Tài liệu Medical solid waste management practices in thai nguyen tuberculosis and lung disease hospital

THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY NGUYEN THI LINH LY Topic title: MEDICAL SOLID WASTE MANAGEMENT PRACTICES IN THAI NGUYEN TUBERCULOSIS AND LUNG DISEASE HOSPITAL BACHELOR THESIS Study Mode: Full-time Major: Environmental Science and Management Faculty: Advanced Education Program Office Batch: 2014 – 2018 Thai Nguyen, 24 /9 /2018 DOCUMENTATION PAGE WITH ABSTRACT Thai Nguyen University of Agriculture and Forestry Degree Program Bachelor of Evironmental Science and Management Student name Nguyen Thi Linh Ly Student ID DTN1453110086 Thesis Title Medical Solid Waste Management Practices in Thai Nguyen Tuberculosis and Lung Disease Hospital Supervisor Assoc. Prof. Trần Văn Điền Supervisor’s signature Abstract: The management of medical waste is great significance due to its related potential environmental impacts and public health hazards. This study aims mainly to assess medical solid waste management practices in Thai Nguyen tuberculosis and lung disease hospital. The descriptive methodology was used in the study. The results showed that the hospital generate a total of 195 kg/day of solid waste, of which about 181 kg (92,8%) are non hazardous and 14 kg (7,2%) are hazardous. Solid wastes are treated by Anh Dang environmental services company limited. The research identified and assessed the current situation of solid waste collection and impacts on the environment. Keywords Medical solid waste, environmental impact, planning and management. Number of pages 55 pages Date of Submission 24/9/2018 i ACKNOWLEDGEMENT I would like to express my sincere gratitude to Thai Nguyen Tuberculosis and Lung Disease Hospital, especially Mrs Ngo Thu Tien – the vice director of the hospital. She not only offered me an opportunity to complete my internship course at hospital but also gave me a lot of information about her organization so that I could find what departure is suitable for me. Besides, I also say thank my supervisor, Assoc.Prof. Tran Van Dien - whose expertise, understanding, generous guidance and support made it possible for me to work on intriguing topic. It was a pleasure working with him. In addition to expressing my gratitude to Thai Nguyen Tuberculosis and Lung Disease Hospital and my supervisor, I want to express my sincere gratitude to my university, especially the Advance Education Program . Moreover, I would like to show my appreciation to all teachers who have taught me for 4 years in Thai Nguyen University of Agriculture and Forestry. They set their heart on teaching their students, included me. That is to say, not until their students understand the lessons clearly, do they finish their hard working day. Therefore, I really hold them in high esteem. Thank you! Nguyen Thi Linh Ly ii TABLE OF CONTENT DOCUMENTATION PAGE WITH ABSTRACT ......................................................i ACKNOWLEDGEMENT ......................................................................................... ii TABLE OF CONTENT ............................................................................................ iii LIST OF FIGURES....................................................................................................vi LIST OF TABLES ................................................................................................... vii PART I. INTRODUCTION ........................................................................................ 1 1.1. Research rationale................................................................................................. 1 1.2. Research’s objectives ........................................................................................... 2 1.2.1: Research’s overall objecties .............................................................................. 2 1.2.2. Research's specific objectives ........................................................................... 2 1.3. Research subject ................................................................................................... 3 1.4. Research questions and hypotheses ...................................................................... 3 1.4.1. Research question.............................................................................................. 3 1.4.2. Hypotheses ........................................................................................................ 3 1.5. Limitations ............................................................................................................ 4 1.6. Definitions ............................................................................................................ 4 PART II: LITERATURE REVIEW. .......................................................................... 6 2.1. Sources and composition of hazardous medical waste ........................................ 7 2.1.1. Stationary sources.............................................................................................. 7 2.1.2. Medical waste components ............................................................................... 7 2.2. Classification of hazardous waste......................................................................... 8 2.3. Principles of classification of medical waste...................................................... 10 iii 2.4. Principles for collection, storage, transportation and treatment of medical waste .......................................................................................................................... 11 2.4.1. Collection of hazardous medical waste ........................................................... 11 2.4.2. Storage of hazardous medical waste ............................................................... 12 2.4.3. Treatment of hazardous medical waste ........................................................... 13 2.5. Impact of medical waste..................................................................................... 14 2.5.1. The impact of medical waste on the environment .......................................... 14 2.5.2. Effects of medical waste on humans ............................................................... 