Medical solid waste management practices in thai nguyen tuberculosis and lung disease hospital

THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY NGUYEN THI LINH LY Topic title: MEDICAL SOLID WASTE MANAGEMENT PRACTICES IN THAI NGUYEN TUBERCULOSIS AND LUNG DISEASE HOS

THAI NGUYEN UNIVERSITY

UNIVERSITY OF AGRICULTURE AND FORESTRY

NGUYEN THI LINH LY Topic title: MEDICAL SOLID WASTE MANAGEMENT

PRACTICES IN THAI NGUYEN TUBERCULOSIS AND LUNG

DISEASE HOSPITAL

BACHELOR THESIS

Study Mode: Full-time

Major: Environmental Science and Management

Faculty: Advanced Education Program Office

Batch: 2014 – 2018

Thai Nguyen, 24 /9 /2018

DOCUMENTATION PAGE WITH ABSTRACT

Thai Nguyen University of Agriculture and Forestry

Degree Program Bachelor of Evironmental Science and Management Student name Nguyen Thi Linh Ly

Student ID DTN1453110086

Thesis Title Medical Solid Waste Management Practices in Thai

Nguyen Tuberculosis and Lung Disease Hospital Supervisor Assoc Prof Trần Văn Điền

Supervisor’s signature

Abstract: The management of medical waste is great significance due to its related potential environmental impacts and public health hazards This study aims mainly to assess medical solid waste management practices in Thai Nguyen tuberculosis and lung disease hospital The descriptive methodology was used in the study The results showed that the hospital generate a total of 195 kg/day of solid waste, of which about 181 kg (92,8%) are non hazardous and 14 kg (7,2%) are hazardous Solid wastes are treated by Anh Dang environmental services company limited The research identified and assessed the current situation of solid waste collection and impacts on the

ACKNOWLEDGEMENT

I would like to express my sincere gratitude to Thai Nguyen Tuberculosis and Lung Disease Hospital, especially Mrs Ngo Thu Tien – the vice director of the hospital She not only offered me an opportunity to complete my internship course

at hospital but also gave me a lot of information about her organization so that I could find what departure is suitable for me Besides, I also say thank my supervisor, Assoc.Prof Tran Van Dien - whose expertise, understanding, generous guidance and support made it possible for me to work on intriguing topic It was a pleasure working with him

In addition to expressing my gratitude to Thai Nguyen Tuberculosis and Lung Disease Hospital and my supervisor, I want to express my sincere gratitude to

my university, especially the Advance Education Program Moreover, I would like

to show my appreciation to all teachers who have taught me for 4 years in Thai Nguyen University of Agriculture and Forestry They set their heart on teaching their students, included me That is to say, not until their students understand the lessons clearly, do they finish their hard working day Therefore, I really hold them

in high esteem

Thank you!

Nguyen Thi Linh Ly

TABLE OF CONTENT

DOCUMENTATION PAGE WITH ABSTRACT i

ACKNOWLEDGEMENT ii

TABLE OF CONTENT iii

LIST OF FIGURES vi

LIST OF TABLES vii

PART I INTRODUCTION 1

1.1 Research rationale 1

1.2 Research’s objectives 2

1.2.1: Research’s overall objecties 2

1.2.2 Research's specific objectives 2

1.3 Research subject 3

1.4 Research questions and hypotheses 3

1.4.1 Research question 3

1.4.2 Hypotheses 3

1.5 Limitations 4

1.6 Definitions 4

PART II: LITERATURE REVIEW 6

2.1 Sources and composition of hazardous medical waste 7

2.1.1 Stationary sources 7

2.1.2 Medical waste components 7

2.2 Classification of hazardous waste 8

2.3 Principles of classification of medical waste 10

2.4 Principles for collection, storage, transportation and treatment of medical

waste 11

2.4.1 Collection of hazardous medical waste 11

2.4.2 Storage of hazardous medical waste 12

2.4.3 Treatment of hazardous medical waste 13

2.5 Impact of medical waste 14

2.5.1 The impact of medical waste on the environment 14

2.5.2 Effects of medical waste on humans 15

2.6 Legal basis to perform the task 16

PART III RESEARCH METHODOLOGIES 18

3.1 Time and research scope: 18

3.2 Research contents: 18

3.3 Research methodology 18

3.3.1 Collecting secondary data 18

3.3.2 Interviewing by questionnaire 18

PART IV RESULTS AND DISCUSSIONS 19

4.1 : Current status of medical solid wastes of Thai Nguyen Tuberculosis and Lung disease hospial 19

