Assessment of medical waste management and treatment status in thai nguyen hospital of traditional medicine

THAI NGUYEN UNIVERSITY THAI NGUYEN UNIVERSITY OF AGRICULTURE AND FORESTRY NGUYEN THI NGOC THUY TOPIC TITLE: “ASSESSMENT OF MEDICAL WASTE MANAGEMENT AND TREATMENT STATUS IN THAI NGUYEN HOSPITAL OF TRADITIONAL MEDICINE” BACHELOR THESIS Study Mode : Full- time Major : Bachelor in Environmental Science and Management Faculty : International Training and Development Centre Batch : K43- Advance Education Program Thai Nguyen, October 2015 DOCUMENTATION PAGE WITH ABSTRACT Thai Nguyen University of Agriculture and Forestry Degree Program Bachelor of Environmental Science and Management Student name Nguyen Thi Ngoc Thuy Student ID DTN1153040143 Thesis Title Assessment of medical waste management and treatment status in Thai Nguyen Hospital of Traditional Medicine Supervisor PhD Ho Ngoc Son Abstract: The purpose of this study is the assessment of medical waste management and treatment status in Thai Nguyen Hospital of Traditional Medicine The main focus is in aspects: the current status of medical waste in Thai Nguyen Hospital of Traditional Medicine, interviewing staff and patients and evaluate how they can understand all in medical waste management and the solutions to manage domestic waste in study area Conclusion, this hospital is becoming more and more complete day by day thanks to the management and the assistance of hospital authorities as well as the relevant agencies Keys Words Medical waste, hazardous waste, treatment, solution Number of Pages 45 Date of 30/9/2015 Submission: Supervisor’s signature ii ACKNOWLEDGMENT I would like to express my gratitude to my supervisor, Dr Ho Ngoc Son for his invaluable useful comments, remarks, encouragement and engagement through the learning process of this graduated thesis I sincerely thank Mr Duong Van Hung who helps me a lot when I work as trainee in Centre for Observation and Environmental Technology Thai Nguyen I also thank the support of Thai Nguyen University of Agriculture and Forestry, the coordinators and program managers for their support and assistance I am using this opportunity to express my gratitude to my classmates, who supported me throughout this course, by their aspiring guidance, invaluably constructive criticism and friendly advice I am sincerely grateful to them for sharing their truthful and illuminating views on a number of issues related to my thesis Also, I like to thank the participants in my survey, who have willingly shared their precious time during the process of interviewing I would like to thank my loved ones, who have supported me throughout entire process, both by keeping me harmonious and helping me putting pieces together Thank you all very much! Sincerely yours, iii TABLE OF CONTENT LIST OF TABLES PART I INTRODUCTION 1.1 Research rationale 1.2 Research’s objective 1.3 Research questions and hypotheses .3 1.4 Limitations .4 1.5 Definitions PART II LITERATURE REVIEW 2.1 Generation sources and medical waste classification 2.1.1 Clinical waste 2.1.2 Radioactive waste 2.1.3 Chemical waste 2.1.4 Tank pressure 2.1.5 Domestic waste 2.2 The origin arising, composition and properties of medical waste 2.2.1 Origins arising 2.2.2 Composition of hospital wastewater 2.3 Influence of medical waste on the environment and public health .11 2.3.1 Harmful effects, the risk of medical waste on the environment and public health .11 2.3.2 Influence of medical waste in Viet Nam .12 iv 2.4 Situation collection and processing of medical waste in the world and Vietnam 14 2.4.1 Status of collection of medical waste in the World .14 2.4.2 Current situation and management of medical waste treatment in Vietnam 15 2.5 Current situation and management of medical waste treatment in Thai Nguyen 20 2.5.1 Forms solid waste collected at the health facility 21 2.5.2 The status of the equipment collected, transported medical waste 22 2.6 Medical waste treatment methods 23 2.6.1 Furnace technology .23 2.6.2 Technology Oven 23 2.6.3 Chemical sterilization 24 2.6.4 Dealing with microwave technology 24 2.6.5 Handling of biotechnology 24 2.6.6 Treated with radioactive substances 25 PART III METHODS 26 3.1 Subject .26 3.2 Research design 26 3.3 Research contents 26 3.4 Research methods .26 3.4.1 Secondary data collection methods 26 3.4.2 Questionnaire and Interview methods 27 3.4.3 Analyzing, synthesizing and assessing data methods 27 v PART IV: RESULT 28 4.1 The current status of medical waste in Thai Nguyen Hospital of traditional medicine 28 4.1.1 Origins incurred hospital waste .28 4.1.2 Status of collection, classification, storage, transportation and disposal of solid