ANNA MARTÍ MONRÓS(1), Sergio García Vicente(2,3), María Morales Suárez-Varela(2), Agustín Llopis González(2).

1. Nephrology Service. General University Hospital of Valencia (Spain). 2. Teaching Unit of Preventive Medicine anf Public Health – University of Valencia (Spain).

3. Management Unit of Health Departament Xàtiva – Ontinyent (Valencia-Spain) – Valencian Health Agency– Valencian Health Ministry (Spain).

CERTIFIED ENVIRONMENTAL MANAGEMENT

DEVELOPMENT

WITHIN THE SPANISH HOSPITAL

BASED HAEMODIALYSIS UNITS

Any activity has an impact on the enviroment and this impact has more than one aspect.

Poured in the water

ACTIVITY

Atmospheric emissions

Noice

Waste

Consumes(water, raw material, power)

Health care activities:

All but among them we have Hemodialysis:

It´s not only a heavy consumer of water and energy but also generates big amount of waste products

Sanitary waste products:

Not enough known and/or identified.

Its management in a secure and sustainable way, considering the environmental effect and preventing pollution:

… Is vital for the Society well-being …

Introduction

Most powerful tools in order to protect environment are:

1. REGULATIONS:

In order to guarantee minimum/basic requirements.

2. FEES – GENERAL & ENVIROMENTAL TAXES.

3. FINANCIAL GRANTS – SUBSIDIES –FISCAL BENEFITS.

But we also have…

Introduction

But we also have…

The voluntary environmental management systems

(SGMA):

ISO(*) 14.001-2.004 and,

EMAS (**) (III - Bylaw CE 1221/2009 EMAS)

(*) ISO: International Organization for Standardization.

(**) EMAS-Environmental Management and Auditing System.

Introduction: Environmental Management Systems (EMS)

The main goal of an EMS are: To establish levels of sanitary waste reduction

achievable and measurable. To integrate all environmental aspects in the

everyday management structures and regulations.

“Environmentally friendly institution”.

SPAIN, fourth country in the world (and second in Europe) in ISO 14001 accreditations: 16.341 (6,1% of all). Only 271, “health institutions”.

Figure 1. Worlwide total of certificates ISO 14001: evolution 2007– 2011(*).(*) Compilation, based on: ISO survey 2011. Available in: www.iso.org/iso/home/standards/certification/iso-survey.htm Last lecture: 05/05/2013.

% in 2011

1 China 30.489 1 China 39.195 1 China 55.316 1 China 69.784 1 China 81.993 30,63%2 Japan 27.955 2 Japan 35.573 2 Japan 39.556 2 Japan 35.016 2 Japan 30.397 11,36%3 Spain 13.852 3 Spain 16.443 3 Spain 16.527 3 Spain 18.347 3 Italy 21.009 7,85%4 Italy 12.057 4 Italy 12.922 4 Italy 14.542 4 Italy 17.064 4 Spain 16.341 6,10%5 United Kingdom 7.323 5 United Kingdom 9.455 5 United Kingdom 10.912 5 United Kingdom 14.346 5 United Kingdom 15.231 5,69%

6 Republic of Korea 6.392 6 Republic of Korea 7.133 6 Republic of Korea 7.843 6 Republic of Korea 9.681 6 Republic of Korea 10.925 4,08%7 USA 5.462 7 Germany 5.709 7 Romania 6.863 7 Romania 7.418 7 Romania 9.557 3,57%8 Germany 4.877 8 USA 4.974 8 Germany 5.865 8 Czech Republic 6.629 8 France 7.771 2,90%9 Sweden 3.800 9 Sweden 4.478 9 USA 5.225 9 Germany 6.001 9 Germany 6.253 2,33%

10 France 3.476 10 Romania 3.884 10 Czech Republic 4.684 10 France 5.251 10 USA 4.957 1,85%

154.572 188.574 222.974 251.548 267.457

26.361 34.002 34.400 28.574 15.909

148 156 160 156 158

2011

Number of countries

Annual growth of certificates

2007 2008 2009 2010

Worlwide total of certificates

Introduction

Aim of the presentation:

As in Spain there is no Public General Registry

where you can find the list of health related institutions

with an SGMA based in ISO 14001-2004 and EMAS.

AIM:

To learn the SGMA implementation level in Hospital

with Haemodialysis Units within the National Health

Care System.

1.First of all we decided to prepare a

list by local health regions with all

Hospital with haemodialysis Unit and

EMAS and/or 14001 accreditation.