15 2.6. Legal basis to perform the task .......................................................................... 16 PART III. RESEARCH METHODOLOGIES ......................................................... 18 3.1. Time and research scope: ................................................................................... 18 3.2. Research contents: .............................................................................................. 18 3.3. Research methodology ....................................................................................... 18 3.3.1. Collecting secondary data ............................................................................... 18 3.3.2. Interviewing by questionnaire ......................................................................... 18 PART IV. RESULTS AND DISCUSSIONS ........................................................... 19 4.1 : Current status of medical solid wastes of Thai Nguyen Tuberculosis and Lung disease hospial ........................................................................................................... 19 4.1.1. Hazardous wastes ............................................................................................ 19 4.1.2. Normal solid waste .......................................................................................... 24 4.1.3. Items for collection and treatment of solid waste ........................................... 26 4.2: Discussions ......................................................................................................... 27 4.2.1: Knowledge of staff and patients on hospital waste management.................... 27 iv 4.2.2: Solutions to improve the management of hazardous medical waste of Thai Nguyen Tuberculosis and Lung disease hospital. ..................................................... 32 4.2.3: Technology measures ...................................................................................... 33 PART V. CONCLUSIONS ....................................................................................... 35 5.1. Conclusions ........................................................................................................ 35 5.2. Petition ................................................................................................................ 36 REFERENCES .......................................................................................................... 38 v LIST OF FIGURES Figure 4.1. Rate of hazardous wastes of Thai NguyenT uberculosis and Lung Disease Hospital in March 2018 ............................................................................... 20 vi LIST OF TABLES Table 2.1: Composition of medical solid waste in Vietnam ....................................... 8 Table 2.2: Some diseases at risk of infection from medical waste ........................... 16 Table 4.1. The volume of hospital infectious waste from March to June ................. 19 Table 4.2: Volume of each type of hazardous waste at the hospital ......................... 19 Table 4.3. Collection of solid medical waste ............................................................ 21 Table 4.4. Transport of hazardous medical waste ..................................................... 23 Table 4.5: Items for collection and treatment of solid waste .................................... 26 Table 4.6: Statistics of knowledge on medical waste management .......................... 28 Table 4.7: Knowledge about the color of item for classify medical waste ............... 29 Table 4.8: Knowledge of hospital's staff about medical waste management ........... 30 Table 4.9: Understanding about hospital waste management of patients and patient's family member .......................................................................................................... 31 vii PART I. INTRODUCTION 1.1. Research rationale Medical waste, due to its content of hazardous substances,poses serious threats to environmental health. Thehazardous substances include pathological and infectiousmaterial, sharps, and chemical wastes. In hospitals, different kinds of therapeutic procedures ( cobalt therapy, chemotherapy, dialysis, surgery, delivery, resection ofgangrenous organs, autopsy, biopsy, para clinical test, injections etc.) are carried out and result in the productionof infectious wastes, sharp objects, radioactive wastes andchemical materials. Medical waste may carry germs ofdiseases such as hepatitis B and AIDS. In developing countries, medical waste has not received much attention and it is disposed of together with domestic waste. Improper medical waste management poses a serious threat to public health. Medical waste contains highly toxic metals, toxic chemicals, pathogenic viruses and bacteria, which canlead to pathological dysfunction of the human body. Medical waste presents a high risk to doctors,nurses, technicians, sweepers, hospital visitors andpatients due to arbitrary management. It has long beenknown that the reuse of syringes can cause the spread ofinfections such as AIDS and hepatitis. The collectionof disposable medical items (particularly syringes), its resale and potential reuse without sterilization could causea serious disease burden. The safe disposal and subsequent destruction of medicalwaste is a key step in the reduction of illness or injurythrough contact with this potentially hazardous material, and in the prevention of environmental contamination. The transmission 1 of blood borne viruses and respiratory, enteric and soft tissue infections through impropermedical waste disposal is not well described. The management of medical waste therefore, has been of majorconcern due to potentially high risks to human health andthe environment. Medical waste is an environmental as well as public health issue that attracts attention in both industrialized and developing countries. Certain categories of medical waste are among the most hazardous and potentially dangerous of all the wastes arising in the community. Improper management of medical waste may pose health hazards through transmission of diseases. In addition to health hazards, environmental hazards have to be considered, such as the contamination of soil, water sources and poisonous emissions from improper burning of medical waste. In the long term, medical waste can not only impair the quality of life of the community, but can also affect the welfare of the entire population and the national economy. 