THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY PHAM THI HUYEN ASSESSMENT OF HAZARDOUS MEDICAL SOLID WASTE MANAGEMENT AT HOSPITALS IN YEN BAI CITY YEN BAI PROVINCE BACHELOR THESIS Study mode : Full-time Major : Environmental Science and Management Faculty : Advanced Education Program Batch : 2014 – 2018 Thai Nguyen, 2018 Thai Nguyen University of Agriculture and Forestry Degree Program Bachelor of Environmental Science and Management Student name Pham Thi Huyen Student ID DTN1453110069 Thesis Title Assessment of Hazardous Medical Waste Management at hospitals in Yen Bai city - Yen Bai province Supervisor Dr Ho Ngoc Son Abstract: There has been an increase in public concern about the medical waste management on a global basis and a significant effort has been directed toward proper and safe management of hazardous medical wastes in Yen Bai city The objective of this study is to analyze the hazardous medical solid waste management of health-care facilities in Yen Bai city, to access to its current situation, investigate people's awareness, and then propose solutions This study was carried out with the member hospitals of Yen Bai's health-care facilities system Observation and questionnaire survey method was used to collect real data of the amount of medical solid waste and the status of medical solid waste management Research showed some existing problems in the medical waste management in all hospitals due to lack of training and resources Moreover, the amount of medical solid waste has been increasing over the years, surveyed hospitals discharged 212 tons in 2017 including 55 tons of hazardous medical solid waste Collection, separation, and transportation of medical waste have been implemented but there were still many limitations Besides, a lack of awareness of the people in Yen Bai city is an serious problem While nurse group and waste worker group shows higher knowledge about medical waste management with over 80%, the figure for doctor group only 57.1%, moreover, only 26.7% of the patient group were aware of the waste management regulations of the Ministry of Health and the Ministry of Natural Resources and Environment Among the major recommendations is that public education and awareness of participants should be developed to encourage sustainably medical solid waste management behavior, increasing construction of material facilities for the collection, separation, transportation and treatment of hazardous medical solid waste; investing in non-burning technology is highly recommended Key Words Yen Bai city, Health-care Facilities, Hazardous Medical Solid Waste Management, Number of Pages 54 pages Date of Submission September 25th, 2018 Supervisor’s signature ii ACKNOWLEDGMENT To finish this thesis, I received enthusiastic help from many people working in the Department of Environmental protection of Yen Bai province, friends and family First and foremost, I have to thank my research supervisor Dr Ho Ngoc Son Without his assistance and contact motivating supervision in every step throughout the process, this study would have never been accomplished I would also like to show gratitude to staff who are working at the Department of Environmental protection of Yen Bai province for supporting me during the drafting process to completing this thesis Most importantly, none of this could have happened without my family and my friends who always beside and support me, moreover, help me a lot during the investigation and data collection as well as to complete this thesis to the final step iii TABLE OF CONTENT ACKNOWLEDGMENT iii TABLE OF CONTENT iv LIST OF FIGURE vii LIST OF TABLE viii LIST OF ABBREVIATIONS ix PART I: INTRODUCTION 1.1 Research rationable 1.2 Research’s objective 1.3 Research questions 1.4 Limitations PART II: LITERATURE REVIEW 2.1 The definitions of medical waste 2.2 Generation and components of MSW 2.2.1 Generation of MSW 2.2.2 The components and characteristic of MSW 2.3 Classification of medical waste 2.3.1 Classification rules 2.3.2 Classification of medical waste .10 2.4 The impact of hazardous medical solid waste on the environment 10 2.4.1 Impact on soil environment 10 2.4.2 Impact on air environment 11 2.4.3 Impact on water environment 11 iv 2.4.4 Impact on human health 12 2.5 Situation of medical waste management 12 2.5.1 Situation of medical waste management of some countries in the world .12 2.5.2 Situation of medical waste management in Viet Nam 13 2.5.3 Situation of