Assessment of medical waste management and treatment status in thai nguyen hospital of traditional medicine

THAI NGUYEN UNIVERSITY THAI NGUYEN UNIVERSITY OF AGRICULTURE AND FORESTRY NGUYEN THI NGOC THUY TOPIC TITLE: “ASSESSMENT OF MEDICAL WASTE MANAGEMENT AND TREATMENT STATUS IN THAI NGUYEN

THAI NGUYEN UNIVERSITY

THAI NGUYEN UNIVERSITY OF AGRICULTURE AND FORESTRY

NGUYEN THI NGOC THUY TOPIC TITLE:

“ASSESSMENT OF MEDICAL WASTE MANAGEMENT

AND TREATMENT STATUS IN THAI NGUYEN HOSPITAL

OF TRADITIONAL MEDICINE”

BACHELOR THESIS

Study Mode : Full- time

Major : Bachelor in Environmental Science and Management Faculty : International Training and Development Centre Batch : K43- Advance Education Program

Thai Nguyen, October 2015

DOCUMENTATION PAGE WITH ABSTRACT

Thai Nguyen University of Agriculture and Forestry

Degree Program Bachelor of Environmental Science and Management

Student name Nguyen Thi Ngoc Thuy

Student ID DTN1153040143

Thesis Title Assessment of medical waste management and treatment status in

Thai Nguyen Hospital of Traditional Medicine

Supervisor PhD Ho Ngoc Son

Conclusion, this hospital is becoming more and more complete day by day thanks to the management and the assistance of hospital authorities as well as the relevant agencies

Keys Words Medical waste, hazardous waste, treatment, solution

Number of Pages 45

Date of

Submission:

30/9/2015 Supervisor’s

signature

ACKNOWLEDGMENT

I would like to express my gratitude to my supervisor, Dr Ho Ngoc Son for his invaluable useful comments, remarks, encouragement and engagement through the learning process of this graduated thesis I sincerely thank Mr Duong Van Hung who helps me a lot when I work as trainee in Centre for Observation and Environmental Technology Thai Nguyen I also thank the support of Thai Nguyen University of Agriculture and Forestry, the coordinators and program managers for their support and assistance

I am using this opportunity to express my gratitude to my classmates, who supported me throughout this course, by their aspiring guidance, invaluably constructive criticism and friendly advice I am sincerely grateful to them for sharing their truthful and illuminating views on a number of issues related to my thesis

Also, I like to thank the participants in my survey, who have willingly shared their precious time during the process of interviewing I would like to thank my loved ones, who have supported me throughout entire process, both by keeping me harmonious and helping me putting pieces together

Thank you all very much!

Sincerely yours,

TABLE OF CONTENT

LIST OF TABLES 1

PART I INTRODUCTION 2

1.1 Research rationale 2

1.2 Research’s objective 3

1.3 Research questions and hypotheses 3

1.4 Limitations 4

1.5 Definitions 4

PART II LITERATURE REVIEW 5

2.1 Generation sources and medical waste classification 5

2.1.1 Clinical waste 5

2.1.2 Radioactive waste 5

2.1.3 Chemical waste 6

2.1.4 Tank pressure 7

2.1.5 Domestic waste 7

2.2 The origin arising, composition and properties of medical waste 7

2.2.1 Origins arising 7

2.2.2 Composition of hospital wastewater 9

2.3 Influence of medical waste on the environment and public health 11

2.3.1 Harmful effects, the risk of medical waste on the environment and public health 11

2.3.2 Influence of medical waste in Viet Nam 12

2.4 Situation collection and processing of medical waste in the world and Vietnam

14

2.4.1 Status of collection of medical waste in the World 14

2.4.2 Current situation and management of medical waste treatment in Vietnam 15 2.5 Current situation and management of medical waste treatment in Thai Nguyen 20

2.5.1 Forms solid waste collected at the health facility 21

2.5.2 The status of the equipment collected, transported medical waste 22

2.6 Medical waste treatment methods 23

2.6.1 Furnace technology 23

2.6.2 Technology Oven 23

2.6.3 Chemical sterilization 24

2.6.4 Dealing with microwave technology 24

2.6.5 Handling of biotechnology 24

2.6.6 Treated with radioactive substances 25

PART III METHODS 26

3.1 Subject 26

3.2 Research design 26

3.3 Research contents 26

3.4 Research methods 26

3.4.1 Secondary data collection methods 26

3.4.2 Questionnaire and Interview methods 27

3.4.3 Analyzing, synthesizing and assessing data methods 27

PART IV: RESULT 28

4.1 The current status of medical waste in Thai Nguyen Hospital of traditional medicine 28

4.1.1 Origins incurred hospital waste 28

4.1.2 Status of collection, classification, storage, transportation and disposal of solid waste in hospital 29

4.2 Understanding of staff, patients on the medical waste management of hospital 29 4.2.1 For hospital staff 30

4.2.2 For patients and patients' family 31

4.3 Proposed solutions for the collection, handling medical waste in Traditional Medicine Hospital Thai Nguyen 32

4.3.1 Solutions for Environmental Management 32

4.3.2 Solutions to improve the sorting, collection, transport 34

PART V DISCUSSION AND CONCLUSION 35

5.1 Discussion 35

5.2 Conclusion 36

REFERENCES 37 APPENDICES

LIST OF TABLES

Table 2.1 Classification of medical waste 8

Table 2.2 Composition of hospital wastewater 9

Table 2.3 The bacteria isolated in hospital wastewater 10

Table 2.4 Sanitary norms in hospital wastewater before and after treatment with biological methods 11

Table 2.5 The volume of medical waste in hospitals hazards of some provinces 16

Table 2.6 The amount of waste generated at the hospital department 17

Table 2.7 Composition of solid waste from hospitals 17

Table 4.1 Understanding the regulation medical waste management 30

Table 4.2 Understanding the color code utensils 30

Table 4.3 Understanding the management of hospital waste 32

PART I INTRODUCTION

1.1 Research rationale

The most vital mission of Health Ministry is supervision, protection and health development for people Today, to meet a demand of the increase of medical examination and health care, the system of medical facilities more and more strengthen, extend and become be perfect However, during operation, health systems, especially hospitals, discharged a huge amount of endanger waste According to WHO, components of hospital waste have about 10% septic waste, 5% toxic waste such as radioactive substances, cytotoxic substances, harmful chemicals generated during the diagnosis and treatment disease, these factors are caused environmental pollution, spread germs from hospitals to surroundings It leads to increases the risk of nosocomial infection and the illness rate of communities living in adjacent areas Vietnam's population is increasing, and economic development, that led to the need and treatment increases, the number of patients increased too According to statistics of Health Ministry, there are about 1050 hospitals, more than 10 thousand commune health stations apart from Research Institute, Preventive Medicine Centre, and the pharmaceutical manufacturing facilities Since 1997, the text of hospital waste management are issued, but most of the hospital waste is not managed in accordance with a closely regulation Environmental pollutions are caused by the activities that the actual health status is less effective treatment of hospital waste These facilities emitted huge amount of garbage, solid waste is more than 400 tons per year (Health

Ministry, 2007) However, only 1/3 amount of waste is burned with modern electric oven, 2/3 of them is burned outdoor, by craft ovens, buried in the grounds of the hospital or exhausted in general landfill It is a culprit of the pollution of environment

In addition, the interaction with medical waste can cause sickness or injury The medical waste may contain infectious elements, which are toxic substances contained

in medical waste, chemicals and pharmaceuticals dangerous, radioactive waste and sharps All employees who exposed to hazardous medical waste can put their health

at risk, include those who work in the health facilities, work in medical waste collection and those in communities exposed to waste due to errors in the waste management process

Starting from the actual situation and requirements of the collection and processing of medical waste in hospitals, the research topic: “Assessment of Medical Waste Management and Treatment status in Thai Nguyen Hospital of Traditional Medicine - Thai Nguyen city” was conducted in Thai Nguyen city

1.3 Research questions and hypotheses

- What is the status of medical waste in Thai Nguyen Hospital of Traditional Medicine?

