472Q - Research Paper

Abstract
Aim:
To improve waste management by reviewing current practices, finding new and innovative ways to reduce, repurpose and recycle waste.  To decrease our environmental impact, whilst maintaining the highest level of patient care. To engage key suppliers, to educate and promote change within our department and throughout Monash Health and beyond. 

Method:
Baseline data collection to understand current state. This included staff knowledge, quantities of wastes produced, current policy and processes both internal and external to our organisation. Staff education, better infrastructure, support and easy to use displays were key. Engagement was improved by using visual tools, key data, evidence and feedback. It is important to highlight that correct waste management does not increase staff workload. 

Results:
A decrease in the amount of waste to landfill. An increase in volume of waste recycled or repurposed. Improved staff compliance with waste separation. Key suppliers’ reduction of packaging and improved understanding of how to best dispose of the waste their product creates.

Conclusion:
The move to being a sustainable dialysis unit is ongoing. As policy and technology improve, so do our plans. How we recycle and repurpose our waste is just the beginning. By in from organisations, staff and key suppliers is fundamental to the success of sustainability improvement within healthcare. 

480C - Research Paper

Abstract:
Case Description:
A closed-circuit Reverse Osmosis system was developed for a four-chair dialysis unit in Coober Pedy, reducing the demand on the local town-water supply by up to 50%.  We present here an improved design, intended for the remote South Australian site of Yalata:  a rainwater-fed 4-chair dialysis unit on the nullarbor plain.  The design will enable zero-water on-country dialysis for Aboriginal people.

Discussion:
We discuss the three water demands of dialysis treatment: Dialysis water, Reverse-Osmosis (RO) brine, system backwashing.  Our established prototypes reclaim RO waste to offset around 50% of the total demand.  Our newest design treats rainwater to increase the water recovery and reduce the backwash demand.  We discuss the limit in dialysis water consumption our goal of zero-water dialysis in remote communities.
 
Conclusion:
Water-efficient dialysis has the potential to improve Aboriginal patient outcomes through on-country dialysis in increasingly dry and remote locations.

485R - Research Paper

Abstract
Aim:
The review aims to examine the existing literature for haemodialysis water conservation practices globally. Providing a range of practical examples of water conservation approaches and their cost-effectiveness may encourage more sustainable haemodialysis in homes and in-patient settings.

Method:
PubMed and Embase databases were searched in March and October 2022. An expert in the field was also consulted to provide additional articles not captured in these searches. Using PRISMA guidelines, several researchers screened abstracts to include 25 articles. Eligible studies discussed water conservation methods in haemodialysis across different sites. All study types including personal statements were included. Non-English articles were excluded.   

Results:
The review highlighted various water conservation strategies. It discussed reusing Reverse Osmosis Reject Water (RORW) for sanitation, sterilization, and irrigation purposes. Additionally, it explored reducing overall water production, reusing post-dialysis effluent, and innovating haemodialysis unit designs. While financial benefits may be limited presently, these approaches offered potential long-term advantages.

Conclusion:
RORW, a valuable yet underutilized resource, holds promise for greywater use. Repurposing it for sanitation and sterilization is sustainable and cost-effective. Although further research is needed for its use in agricultural irrigation, adopting sustainable water approaches in haemodialysis is crucial to combat present water scarcity.

473Q - Research Paper

Abstract
Aim:
Achieve diversion of dialysis waste from landfill into usable items that is sustainable long term.

Method:
Utilise a collaborate partnership approach to quantify and then develop workable solutions to waste problems including issues of manual handling, correct plastic for use and market development.   

Results:
A long-term solution with a local recycling company has diverted over 16,000 pieces of dialysis related plastic from landfill in 8 months and has been successfully made Health District Quality Awards, Pots, Coffee Tables and play equipment.

Conclusion:
Partnering with local companies and working though problems together allows sustainable diversion of waste into usable everyday items.

Update from ANZSN’s Environmental Sustainability Committee Targets to reduce waste in haemodialysis Developing a “green network” and a bank of sustainable initiatives in nephrology