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Nguyen Thu Huyk vd Dtg Tap chi KHOA HOC & CONG NGHE 120(06) 147 152 CONG TAC QUAN LY CHAT THAI RAN Y TE TAI BENH VIEN DA KHOA TRUNG U*ONG THAI NGUYEN Nguyen Thu Huyen*, Nguyin Thi Nham Tuat Trudng Dgi[.]
Nguyen Thu Huyk vd Dtg Tap chi KHOA HOC & CONG NGHE 120(06): 147-152 CONG TAC QUAN LY CHAT THAI RAN Y TE TAI BENH VIEN DA KHOA TRUNG U*ONG THAI NGUYEN Nguyen Thu Huyen*, Nguyin Thi Nham Tuat Trudng Dgi hgc Khoa hgc - DH Thai Nguyen TOMTAT Bai bao da dua cong tac quan ly chat thai ran y te tai benh vien Da khoa Trung uong Thai Nguyen, dac biet la viec quan ly chat thai ran y te nguy hai Tren co sd do, de xuat mgt so giai phap mang tinh nguyen tac niiim khac phuc nhibig ton tai ciia benh vien viec quan ly chat thai ran y te Nghiem ngat thuc hien phan loai tai noi phat sinh, thu gom, van chuyen, luu giii va xii ly chat thai ran y te theo Quy che quan ly chat thai y te - Quyet dinh so 43/2007/QD-BYT, De xuat ap dung cong nghe khit khuan bang thiet bj vi song dieu kien ap suat thudng nham giam thieu lugng chat thai lay nhiem phai thieu hiiy dem lai Igi ich kinh te va gop phan bao ve moi trudng cho benh vien Tu khoa: Chdt thdi ran y ti nguy hgi, chdt thdiy ti phong xa nhiim khudn, khu khudn, mdi trudng DAT VAN DE Hien nay, sy phat trien cua cac ca sd y te da va dang gdp phan lam tang hieu qua viec cham sdc, bao ve siic khde cua nhan dan Day la nhiing tin hieu dang mimg song neu nhin tir gdc mdi trudng Ihi sy phat trien cua cac ca sd y le lai dang ldn tai nhieu lo ngai la van de quan ly chat thai y le (CTYT) Nhiing anh hudng tir CTYT ndi chung va chat thai rSn y te (CTRYT) ndi rieng den ngudi va mdi trudng la rat khd ludng Irude NQl DUNG, PHUONG PHAP NGHIEN CUU Noi dung nghien cihi - Nghien ciiu hien trang CTRYT tai benh vien Da khoa Trung uang Thai Nguyen (thanh phan, sd lugng phat sinh) - Tim hieu cdng tac quan ly CTRYT, dae biel la eac CTRYT nguy hai tai benh vien Da khoa Trung uang Thai Nguyen (phan loai, van chuyen, luu giii va xir ly chat thai) - De xuat mdt sd giai phap quan ly CTRYT tai benh vien Phirong phap nghien cihi Duge lap tir nam 1951, Benh vien Da khoa Tmng uang Thai Nguyen la benh vien h^ng I tryc thugc Bg Y Te, cd nhiem vu kham chiia benh va bao ve siie khoe cho nhan dan cac dan tdc khu vuc mien nui phia Ddng Bac, Benh vien ddng tren dja ban trung tam tinh Thai Nguyen, la trung lam dao tao can bd y le cho cac linh mien niii phia Bac, la co sd thuc hanh chinh ciia cac trudng Y duge Irong tinh Nhan thiie duge miic nguy hiem tir cac CTYT, Benh vien khdng the khong quan tam den van de Chinh vi vay, de lai nghien cihi "Cdng tdc qudn ly CTRYT tai benh vien Ba khoa Trung uang Thdi Nguyen " lao eg scr cho nhiing de xuat de cai thien dieu kien ve sinh mdi irudng benh vien Tel- 0914 569251 Email huyenntdhkh@gmail.coin - Phuang phap thu Ihap, tdng hgp lai lieu - Phuang phap khao sal Ihuc dia - Phugng phap phdng van - Phucmg phap thdng ke loan hgc KET QUA NGHIEN CUU Thu-c trang quan ly CTRYT tai benh vien He thong qudn ly