1.2. Research’s objectives 1.2.1: Research’s overall objecties This study was to assess the medical solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital, of which focus on the evaluation of medical solid waste in the hospital. Thereby, propose appropriate measures to sustain solid waste management in the hospital. 1.2.2. Research's specific objectives • To study the current medical solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital. 2 • To evaluate the perception of staffs and patients on medical solid waste management and environment. • To propose appropriate measures to sustain the solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital. 1.3. Research subject • Types of hazardous medical waste arising in Thai Nguyen Tuberculosis and Lung Disease hospital • Facilities, equipment and human resources to collect, transport and treat waste at the hospital 1.4. Research questions and hypotheses 1.4.1. Research question Problem of the study is to answer these following questions: • How is status quo solid wastes in Thai Nguyen Tuberculosis and Lung disease hospital? • How do solid wastes manage in Thai Nguyen Tuberculosis and Lung disease hospital? • What is the impact of medical waste on the environment and human? • How to improve the efficiency of medical waste management? 1.4.2. Hypotheses • The status of medical solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital is not good. • Medical solid wastes in Thai Nguyen Tuberculosis and Lung disease hospital are seriously impacted on environmental pollution and human healths. 3 • Solutions to improve the waste management in Thai Nguyen Tuberculosis and Lung disease hospital is needed. 1.5. Limitations • The process of operating a medical solid waste incinerator is limited, such as fuel consumption, failure, often requiring maintenance. • Large funds are needed to purchase equipment, facilities for collecting, storing and transporting solid medical waste 1.6. Definitions • Medical wastes are wastes arising in the course of operation of medical establishments, including hazardous medical wastes, ordinary medical wastes and medical wastewater. • Hazardous medical wastes mean medical wastes containing infectious agents or other hazardous properties exceeding hazardous waste thresholds, including contagious wastes and non-contagious hazardous wastes. • Medical waste management is the process of minimizing, classifying, classifying, collecting, storing, transporting, recycling and disposing of medical waste and supervising the implementation process. • Medical waste collection is the process of gathering medical waste from the place of origin and transporting it to the medical waste storage and treatment area within the premises of the medical establishment. • Transportation of medical wastes means the process of transporting medical wastes from the places where waste is stored in medical establishments to the places for storing and disposing of wastes of medical waste treatment 4 establishments for the establishments' clusters. Medical establishments, concentrated medical waste treatment establishments or concentrated hazardous waste treatment facilities containing medical waste treatment items. 5 PART II: LITERATURE REVIEW. Medical wastes are considered a special area where hazards and risks not just confined to the health of generators and operators of hospitals but also the health of general people. In general hospital waste is broadly grouped into infectious waste and non-infectious waste Thai Nguyen Tuberculosis and Lung disease hospital – Tan Thinh Ward, Thai Nguyen City, Thai Nguyen Province. Thai Nguyen Tuberculosis and Lung Disease Hospital (formerly Viet Bac Autonomous Region Hospital) was established on October 12, 1955. In the early days of establishment, the hospital had only 9 officials with the scale of 40 beds. Overcoming the initial difficulties both in terms of facilities and people, the team of doctors and medical staff of the hospital has done well in the treatment of tuberculosis patients in the region. In 1964, the hospital was completely rebuilt in its present location and was officially named Thai Nguyen Tuberculosis and Lung Disease Hospital in August 2003. Up to now, the hospital has become the highest specialized hospital in Thai Nguyen province with 220 beds and a team of 186 medical staffs. Over the past 60 years, the hospital has received over 800,000 patients. From 2007 up to now, the hospital has been continuously implementing new techniques such as bronchoscopy with soft-tube, respiratory probing, mechanical ventilation; implementation of treatment by chemotherapy, drug treatment with multi- drug resistant brought good results, the rate of patients treated over 90%. 6 2.1. Sources and composition of hazardous medical waste 2.1.1. Stationary sources - Waste during surgery - Sharp and brittle objects exposed to blood and pus during surgery. Biological liquids or absorbent paper have been used in medicine. - Blood bandages, bloody pus - Test tubes for germ culture in laboratories - Waste during testing - Expired drugs 2.1.2. Medical waste components - Physical components • Cotton yarn: cotton gauze, bandage, old clothes, wipes ... • Paper: Tool box, waste paper from the toilet ... • Glassware: bottles, glass syringes, test tubes ... • Metal: needles, scalpel, surgical instruments • Blood specimens, gauze sticky blood • Plastic products: containers, wire feed ... • Leaves, rocks - Chemical composition • Inorganic substances: metals, glass bottles, gravel, chemicals • Organic substances: Textiles, Plastic - Biological components: blood, digestive, pathological and pathogenic germs 7 Table 2.1: Composition of medical solid waste in Vietnam Composition of medcal No. Composition of Rate (%) solid waste 1 Organic substances hazardous waste 52.0 No 2 Bottles, plastic bags 10.0Yes 3 Cotton bandage, medical gauze 9.0Yes 4 Metal box 0.7No 5 Needles, syringes 3.0Yes 6 Papers 3.0No 7 Postoperative specimens 0.6Yes 8 Soil, sand and other solids 21.0No Total 100 Rate of hazardous waste 22.0 (Source: Ministry of Health, 2009) The composition of medical waste includes 8 basic types, in which the rate of hazardous waste accounts for 22%. Although they account for nearly a quarter of the solid waste component but they are very harmful to the environment and human health if not collected, transported and treated in accordance with regulations. 