Về ô nhiễm rác thải y tế ở Việt Nam

Về ô nhiễm rác thải y tế ở Việt Nam

H a n o i O c t o b e r 2 0 1 0

Group assignment Solutions for medical wastes in Vietnam

Nguyen Thi Quynh Mai – 0851050049 Phạm Thanh Hải - 0851050064

Table of Contents

What is medical waste 2

Definition of medical wastes 2

Definition according to Wikipedia 2

Definition according to Ministry of Public Health of Vietnam 2

Classification of medical wastes 2

Situation of medical wastes in Vietnam 3

From solid wastes 3

To liquid wastes 4

Financial difficulties 5

Solution of medical wastes in Vietnam 6

Solutions for solid medical wastes 6

Solutions for liquid medical wastes 7

Solution for financial difficulties 8

Conclusion 8

Resources 9

Solutions for medical wastes in Vietnam

1 What is medical waste?

1.1 Definition of medical wastes

1.1.1 Definition according to Wikipedia

 Medical, known as clinical waste, normally refers to waste product that cannot be considered as general waste, produced from healthcare premises, such as hospital, clinics, doctors’ offices, labs and nursing homes

 Medical waste is solid and liquid waste created by diagnosing, treating or immunizing people or animals It can also be the product of the research and testing of biological products

1.1.2 Definition according to the Ministry of Public Health of Vietnam

 Medical wastes are material in form of solid, liquid or gases which are eliminated from healthcare premises Medical wastes include injurious medical wastes and common wastes

 Injurious medical wastes are medical wastes which contain factors that can harm man’s health and environment Those factors should be easy-infectious, radioactive, inflammable, etc

1.2 Classification of medical wastes

1.2.2 Infectious waste

Infectious wastes can cause harm to people or the environment, and this category includes items such as bandages, surgical gloves, surgical instruments, needles and microbial dishes, cultures and cloths

 Sharp waste

 Unsharp wastes

 Extremely infectious wastes

 Surgical wastes

1.2.1 Hazardous chemical wastes

 Expired medicine, low quality medicine

 Harmful chemical factor in healthcare

 Wastes harm cell

 Wastes contain heavy metal

1.2.2 Radioactive wastes 1.2.3 Vessel contains pressure 1.2.4 General wastes

 Life wastes

 Wastes from medical activities do not contain blood, biological juice, etc

 Wastes from administrative activities

 Surrounding wastes

2 Situation of medical wastes in Vietnam

2.2 From solid wastes…

According to the report of Ministry of public health, up to 2005, there were about 1047

hospitals with 140,000 sick-beds and 10,000 medical stations Out of 2.5 kg wastes

eliminated from each sick-bed per day, 10-15% is harmful wastes, which include dressing of

wounds, syringes, sharp matters, medicines, radioactive and parts of body removed after

surgeries

Also from the Ministry of public health, 2/3 of all hospitals have not applied safety waste

disposal methods Most wastes have not been classified and disinfected before discharging

Store houses are non-standard, unsanitary and highly infectious In some areas, medical

wastes are urgent matters because there have been no places for wastes to be gathered

even in provincial hospital level

Recent statistics show that in Thaibinh province, there were about 2,000 sick-beds which

eliminated 1,000-3500 kg wastes per day Out of them, 20% were harmful wastes Most

hospitals have used method of burring wastes in the precincts except hospitals which has

had manual incinerator In other hospitals, the manual incinerator is burned and leaves an

uncomfortable smell

According to the “Regulation of medical waste management” of the Ministry of Public Health,

medical waste must be treated immediately at once, contained in bag or barrel according to

color and standard In fact, in most hospitals, especially in private medical stations, they do

not follow the regulations There have been many sanitation workers dumping waste bags to

roadsides

In particular, Hanoi has thousands of medical stations, making up about 2% of total wastes

Only 60 hospitals and medical centers have signed up for waste treatment contract with

Hard Medical Waste Enterprise with the amount of 1.5 tons per day The rest of these

wastes, for some reasons, are still mixed with household waste and increased rapidly More

than 310 private medical stations have not taken responsibility for their wastes or followed

the regulations They quibble that the amount of waste eliminated was too low or they did

not know where to dispose it

One of the most dangerous problems is that tons of medicine covers, plastic infusion tubes,

cylinder, etc instead of being processed from many hospitals in Hanoi, especially Viet-Duc

hospital, have been sold to scrap purchasers On the 10th of August, when inspecting a truck

which was going to the scrap purchased place in Hanoi, the Department of Natural

Resources and Environment protection detected 60 bags of medical wastes which weighed

about 700 kg These bags contained medicine covers, plastic infusion tubes and cylinders

