luận văn thạc sĩ assessment of status medical waste management and treatment in tuyen quang general hospital

THAI NGUYEN UNIVERSITY
UNIVERSITY OF AGRICULTURE AND FORESTRY

VU LAN TRANG
TOPIC TITLE:
ASSESSMENT OF STATUS MEDICAL WASTE MANAGEMENT
AND TREATMENTIN TUYEN QUANG GENERAL HOSPITAL

BACHELOR THESIS

Study Mode : Full- time
Major

: Bachelor in Environmental Science and Management

Faculty

: International Training and Development Center

Batch

: K42- Advance Education Program

Thai Nguyen, 23/ 01/2015
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Thai Nguyen University of Agriculture and Forestry
Degree Program

Bachelor of Environmental Sciences and Management

Student Name

Vu Lan Trang

Student ID

DTN1053100118

Thesis Title

Assessment of status medical waste management and
treatment in Tuyen Quang General Hospital

Supervisor

Dr. Nguyen Hung Quang

Abstract:
Assessment and analyze the status of medical waste management in Tuyen
Quang General Hospital: Assess the classification, transportation, storage and
treatment of medical waste and wastewater generated in operation process of Tuyen
Quang General Hospital. Analyze and propose solutions: Causing of existence in the
management and treatment of medical waste in hospital. Solutions to improve the
management efficiency and treatment medical waste: Treating waste to improve the
efficiency for medical waste management in Tuyen Quang General Hospital.

Keywords

Medical

waste;

Hazardous

medical

waste;

waste

management; wastewater treatment system; Tuyen Quang;

Number of pages

59

Date of submission

23/01/2015

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ACKNOWLEDGMENT
With the consent of the Managing Board - Thai Nguyen University of

Agriculture and Forestry, International Training and Development Center, the
assistance and guidance of Dr. Nguyen Hung Quang. I conduct research with topic:
"Assessment of status medical waste management and treatment in Tuyen Quang
General Hospital"
In order to complete this thesis, firstly I would like to sincerely thank the
managing board of Thai Nguyen University of Agriculture and Forestry, International
Training and Development Center, thank teachers, who imparted to me the knowledge
and skills during the time I study and practice at Thai Nguyen University of
Agriculture and Forestry.
Especially, I would like to sincerely thank the enthusiastic help of Dr. Nguyen
Hung Quang who guided me during the time of graduation exercises to
implementation and complete this thesis.
I would like to thank the assistance of staffs who are working at Department of
Natural Resources and Environment of Tuyen Quang province, Environmental Protection
Agency has helped me during internships time, impart practical experience for me. I
would like to thank staff and officers at Tuyen Quang General Hospital who created the
best conditions for me to completed this thesis.
This is the first time I've implementation a thesis, due to knowledge of myself
and the time are limited, certainly in my thesis was shortcomings and restrictions. I
hope to receive feedback, comments and additions to my thesis complete and found
the exist shortcomings of myself.
I would like to sincerely thank!
Tuyen Quang, 23 rd January, 2015
Student

Vũ Lan Trang
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TABLE OF CONTENTS
LIST OF FIGURES.................................................................................................. 1
LIST OF TABLES.................................................................................................... 2
LIST OF ABBREVIATIONS................................................................................... 3
PART I. INTRODUCTION ..................................................................................... 4
1.1. Research rationale ....................................................................................... 4
1.2. Research’s objectives .................................................................................. 5
1.3. Research questions and hypotheses.............................................................. 5
1.4. Limitations .................................................................................................. 6
1.5. Definitions................................................................................................... 6
PART II.LITERATURE REVIEW ......................................................................... 8
2.1. Scientific base of the study .......................................................................... 8
2.2. Theoretical base of the study ....................................................................... 9
2.2.1. Classification of the medical waste........................................................... 9
2.2.2. Harmful effects of medical waste............................................................ 11
2.3. Current status of medical waste management in Vietnam .......................... 14
2.3.1. General situation..................................................................................... 14
2.3.2. The process of collecting, sorting and transporting waste in the health care
facilities .................................................................................................................... 18
2.3.3. Measures and technologies to treat hazardous medical waste.................. 19
PART III. METHODS ........................................................................................... 22
3.1. Material..................................................................................................... 22
3.2. Methods .................................................................................................... 23
3.3.1. Interview methodology in the field ......................................................... 23
3.3.2 Methods of analysis, synthesis document................................................. 23
3.2.3 The sampling method of wastewater........................................................ 24
3.2.4. Experimental and analysis methods in the laboratory.............................. 24
PART IV. RESULTS.............................................................................................. 26
4.1. The overview of Tuyen Quang General Hospital ....................................... 26

