Về ô nhiễm rác thải y tế ở Việt Nam

H a n o i O c t o b e r 2 0 1 0 Group assignment Solutions for medical wastes in Vietnam Nguyen Thi Quynh Mai – 0851050049 Phạm Thanh Hải - 0851050064 P u b l i c e c o n o m i c s – L e c t u r e r : L y H o a n g P h u , M s c Group assignment Solutions for medical wastes in Vietnam Public economics Table of Contents What is medical waste ........................................................................... 2 Definition of medical wastes ................................................................ 2 Definition according to Wikipedia ..................................................... 2 Definition according to Ministry of Public Health of Vietnam ........... 2 Classification of medical wastes ........................................................... 2 Situation of medical wastes in Vietnam ................................................ 3 From solid wastes ................................................................................. 3 To liquid wastes .................................................................................... 4 Financial difficulties .............................................................................. 5 Solution of medical wastes in Vietnam.................................................. 6 Solutions for solid medical wastes ....................................................... 6 Solutions for liquid medical wastes ...................................................... 7 Solution for financial difficulties ........................................................... 8 Conclusion .............................................................................................. 8 Resources ............................................................................................... 9 Group assignment Solutions for medical wastes in Vietnam Public economics Solutions for medical wastes in Vietnam 1. What is medical waste? 1.1. Definition of medical wastes 1.1.1 Definition according to Wikipedia  Medical, known as clinical waste, normally refers to waste product that cannot be considered as general waste, produced from healthcare premises, such as hospital, clinics, doctors’ offices, labs and nursing homes.  Medical waste is solid and liquid waste created by diagnosing, treating or immunizing people or animals. It can also be the product of the research and testing of biological products. 1.1.2. Definition according to the Ministry of Public Health of Vietnam  Medical wastes are material in form of solid, liquid or gases which are eliminated from healthcare premises. Medical wastes include injurious medical wastes and common wastes.  Injurious medical wastes are medical wastes which contain factors that can harm man’s health and environment. Those factors should be easy-infectious, radioactive, inflammable, etc. 1.2. Classification of medical wastes 1.2.2. Infectious waste Infectious wastes can cause harm to people or the environment, and this category includes items such as bandages, surgical gloves, surgical instruments, needles and microbial dishes, cultures and cloths.  Sharp waste  Unsharp wastes Group assignment Solutions for medical wastes in Vietnam Public economics  Extremely infectious wastes  Surgical wastes 1.2.1. Hazardous chemical wastes  Expired medicine, low quality medicine  Harmful chemical factor in healthcare  Wastes harm cell  Wastes contain heavy metal 1.2.2. Radioactive wastes 1.2.3. Vessel contains pressure 1.2.4. General wastes  Life wastes  Wastes from medical activities do not contain blood, biological juice, etc.  Wastes from administrative activities  Surrounding wastes 2. Situation of medical wastes in Vietnam 2.2. From solid wastes… According to the report of Ministry of public health, up to 2005, there were about 1047 hospitals with 140,000 sick-beds and 10,000 medical stations. Out of 2.5 kg wastes eliminated from each sick-bed per day, 10-15% is harmful wastes, which include dressing of wounds, syringes, sharp matters, medicines, radioactive and parts of body removed after surgeries. Also from the Ministry of public health, 2/3 of all hospitals have not applied safety waste disposal methods. Most wastes have not been classified and disinfected before discharging. Store houses are non-standard, unsanitary and highly infectious. In some areas, medical wastes are urgent matters because there have been no places for wastes to be gathered even in provincial hospital level. Recent statistics show that in Thaibinh province, there were about 2,000 sick-beds which eliminated 1,000-3500 kg wastes per day. Out of them, 20% were harmful wastes. Most hospitals have used method of burring wastes in the precincts except hospitals which has Group assignment Solutions for medical wastes in Vietnam Public economics had manual incinerator. In other hospitals, the manual incinerator is burned and leaves an uncomfortable smell According to the “Regulation of medical waste management” of the Ministry of Public Health, medical waste must be treated immediately at once, contained in bag or barrel according to color and standard. In fact, in most hospitals, especially in private medical stations, they do not follow the regulations. There have been many sanitation workers dumping waste bags to roadsides. In particular, Hanoi has thousands of medical stations, making up about 2% of total wastes. Only 60 hospitals and medical centers have signed up for waste treatment contract with