4.2. The situation of management of MSW in Health-care facilities in Yen Bai city
4.2.1. Collection, segregation, and storage
a. The volume of arising HMSW, collection and treatment
According to statistics from the Health Department of Yen Bai province and the Department of Natural Resources and Environment of Yen Bai province (through the annual report on hazardous waste management), the amount of MSW arising from medical facilities in the Yen Bai province in general and Yen Bai city in particular increase over each year.
MSW from hospitals in the city originated mainly from the kitchen area, administrative area, packaging, waste from surgery, waste components after administration to patients, waste from the process cleaning, scouring, and waste from the activities of patients and patients. Noxious substances such as radioactive substances, pharmaceutical chemicals, etc are found in the medical examination and treatment departments, experimental activities, pharmacy. HMSW components from these hospitals are mainly cylinders, cotton, gauze, bandages, powders, braces, bottles, pouches, blood bags, clinical specimens, organic components, assorted, metal, glass, vial, etc.
Table 7: The amount of MSW arising in health-care facilities in Yen Bai city in 2017
Hospital
HMSW (kg)
MSW (kg)
Proportion of HMSW/total MSW in the whole
hospital (%)
City General Hospital 4680 12490 27.2
Provincial General Hospital 21689 56900 27.5
Traditional Medicine Hospital 9034 38800 18.8
Pediatric Hospital 14892 18250 44.9
Transportation Hospital 740.9 1650 31
Endocrinology hospital 2239.5 9550 19
Mental hospital 4218 14000 23.1
Hospital for Tuberculosis and Lung Disease
1100 4590 19.3
Total 58593.1 156230
(DONRE, 2017) The total volume of MSW collected in 8 hospitals surveyed in 2017 is 156 tons, of which HMSW accounts for 58 tons, equivalent to 4.8 tons/month. The Provincial General Hospital and Pediatric Hospital are two hospitals with a large scale of hospital beds and high MSW release;
According to the calculations, HMSW accounts for around 37% of total solid waste generated in 8 health facilities. However, the proportion of HMSW / total MSW
in the whole hospital (%) was highest in Pediatric Hospital with 44.9% and lowest in Traditional Medicine Hospital with 18.8%.
Table 8: The amount of each type of HMSW in health-care facilities in Yen Bai City
Hospital
Recycled medical waste
(kg)
Infectious HMSW
(kg)
Noninfectious HMSW
(kg)
City General Hospital 890 2679 1111
Provincial General Hospital 3746 14222 3721
Traditional Medicine Hospital 0 9034 0
Pediatric Hospital 0 14892 0
Transportation Hospital 0 740.9 0
Endocrinology hospital 0 1295.5 944
Mental hospital 0 2500 1718
Hospital for Tuberculosis and Lung Disease
0 680 420
Total 4636 46043.4 7914
(DONRE, 2017) Based on the collected data, HMSW is predominantly infectious waste, accounting for 79% of the total amount, while recycled medical waste accounts for a mere 8% and is available only in the City General Hospital and Provincial General Hospital.
b. Classification
+ Classification situation: 8/8 hospitals have classified MSW reach the required according to the law.
Figure 3: General scheme of waste classification in hospitals
+ Packaging and classification tools - Bag for contain HMSW
Table 9: Compliance rates for HMSW bags at hospitals
Observation content
Number of hospital (n=8)
Satisfactory % Unsatisfactory %
The color code is correct 7 87.5 1 12.5
Thickness of the bag is correct
3 37.5 5 62.5
There are warning signs 3/4 as prescribed
3 37.5 5 62.5
There are symbols as prescribed
3 37.5 5 62.5
The results showed that 87.5% of the health-care facilities establishments complied with the colors code prescribed for HMSW bags. However, up to 62.5% of hospitals used conventional packaging which did not meet the requirements.
- Containers of HMSW
100% of hospitals use closed-container to contain HMSW; only 37.5% of the hospitals have the color of containers compliance with regulations.
Up to 75% of hospital facilities use the container without warning signs 3/4 and the sentence "Do not put above the line" as prescribed; Failure to record the origin the stored HMSW bags in containers from the department/ward. In particular, 100% of hospitals do not print symbols on the containers.
c. Collection
+ Frequency of collection
City General Hospital and Traditional Medicine Hospital which is large and equipped with an incinerator, they collect MSW 2-3 times per day;
Provincial General Hospital and Pediatric Hospital which hires another company to handle their MSW, MSW is collected twice a day to keep in the storage area. Then, Nam Dinh ETC Company and Nam Thanh Company collected those waste 1-3 times per week;
Transportation hospital equipped with steam-oven have the frequency of collection of once-daily management;
The MSW in Endocrinology Hospital is collected in the whole hospital twice a day, then it transferred to treatment at the Mental Hospital twice a week;
Mental Hospital and Hospital for Tuberculosis and Lung Disease have collection rate 2-5 times per week with no more than 5 kg of HMSW per day.
+ Specify the route and collection time
5/8 hospitals have no regulations on time and route of collection; the collection is made according to the amount of MSW at the origin place and the waste manager decision;
For Nam Dinh ETC Company and Nam Thanh Company collecting the MSW at the Provincial General Hospital and Pediatric Hospital have no prescribed time and route.
d. Storage
8/8 hospitals have storage rooms or containers that are sufficiently large to hold the MSW for 4-7 days;
6/8 hospitals do not have separate storage area; HMSW is contained in containers;
7/8 hospitals are not equipped with absorbing material (eg sand or sawdust) and shovels, fire protection equipment as stipulated in Joint Circular No. 58/2015 / TTLT- BYT-BTNMT;
8/8 hospitals do not have chillers installed in the waste storage area;
In addition, there is the phenomenon of preserving HMSW beyond the prescribed time; Containers are not tightly closed and the MSW is put too much and above the specified line.