Power saving for healthcare facilities

 

power button

 

Haemodialysis is particularly power-hungry and, as electricity costs rise, increasing financial burdens will accrue.

A typical standard single-pass machine providing three x 4.0–4.5 hours treatment/week, plus the power required to generate RO water, is about half the weekly power draw for an average 4-person Australian home in 2011.

 

All services should seek to lower their power costs.

 

There are two options to consider:

  1. Reduce excess power use.
  2. Consider renewable power-options… e.g: solar power.

Reducing excess power use

The problem with impacting power consumption is that many of the steps that reduce power wastage appear fiddly, or seemingly insignificant. They annoy us, and seem an inconvenience.

However, most energy experts maintain that the costs of setting up power-reduction strategies are soon recouped from power bill savings.

Regardless of the added costs of ‘taking dialysis home’, a critical look at our own homes will show that lighting, heating and cooling, computers, TVs, and other appliances commonly remain in ‘stand-by’ mode, 24 hours a day, whether in use or not.

Stand-by mode is ubiquitous in day-to-day living, yet it adds a huge surplus household power cost. This also applies to facility bills. The Australian consumer group ‘Choice’ estimates household spend at least $A100 on standby power each year.

So … be smart. Start a campaign to reduce unnecessary power usage in your dialysis unit.

Dialysis equipment

Though most current dialysis machines are now fitted with heat exchangers – inbuilt systems that heat the incoming fresh dialysis fluid by heat exchanging with the outgoing spent dialysate – ensure this is the case via your manufacturer. For example, heat exchangers were not routine in the UK in 2010/11, and significant savings were made through retrofitting machines across the UK.

General equipment

All units should…

  • Ensure computers and photocopiers are auto-configured to enter hibernation, sleep or standby mode when not in use
  • Encourage staff to log off and switch off computers when not in use
  • Ensure fridges and freezers are set at appropriate temperatures (an ideal fridge temperature is 4 or 5°C and an ideal freezer temperature is -15 to -18°C)
  • If you have a second fridge or freezer, only turn it on when you need it
  • Ensure energy efficient appliances are preferentially purchased
  • Use Sustainability Victoria’s Energy Rating Calculator to calculate the energy consumption and running costs of appliances before purchase.

Lighting

Fresenius Medical Care data suggests that up to 20% of all dialysis unit power is used for lighting (1).

All units should…

  • Encourage staff to turn off lighting when not in use
  • Conversion to low-energy light bulbs (use the Light Bulb Saver App) can help identify the best light bulbs for your unit … and how much could be saved)
  • Install motion sensors in low traffic areas

Japanese researchers have reported that light may be detrimental to light-exposed blood – especially fluorescent light, the most common light source used in dialysis services worldwide.  As the extracorporeal dialysis circuit exposes blood to ambient external lighting sources in small-bore, high-surface-area, transparent tubing for ~12 hours/week, we should have long-ago asked the question: ‘is this good for blood rheology and/or vascular reactivity? But, no-one else has. Furthermore, no one has repeated their work – or extended it. That is reprehensible.

These researchers have shown that reactive oxygen species are activated in extracorporeal circuits exposed to fluorescent light and, by induction of endothelial injury, can lead to nitric oxide pathway activation and other metabolic consequences.

Yet, further research into the potentially harmful effects of light has not been performed. If the Japanese work is confirmed, blacked-out extracorporeal lines or the replacement of fluorescent lighting with LED lighting wherever possible may become a future dialysis imperative.

Their work suggests that the environment in which dialysis is provided may be of critical importance – yet no research has been done to examine the physical factors that might impact a dialysis session. So … there is much to be done!

Heating and cooling

  • Ensure heating and cooling is always turned off when not in use
  • Where possible, ensure access to thermostats
  • Ensure thermostats are set at appropriate temperatures

 

Did you know… every degree cooler in summer or warmer in winter increases your energy costs by around 10-15%?

