Water and Waste Reduction on a Renal Unit

Ben Whittaker
Ben Whittaker • 13 May 2024

This project was highly commended in the 2018 Green Ward Competition Royal Devon & Exeter NHS Foundation Trust.


Key learning point: There are multiple opportunities to reduce waste and water usage in renal units which could have significant sustainable value if scaled up and spread.

Setting/Patient Group: Renal unit

Issue to be addressed: Renal units are resource heavy areas of healthcare. A variety of initiatives were explored to improve the sustainability of a single renal unit.

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Project 1: Gambro machine settings

The third heat disinfect cycle has been eliminated and the Hot C-CART cycle started following the third patient.  This saves 24 heat disinfection cycles saved each day and reduces water and energy use.

Project 2: Disposal of bicarbonate canisters

Used bicarbonate canisters (Bi-CART) weighing 100g/canister were being put into clinical waste for disposal, this was changed to general waste disposal

Project 3: Introducing patients own blankets

Letters were sent out to patients asking them to bring their own blanket for use on the dialysis unit saving financial and environmental resources to launder blankets for 109 patients attending multiple times per week

Project 4: Home haemodialysis

The service currently supports 18 patients to undergo home haemodialysis, the aim was to assess the sustainable value of home haemodialysis compared to in-centre haemodialysis

Project 5: Introducing NIPRO machines

Water use is one of the greatest costs and sources of environmental impact for haemodialysis. Some haemodialysis machines such as the NIPRO machines are more water efficient.  12 new NIPRO machines came into use in October 2018 (for haemodialysis and haemodiafiltration, HDF).

Project 6: No Meat Mondays

Kidney Unit staff were invited to sign the ‘Meat-free Monday’ campaign pledge as meat has a high carbon footprint and financial cost.

Cumulative Outcomes for unit:


  • evidence from the literature of patients undergoing home having a better experience of haemodialysis
  • vegetarian diets may slow down progression of kidney disease without compromising nutritional needs. 
  • there are potential benefits to staff in joining a movement and in raising awareness of the environmental impacts of our daily choices and habits.


  • Carbon saving: 7,161 kgCO2e/year
  • Water saving: 258334 litres of water/year


  • £8,509/year








Resource author(s)
Jenkins H, Webb L, Eyles K, Dicks M, McAleer N, Luke R, Al-Zaved H, Harry J, Channing K, Hubbard A & Bingham C
Resource publishing organisation(s) or journal
Centre for Sustainable Healthcare
Resource publication date
December 2018

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