Methods

2. INFORMATION SOURCES:

a. National Catalogue of Hospitals 2012:

• www.msc.es/ciudadanos/prestaciones/centrosServiciosS

NS/hospitales/home.htm

b. Spanish Registry of Sanitary Accreditation and

Certification:

• www.calidadasistencial.es/index.php?page=recas2

c. EMAS Local governments registry:

• www.magrama.gob.es/es/calidad-y-evaluacion-ambiental

/temas/sistema-comunitario-de-ecogestion-y-ecoauditori

a-emas/registro-y-promocion/compet.aspx

Methods: Information sources

d. DATA PROVIDED BY THE INSTITUTIONS

ACREDITATED TO ISSUE ENVIROMENTAL

CERTIFICATONS BY THE SPANISH NATIONAL

ACREDITATION AGENCY:

• www.enac.es

e. INFORMAION ON THE DIFFERENTS HOSPITAL WEB

PAGES.

Methods: Information sources

f. OTHERS:

• SPANISH SOCIETY OF DIALYSIS AND TRANSPLANT

(SEDYT), www.sedyt.org/2004/

• SPANISH SOCIETY OF NEPHROLOGY (SENEFRO),

www.senefro.org

• PATIENT RENAL CARE ASSOCIATIONS (ALCER):

www.alcer.org

Methods: Information sources

1. SPANISH NATIONAL HEALTH SYSTEM:

• 790 HOSPITALS (PRIVATE: 432).

• 210 HOSPITALS, WITH HAEMODIALYSIS UNIT.

• TOTAL HEMDIALYSIS SITES: 4.298.

2. 52 HOSPITAL WITH HEMODIALYSIS UNITS HAVE

“ISO 14001-2004”: 38, PUBLICS & 14, PRIVATES.

• DE 790: 6,6%. DE 210: 25%

Results

3. 14 HOSPITALS WITH HEMODIALYSIS HAVE “EMAS”

plus ISO: 12, PUBLICS & 12 PRIVATE.

• DE 790: 1,8%. DE 210: 6,7%

4.1.291 TREATMENT SITES “WORKS” WITH “EMS”

(ISO 14001; 30% DEL TOTAL).

• ONLY, 296, WITH “EMAS” (6,9% DEL TOTAL).

• ANDALUCÍA, MADRID & VALENCIA ARE THE

REGIONS WITH MORE ACREDITATIONS.

Results

REGION ISO +/- EMAS PUBL./PRIV. DYALISIS CHAIRSHOSPITAL AND LOCATION

ANDALUCÍA

Hospital Virgen del Mar - Almería ISO Private 10

C. H. de Poniente - Almería ISO Public 18

Complejo Hospitalario de Jaén ISO Public 48

Área Hospitalaria Juan Ramón Jiménez - Huelva ISO + EMAS Public 44

Hospital Regional Universitario Carlos Haya - Málaga ISO Public 56

Empresa Pública Hospital Costa del Sol - Málaga ISO + EMAS Public 18

Hospital Univ. Virgen de la Victoria - Málaga ISO Public 2

Hospital Universitario Virgen del Rocío - Sevilla ISO Public 45

Hospital Universitario Virgen de Macarena - Sevilla ISO Public 48

Hospital Universitario Virgen de las Nieves - Granada ISO + EMAS Public 56

ARAGÓN Hospital San Juan de Dios - Zaragoza ISO Private 36

Fundación Hospital Son Llátzer - Mallorca ISO Public 21

Fundación Hospital Manacor - Manacor ISO + EMAS Public 14

Hospital Quirón - Tenerife ISO + EMAS Private 22

Hospital U. Ntra Sra de la Candelaria - Tenerife ISO Public 35

Hospiten Bellevue - Tenerife ISO Private 4

Hospiten Sur - Tenerife ISO Private 27

Clínica San Roque - Las Palmas ISO Private 7

CASTILLA -LEÓN

Hospital de El Bierzo - Ponferrada (León) ISO Public 13

ISO Public 47

CATALUNYA

ANDALUCÍA

BALEARES

CANARIAS

CASTILLA - LA MANCHA

Hospital General Universitario de Ciudad Real

Hospital General de Vic (Consorci Hospitalari) ISO + EMAS Public 26

Hospital Sant Joan de Déu - Barcelona ISO + EMAS Private 2

Hospital de Palamós - Fundación Mossen Miquel Costa ISO + EMAS Public 17

Fundació Salut Empordà - Hospital de Figueres ISO + EMAS Public 20CATALUNYA

Consorcio Hospital General Universitario - Valencia ISO Public 24

Hospital Universitario y Politécnico La Fe - Valencia ISO Public 20

Hospital Universitario de la Ribera - Alzira ISO Public 35

Hospital Imed Levante - Benidorm ISO Private 15

Clínica Vistahermosa - Alicante ISO Private 43

Hospital Perpetuo Socorro - Alicante ISO Private 73

Hospital General Universitari d'Elx - Elche ISO Public 25

Hospital Da Costa - Burela - Lugo ISO + EMAS Public 19

Complejo Hospitalario de Pontevedra ISO Public 26Hospital Nuestra Señora de Fátima - Vigo ISO Private 5