waste in hospital 29 4.2 Understanding of staff, patients on the medical waste management of hospital 29 4.2.1 For hospital staff 30 4.2.2 For patients and patients' family 31 4.3 Proposed solutions for the collection, handling medical waste in Traditional Medicine Hospital Thai Nguyen 32 4.3.1 Solutions for Environmental Management 32 4.3.2 Solutions to improve the sorting, collection, transport 34 PART V DISCUSSION AND CONCLUSION 35 5.1 Discussion .35 5.2 Conclusion 36 REFERENCES 37 APPENDICES vi LIST OF TABLES Table 2.1 Classification of medical waste Table 2.2 Composition of hospital wastewater Table 2.3 The bacteria isolated in hospital wastewater 10 Table 2.4 Sanitary norms in hospital wastewater before and after treatment with biological methods 11 Table 2.5 The volume of medical waste in hospitals hazards of some provinces 16 Table 2.6 The amount of waste generated at the hospital department 17 Table 2.7 Composition of solid waste from hospitals 17 Table 4.1 Understanding the regulation medical waste management 30 Table 4.2 Understanding the color code utensils 30 Table 4.3 Understanding the management of hospital waste 32 PART I INTRODUCTION 1.1 Research rationale The most vital mission of Health Ministry is supervision, protection and health development for people Today, to meet a demand of the increase of medical examination and health care, the system of medical facilities more and more strengthen, extend and become be perfect However, during operation, health systems, especially hospitals, discharged a huge amount of endanger waste According to WHO, components of hospital waste have about 10% septic waste, 5% toxic waste such as radioactive substances, cytotoxic substances, harmful chemicals generated during the diagnosis and treatment disease, these factors are caused environmental pollution, spread germs from hospitals to surroundings It leads to increases the risk of nosocomial infection and the illness rate of communities living in adjacent areas Vietnam's population is increasing, and economic development, that led to the need and treatment increases, the number of patients increased too According to statistics of Health Ministry, there are about 1050 hospitals, more than 10 thousand commune health stations apart from Research Institute, Preventive Medicine Centre, and the pharmaceutical manufacturing facilities Since 1997, the text of hospital waste management are issued, but most of the hospital waste is not managed in accordance with a closely regulation Environmental pollutions are caused by the activities that the actual health status is less effective treatment of hospital waste These facilities emitted huge amount of garbage, solid waste is more than 400 tons per year (Health Ministry, 2007) However, only 1/3 amount of waste is burned with modern electric oven, 2/3 of them is burned outdoor, by craft ovens, buried in the grounds of the hospital or exhausted in general landfill It is a culprit of the pollution of environment In addition, the interaction with medical waste can cause sickness or injury The medical waste may contain infectious elements, which are toxic substances contained in medical waste, chemicals and pharmaceuticals dangerous, radioactive waste and sharps All employees who exposed to hazardous medical waste can put their health at risk, include those who work in the health facilities, work in medical waste collection and those in communities exposed to waste due to errors in the waste management process Starting from the actual situation and requirements of the collection and processing of medical waste in hospitals, the research topic: “Assessment of Medical Waste Management and Treatment status in Thai Nguyen Hospital of Traditional Medicine - Thai Nguyen city” was conducted in Thai Nguyen city 1.2 Research’s objective - Study the status of the collection and disposal of medical waste in Thai Nguyen Hospital of Traditional Medicine - Propose solutions to manage and treat medical waste in Thai Nguyen Hospital of Traditional Medicine 1.3 Research questions and hypotheses - What is the status of medical waste in Thai Nguyen Hospital of Traditional Medicine? - Evaluation of understanding of staff’s hospital, patients on the medical waste management of the hospital - What are solutions to manage domestic waste in study area? 1.4 Limitations The study cannot include all the management issues and treatment of medical waste in Thai Nguyen Hospital of Traditional Medicine Because of the short time studies, the thesis was restricted by many factors in the survey and investigated process about the garbage in the study area 1.5 Definitions Medical waste is material in solid, liquid and