nghiên cứu về thực trạng quản lý chất thải y tế tại bệnh viện đại học norwich và norfolk. do Kenvin Paul Pudussery thực hiện năm 2011. Luận án tập trung chủ yếu về quản lý chất thải y tế tại NNUH. Chương 1 là phần giới thiệu và nhằm mục đích để cung cấp cho một thông tin cơ bản liên quan đến quản lý chất thải y tế và biện minh cho chủ đề. Chương 2 tài liệu hiện hành về quản lý chất thải y tế. Các phương pháp được sử dụng để đạt được các mục tiêu và mục đích của dự án này được giải thích trong chương 3. Các kết quả dự án được đưa ra trong chương 4 và kết quả được trình bày trong chương 5 với so sánh nó với các tài liệu hiện tại và mục tiêu ban đầu. Chương 6 kết thúc các nghiên cứu đưa ra một số khuyến nghị để cải thiện việc quản lý chất thải y tế tại NNUH.
1 A STUDY ON THE MEDICAL WASTE MANAGEMENT AT THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL by KEVIN PAUL PUDUSSERY (4905822) Thesis presented in part-fulfilment of the degree of Master of Science in accordance with the regulations of the University of East Anglia School of Environmental Sciences University of East Anglia University Plain Norwich NR4 7TJ September 2011 © 2011 Kevin Paul Pudussery This copy of the dissertation has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with the author and that no quotation from the dissertation, nor any information derived there from, may be published without the author‘s prior consent. Moreover, it is supplied on the understanding that it represents an internal University document and that neither the University nor the author are responsible for the factual or interpretative correctness of the dissertation 2 ABSTRACT The high generation rate of medical waste in UK is a proof that medical waste management in UK is problematic. Based on a case study undertaken at Norfolk and Norwich University Hospital (NNUH) this research looks in to the various issues in the field of medical waste management. The research explores the staff‘s perception towards the medical waste management. The study aims to examine the knowledge level and attitude and role of health care workers towards the medical waste management. The NHS has set a 10% carbon reduction target to be met by 2015 (NHS, 2009), as part of the strategy to meet the UK Government‘s Climate Change Act. The study examines whether the hospital could reduce its carbon foot print by improving the medical waste management. The study looks in to the various medical waste treatment technologies available and choose the best available technology for the on site treatment of medical waste. A multi criteria decision analysis is used for the same. The results of the study show that the health care workers have a critical role in achieving efficient medical waste management. The study shows that hospital could highly benefit from an on site incinerator coupled with an effective waste management programme geared to waste minimization. This will help hospital to reduce carbon foot print and hence towards sustainability. 3 ACKNOWLEDGEMENT I would like to thank first and foremost Dr David Benson for his invaluable academic supervision and enthusiasm throughout this dissertation, as well as for the support and confidence he gave me from every meeting and point of contact that occurred from start to finish. I would also like to thank Dr. Matt Cashmore who is the course director and other MSc course staff, especially Dr. Alan Bond for their advice and guidance throughout the year. Further thanks go to Chris Paul, Graham Corke, for allowing me to conduct this study at Norwich and Norfolk University Hospital. Thanks must also go to the people who agreed to undertake the surveys, without which the study would have seriously have been compromised. Finally, thanks must go to all my friends and family for their continual support and enthusiasm towards this study, for having confidence in my ability throughout the duration of the course. 4 ABBREVIATIONS NNUH: Norfolk and Norwich University Hospital UEA : University of East Anglia WHO : World Health Organization DoH : Department of Health NHS: National Health Service RCN: Royal College of Nursing UK: United Kingdom. DEFRA: Department of Environment food and Rural Affairs. AoDM Association of Domestic Managers HCW: Health care waste EU: European Union BAT: Best Available Technology 3Rs Reduce, Reuse and Recycle 5 TABLE OF CONTENTS I. ABSTRACT………………………………………………………………………… ii II. ACKNOWLEDGMENT ………………………………………………………….…iii III. ABBREVIATION……………………………………………………………………iv TABLE OF CONTENTS 5 LIST OF TABLES 8 LIST OF FIGURES 9 CHAPTER 1: INTRODUCTION 10 1.1) Definition and Classification of Medical Waste 10 1.2) Waste policies and legislations in UK that applies to medical waste management 11 1.3) Medical waste Management in United Kingdom (UK) and associated problems 13 1.4) Why Medical Waste Management at NNUH: Justification 13 1.5) Overall Objective and Specific Aims 14 1.6) Organisation of study 16 2.1) Medical waste management in UK 17 2.2) Best Practices for Hospital Waste Management 19 2.3) Hazardous waste transportation 20 2.4) Medical waste treatment technologies 21 CHAPTER 3: METHODOLOGY 24 3.1) Introduction to methodology 24 3.2) Interview with the Waste Management Officer at NNUH 25 3.3) Participant Observation. 