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WORKSHOP 1: Teoh Bee Ling_waste
- 1. #LowCarbonHealthCare BEE LING TEOH Nurse Educator Buddhist Tzu-Chi Dialysis Centre Penang, Malaysia
- 2. #LowCarbonHealthCare 2 NGO – providing free HD treatment, blood tests, EPO injections and other subsidies – transport, medications Updated: 30th September 2017 PENANG BUTTERWORTH KEDAH TOTAL HD MACHNES 48 40 24 112 MEDICAL STAFF (RN + AN) 24 + 8 17 + 3 15 + 2 56+ 13 DEDICATED VOLUNTEERS 30 10 1 41 HD PATIENTS 136 104 80 320
- 3. #LowCarbonHealthCare Buddhist Tzu-chi Organization #LowCarbonHealthCare 1. Charity 2. Medical 3. Education 4. Humanitarian International Relief Bone Marrow Registry Community volunteers Environment Protection
- 4. #LowCarbonHealthCare GGHH member since sept 2016
- 5. #LowCarbonHealthCare CS 1 - Food: Vegetarianism and Utilization of Reusable Food Containers reduces Carbon Emission https://gghhconnect.cisconetspace.com/group/food/case-studies CS 2 - Water: A precious Commodity Conserving and Reducing Water Consumption through Using Recycled Reject Water Processed from Water Treatment System https://gghhconnect.cisconetspace.com/group/water/case-studies CS 3 - Waste: Reduce, Re-use, and Recycle For Our Future Generations https://gghhconnect.cisconetspace.com/group/waste/case-studies CS 4 - Energy : The Implementation of Energy Saving Practices Optimizing Consumption and Reduction of Carbon Dioxide Emissions http://www.greenhospitals.net/case-studies-3/#energy
- 6. #LowCarbonHealthCare Buddhist Tzu Chi Dialysis Centre - policy requiring all employees to bring only vegetarian food in reusable containers to work “ONLY VEGETARIAN FOOD POLICY” - implemented since 1997
- 7. #LowCarbonHealthCare Duration Plastic bags saved Average plastic wt – 10 g Reduction of CO2 emission (1 Kg of plastic: 6 Kg of CO2 ) Computation Process (days * average plastic consumption) (average no. of plastic containers * Average plastic wt) (total plastic weight * CO2 Emission of Plastics) 1 Day 200 bags 2 Kg 12 Kg CO2 25 Days 5000 bags 50 Kg 300Kg CO2 300 Days 60,000 bags 600 Kg 3,600 Kg CO2 Carbon Emission Reduction through reduction of plastic bags 100 Employees & Patients = 2 plastic bags each Food packed in reusable containers by patients & Employees
- 8. #LowCarbonHealthCare A matured tree - 22 kg of carbon dioxide per year and 1 ton of carbon dioxide by the time it reaches 40 years old. By reduction of 3,600 Kg CO2, it is equivalent to planting/saving 163 trees in a year ( considering on the working days of 300 days)
- 9. #LowCarbonHealthCare Visitors are following policy and regulations All new patients were briefed and explained on the policy and regulations
- 11. #LowCarbonHealthCare Waste generated by a single haemodialysis treatment was substantial While this waste production cannot be eliminated, there are measures that can be taken to substantially reduce
- 12. #LowCarbonHealthCare Clinical Waste Management: In Malaysia, the clinical waste being classified as scheduled waste that is controlled under the Environmental Quality (Scheduled Wastes) Regulations, 2005. All healthcare establishments in Malaysia adopted the standard colour coding which is widely accepted:- BLACK : General wastes YELLOW : Clinical wastes for incineration only
- 18. #LowCarbonHealthCare 7 Rs Recycle, Refuse, Reduce, Reuse, Repair, Re-gift & Respect
- 20. #LowCarbonHealthCare 12 -13 treatment/month Save at least 20, 400 pcs of papers/year * 2 mature trees saved *It takes up to 20-40 years for a tree to mature Since 2015
- 23. #LowCarbonHealthCare Energy – Reduce consumption Organization Goal Reduction of carbon dioxide emissions through reduction of electricity usage and consumption Reduction of cost and wastage Timer control
- 25. #LowCarbonHealthCare Patients’ participation and involvement
- 26. #LowCarbonHealthCare Water – A Precious Commodity: HD Treatment – 120 L dialysis fluid/session (4 hours) *** Generally the production of RO ( Reverse Osmosis) water – averagely 40-60% rejection rate 50% - 300 L raw water ( preparation and reprocessing of dialyser)
- 28. #LowCarbonHealthCare Water Control System Average Daily Usage Total Water Usage Water Saved Total Water Saved (for 100 persons) RM Saved Water Control System Average Daily usage Total water usage Water saved Total water saved (for 100 persons) Standard Tap (15 L/Min) 5 times (10 secs) / person / day 12.5 L 9.5L 950 L Controlled Flow Tap (4L/Min) 3.0 L Single Flush System (12L/ Flush) 5 times / person / day 60 L 40L 4000 L Dual Flush System (4L/ Min) 20 L Comparison of Water Consumption Base on Water Control System Installed - Water Taps and Toilet Flush
Editor's Notes
- Tzu Chi Dialysis Centre is registered under the NGO and we were the 1st in Malaysia to provide 100% free HD treatment to the under privileged group irrespective of race, religion …….the free treatment also include EPO injections, blood tests and other subsidies e.g transport and medication or other medical aids We have 3 Dialysis centres – all in the northern part of peninsula Malaysia….total of 300 over patients. We too provide subsidies to 150 patients doing dialysis in hospitals or other centres
