior UV lamp to
to tell health-care workers if they are washing their
and the medical staff by indirectly motivating
plasma — the same sort of luminous gas found
constantly disinfect its surface when the handle is
hands properly.
proper and frequent hand washing and compliance
in neon signs, fluorescent tubes and TV displays.
not in use. The lamp clicks off when someone grabs
A startup called IntelligentM wants to make
with the local regulations. It could be used in
This plasma, though, is at room temperature and
the handle, then clicks right back on once they’ve
hospitals healthier by encouraging workers to clean
training: helping medical students to learn effective
pressure, and is engineered to zap germs, including
passed through the portal.
their hands properly. Its solution is a bracelet that
hand disinfection. Beyond, the general public can
the drug-resistant supergerm MRSA.
This concept could greatly cut down on the
vibrates when the wearer has scrubbed sufficiently,
also be trained for proper hand hygiene with it.
The devices can probably be built for $100 or less,
suffering and health risks of colds, influenza and
giving employees a way to check their habits and
Digital image of the hand is automatically analysed
as no expensive parts are used, he said.
other illnesses with no additional effort from users
letting employers know who is and isn’t doing
after a general hand washing procedure had been
things right.
performed. Hand-in-Scan has the potential to
It also collects data from the bracelets through a
reliably compare and verify different hand washing
microUSB connection at the end of each shift, which
techniques, and through microbiological studies,
gives hospital epidemiologists a chance to see how
their correlation to cross-contamination can also
each employee is doing.
be proved, thus it can reduce HAI by 30%, saving
patient lives and hospital treatment costs.
In addition to hand sanitizer has developed a
prototype for plasma jets that can be built into airconditioning systems. As air is transmitted through
the system from one hospital room to another, for
example, the jets inactivate microorganisms, fungi
and viruses in the air.

9. Eco water
Raw material
These are metastable solutions containing wide
Thinking which other substance could be used
variety of very reactive ions and free radicals which
instead of soap or alcohol we had in our mind
led to the description of Electrochemical Activation
activated water but had no idea what is the process
of Water.
of making it active and for how long it had its
Anolyte – acidic in nature
properties or how effective.
- very strong oxidizing compounds
Concept and Principle of Electrochemical Activation
- pH 2 - 4
(ECA)
- ORP - +900 to +1000mV
EAC of Water – exposure of water and the natural
Catholyte – basic
salts therein to a substantial electrical potential
- strong reducing agent
difference in the environment of a special
- pH 10 – 12
conductive metal.
- ORP –800 to -900
Salt is added to water and passed through double-
Neutral Anolyte – formed by mixture of Anolyte and
chamber- membrane
Catholyte or changes in inflow and outflow to and
electrolytic cell
from the reactor
A high-strength active biocide - anolyte - is created
- pH 6.5 – 7.5
in the form of HCLO
- ORP +650 to +810
Anode (-) and Cathode (+) in pure water
For the particular needs of this study, Neutral
Direct current
Anolyte meant to be produced with a pH of 5.5 and
Electrolysis of water at the poles
a redox of +800.
(Breakdown of water into constituent elements
The design was made to approximate the skin pH to
producing gaseous O2 and H+ and migration of
minimize skin reactions while maintaining enough
electrolytes to anodic and cathodic poles).
redox to achieve disinfection of the hands and arms.
In terms of cost for raw materials, plain tap water
will only be the significant cost plus the addition of
a very small amount of electrolyte solution.
The energy cost in electricity is close to a using a 50
watt electric bulb.
How does this disinfection work?
Active components kill pathogens such as bacteria
and viruses by breaking the chemical bonds in
their molecules. Disinfectants that are used for this
Anolyte, as a proposed alternative to the traditional
hand scrubbing agents, has fulfilled the criteria
set by the FDA-TFM in obtaining >90% microbial
reduction. It has been proven to be far more superior
to povidone-iodine in terms of efficacy and safety.
Anolyte was found to have less adverse effects on
the skin.
purpose consist of active compounds which can
exchange atoms with other compounds, such as
enzymes in bacteria and other cells.
Summarizing a bit all written above activated water:
Are non-toxic to both humans and animals;
Do not require special handling;
Are powerful biocides;
Can be safely disposed of in sewage systems;
Composition of Nutrient Broth Used in the Analysis
Peptone………………………..
5.0 g
Yeast Extract………………….
2.5 g
Sodium Chloride……………...
5.0 g
Beef Extract…………………...
2.5 g
Distilled Water…………..........
1000 mL
Final pH………………………..
7.2
Incubation period – 48 hours at 35oC
Are fast-acting;
Can be generated on-site, thus eliminating handling
and storage of
chemicals;
Can be produced on-site from any source tap water
and salt in required
quantities and concentrations of active ingredients
and pH.

