Our EMEA (Europe, Middle East, Africa), North America, Asia-Pacific and Latin America regions are stepping up their environment-related activities every year. The responsible environment managers develop short- and long-term local strategies, partly in cooperation with external consultants, to boost environmental protection in our production sites and clinics and promote environmental awareness among employees. Furthermore, they coordinate environmental audits carried out by external government agencies and institutions as well as our own inspectors at our production sites and clinics.

The EMEA region

Environmental management is a component of our Integrated Management System in the EMEA region. The German technical inspection association TÜV regularly checks that the ISOISOInternational Organization for Standardization. 14001 environmental management standard is implemented at our Company headquarters, in our certified plants and in the national clinic organizations in Europe. At the end of 2010, our seven largest European production sites (2009: five) and the medical device development department were certified according to ISO 14001. We have also introduced the environmental management system at 255 of our European dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemodialysis the membrane of the dialyzer – is used to clean a patient’s blood. clinics (2009: 204 clinics).

Moreover, we implemented our own environmental program in Europe for the first time between 2007 and the end of 2010: Our environment managers worked on numerous projects with colleagues in research and development, production, clinic management, logistics and sales to develop more environmentally-friendly products, conserve resources like energy, water and production materials, introduce production technologies and packaging solutions that use resources more efficiently, and comply with environmental protection laws such as REACH, the EU regulation on chemical substances, by the stipulated deadline.

To cite an example, one of the projects in our environmental program was an energy efficiency initiative at our largest European production sites. Thanks to this project, we now save more than €1 M on energy costs annually. Another project involved the introduction of the clinic software e-con 5, which we have been using in our European dialysis centers since 2008. The software allows us to gather data on the consumption of resources such as water and energy, and on waste disposal. These three factors play an important role in our efforts to conserve resources and make our processes more environment-friendly. At 313 of our European clinics, we now use e-con 5 (2009: 261), and we are continuing to roll out the software to build up a comprehensive environmental data management system step by step throughout Europe. We are already deriving benefits from e-con 5: Our country organizations are now able to compare the ecological efficiency of their clinics on a monthly basis, enabling them to quickly identify improvement potential and take it into account when planning new investments.

We are currently developing a second environmental program for Europe, which is scheduled for introduction during the current fiscal year. As in the first program, our environment managers and the respective divisions together set environmental targets for each step along the value chain, for research and development or for our dialysis clinics, for example. Compared to the first program, however, this time we want to frame more measurable goals. On top of that, we will start merging the existing local occupational safety systems into one centralized occupational safety management system during 2011, and incorporate it into our Integrated Management System in Europe.

We will also continue our environmental initiatives with external partners, such as the “Go Green in Dialysis” project that we started jointly with the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) in 2010. At the end of 2011, we plan to publish a set of environmental guidelines for dialysis nurses, which we are currently developing under “Go Green in Dialysis”. The aim is to help our clinic employees make processes at their workplaces more environment-friendly, for example by reducing the consumption of water, electricity and dialysis concentrate, as well as improving waste management.

North America region

In the U.S., we have established a formal certified environmental health and safety audit program at our sites that reviews all of our manufacturing and laboratory operations on an annual basis. The audit monitors compliance with the U.S. Occupational Safety & Health Administration, the Environmental Protection Agency, the Department of Transportation, as well as state and local statutes. The environmental management in the clinics is inspected both internally and by federal agencies. One of the criteria is adherence to the guidelines for medical waste disposal. We are currently evaluating whether to also have our U.S. clinics and production sites certified according to the ISO 14001 environmental standard.

As in the other regions, both Company environmental management staff and external partners support the U.S. plants and clinics in making their procedures more environmentally compatible, for example with recycling programs. For some years now, we have been running a program to reuse medical waste containers in our clinics together with a specialist waste disposal partner. At the Ogden site, our largest production facility in the U.S., we recycle materials from all areas, including different types of plastics and cardboard. At our Walnut Creek plant, we work with a recycling company specialized in separating waste and recycling medical and electronic devices. In this case, components from our used dialysis machines are recycled for use as spare parts.

In October 2010, we hired an outside service provider to collect and document energy and water consumption data at all of our dialysis clinics in the U.S. on an ongoing basis. The company also pays the energy and water bills on our behalf. This enables us to collect data on the consumption of resources in our dialysis centers according to uniform criteria, so we can better identify opportunities to further improve our energy efficiency in the future.

Internal guidelines ensure that the equipment, fixtures and furnishings in our clinic buildings and interiors in the U.S. are as environmentally compatible as possible. In accordance with these, we use energy-efficient lighting and air-conditioning systems, as well as eco-friendly flooring and wall paint. In addition, the insulation for the roofs, walls, doors and windows all meet or surpass industry standards. When purchasing water treatment systems for dialysis, we also make sure that these use resources and energy efficiently. As of 2010, we have been preparing one of our clinics for environmental certification to the U.S. LEED standard for the first time. LEED stands for “Leadership in Energy and Environmental Design” and defines guidelines for resourceconserving and sustainable construction. Several employees in our Real Estate and Construction Services department are currently preparing for their formal accreditation as LEED experts. Their first task is to coordinate the impending certification together with the landlord of the clinic, and in the future will work with the landlords of our other clinics to establish environmentally-friendly building standards. We plan to have more clinics certified according to the LEED standard in the coming years.

Asia-Pacific and Latin America

In the Asia-Pacific region, local government agencies regularly inspect our wastewater systems and energy consumption, among other things. Furthermore, a team from Fresenius Medical Care conducts annual audits to examine the extent to which production, logistics, laboratories and administration comply with Company guidelines for resource efficiency and environmental protection, and identifies areas for improvement. To this end, the inspectors also utilize data on electricity, gas and water consumption as well as waste disposal which we collect on an ongoing basis in our production plants. We implemented several energy efficiency projects in 2010 as a result of an internal audit at our Jiangsu location in China. For example, we now use the air circulation that is kept at a constant temperature from one of our production areas to air-condition the warehouse. Because our products must be stored under controlled temperature conditions, this saves energy for heating or cooling the hall, depending on the season. At our plant in Buzen, Japan, we achieved a recycling rate of nearly 94% in 2010, thanks to our environmental management. That includes all waste generated in the plant with the exception of waste water, which is treated separately. Also included is thermal energy recovery, i.e. utilizing the heat generated by garbage incineration through a licensed waste disposal company. We have set ourselves the goal of achieving this recycling rate again in 2011.

In Australia, a dialysis unit powered by solar-generated electricity, which is the first in the world to the best of our knowledge, was built with our financial and technical assistance in 2010. A business partner, who is the head of nephrology at an Australian healthcare provider, erected the solar energy system on the roof of his dialysis unit with grants from Fresenius Medical Care. He made arrangements with his electricity provider to feed the energy thus generated into the local power grid and offset it against the overall electricity cost. In this way, the clinic was able to generate over 90% of its energy needs for the dialysis machines and water treatment itself in 2010, even during the comparatively dark winter months; on average for the year, the electricity generated by the clinic even exceeded its consumption in these two areas. The joint project drew interest from professional circles, such as from the most significant industry conference in the United States, the ASN Renal Week ( see here).

We also made progress in the area of environmental management in the Latin America region. In Columbia, for example, we started setting up an environmental management system in accordance with the ISOISOInternational Organization for Standardization. 14001 standard for the country’s entire organization, i.e. both clinics and production facilities, in 2010. The aim is to implement the standard’s criteria as exactly as possible and train our employees accordingly; we are not currently striving for official certification. In Argentina, we have been continuously recording water and energy consumption in all dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemodialysis the membrane of the dialyzer – is used to clean a patient’s blood. centers since 2010, as well as the disposal of medical waste. We also plan to introduce a comprehensive environmental management program in production by the end of 2012. Both business divisions are working with an external Argentine consulting firm to advance the environmental management concept. In Venezuela, we started an environmental awareness campaign for our clinic staff on the topics of waste disposal as well as energy and water consumption in 2010, which we plan to continue during the current fiscal year.

We are increasingly concerned with how Fresenius Medical Care can make its products and processes more environment-friendly. The aim is to provide our customers with added value by helping them save on costs or fulfill environmental requirements more easily.

Product development

Our research and development divisions work continuously on designing our products and processes to be as environmentally compatible as possible by employing new materials with improved environmental properties, pushing the development of new technologies that minimize the resources used by our dialysis machines, and using energy and raw materials efficiently in production. As part of the first environmental program in the EMEA region see here, we developed the smartbag, for example: packaging for liquid concentrates that are mixed with ultrapure water to make a dialysis solutionDialysate (dialyis solution, dialysis fluid)Fluid used in the process of dialysis in order to remove the filtered out substances and excess water from the blood. for hemodialysisHemodialysis (HD)Treatment method for chronic kidney failure where the patient’s blood flows outside the body through disposable bloodlines into a special filter, the dialyzer. The dialysis solution carries away waste products and excess water, and the cleaned blood is returned to the patient. The process is controlled by a hemodialysis machine that pumps blood, adds anticoagulants, regulates the purification process, and controls the mixing of the dialysis solution and its flow rate through the system. A patient typically receives three treatments per week, lasting from three to six hours each.
treatment. The smartbag is PVC-free, and producing it requires only about one-fifth of the product materials needed for a conventional concentrate canister. In addition, the bag can be recycled easily, as it consists of polyolefin. The smartbag’s environment-compatible properties were also verified by an environmental life-cycle assessment conducted jointly by the EMEA region’s environmental management, our research and development and a university. An environmental life-cycle assessment investigates the influences of products on the environment during their entire life cycle, from raw materials production to product manufacturing, sale and use, right up to disposal. In the coming years, our environmental management teams will work even more closely with the research and development department to advance the development of environmentally-friendly new products or product generations. Our environmental life-cycle assessment in 2010 confirmed that such studies can be an important aid, as they make the environmental compatibility of our products measurable and the potential for improvement more clearly recognizable.

Model for a CO₂-neutral dialysis clinic

During the year under review, we also worked on an environmentally-compatible concept for our dialysis services business. This concept is intended to provide customers, such as health insurance companies, with long-term added value based on resource and cost efficiency. We have developed a model for a CO₂-neutral dialysis clinic together with the German Energy Agency (dena): According to this model, by using environment-friendly power and heat supplies, a clinic can reduce its CO₂ (carbon dioxide) greenhouse gas emissions by as much as it produces through energy consumption for dialysis, water treatment and other operations. This can be done, for example, by generating electricity with solar cells on the roof, recovering heat from dialysis waste water, installing special heat insulation in the building shell and walls, and placing the windows to use daylight as efficiently as possible. Our joint model with dena is based on the standard layout of a European Fresenius Medical Care dialysis center, derived from analyzing in detail the energy consumption in existing dialysis centers in different countries. The model views the whole clinic as a closed system in which insulation, renewable energy and an efficient energy recovery are closely coordinated. We plan to optimize the model in the coming year and test the construction of a model clinic. A subsequent implementation of the construction project depends on whether or not suitable partners and grants can be found.