CTRYT He thong kiem soat nhilm khuan (KSNK) ndi chung va he thdng quan ly CTRYT (dac biet la quan ly CTRYT nguy hai) ctia benh vien ndi rieng duge Ihiel lap tao eg sd cho viec quan ly cac chat thai ran cua benh vien (duac the hien d hinh 1) Nguon phdt sinh CTRYT CTR ciia benh vien gdm: CTRYT nguy hai, CTR sinh boat, CTR tai che 147 Nguyen Thu Huygn vd Dtg Tap chi KHOA HOC & CONG NGHE Cac CTRYT nguy hai cua benh vien phai sinh Irong cac boat ddng kham vii dieu tri cho ngudi benh nhu: bom kim tiem, bdng bang Tuy nhien, cd nhiing loai chat thai nguy hai mang dac thu ctia khoa CTRYT thdng thudng va chat thai lai che phat sinh cac hoat ddng chuyen mdn, sinh hoat va tir nhieu ngudn khae Ty le CTRYT duge the hien qua bang Bang V.Tyli cdc chdt thai rdn binh viin T T Chat thai CTR thong thirang CTRYT nguy hai Chat thai tai che Tons Khoi iirffng (Kg/thane) T y l e (%) 95.300 95,20 3.750 3,75 1.050 1,05 loo.ioo 100 120(06); 147-152 Qudn ly CTRYT nguy hai CTRYT nguy hai la mgt phan loan bg luong CTR ctia benh vien Thanh ph3n va s6 lugng CTRYT nguy hai duge the hien d bang Cdng tac phan loai, thu gam, luu giir va xir ly CTRYT duge Ihuc hien nghiem liic, dung quy dinh va cd su kiem tra thudng xuyen Phdn loai, thu gom tai cdc khoa phong - Doi vdi chat thai lay nhiem thugc cac dang: + Chat thai sac nhgn nhu kim tiem, manh thuy linh vd duge cho vao chai nhua cd dung dich khu khuan Presepl 1% hoac Cloramin B 2% + Cac chat thai nhu bdng bang, gae, cac benh phdm, bam tiem (da bd kim) duge cho vao liii mau vang - Doi vdi cac chat hoa hgc nguy hai, chat phong xa: + Cac chat thai ran cd lien quan den phdng xa se duge nhan vien tai Khoa cho vao tiii mau den rdi mang be chua chai thai phdng xa + Cac vo chai, lo Ihudc chiia cac chat ddc hga hgc tai cac khoa nhu Klioa U budu, Khoa Tam than ciing se duge nhan vien thu gom vao tlii mau den Thu gom, van chuyen Cong nlian thu gomchuyen va xuly Nhan vien giam sat Nhan vieny te cac khoa, phong Cong nhan (Thu gom, van chuyen) Hinh \.Sadd he thong qudn ly CTRYT tgi Benh vien Da khoa Trung uang Thai Nguyen Cac chat thai sau duge phan loai, thu gom se duge de cac thimg dat d dau eac khoa, phdng Cac thimg mau vang tir 120 - 140 lit, co ghi "THUNG BO RAC Y TE" va bi6u lu'gng Thung mau den 140 lit, ben ngoai cd ghi "THUNG DUNG RAC NGUY HAI" dat chu yeu tai khoa U budu, khoa Y hgc hat nhan Cac Ihiing dung chat thai se duge cdng nhan ihu gom ciia Cdng ty ICT van chuyen ve nha de rae cua benh vien Thdi gian thuc hien lan/ngay; budi sang tir lOhOO - 10b30 va budi chieu tir 15h30-16b00 Liru giu Do khdi lugng chat thai cd linh phdng xa khdng nhieu nen duge luu giii thang lai hk chiia chat thai phdng xa sau dd mang di xu ly nhu chat thai nguy hai khac (trong dd cd ch5t boa hgc nguy hai) y Nguyin Thu Huyen va Dtg T^ip chi KHOA HOC & CONG NGHE 120(06): 147-152 Bang 2: Thdnh phdn vdsd lugng CTRYT nguy hgi cua benh vien trung binh thdng ddu nam 2013 (kg/thdng) Chdt thai Don vj Chat thai sac nhon Kg Chit thai ngi^ ca lay nhilm Kg Chat thai giai phlu Kg Duge phAm k^m chdt lugng