10. Concepts
The Toaster Concept
The Ball Concept
For the first concept we decided to study the effects
For this concept we aimed to look at natural hand
of extending the arm to place the hands within a
positions designing around them in a way that
device to get them clean
would be natural and easy.
The idea would be to have a device with two
The idea stemmed from the cupped resting position
compartments where the hands are placed, a
of the hand and worked on creating a system that
reservoir of disinfecting solution, spray nozzles and
would utilize this to clean the hands. We deduced
tubing which make up the delivery system and a
the system starts with the user and the hands placed
sensor that detects the presence of the hands and
at a comfortable cupped position, a spray nozzle
triggers the process.
placed within the hands and a mesh that places
the hand at the correct spray distance and also acts
The inception came from the idea of having a ‘black
as an active component to pump the disinfecting
box’ which you insert A in and B is outputted, we
solution through the nozzles from a reservoir.
applied this hands and generated the toaster
concept where dirty hands are inputted into a
device and clean hands are taken out.

11. Process
Mock-up build
We adapted an existing water sprayer to be our
As for the mesh, we acquired prefabricated metal
pump by removing the nozzle and attaching tubing
mesh that we cut down to a
to the pump to extend the reach of the solution. We
manageable size using metal sheers. We then cut at
inserted a splitter channel to the end of the tubing
strategic points so we were able to hammer it into
and attached two nozzles to either side. The system
the desired spherical shape. The sharp edges of the
needed to be pre-pumped to remove air from the
metal mesh were grinded down to be smoother
tubes and fill them with water so it would be able to
and nicer to touch, as well as safer.
work at full capacity.

12. Product solution
Using the device is very easy, hands are placed on
the mesh handles and are made to squeeze both
sides together which in turn activates the pump
which draws disinfecting solution from a reservoir
and ejects it as a dense mist through spray nozzles
placed strategically between the hands, coating the
hands in a layer of the solution. The process is then
completed when the user rubs their hand together
to dry them, which as well gets the solution on to
areas of the hands where the spray mist did not
Handtlers: A New Approach to Hand Hygiene
sufficiently reach, resulting in both dry and clean
Utilizing people’s natural hand positions and
hands.
movements, the Handtlers device seeks to find a
The device is eco-friendly and sustainable. It
unique, easy and relaxed way to effectively disinfect
uses zero-energy to operate, working on purely
germ-ridden hands.
mechanical principles. It consists of only 7 unique
Based on the aforementioned ball concept, the
components that are easily manufactured and
device consists of 3 main parts;
replaced which means the device is durable and
Mesh handles where hands are placed and used
long lasting. Also the device is built around the
to trigger the disinfecting process, a pump that
usage of eco-water as a disinfecting solution that
is activated by the handle, and a reservoir of
is produced using naturally abundant raw material
disinfecting solution where the pump draws from.
and minimal energy.

14. Product Solution and Testing
Prototyping and Testing
Determining the distance of hands from spray
User testing
Future Improvements
had to be tested. First was the effectiveness of the that would release the right amount of solution
The device was given to some users for testing to
We’re seeking to find stronger and finer mesh
spray in covering the hand through the mesh, if the to adequately cover hands. These were major
provide some feedback and suggestions for further
material as to cover more of the hands on the initial
mesh holes were of appropriate size to effectively issues tackled in determining and maximizing the
improvements. Some comments about the product
spraying before rubbing hands together. Seeking
spray hands.
were that it looked peculiar and intriguing to
to find spray nozzles that would spray at a wider
approach, the method was different and strange but
angle and not just concentrate the spray mist on
also exciting. There were concerns about the spray
a small area. Tweaking the pump as to release the
coverage of the full hand due the mesh thickness
right amount of water in one go rather than using
but after usage it was clear that the solution
it multiple times for adequate coverage. We’d like
covered the hand properly after hands were rubbed
to adapt the shame more as to be less ‘pointy’ as to
together. The solution had a faint but distinct odor
not to be a hazard to anyone. Better integrate the
of chlorine despite it being just treated water, it
device in the hospital so it could be used daily by
gave the impression that it was taking action. The
the nurses, and find other usages for the device in
solution didn’t leave the hands feeling dry like
other environments besides hospitals.
During prototyping there were several issues that nozzle. Picking the right type of nozzles and pumps
effectiveness of our final product.
alcohol would of done and the device uses a small
amount of water so a towel was not needed since
rubbing hands was sufficient. There was concern
with hospital wide integration as they couldn’t see
the device being used daily by hospital staff but
could easily see it being integrated at specific parts
such as common rooms and waiting areas to be
used by visitors and children.