gas, which discharged from the medical facility including hazardous medical waste and common waste Hazardous medical waste is medical waste containing hazardous for human health and the environment as infectious, poisonous, radioactive, flammable, explosive, corrosive or properties other hazardous waste if it is not safe destruction Management of hazardous waste is activities related to the prevention, mitigation, delineation, classification, direct reuse, temporary storage, transportation and disposal of hazardous waste Management of medical waste management activities is sorting, initial processing, collection, transportation, storage, reduction, reuse, recycling, treatment and disposal of medical waste and inspects and supervises the implementation Regardless of training, retraining, coaching staff, management staff responsible for medical waste protects the environment in the hospital Organizing propaganda and education raise awareness of patients and patients' relatives on the classification of medical waste, hazardous nature of it with human health We should coordinate with Natural Resources and Environment in the planning, allocation and use of funds for environmental activities; inspecting and examining the medical waste management, environmental protection in hospital Improving accountability medical waste management of the head of the medical establishment: - Responsible for managing medical waste generated from the last to the process of destruction - Repair the transportation, handling and disposal of medical wastes, may contract with organizations and individuals who have done legal status - Planning the management of medical waste and construction investment projects and upgrading infrastructure for medical waste management of the unit - Buy and provided with adequate means of dedicated, qualified for the sorting, collection, transport and waste disposal; in collaboration with environmental authorities, the facility's waste disposal for handling local and disposal of medical wastes according to regulations - Implement measures to reduce the amount of medical waste must be destroyed through mitigation activities, collection, recycling and reuse after handling regulations 33 4.3.2 Solutions to improve the sorting, collection, transport We need sorting waste at source for classifying an important stage in the process of hospital waste management There are categorized in accordance with new regulations, storage, transportation, and treatment in order to ensure hygiene requirements For the classification of medical waste effectively to reinforce the consolidation of departments, infection control structure commensurate with the number of beds and build specific content for active infection control Besides, procurement of equipment, supplies, packaging, basic chemicals implement processes and instruments, sorting garbage Especially should organize training and retraining of staff working in infection control at the base Need to urgently set up projects for new construction, renovation and upgrading of the system of medical waste treatment in hospital solid It should strengthen the direction and guidance, regularly monitor and supervise the implementation of regulations on classification and management of medical waste, protect the environment in the hospital Considering the allocation and use of funds for medical waste treatment in hospitals, ensure adequate and appropriate balance to the reality in the hospital Call for investment, support for the management of hospital waste because medical waste is classified as hazardous special waste, should be the concern of the health sector in particular and society in general 34 PART V DISCUSSION AND CONCLUSION 5.1 Discussion Through research result, it can be discussed the specified contents as following: Firstly, the operation and implementation status of environmental protection in the hospital is relatively good Besides, some staff and patients were still neglected and not strictly controlled Doctors should instruct patients and their family members on the classification of waste so that they can perform Need to strengthen further the guidelines for patients and their family members right away garbage bins specified colour Secondly, the survey results showed that hospital staffs were also informed and strictly implement the provisions of collecting, sorting of hospital rubbish 84.6% of employees have knowledge of regulation of medical waste management Understanding the management of hospital waste is 100% employee However, patients and patients' family lack of understanding of the work of sorting garbage, only 9.5% distinguish the colour of garbage instruments, 