THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY VU LAN TRANG TOPIC TITLE: ASSESSMENT OF STATUS MEDICAL WASTE MANAGEMENT AND TREATMENTIN TUYEN QUANG GENERAL HOSPITAL BACHELOR THESIS Study Mode : Full- time Major : Bachelor in Environmental Science and Management Faculty : International Training and Development Center Batch : K42- Advance Education Program Thai Nguyen, 23/ 01/2015 i n Thai Nguyen University of Agriculture and Forestry Degree Program Bachelor of Environmental Sciences and Management Student Name Vu Lan Trang Student ID DTN1053100118 Thesis Title Assessment of status medical waste management and treatment in Tuyen Quang General Hospital Supervisor Dr. Nguyen Hung Quang Abstract: Assessment and analyze the status of medical waste management in Tuyen Quang General Hospital: Assess the classification, transportation, storage and treatment of medical waste and wastewater generated in operation process of Tuyen Quang General Hospital. Analyze and propose solutions: Causing of existence in the management and treatment of medical waste in hospital. Solutions to improve the management efficiency and treatment medical waste: Treating waste to improve the efficiency for medical waste management in Tuyen Quang General Hospital.
Keywords Medical waste; Hazardous medical waste; waste management; wastewater treatment system; Tuyen Quang; Number of pages 59 Date of submission 23/01/2015 ii n ACKNOWLEDGMENT With the consent of the Managing Board - Thai Nguyen University of Agriculture and Forestry, International Training and Development Center, the assistance and guidance of Dr. Nguyen Hung Quang. I conduct research with topic: "Assessment of status medical waste management and treatment in Tuyen Quang General Hospital" In order to complete this thesis, firstly I would like to sincerely thank the managing board of Thai Nguyen University of Agriculture and Forestry, International Training and Development Center, thank teachers, who imparted to me the knowledge and skills during the time I study and practice at Thai Nguyen University of Agriculture and Forestry. Especially, I would like to sincerely thank the enthusiastic help of Dr.
Nguyen Hung Quang who guided me during the time of graduation exercises to implementation and complete this thesis. I would like to thank the assistance of staffs who are working at Department of Natural Resources and Environment of Tuyen Quang province, Environmental Protection Agency has helped me during internships time, impart practical experience for me. I would like to thank staff and officers at Tuyen Quang General Hospital who created the best conditions for me to completed this thesis. This is the first time I've implementation a thesis, due to knowledge of myself and the time are limited, certainly in my thesis was shortcomings and restrictions.
I hope to receive feedback, comments and additions to my thesis complete and found the exist shortcomings of myself. I would like to sincerely thank! Tuyen Quang, 23 rd January, 2015 Student Vũ Lan Trang iii n TABLE OF CONTENTS LIST OF FIGURES. 1 LIST OF TABLES. 2 LIST OF ABBREVIATIONS.
Research questions and hypotheses. Scientific base of the study. Theoretical base of the study. Classification of the medical waste.
Harmful effects of medical waste. Current status of medical waste management in Vietnam. The process of collecting, sorting and transporting waste in the health care facilities. Measures and technologies to treat hazardous medical waste.
Interview methodology in the field .2 Methods of analysis, synthesis document.3 The sampling method of wastewater. Experimental and analysis methods in the laboratory. The overview of Tuyen Quang General Hospital. Functions and tasks.
Sources of waste and the methods to collect, classify and treat medical waste in Tuyen Quang General Hospital. Common Solid Waste. Assessment the preliminary way of medical waste. Hazardous medical waste.
Assessment the quality of wastewater in Tuyen Quang General Hospital. Sources of wastewater. Result of observational, analysis. Recommendation some solutions for collection and treatment activities of medical waste in Tuyen Quang General Hospital.1 Solution in the collection, storage and treatment of medical waste.
Solutions for wastewater treatment system. DISCUSSION AND CONCLUSION. Area and position of Tuyen Quang General Hospital. Status of waste management and treatment in hospital.
Results of the environmental research. 60 v n LIST OF FIGURES Figure 4.Organization chart of Tuyen Quang General Hospital. Hazardous medical waste generating trendy in 2013-2014. Treatment technology of wastewater.
Preliminary way of domestic waste. Preliminary way of Hazardous medical waste. Preliminary way of wastewater .50 1 n LIST OF TABLES Table2. Some examples of infection due to contact with medical waste.
Microorganism category of pathogenic and procedure infection.Waste arising under the beds in Vietnam in 2012. Distribution of medical waste by type of urban. Comparison of medical waste generated in Vietnam with some neighboring countries in 2012. Notation of sampling locations.
List of hazardous waste generated an average of 01 month .32 at Tuyen Quang General Hospital. Reality amount of hazardous medical waste in Tuyen Quang General Hospitals. Time existence of some microorganisms. Results of the wastewater target analysis of Tuyen Quang General Hospital .51 2 n LIST OF ABBREVIATIONS BOD5 The biochemical oxygen demand in 5 days.
COD Chemical oxygen demand MONRE Ministry of Natural Resources and Environment MOH Ministry of Health MOC Ministry of Construction One member co., Ltd One Member Limited Liability Company 3 n PART I. Research rationale Caring, protecting and improving human's health is an important task of the health sector. In order to adequately meet for medical examination and treatment and health care demand of people, received the attention of the Party and State, medical facility system have been continuously enhanced, expanded and improved. However, during operation process, the health system, especially the hospital has discharged a large amount of medical waste substances, including hazardous medical waste.