Hard Medical Waste Enterprise with the amount of 1.5 tons per day. The rest of these wastes, for some reasons, are still mixed with household waste and increased rapidly. More than 310 private medical stations have not taken responsibility for their wastes or followed the regulations. They quibble that the amount of waste eliminated was too low or they did not know where to dispose it. One of the most dangerous problems is that tons of medicine covers, plastic infusion tubes, cylinder, etc. instead of being processed from many hospitals in Hanoi, especially Viet-Duc hospital, have been sold to scrap purchasers. On the 10th of August, when inspecting a truck which was going to the scrap purchased place in Hanoi, the Department of Natural Resources and Environment protection detected 60 bags of medical wastes which weighed about 700 kg. These bags contained medicine covers, plastic infusion tubes and cylinders. This truck started from Viet-Duc hospital. At the same time, they also detected a truck which contained 16 bags of medical wastes (300 kg) running from Viet-Duc hospital to Hoan Kiem district. The truck drivers declared that they bought wastes from Viet-Duc hospital at the price of 6,000 VND per kilogram for plastic, 1,500 VND per kilogram for small glass bottle. From 2002 to 2007, there were about 300 tons of medical wastes sold from Vietduc hospital to scrap purchasers and all of them were sold to manufacture appliances. 2.3. To liquid wastes Liquid wastes should be ranked the first in term of toxicity because of huge amount of germs and bacteria. Most hospitals have only focused on processing hard waste by incinerator Group assignment Solutions for medical wastes in Vietnam Public economics systems. Liquid wastes of hospitals include liquid wastes originating from the operation activities of the patients, liquid wastes from laboratories, water closets, etc. Besides the common factors such as organic substance or bacterium, liquid wastes contain dirty mineral substances, disinfectants and radioactiveness. Liquid wastes spread very fast because of bacteria, especially liquid wastes from infectious hospitals. For liquid wastes, all they have done is collecting them. It is very dangerous that out of the total liquid wastes, 20% are harmful wastes. If cancer treatment medicines or their metabolic products are eliminated without being treated, they will cause monstrosity or expose cancer to people. According to the Medical Institute of Labor and Environment Sanitation, the level of pollution of liquid wastes in hospitals was 20,000 times more than standard. According to the report of the Ministry of Public Health, out of all hospitals, only 1/3 has liquid wastes treatment system. Most small hospitals do not have specialized units operating liquid wastes treatment plant. Liquid waste systems are not effective because hospitals are lacking of money or systems are below-standard. In Ho Chi Minh city, there have been about 130 hospitals, medical stations which eliminate 17,000m3 of liquid wastes per day. Out of them, 43 hospitals have below-standard- processing systems and 39 hospitals do not have processing systems. Besides, there have been thousands of private medical stations whose treatments are out of control of supervisory. 2.4. Financial difficulties Up to April 2003, 61 hospitals in Vietnam (7%) had incinerators. Most incinerators were very expensive. They operated erratically and inefficiently. Incinerators ran only 1-2 times per week because of high cost operation. Some hospitals had Korean incinerators but they rarely used them as they did not have treatment system. Some Vietnamese factories tried manufacturing incinerators but either they could not apply in reality or incinerators were inefficient. The abatement cost of treating one kilogram of solid medical waste is 8,000vnd on average and that of for liquid wastes is about 5,000VND/m3, which is too high for the financial condition of our hospitals. Meanwhile, for each kilogram of selling medical wastes to the private recyclers, the seller receives about 6,000vnd. The opportunity cost of treating Group assignment Solutions for medical wastes in Vietnam Public economics one kilogram of medical waste is up to 14,000vn. For that reason, hardly anyone wants to tradeoff between a better environment with high cost and a much higher profit. 3. Solution of medical wastes in Vietnam 3.1 Solutions for solid medical wastes The government should promote the programme of managing the treatment of medical wastes by allocating more and more supervisors for the 4 processes of containment, collecting, transporting and treating in wastes centres. Firstly, in the process of waste classification in hospitals, there should be more strict regulations and supervisions. It is shown that out of 400 tons of medical wastes, there are 50 tons that are dangerous and non-recyclable. This means that about 87% of medical wastes can be recycled without harming the community’s health. Moreover, the initial plastics for producing medical equipment are pure and high quality ones such as macromolecular compounds, therefore, these wastes can be recycled efficiently. If classification steps are managed properly, the abatement cost for treating wastes will reduce significantly. This will alleviate the problem of high abatement cost in almost every hospital in our country. The government can control these by setting the regulations for classification