4.1.1 Hazardous wastes 19

4.1.2 Normal solid waste 24

4.1.3 Items for collection and treatment of solid waste 26

4.2: Discussions 27

4.2.1: Knowledge of staff and patients on hospital waste management 27

4.2.2: Solutions to improve the management of hazardous medical waste of Thai

Nguyen Tuberculosis and Lung disease hospital 32

4.2.3: Technology measures 33

PART V CONCLUSIONS 35

5.1 Conclusions 35

5.2 Petition 36

REFERENCES 38

LIST OF FIGURES

Figure 4.1 Rate of hazardous wastes of Thai NguyenT uberculosis and Lung Disease Hospital in March 2018 20

LIST OF TABLES

Table 2.1: Composition of medical solid waste in Vietnam 8

Table 2.2: Some diseases at risk of infection from medical waste 16

Table 4.1 The volume of hospital infectious waste from March to June 19

Table 4.2: Volume of each type of hazardous waste at the hospital 19

Table 4.3 Collection of solid medical waste 21

Table 4.4 Transport of hazardous medical waste 23

Table 4.5: Items for collection and treatment of solid waste 26

Table 4.6: Statistics of knowledge on medical waste management 28

Table 4.7: Knowledge about the color of item for classify medical waste 29

Table 4.8: Knowledge of hospital's staff about medical waste management 30

Table 4.9: Understanding about hospital waste management of patients and patient's family member 31

PART I INTRODUCTION 1.1 Research rationale

Medical waste, due to its content of hazardous substances,poses serious threats to environmental health Thehazardous substances include pathological and infectiousmaterial, sharps, and chemical wastes In hospitals, different kinds of therapeutic procedures ( cobalt therapy, chemotherapy, dialysis, surgery, delivery, resection ofgangrenous organs, autopsy, biopsy, para clinical test, injections etc.) are carried out and result in the productionof infectious wastes, sharp objects, radioactive wastes andchemical materials Medical waste may carry germs ofdiseases such as hepatitis B and AIDS In developing countries, medical waste has not received much attention and it is disposed of together with domestic waste Improper medical waste management poses a serious threat to public health Medical waste contains highly toxic metals, toxic chemicals, pathogenic viruses and bacteria, which canlead to pathological dysfunction of the human body Medical waste presents a high risk to doctors,nurses, technicians, sweepers, hospital visitors andpatients due to arbitrary management It has long beenknown that the reuse of syringes can cause the spread ofinfections such as AIDS and hepatitis The collectionof disposable medical items (particularly syringes), its resale and potential reuse without sterilization could causea serious disease burden

The safe disposal and subsequent destruction of medicalwaste is a key step in the reduction of illness or injurythrough contact with this potentially hazardous material, and in the prevention of environmental contamination The transmission

of blood borne viruses and respiratory, enteric and soft tissue infections through impropermedical waste disposal is not well described The management of medical waste therefore, has been of majorconcern due to potentially high risks to human health andthe environment

Medical waste is an environmental as well as public health issue that attracts attention in both industrialized and developing countries Certain categories of medical waste are among the most hazardous and potentially dangerous of all the wastes arising in the community Improper management of medical waste may pose health hazards through transmission of diseases In addition to health hazards, environmental hazards have to be considered, such as the contamination of soil, water sources and poisonous emissions from improper burning of medical waste In the long term, medical waste can not only impair the quality of life of the community, but can also affect the welfare of the entire population and the national economy

