Low carbon dialysis for James Paget

Great Yarmouth’s James Paget University Hospital trains over one third of the medical students from the University of East Anglia, as well as providing comprehensive acute care for the populations of Great Yarmouth, Lowestoft, and the surrounding areas. Like other NHS Trusts, the hospital is playing its part in achieving the Government’s carbon emissions reduction target. The Trust’s Carbon Management Programme states: “James Paget University Hospitals NHS Foundation Trust will reduce CO2 emissions from our operations by 20% by 2015 from 2007/08 levels”, and energy usage is already 3% below the Good Practice Benchmark identified by NHS Estates. James Paget University Hospital has seen an increasing number of resident renal dialysis patients every year. To meet this demand, the renal ward needed to operate 16 hours each day, and to accommodate up to 18 patients at any one time for three-hour sessions. However the hospital’s existing water purification system needed to be upgraded, so a new, larger water system complying with the latest Renal Association guidelines was the obvious solution.

Purified water ‘critical’

A typical three-hour session uses about 100 litres of purified water, meaning that an average dialysis patient’s blood is exposed to more than 300 litres of purified water per week compared to about 12 litres per week in healthy individuals. This explains why purified water quality is critical. The Renal Association’s guidelines recommend that the water used to produce dialysis fluid is of chemical purity that meets the specification set out in ISO 13959. In addition, the guidelines recommend that all new water treatment plants should be capable of producing water suitable for the production of “ultrapure dialysis fluid”, including a total viable bacteria count of less than 0.1 cfu/mL, and bacterial endotoxin concentration less than 0.03 EU/mL. James Paget’s estates team was given the task of providing a new water purification system that would deliver the required water quality, and meet the additional Renal Association guidelines on water treatment plants. These include: the use of materials compatible with modern methods of ensuring microbiological quality; an effective monitoring and disinfection programme; a direct feed water supply separate from that of the hospital water supply, and minimal use of chemicals. Coupled with the hospital’s target that new systems should reduce its own carbon footprint, this presented a challenge. However, there was a greater challenge to come. The renal team did not wish to transfer patients to an alternative hospital while the new water treatment plant was installed and commissioned. Aside from the cost considerations, there was concern about the human stress that would be associated with relocation of patients. The estates department worked closely with its contractor, ELGA Process Water, with whom it has a long-term and close working relationship, to address the problem.