Kg Cac san pham gay dgc t& bao Kg Pin Doi Bong den huynh quang Chi^c Tong khoi lugng Kg Benh vien xay dyng nha de rae tir nam 1990 de ehiia CTR thdng thudng va CTRYT nguy hai Hang ngay, edng nhan Cdng ty ICT van chuyen cac chat thai den nha de rac Chat thai duge luu giii t?i day eho ddn cudi se duge edng nhan Cdng ty CPMT & CT tiij Thai Nguyen den bag gdi va mang di xu ly - Xir ly ban dau: CTR duge xii ly ban dau tai cac khoa, phdng Ddi vdi chat thai nhu: lam kinh vd, dng lay mau benh pham duge hip udt d 31 "C 15 phiit Cac CTR cd lien quan dgn phdng xa se duge Ihu gom vao tiii den lai khoa Cac chai nhua dyng djch truySn va day truyin CO dinh mau duge ngam dung djch Javen 10% it nhit 30 phiit - Xir ly, tieu hiiy: Lugng CTRYT nguy hai se duge Cdng ty CPMT & CT dd thi Thai Nguyen van ehuyen lir nha de rac benh vien di xii ly tai bai rac Da Mai ciia tinh Qudn ly chdt thdi thong ihir&ng vd chdt thdi tdi che Doi vdi ehat thai r^n thdng thudng benh vi?n bao gdm chat thai ran tir sinh hoat cua benh nhan ngudi nha, nhan vien ciia benh vien; chat thai ngogi eanh se duge phan loai va thu gom rieng biel vdi CTRYT nguy hai Tir nam 2010 benh vien chi dao khoa Duge va khga KSNK cimg ket hgp Ihuc hien Ihu hoi cac chai nhua dyng djeh truyen, chai Ig thuy tinh khdng chiia cac Ihanh phin nguy hgi; giay bao; bia, thimg cation vdi khdi lugng khoang 500kg/thang Cac chit thai duge eac khoa mang len khoa KSNK va phai ki xac nh^n sd lugng tra Ngu6n So iugng 28,7 Cae khoa 3.691,9 Cac khoa 28,1 Khoa giai phau benh, khoa vi sinh 0,3 Khoa Duge I Cac khoa 20 Cac khoa 50 Cac khoa 3.750 Nhihig tdn tai quan ly CTRYT tai benh vien Benh vien da thuc hien kha day dii eae quy dinh vS quan ly CTRYT theo quy chl, dac biet la CTRYT nguy hai Tuy nhien, cdn ton tai mdt sd han che sau: - Cac khoa, phdng hau hel deu cd bang hudng dSn each phan loai, thu gom chSt thai ran Tuy nhien, bang thudng dat d phdng hanh chinh eiia cac khoa hoac luu cap lai lieu [2] - Benh vien cd nha luu giir CTRYT nguy h^i va CTR sinh hoat chung ChSt thai rin edn dung day cac tui ni long va thimg ehira day trudc van chuyen [2] - Benh vien chua quan lam trang bi cho cac khoa hop dyng chat thai sic nhgn theo quy dinh Hien tai, hop dung chat thai sic nhgn duge thdng nhat lam bang Inox va cd dan nhan.[2] - CTRYT duge phan loai tuang doi Idt tir cae khoa Nhung van cd hien tugng ngudi nha benh nhan qua trinh cham sdc da tu thao bdng, bang de vao thimg chua chat thai ran sinh hoat Cae ton tai ndi tren xuat phat tir nguyen nhan thilu phuang tien thu gom, van chuyen ehal thai va kien thiic phan loai cGng nhu y thirc ciia nhuTig ngudi thue hien Mgt so giai phap quan ly CTRYT Da cd the quan ly tot CTRYT he thdng quan ly CTRYT tai B?nh vien Da khoa Trung uong Thai Nguyen can duge Ihyc hi?n nghiem ngai theo quy trinh tai hinh 149 Nguyen Thu Huyen vd Dtg 120(06): - Tap chi KHOA HOC & CONG NGHE C T R Y T benh vien d u g e p h a n loai tai k h o a Nguon phat sinh CTRYT ba loai C T R k h d n g n g u y hai, C T R Y T nguy hai va C T R tai che Sau d o , C T R