Nguyen Thu Huyk vd Dtg Tap chi KHOA HOC & CONG NGHE 120(06) 147 152 CONG TAC QUAN LY CHAT THAI RAN Y TE TAI BENH VIEN DA KHOA TRUNG U*ONG THAI NGUYEN Nguyen Thu Huyen*, Nguyin Thi Nham Tuat Trudng Dgi[.]
Trang 1CONG TAC QUAN LY CHAT THAI RAN Y TE
TAI BENH VIEN DA KHOA TRUNG U*ONG THAI NGUYEN
Nguyen Thu Huyen*, Nguyin Thi Nham Tuat
Trudng Dgi hgc Khoa hgc - DH Thai Nguyen
TOMTAT
Bai bao da dua ra cong tac quan ly chat thai ran y te tai benh vien Da khoa Trung uong Thai phap mang tinh nguyen tac niiim khac phuc nhibig ton tai ciia benh vien trong viec quan ly chat thai ran y te Nghiem ngat thuc hien phan loai tai noi phat sinh, thu gom, van chuyen, luu giii va xii ly chat thai ran y te theo Quy che quan ly chat thai y te - Quyet dinh so 43/2007/QD-BYT, De xuat ap dung cong nghe khit khuan bang thiet bj vi song trong dieu kien ap suat thudng nham giam thieu lugng chat thai lay nhiem phai thieu hiiy dem lai Igi ich kinh te va gop phan bao ve moi trudng cho benh vien
Tu khoa: Chdt thdi ran y ti nguy hgi, chdt thdiy ti phong xa nhiim khudn, khu khudn, mdi trudng
DAT VAN DE
Hien nay, sy phat trien cua cac ca sd y te da
va dang gdp phan lam tang hieu qua trong
viec cham sdc, bao ve siic khde cua nhan dan
Day la nhiing tin hieu dang mimg song neu
nhin tir gdc do mdi trudng Ihi sy phat trien
cua cac ca sd y le lai dang ldn tai nhieu lo
ngai do la van de quan ly chat thai y le
(CTYT) Nhiing anh hudng tir CTYT ndi
chung va chat thai rSn y te (CTRYT) ndi
rieng den con ngudi va mdi trudng la rat khd
ludng Irude
Duge thanh lap tir nam 1951, Benh vien Da
khoa Tmng uang Thai Nguyen la benh vien
h^ng I tryc thugc Bg Y Te, cd nhiem vu kham
chiia benh va bao ve siie khoe cho nhan dan
cac dan tdc khu vuc mien nui phia Ddng Bac,
Benh vien ddng tren dja ban trung tam tinh
Thai Nguyen, la trung lam dao tao can bd y le
cho cac linh mien niii phia Bac, la co sd thuc
hanh chinh ciia cac trudng Y duge Irong tinh
Nhan thiie duge miic do nguy hiem tir cac
CTYT, Benh vien khdng the khong quan tam
den van de nay Chinh vi vay, de lai nghien
cihi "Cdng tdc qudn ly CTRYT tai benh vien
Ba khoa Trung uang Thdi Nguyen " lao eg
scr cho nhiing de xuat de cai thien dieu kien
ve sinh mdi irudng benh vien
Tel- 0914 569251 Email huyenntdhkh@gmail.coin
NQl DUNG, PHUONG PHAP NGHIEN CUU
Noi dung nghien cihi
- Nghien ciiu hien trang CTRYT tai benh vien
Da khoa Trung uang Thai Nguyen (thanh phan, sd lugng phat sinh)
- Tim hieu cdng tac quan ly CTRYT, dae biel
la eac CTRYT nguy hai tai benh vien Da khoa Trung uang Thai Nguyen (phan loai, van chuyen, luu giii va xir ly chat thai)
- De xuat mdt sd giai phap trong quan ly CTRYT tai benh vien
Phirong phap nghien cihi
- Phuang phap thu Ihap, tdng hgp lai lieu
- Phuang phap khao sal Ihuc dia
- Phugng phap phdng van
- Phucmg phap thdng ke loan hgc KET QUA NGHIEN CUU
Thu-c trang quan ly CTRYT tai benh vien
He thong qudn ly CTRYT
He thong kiem soat nhilm khuan (KSNK) ndi chung va he thdng quan ly CTRYT (dac biet