1.2 Research’s objectives

1.2.1: Research’s overall objecties

This study was to assess the medical solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital, of which focus on the evaluation

of medical solid waste in the hospital Thereby, propose appropriate measures to sustain solid waste management in the hospital

1.2.2 Research's specific objectives

• To study the current medical solid waste management in Thai Nguyen

Tuberculosis and Lung disease hospital

• To evaluate the perception of staffs and patients on medical solid waste management and environment

• To propose appropriate measures to sustain the solid waste management in Thai Nguyen Tuberculosis and Lung disease hospital

Problem of the study is to answer these following questions:

• How is status quo solid wastes in Thai Nguyen Tuberculosis and Lung

disease hospital?

• How do solid wastes manage in Thai Nguyen Tuberculosis and Lung disease hospital?

• What is the impact of medical waste on the environment and human?

• How to improve the efficiency of medical waste management?

• Solutions to improve the waste management in Thai Nguyen Tuberculosis and Lung disease hospital is needed

1.5 Limitations

• The process of operating a medical solid waste incinerator is limited, such

as fuel consumption, failure, often requiring maintenance

• Large funds are needed to purchase equipment, facilities for collecting, storing and transporting solid medical waste

1.6 Definitions

• Medical wastes are wastes arising in the course of operation of medical establishments, including hazardous medical wastes, ordinary medical wastes and medical wastewater

• Hazardous medical wastes mean medical wastes containing infectious agents or other hazardous properties exceeding hazardous waste thresholds, including contagious wastes and non-contagious hazardous wastes

• Medical waste management is the process of minimizing, classifying, classifying, collecting, storing, transporting, recycling and disposing of medical waste and supervising the implementation process

• Medical waste collection is the process of gathering medical waste from

the place of origin and transporting it to the medical waste storage and treatment area within the premises of the medical establishment

• Transportation of medical wastes means the process of transporting medical wastes from the places where waste is stored in medical establishments to the places for storing and disposing of wastes of medical waste treatment

establishments for the

establishments' clusters Medical establishments, concentrated medical waste treatment establishments or concentrated hazardous waste treatment facilities containing medical waste treatment items

PART II: LITERATURE REVIEW

Medical wastes are considered a special area where hazards and risks not just confined to the health of generators and operators of hospitals but also the health of general people In general hospital waste is broadly grouped into infectious waste and non-infectious waste

Thai Nguyen Tuberculosis and Lung disease hospital – Tan Thinh Ward, Thai Nguyen City, Thai Nguyen Province Thai Nguyen Tuberculosis and Lung Disease Hospital (formerly Viet Bac Autonomous Region Hospital) was established

on October 12, 1955 In the early days of establishment, the hospital had only 9 officials with the scale of 40 beds Overcoming the initial difficulties both in terms

of facilities and people, the team of doctors and medical staff of the hospital has done well in the treatment of tuberculosis patients in the region In 1964, the hospital was completely rebuilt in its present location and was officially named Thai Nguyen Tuberculosis and Lung Disease Hospital in August 2003 Up to now, the hospital has become the highest specialized hospital in Thai Nguyen province with

220 beds and a team of 186 medical staffs Over the past 60 years, the hospital has received over 800,000 patients From 2007 up to now, the hospital has been continuously implementing new techniques such as bronchoscopy with soft-tube, respiratory probing, mechanical ventilation; implementation of treatment by chemotherapy, drug treatment with multi- drug resistant brought good results, the rate of patients treated over 90%

2.1 Sources and composition of hazardous medical waste

2.1.1 Stationary sources

- Waste during surgery

- Sharp and brittle objects exposed to blood and pus during surgery Biological liquids or absorbent paper have been used in medicine