khdng nguy hai d u g e d u n g tiii m a n x a n h dem Phan loai tai chd (khoa, phdng ) di chdn lap C T R n g u y hai d y n g tiii m a u vang mang di thieu dot v a tro ciing d u g e chdn lap Cdn C T R tai che d u g e t h u g o m va ban cho cac c a sd Vdi viec thiel lap he t h d n g tren se g d p p h a n CTRYT CTRYT nguy hai (dii mau vang) CTR khong nguy hai (tlii mau xanh) tai che vach rd h u d n g quan ly C T R Y T ciia benh vien Hien nay, c d n g tac q u a n ly C T R Y T ciia benh vien van tdn tail m d t so han che, khd khan V i vay hoat d g n g ciia he thdng quan ly d u a se gdp phan m a n g lai hieu qua sau: Thu gom (hg ly, cong nhan) Thu gom (hd ly, cdng nhan ) Giii gin ve sinh mdi t r u d n g b e n h vien, n a n g cao chat l u g n g cham sdc benh nhan, gdp p h a n Thieu huy (16 d6t) giam thieu nhiing nil ro nghe n g h i e p ; Thu gom (ho ly, cong nhan) Xii ly so bo, khu khuan H e thdng di v a o hoat d d n g tao nhirng h u d n g rd rang va tag e g s d viec quan ly triet de va an toan l u g n g C R T Y T ciia b e n h vien; Giam chi phi quan ly C R T Y T thdng qua viec ban tai c h e v a g i a m thieu rac phai sinh tir giam l u g n g rac d e m thieu huy D a y la md hinh p h u h g p de cae b e n h vien khac Irong tinh ndi chung va tren dja ban phd Thai N g u y e n ndi rieng t h u c hien, gdp p h i n giu gin ve sinh mdi t r u d n g v a cai thien siic khde n g u d i dan tinh Hien nay, Benh vien D a khoa Trung u a n g Thai N g u y e n d a n g xii ly chat thai rSn y \.i Bai rac Da Mai Tro dot Tai che, tai sir dung Hinh Hi thdng qudn ly CTR YT tgi Binh vien Da khoa Trung ucmg Thdi Nguyin Viec ap d u n g cac c o n g n g h e thay th6 cho c d n g nghe d d t la rat can thiet, phii h g p vdi xu h u d n g chung cua I h l gidi, t h y c hien cac cam ket g i a m p h a t thai cac chat d n h i l m hiiu co khd p h a n hiiy de b a o v e mdi t n r d n g va siic khde n g u d i Hien nay, B e n h vien D a k h o a T n m g uong theo p h u a n g p h a p thieu ddt b i n g Id d o t Hoval Thai N g u y e n d a n g tiSn h a n h d u an xir ly M Z Bg Khoa h g c vii C d n g nghe c u n g da CTRYT ban hanh cac tieu chuan cd lien quan den Id k h u i n se m a n g lai nhieu Igi ich \t ddt nhu: T C V N 6560 - 0 : "Khi thai 16 d6l mdi t r u d n g v a q u a n ly vi chi phi d i u tu va chat thai ran y te - Gidi han cho phep v a m g t van h a n h re h o n p h u a n g p h a p thieu ddt Cdng sd tieu chuan khac ve cac p h u g n g p h a p xac nghe k h u k h u a n k h d n g p h a t sinh thai dgc dinh cac chat d nhiem thai, thay lh6 hai (dac biet la dioxin v a fijran), k h d n g phat cho cac lieu chuan ban hanh n a m 0 " T u y viy, viec kiem soat thai Id ddi va nhiel dg budng dot cdn gap nhieu khd k h a n cd m g l sd chi tieu hien n h u n d n g dg dioxin phai gui m i u n u d c ngoai vdi chi phi rat cao (khoang nghin USD/mau xet nghiem dioxin) Ld dot chat thai y te ciing p h a i smh dioxin va thuy n g i n nguy hai b S n g c d n g nghe khii kinh t£, sinh tro xi d d c hai chiia k i m loai nang va chit thai sau khii k h u i n