of medical wastes, such as “medical waste should be required to be stored in airtight containers placed in cool, dark places such as refrigerators. The lid on the containers should be leak-proof and unable to be punctured, and the container should be labeled appropriately and indicated to be a biohazard material” etc. In addition to that, there should be one department in each hospital responsible for managing the waste classification instead of relying on “Urban Environment” companies. This makes them more committed to the quality of these tasks. Secondly, in the process of transporting wastes, the pickups should be supervised to ensure whether the total weight of wastes is constant before and after being carried out of the hospital or not. In addition, there should be reports delivered from the hospital to the waste- treating companies for the sake of transparency. Thirdly, for the treatment process of recyclable and non-recyclable medical wastes, supervision should also be enhanced. For non-recyclable wastes, The Ministry of Public Group assignment Solutions for medical wastes in Vietnam Public economics Health, together with Ministry of Science, Technology and Environment, Ministry of Planning and Investment, have invested the matter in various hospitals and submitted the project of constructing “the centre of waste treatment” for hospitals in Vietnam, especially in cities. Therefore, dangerous and contaminated medical wastes can be collected for treatment in one centre. This would reduce the problems of illegally selling the wastes out. Incinerators, equipment and many devices will be upgraded or replaced. By that way, these centres will contribute to separating the normal wastes from medical wastes and treat them in special ways. For recyclable wastes, the government should ban enterprises from producing housewares, personal belongings and medical supplies. Those who produce allowed products should be force to either upgrade technology or exit from the recycling and producing process. The government can control these by issuing the permit, which is handed out to enterprises only when they meet the standard criteria. By that way, only qualified enterprises have the rights to produce and sell medical-waste-recycling-products. The community awareness of the danger of medical wastes should be raised through various ways, ranging from propaganda, education and dissemination of information. Having acknowledged the jeopardy of medical wastes, everyone, especially the medical staffs, who sold out the wastes illegally, and the collectors of these wastes, will gradually manage their actions. The one who violates the regulations should be severely penalized, especially by financial fines. The fines would be equal or more than the profit from wastes’ sales or waste disposal. This will serve to prevent potential commitments and contribute to the budget for medical waste treatment. 3.2. Solutions for medical liquid wastes Liquid medical wastes can be treated much more easily by using one of the latest technologies – Biofast – a kind of machine for filtering liquid wastes. Biofast are outstanding because of its effectiveness and efficiency. Biofast operates automatically; therefore, it reduces the man-made mistakes during the operation. Secondly, it uses ozone diffusing devices, which save time by 10-fold in comparison with the non-ozone diffusers. Moreover, Biofast can entirely deodorize and Group assignment Solutions for medical wastes in Vietnam Public economics remove poisonous gases. The computerized automations in observing, management and operation will reduce the possibility of occupational accidents and promote the transparency and effectiveness of the whole system. As Biofast uses solar energy for its operations, it reduces the expenses of energy. Biofast uses automatic ozone creators, which saves the labour from mixing components. Therefore, it reduces the operating costs and saves the operating areas by 70%. Moreover, as Biofast are domestic productions, its price is much more reasonable for domestic demands. 3.3. Solutions for financial difficulties A large national budget should be spent for hospitals in Vietnam for the procurement of modern solid waste incinerators, replacing the old and inefficient ones used at the moment. At first, the expenses could be rather expensive but it will be weighed up by the abatement cost saved and the sustainability of living environment. The fund for these projects should be partly extracted from National budget and partly raised from the environment taxes levied on the patients or using hospital services. In addition, the hospitals themselves have to extract about 1% of their revenue for investment in waste- treatment-systems. Research and Development projects should also be invested in to find out the best technologies for reducing abatement cost and increasing the effect and efficiency of medical waste treatments. 4. Conclusion Medical waste disposals are becoming more and more of a hotly debated issue in our country nowadays because of its hazardousness and complexity. The government should promote community awareness, support financial difficulties and use various methods and criteria for treating both solid and liquid medical wastes in order to alleviate the problems of medical wastes disposal. Group assignment Solutions for medical wastes in Vietnam Public economics 5. Resources ly%E2%80%9D-phan-phoi-vi-trung.html QD43-2007-BYT: