1. Green Mileage (GM)– sustainable program towards eco-friendly dialysis in Saudi Arabia: Results of Phase One Evelyn D Bunani Archie D Bunani, John “JM” Sedgewick

2. Background Dialysis-related wastes Water consumption and sewage Water source for HDF use Electrical consumption Carbon footprint Equipment-related incidences and accidents Better dialysis-outcomes

3. Program Objectives Better dialysis outcomes to 15,000+ patients Reduction of carbon footprint to at least 20% in each Phase of implementation Reduction of water sewage wastes to at least 30% in each Phase Reduction of equipment-related to incidences and accidents to at least 50% in each Phase

4. Program Lay out PHASE ONE (P1) – 2011 to 2013 ◦Regulation compliance  AAMI, MoH, CBAHI, JCIA, ISO ◦Water Reusability  2009 - ±1600 m 3 /day consumption (35 mtons) ◦ 60% dialysis related operations ◦ 25% HDF dialysis operations ◦ 15% facility consumptions  2010 - ±2100 m 3 /day consumption (45 mtons) ◦ 65% dialysis related operations ◦ 15% HDF dialysis operations ◦ 20% facility consumptions

5. Program Lay out PHASE 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

6. Program Lay out PHASE 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)

7. Program Lay out PHASE THREE (P3) – 2015 to 2017 ◦100% of equipment update (FMC 5008 to 5008s) ◦Reduction of Carbon footprint ◦Improve HDF experience to at least 30%

8. PHASE 1 METHODS Three centers approach ◦Unit A – control (no change applied) ◦Unit B – manipulation (applied interventions) ◦Unit C – mixed (15 stations on conventional, 6 stations on HDF)

9. PHASE 1 METHODS UNIT 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)

10. PHASE 1 METHODS UNIT B approach ◦Reverse Osmosis Series Series approach Series 1 Series 2 goes back to series 1

11. PHASE 1 METHODS UNIT B approach ◦Waste water “underground” Goes to distillation Goes to reservoir for toilet and other use

12. PHASE 1 METHODS UNIT B approach ◦Use of portable RO for sporadic dialysis to 1 to 2 patients in a non-unit/ICU operation

13. PHASE 1 METHODS UNIT B approach ◦Solar Power

14. SIGNIFICANT RESULTS Water consumption ◦Reduced to 42% (base is 45 mtons/mo)  2011 - ±26.1 mtons – Sept 2011 (±1300 m 3 /day)  2012 - ±25.8 mtons – Aug 2012 (±1750 m 3 /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

15. SIGNIFICANT RESULTS Electric 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.

16. CONCLUSION GM 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.” GM 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.”

17. THANK YOU! THANK YOU!