4.1.1. Functions and tasks................................................................................. 27

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4.2. Sources of waste and the methods to collect, classify and treat medical waste
in Tuyen Quang General Hospital............................................................................. 30
4.2.1. Common Solid Waste ............................................................................. 30
4.2.3. Hazardous waste..................................................................................... 32
4.2.3 .Wastewater............................................................................................. 35
4.2.3. Gas emission .......................................................................................... 40
4.3. Assessment the preliminary way of medical waste .................................... 47
4.3.1. Domestic waste ...................................................................................... 47
4.3.2. Hazardous medical waste........................................................................ 48
4.3.3. Wastewater............................................................................................. 49
4.4. Assessment the quality of wastewater in Tuyen Quang General Hospital .. 50
4.4.1. Sources of wastewater ............................................................................ 50
4.4.2. Result of observational, analysis............................................................. 51
4.5. Recommendation some solutions for collection and treatment activities of
medical waste in Tuyen Quang General Hospital...................................................... 53
4.5.1 Solution in the collection, storage and treatment of medical waste........... 53
4.5.2. Solutions for wastewater treatment system ............................................. 54
4.5.3. Management mission.............................................................................. 54

PART V. DISCUSSION AND CONCLUSION..................................................... 56
5.1. Discussion ................................................................................................. 56
5.1.1. Area and position of Tuyen Quang General Hospital .............................. 56
5.1.2. Status of waste management and treatment in hospital............................ 56
5.1.3. Results of the environmental research..................................................... 57
5.2. Conclusion ................................................................................................ 58
REFERENCES ....................................................................................................... 60

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LIST OF FIGURES
Figure 4.1.Organization chart of Tuyen Quang General Hospital.............................29
Figure 4.2. Hazardous medical waste generating trendy in 2013-2014 .....................34
Figure 4.3. Treatment technology of wastewater......................................................37
Figure 4.4. Preliminary way of domestic waste........................................................48
Figure 4.5. Preliminary way of Hazardous medical waste ........................................49
Figure 4.6. Preliminary way of wastewater ..............................................................50

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LIST OF TABLES
Table2.1. Some examples of infection due to contact with medical waste.
Microorganism category of pathogenic and procedure infection. ...............................12
Table 2.2.Waste arising under the beds in Vietnam in 2012 .......................................15
Table 2.3. Distribution of medical waste by type of urban .........................................16
Table 2.4. Comparison of medical waste generated in Vietnam with some neighboring
countries in 2012 .......................................................................................................17
Table 3.1. Notation of sampling locations..................................................................22
Table 4.1. List of hazardous waste generated an average of 01 month .......................32
at Tuyen Quang General Hospital ..............................................................................32
Table 4.2. Reality amount of hazardous medical waste in Tuyen Quang General
Hospitals....................................................................................................................33
Table 4.3. Time existence of some microorganisms ...................................................42
Table 4.4. Results of the wastewater target analysis of Tuyen Quang General Hospital .......51

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LIST OF ABBREVIATIONS
BOD5

The biochemical oxygen demand in 5 days.

