THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY NGUYEN THI LINH LY Topic title: MEDICAL SOLID WASTE MANAGEMENT PRACTICES IN THAI NGUYEN TUBERCULOSIS AND LUNG DISEASE HOSPITAL BACHELOR THESIS Study Mode: Full-time Major: Environmental Science and Management Faculty: Advanced Education Program Office Batch: 2014 – 2018 Thai Nguyen, 24 /9 /2018 DOCUMENTATION PAGE WITH ABSTRACT Thai Nguyen University of Agriculture and Forestry Degree Program Bachelor of Evironmental Science and Management Student name Nguyen Thi Linh Ly Student ID DTN1453110086 Thesis Title Medical Solid Waste Management Practices in Thai Nguyen Tuberculosis and Lung Disease Hospital Supervisor Assoc Prof Trần Văn Điền Supervisor’s signature Abstract: The management of medical waste is great significance due to its related potential environmental impacts and public health hazards This study aims mainly to assess medical solid waste management practices in Thai Nguyen tuberculosis and lung disease hospital The descriptive methodology was used in the study The results showed that the hospital generate a total of 195 kg/day of solid waste, of which about 181 kg (92,8%) are non hazardous and 14 kg (7,2%) are hazardous Solid wastes are treated by Anh Dang environmental services company limited The research identified and assessed the current situation of solid waste collection and impacts on the environment Keywords Medical solid waste, environmental impact, planning and management Number of pages 55 pages Date of Submission 24/9/2018 i ACKNOWLEDGEMENT I would like to express my sincere gratitude to Thai Nguyen Tuberculosis and Lung Disease Hospital, especially Mrs Ngo Thu Tien – the vice director of the hospital She not only offered me an opportunity to complete my internship course at hospital but also gave me a lot of information about her organization so that I could find what departure is suitable for me Besides, I also say thank my supervisor, Assoc.Prof Tran Van Dien - whose expertise, understanding, generous guidance and support made it possible for me to work on intriguing topic It was a pleasure working with him In addition to expressing my gratitude to Thai Nguyen Tuberculosis and Lung Disease Hospital and my supervisor, I want to express my sincere gratitude to my university, especially the Advance Education Program Moreover, I would like to show my appreciation to all teachers who have taught me for years in Thai Nguyen University of Agriculture and Forestry They set their heart on teaching their students, included me That is to say, not until their students understand the lessons clearly, they finish their hard working day Therefore, I really hold them in high esteem Thank you! Nguyen Thi Linh Ly ii TABLE OF CONTENT DOCUMENTATION PAGE WITH ABSTRACT i ACKNOWLEDGEMENT ii TABLE OF CONTENT iii LIST OF FIGURES vi LIST OF TABLES vii PART I INTRODUCTION 1.1 Research rationale 1.2 Research’s objectives 1.2.1: Research’s overall objecties 1.2.2 Research's specific objectives 1.3 Research subject 1.4 Research questions and hypotheses 1.4.1 Research question 1.4.2 Hypotheses 1.5 Limitations 1.6 Definitions PART II: LITERATURE REVIEW 2.1 Sources and composition of hazardous medical waste 2.1.1 Stationary sources 2.1.2 Medical waste components 2.2 Classification of hazardous waste 2.3 Principles of classification of medical waste 10 iii 2.4 Principles for collection, storage, transportation and treatment of medical waste 11 2.4.1 Collection of hazardous medical waste 11 2.4.2 Storage of hazardous medical waste 12 2.4.3 Treatment of hazardous medical waste 13 2.5 Impact of medical waste 14 2.5.1 The impact of medical waste on the environment 14 2.5.2 Effects of medical waste on humans 15 2.6 Legal basis to perform the task 16 PART III RESEARCH METHODOLOGIES 18 3.1 Time and research scope: 18 3.2 Research contents: 18 3.3 Research methodology 18 3.3.1 Collecting secondary data 18 3.3.2 Interviewing by questionnaire 18 PART IV RESULTS AND DISCUSSIONS 19 4.1 : Current status of medical solid wastes of Thai Nguyen Tuberculosis and Lung disease hospial 19 4.1.1 Hazardous wastes 19 4.1.2 Normal solid waste 24 4.1.3 Items for collection and treatment of solid waste 26 4.2: Discussions 27 4.2.1: Knowledge of staff and patients on hospital waste management 27 iv 4.2.2: Solutions to improve the management of hazardous medical waste of Thai Nguyen Tuberculosis and Lung disease hospital 32 4.2.3: Technology measures 33 PART V CONCLUSIONS 35 5.1 Conclusions 35 5.2 Petition 36 REFERENCES 38 v LIST OF FIGURES Figure 4.1 Rate of hazardous wastes of Thai NguyenT uberculosis and Lung Disease Hospital in March 2018 20 vi LIST OF TABLES Table 2.1: Composition of medical solid waste in Vietnam Table 2.2: Some diseases at risk of infection from medical waste 16 Table 4.1 The volume of hospital infectious waste from March to June 19 Table 4.2: Volume of each type of hazardous waste at the hospital 19 Table 4.3 Collection of solid medical waste 21 Table 4.4 Transport of hazardous medical waste 23 Table 4.5: Items for collection and treatment of solid waste 26 Table 4.6: Statistics