d u g e chdn l i p nhu ehat thai t h d n g t h u d n g Benh vien cd the kiem s o i l chat Iugng khii k h u i n vi cd k h o a vi sinh se thuan lien va k h a thi h a n so vdi viec kiem soat thai Id dot chat thai r i n y te C o n g n g h e k h d n g dot se tieu diet vi k h u i n m i m benh Irong chat thai y tg lay n h i l m 150 Nguyen Thu Huyk va Dtg Tap chi KHOA HOC & CONG NGHE Chdi thdi Idy nhiem + khu/tiet khudn = chdt thai khong khd ndng Idy nhiim Cong nghe khong ddt hien cd nhieu loai: Cdng nghe hda hgc, cdng nghe vi sinh, cdng nghe nhiet khd va cdng nghe nhiel im (cdng nghe hap udt, cdng nghe vi sdng kel hgp hoi nudc bao hda d ap suat thugng, edng nghe vi song kel hgp hai nudc bao hda d ap suit cao) Tir nam 2010, tai Viet Nam cd khoang 18 he thdng xu ly chat thai y le bang cdng nghe khdng ddt duge dau tu va van hanh Trong do, chi ed he thdng duge dau lu cdng nghe hap udt nhung den vin hgat ddng eim chtrng Cdn lai 16 he thong deu dung cdng nghe vi sdng va da chiing minh duge hieu qua nhal dinh Loai Ihiel bi cong nghe vi sdng ket hgp hgi nudc bao hda ap suat cao khdng cd loai cdng suat phil hgp vdi benh vien da khoa TW Thai Nguyen Cong suit loai chi d mirc toi da 20 kg/gid van hanh Nhu vay, de xir ly hel lugng chat thai y le ciia benh vien Ihl Ihiel bi phai van hanh 10 gid (tuang lai co the la 13 gig) Se can thiet bj loai (van hanh - gig mdi ngay) dc van hanh hgp ly Tuy nhien, rat kho miic dau lu rat Idn Cong nghe ap suat d dieu kien ap suit thudng CO nhieu lya chgn hgn ve cdng suit xu ly (10 - 35 kg/me) va duge su dung d nhieu nudc tren the gidi nhu My, Canada, mdt sd nudc ehau Au va chau A khac Chi phi diu tu thiet bi cong nghe khir khuan bang vi sdng ap suat thudng Ihap ban loai ap sual cao Chinh vi viiy, Benh vien Da khoa Trung uang Thai Nguyen da lya chgn trang bi be thdng xu ly CTRYT lay nhiem bang cdng nghe vi sdng ap suit thudng Ben canh benli vien can thyc hien mdt so giai phap sau: - Trang bi day dii phuang Uen, trang thiet bi phpc vu cdng tac quan ly CRTYT - Tien hanh thudng xuyen cong tac kiem tra, giam sat lir khau phan loai, thu gom den xii ly CTRYT dac bict la cac CTRYT nguy hai 120(06): 147-152 - Xay dung ke hoach tap huan, ning cao nhan thiic ve y nghia cua viec quan ly CTRYT cho toan the nhan vien y le, nhan vien ve sinh, sirih vien Dac biel, can tuan Ihii ehal che eac quy dinh Irong Quyet dinh 43/2007/QDBYT ve quy che Quan ly chat thai y te - Cd ke hoach dieu chjnh sd lugng tiii, loai tui, kich cd tlii va thimg eho phu hgp vdi Iugng chat thai phat sinh d cac khoa khac - Quan ly chat che cac ngudn phdng xa, hoa chat, duge phim khdng de phat tan mdi Irutmgben ngoai KET LUAN Cong lac quan ly CTRYT lai Benh vien Da khoa Trung ugng Thai Nguyen duge thyc hien kha tdt ve phin loai va xu ly eae chat thai ran, dac biet la CTRYT nguy hai Tuy nhien, qua Irinh quan ly van cdn cd nhiing sai sdt mang tinh chii quan (y thiic cua nhiing ngudi tryc tiep thyc hien viee phan loai, thu gom ) va ca tinh khach quan (cdng nghe xii ly CRTYT, sy thieu hieu biet eua nhirng ngudi