- Evaluation of understanding of staff’s hospital, patients on the medical waste management of the hospital

- What are solutions to manage domestic waste in study area?

1.4 Limitations

The study cannot include all the management issues and treatment of medical waste in Thai Nguyen Hospital of Traditional Medicine Because of the short time studies, the thesis was restricted by many factors in the survey and investigated process about the garbage in the study area

1.5 Definitions

Medical waste is material in solid, liquid and gas, which discharged from the

medical facility including hazardous medical waste and common waste

Hazardous medical waste is medical waste containing hazardous for human

health and the environment as infectious, poisonous, radioactive, flammable, explosive, corrosive or properties other hazardous waste if it is not safe destruction

Management of hazardous waste is activities related to the prevention,

mitigation, delineation, classification, direct reuse, temporary storage, transportation and disposal of hazardous waste

Management of medical waste management activities is sorting, initial

processing, collection, transportation, storage, reduction, reuse, recycling, treatment and disposal of medical waste and inspects and supervises the implementation

PART II LITERATURE REVIEW

2.1 Generation sources and medical waste classification

2.1.1 Clinical waste

- Group A: the contaminated waste, including blood absorbent materials, absorbent service, the excreta of an infected person like gauze, cotton, gloves, bags, blood transfusion, the catheters, wires and fluid bags saved

- Group B: the sharps, including needles, scalpel blades and personnel, syringes, broken glass and all materials that can cause cuts and puncture whether they can infected or not infected

- Group C: waste is highly infectious risk, arising from the laboratory, including: gloves, glass slides, test tubes, and swabs after testing, blood bags

- Group D: pharmaceutical wastes, including overdue Pharmaceuticals, pharmaceutical contamination, spillage, pharmaceuticals no longer needs to use cytotoxic drugs

- Group E: Were the tissues, organs of people and animals, including all body tissues, organs, limbs, placentas, foetuses, dead animals/[5]

2.1.2 Radioactive waste

Radioactive waste is that individual activities like radioactive substances At the health facility, radioactive wastes are arising from the operation diagnosis, chemotherapy, and research Radioactive waste is including solid waste, liquid and gas

- Solid radioactive waste, including materials used in the tests, diagnosis, treatment, such as antiseptic swabs, test tubes, bottles radioactive substances

- Liquid radioactive wastes, including: solutions containing radionuclides generated during the diagnosis and treatment of diseases such as urine, excrement, and rinse water containing the radioactive instruments

- Radioactive waste gas, including clinical gases The gas released from the radioactive material storage/[5]

2.1.3 Chemical waste

Chemical waste includes solid waste, liquid and gas Wastes in medical establishments are classified into two categories: waste non-hazardous chemicals such as sugars, fatty acids, some inorganic salt, organic and hazardous chemical wastes include:

- Formaldehyde is used in surgery, dialysis, embalming and preserving the samples in a number of other departments

- Photochemical substances are included in the fixed solution and coated film, silver

+ The chemical mixture: include cleaning solutions and disinfectants such as phenols, lubricants, cleaning solvents, ethanol, methanol, and acid/[5]

2.1.4 Tank pressure

The medical facilities often have the pressure gas cylinders as pitchers O2, CO2, gas tanks and gas cylinders content disposable These cylinders are flammable and explosive when burned, so be collected separately/[5]

2.1.5 Domestic waste

Domestic waste is waste not contain infectious elements, hazardous chemical, radioactive, flammable, and explosive, including: Domestic waste from the wards (except isolation wards); waste arising from the activities of medical professionals such as glass bottles, bottles of serum, the plastic material, the type cast in closed fractures These wastes are not stained with blood, biological fluids and hazardous chemicals; waste arising from the administrative work: paper, newspapers, documents, packing materials, cartons, plastic bags, film bags; external waste: leaves and debris from the external sector/[5]

