ASSESSMENT OF STATUS MEDICAL WASTE MANAGEMENT AND TREATMENTIN 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 BA

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

Thai Nguyen University of Agriculture and Forestry

Degree Program Bachelor of Environmental Sciences and Management

Student Name Vu Lan Trang

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

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!

Student

Vũ Lan Trang

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

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

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

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

LIST OF ABBREVIATIONS

MONRE Ministry of Natural Resources and Environment

One member co., Ltd One Member Limited Liability Company

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

500 beds, with all the Department of Internal Medicine, Department of Surgery and Clinical Departments The number of patients examined on average is between 400-

500 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?

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

- 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

products under a new function or purpose

PART II LITERATURE REVIEW

2.1 Scientific base of the study

- Protection environment of Vietnam Law, 2005;

- Decide No.22/2006/Decide – MONRE dated December 18th , 2006 Ministry

of Natural Resources and Environment about compel application Vietnam environment standard;

- Decree No 59/2007/ Decree – Government dated April 09th , 2007 the Government of Socialist Republic of Vietnam about solid waste management;

- Circular No.13/2007/Circular - MOC dated December 31st , 2007 the Ministry

of Construction issued guidance some articles of Decree No.59/2007/Decree-The Government dated April 09th , 2007 the Government of Socialist Republic of Vietnam about solid waste management;

- Decide No 43/2007/Decide – MOH dated November 30th, 2007 Ministry of Health promulgate Regulations about medical waste management;

- Circular No.16/2009/Circular - MONRE dated October 7th, 2009 of the Ministry of Natural Resources and Environmental - Regulations on National technical regulations on the environment;

- Circular No.12/2011/Circulars - MONRE dated April 14th, 2011 Ministry of Natural Resources and Environment about hazardous waste management

- Circular No.31/2013/ Circular - MOH dated October 15th, 2013 of the Ministry of Health - Regulations about environmental impact observation from examination and treatment activities of the hospital

2.2 Theoretical base of the study

2.2.1 Classification of the medical waste

According to MONRE (2007), Medical wastes are classified into the following categories:

Infectious waste:

- Acuity waste (category A): this type of wastes can cause cuts or puncture, bacterial infections including: needles and syringes, surgical knife blade, saws, broken

glass pieces and other sharp items used in medical activities

- Un-sharp infection waste (category B): waste being soaked in blood or biological fluids of the body and generated from the isolation disease prevention

- Wastes with high risk of infection (category C): waste generated in laboratories such as specimens and other utensils thoroughly

- Waste from surgery (category D): including the tissues, organs, body parts, placentas and laboratory animal carcasses

Hazardous chemical waste:

Chemical and pharmaceutical waste generated from the tests, diagnosis activities includes: formaldehyde, photo-resist chemicals, solvents, ethylene, and

- Solid radioactive waste includes materials to be used in the laboratory, diagnosis, treatment, such as syringes, needles, safety goggles, waterproof paper, antiseptic swabs, test tubes, bottles of radioactive substances

- Liquid radioactive waste includes a solution containing radionuclide generated during the diagnosis as the patient's urine, ejector, and water washing of appliances containing radioactive substances

- Radioactive gases including gas used in 133C clinical, the gas escapes from storage of radioactive materials

Pressure tank

It is including oxygen, CO2, gas tanks These cylinders are inflammable or

explosive when burned

Ordinary waste

Ordinary waste does not typically contain infectious elements, hazardous

chemical, radioactive, flammable, explosion including:

- Domestic waste generated from the patients' rooms (except the isolation patients' rooms)

- Waste generated from the activities of a medical professional such as glass bottles, serum bottles, plastic materials, powders to bunch for broken bones These wastes not contaminated with blood, biological fluids and hazardous chemicals

- Waste generated from administrative work: newspapers, documents, packaging materials, plastic bags

- Surroundings waste: leaves and rubbish from the surrounding areas

2.2.2 Harmful effects of medical waste

In accordance with the older literature such as Jenny (2000), medical waste if not be well treatment, when it discharge into the environment may affect to human

health, cause major epidemics in the community

a People who are at high risk:

People who are at risk of disease due to medical waste are those who have regular personal contact with them They are usually located in the following groups:

- Doctors, nurses, health care personnel and hospital staffs

- Patients of the hospital or health care center

- Guests or family member of hospital or health care center

- Staff in the hospital, support services and health care centers such as laundry, transportation and waste treatment

- Employees working in the waste management facilities such as waste incinerators

b Harmful effects of infectious waste and acuity waste

With the diseases have infectious potentially, dangerous caused by virus like

highest risk of infection through wounds caused by sharp objects contaminated blood

of patients

The rate of lesions caused by sharp objects in medical waste and sanitation services within and outside the hospital causing has been registered with agency of toxins and diseases United States (ATSDR) assessment Many lesions caused by

needles before throw into the container, so the metal container is not closed or made of materials that easily torn or pierced ( LaGrega, 2010)