14.3% of people known to Regulation No 43 of the Health Ministry, 100% aware of the impact of hospital waste on the environment Finally, hospitals should invest more in facilities for the collection, disposal to ensure sanitation for the hospital as the need to purchase bins and garbage bags in black and white, container sharp waste standards of the Ministry of Health, putting bins with different colour codes as defined in the departments of hospital and hospital campus in the future, replace the instrument was timely damaged and required warning labels on hazardous waste collection tools, storage 35 5.2 Conclusion This study shows that hospital’s staff under Decision No 43/2007 managed the amount of this waste / QD-BYT of the Ministry of Health, however, has not been fully The hospital has a staff of daily garbage collection in each department, waste separation at source However, the collection, sorting garbage implemented only in 03 categories: yellow clinical waste container, green waste containers usual, sharp wastes contained in leak-proof bins to secure throughout the collection and transportation; missing crate, bag black and white Containers and waste bags are not met regulatory standards Sometimes wastes also contain provisions wrong colour The hospital also has a waste storage prior to treatment; this building is a separate area away from the doctor and the hospital's dining area, fenced and locked security door The infectious waste is kept cold in insulated oven before removal process But time is too long to store full of new garbage removal 36 REFERENCES Dao, N.P., Nguyen, T.T., and Do, V.H (1998) “Research on environmental pollution and possible transmission of waste water from hospitals in Hanoi.” Proceedings of Workshop Manager hospital waste, Hanoi, pp 18-34 Nguyen, H.N (2014) “Medical waste management is inadequate” Retrieved from: http://anninhthudo.vn/moi-truong/bao-dong-sai-pham-trong-quan-ly-chat-thai-yte/555999.antd (assessed from 19/6/2014) Nguyen, T.K.T (2011) "Managing waste from hospitals in Vietnam situation and future orientation" Retrieved from:http://vea.gov.vn/vn/truyenthong/tapchimt/nctd420 09/Pages/Quản-lý-chất-thải-từ-các-bệnh-viện-ở-việt-nam-thực-trạng-và-định-hướngtương-lai.aspx (assessed on 21/1/2012) Phung, T.T.T (2009) “Situation Analysis of hospital waste in the Central provinces Vietnam ’’ Thai Nguyen Department of Natural Resources and Environment (2010) "Environmental Status Report of Thai Nguyen province in the period 2005- 2010" The Ministry of Health (2007) Regulation of medical waste management Tran, T.M.T (2006) “A survey of medical waste management in some hospitals outside Hanoi.” Medical doctoral thesis Ha Noi Medical University Viet Nam Ministry of Health (2009) - Planning the management of medical waste The Ministry of Health (2009) "Environmental protection plan health sector 20092015" Decision No 1783 / QD-BYT dated 28/05/2009 37 The Ministry of Health, Department of Rehabilitation, care management statement medical mission in 2011 Hoang, T.L (2009) "Research reality some elements related to the management of medical waste at the Thai Nguyen central hospital " PhD Thesis, University of Medicine and Pharmacy Thai Nguyen The Ministry of Health (2002) Regulations on management of medical waste Medical Publishing House Hanoi The Ministry of Health (2000) Practical Handbook of medical waste management Medical Publishing House, Hanoi 38 APPENDICES APPENDIX I: SAMPLE SURVEY QUESTIONNAIRE ASSESSMENT OF MEDICAL WASTE MANAGEMENT AND TREATMENT STATUS IN THAI NGUYEN HOSPITAL OF TRADITIONAL MEDICINE This survey questionnaire is part of real study of students in K43 -Environmental Science Management (Advanced Education Program) - Thai Nguyen University of Agriculture and Forestry Information that you provide will help students collect data and information for research: "Assessment of medical waste management and treatment status in Thai Nguyen Hospital of Traditional Medicine” With permission and supervision of Centre for Observation and Environmental Technology Thai Nguyen and Thai Nguyen University of Agriculture and Forestry, I guarantee that the information done by students will not cause any effects to you We appreciate your enthusiasm in providing information in high accuracy during this survey Sincerely yours! Interviewer: Nguyen Thi Ngoc Thuy Class: K43 - Environmental Science and Management (Advanced Education Programs)-Thai Nguyen University of Agriculture and Forestry APPENDIX NO.1 INTERVIEW STOCK WORKERS HEALTH STATUS OF WASTE MANAGEMENT HEALTH HOSPITALS (Based on your understanding of the management of medical waste in hospitals, you please answer the question