Skip to main content

Intelligent Sanitary Unit for Disabled and Elderly People

Final Report Summary - ISU-DEP (Intelligent Sanitary Unit for Disabled and Elderly People)

Executive Summary:

General

As the percentage of citizens above 80 is expected to double in the next 25 years, the role of care givers (family and institutional) becomes more and more important. Self-care with respect to toileting, bathing, showering and other necessities of personal hygiene is a challenging business for the aging population and also often a reason for having to give up independent living at home. Existing solutions for sanitation in bed or at the bedside care show remarkable shortcomings with respect to hygiene, usability, dignity and ease of handling for the old persons or the patient as well as for the care personnel.

The ISU-DEP Solution:

The ISU-DEP project offers an intelligent and affordable solution to patients, old people, care givers and nurses. A mobile system of sanitary components for improving hygiene, care-provision and quality of life was developed, consists of four main components:
- A mobile bed-side toilet (commode) which offers WC flushing, odour-free vacuum disposal of faecal-matter, bidet-function and assistance for transfer from/to the toilet – functions which presently are offered only from stationary assistive toilets.
- A bed-shower for washing a bedridden or immobile person without spilling water to the environment (the bed or the floor) using a closed-circuit system for fresh and waste water as well as applying air for drying and lotions for skin care.
- A (mobile) bed side service module which is shared by the mobile units containing tanks for freshwater and sewage, rechargeable batteries, pumps, heater, fans and controls to operate the bedside components.
- A (stationary) docking station to serve as a central hub where the service module is automatically re-loaded and cleaned.

User involvement and Ethics:

User involvement was performed continuously from the beginning throughout the whole project. Already at the project start networks of stakeholders with users, care professionals and experts in care from all partner countries were set up. Results from questionnaires for primary users and care professionals were used to retrieve demands for the envisaged system. Tests of prototypes confirmed feasibility and provided guidance for the development process. Ethical requirements and implications for working in the highly sensitive area of personal hygiene were set up at the beginning of the project. Guidelines to be used when involving users personally and directly were developed.

Impact:

For the entire consortium this project is an emergence into a completely new market segment. SME-partners move their expertise from stationary assistive devices into mobile ones and thus unlocking a door to the new and rapidly growing market of home-care, strengthening their national and international market position. For the group of ageing, but still partially autonomously living people ISU-DEP will provide an attractive change to sustain hygienic standards, increase safety at home and lower the burden of self-care. Formal and informal carers will be significantly assisted in their daily routine. Institutional care organisation will face reduce the workload of the care personnel without reducing the quality of care.

Project Context and Objectives:

