2.5.1. Situation of medical waste management of some countries in the world
Research on medical solid waste (MSW) has been conducted in many countries around the world, especially in developed countries such as the United Kingdom, the United States, Japan, and Canada, etc. Which, referring to many areas such as MSW arising situation and classification; Medical solid waste management (measures to reduce waste, reuse of waste, treatment of waste, assessment of the effectiveness of waste treatment measures); Harms of health-care solid waste to the environment and human health (Le Minh Sang. 2016). Moreover, the study proposes measures to reduce the harmful effects of MSW on public health; the threat of infectious waste to the community; the impact of medical wastewater on disease transmission; issues of the public health problem related with MSW (DONRE, 2016). Hospital waste generation has become a prime concern due to its multidimensional ramifications as a risk factor.
The generation of hospital wastes differs not only from country to country but also within a country. In middle- and low-income countries, health-care waste generation
is usually lower than in high-income countries (Miller et al. 2016). Developed countries face challenges with the sheer volume of waste from the use of disposable items. On the other hand, developing countries, whose supplies are limited, are dealing with challenges of sorting and disposing of all types of medical waste in a sanitary manner (Sushma Rudraswamy, 2013)
Table 3: Health-care waste generation according to national income level
National income level Annual waste generation (kg/head)
High income counties All health-care waste 1.1-12.0 Hazardous health-care waste 0.4-5.5 Middle-income
countries
All health-care waste 0.8-6.0 Hazardous health-care waste 0.3-0.4 Low-income countries All health-care waste 0.5-3.0
(DONRE, 2017) 2.5.2. Situation of medical waste management in Viet Nam
According to statistics of the Ministry of Health's Health Environment Management Agency in 2012, there are more than 1,000 hospitals in the country, 350- 500 tons of medical waste each day, of which about 47 tons of HMSW. However, many hospitals do not have a dedicated burner system As a result, there are serious incidents of hospital hazardous waste incineration, which directly affect the patients as well as the citizens live nearby (Nguyen Hang, 2012). For solid waste generated from medical activities, along with the increase in hospital beds, the MSW volume tends to increase. Currently, in the whole country, the average amount of solid waste discharged daily is 0.86 kg / bed, in which hazardous medical waste is 0.14 kg / bed.
The total amount of solid waste in hospitals across the country is up to 100 tons and 16
tons of medical waste need to be treated (Le Thi Tai, 2004). It is estimated that in 2015, the amount of medical discharge was 600 tons/day and in 2020 will be 800 tons/day. However, there is not enough statistics on the number of hospitals where medical curing facilities are available to meet the required hygiene requirements.
By 2015, the rate of collected medical MSW reached over 75%; The proportion of hazardous waste collected and treated is about 65%. Most hospitals collect and classify wastes but the collection vehicles are lacking and incomplete which most of them are not up to standards and there are no vehicles to ensure the transportation process is secure. At present, technology for medical treatment of MSW is mainly by incinerators, however, some technologies for treatment of medical wastes by non- burning methods are encouraged and prioritized for development.
Table 4: Volume of HMW in some localities in Viet Nam in 2014
St. Name of province Amount of HMW (ton/year)
1 Ha Noi 1.632
2 Ninh Binh 887
3 Dong Nai 756
4 Nghe An 616
5 Thanh Hoa 283
6 Lang Son 256
7 An Giang 236
8 Nam Dinh 233
9 Dien Bien 173
10 Ninh Thuan 146
11 Ha Tinh 134
12 Kon Tum 64
(DONRE, 2015)
2.5.3. Situation of medical waste management in Yen Bai city
2.5.3.1. Overview of medical facilities and the amount of HMSW arising in Yen Bai province
By the end of March 2016, the number of health facilities in Yen Bai province was 6 hospitals and 07 provincial preventive medicine centers, 09 district health centers, 19 multi-clinics 180 health clinics in the commune / ward / township, 01 training center, 01 private hospital, 105 general and private clinics and 01 branch hospital (Hospital of Transportation) located in the area
Table 5: Situation of HMSW arising in medical establishments in Yen Bai province
No. Type of HMSW Total avarage amount (kg/day)
1 Infectious waste 309.06
1.1 Group A 100.67
1.2 Group B & C 173.95
1.3 Group D 34.44
2 Chemical waste 18.42
3 Radioactive waste 5.27
4 Pressure tanks 4.76
Total 337.51
(DONRE, 2015) 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 medical waste arising from local hospitals the province in general and Yen Bai city in particular increase
over each year. In particular, in 2014, the total volume of MSW generated from all medical facilities in the province was 413.8 tons, of which MSW generated in 07 hospitals in Yen Bai City was 117.71 tons, accounting for nearly 30 %. The HMSW volume arising from 07 hospitals in Yen Bai City is nearly 43 tons, accounting for 38% of the HMSW incurred in the province (112.4 tons) and accounting for 36.5% of the MSW generated from those hospitals.
2.5.3.2. Status of management and capacity to handle HMSW in Yen Bai province a. HMSW collection, segregation, storage and transportation
Almost medical facilities have plastic bags, safety boxes and buckets to serve the collection and classification. Basically, the collection and classification of medical solid waste, including solid hazardous medical waste have met requirements in accordance with the law. However, the arrangement of plastic bags and safety boxes is not enough or they do not meet the requirements in accordance with the law. In some establishments, there is the phenomenon of hazardous wastes are puted in wrong collection prescribed equipment or hazardous wastes and ordinary wastes and other hazardous wastes are stored together.
Temporary waste storage facilities are built in almost health-care facilities in Yen Bai province basically to meet the requirements of the law.
b. HMSW processing capacity
At present, there are only five hospitals and one provincial-level health facility, and five district-level units under the management of the provincial Health Services have had hazardous medical waste incinerators with total designed
capacity approximately 1,690 kg / day and 01 hospital (transport hospital) with a system of medical waste treatment by steam sterilization method which is Italian technology with a capacity of 7kg/hour (56kg / 8 hours) (People’s Committee of Yen Bai province. 2016);
Moreover, some hazardous medical waste incinerators have deteriorated resulting in damage to efficiency handling (People’s Committee of Yen Bai province. 2016).