Hospitals must strictly implement waste management in accordance with Joint Circular No. 58/2015 / TTLT-BYT-BTNMT issued by Minister of Health and Minister of Natural Resources and Environment in 2015. Medical waste management should be done right from the stage of collection, segregation, transportation, treatment, and disposal;
Attention should be paid to the fostering and training of medical staff and waste worker in hospitals as well as educated the patients and their family members about the classification of medical waste and how HMSW effect human health;
It is necessary to coordinate well with the Natural Resources and Environment sector in planning, allocating and using environmental non-business expenditures and inspection of medical waste management and environmental protection in hospitals.
4.4.2. Measures to improve the collection, segregation, storage, transportation and treatment of HMSW
a. Collection and segregation
The Department of Health shall frequently guide all medical establishments, especially for medical staffs who directly exposed to MSW at the sources, to collect and segregate according to the provisions of Joint Circular No. 58/2015 / TTLT-BYT- BTNMT of the Minister of Health and the Minister of Natural Resources and Environment;
In order to effectively segregate MSW, it is necessary to strengthen the departments and teams in charge of bacterial contamination and to develop specific contents for infection control activities;
Arranging banners with basic and understandable information on the principle of classification and hazardous properties of MSW in hospital rooms, as well as regularly propaganda for patients and family members on MSWM.
b. Storage
Healthcare facilities increase the cost to invest in HMSW packaging and storage equipment (packaging, storage equipment, medical devices now only meet the basic color problems, not meet: thick pockets with 3/4 markers and inscription, with the symbol as prescribed);
Recommend 9 hospitals equip with absorbent materials (eg dry sand or sawdust), shovels at the stored area to use in case of leakage, spillage of hazardous medical waste in liquid form and fire protection equipment according to the guidance of the competent authority on fire prevention;
Constructing the HMSW waste storage area for Commune Health Stations to ensure technical requirements as prescribed;
For small clinics: it is necessary to arrange storage devices such as in containers with lids to contain waste as well as avoid the HMSW causing the risk of pathogen infection.
c. Transportation
Forwarding waste: 3 hospitals which rent other facilities to treat thier waste have to establish the medical waste transfer and reception book as stipulated in Appendix 8 in Joint Circular No. 58/2015 / TTLT-BYT-BTNMT;
All health-care facilities need to termination of transportation HMSW to the wrong storage areas as well as using transport equipment in accordance with the law.
Besides, Yen Bai has been not built any control plan to avoid the collection of radioactive waste, therefore, it is essential to invest in radiometer equipment.
d. Treatment
Only use the HMSW treatment facility to handle the generated HMSW and OMW are recyclables which should be handled separately by the prescribed methods;
Hospitals need to preserve and treat ash which created after burning HMSW in accordance with the law.
4.4.3. Alternative Treatment Technologies
Incinerators are commonly used for treat HMSW in Viet Nam, however, if this equipment not well controlled for emissions or the operation is not in accordance with regulations, there will be the risk of environmental pollution (Pham Thu Ly, 2016).
The alternative technologies for healthcare waste disposal are steam sterilization, advanced steam sterilization, microwave treatment, dry heat sterilization, alkaline hydrolysis, biological treatment and plasma gasification (Salman Zafar, 2018);
• Steam sterilization (or autoclaving) is the most common alternative treatment method. Steam sterilization is done in closed chambers where both heat and pressure are applied over a period of time to destroy all microorganisms that may be present in healthcare waste before landfill disposal. Among alternative systems, autoclaving has the lowest capital costs and can be used to process up to 90% of medical waste, and are easily scaled to meet the needs of any medical organization.
• Advanced autoclaves or advanced steam treatment technologies combine steam treatment with vacuuming, internal mixing or fragmentation, internal shredding, drying, and compaction thus leading to as much as 90% volume reduction. Advanced steam systems have higher capital costs than standard autoclaves of the same size.
However, rigorous waste segregation is important in steam sterilization in order to exclude hazardous materials and chemicals from the waste stream.
•Microwave treatment is a promising technology in which treatment occurs through the introduction of moist heat and steam generated by microwave energy. A typical microwave treatment system consists of a treatment chamber into which
microwave energy is directed from a microwave generator. Microwave units generally have higher capital costs than autoclaves and can be batch or semi-continuous.
• Chemical processes use disinfectants, such as lime or peracetic acid, to treat waste. Alkaline digestion is a unique type of chemical process that uses heated alkali to digest tissues, pathological waste, anatomical parts, or animal carcasses in heated stainless steel tanks. Biological processes, like composting and vermicomposting, can also be used to degrade organic matter in healthcare waste such as kitchen waste and placenta.
• Plasma gasification is an emerging solution for sustainable management of healthcare waste. A plasma gasifier is an oxygen-starved reactor that is operated at the very high temperatures which result in the breakdown of wastes into hydrogen, carbon monoxide, water etc. The main product of a plasma gasification plant is energy-rich syngas which can be converted into heat, electricity and liquids fuels. Inorganic components in medical wastes, like metals and glass, get converted into a glassy aggregate.
The Transportation hospital in Yen Bai city has adopted microwave pressure technology seen 2011 which bring many advantages compared with other hospitals.