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      THE GREEN NEPHROLOGY SURVEY OF SUSTAINABILITY IN RENAL UNITS IN ENGLAND, SCOTLAND AND WALES : THE GREEN NEPHROLOGY SURVEY OF SUSTAINABILITY IN RENAL UNITS IN ENGLAND, SCOTLAND AND WALES

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      Journal of Renal Care
      Wiley

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          Abstract

          The impact of unmitigated climate change upon global health is predicted to be disastrous. However, the very provision of healthcare itself has a significant environmental impact, and the contribution of kidney care to the carbon footprint of the NHS is likely to be disproportionately high. Furthermore, the current economic climate will ensure that healthcare systems face unprecedented reductions in resources (or, at the very least, diminished expansion in the face of ongoing increases in demand). Improvements in the way that renal services use resources will address both issues. This survey was designed to identify a baseline for sustainability in kidney care, to support a clinical transformation to lower carbon kidney care by identifying fruitful areas for attention, and to act as an educational tool. The survey identified measures for improvement across the different areas of the provision of kidney care, including building energy use, patient and staff transport, water use and the consumption and procurement of resources. The results of the survey, which was completed by 58 adult and paediatric renal units across England, Scotland, and Wales, are reported here and potential changes are discussed.

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          Is health care getting safer?

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            Coming round to recycling

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              Using water wisely: New, affordable, and essential water conservation practices for facility and home hemodialysis.

              Despite a global focus on resource conservation, most hemodialysis (HD) services still wastefully or ignorantly discard reverse osmosis (R/O) "reject water" (RW) to the sewer. However, an R/O system is producing the highly purified water necessary for dialysis, it rejects any remaining dissolved salts from water already prefiltered through charcoal and sand filters in a high-volume effluent known as RW. Although the RW generated by most R/O systems lies well within globally accepted potable water criteria, it is legally "unacceptable" for drinking. Consequently, despite being extremely high-grade gray water, under current dialysis practices, it is thoughtlessly "lost-to-drain." Most current HD service designs neither specify nor routinely include RW-saving methodology, despite its simplicity and affordability. Since 2006, we have operated several locally designed, simple, cheap, and effective RW collection and distribution systems in our in-center, satellite, and home HD services. All our RW water is now recycled for gray-water use in our hospital, in the community, and at home, a practice that is widely appreciated by our local health service and our community and is an acknowledged lead example of scarce resource conservation. Reject water has sustained local sporting facilities and gardens previously threatened by indefinite closure under our regional endemic local drought conditions. As global water resources come under increasing pressure, we believe that a far more responsible attitude to RW recycling and conservation should be mandated for all new and existing HD services, regardless of country or region.
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                Author and article information

                Journal
                Journal of Renal Care
                Wiley
                17556678
                September 2010
                August 03 2010
                : 36
                : 3
                : 153-160
                Article
                10.1111/j.1755-6686.2010.00183.x
                20690969
                071ce7b1-4d0b-442a-9853-4dba1861981f
                © 2010

                http://doi.wiley.com/10.1002/tdm_license_1.1

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