(Luận văn) assessment of status medical waste management and treatment in tuyen quang general hospital

THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY lu an VU LAN TRANG n va tn to TOPIC TITLE: p ie gh ASSESSMENT OF STATUS MEDICAL WASTE MANAGEMENT AND TREATMENTIN TUYEN QUANG GENERAL HOSPITAL oa nl w d BACHELOR THESIS oi lm ul nf va an lu Study Mode : Full- time z at nh : Bachelor in Environmental Science and Management Faculty : International Training and Development Center Batch : K42- Advance Education Program z Major m co l gm @ an Lu n va Thai Nguyen, 23/ 01/2015 ac th i si 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 lu an Supervisor Dr Nguyen Hung Quang n va tn to Abstract: gh Assessment and analyze the status of medical waste management in Tuyen p ie Quang General Hospital: Assess the classification, transportation, storage and w treatment of medical waste and wastewater generated in operation process of Tuyen oa nl Quang General Hospital Analyze and propose solutions: Causing of existence in the management and treatment of medical waste in hospital Solutions to improve the d an lu management efficiency and treatment medical waste: Treating waste to improve the Keywords oi lm ul nf va efficiency for medical waste management in Tuyen Quang General Hospital Medical waste; Hazardous medical waste; waste z at nh management; wastewater treatment system; Tuyen Quang; Date of submission 23/01/2015 m co l gm @ 59 z Number of pages an Lu n va ac th ii si 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 lu Training and Development Center, thank teachers, who imparted to me the knowledge an and skills during the time I study and practice at Thai Nguyen University of va n Agriculture and Forestry to gh tn 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 ie p implementation and complete this thesis nl w I would like to thank the assistance of staffs who are working at Department of d oa Natural Resources and Environment of Tuyen Quang province, Environmental Protection Agency has helped me during internships time, impart practical experience for me I an lu would like to thank staff and officers at Tuyen Quang General Hospital who created the va ul nf best conditions for me to completed this thesis oi lm 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 z at nh hope to receive feedback, comments and additions to my thesis complete and found the exist shortcomings of myself z @ I would like to sincerely thank! Student m co l gm Tuyen Quang, 23 rd January, 2015 an Lu n va Vũ Lan Trang ac th iii si TABLE OF CONTENTS LIST OF FIGURES LIST OF TABLES LIST OF ABBREVIATIONS PART I INTRODUCTION 1.1 Research rationale 1.2 Research’s objectives 1.3 Research questions and hypotheses lu an 1.4 Limitations n va 1.5 Definitions 2.1 Scientific base of the study gh tn to PART II.LITERATURE REVIEW 2.2 Theoretical base of the study p ie 2.2.1 Classification of the medical waste nl w 2.2.2 Harmful effects of medical waste 11 oa 2.3 Current status of medical waste management in Vietnam 14 d 2.3.1 General situation 14 lu va an 2.3.2 The process of collecting, sorting and transporting waste in the health care facilities 18 nf oi lm ul 2.3.3 Measures and technologies to treat hazardous medical waste 19 PART III METHODS 22 z at nh 3.1 Material 22 3.2 Methods 23 z 3.3.1 Interview methodology in the field 23 @ 3.3.2 Methods of analysis, synthesis document 23 gm 3.2.3 The sampling method of wastewater 24 l m co 3.2.4 Experimental and analysis methods in the laboratory 24 PART IV RESULTS 26 an Lu 4.1 The overview of Tuyen Quang General Hospital 26 n va 4.1.1 Functions and tasks 27 ac th iv si 4.2 Sources of waste and the methods to collect, classify and treat medical waste in Tuyen Quang General Hospital 30 4.2.1 Common Solid Waste 30 4.2.3 Hazardous waste 32 4.2.3 Wastewater 35 4.2.3 Gas emission 40 4.3 Assessment the preliminary way of medical waste 47 4.3.1 Domestic waste 47 4.3.2 Hazardous medical waste 48 lu an 4.3.3 Wastewater 49 n va 4.4 Assessment the quality of wastewater in Tuyen Quang General Hospital 50 tn to 4.4.1 Sources of wastewater 50 4.4.2 Result of observational, analysis 51 p ie gh 4.5 Recommendation some solutions for collection and treatment activities of medical waste in Tuyen Quang General Hospital 53 nl w 4.5.1 Solution in the