2.2 The origin arising, composition and properties of medical waste

2.2.1 Origins arising

According to the Regulation on Medical Waste Management (Health Ministry), the medical waste as material in solid, liquid and gas, was discharged from the medical facility including medical waste and hazardous substances ordinary waste

Hazardous medical waste is medical waste containing hazardous for human health and the environment as infectious, poisonous, radioactive, flammable, explosive, corrosive or risk characteristics other harmful if these wastes are not completely destroyed

Table 2.1 Classification of medical waste

- Solid waste

hazardous medical

- Sharp infectious waste (needles, sharp head of service line, surgical blades, surgical nails, saws, syringes, broken glass and other sharp objects),

- Infectious waste is not sharp (cotton, bandages, gauze); Waste at risk of infection (clinical and pathological stick utensils);

- Anatomical wastes (tissues, organs, human body parts, placentas, foetuses);

- Hazardous chemical waste (pharmaceuticals overdue and degraded inability to use, harmful chemicals used in healthcare),

- Waste containing heavy metals (mercury from thermometers, blood pressure gauges rupture)

- Non-hazardous

waste

+ Domestic waste arising from the ward (except isolation wards) + Waste arising from the activities of medical professionals (bottles, glass jars, bottles of serum, the plastic material, the fracture type cast in secret These wastes are not stained with blood, biological fluids and hazardous chemical substances); waste arising from the administrative work (paper, newspapers, documents, plastic bags ); external waste (leaves, trash in the external sector)

2.2.2 Composition of hospital wastewater

Hospital waste water except conventional pollution as waste water of civil servants, of the patient, the patient's home, the floor mop water, septic tank of the treatment area (organic pollution), and water in the rainy season can arise chemicals contaminated in the process of diagnosis and treatment of diseases such as medicines, disinfectants, radioactive isotopes, the test area, the operating room Besides, hazardous hospital waste in terms of sanitation by hospital wastewater containing bacteria, pathogenic protozoa, worm eggs, the virus From blood, serum, sputum, the faeces of an infected person

Table 2.2 Composition of hospital wastewater

Domestic wastewater of patients, family members of patients, visitors and staff officers in hospital Detergents Salts of higher fatty acids Hospital laundries

- The chemical mixture comprises the cleaning and disinfection

- Medicines used for patients

- Use in pathological surgery, sterilization, embalming and storage use patterns in a number

streptococcus, gastrointestinal virus, poliovirus, parasite infection, amoebae and fungi

There is blood, bacterial ooze, sputum, faeces of an infected person

(Source: Ministry of Health and Construction Project 2007) [9]

General assessment of hospital wastewater in Vietnam, the research results of Nguyen Xuan Nguyen and his colleagues (National Steering Committee to provide clean water and sanitation) shows that for the provincial hospital jaw of suspended solids in the effluent at the average, high dissolved oxygen, small ammonium nitrogen levels But total coliform in hospital wastewater is very high Most of the indicators of the wastewater exceeded permissible standards, 1 multiplied indicators Medical wastewater unpasteurized before being discharged into the sewage system as a whole Hospital wastewater discharged untreated into waterways will pollute and do spread disease Most provincial hospitals are concentrated in densely populated areas, thus easily spread disease quickly

Table 2.3 The bacteria isolated in hospital wastewater

Table 2.4 Sanitary norms in hospital wastewater before and after treatment with

biological methods

treatment

After treatment

Performance (%)

(Source: Phung Thi Thanh Tu, 2009)[4]

2.3 Influence of medical waste on the environment and public health

2.3.1 Harmful effects, the risk of medical waste on the environment and public health

Medical waste is waste containing pathogenic organisms, toxic substances such

as chemicals, cytotoxic all radioactive substances Epidemiological studies around the world have proven, the hospital waste have major impact on health personnel, health workers, community medical waste if not managed properly These pathogens can invade the human body through: skin (through punctures, abrasions or cuts on the skin), the lining (mucosa), respiratory tract (by inhalation, inhalation), gastrointestinal, indirect effects caused by environmental pollution, or exposure to the intermediary agents like flies, mosquitoes, rats All those who come into contact with hazardous medical waste is subject to there risk of being affected by medical waste, including doctors, nurses, orderlies; Patients inpatient or outpatient; visitors or patients' relatives;

those directly involved in the handling of waste in the garbage dumps or incinerators For collectors, rubbish collectors