Table2.1 Some examples of infection due to contact with medical waste

Microorganism category of pathogenic and procedure infection

Genital infectious Neiserreria gonorrhoeac,

Anthrax

(perspiration, egesta) Meningitis Meningococcal ( Neisseria

Petechial fever Virus: junin, lassa, ebola,

Blood

Hepatitis B, C Hepatitis B, C virus Blood, body juice

( Prüss, 1999)

c Harmful effects of chemical waste and pharmaceutical

Many chemicals and pharmaceuticals used in health care facilities are the risk to human’s health such as the poisonous, the toxic gene, cell poisons, corrosives, reaction substances, explosion, anaphylactic shock It is frequently occupied a small amount of medical substances or sometimes with a high rate but in the form of drugs, biological are overdue, drug redundant or wears off should discard

It caused poisoning by acute exposure and chronic poisoning, caused damage such as burns The contamination may be the result of absorption of chemicals or pharmaceuticals through skin, mucous membrane, through the respiratory tract or gastrointestinal tract

Exposing with flammable substances, corrosive substances, reactive substances

(formaldehyde) and other volatile substances can cause damage to skin, eyes or

respiratory mucous membrane The most common injuries are different types of burns (Lien, 2009)

Disinfection chemical is a particularly important component of medical waste group in chemicals form It is often used in large quantities and usually corrosive substances It should also be noted that this is the kind of reactions chemical and also can be create a secondary mixture have highly toxic

Killing insect chemical overdue stored in the leak tank or puncture bag may be directly or indirectly affect the health of anyone exposed to it

The chemical products discharged directly into the sewage system can be detrimental to the operation of the wastewater treatment systems (the most is treatment

system by biotechnology) or cause toxic effects to natural ecosystems receiving this water The same problem can also occur due to the products of preparation medicine process including antibiotics and other drugs, heavy metals such as mercury, phenol and derivatives, the disinfectants chemical

d Harmful effects of radioactive waste:

The types of diseases caused by radioactive waste determined by the type, objects and scope of exposed The radioactive waste as well as pharmaceutical waste is a type of toxic effect to cell, genes, and may also affect the genetic factors Exposure to radioactive sources with high activity, such as the radiation source by diagnostics means such as X-ray machine, CT scanner, can cause a variety of lesions such as destroy the tissue, causing acute burns (with some serious cases, this can lead to the removal or amputation

of the affected body part)

e Harmful effects of medical waste

Wastewater from the medical facility is the place "supply" of pathogenic bacteria, especially wastewater from hospitals specializing in infectious diseases as well as infectious department of the hospital Wastewater is one of the basic factors that have the potential to spread of infectious diseases through the digestive tract

2.3 Current status of medical waste management in Vietnam

2.3.1 General situation

Currently, in Vietnam, there are 13,149 health care facilities, of which 30 health care facilities belong to the Ministry of Health, 12,259 health care facilities belong to provincial Department of Health and 860 other facilities (Lien, 2009) This is the primarily source of medical waste

According to the Department of Environmental Health Management, in 2010, each day nationwide the health care facilities discharged 380 tons of solid waste Of these, approximately 45 tons is hazardous medical waste Currently, the rate of medical waste increase is about 7.6% / year Estimates for 2020, the waste volume will double to about 800 tons / day

Table 2.2.Waste arising under the beds in Vietnam in 2012

medical waste

Hazardous

medical waste

(Department of Environmental Management, 2012)

Table 2.3 Distribution of medical waste by type of urban

In accordance with the older literature such as MONRE (2010), the amount of wastewater generated in the health care facilities is currently around 150,00m3/day, not mention to the amount of wastewater of Preventive Medicine institutions, the medical institutions and drug manufacturing The estimated amount for 2015 of medical wastewater will increase over 300,000 m3/day

Emission trends of medical waste:

Although the general total of medical waste discharged has not changed or just slightly increased, but the amount of hazardous medical waste must be treated specially to increases over time by two trends:

- Increasing use of disposable tools such as needle, pressing tongue, surgical gloves, catheters, cotton bandage

- Increasing the number of beds at the treatment facility from district level and equivalent or higher

Table 2.4 Comparison of medical waste generated in Vietnam with some

neighboring countries in 2012

Medical waste arises per capita/year (kg) 0.16 0.2 0.19

(Statistical data via the internet)

Comparing with other countries in ASEAN group, the amount of medical waste generated of Vietnam at lower levels in the region