collection, storage and treatment of medical waste 53 oa 4.5.2 Solutions for wastewater treatment system 54 d 4.5.3 Management mission 54 lu va an PART V DISCUSSION AND CONCLUSION 56 5.1 Discussion 56 nf oi lm ul 5.1.1 Area and position of Tuyen Quang General Hospital 56 5.1.2 Status of waste management and treatment in hospital 56 z at nh 5.1.3 Results of the environmental research 57 5.2 Conclusion 58 z REFERENCES 60 m co l gm @ an Lu n va ac th v si LIST OF FIGURES Figure 4.1.Organization chart of Tuyen Quang General Hospital 29 Figure 4.2 Hazardous medical waste generating trendy in 2013-2014 .34 Figure 4.3 Treatment technology of wastewater 37 Figure 4.4 Preliminary way of domestic waste 48 Figure 4.5 Preliminary way of Hazardous medical waste 49 Figure 4.6 Preliminary way of wastewater 50 lu an n va p ie gh tn to d oa nl w oi lm ul nf va an lu z at nh z m co l gm @ an Lu n va ac th si LIST OF TABLES Table2.1 Some examples of infection due to contact with medical waste Microorganism category of pathogenic and procedure infection 12 Table 2.2.Waste arising under the beds in Vietnam in 2012 .15 Table 2.3 Distribution of medical waste by type of urban 16 Table 2.4 Comparison of medical waste generated in Vietnam with some neighboring countries in 2012 .17 Table 3.1 Notation of sampling locations 22 lu Table 4.1 List of hazardous waste generated an average of 01 month .32 an at Tuyen Quang General Hospital 32 va n Table 4.2 Reality amount of hazardous medical waste in Tuyen Quang General to Hospitals 33 gh tn Table 4.3 Time existence of some microorganisms 42 p ie Table 4.4 Results of the wastewater target analysis of Tuyen Quang General Hospital .51 d oa nl w oi lm ul nf va an lu z at nh z m co l gm @ an Lu n va ac th si LIST OF ABBREVIATIONS lu The biochemical oxygen demand in 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 an BOD5 n va p ie gh tn to d oa nl w oi lm ul nf va an lu z at nh z m co l gm @ an Lu n va ac th si PART I INTRODUCTION 1.1 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, lu during operation process, the health system, especially the hospital has discharged a an n va large amount of medical waste substances, including hazardous medical waste medical waste about 10% of the infection waste and 5% is noxious waste such as ie gh tn to According to the World Health Organization (WHO, 1994), the components of p radioactive, cytotoxic substances, toxic substances generated in the diagnosis and oa nl w treatment procedure It is risk factors of environmental pollution, pathogens spread from hospital to surroundings area, lead to increased risk of monomial infection and d lu va an increased disease incidence of local communities living in contiguous areas ul nf In order to assess the status of medical waste as well as the impact of medical oi lm waste on the environment, they need to have research of the scientists and agencies z at nh 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 z gm @ medical examination and treatment of people, the overload of many hospitals, lack of hospitals is not guaranteed m co l uniformity in infrastructure of the hospital means environmental sanitation of many an Lu Tuyen Quang General Hospital is the provincial hospital It is the medical n va examination and treatment center of Tuyen Quang province The scale of hospital is ac th si 500 beds, with all the Department of Internal Medicine, Department of Surgery and Clinical Departments The number of patients examined on average is between 400500 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 lu Stemming from the above problems I conducted research topics “Assessment of an status medical waste management and treatment in Tuyen Quang General n va 1.2 Research’s objectives - Cursory review of Tuyen Quang General Hospital p ie gh tn to Hospital” w oa nl - Assessment of status medical waste management and treatment in Tuyen d Quang General Hospital an lu oi lm ul reduce pollution nf va - Propose solutions to increase the effect of medical waste management and 1.3 Research questions and hypotheses z at nh - What is the current situation of medical waste management in Tuyen Quang z General Hospital? gm @ - What is the way to treatment medical waste of Tuyen Quang General m co l Hospital? General Hospital? an Lu - How we can closely management the