27 3.4) A Questionnaire survey about the waste management practices of Staffs at NNUH hospital 29 3.4.1) Identifying what information is needed 29 3.4.1) Deciding what sort of questionnaire to use 29 3.4.2) Framing the questions 30 3.4.3) Designing of the Self-completion Questionnaire 30 3.4.4) Creating the first draft, editing and revising 31 3.4.5) Sampling and revising 31 3.4.6) Conducting the survey 32 3.5) Questionnaire survey to understand the public perception about medical waste treatment technologies: 32 3.5.1) Framing the questions: 32 6 3.5.2) Analysis of the result 33 3.6) Comparison of different medical waste treatment technologies 33 3.6.1) Selection of Alternative technologies. 34 3.6.2) Selection of the evaluation criteria, and analysis of possible actions. 34 3.6.3) Determination of the significant coefficients (Ranking and weighting). 35 3.6.4) Analysis of the results and selection of best technology. 36 CHAPTER 4: RESULTS 38 4.1) Primary Data Analysis 38 4.1.1) Medical waste management policy and plan at the NNUH. 38 4.1.2) Details of medical waste generated at NNUH. 39 4.1.3) GHG emissions from transportation of medical waste: 41 4.2) Health care workers perception on Medical waste and its management 43 4.2.2) Perceptions about the Constituents of medical waste: 44 4.2.3) Employees perception towards Current waste management practice 45 4.2.4) Attitude towards training 48 4.2.5) Perception towards best treatment technology 49 4.3) Consideration of alternatives:- 49 4.3.1) Capital Investment and Operational cost (C1) 49 4.3.3) Volume and Mass reduction of medical waste(C3) 51 4.3.4) Environmental Impacts of the proposed technology(C4) 51 4.3.5) Public acceptance (C5) 53 4.3.6) Training and operational requirements(C6) 54 4.3.7) Occupational Health and safety including needle stick prevention(C7) 54 4.3.8) Analysis of the result: 54 4.4) Public Perception about Medical waste treatment technologies. 56 4.4.1) Demographic data 56 4.3.2) Public perception about medical waste treatment technologies. 57 CHAPTER 5: DISCUSSION 59 5.1) Waste management policy, plans and practice 59 5.2) Practitioner‘s perception towards medical waste management. 60 5.3) Alternatives for medical waste treatment and selection of Best Available Technology. 63 5.4) Public perception about various medical waste treatment technologies. 64 5.4) Limitations of the study 64 7 6.1) Conclusion 66 6.2) Recommendations. 67 Reference 69 APPENDIX……………………………………………………………………………………………………………………………………… 67 8 LIST OF TABLES Table 1.1: Types of medical waste ……………………………………………………….5 Table 2.1: Health care waste generation in selected countries ………………………….12 Table 3.1: Methodology of research…………………………………………………… 20 Table: 3.2: Sampling size of the surv ……………………………………………………26 Table 3.3: MCDA matrix ……………………………………………………………… 29 Table.3.4: Criteria‘s for the selection of best treatment technology ……………………30 Table 4.1: Waste segregation at NNUH……………………………………………… 32 Table 4.2: Comparison of the RCN guidance and NNUH waste management policy…. 33 Table 4.3: Calculations of GHG emissions from medical waste transportation. ……… 36 Table 4.4: demographic data of the people surveyed ……………………………………37 Table: 4.5: knowledge of employees about the constituents of medical waste …………38 Table 4.6: Ranking: Capital cost………………………………………………………… 44 Table 4.7: Ranking: On types of waste treated ………………………………………… 45 Table: 4.8: Ranking: Volume and mass reduction ……………………………………….45 Table: 4.9: Environmental impacts of various technologies…………………………… 47 Table 4.10: Ranking: Environmental impacts…………………………………………… 47 Table 4.11: Ranking: Public acceptance ………………………………………………….47 Table: 4.12: Ranking: Training and operational requirements ………………………… 48 Table: 4.13: Ranking: Occupational health and safety:…………………………………. 48 Table: 4.14: MCDA matrix ………………………………………………………………49 Table: 5.15: Demographic data of public survey ……………………………………… 50 9 LIST OF FIGURES Figure: 1.1: The overall objective of the project…………………………………………….10 Figure: 3.1: Flow chart showing the various processes involved in an Interview ………….21 Figure: 4.1: Composition of health care waste at NNUH ………………………………….34 Figure 4.2: Employees attitude towards medical waste management for different age groups at NNUH ………………………………………………………………………… 38 Figure: 4.3: Knowledge about the hazardous nature of medical waste ………………… 39 Figure: 4.4: Frequency of waste going to wrong bin ………………………………………40 Figure: 4.5: Problems faced by employees during segregation of medical waste………….40 Figure: 4.6: Problems faced by employees during segregation of medical waste …………………41 Figure: 4.7: Knowledge of the employees as if when the medical waste bin should be sealed … 41 Figure: 4.8: Importance of training in waste management ……………………………… 42 Figure: 4.9: Perception of workers towards various treatment Technologies …………………….43 Figure: 5.10: Figure showing the perception of people about medical waste……………… 51 Figure: 4.11: Public perception towards various medical waste treatment technologies… 52 10 CHAPTER 1: INTRODUCTION Great strides have been made in the field of health care system over the years. Ironically, along with restoring and maintaining community health, health care settings also threaten their well-being. The health of public, patients and professionals alike are affected by poor waste management practices (Shinee et al, 2008). In addition to this, it also contributes to environmental degradation. In 1983, a meeting was held at Bergen, Norway. The meeting was convened by the World Health Organization (WHO) regional office for Europe. The Biomedical waste management issue was first discussed during this meeting. The ―beach wash-ups‖ of summer 1988 bought this issue to the limelight (Lee et al,1996). Now, years later, this has turned into a global humanitarian issue. 