la quan ly CTRYT nguy hai) ctia benh vien ndi rieng duge Ihiel lap tao eg sd cho viec quan ly cac chat thai ran cua benh vien (duac the hien d hinh 1)
Nguon phdt sinh CTRYT
CTR ciia benh vien gdm: CTRYT nguy hai, CTR sinh boat, CTR tai che
Trang 2Cac CTRYT nguy hai cua benh vien phai sinh
Irong cac boat ddng kham vii dieu tri cho
ngudi benh nhu: bom kim tiem, bdng bang
Tuy nhien, cd nhiing loai chat thai nguy hai
mang dac thu ctia khoa CTRYT thdng
thudng va chat thai lai che phat sinh trong cac
hoat ddng chuyen mdn, sinh hoat va tir nhieu
ngudn khae nhau Ty le CTRYT duge the
hien qua bang 1
Bang V.Tyli cdc chdt thai rdn trong binh viin
T
T
1
2
3
Chat thai
CTR thong
thirang
CTRYT
nguy hai
Chat thai tai
che
T o n s
Khoi
iirffng
(Kg/thane)
95.300
3.750
1.050
loo.ioo
T y l e (%)
95,20
3,75
1,05
100
Cong
nlian thu
gom-chuyen va
xuly
Nhan
vien
giam
sat
Nhan
vieny
te cac
khoa,
phong
Cong nhan (Thu gom, van chuyen)
Hinh \.Sadd he thong qudn ly CTRYT tgi Benh
vien Da khoa Trung uang Thai Nguyen
Qudn ly CTRYT nguy hai
CTRYT nguy hai la mgt phan trong loan bg luong CTR ctia benh vien Thanh ph3n va s6 lugng CTRYT nguy hai duge the hien d bang
2 Cdng tac phan loai, thu gam, luu giir va xir
ly CTRYT duge Ihuc hien nghiem liic, dung quy dinh va cd su kiem tra thudng xuyen
Phdn loai, thu gom tai cdc khoa phong
- Doi vdi chat thai lay nhiem thugc cac dang:
+ Chat thai sac nhgn nhu kim tiem, manh thuy linh vd duge cho vao chai nhua cd dung dich khu khuan Presepl 1% hoac Cloramin B 2% + Cac chat thai nhu bdng bang, gae, cac benh phdm, bam tiem (da bd kim) duge cho vao liii mau vang
- Doi vdi cac chat hoa hgc nguy hai, chat phong xa:
+ Cac chat thai ran cd lien quan den phdng xa
se duge nhan vien tai Khoa cho vao tiii mau den rdi mang ra be chua chai thai phdng xa + Cac vo chai, lo Ihudc chiia cac chat ddc hga hgc tai cac khoa nhu Klioa U budu, Khoa Tam than ciing se duge nhan vien thu gom vao tlii mau den
Thu gom, van chuyen
Cac chat thai sau khi duge phan loai, thu gom
se duge de trong cac thimg dat d dau eac khoa, phdng Cac thimg mau vang tir 120 - 140 lit, co ghi "THUNG BO RAC Y TE" va bi6u lu'gng Thung mau den 140 lit, ben ngoai cd ghi
"THUNG DUNG RAC NGUY HAI" dat chu yeu tai khoa U budu, khoa Y hgc hat nhan Cac Ihiing dung chat thai se duge cdng nhan ihu gom ciia Cdng ty ICT van chuyen ve nha de rae cua benh vien Thdi gian thuc hien 2 lan/ngay; budi sang tir lOhOO - 10b30 va budi chieu tir 15h30-16b00
Liru giu
Do khdi lugng chat thai cd linh phdng xa
khdng nhieu nen duge luu giii 3 thang lai hk
chiia chat thai phdng xa sau dd mang di xu ly nhu chat thai nguy hai khac (trong dd cd ch5t boa hgc nguy hai)
y
Trang 3Bang 2: Thdnh phdn vdsd lugng CTRYT nguy hgi cua benh vien
trung binh trong 6 thdng ddu nam 2013 (kg/thdng)
1 Chat thai sac nhon Kg
2 Chit thai ngi^ ca lay nhilm Kg
3 Chat thai giai phlu Kg
4 Duge phAm k^m chdt lugng Kg
5 Cac san pham gay dgc t& bao Kg
6 Pin Doi
