Water: Securing high quality, reducing consumption

Around 15 million m³ of water in 2023 – what for?

In 2023, we withdrew 15.1 million m³ of water – approximately as much water as that consumed by two million people in Germany every day.¹ At Fresenius, water is primarily used in two areas:

1. Water in production
   In production, we use water for most sterilization and cooling processes, as a component in the manufacture of medical products, and for hygiene procedures. The water used for our products, e.g. for infusion solutions such as sodium chloride, has to meet stringent quality requirements to ensure product quality and patient safety.
2. Water in our healthcare facilities
   For our healthcare facilities, an adequate supply of fresh water is vital to patient well-being and hygiene. Most of the water is withdrawn from local public water utilities.

Sufficient volumes of water of the highest quality are therefore absolutely essential. At the same time, we are responsible for appropriate handling of wastewater, particularly in relation to water from production facilities.

Our approach to water

We use internally and externally controlled water management systems to control all the workflows in our daily operations. The aim is to use no more water than is absolutely necessary and where possible to make savings, and to ensure the maximum water quality at all times.

Since 2021, we have continuously reduced our relative water withdrawal per €1 million of revenue and reduced consumption by nearly 16%.

Absolute water withdrawal
(m³ in millions)

Relative water withdrawal
(in m³ per €1 million revenue)

Monitoring and guaranteeing drinking water quality

Water quality is key for delivering high-quality and safe healthcare to people, and for the manufacture of medical products. All our facilities have risk-based processes in place to identify contamination or irregularities in the drinking water. Where necessary we can treat water. Most importantly, for situations where fresh water is polluted or contaminated by hazardous substances, our hospitals have access to appropriate technology.

We communicate directly with local authorities and inform them immediately if we have detected critical deviations from the local drinking-water standard. A number of our hospitals in Germany even act as test centers for the quality of local drinking water. This service allows us to protect the safety of our patients, as well as ensuring that the local population and the local communities which supply us have access to safe drinking water.

Know your risk – Risk assessment in water management

We aim to make our daily water consumption as resource-efficient as possible. For this we need to be able to precisely assess the impacts of our water usage at the different locations. We analyze the local shortage and availability of water at our locations across the world, and derive the current and potential future water risks from the data available.

This analysis informs us about the production sites that are in areas at high risk of water shortage. These areas are then identified as particularly important for efficient management of water as a natural resource in order to ensure the availability of water for our production and healthcare services and to avoid the negative impacts on the local water situation as far as possible.

Our production sites also generate a climate risk analysis which includes water risks such as flooding, droughts, or heavy rain. On the basis of these risk profiles, they take appropriate measures to avoid risks or mitigate their consequences. Such measures are documented in action plans for high water risk sites. Measures in an action plan may include regular inspection and maintenance of high water-consuming machinery, reviewing emergency management procedures, or training employees to optimize water use.

Reducing water consumption

We are working in all regions – irrespective of whether they have a high or low risk of water shortage – to reduce the consumption of water as much as possible. This is achieved by our water management systems making provision for appropriate savings measures. Water is reused at a number of production locations, e.g. condensate water from air conditioning systems or by using steam condensate recovery systems. Wastewater treatment systems and recycling programs also aim to minimize the amount of wastewater discharged and to use resources more efficiently.

The use of fresh water plays a key role in our healthcare facilities because this enables us to comply with hygiene regulations and hence guarantee patient safety. This is why we are not targeting a significant reduction in water withdrawal in this area. Due to strict internal regulations for the quality of drinking water, we do not reuse water, or use gray water, i.e., treated water from showers or wash basins.

Water treatment and discharge – focus on antibiotics

Our wastewater should minimize a negative impact on the environment. The production of antibiotics is one example of the special requirements governing wastewater management in healthcare. If antibiotics find their way into the environment through the wastewater from production, they may promote the development of resistant bacteria. This may in turn lead to these drugs becoming less effective for medical treatments. Our goal is to minimize these risks as far as possible. With this in mind, we have implemented high quality and safety standards at our production sites. Furthermore, we are committed to the following measures:

Responsible antibiotic production: International cooperation

Fresenius Kabi has been a member of the Antimicrobial Resistance (AMR) Industry Alliance (AMRIA) since 2020 and has been actively involved in the association’s governing bodies since 2021. In 2022, AMRIA and BSI Standards Limited released the Antibiotic Manufacturing Standard, providing guidance to manufacturers on responsible antibiotic production. A key component of the approach involves the use of a risk-based methodology to evaluate waste streams generated during antibiotic manufacturing and to control them.

Mass balance approach in wastewater management

In 2022, Fresenius Kabi introduced a methodology that supports the manufacturing sites producing antibiotics in complying with the regulations governing concentrations of antibiotics in wastewater. The overarching goal of this mass balance approach is alignment with the Predicted No-Effect Concentrations (PNEC) defined by AMRIA. This refers to a concentration level of a substance in the environment below which no adverse effects are expected. We have developed a template for this purpose that enables our locations to implement the approach and collect comparable data across the Group.

Antibiotic Manufacturing Standard: Communication across sites

Furthermore, Fresenius Kabi has developed a dedicated communication channel that connects local sites with the global environmental team of the business segment. This initiative is intended to assist the sites in continuously aligning with the Antibiotic Manufacturing Standard for the production of antibiotics published in 2022. At the same time, the aim is to foster ongoing compliance and improvement in the future.