As the percentage of citizens above 80 years of age is expected to double in the next 25 years, the role of care givers (family and institutional) will become increasingly important and the demand for findingways and means to make their care work less strenuous and more efficient rises.
Self-care with respect to toileting, bathing, showering and all other necessities of personal hygiene is not only a challenge for the aging population but it is also often the main reason for having to give up one’s independent living at home and to transferinto some kind of institutional care.
To ensure sufficient care provision and to sustain quality of life for care givers and the people cared for the ISU-DEP project provides an intelligent and affordable solution. The existing solutions for sanitation in bed or at the bedside show remarkable shortcomings with respect to hygiene, usability, dignity and the ease of handling for the old persons or the patient themselves as well as for the care personnel. There is a high user need for integrated solutions combining toileting and washing with a strong demand to disburden end users, especially care givers and nurses, from time-consuming and exhausting manual handling of fresh water and sewage disposal when performing bedside toileting and sanitation. The ISU-DEP project offers solutions to patients, old people, care givers and nurses to sustain hygienic standards, to increase safety at home and to lower the burden of care and thereby contributing to restoring dignity and self-esteem in the most sensitive area of personal hygiene. The project developed a mobile system of sanitary components for improving hygiene, care-provision and quality of life. This modular system consists of four main components:
- A mobile bed-side toilet (commode) which offers (WC) flushing, odour-free vacuum disposal of faecal-matter, bidet-function and assistance for transfer from/to the toilet – functions which presently are offered only on stationary assistive toilets. Therefore, the mobile bed-side toilet uses the bedside service module for flushing into a closed circuit sewage system (vacuum flushing and disinfecting, significant reduction of odours and increasing hygiene) and operating the bidet function and the dryer. The seat-height of the toilet is adjustable, transfer from and into a wheelchair are supported. Disposal of sewage, refilling freshwater and recharging batteries is achieved by removing the service module from the bed-side toilet and plugging it into the docking station.
- A bed-shower for washing a bedridden or immobile person without spilling water in the surroundings (the bed or the floor) using a closed-circuit system for fresh and waste water as well as applying air for drying and lotions for skin care. The bed-shower uses a brush-head with integrated sprinkler and vacuum-suction which makes it possible to wash an immobile or bedridden person in the bed without any need for waterproof sheets or transferring the person to a bathroom. The bed-shower uses the (mobile) bed side service module for the freshwater supply (pre-heated), for sucking-off waste water and for applying air for drying. The controls will allow for easy one-hand operation. The shower heads are changeable according to the desired function and user needs (brush, sponge, hair-washing etc.).
- A (mobile) bed side service module is shared by the mobile units which are used in the bed or at the bedside (shower, toilet). It contains tanks for freshwater and sewage, rechargeable batteries, pumps, a heater, fans and controls to operate the “Bed and Bedside Components” in an “off-line” mode. When plugged into the docking station, the sewage tank is emptied, cleaned and disinfected, the freshwater tank is refilled (and heated) and the batteries are recharged. Thus the service module is made ready for its next off-line use at the bedside.
- A (stationary) docking station to serve as a central hub where the service module is automatically re-loaded and cleaned. It is located in the washroom or bathroom and will provide all the necessary connections to the freshwater and sewage lines and to the electric mains. It provides sewage delivery, freshwater intake and battery charging to the service module.
The development of such a complex, modular system of sanitary components holding the potential for future expansion is a challenging design task which demands a clear and structured concept of interoperability. In the near future this system shall also fit into emerging concepts of smart homes, Ambient Assisted Living (AAL) and robotic solution to be used in healthcare and homecare. Presently manufacturers and distributors of sanitary equipment significantly lag behind cutting-edge technology in this area.
Therefore the ISU-DEP project formed cooperation in the following areas:
- RTD-institutions being actively engaged in the area of Ambient Assisted Living (AAL), providing necessary know-how to the participating SMEs and management experienced in projects of European size.
- SMEs in different European countries with complementary products to generate an integrated solution. This increases their competitiveness in the market and contributes to long-term sustainability and increases European-wide market chances.
- Personal hygiene and toileting are ethically sensitive areas. A university institute experienced in the field of ethical issues will address these, especially when it comes to testing in real-life settings and to the evaluation of prototypes. The academic partner provides the framework for ethical governance and makes sure that not only technological progress will take place that also a social, human and ethical aspects will be adequately addressed.
The workflow in the project follows a strict user-driven design process (participatory design) to achieve a yet unreached degree of usability in this area. Usability and ergonomics are followed in two directions to accommodate the primary users (patients, bedridden persons, old persons) in their full range of diversity (age, sex, disabilities, skills, preferences etc.) and also the secondary users, in other words the formal and informal caregivers but also those who provide the financial support for care (funds, insurances, charities etc.).

Project Results:

