From Pilot Program to Transfer Model: HACK-IT-NET

Disposing of unused components, failing to make full use of reusable products, and packaging individual instruments in a way that is resource-intensive: Such waste of resources cannot be addressed solely at the point where it occurs. Changes must also be made in purchasing, hygiene, reprocessing, and disposal. This is precisely where Bavaria’s contribution to HACK-IT-NET comes in. Within this framework, Bayern Innovativ combines training, collaborative idea development, and guided implementation. The project, co-funded by the EU through the Interreg Alpine Space program, will bring together nine organizations from six countries in the Alpine region from July 1, 2024, to June 30, 2027, to test sustainable and digital approaches and prepare for their transfer.

For the hospital teams, this process begins with training on prevention and extended use. Employees then contribute ideas from their daily work, which the relevant departments jointly review and prioritize. Bayern Innovativ provides support through expert input and facilitation; status meetings accompany implementation and evaluation. Clinical evaluation and responsibility for patient safety and quality of care remain with the hospital. In this way, in addition to individual measures, insights are gained into the coordination required to make them possible in the first place.

A nine-month pilot project at Nuremberg Hospital demonstrates how this works in practice. Employees from departments including the operating room, anesthesia, purchasing, sanitation, and reprocessing examined existing material flows. Existing reusable laryngoscope blades were utilized more extensively; at the same time, packaging units were changed from one blade to five. The project report cites an 80 percent reduction in packaging material as a result—corresponding to more than 4,000 bags.

Other measures addressed the material cycle at various stages: ZVD lines delivered separately as needed are intended to prevent unused components from being disposed of. The report estimates a savings of 12,000 lines and approximately 192 kilograms of PVC without packaging. For used CLIC absorber cartridges, however, a return process to the manufacturer was established. In addition, waste separation and packaging processes were reviewed, and platinum-containing catheter tips were collected for recovery.

Taken together, the report estimates annual savings of nearly 400 kilograms of plastic and more than 1.5 metric tons of CO₂; a later update cites over 400 kilograms of plastic. These figures do not constitute an independently validated overall assessment. Catheter recovery is not included due to a lack of quantity data. For HACK-IT-NET, what matters most—besides the scale of these figures—is the insight into implementation hurdles: risks of mix-ups, new collection sites, and cross-site coordination highlight what other institutions must consider when making similar changes.

This is where Erlangen and Munich come in. It is not the Nuremberg catalog of measures that is being adopted, but rather the participation structure—since supply contracts, material requirements, and reprocessing capacities differ. On July 28, 2026, Erlangen prioritized reuse, material redistribution, and reduced paper use; comparable quantified results are not yet available. As of October 2026, the TUM Klinikum Rechts der Isar is collecting ideas for surgery and anesthesia, with the project running through April 2027. The additional pilot projects are intended to demonstrate how the approach can be adapted to other conditions.

To ensure this knowledge can be applied beyond the pilot hospitals, the international network is compiling experiences and methods. Transfer documents explain the process, roles, and time requirements. Uptake communities are intended to test the approach and provide feedback; for the Bavarian pilot, the Bavarian Hospital Association is designated as the multiplier. Maintaining partner continuity, involving suppliers, and making local adaptations remain challenges. A successful pilot alone does not yet prove widespread transferability.

The next step is therefore to permanently establish this collaboration. In Nuremberg, a Circular Economy task force is set to build on this; this requires clear responsibilities, time for coordination, and support from hospital management. Through June 2027, the focus at the project level will be on transfer documentation, expanded networks, and a long-term operational model. This brings us full circle: The success of HACK-IT-NET will be measured by whether other institutions develop sustainable changes based on their own observations of daily operations—and continue these changes even after the pilot program ends.