This truck started from Viet-Duc hospital At the same time, they also detected a truck which

contained 16 bags of medical wastes (300 kg) running from Viet-Duc hospital to Hoan Kiem

district The truck drivers declared that they bought wastes from Viet-Duc hospital at the

price of 6,000 VND per kilogram for plastic, 1,500 VND per kilogram for small glass bottle

From 2002 to 2007, there were about 300 tons of medical wastes sold from Vietduc hospital

to scrap purchasers and all of them were sold to manufacture appliances

2.3 To liquid wastes

Liquid wastes should be ranked the first in term of toxicitybecause of huge amount of germs

and bacteria Most hospitals have only focused on processing hard waste by incinerator

systems Liquid wastes of hospitals include liquid wastes originating from the operation

activities of the patients, liquid wastes from laboratories, water closets, etc Besides the

common factors such as organic substance or bacterium, liquid wastes contain dirty mineral

substances, disinfectants and radioactiveness Liquid wastes spread very fast because of

bacteria, especially liquid wastes from infectious hospitals

For liquid wastes, all they have done is collecting them It is very dangerous that out of the

total liquid wastes, 20% are harmful wastes If cancer treatment medicines or their metabolic

products are eliminated without being treated, they will cause monstrosity or expose cancer

to people According to the Medical Institute of Labor and Environment Sanitation, the level

of pollution of liquid wastes in hospitals was 20,000 times more than standard According to

the report of the Ministry of Public Health, out of all hospitals, only 1/3 has liquid wastes

treatment system Most small hospitals do not have specialized units operating liquid wastes

treatment plant Liquid waste systems are not effective because hospitals are lacking of

money or systems are below-standard

In Ho Chi Minh city, there have been about 130 hospitals, medical stations which eliminate

17,000m3 of liquid wastes per day Out of them, 43 hospitals have

below-standard-processing systems and 39 hospitals do not have below-standard-processing systems Besides, there have

been thousands of private medical stations whose treatments are out of control of

supervisory

2.4 Financial difficulties

Up to April 2003, 61 hospitals in Vietnam (7%) had incinerators Most incinerators were very

expensive They operated erratically and inefficiently Incinerators ran only 1-2 times per

week because of high cost operation Some hospitals had Korean incinerators but they

rarely used them as they did not have treatment system Some Vietnamese factories tried

manufacturing incinerators but either they could not apply in reality or incinerators were

inefficient The abatement cost of treating one kilogram of solid medical waste is 8,000vnd

on average and that of for liquid wastes is about 5,000VND/m3, which is too high for the

financial condition of our hospitals Meanwhile, for each kilogram of selling medical wastes

to the private recyclers, the seller receives about 6,000vnd The opportunity cost of treating

one kilogram of medical waste is up to 14,000vn For that reason, hardly anyone wants to

tradeoff between a better environment with high cost and a much higher profit

3 Solution of medical wastes in Vietnam

The government should promote the programme of managing the treatment of medical

wastes by allocating more and more supervisors for the 4 processes of containment,

collecting, transporting and treating in wastes centres

Firstly, in the process of waste classification in hospitals, there should be more strict

regulations and supervisions It is shown that out of 400 tons of medical wastes, there are

50 tons that are dangerous and non-recyclable This means that about 87% of medical

wastes can be recycled without harming the community’s health Moreover, the initial

plastics for producing medical equipment are pure and high quality ones such as

macromolecular compounds, therefore, these wastes can be recycled efficiently If

classification steps are managed properly, the abatement cost for treating wastes will

reduce significantly This will alleviate the problem of high abatement cost in almost every

hospital in our country The government can control these by setting the regulations for

classification of medical wastes, such as “medical waste should be required to be stored in

airtight containers placed in cool, dark places such as refrigerators The lid on the containers

should be leak-proof and unable to be punctured, and the container should be labeled

appropriately and indicated to be a biohazard material” etc In addition to that, there should

be one department in each hospital responsible for managing the waste classification

instead of relying on “Urban Environment” companies This makes them more committed to

the quality of these tasks

Secondly, in the process of transporting wastes, the pickups should be supervised to ensure

whether the total weight of wastes is constant before and after being carried out of the

hospital or not In addition, there should be reports delivered from the hospital to the

waste-treating companies for the sake of transparency

Thirdly, for the treatment process of recyclable and non-recyclable medical wastes,

supervision should also be enhanced For non-recyclable wastes, The Ministry of Public