Description of work performed in the project
The project started with setting up a network of stakeholders with users, care professionals and experts in care from the partner countries Austria, Denmark, Germany and Hungary. This network was available throughout the entire project for continuous user involvement.
Two questionnaires - one intended for primary users and the other intended for care professionals and experts in care - were developed and distributed among the stakeholder network members. The evaluation of the completed questionnaires resulted in user demands for the envisaged system. Together with the SME’s knowledge about the market and a market analysis done by the responsible partners these user demands served as a starting point for the specification of the ISU-DEP system.
Another important topic tackled in that early project phase touches the ethical requirements and implications for working in the highly sensitive area of personal hygiene. Therefore, ethical guidelines for the project and form sheets for an informed consent procedure to be used when involving users personally and directly were developed.
The next step was the translation of the documented user and market demands into a concrete system concept and technical specifications of the four modules Docking Station, Service Module, Bed-Side Toilet and Bed Shower. These specifications contain detailed schematics of the modules and parts lists as well as descriptions of system states and processes and form a starting point for the development of the prototype.
In parallel, investigations in the areas of hygiene, usage in hospitals and care facilities and Medical Device Directive were done. The results from that investigation are special requirements and (to some extent) mandatory prescriptive limits with respect to hygiene, patient safety etc. and form another starting point for prototype development.
The third part of the project was dedicated to the development of the prototype. Contrary to the original plan to build one Service Module for both toilet and shower the results from the user needs evaluation and the marketing plans of the SME partners led to the approach of building a dedicated module for the shower and another for the toilet as well as splitting the Bed-Side Toilet into a Service Module and a Mobile Toilet Seat. Functional prototypes of the Bed Shower Service Module and the Shower Head were the first to be developed and internally tested. A little later – and from then on in parallel – work on the functional prototype of the Bed-Side Toilet Service Module was done. This module underwent internal testing, too.
A major task was the transformation of the functional prototypes – which offer full functionality but are not fit for real life testing in a field trial setting – into field trial prototypes which should also be as close as possible to a pre-production prototype. The development and construction of the Docking Station and the Mobile Toilet Seat were also part of this task. The developed modules aim for the professional market (care institutions, hospitals, etc.) for this area has the strictest technical requirements but also offers the best entry point to the market as production and final costs can be higher and may also act as multiplier for the home market use.
The planning of lab and field trials was initiated. However, as it was unfortunately not possible to get a minor project extension, the various technical challenges and delivery problems of components did not allow the finishing of the trials on time. As a consequence the redesign and future system expansion task could not be completed although work progressed as far as possible and a plan to continue towards completion was elaborated.
As part of the disseminationwork a project webpage at www.isu-dep.eu was set up. This webpage shows the idea, concept and status of the project and offers means for contacting the consortium. A forum for discussions about the ISU-DEP system and care-related topics is also available. Apart from this the project was presented on exhibitions and to care professionals and institutions as well as political decision makers. Additionally, interviews for print and online media were given.

Results

The development process of the ISU-DEP modules led to a number of modifications and additions as compared to the original plan.
The initial idea of the ISU-DEP system was to have one Docking Station – a device connected to water and power line that supports the automatic cleaning and refilling of the system – and one Service Module – a device containing fresh and waste water tank, batteries, electronics, etc. This service module was intended to have two connectors: one to connect a shower head thus building the ISU Bed Shower and another to connect a toilet bowl with a seat thus building the Bed-Side Toilet. The Docking Station and Service Module were intended to be the common modules of the system.
Rather early in the project results from the user surveys showed that there was quite some reluctance against having a shower and a toilet combined in one device. A number of users said that they would always have the impression of being washed with toilet water. Also, the SME partner interested in the Bed-Shower and the one interested in the Bed-Side Toilet thought that selling each single system with a Service Module which was able to serve both the shower and the toilet would make the system rather complex and expensive while offering very limited additional value.
The reasons mentioned above led to a modified system structure that still has a common part but allows for the freedom to select between the shower and the toilet.
The Docking Station is this common part and can be used both for the Bed-Shower and the Bed-Side Toilet. This module is mounted to the wall in the bathroom or another room with water and power connection and contains the charging unit for the Service Modules, a water heater (boiler) that provides hot water for the Bed Shower (the Service Module of the Bed-Side Toilet is filled with cold water by bypassing the water heater) and some part of the infrastructure necessary to fulfil the service task for and together with the Service Module. The Docking Station – and the rest of the system – operates with safety extra-low voltage (except the connection to the power line which is separately insulated and protected).
The Service Modules are connected to the Docking Station by means of the so-called Multi Connecter. This connector contains the coupling for fresh and waste water as well as for the electrical parts and is designed in a way that allows easy connection and disconnection with minimal strain. In case of a service (i.e. cleaning, refilling of water, recharging of batteries) the Service Module is brought to the Docking Station and the Multi-Connector from the Docking Stations is plugged into the fitting female connector of the Service Module.

