To describe the situation of generation and management of medical solid waste at some hospitals in Vietnam from 2015 to 2016. Methods: Retrospective studies had analyzed over 92 hospitals.
Journal of military pharmaco-medicine no9-2019 SITUATION OF GENERATION AND MANAGEMENT OF MEDICAL SOLID WASTE AT SOME CENTRAL AND PROVINCIAL HOSPITAL IN 2015 - 2016 Dam Thuong Thuong1; Nguyen Thanh Ha2; Tran Van Tuan3 SUMMARY Objectives: To describe the situation of generation and management of medical solid waste at some hospitals in Vietnam from 2015 to 2016 Methods: Retrospective studies had analyzed over 92 hospitals Results: Average amount of medical waste was 1.769 ± 1.022 kg/bed/day, of which amount of ordinary waste was 1.53 ± 0.83 kg/bed/day (86.49%), amount of infectious waste was 0.224 ± 0.15 kg/bed/day (12.66%), amount of non-infectious hazardous waste was 0.015 ± 0.042 kg/bed/day (0.85%) There was no average difference in the rate of hazardous solid waste generation by hospital levels with p > 0.05 Central hospitals were better than provincial hospitals in compliance with the law on environment as well as environmental monitoring work 100% of central hospitals and 96.6% of provincial hospitals had registered for EIA approval or environmental protection projects, however the rate of implementation of environmental monitoring in content and frequency in accordance with the regulations was only 88.2% for central hospitals and 65.5% for provincial hospitals Conclusion: There was an average difference in the rate of medical waste generation among hospital levels Implementing the management of medical waste at the central hospital was better than the provincial hospital The central and provincial hospitals need to strengthen the training for health workers and staff on the management of medical solid waste, and also on implementation of the environmental monitoring with full parameters in EIA reports or environmental protection schemes * Keywords: Medical waste; Medical waste management; Infectious waste INTRODUCTION Medical wastes are the ones generated during the operation of medical facilities, including hazardous medical wastes, ordinary medical wastes and medical wastewater [1] Medical wastes are classified into infectious medical wastes, non-infectious hazardous medical wastes and ordinary medical wastes Medical waste that is not handled well will create health risks for medical workers, public health and impacts on soil, water and air [2, 3] Each year, about 5.2 million people die of waste-related illness worldwide [4] Other environmental impacts that can also be found from poor management of medical waste are the problem of odor pollution, the generation of flies, cockroaches, insects, rodents and more dangerous than the pollution of groundwater and the development of natural species due to improper disposal of medical waste [5] National Institute of Occupational and Environmental Health Health Enviroment Management Agency Vietnam Military Medical University Corresponding author: Dam Thuong Thuong (damthuongthuong.nioeh@gmail.com) Date received: 11/10/2019 Date accepted: 26/11/2019 202 Journal of military pharmaco-medicine no9-2019 Environmental monitoring is an important tool to determine the amount of medical waste generation, thereby finding solutions on organization and management of medical waste medical solid waste generated per hospital bed in 2015 - 2016 At present, the investment in facilities and equipment for medical waste treatment is inadequate and unsuitable due to lack of funding, the monitoring system is lacking and qualified manpower is insufficient Some general and specialized hospitals at the central and provincial hospitals The amount of medical solid waste generated per hospital bed is the standard basis for planning investment, construction, procurement of facilities, equipment, consumable materials and human resources in management and treatment of medical solid waste Therefore, we conduct research with the aim: Collecting and assessing the composition, quantity and management of SUBJECTS AND METHODS Subjects Methods * Study design: A retrospective study that analyzed and retrospected medical monitoring data of 92 central and provincial hospitals in 2015 - 2016 * Sample size: Selecting all 92 central and provincial hospitals to carry out health environment monitoring by Institutes of Occupational Health and Environment, Nha Trang Pasteur Institute, Tay Nguyen Institute of Hygiene and Epidemiology and Institute of Public Health in Hochiminh City Table 1: Number of studied hospitals Central hospital Provincial hospital Criteria Total Speciality General Speciality General Hospitals with less than 300 beds No 4 17 % 18.18 0.00 80.00 16.98 18.48 Hospitals with 300 beds and further No 18 12 44 75 % 81.82 100.00 20.00 83.02 81.52 No 22 12 53 92 % 100.00 100.00 100.00 100.00 100.00 Total * Data collection method: Retrospective which used a summary sheet to collect data from the Health Environmental Management Agency's report on the health environment monitoring results of 92 central and provincial hospitals in 2015 - 2016 which conducted by four research institutes 203 Journal of military pharmaco-medicine no9-2019 RESULTS AND DISCUSSIONS Situation of