medical waste management in Yen Bai city .15 2.6 Measures for hazardous medical waste treatment 17 2.6.1 Incinerator technology 17 2.6.2 Steam-oven technology 17 2.6.3 Sterilize by chemicals 18 2.6.4 Microwave technology 18 2.6.5 Biotechnology treatment .19 2.6.6 Radioactive treatment 19 PART III: METHODS 20 3.1 Material .20 3.2 Study design .20 3.3 Participants .20 3.4 Location and research background 21 3.5 Data collection 21 3.6 Data analysis and processing 22 PART IV: RESULTS AND DISCUSSIONS 23 4.1 The overview of health facilities in Yen Bai city 23 4.2 The situation of management of MSW in Health-care facilities in Yen Bai city 25 4.2.1 Collection, segregation, and storage .25 v 4.2.2 Transportation, treatment, and equipment 30 4.3 The awareness of healthcare workers, patients and patient’s family members about HMSWM 35 4.3.1 For medical staff 35 4.3.2 For patients and patient's family members 37 4.4 Solutions to improve hazardous medical waste management in Yen Bai city 38 4.4.1 Measures on environmental management .38 4.4.2 Measures to improve the collection, segregation, storage, transportation and treatment of HMSW 39 4.4.3 Alternative Treatment Technologies .41 PART V: CONCLUSIONS AND RECOMMENDATIONS .43 5.1 Conclusions 43 5.2 Recommendations 45 REFERENCES Error! Bookmark not defined APPENDIX 48 APPENDIX 53 APPENDIX 57 vi LIST OF FIGURE Figure 1: Typical waste compositions in health-care facilities .7 Figure 2: The average components of medical waste in Yen Bai province Figure 3: General scheme of waste classification in hospitals 28 Figure 4: Perception of color codes for waste containers .36 vii LIST OF TABLE Table 1: Source of medical waste from health sector activities Table 2: Physical and chemical properties of MSW in Yen Bai province Table 3: Health-care waste generation according to national income level 13 Table 4: Volume of HMW in some localities in Viet Nam in 2014 .14 Table 5: Situation of HMSW arising in medical establishments in Yen Bai province 15 Table 6: The overview of hospitals in Yen Bai city 24 Table 7: The amount of MSW arising in health-care facilities in Yen Bai city in 2017 .26 Table 8: The amount of each type of HMSW in health-care facilities in Yen Bai City .27 Table 9: Compliance rates for HMSW bags at hospitals 28 Table 10: Situation of MSW treatment at hospitals in Yen Bai city .33 Table 11: The awareness of medical staffs about the medical waste management regulation .35 Table 12: Medical staff knowledge and awareness of hospital waste management .36 Table 13: The awareness of participant about medical solid waste management 37 viii LIST OF ABBREVIATIONS HMSW Hazardous Medical Solid Waste HMSWM Hazardous Medical Solid Waste Management MSW Medical Solid Waste MSWM Medical Solid Waste Management OMW Ordinary Medical Waste WHO World Health Organization YHF Yen Bai’s Health-care Facilities ix the prescribed time; Containers are not tightly closed and the MSW is put too much and above the specified line • In surveyed hospitals, the collection, transportation of MSW is mainly done by manual methods (eg hand trolleys or wheeled containers) to transport MSW, which resulting many risks for participants; Specifically, except for the Transportation Hospital which is equipped with microwave treatment, the remaining hospitals mainly have applied the CHUWASTAR ovens which are incinerator technology to treat MSW, however, HMSW incinerators of some hospitals in the city have degraded, affecting the quality of treatment; • Among questioned participants, 86.7% of them were aware of Regulation medical waste management on Joint Circular No 58/2015 / TTLT-BYT-BTNMT Besides, the awareness of medical staff about the color codes for medical waste containers was still low and only 46.7% instructed the patient about the color code of the garbage containers Only 26.7% of interviewed patient and patient's family member was aware of the waste management regulations of the Ministry of Health and the Ministry of Natural Resources and Environment, 20% discerned the color code of the waste container Raising people awareness is one of the most necessary activities for all healthcare facilities in Yen Bai city to improve MSWM In conclusion, investing in education and propaganda to raise people awareness are the suggested effective solutions In addition, hospitals should spend on equipment to improve MSWM (eg collection and transportation tools, storage area, etc), and use non-burning technology