Evelyn D Bunani Archie D Bunani , John “JM” Sedgewick

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

3. 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 Program Objectives

4. PHASE 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 out

5. 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 Program Lay out

6. 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) Program Lay out

7. 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% Program Lay out

8. 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) PHASE 1 METHODS

9. 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) PHASE 1 METHODS

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

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

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

13. UNIT B approach • Solar Power PHASE 1 METHODS

14. Water 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 RESULTS

15. 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. SIGNIFICANT RESULTS

16. 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.” CONCLUSION

17. THANK YOU!