- Blood bandages, bloody pus

- Test tubes for germ culture in laboratories

- Waste during testing

- Expired drugs

- Physical components

• Cotton yarn: cotton gauze, bandage, old clothes, wipes

• Paper: Tool box, waste paper from the toilet

• Glassware: bottles, glass syringes, test tubes

• Metal: needles, scalpel, surgical instruments

• Blood specimens, gauze sticky blood

• Plastic products: containers, wire feed

• Leaves, rocks

- Chemical composition

• Inorganic substances: metals, glass bottles, gravel, chemicals

• Organic substances: Textiles, Plastic

- Biological components: blood, digestive, pathological and pathogenic germs

Table 2.1: Composition of medical solid waste in Vietnam

2 Bottles, plastic bags 10.0Yes

3 Cotton bandage, medical gauze 9.0Yes

7 Postoperative specimens 0.6Yes

8 Soil, sand and other solids 21.0No

(Source: Ministry of Health, 2009)

The composition of medical waste includes 8 basic types, in which the rate

of hazardous waste accounts for 22% Although they account for nearly a quarter of the solid waste component but they are very harmful to the environment and human health if not collected, transported and treated in accordance with regulations

2.2 Classification of hazardous waste

Hazardous waste classification is a very important step in the management and disposal of waste If this separation activity is well implemented, the following steps will be effective, limiting the impact on human health and the surrounding environment

Based on the physical, chemical, biological and hazardous properties the Joint circular No 58/2015 / TTLT-BYT-BTNMT of the Ministry of Health and the Ministry of Natural Resources and Environment issued on 31 December 2015 stated that The waste in health care facilities is classified into the following groups

- Infectious waste includes:

+ Sharp infectious waste is an infectious waste that can cause cuts or punctures including needles, sharp tips of the line, acupuncture needles, surgical blades and other sharp objects

+ Non-sharp infectious wastes include: Blood-contaminated wastes or biological fluids of the body, waste arising from isolation chambers

+ High-risk wastes include: specimens, samples of specimens and specimen waste discharged from biosafety laboratories according to the provisions of Decree

No 92/2010 / ND-CP dated 30 August 2010 of the Government

+ Surgical waste includes: Human organs discharged

- Non-contagious hazardous wastes include:

+ Chemical waste is hazardous

+ Disposed cytotoxic drugs or hazardous warnings from the manufacturer + Medical devices that have been damaged, have been disposed of containing mercury and other heavy metals

+ Other hazardous wastes according to the provisions of the Minister of Natural Resources and Environment's Circular No 36/2015 / TT-BTNMT of June

30, 2015 on hazardous waste management

- General medical waste includes

+ Daily-life solid waste arising in human daily-life activities

+ Common solid wastes arising from medical establishments not on the list

of those subject to hazardous medical wastes or on the list of hazardous medical wastes prescribed at Point a, Clause 4, hazardous wastes under allowable threshold

+ Non-hazardous liquid waste products

2.3 Principles of classification of medical waste

- The principle of classification of medical waste

+ Hazardous medical waste and conventional medical waste must be classified for management at the place of origin and at the time of arising

+ Each kind of medical waste must be separately classified into the package, tools and equipment for containing hazardous wastes according to regulations In cases where hazardous medical wastes are incapable of reacting, interacting with one another and applying the same treatment method, they may be classified in the same package, tool or storage device

+ When the waste is mixed with other wastes or vice versa, the mixture must

be collected, stored and treated as contaminated waste

- Packaging placement, waste sorting equipment

+ Each department must arrange the position to put packages and tools for medical waste classification

+ Placement of medical waste sorting tools and packages must include instructions on how to classify and collect wastes

- Classification of medical waste

+ Sharp infectious waste: Stored in yellow box

+ Non-sharp infectious waste: Store in a yellow bag

+ Highly infectious waste: Store in a yellow bag

+ Surgical waste: Store in double yellow bag or yellow box

+ Non-infectious solid wastes: Store in a black bag or a black box

+ Non hazardous liquid wastes: Store in closed containers

+ Normal medical waste not for recycling purposes: Store in a blue bag or in

2.4.1 Collection of hazardous medical waste

- Collected infection waste

+ Infectious wastes must be collected separately from the places where waste

is deposited in the premises of the medical establishment

+ In the course of collection, the waste bags must be sealed, the waste bins must have a tight-fitting lid, ensuring that the waste is not dropped during the collection process