- Tzu Chi means COMPASSION RELIEF Tzu Chi missions are a network of universal love. Tzu Chi works in the missions of charity, medical, education and humanitarian – Tzu Chi Dialysis centres are under the Medical mission Other than 4 Missions, TC are actively involved in International relief, Bone marrow registry, community volunteerism and environment protection
- In line with this mission, Tzu Chi dialysis centre participated in Global Green Healthy Hospital - GGHH and be a member since September 2016 with initial commitment in Waste, Energy, Water and Food out of the 10 Goals set by GGHH
- Since then we had 4 case studies being published . 1st was on FOOD 2nd was on Water 3rd was on Waste 4th was on Energy
- The carbon emission of plastic is about 6 kg CO2 per Kg of plastic. A normal plastic bag used for food packaging is about 5 g -20 g depending on size and thickness. For the computation we used 10g and 100 pax 100 Employees and patients = 2 bags each pax …. In Malaysia if we pack noodle for a person, we get 3 bags (at least) – 1 for the noodle, 1 for the soup/gravy and another to put those 2 in….that did not include if the noodle comes with sauces or additional ingredients. 200 bags/day !!! In a year we can saved up to 600 kgs of plastic waste and reduction of 3,600 Kg CO2
- With every employee and patient putting effort into practice – by not using plastic bags in food packaging we are able to reduce so much of carbon emission – 3,600 Kg which is equivalent to 163 tress being planted or saved. And not forgetting the reduction in the landfill too…..
- We do not only encourage our staff to eat vegetarian meals but also to all our visitors and patients….we are protecting the environment , reduce water pollution and deforestation and also reduce animal cruelty, suffering and deaths of countless animals. With this practice we are improving our individual health by eating responsibly and ethically. We do not face any issues of rejection or anyone against this policy, as we all respect and understand its implementation- even visitors from other countries …example here the nurses from Nepal, they too were so willing to learn and accepted the culture and policy.
- We also actively participated in activity like Ethical Eating Day which involved all our employees/nurses, patients and family and volunteers In this activity we not only promote vegetarian food but …..ethically and healthily 1. Waste not/eat less 2. Eat local produce 3. CHOOSE WHOLE FOODS - instead of processed food 4. grow own 5. Eat at home when possible.
- The appropriate handling and disposal of clinical wastes generated from hospitals and other health care institutions and facilities is essential in order to mitigate against adverse health and environmental consequences. ISO SINCE 2003 – ISO 9001/ MSQH –ACCREDITATION
- There are items that we can control and prevent them from being thrown as waste and end up in the landfills.
- Other than the segregation of the recyclable items – we used them for posters, decorations and teaching materials
- In Malaysia we have many festivals and we celebrate all festivals because our patients are from different races and religions. We also use the recyclable items to make cards and decorative items as gifts
- Recycle: to re-use the item and create something else with it. Refuse: to avoid buying products that are not sustainable or recyclable Reduce: use less of something. Reuse: to put into action or service again. Repair: to repair products rather than buy new ones. Re-gift Respect: treat with consideration • • Rethink: to think about how you can reuse a product or its materials •
- For every HD treatment – we use about 120 L of dialysis fluid/4 hrs /session ( which based on 500mls/flow rate per min) On average, the RO water treatment system produces about 40-60% of rejection rate. So if we take 50% rate – for each patient we will require about 300 L of raw water. 100 patients = 30,000 L of Raw water – that’s a lot of water requirement. In Tzu Chi Dialysis centre, ** The reject water are all reused for toilet flushing, cleaning of premises This saved up a lot of water but we do not stop there…..
- Even though we are re- using the water, we still encourage all our staff to save water in every way we can…this is an on-going campaign
- . In addition to the Water Treatment System which allows us to utilize reject water, we are also implementing controls to reduce water consumption. These controls are as follows: Volume Controlled Faucets: typical taps discharge 15 to 18 liters per minute compared with low-flow and aerating models which use as little as 4 litres per minute depending on the intended application Taps with an aerator or flow restrictor may reduce flow to less than one third of the standard taps. Dual Flush Toilets an old-style single flush toilet can use up to 12 liters of water in one flush, whereas more water efficient dual flush toilets average less than four liters By using the controlled flow tap and dual flush toilets, on average of each visit to the washroom enable us to save 9.9 L of water. With the total occupant of 100 people and on average of 5 visits per person to the washroom, we are able to save 4,950 L of water per day,