and fill in the blanks X) PART I: GENERAL INFORMATION - Full name of person being interviewed: - Gender: Ethnicity: - Educational level: - Job:………………………………………………………………… - Science: PART II: STATUS OF MEDICAL WASTE MANAGEMENT OF HOSPITAL You have been guiding the regulation of medical waste management by the Ministry of Health does not? Yes ☐; No ☐ - If you are guided, guided by whom? ☐ Hospital ☐ Urban Environmental Company ☐ Health Department ☐Other Which regulation of medical waste management is applied is the regulation was enacted in text: ☐ Decision No 2575/1999 / QD-BYT dated 08/27/1999 of the Minister of Health promulgating regulations on medical waste management ☐ Decision No 43/2007 / QD-BYT dated 30/11/2007 of the Minister of Health promulgating regulations on medical waste management; ☐ Unknown How many regulations of medical waste management regulations currently applied medical waste including those groups? ☐ groups ☐ groups ☐ groups ☐ groups ☐ groups ☐ Unknown These are the groups of waste following groups? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Do you know the colour code specified packaging for solid waste containers Medical? Yes ☐; No ☐ - If you know the answer to the following questions: Which packaging tools (bags, bins, boxes) with code yellow waste containers? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Which packing tools (bags, bins, and boxes) have black code does contain waste? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Which packaging tools (bags, bins, boxes) with color-coded green waste containers? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Which packing tools (bags, bins, boxes) white colour coded waste containers? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐ Sharp Waste ☐Unknown 10 On injection vehicles, vehicles equipped with pocket tips, barrel infectious waste collection, sharp, fully recycle it: ☐ Lack ☐ Enough ☐ No 11 Can you practice sorting medical waste in accordance with regulations? Yes ☐; no ☐ 12 Do you guide the patient about the colour codes of garbage not appliances? Yes ☐; no ☐ 13 Does medical waste have harmful adverse effects on human health and the environment? Yes ☐; no ☐ unknown ☐ 14 Does medical waste causing harm to the environment and health of people exposed? ☐ Spreading disease ☐ Generating insect vectors ☐Carcinogenesis ☐ Affect psychology, environment ☐ Causes sharps injuries ☐ Unknown ☐ Other 15 Does the hospital have the focus, not the waste storage? Yes ☐; no ☐ 16 Does medical waste and hazardous waste can usually be kept in separate compartments? Yes ☐; no ☐ 17 Does the hospital have a contract transport, waste treatment with the base, the unit? Yes ☐; no ☐ - Unit contract collection, transportation - Contract processing unit Sincerely thank! APPENDIX NO.2 INTERVIEW FORM PATIENTS AND PATIENTS’s FAMILY (Based on your understanding of the management of medical waste in hospitals, you please answer the question and fill in the blanks X) PART I: GENERAL INFORMATION - Full name of person being interviewed: - Gender: Ethnicity: - Educational level:…………………………………………………………… - Job:………………………………………………………………… - Address:……………………………………………………………………… PART II: STATUS OF MEDICAL WASTE MANAGEMENT OF HOSPITAL You have been guiding clinical hygiene rules when in hospital? Yes ☐; no ☐ Do you know to waste management regulations issued by the Ministry of Health? Yes ☐; no ☐ Have you been guided on colour coded on the packaging of the instruments (bags, bins, boxes) containing medical waste? Yes ☐; no ☐ At the department, which kinds of colours have in bags, bins? ☐ Blue ☐ Black ☐White ☐Yellow Which packaging tools (bags, bins, boxes) with code yellow waste containers? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Which packing tools (bags, bins, and boxes) have black code does contain waste? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Which packaging tools (bags, bins, boxes) with color-coded green waste containers?☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐ Sharp Waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐Unknown Which packing tools (bags, bins, boxes) white colour coded waste containers? ☐ Clinical waste ☐Recycling waste ☐Hazardous chemical waste ☐Domestic waste ☐Pressure cylinders ☐Radioactive waste ☐ Sharp Waste ☐Unknown Does your patient’s cab get regular garbage collection every day? Yes ☐; no ☐ 10 Every day in the hospital, have you put the garbage at the prescribed places? Yes ☐; no ☐ 11 In your opinion, does hospital waste adversely affects the health? Yes ☐; no ☐ 12 In the department, has it posted notices guide clinical hygiene rules not? Yes ☐; no ☐ Sincerely thank! [...]