Bed Shower

The Bed Shower is now implemented as a dedicated Service Module with the Shower Head connected to the module with a hose. The module is mounted on wheels and can easily be moved to the desired location. It contains the tanks for fresh and waste water, batteries, valves and the tube system for operation. The Shower Head rests in a special tray in on the Service Module; Shower Head attachments (i.e. sponges, “washcloths”, etc.) are stored in another tray.
When washing a patient the caregiver takes a new Shower Head attachment (these small items are disposable for reasons of hygiene) for washing. It may be necessary (depending on the washing procedure applied) to change the Shower Head attachment once or even several times which can be done easily by just snapping it on the Head. The washing itself is done in a simple yet innovative way. The Bed Shower sprays water onto the skin of the patient and sucks it off the skin again which – together with the washing movement – leaves just some moisture on the skin thus avoiding drenching the bed. Depending on the degree of need for washing it may be necessary to apply some soap or other cleaning agent and repeat the process.
After cleaning the Shower Head attachment is disposed of and the Shower Head itself is cleaned/disinfected by wiping it clean with disinfection tissues if necessary. The capacity of the Bed Shower allows for washing two patients before the need of service arises. Service is done by moving the Service Module to the Docking Station, connecting it using the Multi-Connector and starting a service cycle. During this service cycle the waste water is disposed of and the whole pipe and tank system in the Service Module is rinsed. Then the freshwater tank is filled. The batteries are charged throughout the while service cycle.

Bed-Side Toilet

The Bed-Side Toilet is now also implemented as dedicated Service Module that contains the toilet bowl and, therefore, is a closed system with only one waste connection to the Docking Station. The module is mounted on wheels and can easily be moved to the desired location. It contains the tanks for fresh and waste water, batteries, valves and the tube system for operation.
The second part of the Bed-Side Toilet is the Mobile Toilet Seat. This seat may be used as any other ordinary commode but has some advantages: It can be combined with the Service Module thus forming the complete Bed-Side Toilet (actually, the seat is moved over the bowl of the Service Module and is locked there). The seat offers motor-driven support for sitting down and rising and is equipped with variable handgrips for easy transfer from and to the chair. In addition to that the chair may also be used stand-alone offering two cases of application: for one it can be used as any other commode with a simple removable bowl below the seat but with the additional support for sitting down and getting up; for another it can be placed of a stationary standard toilet bowl thus temporary transforming that toilet into one with support for rising and sitting down.
The full Bed-Side Toilet (Service Module and Mobile Toilet Seat) operates as mobile water closet allowing flushing after using it. The bowl of the Service Module and the flushing system are designed in a way to clean the toilet as well as possible; it may, however, be necessary to use a toilet brush for optimal results. The Bed-Side Toilet is cleaned every now and again as any other toilet by using a cleaning agent for the bowl and wiping the surfaces.
The capacity of the Bed-Side Toilet allows at least for two flushing cycles before the need of service arise. The service is done similarly to the Bed Shower by using the Docking Station.

Potential Impact:

Economic Impact:

For the entire consortium as well as for all individual partners, this project is an emergence into a completely new market segment. For the SME-partners it means moving their expertise from stationary assistive devices into mobile ones and thus unlocking a door to the new and rapidly growing market of home-care. A start-up company (spinning off from an SME-partner) is at a launch into the growing market of assistive technology and products for care.
Thanks to the project’s innovative approaches, the participating SMEs will strengthen their national and international market position. During the next years the individual SME partners will, due to the cooperation initiated within this project, be able to target new markets outside their home countries and established markets. For the market expansion beyond the present target markets, the partners will establish their own new distribution channels and personnel resources or cooperate with existing distribution partners in Europe and globally. Beyond the European market, here have already been initial talks with the Japanese and the South Korean Chamber of Commerce to enquire about legal aspects for marketing the products and for potential production (licensing) and/or distribution partners. Agreements between partners regarding dedicated market areas have already been established and will be updated after project completion. As an additional positive indirect economic impact, it can be expected that due to new collaborations and products, the sale figures in the existing product portfolio of the SME partners will increase too.
An Austrian patent (principle for the Bed Shower) is the fundamental base of this project. Within the development process some other patents were made and are base of further development to be exploited by the consortium partners.