LA RIOJA Fundación Hospital Calahorra - La Rioja ISO + EMAS Public 20

COMUNIDAD VALENCIANA

GALICIA

MADRID

Hospital Universitario Sanchinarro ISO Private 1

Hospital Universitario La Paz - Madrid ISO Public 37

Hospital Universitario 12 de Octubre - Madrid ISO Public 31

Hospital Central de la Defensa Gómez Ulla - Madrid ISO Public 19

Hospital Clínico San Carlos - Madrid ISO + EMAS Public 16

Hospital General Universitario Gregorio Marañón - Madrid ISO Public 28

Hospital Universitario Príncipe de Asturias - Alcalá de H. ISO Public 28

Hospital Universitario Fundación Alcorcón ISO Public 37

Hospital Universitario de Getafe ISO Public 25

Hospital Infanta Elena (Valdemoro - Madrid) ISO Public 16

Hospital Universitario del Henares - Coslada ISO Public 8

Hospital Infanta Cristina - Parla ISO Public 16

MURCIA Hospital Universitario Virgen de la Arrixaca - Murcia ISO Public 33

Hospital Galdakao-Usansolo - Bilbao ISO + EMAS Public 22

Clínica Virgen Blanca - Bilbao ISO Private 15

Hospital San José - Vitoria-Gasteiz ISO Private 1

Hospital de Zumárraga - Zumárraga ISO Public 17

MADRID

PAÍS VASCO

5. OUT OF THE 19 CERTIFIERS ENTITIES IN SPAIN, ONLY

6 HAVE CERTIFIED HOSPITALS WITH HEMDIALYSIS

UNITS.

• We´ve decided not to mention the certifiers entities to

avoid bias.

6. 20 HOSPITALES out of 52 do not include any

environmental management related information in

their web site.

• Only 2 HOSPITALS have no web site.

Results

1. DESPITE THE BIG IMPACT IN WASTE PRODUCTS

GENERATION, THERE IS NO UPDATED OFFICIAL

REFERENCE LIST, SHOWING THE HEALTH CARE

INSTITUTIONS IMPLEMENTATION OF SGMA AND

MORE PARTICULARLY FOR HEMAODIALYSIS

FACILITIES, THE AVAILABE DATA IS SCARE AND OF

DIFFICULT ACCES.

2. PREPARATION OF A DATABASE OFFER AND

APROXIMATION TO THIS SITUATION.

Conclusions

3. SGMA IMPLEENTATION AT HEMODIALYSIS LEVELS

COULD AND SHOULD BE IMPROVED.

4. THIS PRESENTAIONIS PART OF A LARGER

RESEARACH AIMING TO DEMOSTRATE THE

ENVIROMENTAL IMPACT OF DILAYSIS TRATMENTS AND

WHETHER SGMA IMPLEMENTATION IMPROVE

DANGEROUS WASTE PRODUCTS MANAGMENTS OR NOT

AND CONSEQUENTLY THE CONSUME OF NATORUAL

RESURCES.

Conclusions

KEYWORDS: Environmental management system; hemodialysis; healthcare waste management; hospital. CONFLICT OF INTEREST STATEMENT:

We certify that there is no conflict of interest with any organization regarding the material discussed in the document – ppt. Funding: exclusively personal.

PRINCIPLE OF EQUALITY BETWEEN WOMEN AND MEN:The use of a single genus in the writing of this communication is intended to facilitate viewing and prevent duplicate articles, nouns and adjectives by the use of the female and male genders simultaneously. We therefore declare that this document is ensured by the transmission of an egalitarian and diverse image of women and men and promotes the knowledge and dissemination of the principle of equality.

CONTACT ADDRESS: Dra. M. Morales. Teaching Unit of Preventive Medicine anf Public Health – Pharmacy School - University of

Valencia. Av. Vicent Andrés Estellés, s/n. 46100 – Burjassot – Valencia – Spain. Phone: (+34)963.544.951. Email: anna.marti.monros@gmail.com

THANK YOU VERY MUCH

FOR YOUR ATTENTION