 

Renewable power options

There is now some limited trial data surrounding the use of solar panels to augment the power requirements of haemodialysis, both in facilities, and for home patients (2). Specifically, a study from Barwon Health, Geelong, has shown that a 3-kWh solar array is able to generate 81% of the total power required to run 4 dialysis machines and associated equipment 4 times per week, reducing electricity costs by 76.5%.

As electricity prices rise and as a variety of CO2 taxes and levies are debated and/or introduced, power costs will loom larger for healthcare organisations, especially if utility rebates lag or diminish. In addition, any energy sourced from “green” power options promise to alleviate the carbon burden of non-renewable energy sources, e.g. coal.

Working out your haemodialysis unit solar power requirements

Solar panel installation companies will assist you in working out the solar requirements of your unit based on your electricity bills and meter data. They should also be able to advise on the appropriate sized unit to meet your needs. Ensure you obtain at least two quotes so you can compare recommendations and prices.

Alternatively, you can work this out for yourself.

  • Apply a standard industrial power-meter to your dialysis equipment – both dialysis machine and reverse osmosis system.
  • Measure their average hourly power draw (kWh). Perform several measurements on several machines and mean the data.
  • Determine the daily average solar insolation at the latitude and longitude of your unit or patient home, using the following method.
  • Go to ‘Wunderground‘.
  • Enter your city (e.g. Geelong) and country (e.g. Australia).
  • Check the ‘Give raw insolation data’ box, scroll down to ‘Submit’, and click. A graph will appear, showing the raw monthly insolation data for your location (e.g. Geelong) in kWh/m2/day.
  • The average kWh/m2/day is then calculated for you (e.g. Geelong = 6 kWh/m2/day …  which means each m2 of solar panel will generate ~6 kWh/day power).

Next…

  • Select a ‘panel model’ … NB: a number of potential solar arrays are modelled at this Internet site.
  • In addition, check your local solar power suppliers for their range of products, and apply.

The ‘generative efficiency’ is then automatically determined. If the chosen or preferred array is unlisted, the efficiency rating for that array can be supplied by the chosen manufacturer.

Finally, a predicted potential cost/benefit outcome can be calculated, based on power requirements, array size, installation cost, and any locally applicable rebate or pay-back arrangements.

Home HD patients should also be supported in considering renewable energy options (see ‘Solar power for home dialysis patients’ later in this website).

 

Choosing a Green Electricity Provider

If solar power isn’t an option for your facility, then consider how else you might be able to augment your power needs with another renewable power source applicable to your area (wind, geo-thermal, or hydroelectric).

Alternatively, question your power supplier about the % of power drawn from renewable power sources.

Shop around. You might be surprised at both the differences in price, and the % of power your company offers from “green” power sources. By choosing a green retailer that generates its energy from renewable sources rather than fossil fuels, you will not only be reducing the environmental impact of your energy usage, but also supporting the renewable energy industry in Australia and sending a signal to Australian energy companies that you want them to get serious about tackling climate change.

Helpful resources:

  • Greenpeace has compiled a Green Electricity Guide that provides an independent, unbiased ranking of the environmental performance of all retailers selling electricity to Australian households.
  • Choice has also compiled a Green Electricity Review that provides an independent review of 23 energy retailers on their green credentials.
  • The Australian Government site, EnergyMadeEasy allows a comparison of the cost of different electricity offers from energy retailers in Victoria. Similar resources are available in other states also.

 

Home patients should also be encouraged to consider green power options. See the later section on green electricity providers for home dialysis patients.

 

 


References

  1. Kastl J, Pancirova J. (Eds.). Environmental Guidelines for Dialysis: A Practical Guide to Reduce the Environmental Burden of Dialysis. (First Edition: September 2011) European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA). Luzern, Switzerland. ISBN: 978-84-615-0988-0.
  2. Agar JWM, Perkins A, Simmonds RE, Tjipto A. An affordable model for solar-assisted home haemodialysis. (Abstract only) Proceedings: 49th ERA-EDTA Congress, Paris, 2012.