1.1) Definition and Classification of Medical Waste All the wastes generated by medical activities come under Health-care waste. They are involved in diagnostic activities and preventive, curative and palliative treatments in both the human and veterinary fields of medicine. In short, health-care waste is all the waste produced by a medical institution (public or private), a medical research facility or a laboratory (Graikos et al 2010). There are two types of health care waste as shown in table 1.1. 1) Hazardous waste Clinical/Infectious/medical waste, cytotoxic and cytostatic medicines, batteries, health are chemicals and hazardous properties, radioactive substances, X ray photo chemicals. 2) Non- Hazardous waste. Offensive/hygiene waste, non cyto-toxic and cyto-static medicines, domestic waste, packaging waste, recyclable waste food waste. Table 1.1: Types of medical waste. (Source: The safe management of health care waste, RCN, 2007) [...]... waste management in UK 1.4) Why Medical Waste Management at NNUH: Justification The Norfolk Norwich University Hospital (NNUH) is a general acute hospital, which was opened to patients in November 2000 The hospital is built by Octagon Healthcare Limited, managed by NHS Trust staff and the nonclinical services are managed by Serco As a health care institution Norfolk and Norwich hospital produces a lot... microwave process utilizes the radiant energy to kill infectious agents by convering radiant energy to heat and pressure Shredding is usually combined with microwave 21 technology A combined on site Microwave - small scale incinerator technology is the most cost effective and environmental friendly treatment technology (Lee et al 2003) The disinfection efficiency of microwave can be a performance issue... here is that although this system helps in separating different types of waste, it doesn‘t actually reduce the amount of waste produced In fact it has created some confusion among the workers to put which waste in which bin Hence there is every chance that the waste ends up in a wrong bin especially when the bins are kept together In a study conducted by Saini et al(2005), they found that there is a significant... The argument her is that the waste management policy should target more on waste minimization Also, the perception of health care staff is highly critical towards waste minimization This study looks on the possibility of reducing carbon emissions by reducing the medical waste generated and also by avoiding the unnecessary transport of medical waste by building an onsite waste treatment plant Since one... questionnaire is a very important step especially in social science research Dilman (1983) points out that clear instructions and an attractive layout can improve the response rate whereas steps like making a questionnaire shorter than it really is - such as reducing margins and spaces – make it look cramped and thereby attractive The total appearance can be enhanced by using a variety of print styles like different... from the pilot were analysed and the questions were reviewed before sending out the questionnaires 3.4.6) Conducting the survey The questionnaire was distributed among the hospital staff: Doctors, nurses, paramedical staff and ancillary workers Survey was conducted in wards and staff restaurants in the evenings when most of the employees are less busy Analyzing the result Analysis of the questions was... which technology does him/she considers as the best way to treat medical waste The 7th question was to find out whether the people are willing to take part in a public meeting if any medical waste treatment plant is planned to be built in their nearby locality Sampling and the obtained results were analyzed before distributing the final questionnaires 3.5.2) Analysis of the result Analysis of the questions... the answers of the questionnaires by visualization and interpretation The results were tabulated in Microsoft Excel and were analyzed using graphs and tables Extra care was taken in the introductory note to make people understand that it is just a part of the academic study and there is no plan in reality, to build any waste treatment plants in the nearby locality For the same reason, the NNUH was... technology (WC4) the 1.25 Public Acceptance(WC5) 1.25 Training and operational requirements (WC6) 1 Occupational Health and safety 1 including needle stick prevention (WC7) Table.3.4: Criteria‘s for the selection of best treatment technology 3.6.4) Analysis of the results and selection of best technology The overall score for each alternative was found by multiplying the value score on each criterion by the... should be formulated such that it will help you to answer your research questions Comprehensible and relatively simple language should be used while you are interviewing people Do not ask leading questions The information you collect, be it a general data (like age, gender) or specific data (like position in company, numerical data), make sure that you ask or record ‗factsheet‘s these information . Sciences University of East Anglia University Plain Norwich NR4 7TJ September 2011 © 2011 Kevin Paul Pudussery This copy of the dissertation has been supplied on condition that anyone. ON THE MEDICAL WASTE MANAGEMENT AT THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL by KEVIN PAUL PUDUSSERY (4905822) Thesis presented in part-fulfilment of the degree of Master of Science