The risk of disease is medical waste gastrointestinal diseases caused by cholera, dysentery, typhoid, worm eggs; Respiratory tract infections caused by tuberculosis bacteria by faulty bridge; occupational injury; skin infections; anthrax; HIV / AIDS; sepsis; type of liver disease, neurological diseases; toxic, corrosive, explosive

2.3.2 Influence of medical waste in Viet Nam

a) The impact of medical waste on the environment: studies show that environmental pollution in our country is mainly water and air environment

According to documents collected by Tran, T.M.T (2006): a survey of medical waste management in some suburbs of Hanoi Hospital of Bui Van Truong, Nguyen Tat Ha (1998) shows: wastewater targets as COD, BOD5, NH4, coliform and Faecal coliform contamination levels in heavy than standard allows The bacteria can cause illness isolated from drinking water, wastewater, and air and using her specialty in the hospital mainly intestinal bacteria

b) Impact of economic waste to public health

The study in Vietnam showed the big impact of medical waste to the community around the hospital but no depth studies evaluated the impact of the state of knowledge

of medical waste in health people exposed to medical waste

Dao Ngoc Phong and his colleagues (2006) study of environmental pollution and the possibility of transmission from hospital wastewater caused in Hanoi showed that many patients significant surges in residential areas exposed to effluent particularly hospital gastrointestinal diseases/[1]

For health: exposure to medical waste can cause illness or injury to the body caused by sharp objects (such as needles) Sharp objects will not only cause cuts, stab, but also cause infection if the wound is infected sharps pathogens Thus the sharp objects here are considered, as waste is very dangerous because it hurts dual (both hurting just cause infectious diseases such as hepatitis B, HIV )

Moreover, in the medical waste containing infectious pathogens such as staphylococcus, hepatitis B, HIV These agents can penetrate into the body through scratches; stain penetration, through mucosa, inhalation (inhalation), gastrointestinal-tract (by swallowing or ingestion) Hospital wastewater is a place to "deliver" the pathogenic bacteria, especially wastewater from the hospital specializing in infectious diseases as well as in the departments of the hospital infection The wastewater is one

of the basic factors that have the potential to spread infectious diseases through the digestive tract Especially it was dangerous when sewage infected with the bacteria that can lead to diseases to humans and animals through the water when using this water for irrigation purposes, dining

- If the collection, sorting and disposal of medical wastes no guarantee that will affect public health and the people most directly exposed to the waste

- For the environment: As the medical waste is not properly disposed of (landfilled, burned no regulations, standards) will lead to environmental pollution, soil, water and air pollution and this will impact directly or indirectly to human health and ecosystems/[9]

- To avoid the dangers of medical waste for human health, the environment, and

to protect those who are constantly exposed to medical waste, the health sector must invest more interested working again for Medical waste treatment

2.4 Situation collection and processing of medical waste in the world and Vietnam

2.4.1 Status of collection of medical waste in the World

The volume of medical waste generated varies by geographical area, seasonally and depends on objective factors such as disease patterns, disease, illness, number of beds, methods and practices used by medical personnel in work and treatment, patient care and the patient's waste in the wards

Following the recommendations of the WHO (1992) in the developing countries may classify medical waste into the following categories: non-toxic substances (including municipal waste is not contaminated wastes risk factors), sharp waste (infectious or non-infectious) contaminated waste (other than sharps infection), chemical waste and pharmaceuticals (excluding toxic drugs with global hunger cell), other hazardous waste (radioactive waste, the toxic drug to the cell, the gas cylinders

of high pressure

According to the WHO, 18-64% has no health facility waste disposal measures properly At the health facility 12.5% of workers waste needle stick hurt occurs in the processing of medical waste This lesion is also the occupational exposure to blood is the most common, mainly using metal hands and collecting assembly sharps disposal, around 50% of hospitals surveyed transporting medicine waste pregnant patients go through areas that were not put in the car tank with a lid

