Green Mileage (GM)– sustainable program towards eco-friendly

dialysis in Saudi Arabia: Results of Phase One

Evelyn D BunaniArchie D Bunani, John “JM” Sedgewick

BackgroundDialysis-related wastesWater consumption and sewage Water source for HDF useElectrical consumptionCarbon footprintEquipment-related incidences and

accidentsBetter dialysis-outcomes

Program ObjectivesBetter dialysis outcomes to 15,000+

patientsReduction of carbon footprint to at least

20% in each Phase of implementationReduction of water sewage wastes to at

least 30% in each PhaseReduction of equipment-related to

incidences and accidents to at least 50% in each Phase

Program Lay outPHASE ONE (P1) – 2011 to 2013

◦Regulation compliance AAMI, MoH, CBAHI, JCIA, ISO

◦Water Reusability 2009 - ±1600 m3/day consumption (35 mtons)

◦60% dialysis related operations◦25% HDF dialysis operations◦15% facility consumptions

2010 - ±2100 m3/day consumption (45 mtons)◦65% dialysis related operations◦15% HDF dialysis operations◦20% facility consumptions

Program Lay outPHASE ONE (P1) – 2011 to 2013

◦Electrical Consumption 2009 - ±1400 kw/day consumption (18 HOO)

◦ 85% dialysis related operations◦ 15% facility consumptions

2010 - ±2300 kw/day consumption (20 HOO)◦ 80% dialysis related operations◦ 20% facility consumptions

◦Equipment related incidences/accidents 2009 - ±16 incidences of post RO spill 2009 - ±84 incidences of multiple mandatory rinses post

normal mandatory rinse 2010 - ±8 accidents as to falls (Staff) due to post RO spill

Program Lay outPHASE TWO (P2) – 2013 to 2015

◦Better Dialysis-outcomes◦Reduction of dialysis-related wastes

(not by reusing of materials) Centralization approach

◦Reduction of office-material use◦50% of equipment update (FMC 5008 to 5008s)

Program Lay outPHASE THREE (P3) – 2015 to 2017

◦100% of equipment update (FMC 5008 to 5008s)

◦Reduction of Carbon footprint◦Improve HDF experience to at least 30%

PHASE 1 METHODSThree centers approach

◦Unit A – control (no change applied)◦Unit B – manipulation (applied interventions)◦Unit C – mixed (15 stations on conventional, 6

stations on HDF)

PHASE 1 METHODSUNIT B approach

◦Reverse Osmosis Series◦Waste water “underground”◦Use of portable RO for sporadic dialysis to 1 to

2 patients in a non-unit/ICU operation◦Unit operations of Unit B are all functioned by

Solar Power (except in-house dialysis like ICU, or use of Portable RO)

PHASE 1 METHODSUNIT B approach

◦Reverse Osmosis Series

Series approach

Series 1

Series 2 goes back to series 1

PHASE 1 METHODSUNIT B approach

◦Waste water “underground”

Goes to distillation

Goes to reservoir for toilet and other use

PHASE 1 METHODSUNIT B approach

◦Use of portable RO for sporadic dialysis to 1 to 2 patients in a non-unit/ICU operation

PHASE 1 METHODSUNIT B approach

◦Solar Power

SIGNIFICANT RESULTSWater consumption

◦Reduced to 42% (base is 45 mtons/mo) 2011 - ±26.1 mtons – Sept 2011 (±1300 m3/day) 2012 - ±25.8 mtons – Aug 2012 (±1750 m3/day) Average - ±25.2 mtons/mo

Reject water (sewage)◦Reduced to 32-35% (base is 15 mtons/mo)

2011 - ±10.4 mtons – Sept 2011 2012 - ±10.2 mtons – Aug 2012 Average - ± 9.8 mtons

SIGNIFICANT RESULTSElectric consumption (based on budget

expenditure)◦Reduced to 85% (facility consumptions)

2011 - ±945kw/mo only– Sept 2011 (±6300 kw/mo)

2012 - ±2760kw/mo only –Aug 2012 (±13800 kw/mo)

Average - ±1100 kw/mo All power consumed are based on Solar Power No adequate reference can be used on basis of power use.

CONCLUSIONGM P1 has been an effective tool to

efficiently promote environmental sustainability while protecting patient safety.  It also enables the health team to adequately control and “reuse waste products while achieving better outcomes.”

THANK YOU!