instead of degraded incinerators 44 5.2 Recommendations The thesis gave an overview of the current status and proposed management solutions for HMSW in Yen Bai's healthcare facilities To better work on MSWM in Yen Bai City, the author recommends: • Application of the 3R model (Reduce - Reuse - Recycle) in all health-care facilities: Reduce the volume of MSW through lifestyle changes and usage habits, improving production processes, using eco-friendly products, etc Reuse and recycle things that are usable according to the law norms; • Invest more equipment for waste collection, storage, and treatment to ensure environmental sanitation; Equipment systems need to set logically in each department to avoid confusion when separate MSW, waste bin needs to appropriate for each type of waste (color-code, symbol, etc) • Improving the awareness and education of medical staffs as well as patient and family member on medical solid waste management And, enhancing the management of the waste manager in each health-care facilities; • Inviting businesses, investors and organizations inside and outside the country to invest in hospitals to more effective medical solid waste management; • The municipal corporations need to make stringent laws and ensure its compliance by both the hospital management and its staff.; Finally, to take a reasonable and comprehensive solution for environmental sanitation, it needs to have deeper research and constantly to have the reviews, catch the things to change so that further improves the models of MSWM 45 REFERENCES REFERENCES Bach, D V (2018) Overview of Yen Bai province Yen Bai Chartier, Yves, Emmanuel, Jorge, Pieper, Ute World Health Organization (2014) Safe management of waste from healthcare activities Switzerland Department of Natural Resources and Environment of Yen Bai province (2015) Report on the status of environmental in Yen Bai province (2011-2015) Yen Bai Hang, N (2012) Situation and solutions for waste management in the health sector Ha Noi Hoang, M (2015) Strengthening grassroots health, ensuring basic health care for people Ha Noi Ly, P T (2016) Towards the selection of environmentally friendly medical waste treatment technologies, Ha Noi Mankolli, H (2013) Hospital Solid Wastes and Its Effect on Environment, Albania Michelle (2014) Medical Waste: Challenges Faced Around the World Retrieved from:http://www.globalization101.org/medical-waste-challenges-faced-aroundthe-world-2/ Miller, R.K and Rupnow, M E (2016) Survey on medical waste management and Future Technology Surveys Georgia Minister of Health (2007) REGULATION ON MANAGEMENT OF MEDICAL WASTE - Promulgated in conjunction with Decision No 43/2007 / QD-BYT Ha Noi Ministry of Health and Ministry of Natural Resources and Environment (2015) Joint Circular No 58/2015 / TTLT-BYT-BTNMT Ha Noi 46 Ministry of Natural Resources and Environment (2011) Circular No 12/2011 / TTBTNMT Ha Noi People's Committee of Yen Bai province (2016) Decision No 1433 / QD-UBND promulgating the plan for collection, transportation, and treatment of hazardous medical waste in Yen Bai province Yen Bai Quy, V (2011) Some environmental and global issues in Viet Nam Ha Noi Sang, L M (2016) Experience in some countries around the world in medical waste management Ha Noi Sushma Rudraswamy, M.D.S (2013) Global scenario of Hospital waste management India Tap, V H (2016) Impact of medical waste on the environment Ha Noi Trang V T H (2016), Patterns of solid waste management in Yen baI province, Yen Bai WHO (2010) Safe management of wastes from healthcare activities Geneva Yen Bai Portal (2016) Overview of yen yai province Retrieved from: http://yenbai.gov.vn/Pages/Gioi-Thieu-Chung.aspx Zafar, S (2018) Medical Waste Management in Developing Countries Oman 47 APPENDIX Survey questionnaire for medical staff RESEARCH: ASSESSMENT OF HAZARDOUS MEDICAL WASTE MANAGEMENT IN YEN BAI CITY - YEN BAI PROVINCE Researcher: Pham Thi Huyen Date: Please put a check mark (√) in a box □ which corresponds to your answe Part 1: Personal background Name: Age: Gender: Group: Part 2: Level of awareness on HMWM Do you have guidelines for the regulation of HMWM issued by the Ministry of Health? □ Yes □ No If you had, who guided you? □ Hospital □ Yen Bai Department of Health □ Urban Environmental Company 48 □ Others What is the current regulation on medical waste management in hospitals/clinics? □ Decision No 2575/1999 / QD-BYT of August 27, 1999 of the Minister of Health promulgating the Regulation on management of medical wastes □ Decision No 43/2007 / QD-BYT dated 30 November 2007 of the Minister of Health promulgating the regulation on management of medical waste; □ Joint Circular No 58/2015 / TTLT-BYT-BTNMT of the Minister of Health and the Minister of Natural Resources and Environment promulgating regulations on management of medical waste; □ I not know How many group of HMW is classified in the current regulation on medical waste management? □ Groups □ Groups □ Groups □ Groups □2Groups □ I not know Among those groups below, which groups of HMW are on the current regulation on medical waste management? □ Infectious waste □ Radioactive waste 49 □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know Do you know prescribes of the color coded packaging for solid medical waste containers? □ Yes □ No - If you answer "yes" please the following questions: What kind of SMW is stored in the yellow packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know What kind of SMW is stored in the black packaging? □ Infectious waste □ Radioactive waste 50 □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know What kind of SMW is stored in the blue packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know What kind of SMW is stored in the white packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste 51 □ I not know 10 Do the injection vehicle or car tricks has fully bags and box equipped to collect: infectious, sharp, recycling waste? □ Yes □ No 11 Do you practice the classification of medical waste according to regulations? □ Yes □ No 12 Have you directed the patient and their family about the color code of the garbage? □ Yes □ No 13 Do you know that medical waste has harmful effects on human health and the environment? □ Yes □ No 14 Does the hospital has the place to gather and store waste? □ Yes □ No 15 Are hazardous waste and conventional waste stored in separate compartments? □ Yes □ No Thanks for your answers 52 APPENDIX Survey questionnaire for patients and family members RESEARCH: ASSESSMENT OF HAZARDOUS MEDICAL WASTE MANAGEMENT IN YEN BAI CITY - YEN BAI PROVINCE Researcher: Pham Thi Huyen Date: Please put a check mark (√) in a box □ which corresponds to your answers Part 1: Personal background Name: Age: Gender: Group: Part 2: Level of awareness on HMWM When you go to hospital, you have a guide for hygiene in the hospital room? □ Yes □ No Do you know about waste management regulations issued by the Ministry of Health? □ Yes □ No 53 Do you get guide on the color coding of medical waste packaging (bags, boxes)? □ Yes □ No Please tell me what kind of bags or bins are putted in the department in hospital? □ Blue □ Yellow □ Black □ White Do you know prescribes of the color coded packaging for solid medical waste containers? □ Yes □ No - If you answer "yes" please the following questions: What kind of SMW is stored in the yellow packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste 54 □ I not know What kind of SMW is stored in the black packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know What kind of SMW is stored in the blue packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know What kind of SMW is stored in the white packaging? □ Infectious waste □ Radioactive waste □ Ordinary mediacal waste 55 □ Noninfectious hazardous waste □ Recyclable waste □ Sharp waste □ Hazardous chemical waste □ I not know 10 Do your room in hospital have collected daily garbage? □ Yes □ No 11 In the hospital, you put waste in the right place? □ Yes □ No 12 In your opinion, hospital waste has a negative impact on health? □ Yes □ No Thanks for your answers 56 APPENDIX MSW is collected and classified at the source as prescribed MSW is stored incorrectly at the Provincial General Hospital 57 The incinerator at Mental Hospital Microwave at Transportation Hospital 58 ... volume of medical waste (including medical waste and medical wastewater) generated by hospitals in the city accounts for the majority of medical waste generated in the province The number of people... city, Yen Bai province Village 1, Phuc Loc Hire ETC commune, Yen Bai city, 500 650 129 Yen Bai province Yen Ninh Street, Yen Bai City, Yen Bai Province 120 240 120 Hospital Incinerator Hire Nam... LITERATURE REVIEW 2.1 The definitions of medical waste • Medical wastes are wastes generated during the operation of medical establishments, including HMSW, ordinary medical wastes and medical wastewater