Worldwide, hospital waste management is many countries interested in and conducts a thorough so long On management, a series of policy provisions, were issued to strictly control this waste International treaties, principles, laws and

regulations on hazardous waste, including hospital waste has also been recognized and implemented in most countries around the world

The Basel Convention: Originally signed by over 100 countries, the regulations

on the transport of hazardous substances across the border, simultaneously applied, both with medical waste This Convention lays down the principle only lawful transportation of hazardous waste from countries without conditions and appropriate technology to countries with technical and material conditions for the safe handling some special wastes special

Polluter pay’s principles: Clearly state everyone, all the organs that discharge

waste must be removed responsibility for law and finance in ensuring safe and keeping clean environment

Proximity’s principles: Provides that the disposal of hazardous wastes should be carried out immediately in which they arise as soon as possible Avoid waste being stored for long periods of environmental pollutants

Waste hospitals, depending on economic conditions and the science and technology, many countries around the world have different ways to handle this type

of hazardous waste

2.4.2 Current situation and management of medical waste treatment in Vietnam

Currently, there are 1,511 health care establishments with 200,000 beds and treatment, not to mention the private health sector has about 701 health facilities from clinic to clinic operations/[10]

Quantity and medical network is so big compared with other countries in the region, but the problem of environmental hygiene, waste treatment at the facility from the central to local levels is still too weak, almost no systematic waste or garbage, a few places but have not yet reached operational and technical requirements

With such health networks, medical solid waste volume generated nationally is 11 800-tones/ day Of which was about 900 tones of hazardous medical waste According

to Prof Nguyen Huy Nga, Director of Environmental Management in Health/[2] in our country, in about 95% of medical waste is collected only 70% is processed by method burned in incinerators Burning technology is being adopted widely, but usually only the small furnace, no exhaust treatment system in jeopardy This leads to serious consequences, especially persistent substances (POPs), substances hazardous to health, carcinogens such as dioxin, furan Also, cost quite waste incineration high, around 80,000 VND/ kg waste and ordinary hospital very few hospitals have the capacity to emit enough gas after a few days of the new furnace should be destroyed once Each time the combustion process must be carried out again, consuming no energy from burning continuously while costs are not included in hospital charges/[2]

Table 2.5 The volume of medical waste in hospitals hazards of some provinces Province,

Haiphong 570 Ho Chi Minh City 4730

Phu-Tho 70 Dong Nai 180

Can Tho 110 Binh Duong 368

Ha Noi 410 Ba Ria Vung Tau 288

Quang Ninh 190 Thai Nguyen 215

Hung Yen 73 Hai Duong 132

(Source: Environmental Status Report of the provinces across the country)

Table 2.6 The amount of waste generated at the hospital department

Faculty The total volume of waste

generated (kg / bed / day)

The total amount of hazardous medical waste (kg /bed/day)

Central

Hospital

Province Hospital

District Hospital Average

Central Hospital

Province Hospital

District Hospital Resuscitation 1.08 1.27 1.00 0.30 0.31 0.18 Internal

Medicine 0.64 0.47 0.45 0.04 0.03 0.02 Paediatrics 0.50 0.41 0.45 0.04 0.05 0.02 Surgery 1.01 0.87 0.73 0.26 0.21 0.17 Obstetrics 0.82 0.95 0.74 0.21 0.22 0.17 Eye / Ear Nose

& Throat 0.66 0.68 0.34 0.12 0.10 0.08 Subclinical 0.11 0.10 0.08 0.03 0.03 0.03

(Source: Ministry of Health - Planning the management of medical waste, 2009)[8]