The amount of medical waste tends to increase over time It is increase in both general medical waste and hazardous medical waste

Meanwhile, environmental of health issues are not adequate attention According to statistics from the Ministry of Health (2012), currently only about 44% hospitals have solid waste treatment system, but many places have fallen into disrepair Even in the central hospitals still 25% have no waste treatment system, corresponding to 50% and 60% in provincial and district hospitals

2.3.2 The process of collecting, sorting and transporting waste in the health care facilities

According to Tao (2002), waste generated in the health care facilities is divided into two categories: Domestic waste and medical waste

Laborer has responsible for the collect domestic waste daily at the facility and transport to gathering place of waste Health care facilities usually cooperation with the local urban environment company to collect and treat domestic waste

For the medical waste with high hazard usually have method of collecting, transporting separately This type of waste is packed in special bags:

- Waste from the patient’s room is packed in yellow plastic bag marked hazard symbol

bio The common of waste and cells poisonous are packed in blue plastic bags

- Chemical wastes and radioactive substances are packed in black plastic bag with special materials which are labeled indicating the waste resources

All type of wastes will be treated in the incinerator

2.3.3 Measures and technologies to treat hazardous medical waste

The general requirements:

- Making hazardous medical waste harmless for human health and environment

- Reducing the quantity

- Meet the requirements of economy and efficiency of socio-economic cycle

Principles for treatment of hazardous medical waste:

- None cause secondary pollution

- Within the general provisions on the management and treatment of waste, satisfy the environmental protection laws

Technology of treatment and destroy:

There are many methods and technologies to treat hazardous medical waste (Thuy, 2002) Some main technologies and solutions such as:

treatment many types of waste especially clinical waste This method can minimize the amount and volume of waste and completely destroy the pathogens in medical waste This method requires the high cost for initial investment, running and maintenance costs are relatively expensive

microorganisms can make waste safe in terms of microorganisms Chemicals usually used

include formaldehyde (HCHO); ethylene oxide (CH 2 O CH 2 ); glutaraldehyde (CHO-

lower costs for the original investment, operating costs expensive or not depending on the

type of chemical, some secondary pollution can happen from the residual chemicals The cost used for treatment medical waste in the industrialized countries around 100-120 USD/ ton

- Wet and dry thermal treatment technology: Using moist heat (autoclave) or

steaming dry (ovens) to kill bacteria at temperatures 121- 160oC Almost all pathogens are destroys at this temperature Advantage of this method is applicable to the case of very small quantities of waste and disadvantage of this method is poorly effective in minimizing both volume and weight

- Microwave irradiation technology: Microwave technology to treat hazardous

medical waste is a new technology and efficiency The modern equipment can treat about 250 kg/ hour approximate 3,000 tons/year This type of microwave often used source of electromagnetic radiation with ultra-high frequency from 2450 MHz, wavelength around 12.24cm The original cost is relatively expensive, but medical waste treated by this method, many materials can reuse as raw materials for inclusion

in the economic cycle

cheap operating costs, but it should only be undertaken when the authorities manage environmental permit and natural conditions suitable such as a large area, soil characteristics, characteristics of groundwater resources, far from residential areas

as cement and lime People usually mixing 65% hazardous medical waste, 15% lime, 15% cement and 5% water This mixture is compressed into chunks

Appropriate technology:

Treating and destroying the hazardous solid waste have many measures and technologies but there is no one technology that can be exhaustive in solving all aspects including modern incineration technology Towards a healthy environment and protect the public health, hazardous waste must be treated However, treatment technologies must rely on many factors, as well as the specific conditions of each region

This type of waste will be treated in the incinerator

PART III METHODS

3.1 Material

In oder to conducting the research, I collected data and documents in

2013-2014 from Department of Planning – Synthetic of Tuyen Quang General Hospital and Tuyen Quang Department of Natural Resources and Evironment

Interview the staffs and workers of hospital

Taking sample in the wastewater treatment system of Tuyen Quang General Hospital

- Tools:

4 Poly-ethylene plastic bottle 500ml

Glove, dipper, elastic, pen, paper

All sample bottles need to be cleaned with soap water, then washed carefully with clean water, rinsed with distilled water, before we take sample need to rinse by wastewater at least once times before take this sample

Samples were taken on October 16th , 2014 at 14:30 p.m

Conditions: Sunny, dry Temperature: 28 ° C

Table 3.1 Notation of sampling locations

1 NT1 Taking medical wastewater before treatment in concentrate tank

2 NT2 Taking medical wastewater in concentrate discharge points

3.2 Methods

3.3.1 Interview methodology in the field

Interview and assessment methodology is the method decisions the most effective of the research