generation provincial hospitals of medical solid waste at central and Table 2: Situation of amount of medical solid waste generated by kg/bed/day Type of medical solid waste (n = 92) Mean Standard deviation (SD) Min Max Ordinary solid waste 1.53 0.83 0.43 4.64 Infectious solid waste 0.224 0.15 0.01 1.12 Non-infectious hazardous solid waste 0.015 0.042 0.0 0.38 1.769 1.022 0.44 6.14 Total The total amount of medical solid waste of 92 hospitals was an average of 1.769 kg/bed/day, of which the highest proportion was ordinary medical solid waste with an average of 1.53 kg/bed/day, average infectious medical solid waste was of 0.224 kg/bed/day, the amount of non-infectious hazardous solid waste was of 0.015 kg/bed/day The average amount of medical waste generated in our study was lower than that in Pakistan with 2.07kg/bed/day (range from 1.28 - 3.47) [3] Our study was also lower than that of Eker H.H et al’s study (2011), which studied 357 health facilities in Istanbul (Turkey), showing the author's domestic solid waste volume for the site: inpatient 4.23 ± 9.98 kg/bed/day, in outpatient area of 3.62 ± 33.19 kg/bed/day However, the amount of hazardous medical solid waste in the inpatient area was 0.168 ± 0.664 kg/person/day, the outpatient was 0.018 ± 0.062 kg/person/day, which was lower than ours [6] However, our research was similar or higher than that of some foreign authors 204 According to Debere M.K et al (2013), research on hospitals in Ethiopia showed that the amount of waste generated was very different among different hospitals, ranging from about 0.361 to 0.669 kg/patient/day, of which non-contagious medical wastes in hospitals from 0.297 kg/patient/day to 0.559 kg/patient/day, hazardous waste from 0.531 kg/patient/day to 0.668 kg/patient/day, infectious waste from 0.037 to 0.098 kg/patient/day, pharmaceutical waste accounted for 0.027 to 0.052 kg/patient/day [7] In central Macedonia hospitals, infectious wastes ranged from 0.51 to 1.22 kg/bed/day [8] Our study was similar to WHO's opinion, the composition of medical solid waste was 85% of non-hazardous waste, 10% was infectious waste, and 5% was chemical and pharmaceutical waste hazardous substances and radioactive substances [3] However, our study differed from that of Debere M.K et al’s study (2013), showing that 58.69% was non-hazardous waste and 41.31% was hazardous waste [7] Journal of military pharmaco-medicine no9-2019 Figure 1: Percentage of types of medical solid waste generated at 92 hospitals The amount of ordinary medical waste accounted for the highest proportion with 85.56%, followed by infectious medical solid waste with 13.63% and the lowest of non-infectious hazardous solid waste with 0.81% Table 3: Average medical waste generated kg/bed/day by level Types of medical solid waste Ordinary Infectious Non-infectious hazardous Total Hospital level Central Mean 1.74 0.24 0.02 2.00 (n = 34) SD 0.91 0.22 0.06 1.03 Mean 1.41 0.21 0.01 1.63 SD 0.76 0.09 0.017 0.79 > 0.05 > 0.05 > 0.05 > 0.05 Provincial (n = 58) p The generation of ordinary waste, infectious waste and non-infectious hazardous waste per bed/day of provincial hospitals was smaller than the central hospitals but there was no difference (p > 0.05) 205 Journal of military pharmaco-medicine no9-2019 Actual situation of medical solid waste management at central and provincial hospitals Table 4: Actual situation of compliance with administrative regulations on medical environmental protection of hospital Content Central hospital (n = 34) Provincial hospital (n = 58) Total (n = 92) No % No % No % Having assigned hazardous waste management for the department of infection control 34 100 57 98.3 91 98.9 Having issued decision for establishment of infection control council, infection control network 34 100 57 98.3 91 98.9 Having organized training on medical waste management 28 82.4 35 60.3 63 68.5 For the assignment and network of infection control, the central hospital accounted for 100%, the provincial hospital accounted for 57% Thus, the situation of assigning and managing human resources in the field of medical environment at central hospitals was better than the provincial hospitals For the medical waste management organization, the central hospital accounted for 82.4%, the provincial hospital accounted for a smaller percentage, but also reached the average level of 60.3% Our research showed that there was a statistically significant difference in the amount of some types of waste by level, by hospitals at general and specialty levels, by type of hospital In particular, the amount of waste in general at the provincial hospital was higher than the central hospital; however, the infectious waste was the highest at the central 206 hospital, followed by the provincial and district levels Our study was similar to the aggregate data of WHO in South Africa in which central hospitals were 1.24 kg/bed/day, provincial hospitals were 1.53 kg/bed/day, regional hospitals were 1.05 kg/bed/day, district hospital was 0.65 kg/bed/day [9] This may be due to higher levels of health care services generated by higher health facilities, as more ill patients have to use more services, including more visits Thus, different hospitals had different amounts of waste and