2.2. Classification of hazardous waste Hazardous waste classification is a very important step in the management and disposal of waste. If this separation activity is well implemented, the following steps will be effective, limiting the impact on human health and the surrounding environment. 8 Based on the physical, chemical, biological and hazardous properties the Joint circular No. 58/2015 / TTLT-BYT-BTNMT of the Ministry of Health and the Ministry of Natural Resources and Environment issued on 31 December 2015 stated that. The waste in health care facilities is classified into the following groups. - Infectious waste includes: + Sharp infectious waste is an infectious waste that can cause cuts or punctures including needles, sharp tips of the line, acupuncture needles, surgical blades and other sharp objects. + Non-sharp infectious wastes include: Blood-contaminated wastes or biological fluids of the body, waste arising from isolation chambers + High-risk wastes include: specimens, samples of specimens and specimen waste discharged from biosafety laboratories according to the provisions of Decree No. 92/2010 / ND-CP dated 30 August 2010 of the Government. + Surgical waste includes: Human organs discharged - Non-contagious hazardous wastes include: + Chemical waste is hazardous + Disposed cytotoxic drugs or hazardous warnings from the manufacturer + Medical devices that have been damaged, have been disposed of containing mercury and other heavy metals. + Other hazardous wastes according to the provisions of the Minister of Natural Resources and Environment's Circular No. 36/2015 / TT-BTNMT of June 30, 2015 on hazardous waste management - General medical waste includes 9 + Daily-life solid waste arising in human daily-life activities + Common solid wastes arising from medical establishments not on the list of those subject to hazardous medical wastes or on the list of hazardous medical wastes prescribed at Point a, Clause 4, hazardous wastes under allowable threshold + Non-hazardous liquid waste products 2.3. Principles of classification of medical waste - The principle of classification of medical waste + Hazardous medical waste and conventional medical waste must be classified for management at the place of origin and at the time of arising + Each kind of medical waste must be separately classified into the package, tools and equipment for containing hazardous wastes according to regulations. In cases where hazardous medical wastes are incapable of reacting, interacting with one another and applying the same treatment method, they may be classified in the same package, tool or storage device. + When the waste is mixed with other wastes or vice versa, the mixture must be collected, stored and treated as contaminated waste. - Packaging placement, waste sorting equipment + Each department must arrange the position to put packages and tools for medical waste classification + Placement of medical waste sorting tools and packages must include instructions on how to classify and collect wastes - Classification of medical waste + Sharp infectious waste: Stored in yellow box 10 + Non-sharp infectious waste: Store in a yellow bag + Highly infectious waste: Store in a yellow bag + Surgical waste: Store in double yellow bag or yellow box + Non-infectious solid wastes: Store in a black bag or a black box + Non hazardous liquid wastes: Store in closed containers + Normal medical waste not for recycling purposes: Store in a blue bag or in a blue box + Normal medical waste for recycling purposes: Store in a white bag or in a white box 2.4. Principles for collection, storage, transportation and treatment of medical waste According to Joint Circular No. 58/2015 / TTLT-BYT-BTNMT on medical waste management, the principle of classification, collection, transportation and storage of hazardous medical waste at the medical facility specifically as follows: 2.4.1. Collection of hazardous medical waste - Collected infection waste + Infectious wastes must be collected separately from the places where waste is deposited in the premises of the medical establishment + In the course of collection, the waste bags must be sealed, the waste bins must have a tight-fitting lid, ensuring that the waste is not dropped during the collection process. + The medical establishment shall stipulate the appropriate route and time for the collection of infectious waste to limit the impact on the patient care area and 11 other areas in the hospital. + Highly infectious wastes must be preliminarily treated before being collected into the waste storage and treatment areas within the hospital's premises. + Frequency of collection of infectious waste from the place of origin to the waste storage area within the hospital premises at least once a day. + For medical establishments with less than 5kg / day of infectious wastes, the frequency of collecting the sharp infectious waste from the place of incineration to the temporary storage area within the hospital or putting them to trial at least once a month - Non-infectious hazardous waste collection + Non-infectious hazardous wastes shall be collected and kept separately at the waste storage areas within the hospital's premises + Mercury-containing wastes are collected and stored separately in plastic containers or suitable materials and ensure no leakage or release of mercury vapor into the environment. 2.4.2. Storage of hazardous medical waste - Hospitals dealing with treatment of hazardous medical wastes must have hazardous medical waste storage areas meeting the following technical requirements: + Having a roof for the storage area, ensuring that the floor is not flooded, to prevent rainwater from entering the outside, not to spill liquids outside when the leakage, overflow + Absorbent material such as dry sand or sawdust and shovel for use in the 12