Conducting the interview around hospital, department, corridors, the external area, warehouse insulation, incinerator area

3.3.2 Methods of analysis, synthesis document

Document analysis is the method to study document by analyzing them into each face, each department to understand the problem fully and comprehensively and

then select the important information for research

Synthesis method is a method to linking each face, each unit of information, from the theory was collected to create a new theory system completely and more deeply on research issue

Analyzing document ensures that fast and selective synthesis necessary information, synthesis help for more deeply analysis

- Collecting data from the staffs and faculties of Infection Control Department and Plan -Synthesis Department

- Collecting the rules and standards of medical solid waste, hazardous medical waste and domestic solid waste

- Gathering comments from teachers, professionals

- Collecting documents related to the concept of solid waste, hazardous medical waste

3.2.3 The sampling method of wastewater

Selection criteria analysis: Selection criteria specific to wastewater of hospital according to Vietnam Standards 28:2010/MONRE about quality of hospital wastewater

3.2.4 Experimental and analysis methods in the laboratory

Water samples were taken and stored, analyzed in accordance with Vietnam Standards (Vietnam Standards 5999: 1995) and according to the method in the laboratory

The method of taking and analysis of water samples can be presented as follows:

- Conducting take the samples

Samples were taken at the wastewater treatment system from the hospital is operating, each sample 1000ml (2 bottles)

Attached to the form must be clearly stated (date, time, name of the sample, weather conditions, location taken sample)

Preservation and transportation of samples: According to the Vietnam

Standard 5999: 1995

Transit time from the place taken sample to the laboratory as short as possible,

to avoid samples changing characteristics and components, especially for wastewater samples of hospital, it contained more microorganisms so easy to changes the characteristics

The preservation conditions depending on target analysis

Wastewater sample need to attack before analysis, this phase helps to separate the organic compounds unrelated to analysis in process, makes the analysis process more accurate The process of attack wastewater will be conducted on the 705 attack sample machine (set at 90oC during 45 minutes)

PART IV RESULTS

4.1 The overview of Tuyen Quang General Hospital

Tuyen Quang General Hospital was established in 1945 predecessor from the revolutionary policlinic of Tuyen Quang province

Tuyen Quang General Hospital is located in the center of Tuyen Quang city It belongs to Tan Ha ward, surrounded by a densely populated area and located in the main transport hub of the city, convenient traffic and transportation of patients to medical care Facilities of the hospital are improving The construction of the hospital

is constantly renovating, building or upgrading

Tuyen Quang General Hospital is a provincial hospital, have fully the Department of Internal Medicine, Department of Surgery, Clinical Departments Hospital is the clinics and treatment center of Tuyen Quang province with scale of 500 beds The number of patients examined averages between 500 to 600 cases/ day Percentage of bed occupancy reached 135% (Tuyen Quang General Hospital, 2013)

- Equipment and facilities for collection, transport, storage and treatment medical waste:

+ Tools to collect medical waste in the Clinical Departments, Subclinical Departments

+ Transship facilities the medical waste from Clinical Departments, Subclinical Departments to gathering zone of hospital

+ The gathering system, storage waste of hospital waste

+ Waste treatment station of hospital

4.1.1 Functions and tasks

It is a provincial hospital grade II, Tuyen Quang General Hospital has the

following functions and task:

a Emergency - Examination - Treatment

Receive all cases of patient from the outside or from other hospitals transfer to emergency, medical examination, treatment for inpatient and outpatient

Organize to health care and health certificates as prescribed by the State

It has responsibility to solve most of the disease in the provinces and cities directly under the Central Government and the sectors

Organize to examine the health, forensic examination when medical examiners council of province or law enforcement agencies referendum

Transfer patient to hospital in higher gland when has not afford solved

b Training medical staffs

Hospital is the practical facility for training medical staff in the tertiary and

intermediate level

Organize continuing medical education for members of hospital and down line

to upgrade the professional qualifications

c Scientific research in medicine

Organize research, collaborative research medicine projects at the State, Department or Installation level, focuses on research about traditional medicine combination with modern medicine and healing methods does not used drugs

It combines with the hospitals in higher gland and referral hospitals to development about the technical

d Directing the hospitals of down line about expertise, technical

Planning and directing the down line (Hospital Grade III) perform technical- expertise development

Combining with hospitals in down line implemented primary health care programs in the province area, city and sectors

e Disease prevention

Coordinate with preventive health facilities often performed the prevention and quarantine tasks

f Medical Economic Cooperation

Planning to uses budget effectively of the State Strictly implement the provisions

of the State about revenues, expenditures, gradually performed cost accounting

examination and treatment

Creating more fund sources from the health service such as user fees, health insurance, foreign investment and other economic organizations