7 Bong den huynh quang Chi^c
Tong khoi lugng Kg
28,7 Cae khoa 3.691,9 Cac khoa 28,1 Khoa giai phau benh, khoa vi sinh 0,3 Khoa Duge
I Cac khoa
20 Cac khoa
50 Cac khoa 3.750
Benh vien xay dyng nha de rae tir nam 1990 de
ehiia CTR thdng thudng va CTRYT nguy hai
Hang ngay, edng nhan Cdng ty ICT van chuyen
cac chat thai den nha de rac Chat thai duge luu
giii t?i day eho ddn cudi ngay se duge edng
nhan Cdng ty CPMT & CT do tiij Thai Nguyen
den bag gdi va mang di xu ly
- Xir ly ban dau: CTR duge xii ly ban dau
ngay tai cac khoa, phdng Ddi vdi chat thai
nhu: lam kinh vd, dng lay mau benh pham
duge hip udt d 31 "C trong 15 phiit
Cac CTR cd lien quan dgn phdng xa se duge
Ihu gom vao tiii den ngay lai khoa
Cac chai nhua dyng djch truySn va day truyin
CO dinh mau duge ngam trong dung djch
Javen 10% it nhit 30 phiit
- Xir ly, tieu hiiy: Lugng CTRYT nguy hai se
duge Cdng ty CPMT & CT dd thi Thai
Nguyen van ehuyen lir nha de rac benh vien
di xii ly tai bai rac Da Mai ciia tinh
Qudn ly chdt thdi thong ihir&ng vd chdt thdi
tdi che
Doi vdi ehat thai r^n thdng thudng trong benh
vi?n bao gdm chat thai ran tir sinh hoat cua benh
nhan ngudi nha, nhan vien ciia benh vien; chat
thai ngogi eanh se duge phan loai va thu gom
rieng biel vdi CTRYT nguy hai
Tir nam 2010 benh vien chi dao khoa Duge
va khga KSNK cimg ket hgp Ihuc hien Ihu
hoi cac chai nhua dyng djeh truyen, chai Ig
thuy tinh khdng chiia cac Ihanh phin nguy
hgi; giay bao; bia, thimg cation vdi khdi
lugng khoang 500kg/thang Cac chit thai nay
duge eac khoa mang len khoa KSNK va phai
ki xac nh^n sd lugng tra
Nhihig tdn tai trong quan ly CTRYT tai benh vien
Benh vien da thuc hien kha day dii eae quy dinh vS quan ly CTRYT theo quy chl, dac biet la CTRYT nguy hai Tuy nhien, cdn ton tai mdt sd han che sau:
- Cac khoa, phdng hau hel deu cd bang hudng dSn each phan loai, thu gom chSt thai ran Tuy nhien, bang nay thudng dat d phdng hanh chinh eiia cac khoa hoac luu trong cap lai lieu [2]
- Benh vien cd nha luu giir CTRYT nguy h^i
va CTR sinh hoat chung ChSt thai rin edn dung day trong cac tui ni long va thimg ehira day trudc khi van chuyen [2]
- Benh vien chua quan lam trang bi cho cac khoa hop dyng chat thai sic nhgn theo quy dinh Hien tai, hop dung chat thai sic nhgn duge thdng nhat lam bang Inox va cd dan nhan.[2]
- CTRYT duge phan loai tuang doi Idt tir cae khoa Nhung van cd hien tugng ngudi nha benh nhan trong qua trinh cham sdc da tu thao bdng, bang de vao thimg chua chat thai ran sinh hoat
Cae ton tai ndi tren xuat phat tir nguyen nhan do thilu phuang tien thu gom, van chuyen ehal thai
va kien thiic phan loai cGng nhu y thirc ciia nhuTig ngudi thue hien
Mgt so giai phap quan ly CTRYT
Da cd the quan ly tot CTRYT he thdng quan
ly CTRYT tai B?nh vien Da khoa Trung uong Thai Nguyen can duge Ihyc hi?n nghiem ngai theo quy trinh tai hinh 2
Trang 4C T R Y T b e n h vien d u g e p h a n loai tai k h o a
thanh ba loai C T R k h d n g n g u y h a i , C T R Y T