of knowledge on medical waste management 28 Table 4.7: Knowledge about the color of item for classify medical waste 29 Table 4.8: Knowledge of hospital's staff about medical waste management 30 Table 4.9: Understanding about hospital waste management of patients and patient's family member 31 vii PART I INTRODUCTION 1.1 Research rationale Medical waste, due to its content of hazardous substances,poses serious threats to environmental health Thehazardous substances include pathological and infectiousmaterial, sharps, and chemical wastes In hospitals, different kinds of therapeutic procedures ( cobalt therapy, chemotherapy, dialysis, surgery, delivery, resection ofgangrenous organs, autopsy, biopsy, para clinical test, injections etc.) are carried out and result in the productionof infectious wastes, sharp objects, radioactive wastes andchemical materials Medical waste may carry germs ofdiseases such as hepatitis B and AIDS In developing countries, medical waste has not received much attention and it is disposed of together with domestic waste Improper medical waste management poses a serious threat to public health Medical waste contains highly toxic metals, toxic chemicals, pathogenic viruses and bacteria, which canlead to pathological dysfunction of the human body Medical waste presents a high risk to doctors,nurses, technicians, sweepers, hospital visitors andpatients due to arbitrary management It has long beenknown that the reuse of syringes can cause the spread ofinfections such as AIDS and hepatitis The collectionof disposable medical items (particularly syringes), its resale and potential reuse without sterilization could causea serious disease burden The safe disposal and subsequent destruction of medicalwaste is a key step in the reduction of illness or injurythrough contact with this potentially hazardous material, and in the prevention of environmental contamination The transmission of blood borne viruses and respiratory, enteric and soft tissue infections through impropermedical waste disposal is not well described The management of medical waste therefore, has been of majorconcern due to potentially high risks to human health andthe environment Medical waste is an environmental as well as public health issue that attracts attention in both industrialized and developing countries Certain categories of medical waste are among the most hazardous and potentially dangerous of all the wastes arising in the community Improper management of medical waste may pose health hazards through transmission of diseases In addition to health hazards, environmental hazards have to be considered, such as the contamination of soil, water sources and poisonous emissions from improper burning of medical waste In the long term, medical waste can not only impair the quality of life of the community, but can also affect the welfare of the entire population and the national economy 1.2 Research’s objectives 1.2.1: Research’s overall objecties This study was to assess the medical solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital, of which focus on the evaluation of medical solid waste in the hospital Thereby, propose appropriate measures to sustain solid waste management in the hospital 1.2.2 Research's specific objectives • To study the current medical solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital destroyed through mitigation, collection and reuse activities after treatment in accordance with regulations 4.2.2.2 : Measures to improve classification, collection and transportation Classification of waste at source should be an important step in the management of hospital waste In order to effectively classify medical waste, the department of infectious disease control commensurate with the number of beds and develop specific content for infection control In addition, investment in procurement of equipment, materials, packaging to carry out the equipment treatment process, classification of waste Particular attention should be paid to the training of personnel in charge of infection management To intensify the direction and guidance, regularly monitor and inspect the implementation of the regulations on classification and management of medical wastes and environmental protection in hospitals 4.2.3 : Technology measures Hospital waste treatment solutions can be applied as: - Establishment of solid hazardous medical waste at source and minimization of hazardous medical wastes: The waste in medical establishments is divided into groups, including: contamination wastes, hazardous chemicals, reporters pressure vessels and conventional waste The isolation of these waste groups may be based on the hazards of the waste, particularly on the contaminated waste group 33 - Improve and make use of existing incinerators: Medical waste incinerators are currently of small capacity (less than 200 kg / h), inefficient and inefficient gas cleaning equipment While, biomedical solid waste incineration is one of the major sources of dioxin, furan, mercury, lead and many other hazardous substances Therefore, for incinerators without exhaust