medical waste of Tuyen Quang n va ac th si Departments, chambers Campus’s hospital Canteen, kitchen of hospital Patient’s room Workers of Tuyen Quang Environmental Services and Urban Management One member Co., Ltd Green containers, volume 240l Collect and transport to gather place lu an Classification n va gh tn to Solid waste taken to treatment at Recycle waste was stored at the Infectious Control Department and sold for units have recycling function Nhu Khe landfill twice a day, at ie p a.m and p.m d oa nl w Figure 4.4 Preliminary way of domestic waste 4.3.2 Hazardous medical waste an lu va Hazardous medical waste is frequently collected by sanitation team of hospital ul nf from Clinical, Subclinical, Infection Control and Pharmacy Departments In oi lm departments, chambers have yellow bins with plastic bags available to contain hazardous medical waste, bins have lids and sanitation team of the hospital collected z at nh and transported immediately next to the incinerator system and at 13 p.m daily, caseworker conducted incinerated waste Ashes of incinerator system have been buried z m co l gm @ and rendered inert in the hospital campus an Lu n va ac th 48 si Yellow bins with plastic bags Clinical Departments Subclinical Departments Infection Control Departments Pharmacy Departments Sanitation team lu Collect and transport to gather place located near the incinerator system an va 13 pm daily n to p ie gh tn Incinerating waste Ashes of incinerator system w oa nl have been d inverted in buried the and hospital an lu campus oi lm ul 4.3.3 Wastewater nf va Figure 4.5 Preliminary way of Hazardous medical waste Wastewater from functional departments, patient's room, canteen, kitchen of z at nh hospital directly flow to the preliminary treatment through the underground septic z tanks system of hospital with capacity around 210 m3/ day After that it leads directly @ l gm into the wastewater treatment system of hospital located inside Tuyen Quang Tuberculosis and Lung Diseases Hospital next to Tuyen Quang General Hospital with m co capacity approximate 330m3 /day to thoroughly treat before discharged into the sewer an Lu system of the city Particularly sludge from septic tanks will be sucked periodically n va and taken for treatment ac th 49 si Function Departments Canteen Patient’s room Rainwater runoff in hospital’s campus Preliminary treatment through the underground septic tanks system with capacity 210 m3/day lu an Wastewater treatment system located inside Tuyen Quang Tuberculosis and Lung Diseases Hospital next to Tuyen Quang General Hospital with capacity approximate 330m3/day Sludge will be suck n va periodically and take to tn to treat from to p ie gh months/times d oa nl w Sewer system of the city Figure 4.6 Preliminary way of wastewater an lu 4.4 Assessment the quality of wastewater in Tuyen Quang General Hospital nf va 4.4.1 Sources of wastewater oi lm ul Wastewater of Tuyen Quang General Hospital generated primarily from the z at nh following sources: - Domestic wastewater of officers and workers, patients, family members of z @ patients and visitors: the wastewater effluents from the floor, sink and septic tank of m co l gm treatment facilities, offices, administrative areas - Wastewater generated from the course of medical treatment: Wastewater an Lu effluents from the floor and sink of the tests and X-rays area, emergency rooms, operating n va rooms ac th 50 si Wastewater from two sources contained organic substances, suspended solids, detergents, pharmaceuticals and especially pathogenic bacteria - Surface wastewater: Mostly rainwater runoff will be entrainment waste, soil and other suspended substances 4.4.2 Result of observational, analysis Table 4.4 Results of the wastewater target analysis of Tuyen Quang General Hospital lu va pH BOD5 mg/l 7.5 54 7.6 26 ie an Vietnam Standards 28:2010/MONRE (Column B) 6.5-8.5 50 COD mg/l 130 35 100 PO43- mg/l 4.9 4.6 10 mg/l MNP/100ml 2.3 1500 1.8 900 50 5000 n No Indicators Unit gh tn to p w NO3Coliform After treatment (NT2) d oa nl Before treatment (NT1) an lu nf va