nguy hai va C T R tai che Sau d o , C T R k h d n g
nguy hai d u g e d u n g trong tiii m a n x a n h d e m
di c h d n lap C T R n g u y hai d y n g trong tiii m a u
v a n g m a n g di thieu dot v a tro ciing d u g e c h d n
lap Cdn C T R tai c h e d u g e t h u g o m va b a n
cho cac c a sd
V d i viec thiel lap h e t h d n g tren se g d p p h a n
vach rd h u d n g quan ly C T R Y T ciia b e n h
vien Hien nay, c d n g tac q u a n ly C T R Y T ciia
benh vien van tdn tail m d t s o h a n c h e , k h d
khan V i vay h o a t d g n g ciia h e t h d n g q u a n ly
d u a ra se g d p p h a n m a n g lai hieu q u a sau:
Giii gin v e sinh mdi t r u d n g b e n h vien, n a n g
cao chat l u g n g c h a m sdc b e n h n h a n , g d p p h a n
giam thieu nhiing nil ro trong n g h e n g h i e p ;
H e thdng di v a o h o a t d d n g tao r a nhirng
h u d n g rd rang va t a g e g s d trong viec q u a n ly
triet d e va an toan l u g n g C R T Y T ciia b e n h
vien; G i a m chi p h i trong q u a n ly C R T Y T
thdng q u a viec b a n tai c h e v a g i a m thieu rac
p h a i sinh tir d o giam l u g n g rac d e m thieu huy
D a y la md hinh p h u h g p d e c a e b e n h vien
khac Irong tinh n d i c h u n g va tren dja b a n
thanh p h d Thai N g u y e n ndi rieng t h u c hien,
gdp p h i n giu gin v e sinh m d i t r u d n g v a cai
thien siic khde n g u d i dan trong tinh
Hien nay, B e n h vien D a khoa T r u n g u a n g
Thai N g u y e n d a n g xii ly chat thai rSn y \.i
theo p h u a n g p h a p thieu ddt b i n g Id d o t Hoval
M Z 4 B g K h o a h g c vii C d n g n g h e c u n g da
ban hanh cac tieu chuan cd lien q u a n den Id
ddt n h u : T C V N 6 5 6 0 - 2 0 0 5 : "Khi thai 16 d 6 l
chat thai ran y te - Gidi han cho p h e p v a m g t
sd tieu chuan k h a c v e cac p h u g n g p h a p x a c
dinh cac chat d n h i e m trong khi thai, thay lh6
cho cac lieu chuan b a n h a n h n a m 2 0 0 4 " T u y
v i y , viec kiem soat k h i thai Id d d i va nhiel dg
b u d n g dot cdn gap n h i e u k h d k h a n d o cd m g l
sd chi tieu hien n a y n h u d o n d n g dg dioxin
phai gui m i u ra n u d c ngoai v d i chi p h i rat cao
(khoang 2 nghin U S D / m a u xet n g h i e m
dioxin) L d dot chat thai y te ciing p h a i smh ra
dioxin va thuy n g i n
150
Nguon phat sinh CTRYT
Phan loai tai chd (khoa, phdng )
CTR khong nguy hai (tlii mau xanh)
CTRYT nguy hai (dii mau vang)
Thu gom (hg ly, cong nhan)
Thu gom (hd ly, cdng nhan )
CTRYT
tai che
Thu gom (ho ly, cong nhan)
Bai rac
Da Mai
Thieu huy (16 d6t)
Xii ly so bo, khu khuan
Tro dot
Tai che, tai sir dung
Hinh 2 Hi thdng qudn ly CTR YT tgi Binh vien
Da khoa Trung ucmg Thdi Nguyin
V i e c ap d u n g c a c c o n g n g h e thay th6 cho
c d n g n g h e d d t la rat c a n thiet, phii h g p vdi xu
h u d n g c h u n g cua I h l gidi, t h y c hien cac cam ket g i a m p h a t thai cac chat d n h i l m hiiu co
k h d p h a n hiiy d e b a o v e m d i t n r d n g va siic
k h d e c o n n g u d i
