Situation of generation and management of medical solid waste at some central and provincial hospital in 2015-2016

To describe the situation of generation and management of medical solid waste at some hospitals in Vietnam from 2015 to 2016. Methods: Retrospective studies had analyzed over 92 hospitals.

SITUATION OF GENERATION AND MANAGEMENT OF MEDICAL SOLID WASTE AT SOME CENTRAL AND

PROVINCIAL HOSPITAL IN 2015 - 2016

Dam Thuong Thuong 1 ; Nguyen Thanh Ha 2 ; Tran Van Tuan 3

SUMMARY

Objectives: To describe the situation of generation and management of medical solid waste

at some hospitals in Vietnam from 2015 to 2016 Methods: Retrospective studies had analyzed over 92 hospitals Results: Average amount of medical waste was 1.769 ± 1.022 kg/bed/day, of which amount of ordinary waste was 1.53 ± 0.83 kg/bed/day (86.49%), amount of infectious waste was 0.224 ± 0.15 kg/bed/day (12.66%), amount of non-infectious hazardous waste was 0.015 ± 0.042 kg/bed/day (0.85%) There was no average difference in the rate of hazardous solid waste generation by hospital levels with p > 0.05 Central hospitals were better than provincial hospitals in compliance with the law on environment as well as environmental monitoring work 100% of central hospitals and 96.6% of provincial hospitals had registered for EIA approval or environmental protection projects, however the rate of implementation of environmental monitoring in content and frequency in accordance with the regulations was only 88.2% for central hospitals and 65.5% for provincial hospitals Conclusion: There was an average difference in the rate of medical waste generation among hospital levels Implementing the management of medical waste at the central hospital was better than the provincial hospital The central and provincial hospitals need to strengthen the training for health workers and staff

on the management of medical solid waste, and also on implementation of the environmental monitoring with full parameters in EIA reports or environmental protection schemes

* Keywords: Medical waste; Medical waste management; Infectious waste

INTRODUCTION

Medical wastes are the ones generated

during the operation of medical facilities,

including hazardous medical wastes,

ordinary medical wastes and medical

wastewater [1] Medical wastes are

classified into infectious medical wastes,

non-infectious hazardous medical wastes

and ordinary medical wastes

Medical waste that is not handled well

will create health risks for medical

workers, public health and impacts on soil, water and air [2, 3] Each year, about 5.2 million people die of waste-related illness worldwide [4] Other environmental impacts that can also be found from poor management of medical waste are the problem of odor pollution, the generation

of flies, cockroaches, insects, rodents and more dangerous than the pollution of groundwater and the development of natural species due to improper disposal

of medical waste [5]

1 National Institute of Occupational and Environmental Health

2 Health Enviroment Management Agency

3 Vietnam Military Medical University

Corresponding author: Dam Thuong Thuong (damthuongthuong.nioeh@gmail.com)

Date received: 11/10/2019 Date accepted: 26/11/2019

Environmental monitoring is an important

tool to determine the amount of medical

waste generation, thereby finding solutions

on organization and management of

medical waste

At present, the investment in facilities

and equipment for medical waste

treatment is inadequate and unsuitable

due to lack of funding, the monitoring

system is lacking and qualified manpower

is insufficient

The amount of medical solid waste

generated per hospital bed is the standard

basis for planning investment, construction,

procurement of facilities, equipment,

consumable materials and human

resources in management and treatment

of medical solid waste

Therefore, we conduct research with

the aim: Collecting and assessing the

composition, quantity and management of

medical solid waste generated per hospital bed in 2015 - 2016.

SUBJECTS AND METHODS

1 Subjects

Some general and specialized hospitals

at the central and provincial hospitals

2 Methods

* Study design:

A retrospective study that analyzed and retrospected medical monitoring data

of 92 central and provincial hospitals in

2015 - 2016

* Sample size:

Selecting all 92 central and provincial hospitals to carry out health environment monitoring by Institutes of Occupational Health and Environment, Nha Trang Pasteur Institute, Tay Nguyen Institute of Hygiene and Epidemiology and Institute of Public Health in Hochiminh City

Criteria

Total

Hospitals with less than

300 beds

Hospitals with 300 beds

and further

Total

Retrospective which used a summary sheet to collect data from the Health Environmental Management Agency's report on the health environment monitoring results of 92 central and provincial hospitals in 2015 - 2016 which conducted by four research institutes

RESULTS AND DISCUSSIONS

1 Situation of generation of medical solid waste at central and provincial hospitals

The total amount of medical solid

waste of 92 hospitals was an average of

1.769 kg/bed/day, of which the highest

proportion was ordinary medical solid

waste with an average of 1.53 kg/bed/day,

average infectious medical solid waste

was of 0.224 kg/bed/day, the amount of

non-infectious hazardous solid waste was

of 0.015 kg/bed/day

The average amount of medical waste

generated in our study was lower than

that in Pakistan with 2.07kg/bed/day

(range from 1.28 - 3.47) [3] Our study

was also lower than that of Eker H.H et

al’s study (2011), which studied 357 health

facilities in Istanbul (Turkey), showing the

author's domestic solid waste volume for

the site: inpatient 4.23 ± 9.98 kg/bed/day,

in outpatient area of 3.62 ± 33.19 kg/bed/day

However, the amount of hazardous medical

solid waste in the inpatient area was

0.168 ± 0.664 kg/person/day, the outpatient

was 0.018 ± 0.062 kg/person/day, which

was lower than ours [6]