Wastewater before treatment oi lm ul Medical wastewater contains chemicals and has important cumulative property to evaluate the quality of wastewater Through the analysis results of wastewater before z at nh treatment, some indicators not achieved and exceed the standards quality allowed under z Vietnam Standard 28: 2010 Specifically as follows: @ l gm - Indicator BOD5 is 54 mg/l exceed 1.08 times compared with the standard m co quality allowed BOD5 is one indicator to assess the level of pollution of waste and self-cleaning ability of water, due to the characteristics of medical waste is collected an Lu from the surgery room, examination and treatment area so the content of BOD5 in n va medical wastewater exceed Vietnam Standard 28: 2010 /MONRE ac th 51 si - Indicator COD is 130 mg/l exceed 1.3 times compared with the standard quality allowed COD is used to define the amount of organic contamination found in wastewater surface, is a useful measure of water quality When oxygen demand exceeds indicator allowed so the self-cleaning ability of water is not responding, due to characteristic of medical wastewater is collected from the surgery room, examination and treatment area so the content of COD in wastewater exceed Vietnam Standard 28: 2010/MONRE lu an
Wastewater after through treatment system va n Medical wastewater after through treatment system, the physical, biological gh tn to indicators had dropped to standard quality allowed by Vietnam Standard 28:2010 p ie /MONRE Specifically as follows: - Indicator BOD5 decreased to 26 mg/l nl w d oa - Indicator COD decreased to 35 mg/l nf va after treatment an lu
Comparison results of the analysis of wastewater samples before and oi lm ul Through the table 10 compare results of the analysis of wastewater samples before and after treatment of hospital showed that: the process of system did reduce the z at nh contamination rate than the incoming wastewater The basic indicators are within the limits z allowed under Vietnam Standard 28: 2010/MONRE And medical wastewater samples @ l gm before treatment have content of BOD5, COD exceed the limit allowed m co - Content of BOD5 in wastewater samples before treatment exceed 1.08 times an Lu than Vietnam Standard 28: 2010/MONRE After treatment in wastewater treatment system of hospital, it reduced in the range of allowed under Vietnam Standard 28: n va 2010/ MONRE ac th 52 si - Content of COD in wastewater samples before treatment exceed 1.3 times than Vietnam Standard 28: 2010/MONRE After treatment in wastewater treatment system of hospital, it reduced in the range of allowed under Vietnam Standard 28: 2010/MONRE 4.5 Recommendation some solutions for collection and treatment activities of medical waste in Tuyen Quang General Hospital 4.5.1 Solution in the collection, storage and treatment of medical waste lu an - Reducing at source: Choosing to purchase and sale medical materials arise a small n va tn to amount of hazardous medical waste, prevent medical materials prodigal ie gh -Management chemicals and pharmaceuticals warehouse: Order with moderate p amounts, have a long shelf life Hospital should use the recyclable materials inside or oa nl w outside hospital d - Waste classify: Classification carefully into different categories can an lu significantly reduce amount of medical waste, so this activity will be the highest oi lm ul nf va priority implementation - Recycling and using domestic waste: recycling materials such as paper, glass, z at nh plastics can be save for hospital the costs for transportation, treatment or get more money from the sale of scrap recycling so should be encouraged to implement this task z @ l gm - Planting more trees for air equable in hospital, often spray disinfectants in hospital campus to ensure the best environment for examination and treatment m co activities an Lu n va ac th 53 si 4.5.2 Solutions for wastewater treatment system - Hospitals should regularly check and take measures to deal with the septic tanks construction and toilets to avoid the blocked pipe and increase efficiency for wastewater treatment system - Regular inspection of the underground sewer system from the functional areas to wastewater treatment system to avoid the risk of clogging by waste and inorganic waste lu 4.5.3 Management mission an n va - Function organizations needs to supervise and inspect surrounding gh tn to environment periodically in order to timely detect serious violation to the environment: p ie nl w + Conducting periodic observation to detect the signs of pollution d oa + Environmental Protection Agency of Tuyen Quang province and an lu Environmental Police should cooperate to carry out unannounced inspections about oi lm ul hospital nf va wastewater treatment system as well as sanitary and environmental activities of the - Board of leaders as well as staff of Tuyen Quang General Hospital should z at nh increase the awareness in environmental protection, strengthen and upgrade the z wastewater treatment system, adding more human resource to be suitable with the l gm @ hospitals current scale m co - Adding more expense, equipment, human resource on urban management and an Lu more staff being in charge of environment matters n va ac th 54 si + Holding short-term training courses, seminars about new technologies for staff in charge of environmental matters Receiving and integrating the global scientific knowledge for the hospitals lu an n va p ie gh tn to d oa nl w oi lm ul nf va an lu z at nh z m co l gm @ an Lu n va ac th 55 si PART V DISCUSSION AND CONCLUSION 5.1 Discussion 5.1.1 Area and position of Tuyen Quang General Hospital Tuyen Quang General Hospital is provincial hospital grade II with the total area approximate 48.284 m2, the scale 500 beds Ensuring the hygiene standards about surface area/bed (96.5m2) Hospital located at 44 Le Duan Street, Tan Ha ward, Tuyen Quang city lu where is far from city center 2,000 m to the North Position of Tuyen Quang General Hospital an n va shows that it has specific effect to economic – society of Tan Ha ward, as well as Tuyen because annual examination and treatment for the thousands turn of people Quality of ie gh tn to Quang city In social terms,Tuyen Quang General Hospital has wide effect in province p service, whole-hearted of staffs, doctors in hospital to patients and relatives people will have a oa nl w positive impact on society, citizens are believed which is contribute to social stability in the province However, the hospital is located in detrimental position to residential areas Around d lu va an is concentrated population So if medical waste is not well management, the ability affect to residential areas is unavoidable ul nf oi lm 5.1.2 Status of waste management and treatment in hospital z at nh a Status of waste management Domestic waste is collected by sanitary team of Tuyen Quang Environmental z @ Services and Urban Management One member Co., Ltd which has responsible for m co l gm collect and taken to treat Particularly, medical waste is collected by sanitation teams of hospital from an Lu departments/chambers and transport to gathering place to sort, then it is treated at n va incinerators in campus of hospital ac th 56 si Hospital has implemented the collection and classification of waste at source However, we can unavoidable mistakes in classify activity from that can be increase costs for hazardous waste treatment, increase the risk of environmental pollution due to cross-contamination between the types of waste, on the other hand, increases the risk of injury to people who are collect and transport So there should be a specific assignment, reasonable in the waste management to attach people to their lu responsibilities and also facilitates for control and supervision are conveniently an n va Gathering place is meets the sanitation standards: closed, roofed, there is no gh tn to water from gathering place seeping outside b The situation of waste treatment p ie w - Liquid Waste: Wastewater is preliminary treated through the underground septic d oa nl system of the hospital before being led to treat at the wastewater treatment system of Tuyen Quang General Hospital and Tuyen Quang Tuberculosis and Lung Disease Hospital The an lu nf va biochemical indicators standards before discharged into the sewer system of city oi lm ul - Solid medical waste: Hospital treated whole volume of all clinical waste by incinerators Ashes of incinerators system is chemical inverted and buried in campus z at nh of hospital z 5.1.3 Results of the environmental research gm @
Before through wastewater treatment system l m co Wastewater pre-treatment of hospital have BOD, COD exceeds the B allowed limit an Lu The indicators pH, PO43-, NO3- are in the range of permissible limits n va ac th 57 si