H i e n n a y , B e n h v i e n D a k h o a T n m g u o n g Thai N g u y e n d a n g tiSn h a n h d u an xir ly
C T R Y T n g u y h a i b S n g c d n g n g h e khii
k h u i n se m a n g lai n h i e u Igi ich \t kinh t£,
mdi t r u d n g v a q u a n ly vi chi p h i d i u t u va van h a n h re h o n p h u a n g p h a p thieu ddt Cdng
n g h e k h u k h u a n k h d n g p h a t sinh khi thai dgc hai (dac biet la dioxin v a fijran), k h d n g phat sinh tro xi d d c hai chiia k i m loai n a n g va c h i t thai sau khi k h i i k h u i n d u g e c h d n l i p n h u ehat thai t h d n g t h u d n g B e n h vien cd the kiem
s o i l chat I u g n g khii k h u i n vi cd k h o a vi sinh
se t h u a n lien va k h a thi h a n so v d i viec kiem soat khi thai Id dot chat thai r i n y te
C o n g n g h e k h d n g dot se tieu diet vi k h u i n
m i m b e n h Irong chat thai y tg lay n h i l m
Trang 5Chdi thdi Idy nhiem + khu/tiet khudn = chdt
thai khong con khd ndng Idy nhiim
Cong nghe khong ddt hien nay cd nhieu loai:
Cdng nghe hda hgc, cdng nghe vi sinh, cdng
nghe nhiet khd va cdng nghe nhiel im (cdng
nghe hap udt, cdng nghe vi sdng kel hgp hoi
nudc bao hda d ap suat thugng, edng nghe vi
song kel hgp hai nudc bao hda d ap suit cao)
Tir nam 2010, tai Viet Nam cd khoang 18 he
thdng xu ly chat thai y le bang cdng nghe
khdng ddt duge dau tu va van hanh Trong
do, chi ed 2 he thdng duge dau lu cdng nghe
hap udt nhung den nay vin hgat ddng eim
chtrng Cdn lai 16 he thong deu dung cdng
nghe vi sdng va da chiing minh duge hieu qua
nhal dinh
Loai Ihiel bi cong nghe vi sdng ket hgp hgi
nudc bao hda ap suat cao khdng cd loai cdng
suat phil hgp vdi benh vien da khoa TW Thai
Nguyen Cong suit loai nay chi d mirc toi da
20 kg/gid van hanh Nhu vay, de xir ly hel
lugng chat thai y le ciia benh vien Ihl 1 Ihiel
bi phai van hanh 10 gid (tuang lai co the la 13
gig) Se can 2 thiet bj loai nay (van hanh 5 - 6
gig mdi ngay) dc van hanh hgp ly Tuy nhien,
rat kho do miic dau lu rat Idn
Cong nghe ap suat d dieu kien ap suit thudng
CO nhieu lya chgn hgn ve cdng suit xu ly (10
- 35 kg/me) va duge su dung d nhieu nudc
tren the gidi nhu My, Canada, mdt sd nudc
ehau Au va chau A khac Chi phi diu tu thiet
bi cong nghe khir khuan bang vi sdng ap suat
thudng Ihap ban loai ap sual cao Chinh vi
viiy, Benh vien Da khoa Trung uang Thai
Nguyen da lya chgn trang bi be thdng xu ly
CTRYT lay nhiem bang cdng nghe vi sdng ap
suit thudng
Ben canh do benli vien can thyc hien mdt so
giai phap sau:
- Trang bi day dii phuang Uen, trang thiet bi
phpc vu cdng tac quan ly CRTYT
- Tien hanh thudng xuyen cong tac kiem tra,
giam sat lir khau phan loai, thu gom den xii ly
CTRYT dac bict la cac CTRYT nguy hai
- Xay dung ke hoach tap huan, ning cao nhan thiic ve y nghia cua viec quan ly CTRYT cho toan the nhan vien y le, nhan vien ve sinh, sirih vien Dac biel, can tuan Ihii ehal che eac quy dinh Irong Quyet dinh 43/2007/QDBYT ve quy che Quan ly chat thai y te