gas treatment units, it is necessary to invest in upgrading and installing additional exhaust gas treatment units When burners are used up, they are replaced by non-combustion (disinfection) 34 PART V CONCLUSIONS 5.1 Conclusions Thai Nguyen Tuberculosis and Lung disease hospital is currently operating with 220 patient beds and 186 staff members The amount of medical waste arising from the operation of the hospital is 195kg /day, of which about 181 kg (92,8%) are non hazardous and 14 kg (7,2%) are hazardous The waste was managed by the hospital according to the Ministry of Health Decision No 43/2007 / QD-BYT The hospital's staff collects daily garbage at each department, sorting garbage at the source However, the collection and classification of waste is stopped in four types: black bag for chemical waste, yellow bag for clinical waste, blue bag for ordinary waste and sharp waste into the barrel to ensure safety when collecting and transporting There is a lack of white bags for recycling waste Hazardous medical waste arising from medical examination and treatment, mainly contain needles and syringes, gloves, cotton, blood stains, gauze bags, neon bulbs, etc Contaminated waste components are mainly derived from clinical, paraclinical, pharmaceutical, visual diagnostic Mud from waste water treatment system In addition, a small amount of hazardous waste is generated from construction activities such as grease wipes, neon bulbs, grease, etc Hazardous waste transportation and treatment is contracted by the hospital with Anh Dang environmental services company limited The usual solid waste is handed over to the Thai Nguyen environmental and urban works joint stock company Survey results show that hospital's staffs are well aware of and strictly follow the hospital waste collection and classification regulations 81.8% of staff knew 35 about the regulation of medical waste management Understanding hospital waste management is 100% staff However, patients and patient's family members lack knowledge about garbage sorting, only 12% have differentiated the color of garbage containers 16% of respondents knew of the Regulation No 43 100% aware of the impact of hospital waste on the environment and people So attention should be paid to the training and retraining of officials and employees in charge of environmental waste management in hospitals Organize communication and education to raise the awareness of patients and their family members about the classification of medical waste, its harmful nature to human health It is necessary to coordinate well with the natural resources and environment sector in planning, allocating and using environmental non-business expenditures, inspecting the management of medical wastes and environmental protection in hospitals Improve employee medical waste management of staffs + To be responsible for the management of medical waste from the time they occur to the final stage of destruction + Planning medical waste management and developing investment projects, upgrading infrastructure for hospital waste management + Implement measures to reduce the amount of medical waste that must be destroyed through mitigation, collection and reuse activities after treatment in accordance with regulations 5.2 Petition - The hospital should invest more in equipment for waste collection and treatment to ensure environmental sanitation for hospital 36 + Need to buy more white bags for recycling waste + Replace broken tools - Hospitals need to educate patients and patent's family members about waste classification so that they can work together It is important to strengthen the guidelines for patients and their relatives to put rubbish in the correct color of the bag 37 REFERENCES Books: Sở Tài nguyên Môi trường Thái Nguyên (2017) Báo cáo nhiệm vụ điều tra, lập kế hoạch thu gom, vận chuyển xử lý chất thải y tế nguy hại địa bàn tỉnh Thái Nguyên Bệnh viện Lao Bệnh phổi Thái Nguyên (2017) Đề án bảo vệ môi trường chi tiết Bệnh viện Lao Bệnh phổi Thái Nguyên Bệnh viện Lao Bệnh phổi Thái Nguyên (2018) Báo cáo kết quan trắc môi trường đợt năm 2018 Bệnh viện Lao Bệnh phổi Thái Nguyên Internet resource: Dalhousie University (2011) Waste Management Practices: Literature Review Retrieved from: https://cdn.dal.ca/content/dam/dalhousie/pdf/dept/sustainability/Waste%20Management %20Literature%20Review%20Final%20June%202011%20%281.49%20MB %29.pdf (accessed on July, 2018) Duong Thi Luyen (2012) Đánh giá trạng đề xuất số giải pháp quản lý rác thải y tế bệnh viện Đa khoa huyện Đại Từ-tỉnh Thái Nguyên Retrived from:http://luanvan.net.vn/luan-van/danh-gia-hien-trang-va-de-xuat-mot-sogiai-phap-quan-ly-rac-thai-y-te-tai-benh-vien-da-khoa-huyen-dai-tu-tinhthai-69539/(accessed on July, 2018) Selỗuk University, Konya, Turkey (2013) Hospital Solid Wastes and Its Effect on Environment Retrived from: 38 https://translate.google.com/#en/vi/Hospital%20Solid%20Wastes%20and%20Its% 20Effect%20on%20Environment (accessed on July, 2018) Journal of Applied and Industrial Sciences (2014) Assessment of Medical Solid Waste Management in Khartoum State Hospitals