COD

Chemical oxygen demand

MONRE

Ministry of Natural Resources and Environment

MOH

Ministry of Health

MOC

Ministry of Construction

One member co., Ltd

One Member Limited Liability Company

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PART I. INTRODUCTION
1.1. Research rationale
Caring, protecting and improving human's health is an important task of the
health sector. In order to adequately meet for medical examination and treatment and
health care demand of people, received the attention of the Party and State, medical
facility system have been continuously enhanced, expanded and improved. However,
during operation process, the health system, especially the hospital has discharged a
large amount of medical waste substances, including hazardous medical waste.
According to the World Health Organization (WHO, 1994), the components of
medical waste about 10% of the infection waste and 5% is noxious waste such as
radioactive, cytotoxic substances, toxic substances generated in the diagnosis and
treatment procedure. It is risk factors of environmental pollution, pathogens spread
from hospital to surroundings area, lead to increased risk of monomial infection and
increased disease incidence of local communities living in contiguous areas.
In order to assess the status of medical waste as well as the impact of medical
waste on the environment, they need to have research of the scientists and agencies.
Research has been showing that existed in the medical waste management in our
country. However currently, for many reasons, including the pressure on the need of
medical examination and treatment of people, the overload of many hospitals, lack of
uniformity in infrastructure of the hospital means environmental sanitation of many
hospitals is not guaranteed.
Tuyen Quang General Hospital is the provincial hospital. It is the medical
examination and treatment center of Tuyen Quang province. The scale of hospital is

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500 beds, with all the Department of Internal Medicine, Department of Surgery and
Clinical Departments. The number of patients examined on average is between 400500 cases/ day. The rate of bed occupancy often exceeds 100%. The hospital is located
in the city center where it is the largest concentration of population so that the
shortcomings in the management and treatment of medical waste will greatly affect to
surrounding communities.
Stemming from the above problems I conducted research topics “Assessment of
status medical waste management and treatment in Tuyen Quang General
Hospital”.
1.2. Research’s objectives
- Cursory review of Tuyen Quang General Hospital.
- Assessment of status medical waste management and treatment in Tuyen
Quang General Hospital.
- Propose solutions to increase the effect of medical waste management and
reduce pollution.
1.3. Research questions and hypotheses
- What is the current situation of medical waste management in Tuyen Quang
General Hospital?
- What is the way to treatment medical waste of Tuyen Quang General
Hospital?
- How do we can closely management the medical waste of Tuyen Quang

General Hospital?

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1.4. Limitations
The time is limited; I have only 4 months for research. So I choose this matter
in Tuyen Quang General Hospital to assess the status of management and treatment
mission.
Due to Tuyen Quang General Hospital located in convenient area with the high
population density and big scale of hospital so the assessment activities has limit.
1.5. Definitions
According to MONRE (2007), there are some definitions which are use in the
research:
- Medical waste is all waste materials generated at health care facilities, such as
hospitals, clinics, physician's offices, dental practices, blood banks, and veterinary
hospitals/clinics, as well as medical research facilities and laboratories.
- Hazardous waste is waste that is dangerous or potentially harmful to our
health or the environment. Hazardous wastes can be liquids, solids, gases, or sludges.
They can be discarded commercial products, like cleaning fluids or pesticides, or the
by-products of manufacturing processes.
- Hazardous medical waste management is controlled waste activities during
the process from waste generation to initial treatment, collection, transport, storage and

disposal of hazardous medical waste.
- Collecting is the separation, classification, collection, packing and temporary
storage of waste at the central location of medical facility.

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luan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospital


luan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospitalluan.van.thac.si.assessment.of.status.medical.waste.management.and.treatment.in.tuyen.quang.general.hospital

- Transportation is the process of transporting waste from the place generated
to place of initial treatment, storage and treatment.
- Preliminary treatment is the disinfection or sterilizing process of waste which
have high risk of infection near place waste generated before transportation to store or
destroy.
- Handling and treatment is the process of using the technology in order to lose
potentially of hazardous waste on human’s health and environment.
- Re-use is use a product several times until the end the life of products or use
products under a new function or purpose.
-Recycle is reproduction of discarded materials to a new product.

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