- Cd ke hoach dieu chjnh sd lugng tiii, loai tui, kich cd tlii va thimg eho phu hgp vdi Iugng chat thai phat sinh d cac khoa khac nhau
- Quan ly chat che cac ngudn phdng xa, hoa chat, duge phim khdng de phat tan ra mdi Irutmgben ngoai
KET LUAN Cong lac quan ly CTRYT lai Benh vien Da khoa Trung ugng Thai Nguyen duge thyc hien kha tdt ve phin loai va xu ly eae chat thai ran, dac biet la CTRYT nguy hai Tuy nhien, trong qua Irinh quan ly van cdn cd nhiing sai sdt mang tinh chii quan (y thiic cua nhiing ngudi tryc tiep thyc hien viee phan loai, thu gom ) va ca tinh khach quan (cdng nghe xii ly CRTYT, sy thieu hieu biet eua nhirng ngudi khong lien quan tryc liep nhu' benh nhin, ngudi eham sdc )
De cd duge ket qui tot can phai ke den sy quan lam cua Ban lanh dao benh vien, eae Cdng ty lien quan ciing nhu viee luan thu cac quy dinh, quy che ciia loan bg nhan vien y le, cong nhin ve sinh
Hien nay, Benh vien da lua chgn trang bi he thdng xii ly CTRYT lay nbilm bang edng nghe vi sdng ap suit thudng
TAI LIEU THAM KHAO
1 Bg Y tl, Quyat dinh 43/2007/QDBYT - Quy chl quan ly chit thai y te ngay 30/11/2007
2 Bg Y te, Bdo cdo kit qud quan trdc vd mdi tnrdng benh vien Da khoa Trung uang Thdi Nguyin, 2012
3 Bo Y tl, (2013) Bdo cdo kinh ti ky thudt nhiem vu bdo vi mdi trudng, Du dn hd trg trang bi he thdng
xu ly chdt thdi rdn y ti lay nhiem bdng cdng ngh^ khong ddt tai da khoa trung uang Thdi Nguyen
4 Bo Y tl, (2013) Hudng ddn cdng nghi khdng ddt xir ly chdt thai rdn y ti Du dn hd trg xir ly chdi thai benh viin
Trang 65 Benh vien Da khoa Tmng ucmg Thai Nguyen, 6 Benh vien Da khoa Trung uofng Thai Nguyen,
Bdo cdo qudn ly chdt ihdi nguy hai vd chdt thai Ho sa ddng kv chu ngudn chdt thdi nguy hgi, khac 6 thdng dau ndm 2013 22/11/2012
S U M M A R Y
T H E M A N A G E M E N T O F M E D I C A L S O L I D W A S T E
A T T H A I N G U Y E N I N T H E C E N T R A L H O P I T A L
Nguyen Thu Huyen Nguyen Thi Nham Tuat
College qf Sciences - TNU
This article about medical solid waste management in Thai Nguyen National General Hospital, particularly the management of hazardous medical solid wastes Based on the actual conditions and proposed some principal solutions to settle some existing problems on medical solid waste management Strictly classify the medical solid waste at sources, collection, transportation and storage according to the Decision No 43/2007/QD-BYT dated November 30, 2007 of the Vietnam- Ministry of Health promulgating the Regulation on management of medical sohd wastes normal pressure conditions in order to reduce the amount of infectious wastes must be treated to bring economic benefits and improve environmental protection in the hospital
Key words; hazardous medical solid waste, radioactive medical waste, infection, disinfection,
environment
Ngdy nhdn bdi 13/2/2014, Ngdyphdn biin:20/2/2014; Ngdy duy^i ddng: 09/6/2014
Phdn bien khoa hoc: TS Ngd Vdn Gidi - Trudng Dat hoc Khoa hgc - DHTN
Tel- 0914 569251 Emad huyenni.dhkh@gmail a