Retrived from: https://pdfs.semanticscholar.org/8d63/90f2fd1e0a593667b0930fd78713fdde6 f1a.pdf (accessed on July, 2018) Nguyen Van Tien (2013) Nghiên cứu quản lý chất thải rắn y tế bệnh viện Đa khoa Thành phố Vĩnh Yên, Tỉnh Vĩnh Phúc Retrived from: https://text.123doc.org/document/1347036-nghien-cuu-quan-ly-chat-thai-ran-yte-benh-vien-da-khoa-moi-thanh-pho-vinh-yen-tinh-vinh-phuc.htm (accessed on July, 2018) M Manzurul Hassan, Shafiul Azam Ahmed, K Anisur Rahman and Tarit Kanti Biswas (2008) Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh Retrived from: https://www.researchgate.net/publication/5629375_Pattern_of_medical_waste_manage ment_Existing_scenario_in_Dhaka_City_Bangladesh (accessed on July,2018) 39 Medical solid waste storage place The process of transferring solid waste to the environment company Solid waste bins Garbage bins on the cart of nurse The process of transporting waste from the place of origin to the place of storage Medical solid waste collection INTERVIEW QUESTIONS FOR HOSPITAL'S STAFF ABOUT MEDICAL SOLID WASTE MANAGEMENT (Based on your understanding of hospital waste management, answer questions and write X in the boxes.) Part I General information Name: Position: Part II Status of hospital waste management Do you have guidelines for the regulation of medical waste management issued by the Ministry of Health?  Yes  No If directed, who guides you?  Hospital  Environment company  Health service  Another one What is the current regulation on medical waste management in Vietnam?  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 of November 30, 2007, promulgating the Regulation on management medical wastes  Don’t know How many groups of medical waste according to the regulation of medical waste management?  groups  groups  groups  groups  groups  Don’t know Which the following groups of waste?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know Do you know the color coding rules for medical waste containers?  Yes  No -If you know then answer the following questions: What type of waste put in yellow packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know What type of waste put in black packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know What type of waste put in blue packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know What type of waste put in white packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know 10 Are cart of nurse fully equipped with a bag or box to collect waste?  Fully  Lack  Don’t have 11.Do you practice the classification of medical waste according to the regulations?  Yes  No 12 Do you guide for patient about color coding medical waste ?  Yes  No 13.Do you know that medical waste causes harm to human health and the environment?  Yes  No 14.What are the harmful effects of medical waste on the environment and human health?  Spread the disease  Arise insect pests  Cancer Affect the psychology  Injury caused by sharp objects Don’t know 15 Does the hospital have solid wastes storage area?  Yes  No 16 Are hazardous waste and normal waste stored in separate compartments?  Yes  No 17.Does the hospital have a contract for transporting and treating waste with any environmental company?  Yes  No Thank you! INTERVIEW QUESTIONS FOR PATIENT AND PATIENT’S FAMILY MEMBER (Based on your knowledge of hospital waste management activities, please answer the questions and fill X in the boxes.) Part I General information Name: Age: Part II Status of hospital waste management Do you have guidelines on hygienic conditions when you go to hospital?  Yes  No Do you know about waste management regulations issued by the Ministry of Health?  Yes  No Do you know about the color coding of medical packaging (bags, boxes)?  Yes  No What color of bags, trash bags are there at the clinic?  Blue  Black  Yellow  White What type of waste put in yellow packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know What type of waste put in black packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know What type of waste put in blue packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know What type of waste put in white packaging?  Clinical waste  Recycled waste  Radioactive waste  Sharp waste  Domestic waste  Hazardous chemical waste  Air pressure tank  Don’t know Does your room have regular daily garbage collection?  Yes  No 10 In the hospital, you put the garbage in the right place?  Yes  No 11.Do you think hospital waste has a negative impact on human health and the environment?  Yes  No Thank you! ... sustain the solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital 1.3 Research subject • Types of hazardous medical waste arising in Thai Nguyen Tuberculosis and Lung Disease. .. general hospital waste is broadly grouped into infectious waste and non-infectious waste Thai Nguyen Tuberculosis and Lung disease hospital – Tan Thinh Ward, Thai Nguyen City, Thai Nguyen Province Thai. .. these following questions: • How is status quo solid wastes in Thai Nguyen Tuberculosis and Lung disease hospital? • How solid wastes manage in Thai Nguyen Tuberculosis and Lung disease hospital?