CleanCath is a catheter sterilizer that was developed in the context of Souvik Paul's MFA thesis Unbound, which explored how different design capabilities could be used to positively intervene in the life of someone who has sustained a spinal cord injury [SCI/D]. The sterilizer uses UV-C radiation to kill bacteria on silicone intermittent catheters, and was developed after Souvik realized that having to relearn urination and defecation was one of the hardest things to adjust to after sustaining an SCI/D because urination and defecation are two of the first things that individuals learn in their development as human beings, before even forming memory. In order to compensate for the fact that the neural network of people with SCI/D has been broken, interrupting their ability to know when they need to urinate or even how to urinate, most individuals with SCI/D are on a urination program, in which they catheterize themselves 4 to 6 times a day.
What began as an inquiry into how a Bluetooth-enabled implant could restore bladder control to someone with SCI/D evolved from speculative design for the future into practical design for everyday life. Souvik learned from one of his subject matter experts that she reused single-use catheters for her urination program. This isn't a doctor-recommended activity because of the potential of developing a urinary tract infection, but because her insurance paid out once a month, she had to predict ahead of time how much she would urinate in a month. This fact combined with the financial complexity of most insurance programs, which can cover anywhere between 120 and 180 catheters, while requiring that individuals pay anywhere between 20% and 30% of the cost of catheters, it was no wonder that Souvik's SME was forced to stockpile and reuse catheters. Early in the design process, Souvik explored various methods of sterilizing catheters, from rinsing with hot water and rubbing alcohol to using dry heat to using UV-C radiation, which is germicidal within a specific wavelength [less than 280 nm]. The last method was employed in the later iterations of the CleanCath device, which incorporated a UV-C fluorescent bulb in its design, allowing users to quickly and effectively sterilize their catheters.
In order to use the CleanCath, users rinse out used catheters with warm water, and place them into the body of the device. Closing the lid initiates the cleaning cycle, turning on the UV-C bulb, which irradiates the catheters rendering them sterile. The device sits at an angle in its charging base so that a wheelchair user could examine and manipulate the contents of the CleanCath comfortably from a seated position. The sterilizer was designed to fit multiple catheters at once – up to eight female catheters and up to two male catheters – and to be easily taken with the user if he or she was on an extended trip away from home. The form of the container allows for a single catheter to be removed at a time with minimal risk of contaminating the other catheters.
Implant SchematicThis schematic reflected Souvik's early approach to "solving" the problem of urination amongst people with SCI/D, instead of "responding" to their needs.
Early Prototype IThis is an early prototype that incorporated a UVC bulb into its design. Early designs called for the unit to be detachable from a base, and to be biased at a tilt relative to the surface that it was resting on. The function of the tilt was to ensure that users in wheelchairs could access the contents of the device. It housed each catheter in a quartz glass tube, because quartz is UVC transparent, preserving its germicidal qualities.
Early Prototype IIThis is an early prototype that incorporated a UVC bulb into its design. Early designs called for the unit to be detachable from a base, and to be biased at a tilt relative to the surface that it was resting on. The function of the tilt was to ensure that users in wheelchairs could access the contents of the device. It utilized a quartz-glass interior, as quartz is transparent to UVC.
UVC Sterilizer TeardownThis teardown of the UVC sterilization wand gave Souvik a more concrete idea of the electronics that his sterilizer would need.
Ideation SketchesFollowing the teardown, Souvik ideated the form of the device by sketching.
Blue Foam ModelsBlue Foam Models allowed Souvik to experiment with the ergonomics of his device and develop additional features like a prominent grip to allow users with limited dexterity to hold and operate the device.
CleanCathThe final configuration of the device still features a base that tilts the opening of the device towards users, enabling them to access its contents from a seated position.
Souvik's thesis journey began—violently—two weeks before he stepped foot in the School of Visual Arts, when his good friend was involved in a car accident in California. When a tractor trailer rear-ended her car while she was traveling on a family road trip, her spinal cord was severed at the T2/T3 vertebrae, paralyzing her from the chest down. Souvik visited her in the hospital and saw how difficult her transition to life in a wheelchair was, both mentally and physically. Believing in the power of design to help his friend, Souvik decided to use his thesis as an opportunity to investigate how design could help people who sustain spinal cord injuries recapture their sense of agency and identity in the face of massive physical and emotional trauma.
Reflecting on the start of his thesis Souvik recalls, "I initially wanted to design the exoskeleton concept that no one had thought of, or the wheelchair that used functional electrical stimulation [FES] technology to let users pedal themselves around by stimulating their muscles with electrical currents. In the case of design for SCI/D, I believed that aesthetics was not nearly as important as function." And as his thesis evolved, Souvik's approach also changed from investigating potential "cures" for spinal cord injuries, to focusing on facilitating adaptation to life with SCI/D.