+ The medical establishment shall stipulate the appropriate route and time for the collection of infectious waste to limit the impact on the patient care area and

other areas in the hospital

+ Highly infectious wastes must be preliminarily treated before being collected into the waste storage and treatment areas within the hospital's premises

+ Frequency of collection of infectious waste from the place of origin to the waste storage area within the hospital premises at least once a day

+ For medical establishments with less than 5kg / day of infectious wastes, the frequency of collecting the sharp infectious waste from the place of incineration

to the temporary storage area within the hospital or putting them to trial at least once a month

- Non-infectious hazardous waste collection

+ Non-infectious hazardous wastes shall be collected and kept separately at the waste storage areas within the hospital's premises

+ Mercury-containing wastes are collected and stored separately in plastic containers or suitable materials and ensure no leakage or release of mercury vapor into the environment

2.4.2 Storage of hazardous medical waste

- Hospitals dealing with treatment of hazardous medical wastes must have hazardous medical waste storage areas meeting the following technical requirements:

+ Having a roof for the storage area, ensuring that the floor is not flooded, to prevent rainwater from entering the outside, not to spill liquids outside when the leakage, overflow

+ Absorbent material such as dry sand or sawdust and shovel for use in the

case of leakage, spillage of hazardous medical waste in liquid form

+ Waste materials and equipment must be cleaned regularly

- Instruments and equipment for storing hazardous medical wastes at the hospital waste storage areas must be consistent with the following requirements:

+ Having hard walls, no breaks, leakage during storage

+ The equipment and equipment for storing contagious wastes must have a lid

- Hazardous medical waste and normal medical waste must be stored separately at the waste storage area within the hospital premises

- Infectious waste and non-infectious hazardous waste wastes must be stored separately, unless these wastes are treated in the same way

- Normal medical waste for recycling purposes and normal medical wastes not for recycling purpose are stored separately

- Time of storage of infectious waste

+ For infectious wastes generated in hospitals, the storage time of infectious wastes must not exceed 2 days under normal conditions In case of storage of infectious waste in refrigerated storage equipment below 8 degrees Celsius, the maximum storage time is 7 days

+ In cases where it is not handled right in the day, it must be kept at a temperature of under 20 degrees celsius and the storage time must not exceed 2 days

2.4.3 Treatment of hazardous medical waste

- Hazardous medical waste must be treated up to national technical standards on environment

- Priority should be given to the selection of non-burning, environmentally

friendly technologies and the achievement of national technical standards on environment issued by the Minister of Natural Resources and Environment

- The form of treatment of hazardous medical wastes shall be in the following order of priority

+ Handle at the hazardous medical waste treatment facilities or at concentrated hazardous waste treatment facilities containing medical waste treatment items

+ To treat hazardous medical waste according to the model of medical

establishments

+ Self treatment at hazardous medical waste treatment facilities within

hospital premises

2.5 Impact of medical waste

2.5.1 The impact of medical waste on the environment

- For land environment

When medical wastes are wrong treated in stages before being disposed of in the environment, pathogenic microorganisms, toxic chemicals and microorganisms can be leached into the environment causing toxicity to the environment The deep layers in the soil and the underdeveloped organisms make it difficult to overcome the consequences

- For the air environment

Hospital waste from the beginning to the end of the treatment process has a negative impact on the air environment When sorted at source, collected, transported, they spread the dust, microorganism spores into the air At the process

of treatment (burning, burial) generated when toxic HX, dioxin, furan from the furnace and 4,

3, from landfill These gases, if not recovered and treated, will have

a negative impact on human health

- For water environment

Water may be contaminated by toxic substances in the hospital waste They may contain pathogenic microorganisms Medical burying is not technically correct and not hygienic Particularly, medical wastes buried with domestic wastes can pollute underground water sources

