Global Dialysis is supporting moves towards greener nephrology as the 7th key element in a responsible quality management plan for dialysis centres.  Adopting green nephrology policies within units can drastically reduce waste, take out costs, increase productivity, energise dialysis users as well as reduce the carbon footprint of your unit.

The seven core elements of quality in dialysis centres are:

• safety,
• timely,
• effective,
• efficient,
• equitable,
• patient centered, and
• sustainable.

The NHS in the UK sees sustainability as part of the solution for improving quality.  It's not just about climate change, it also look at reducing waste, reducing costs, developing healthcare systems that are closer to home, self care, more efficient use of drugs and equipment and better use of limited resources.

80% of units in the UK are involved with implementing sustainability measures within dialysis centres, a move stimulated by the appointment of Dr Andrew Connor, the first Green Nephrology Fellow (2009 - 2010).  Dr Connor conducted a benchmarking survey of the carbon footprint across dialysis units in the UK and has bench-marked units against an aggregated national score.  The programme has produced case studies of best practice.

The 10:10 renal checklist is a useful tool too. Units implementing this tool can cut their carbon footprint by as much as 16% by implementing these measures.

1. Lighting

Low energy lighting is a good investment - low energy light bulbs will save money as well as resources. Turn lights off in rooms not used and use motion sensors switches in cupboards and toilets.

2. Heating and cooling

Find the thermostat and make sure temperatures are comfortable for staff and patients and that air conditioning and heating is not set to come on at the same time!

3. Staff travel

Spending less time in cars makes your staff fitter and more dynamic! Encourage public transport, cycling and car sharing. Think how much your team could save on car parking and keep fit.

4. Patient travel

Develop a sustainable patient transport plan - work with patient transport, coordinate clinics to get patients' visits completed on the same day, use low emission vehicles.

5. Virtual clinics

Reduce travel and empower patients. Set up telephone follow-up service for stable transplant patients.  Great case study example is here where Coventry where telephone clinics are in use

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6. Low carbon shipping

Bring sustainability into procurement.  Try purchasing fluids in the smallest possible volumes (highest concentrations) and ask suppliers to take back packaging - scoring them on their environmental policies when you buy.

7. Printers and paper

Use recycled paper and monitor paper usage. Set printers to double-sided and draft.

8. Reduce, re-use, recycle

Look for ways to use fewer resources (e.g. open sterile kit when required, not in advance). Put our well positioned bins for recycling paper and plastics, domestic and clinical wastes. Conduct waste audits.
Case study on retro fitting heat exchangers
Case study reduce, re-use, recyle

9. Save water

Use water saving taps and conduct a business case for recovering waste water - this could save a great deal of money each year.  Case study and "How to" here with examples from Canterbury and Ashford Hospitals

10. De-carbonise care

Preventative care is the best.  Do your elderly patients get cold at home (this impacts on blood pressure control). Are the diabetics benefiting from active travel? Are families reducing red meat and the health and carbon reducing benefits this brings about?

Useful links

• www.greenerhealthcare.org/green-nephrology
• 10:10 Renal Unit Checklist: http://www.greenerhealthcare.org/1010-renal-checklist
• SHEBA renal pages: www.sustainabilityforhealth.net/renal
• SAP - Sustainable Action Planning resources for clinical teams: sap.greenerhealthcare.org
• NHS Carbon Reduction Strategy (Jan 2009): www.sdu.nhs.uk
• Carbon Trust guidance on preparing a business case: www.carbontrust.co.uk/energy/startsaving/project-plan-business-case.htm
• The Green Nephrology "Green Stars" initiative: http://greenerhealthcare.org/green-nephrology-green-stars-initiative

Downloads

In addition to the downloads below, there are a number of slide packs on climate change and health for general use at www.theclimateconnection.org/library/downloads .

Contacts

• General contact for the green nephrology programme: Frances Mortimer, Medical Director, The Campaign for Greener Healthcare - email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it , tel: 01865 515811.  Or Andrew Connor, Green Nephrology Fellow - email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• For information on renal unit wastewater recycling: Steve Milne, Renal Technical Manager, Kent and Canterbury Hospital. Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Tel. 01227 868639.
• Green Nephrology local representatives: all kidney units have been invited to nominate a Green Nephrology local representative.  We cannot publish their contact details, but you can find out whether your unit is represented by clicking here.

Are you involved in green nephrology initiatives around the world?  If so we'd love to show case best practice here.  Send us your examples This e-mail address is being protected from spambots. You need JavaScript enabled to view it .