This shift came after conducting a co-designing workshop with three wheelchair users, who revealed that adaptation was far more important to people who actually lived with disabilities. The outcomes of the workshop included the Zero Step—a modular, flexible, and inexpensive solution to accessibility for small restaurants in crowded cities, and the Store-n-fly—a packing solution for wheelchairs on flights.
Souvik also interviewed subject matter experts who shed light on his design approach. "I learned that 'fresh patients' with SCI/D do tend to view functional electrical stimulation [a technology that externally stimulates the muscles of individuals with paralysis with electrical currents, causing their muscles to contract] as the key to their recovery, but that they would do well to focus more on adaptation," Souvik reflects. "This changed everything. I realized that I was doing exactly the same thing as a designer for SCI/D: Trying to solve instead of respond."
By setting up ongoing challenges for himself, Souvik was able to further expand his perspective as a designer. Spending one week in a wheelchair—navigating the streets of New York City—was humbling, and revealed his skewed perspective as an able-bodied designer for the disabled population: "My implicit bias that using a wheelchair was merely a matter of will and strength was revealed to me in an extremely challenging way. I became really angry at myself for assuming knowledge about what it was like to be disabled, and I took this perspective and used it to evaluate the assumptions that I had about the other design outputs of my thesis." In so doing, Souvik felt compelled to redouble his outreach to potential users, and to buttress his perspective with theirs whenever possible.
It was through the course of interviews with subject matter experts that Souvik learned how difficult it was for someone with SCI/D to have to relearn how to urinate and defecate. This difficulty was both physical – learning the processes needed to work around interrupted neural networks to urinate and defecate – and mental – having to relearn how to do something that most people learn to do at 2 years old. Initially falling into the trap of designing to solve, Souvik initially designed a Bluetooth-enabled implant that would use electrical impulses to monitor and modulate neural signals coming to and from the bladder. He prototyped this using an Arduino board and a hacked together representation of the human urinary system.
Realizing that the successful development of an implant would require years, if not decades, of lead time, and wanting to design for the immediate future, Souvik investigated if there were other ways that he could help individuals with SCI/D manage their excretory programs. He learned from his friend that she reused her catheters for her urination program out of necessity, but would sometimes develop urinary tract infections [UTIs] as a result. This finding was confirmed by interviews with other individuals with SCI/D. Souvik decided to focus his efforts on creating a sterilizer for catheters, despite the fact that most doctors would not recommend the practice of catheter reuse. In doing so, he wanted to privilege the actual patient practice that was taking place, as opposed to doctor recommendations that described ideal practices that didn't necessarily translate to reality.
In designing the product, Souvik wanted to eschew the traditional look and feel of medical products – which are usually covered in sterile white plastic, with blue and green accents. He reasoned that this traditional method of designing medical devices usually doesn't affect individuals who only interact with them in the context of a hospital. However, when someone with a chronic illness or condition uses these devices every day, they subconsciously transport the user back to the hospital, reminding them of their "abnormality". Instead, Souvik wanted his device to invoke the same sense of pride that something like an iPhone does in its users. As he developed the sterilizer, he purposefully emulated the design of high-end consumer electronics.
Souvik investigated different sterilizing techniques for catheters, and quickly settled on UVC sterilization. UVC refers to a specific wavelength of UV light, measured at less than 280 nanometers. This light is germicidal, and is used in applications ranging from surface sterilization to water sterilization. It doesn't require anything other than a power source to turn the light on, making it suitable for portability. Souvik knew that his device needed to be portable in order to allow users to bring it with them into bathrooms where their urination programs took place.
Early prototypes of the device failed to depart from the severe design language of medical devices, primarily because of the size of the bulb that Souvik incorporated in his designs. It wasn't until Souvik completed a tear down of an existing UVC sterilizing wand that he began to understand the dimensional requirements of the device. Afterwards, he quickly ideated form through sketching and creating blue foam models. Tactility and ergonomics were a key consideration in the design of the sterilizer because many individuals with SCI/D have limited dexterity, so Souvik designed a form for the sterilizer that was easy to grip, and specified large buttons on the exterior of the device in order to ensure that his users would be able to operate the sterilizer.
As he rounded out the features of the device, he specified for the body of the device to be made out of aluminum – both for the familiar aesthetic appeal of aluminum, but also for its specific material properties, as aluminum is one of the only materials that can reflect UVC light in the same wavelength, preserving its germicidal properties and ensuring adequate coverage of the internal chamber of the sterilizer by the UVC light. In this respect, the aesthetic and functional considerations of the device dovetailed to a single point.
Souvik began his thesis as a designer who was enamored of function and features, tending to discount the importance of aesthetics and form as mere window-dressing. He learned that aesthetics and form can be just as functional as product features, especially for individuals looking to regain their sense of identity in the face of a life-altering accident.