khong lien quan tryc liep nhu' benh nhin, ngudi eham sdc ) De cd duge ket qui tot can phai ke den sy quan lam cua Ban lanh dao benh vien, eae Cdng ty lien quan ciing nhu viee luan thu cac quy dinh, quy che ciia loan bg nhan vien y le, cong nhin ve sinh Hien nay, Benh vien da lua chgn trang bi he thdng xii ly CTRYT lay nbilm bang edng nghe vi sdng ap suit thudng TAI LIEU THAM KHAO Bg Y tl, Quyat dinh 43/2007/QDBYT - Quy chl quan ly chit thai y te 30/11/2007 Bg Y te, Bdo cdo kit qud quan trdc vd mdi tnrdng benh vien Da khoa Trung uang Thdi Nguyin, 2012 Bo Y tl, (2013) Bdo cdo kinh ti ky thudt nhiem vu bdo vi mdi trudng, Du dn hd trg trang bi he thdng xu ly chdt thdi rdn y ti lay nhiem bdng cdng ngh^ khong ddt tai da khoa trung uang Thdi Nguyen Bo Y tl, (2013) Hudng ddn cdng nghi khdng ddt xir ly chdt thai rdn y ti Du dn hd trg xir ly chdi thai benh viin 151 Nguyen Thu Huyln vd Dtg Tap chi KHOA HQC & CONG NGHE Benh vien Da khoa Tmng ucmg Thai Nguyen, Bdo cdo qudn ly chdt ihdi nguy hai vd chdt thai khac thdng dau ndm 2013 120(06); 147 - 152 Benh vien Da khoa Trung uofng Thai Nguyen, Ho sa ddng kv chu ngudn chdt thdi nguy hgi, 22/11/2012 SUMMARY THE MANAGEMENT OF MEDICAL SOLID WASTE AT THAI N G U Y E N IN T H E C E N T R A L H O P I T A L Nguyen Thu Huyen Nguyen Thi Nham Tuat College qf Sciences - TNU This article about medical solid waste management in Thai Nguyen National General Hospital, particularly the management of hazardous medical solid wastes Based on the actual conditions and proposed some principal solutions to settle some existing problems on medical solid waste management Strictly classify the medical solid waste at sources, collection, transportation and storage according to the Decision No 43/2007/QD-BYT dated November 30, 2007 of the Vietnam- Ministry of Health promulgating the Regulation on management of medical sohd wastes Proposal is applying bactena stenlizing technology by microwave equipment which operation in normal pressure conditions in order to reduce the amount of infectious wastes must be treated to bring economic benefits and improve environmental protection in the hospital Key words; hazardous medical solid waste, radioactive medical waste, infection, disinfection, environment Ngdy nhdn bdi 13/2/2014, Ngdyphdn biin:20/2/2014; Ngdy duy^i ddng: 09/6/2014 Phdn bien khoa hoc: TS Ngd Vdn Gidi - Trudng Dat hoc Khoa hgc - DHTN Tel- 0914 569251 Emad huyenni.dhkh@gmail a 152 ... Cac khoa 20 Cac khoa 50 Cac khoa 3.750 Nhihig tdn tai quan ly CTRYT tai benh vien Benh vien da thuc hien kha day dii eae quy dinh vS quan ly CTRYT theo quy chl, dac biet la CTRYT nguy hai Tuy nhien,... quan ly CTRYT tai B?nh vien Da khoa Trung uong Thai Nguyen can duge Ihyc hi?n nghiem ngai theo quy trinh tai hinh 149 Nguyen Thu Huyen vd Dtg 120(06): - Tap chi KHOA HOC & CONG NGHE C T R Y T benh... lac quan ly CTRYT lai Benh vien Da khoa Trung ugng Thai Nguyen duge thyc hien kha tdt ve phin loai va xu ly eae chat thai ran, dac biet la CTRYT nguy hai Tuy nhien, qua Irinh quan ly van cdn