After through wastewater treatment Generally, after wastewater through wastewater treatment system, indicators in the range of B permissible limits Comparing the quality of wastewater before and after through treatment system we see the quality of wastewater after treatment is satisfied the standards when it discharged into the sewage system of the city Even when untreated, quality of lu wastewater has satisfied biochemical indicators I think probably in hospital, an n va wastewater is pretreatment in the departments/ chambers and through the underground hospital strictly implemented wastewater treatment from the departments/chambers ie gh tn to septic system before flowing into the wastewater treatment system So clearly the p will limit the risk of pollution to the environment oa nl w 5.2 Conclusion d During internships time, based on analysis of hospital operation process, an lu collecting data, investigating of pollution sources I have the following conclusion: va oi lm ul nf Tuyen Quang General Hospital is located in a convenient area to medical examination and treatment for people in province and contiguous provinces Tuyen Quang General z at nh Hospital is in a safe area for not being effected by flood in the wet season 100% solid waste of the hospital is collected and sorted at sources before being z @ gm taken to storage area by sanitary staffs, the path to transport are specified separately, m co l avoid passing through areas of patient health care and other clean areas, go the way after hospital and put into storage place Hazardous medical waste is treated by an Lu incineration methods whereby incinerator has the capacity to process 35kg/hour n va (built in 2003) and incinerator has capacity to process 40kg/hour (built in 2011) ac th 58 si Domestic waste of the Hospital is contracted with Tuyen Quang Environmental Services and Urban Management -One member Co., Ltd cleaned up and collected and taken to treat at Nhu Khe landfill with frequency times/ day, at am and pm Wastewater of hospital is treated by wastewater treatment system located inside Tuyen Quang Tuberculosis and Lung Diseases Hospital next to Tuyen Quang General Hospital with capacity approximate 330m3/day After treated, wastewater will reach lu following standard before joining the sewer system of the city: an n va - Indicator BOD5 decreased to 26mg/l to Environmental protection measures being applied by hospital ensure that p ie gh tn - Indicator COD decreased to 35mg/l w operation and business of Tuyen Quang General Hospital will take no effect to d oa nl surrounding environment oi lm ul nf va an lu z at nh z m co l gm @ an Lu n va ac th 59 si REFERENCES Environmental Technical Institute (2006) Technical of wastewater treatment Hanoi Frank, L.C (1973) Handbook on hospital solid waste management Techno Publishing co Jenny, A., & Mansoor, A (2000) Risk from healthcare waste to the poor Well, USA Ha Noi Environmental Science and Technology Department (1996) Report on the situation of hospital waste quality Hanoi lu an n va LaGrega, M D., Buckingham, P L., & Evans, J C (2010) Hazardous waste management Waveland Press gh tn to Lee, C C., & Huffman, G L (1996) Medical waste management/incineration Journal of Hazardous Materials, 48(1), 1-30 p ie Lien, H.T (2009) Research about the status a number of factors related to the management of medical waste in Thai Nguyen Central hospitals Master Thesis, nl w d oa University of Medicine and Pharmacy Thai Nguyen an lu MONRE (2005) The situation and treatment solutions pollution in hospitals Journal nf va of Environmental Protection, No.3/2005 Hanoi oi lm ul MOH (2007) Regulation about Medical waste management of the Ministry of Health issued Decide No 43/2007/Decide - MOH dated November 30th, 2007 Hanoi z at nh MOH (2007) Decide No.43/2007/Decide – MOH dated November 30th, 2007 Ministry of z Health promulgate Regulations about Medical waste management Hanoi l gm @ MONRE (2010) Annual report of the local Hanoi MONRE (2011) Circular No.12/2011/Circulars – MONRE dated April 14th, 2011 m co Ministry of Natural Resources and Environment about Hazardous waste an Lu management Hanoi n va ac th 60 si MOH (2014) Circular No.2340/2014/Circular – MOH dated April 29th , 2014 Ministry of Health about Strengthening about medical waste management Hanoi Prüss, A., Giroult, E., & Rushbrook, P (Eds.) 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