According to the World Health Organization (WHO, 1994), the components of medical waste about 10% of the infection waste and 5% is noxious waste such as radioactive, cytotoxic substances, toxic substances generated in the diagnosis and treatment procedure. It is risk factors of environmental pollution, pathogens spread from hospital to surroundings area, lead to increased risk of monomial infection and increased disease incidence of local communities living in contiguous areas. In order to assess the status of medical waste as well as the impact of medical waste on the environment, they need to have research of the scientists and agencies. Research has been showing that existed in the medical waste management in our country.
However currently, for many reasons, including the pressure on the need of medical examination and treatment of people, the overload of many hospitals, lack of uniformity in infrastructure of the hospital means environmental sanitation of many hospitals is not guaranteed. Tuyen Quang General Hospital is the provincial hospital. It is the medical examination and treatment center of Tuyen Quang province. The scale of hospital is 4 n 500 beds, with all the Department of Internal Medicine, Department of Surgery and Clinical Departments.
The number of patients examined on average is between 400- 500 cases/ day. The rate of bed occupancy often exceeds 100%. The hospital is located in the city center where it is the largest concentration of population so that the shortcomings in the management and treatment of medical waste will greatly affect to surrounding communities. Stemming from the above problems I conducted research topics “Assessment of status medical waste management and treatment in Tuyen Quang General Hospital”.
Research’s objectives - Cursory review of Tuyen Quang General Hospital. - Assessment of status medical waste management and treatment in Tuyen Quang General Hospital. - Propose solutions to increase the effect of medical waste management and reduce pollution. Research questions and hypotheses - What is the current situation of medical waste management in Tuyen Quang General Hospital? - What is the way to treatment medical waste of Tuyen Quang General Hospital? - How do we can closely management the medical waste of Tuyen Quang General Hospital? 5 n 1.
Limitations The time is limited; I have only 4 months for research. So I choose this matter in Tuyen Quang General Hospital to assess the status of management and treatment mission. Due to Tuyen Quang General Hospital located in convenient area with the high population density and big scale of hospital so the assessment activities has limit. Definitions According to MONRE (2007), there are some definitions which are use in the research: - Medical waste is all waste materials generated at health care facilities, such as hospitals, clinics, physician's offices, dental practices, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories.
- Hazardous waste is waste that is dangerous or potentially harmful to our health or the environment. Hazardous wastes can be liquids, solids, gases, or sludges. They can be discarded commercial products, like cleaning fluids or pesticides, or the by-products of manufacturing processes. - Hazardous medical waste management is controlled waste activities during the process from waste generation to initial treatment, collection, transport, storage and disposal of hazardous medical waste.
- Collecting is the separation, classification, collection, packing and temporary storage of waste at the central location of medical facility. 6 n - Transportation is the process of transporting waste from the place generated to place of initial treatment, storage and treatment. - Preliminary treatment is the disinfection or sterilizing process of waste which have high risk of infection near place waste generated before transportation to store or destroy. - Handling and treatment is the process of using the technology in order to lose potentially of hazardous waste on human’s health and environment.
- Re-use is use a product several times until the end the life of products or use products under a new function or purpose. -Recycle is reproduction of discarded materials to a new product. Scientific base of the study - Protection environment of Vietnam Law, 2005; - Decide No.22/2006/Decide – MONRE dated December 18th , 2006 Ministry of Natural Resources and Environment about compel application Vietnam environment standard; - Decree No. 59/2007/ Decree – Government dated April 09th , 2007 the Government of Socialist Republic of Vietnam about solid waste management; - Circular No.13/2007/Circular - MOC dated December 31st , 2007 the Ministry of Construction issued guidance some articles of Decree No.59/2007/Decree-The Government dated April 09th , 2007 the Government of Socialist Republic of Vietnam about solid waste management; - Decide No.
43/2007/Decide – MOH dated November 30th, 2007 Ministry of Health promulgate Regulations about medical waste management; - Circular No.16/2009/Circular - MONRE dated October 7th, 2009 of the Ministry of Natural Resources and Environmental - Regulations on National technical regulations on the environment; - Circular No.12/2011/Circulars - MONRE dated April 14th, 2011 Ministry of Natural Resources and Environment about hazardous waste management.31/2013/ Circular - MOH dated October 15th, 2013 of the Ministry of Health - Regulations about environmental impact observation from examination and treatment activities of the hospital. Theoretical base of the study 2. Classification of the medical waste According to MONRE (2007), Medical wastes are classified into the following categories: Infectious waste: - Acuity waste (category A): this type of wastes can cause cuts or puncture, bacterial infections including: needles and syringes, surgical knife blade, saws, broken glass pieces and other sharp items used in medical activities. - Un-sharp infection waste (category B): waste being soaked in blood or biological fluids of the body and generated from the isolation disease prevention.
- Wastes with high risk of infection (category C): waste generated in laboratories such as specimens and other utensils thoroughly. - Waste from surgery (category D): including the tissues, organs, body parts, placentas and laboratory animal carcasses. Hazardous chemical waste: Chemical and pharmaceutical waste generated from the tests, diagnosis activities includes: formaldehyde, photo-resist chemicals, solvents, ethylene, and mixture of chemicals. Radioactive waste: Including solid, liquid and gas radioactive waste generated from the diagnosis, treatment, research and production activities.
Radioactive waste including: 9 n - Solid radioactive waste includes materials to be used in the laboratory, diagnosis, treatment, such as syringes, needles, safety goggles, waterproof paper, antiseptic swabs, test tubes, bottles of radioactive substances.