IPR-Issues:
Based on an Austrian patent the project idea was formulated. Resulting from the development process within the project some other patents were made and are base of further development.
The European markets will be addressed by the SME partners until 2016. Licences for the Asiatic market are also planned to be offered in an early stage. Relevant other markets outside Europe like USA and Canada, Brazil, China, South Africa and the Arabic Countries will follow.

Market figures

It is a known fact, that the risk to be in need of care is significant higher at the age of 80+: Within the group of 60-80 years old European citizens, 9% need care, above 80 years the figure rises to 50% and the number of people above 80 is expected to double in the next 25 years. Although the figures might change in the future due to medical progress and improved life conditions, the number of people in need of care is huge and growing fast National data indicate that EU-wide the percentage of people who need care ca. 4%. Extrapolating this number to the entire EU population (currently 504 mio.) suggests that, in a conservative estimate, around 20 million people are currently in need of care. This number will grow significantly in the next decade. Not only due to a growing percentage of older people and the stagnation of the number of possible caregivers on European level , there is an increased need to assist older people in their desire to stay independent as long as possible and to “age well at home”. For many older or disabled people staying at home is a massive improvement of quality of life and well-being compared to institutional care. This view is shared both by elderly citizens and their relatives . However, the stress for relatives is high, and, therefore, any assistance, especially in delicate hygiene issues, has a positive effect on the patient and the care giver.
For the first 18 months after production start it is expect to sell about 100 units and until end of 2016 approximately 1400 units. For Austria this will result in market coverage of about 0.034% and already provide a complete return of investment. EU-wide this coverage will be at about 0.00125%.

Societal impact

For the group of ageing, but still partially autonomously living people ISU-DEP will provide an attractive change to sustain hygienic standards, increase safety at home and lower the burden of self-care. For this target group the Bed-Side Toilet seems especially interesting. Toileting and personal hygiene is a rather sensible area where help from another person is avoided as long as possible. In doing so, people are running the risk of slipping and falling which could easily be avoided using the proper assistive technology.
For persons receiving care at their own home, ISU-DEP will significantly assist formal and informal carers in their daily routine. Especially where family members or relatives are primary caregivers, assistance in toileting and talking care of personal hygiene are tasks which are both physically and emotionally strenuous for obvious reasons. The Bed-Shower which provides better washing without making the bed wet, and the hygienic, self-cleaning Bed-Side Toilet will ease the tasks of carers, positively contribute to the personal hygiene and self-esteem of the person cared for and reduce costs, risks and workload.
In organisations that offer institutional care ISU-DEP will reduce the workload of the care personnel without reducing the quality of care. When necessary, more services can be administered in bed or at the bedside without the need and the risk to carry or wheel a patient to the bathroom or the toilet. Where possible, patients will get a chance for self-care.
In general, ISU-DEP aims at a rapidly growing market, characterised by an immense backlog demand and an expected high socio-economic impact.

List of Websites:

Website: http://www.isu-dep.eu

The co-ordinator of the project ISU-DEP:
Institute of Design & Assessment of Technology at the Vienna University of Technology
Favoritenstraße 11/187-2b
A-1040 Vienna
Tel: +43-1-58801/187701
Fax: +43-1-58801/187799
Email: isu-tuw@fortec.tuwien.ac.at

Email-addresses for questions in different languages:
Danish: dansk@isu-dep.eu
English: english@isu-dep.eu
German: deutsch@isu-dep.eu
Hungarian: magyar@isu-dep.eu