However, our research was similar or

higher than that of some foreign authors

According to Debere M.K et al (2013), research on 6 hospitals in Ethiopia showed that the amount of waste generated was very different among different hospitals, ranging from about 0.361 to 0.669 kg/patient/day, of which non-contagious medical wastes in

6 hospitals from 0.297 kg/patient/day

to 0.559 kg/patient/day, hazardous waste from 0.531 kg/patient/day to 0.668 kg/patient/day, infectious waste

from 0.037 to 0.098 kg/patient/day, pharmaceutical waste accounted for 0.027 to 0.052 kg/patient/day [7] In central Macedonia hospitals, infectious wastes ranged from 0.51 to 1.22 kg/bed/day [8]

Our study was similar to WHO's opinion, the composition of medical solid waste was 85% of non-hazardous waste, 10% was infectious waste, and 5% was chemical and pharmaceutical waste hazardous substances and radioactive substances [3] However, our study differed from that of Debere M.K et al’s study (2013), showing that 58.69% was non-hazardous waste and 41.31% was hazardous waste [7]

Figure 1: Percentage of types of medical solid waste generated at 92 hospitals

The amount of ordinary medical waste accounted for the highest proportion with 85.56%, followed by infectious medical solid waste with 13.63% and the lowest of non-infectious hazardous solid waste with 0.81%

Types of medical

solid waste Hospital level

Central

Provincial

The generation of ordinary waste, infectious waste and non-infectious hazardous waste per bed/day of provincial hospitals was smaller than the central hospitals but there was no difference (p > 0.05)

2 Actual situation of medical solid waste management at central and provincial hospitals

environmental protection of hospital

Central hospital (n = 34)

Provincial hospital (n = 58)

Total (n = 92) Content

Having assigned hazardous waste management

Having issued decision for establishment of

infection control council, infection control

network

Having organized training on medical waste

For the assignment and network of

infection control, the central hospital

accounted for 100%, the provincial hospital

accounted for 57% Thus, the situation of

assigning and managing human resources

in the field of medical environment at

central hospitals was better than the

provincial hospitals For the medical waste

management organization, the central

hospital accounted for 82.4%, the provincial

hospital accounted for a smaller percentage,

but also reached the average level of

60.3%

Our research showed that there was a

statistically significant difference in the

amount of some types of waste by level,

by hospitals at general and specialty

levels, by type of hospital In particular,

the amount of waste in general at the

provincial hospital was higher than the

central hospital; however, the infectious

waste was the highest at the central

hospital, followed by the provincial and district levels Our study was similar to the aggregate data of WHO in South Africa in which central hospitals were 1.24 kg/bed/day, provincial hospitals were 1.53 kg/bed/day, regional hospitals were 1.05 kg/bed/day, district hospital was 0.65 kg/bed/day [9] This may be due to higher levels of health care services generated by higher health facilities, as more ill patients have to use more services, including more visits

Thus, different hospitals had different amounts of waste and solid waste composition, so the investment in technology

as well as the practice of waste collection and treatment were different However, it should be noted that the amount of waste and the composition of waste does not depend only on the size, type, medical examination and treatment services; it also depends on the practice of the health staff and each patient

Table 5: Comply with legal documents on medical waste management in hospitals

Central (n = 34)

Provincial (n = 58)

Total (n = 92)

Content

environmental protection scheme

For the procedure to apply for approval of environmental impact assessment or environmental protection scheme and register of hazardous waste source owner, the central hospitals had performed very well at the rate of 100%, provincial hospitals were also at a high level For the procedure to apply for discharge permits, the average rate was 73.5% at the central hospitals and 56.9% at the provincial hospitals

Central (n = 34)

Provincial (n = 58)

Total (n = 92)

Content

Having environmental monitoring according to the

report on environmental impact

assessment/environmental protection scheme with full

content and frequency

Having environmental monitoring hospital according to

Having environmental monitoring hospital according to

Most central and provincial hospitals only carried out environmental monitoring according to the Environmental Impact Assessment Report/Scheme with full environmental protection content and frequency, specifically at central hospital (88.2%) and provincial hospital was lower (65.5%)

Regarding the compliance with the provisions of the law on environment as well as the environmental monitoring of central hospitals was better than the provincial hospital Specifically, 100% of central hospitals had registered for environmental impact assessment or environmental protection scheme and provincial hospitals were 96.6%, but the rate of implementation of environmental monitoring according to in compliance with regulations of central hospitals on content and frequency was 88.2% and provincial hospitals reached 65.5%

CONCLUSION

Through the environmental monitoring

study conducted by 04 institutes at 92

public hospitals in Vietnam in 2015 - 2016,

the results showed that the average

amount of medical equipment was 1.769

kg/bed/day, of which ordinary waste was

1.53 kg/bed/day (accounting for 86.49%);

the amount of infectious medical solid

waste was 0.224 kg/bed/day (accounting

for 12.66%), the amount of non-communicable

hazardous medical solid waste was

0.015 kg/bed/day (accounting for 0.85%)

Most central hospitals perform better

environmental management than provincial

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