2.5.2 Effects of medical waste on humans

Exposure to medical waste can cause illness or injury to the body by sharp objects such as needles These sharp objects not only cause cuts, stabs but also infection of the wound if the sharp object is infected with pathogens These agents can penetrate the body through scratches, piercings, mucosal, respiratory, gastrointestinal tract People at high of infection

+ Doctors, nurses, health care workers, and hospital staff

+ Patients and family members of patients to hospital

+ Employees working in waste treatment facilities such as disposal pits or incinerators

Table 2.2: Some diseases at risk of infection from medical waste

Forms of infection Examples of

Stool and vomit

Respiratory infections Herpes Secretions in the eye

Anthrax Bacillus Secretion through the skin

the genitals

Hepatitis A Hepatitis A virus Stool

Hepatitis B and C HepatitisB and C virus Blood

Skin infections Pneumococcal

bacteria

Pus

(Source: Pham Ngoc Chau, Environment from the perspective of waste safety management - Department of Environmental Protection)

2.6 Legal basis to perform the task

- The Law on Environmental Protection of Vietnam No 55/2014 / QH13 passed by the National Assembly on June 23, 2014, effective January 1, 2015

- Decree No 155/2016 / ND-CP of November 18, 2016 of the Government stipulating the sanctioning of administrative violations in the field of environmental protection

- Governmental Decree No 38/2015 / ND-CP dated April 24, 2015 on waste and scrap management

- Circular No 18/2009 / TT-BYT dated October 14, 2009 of the Ministry of Health guiding the implementation of infection control in hospitals

- Circular No 36/2015 / TT-BTNMT dated June 30, 2015 of the Ministry of Natural Resources and Environment regulating the management of hazardous waste

- Circular No 31/2013 / TT-BYT, circular regulating environmental impact monitoring from hospital operations

- Joint Circular No 58/2015 TTLT-BYT-BTNMT dated 31 December 2015

of the Ministry of Health and the Ministry of Natural Resources and Environment

- Decision No 2038 / QD-TT dated 15 November 2011 of the Prime Minister approving the master plan for treatment of medical waste in the period 2011-2015 and orientation to 2020

- Decision No 170 / QD-TT dated February 8, 2011 of the Prime Minister approving the master plan for solid hazardous waste treatment system up to 2025

- Document 2340 / BYT-MT in 2014 to strengthen the management of medical waste management

- Decision No 2598 / QD-UBND dated 5 November 2012 approving the environmental protection communication plan of Thai Nguyen province up to 2015 and orientation to 2020

- Directive No 21 / CT-UBND dated 30 October 2013 on enhancing the management of ordinary solid waste and hazardous waste in Thai Nguyen province

PART III RESEARCH METHODOLOGIES 3.1 Time and research scope:

- Time: The research was conducted from March 1, 2018 to June 30, 2018

- Research scope: Management of medical solid wastes of Thai Nguyen Tuberculosis and Lung disease hospital

3.3.1 Collecting secondary data

Documents related to the study contents, including the annual report on hazardous medical waste and the contract for collection and treatment of hazardous waste of Thai Nguyen Tuberculosis and Lung disease hospital was collected, studied and analyzed Other research papers related to research topics, medical waste management were also collected for references

PART IV RESULTS AND DISCUSSIONS

4.1 : Current status of medical solid wastes of Thai Nguyen Tuberculosis

and Lung disease hospial

4.1.1 Hazardous wastes

4.1.1.1 The volume of hazardous waste at the hospital

Table 4.1 The volume of hospital infectious waste from March to June

(Source: Department of Infection Management, Thai Nguyen Tuberculosis

and Lung Disease Hospital-2018)

The table above shows that the amount of infectious waste in May is higher than difference months The average infectious waste is 410 kg / month Equivalent to 13.7kg / day

Table 4.2: Volume of each type of hazardous waste at the hospital

No Type of hazardous waste Volume

(kg)

Total (kg) Rate

(%)

1 Non-sharp infectious waste 328 420 78.1

4 Non-infectious hazardous waste 15 3.6

(Source: Waste data in March, 2018 - Thai Nguyen Tuberculosis and Lung

Disease Hospital)