... medical waste - Location and conducting-time + Location of the research: Thai Nguyen hospital of traditional medicine + Conducting-time: From 10 March to 29 June 2015 3.3 Research contents - The status classification, collection, storage, transportation and disposal of medical waste in Thai Nguyen hospital of traditional medicine - Knowledge of hospital staff, patients on the issue of medical waste management. .. the hospital staff collecting themselves for sale to recycling facilities + For medical solid waste hazardous: 03 hospital incinerators are equipped to handle in place as hospital C, Tuberculosis and Lung Diseases Hospital, Hospital of Steel The remaining hospitals are leased Joint Stock Company of Environment and Public Works Thai Nguyen Urban transport and disposal of medical waste incinerators in. .. Analyzing, synthesizing and assessing data methods The data and documents collected will be aggregated, using Word and Excel software for statistical and data processing From there to see the current situation to make the assessment and conclusions on the management of medical waste by hospitals 27 PART IV: RESULT 4.1 The current status of medical waste in Thai Nguyen Hospital of traditional medicine. .. waste management of the hospital - Solutions to improve the management of medical waste in Thai Nguyen hospital of traditional medicine 3.4 Research methods 3.4.1 Secondary data collection methods Secondary data are collected through official documents of Thai Nguyen city People’s Committee, Tan Thinh Ward People’s Committee, management board of Thai Nguyen hospital of traditional medicine, etc on natural,... protect those who are constantly exposed to medical waste, the health sector must invest more interested working again for Medical waste treatment 13 2.4 Situation collection and processing of medical waste in the world and Vietnam 2.4.1 Status of collection of medical waste in the World The volume of medical waste generated varies by geographical area, seasonally and depends on objective factors such as... illness, number of beds, methods and practices used by medical personnel in work and treatment, patient care and the patient's waste in the wards Following the recommendations of the WHO (1992) in the developing countries may classify medical waste into the following categories: non-toxic substances (including municipal waste is not contaminated wastes risk factors), sharp waste (infectious or non-infectious)... solid waste in hospitals is not processed before landfilling or incineration A few hospitals have medical incinerators, but too old or open-pit burning environmental pollutants * Classification of medical waste: Most of the hospital which sort waste at the source do not only the classification of partial but also ineffective because staff have not been trained * Medical Waste collection: As a rule, medical. .. made in 04 categories waste classification prescribed by the Ministry of Health and the private collection of the Ministry of Health Also Pho Yen General Hospital has been equipped for hazardous waste incinerators, 08 units remaining district Solid Waste handling hazardous onsite hospital incineration method manually or burial/[3] 2.5.2 The status of the equipment collected, transported medical waste. .. collected, transported medical waste Provincial hospitals: 05/12 hospital waste collection vehicles are Hospital A, Hospital C, Central Hospital of Thai Nguyen, Psychiatric Hospital, Traditional Medicine Hospital The rest are no garbage trucks The hospital has implemented solid waste sorting activities and actively invest in individual storage devices such as container waste, different colour plastic bags,... Collect medical waste (yellow Joint Stock Company of bags) The Normal waste Preservation garbage Collect Transport environment and urban management (green bags) Handlin g Figure 4.1: Diagram of the general management of hospital waste From Figure 4.1 we can see that medical waste is divided into 2 types of hazardous wastes and normal wastes Hazardous waste is collected in yellow bags while waste is ... management and treatment status in Thai Nguyen Hospital of Traditional Medicine The main focus is in aspects: the current status of medical waste in Thai Nguyen Hospital of Traditional Medicine, ... of medical waste in Thai Nguyen Hospital of Traditional Medicine - Propose solutions to manage and treat medical waste in Thai Nguyen Hospital of Traditional Medicine 1.3 Research questions and. .. What is the status of medical waste in Thai Nguyen Hospital of Traditional Medicine? - Evaluation of understanding of staff’s hospital, patients on the medical waste management of the hospital -