Table 2.7 Composition of solid waste from hospitals

Composition Classification

Domestic waste (crust, leaves, fruits admit ) 26.8- 40

Paper packaging of all kinds 3.0- 9.84

The proportion of hazardous waste (t / m3) 0.12- 12:16

Humidity of hazardous waste (%) 38.2- 40.5

Ash of hazardous waste (%) 12.5- 15.6

Calorific value (Kcal / kg) 2400- 3200

(Source: Nguyen Thi Kim Thai, 2007)[3]

Many environmental experts have warned if medical wastes are managed and handled property process will result in a risk to the environment and public health

In Hanoi, where many large hospitals, healthcare institution network dense, environmental health work much longer exists Most of the premises have no waste disposal system Some facilities have a capacity of treatment plants but little unsatisfactory Many medical facilities in operation are not registered examination working environment, no garbage collection registered with authorities, making it difficult to control/[2]

Another concern was the National Office for Radiation and Nuclear Safety, the Ministry of Health and Department of Environmental Crime test shows: The use of radiation equipment like X-ray machine is done in most large hospitals, but not to ensure safety for patients while 90% of the radiation dose that people receive from artificial sources is due to medical irradiation The country has more than 2,000 X-ray facility, but to 55% studio not guarantee shielding, 70% unqualified size and plenty of room to capture radiation levels exceeded the permitted limit of 2.5 times/[2]

That's not to mention the excreta of the X-ray have also caused great harm to the people around, if not strictly controlled Only a few hospitals have control of modern radiation sources like Bach Mai Hospital, National Cancer Institute, the Hue Central Hospital, Phu Tho General Hospital (HCMC), etc It is almost not neck This according to medical experts, the harmful effects of radiation exposure is long term

consequences may stop working as bone marrow, weight loss, blood poisoning, infertility, cancer, etc /[2]

* Waste management:

92.5% of hospitals have regular garbage collection, 14% of hospital medical waste separation for disposal But from the scientific waste classification and treatment clinic patients have not become popular Most solid waste in hospitals is not processed before landfilling or incineration A few hospitals have medical incinerators, but too old or open-pit burning environmental pollutants

* Classification of medical waste:

Most of the hospital which sort waste at the source do not only the classification

of partial but also ineffective because staff have not been trained

* Medical Waste collection:

As a rule, medical waste and municipal waste is the public health nurse and collected daily at the departments Other entities such as physicians, nurses have not been trained to participate in the management of medical waste The general condition

is that the hospital does not have adequate protective clothing and other protective equipment for staff directly involved in the collection, transportation and disposal of waste

* Medical waste storage:

Most of the focus points are located on the campus garbage hospital hygiene is not guaranteed, there is more risk of losses due to sharp objects scattered, many insects from entering the environment affects hospital Some focus points not covered trash,

no protective barrier, located near commuter, who do not have easy infiltration mission

* Transporting waste outside medical facilities:

Employees of urban environmental company to collect the bags of hospital waste, does not have the specialized vehicles for the transport of hospital waste Both hospital staff and employees urban environment have not been training, guidance on the risk related to the collection, transportation and disposal of waste

2.5 Current situation and management of medical waste treatment in Thai Nguyen

Thai Nguyen province has 21 health units including 01 central unit managing the Central Hospital, 11 provincial management units and 9-health facilities management district (excluding commune health stations) The total amount of solid waste generated in the health unit is 6187 kg / day, in which the proportion of hazardous waste accounted for 9.6% of the total volume of solid waste generated For the district health facility, the volume of daily solid wastes that approximately 1233 kg / day, representing 20% of the solid waste generated in the health units across the province Hazardous solid waste health at the district health unit is about 58 kg / day, representing approximately 4.7% of the total waste generated by the district health unit/[3]

Household waste provincial level is: accounting for 82.82% 2.8880kg Medical waste is 445,1kg ratio is 12.79% occupied cabinets Hazardous medical waste is 2.05% Recycled garbage accounted for 2.04% and others 0.3% Domestic waste is 756kg district proportion of 80.16% Medical waste is 95kg percentage is 10.07% Hazardous medical waste accounts for 2.97% Waste recycling percentage 5.02% and