Health, together with Ministry of Science, Technology and Environment, Ministry of Planning

and Investment, have invested the matter in various hospitals and submitted the project of

constructing “the centre of waste treatment” for hospitals in Vietnam, especially in cities

Therefore, dangerous and contaminated medical wastes can be collected for treatment in

one centre This would reduce the problems of illegally selling the wastes out Incinerators,

equipment and many devices will be upgraded or replaced By that way, these centres will

contribute to separating the normal wastes from medical wastes and treat them in special

ways For recyclable wastes, the government should ban enterprises from producing

housewares, personal belongings and medical supplies Those who produce allowed

products should be force to either upgrade technology or exit from the recycling and

producing process The government can control these by issuing the permit, which is

handed out to enterprises only when they meet the standard criteria By that way, only

qualified enterprises have the rights to produce and sell medical-waste-recycling-products

The community awareness of the danger of medical wastes should be raised through

various ways, ranging from propaganda, education and dissemination of information Having

acknowledged the jeopardy of medical wastes, everyone, especially the medical staffs, who

sold out the wastes illegally, and the collectors of these wastes, will gradually manage their

actions

The one who violates the regulations should be severely penalized, especially by financial

fines The fines would be equal or more than the profit from wastes’ sales or waste disposal

This will serve to prevent potential commitments and contribute to the budget for medical

waste treatment

3.2 Solutions for medical liquid wastes

Liquid medical wastes can be treated much more easily by using one of the latest

technologies – Biofast – a kind of machine for filtering liquid wastes Biofast are outstanding

because of its effectiveness and efficiency

Biofast operates automatically; therefore, it reduces the man-made mistakes during the

operation Secondly, it uses ozone diffusing devices, which save time by 10-fold in

comparison with the non-ozone diffusers Moreover, Biofast can entirely deodorize and

remove poisonous gases The computerized automations in observing, management and

operation will reduce the possibility of occupational accidents and promote the transparency

and effectiveness of the whole system

As Biofast uses solar energy for its operations, it reduces the expenses of energy Biofast

uses automatic ozone creators, which saves the labour from mixing components Therefore,

it reduces the operating costs and saves the operating areas by 70% Moreover, as Biofast

are domestic productions, its price is much more reasonable for domestic demands

3.3 Solutions for financial difficulties

A large national budget should be spent for hospitals in Vietnam for the procurement of

modern solid waste incinerators, replacing the old and inefficient ones used at the moment

At first, the expenses could be rather expensive but it will be weighed up by the abatement

cost saved and the sustainability of living environment

The fund for these projects should be partly extracted from National budget and partly raised

from the environment taxes levied on the patients or using hospital services In addition, the

hospitals themselves have to extract about 1% of their revenue for investment in

waste-treatment-systems

Research and Development projects should also be invested in to find out the best

technologies for reducing abatement cost and increasing the effect and efficiency of medical

waste treatments

4 Conclusion

Medical waste disposals are becoming more and more of a hotly debated issue in our

country nowadays because of its hazardousness and complexity The government should

promote community awareness, support financial difficulties and use various methods and

criteria for treating both solid and liquid medical wastes in order to alleviate the problems of

medical wastes disposal

5 Resources

http://community.h2vn.com/index.php?topic=2983.0

http://www.ykhoanet.com/thoisu/chatthaibenhvien/nuochaibenhvien.htm

http://tuoitre.vn/Chinh-tri-Xa-hoi/283183/Nuoc-thai-y-te-Bai-1 -Nhung-%E2%80%9Cdai-ly%E2%80%9D-phan-phoi-vi-trung.html

http://en.wikipedia.org/wiki/Medical_waste

QD43-2007-BYT: http://www.mediafire.com/?pbgmvaoed3giorj