title: Development of certified environmental management in hospital and outpatient haemodialysis units.
abstract: BACKGROUND
  The environmental impact of haemodialysis is very high. Institutional activity in this sense is important, even in the production of references. Voluntary environmental management systems (EMS), environmental management and auditing systems (EMAS) and the International Organization for Standardization standards (ISO 14001) are important tools for environmental protection, together with legislation, taxation and tax benefits.
  
  
  OBJECTIVE
  To determine the degree of implementation of EMS in hospital units and outpatient haemodialysis in the Spanish National Health System to provide a group of reference centres in environmental management in this healthcare activity.
  
  
  METHODS
  Development of a list by autonomous communities showing hospital and outpatient dialysis units using an EMAS and/or ISO 14001 in 2012-2013. The sources of information were the Spanish National Catalogue of Hospitals, Spanish Registry of Healthcare Certification and Accreditation, European and regional EMAS records, world ISO registrations, dialysis centre lists from scientific societies and patients, responses from accredited entities in Spain for environmental certification and the institutional website of each haemodialysis centre identified.
  
  
  RESULTS
  Of the 210 hospitals with a dialysis unit, 53 (25%) have the ISO 14001 and 15 of these also have an EMAS). This constitutes 30% of all hospital dialysis chairs in Spain: 1,291 (of 4,298). Only 11 outpatient clinics are recorded, all with the ISO 14001.
  
  
  CONCLUSIONS
  There is no official documentation of the implementation of EMS in dialysis units. Making this list provides an approach to the situation, with special reference to haemodialysis because of its significant environmental impact.
authors.affiliation: Departamento de Gerencia, Hospital Lluís Alcanyís, Conselleria de Sanitat, Generalitat Valenciana, Xàtiva (Valencia) España.
authors.forename: Sergio
authors.initials: S
authors.lastname: García Vicente
authors.affiliation: Unidad Docente de Medicina Preventiva y Salud Pública, Facultad de Farmacia, Universidad de Valencia, Burjassot (Valencia), España. Electronic address: sergarvi@alumni.uv.es.
authors.forename: María
authors.initials: M
authors.lastname: Morales Suárez-Varela
authors.affiliation: Servicio de Nefrología, Consorcio Hospital General Universitario de Valencia, Valencia, España.
authors.forename: Anna
authors.initials: A
authors.lastname: Martí Monrós
authors.affiliation: Unidad Docente de Medicina Preventiva y Salud Pública, Facultad de Farmacia, Universidad de Valencia, Burjassot (Valencia), España.
authors.forename: Agustín
authors.initials: A
authors.lastname: Llopis González
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000592:standards; D002568:Certification; D003247:Conservation of Natural Resources; D004777:Environment; D004787:Environmental Pollution / Q000517:prevention & control*; D019983:Guideline Adherence; D006291:Health Policy; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D007390:International Agencies; D020407:Internet; D008330:Management Audit / Q000458:organization & administration* / Q000592:standards; D012042:Registries; D006435:Renal Dialysis / Q000592:standards; D013030:Spain
keywords: Atención sanitaria; Clínica ambulatoria; Diálisis; Environmental; Gestión; Haemodialysis; Healthcare; Hospital; Management; Medio ambiente; Nefrología; Nephrology; Outpatient clinic; Residuo; Waste