solid waste composition, so the investment in technology as well as the practice of waste collection and treatment were different However, it should be noted that the amount of waste and the composition of waste does not depend only on the size, type, medical examination and treatment services; it also depends on the practice of the health staff and each patient Journal of military pharmaco-medicine no9-2019 Table 5: Comply with legal documents on medical waste management in hospitals Central (n = 34) Content Provincial (n = 58) Total (n = 92) No % No % No % 34 100 56 96.6 90 97.8 Discharge permits 25 73.5 33 56.9 58 63.0 Register of hazardous waste source owner 34 100 50 86.2 84 91.3 There is a decision approving environmental impact assessment environmental protection scheme the or For the procedure to apply for approval of environmental impact assessment or environmental protection scheme and register of hazardous waste source owner, the central hospitals had performed very well at the rate of 100%, provincial hospitals were also at a high level For the procedure to apply for discharge permits, the average rate was 73.5% at the central hospitals and 56.9% at the provincial hospitals Table 6: Implementation of environmental monitoring Content Central (n = 34) Provincial (n = 58) Total (n = 92) No % No % No % Having environmental monitoring according to the report on environmental impact assessment/environmental protection scheme with full content and frequency 30 88.2 38 65.5 68 73.9 Having environmental monitoring hospital according to Circular 31/2013/BYT with full content and frequency 21 61.8 13 22.4 34 37.0 Having environmental monitoring hospital according to Circular 19/2011/BYT with full content and frequency 10 29.4 13.8 18 19.6 Most central and provincial hospitals only carried out environmental monitoring according to the Environmental Impact Assessment Report/Scheme with full environmental protection content and frequency, specifically at central hospital (88.2%) and provincial hospital was lower (65.5%) Regarding the compliance with the provisions of the law on environment as well as the environmental monitoring of central hospitals was better than the provincial hospital Specifically, 100% of central hospitals had registered for environmental impact assessment or environmental protection scheme and provincial hospitals were 96.6%, but the rate of implementation of environmental monitoring according to in compliance with regulations of central hospitals on content and frequency was 88.2% and provincial hospitals reached 65.5% 207 Journal of military pharmaco-medicine no9-2019 CONCLUSION Through the environmental monitoring study conducted by 04 institutes at 92 public hospitals in Vietnam in 2015 - 2016, the results showed that the average amount of medical equipment was 1.769 kg/bed/day, of which ordinary waste was 1.53 kg/bed/day (accounting for 86.49%); the amount of infectious medical solid waste was 0.224 kg/bed/day (accounting for 12.66%), the amount of non-communicable hazardous medical solid waste was 0.015 kg/bed/day (accounting for 0.85%) Most central hospitals perform better environmental management than provincial REFERENCES Ministry of Health, Ministry of Natural Resources and Environment Circular 58/2015/TTLT-BYT-BTNMT: Joint Circular regulating medical waste management Hanoi 2015 Nguyen Huy Nga, Nguyen Thanh Ha Medical waste management for managers Ministry of Health Medical Publishing House 2015 Chartier Y et al Safe management of wastes from health-care activities World Health Organization 2014 208 B Aylin Alagöz The evaluation of the medical waste control regulation of Turkey in comparison with the E.U Environmental Directives Proc ISWA Annu Congr Cph Den 2006 B.-K Lee, M.J Ellenbecker, R.MoureErsaso Alternatives for treatment and disposal cost reduction of regulated medical wastes Waste Manag 2004, Vol 24, No 2, pp.143-151 H.H Eker, M.S Bilgili Statistical analysis of waste generation in healthcare services: A case study Waste Manag Res J Solid Wastes Public Clean Assoc ISWA 2011, Vol 29, No 8, pp.791-796 M.K Debere, K.A Gelaye, A.G Alamdo, Z.M Trifa Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011 BMC Public Health 2013, Vol 13, p.28 G Sanida, A Karagiannidis, F Mavidou, D Vartzopoulos, N Moussiopoulos, S Chatzopoulos Assessing generated quantities of infectious medical wastes: A case study for a health region administration in Central Macedonia, Greece Waste Manag 2010, Vol 30, No 3, pp.532-538 WHO Starting Health care Waste management in Medical Institutions Health Care Waste Practical Information Series Geneva, Switzerland 2007 ... research institutes 203 Journal of military pharmaco-medicine no9-2019 RESULTS AND DISCUSSIONS Situation of generation provincial hospitals of medical solid waste at central and Table 2: Situation of. .. Journal of military pharmaco-medicine no9-2019 Actual situation of medical solid waste management at central and provincial hospitals Table 4: Actual situation of compliance with administrative... management of medical waste medical solid waste generated per hospital bed in 2015 - 2016 At present, the investment in facilities and equipment for medical waste treatment is inadequate and unsuitable