B GIO DC V O TO

TRNG I HC HNG VNG

.................

SV: TRN L PHNG THO

QUN L RC THI TI BNH VIN A KHOA

TH C HIN TRNG MT S GII PHP

KHA LUN TT NGHIP I HC

Chuyn ngnh: QUN TR BNH VIN

TP. HCM, THNG 7/2009

Kha lun tt nghip i hc

GVHD: TS.BS.Hunh Tn Tin

ii

CNG HA X HI CH NGHA VIT NAM

B GIO DC V O TO
TRNG I HC HNG VNG

c lp T do Hnh phc

KHOA QUN TR BNH VIN

NHIM V KHA LUN TT NGHIP

H v tn : TRN L PHNG THO Lp : 05 QB

Ngnh : QUN TR KINH DOANH Chuyn ngnh : QUN TR BNH VIN
Tn ti : QUN L RC THI TI BNH VIN A KHOA KHU VC TH
C HIN TRNG MT S GII PHP
Mc tiu, ni dung KLTN :
Tm hiu mt s khi nim c bn v rc thi bnh vin, ngun gc, phn
loi, mc gy nhim ca rc thi i vi mi trng v sc khe, h
thng qun l rc thi .
Kho st hin trng v h thng qun l rc thi ti Bnh vin a khoa
khu vc Th c hin nay.Nhng mt tch cc v mt s tn ti cn
khc phc .
Kin ngh mt s gii php nhm nng cao hiu qu qun l rc thi ti
Bnh vin a khoa khu vc Th c trong thi gian ti.
Ngy nhn ti KLTN .............................................................................................
H v tn ging vin hng dn

H v tn ging vin phn bin

.............................................
..............................................
Ngy hon tt phn bin

Ngy hon thnh KLTN

( k v ghi r h tn)

( k v ghi r h tn)

Ni dung yu cu KLTN c khoa thng qua

Ngy Thngnm
Trng khoa
SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

iii

GVHD: TS.BS.Hunh Tn Tin

Qua 4 nm sng v hc tp di i gia nh Hng Vng em c thy c

truyn t rt nhiu kin thc v kinh nghim bc vo tng lai .
u tin con xin cm n ba, m nui dy con nn ngi. Em xin gi n thy
c trng H Hng Vng ni chung v tp th thy c Khoa Qun Tr Bnh Vin ni
ring nhng li cm n chn thnh nht.Cc thy c to mi iu kin cho em trong
sut qu trnh hc tp ti ni y, t bit l thy Hunh Tn Tin hng dn tn
tnh truyn t nhng kin thc b ch em hon thnh tt ti ny.
Em xin chn thnh cm n Ban Gim c Bnh vin a khoa khu vc Th c
,nht l cc c ch, anh ,ch phng HCQT tn tnh gip cung cp ti liu trong
thi gian em kho st thc t bnh vin hon thnh kha lun.Nhng v ngun
kin thc cn hn ch v thiu kinh nghim trong thc t nn s kh trnh khi nhng
thiu st ,sai lm.V vy em rt mong s gip ,ng gp kin t qu thy c c
th b sung,hon thin bi lun vn ny tt hn.
Knh chc qu thy c nhiu sc khe,cc c ch ,anh, ch cng tc ti bnh
vin t c thnh cng trong cng vic

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

iv

GVHD: TS.BS.Hunh Tn Tin

Trang
Nhim v KLTN .................................................................................................. i
Li cm n ......................................................................................................... ii
Mc lc.............................................................................................................................. iii
Danh sch cc t vit tt................................................................................................... ix
Danh sch cc bng biu ....................................................................................................x
Danh sch cc hnh v,biu ......................................................................................... xi
PHN 1: M U
1. t vn :...............................................................................................................1
2. L do chn ti:......................................................................................................2
3. Mc tiu ca ti: ...................................................................................................2
4. Phm vi nghin cu: .................................................................................................2
5. Phng php thc hin: ............................................................................................2
PHN 2: NI DUNG KHO ST

Chng 1: C S L LUN RC THI BNH VIN

1.1. MT S VN C BN V RC THI BNH VIN ..................................4

1.1.1Cc khi nim v rc thi bnh vin v h thng qun l rc thi .....................4
1.1.1.1 Cht thi y t: ................................................................................................4
1.1.1.2 Rc thi y t : ................................................................................................4
a) Thnh phn vt l..................................................................................................5
SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

GVHD: TS.BS.Hunh Tn Tin

b) Thnh phn ha hc..............................................................................................5

c) Thnh phn sinh hc.............................................................................................5
1.1.1.3 Cht thi y t nguy hi..................................................................................5
1.1.1.4 H thng qun l rc thi .............................................................................5
1.1.2. Quy ch Qun l rc thi y t .............................................................................6
1.1.3. Tnh hnh rc thi bnh vin TP.H Ch Minh...............................................6
1.1.3.1 Thnh phn v khi lng rc thi pht sinh ti cc c s y t.................7
a) Thnh phn: ..........................................................................................................7
b) Khi lng: ...........................................................................................................8
1.1.3.2 Cc yu t nguy c ca rc thi bnh vin v nh hng ca n i
vi sc khe................................................................................................................9
a) i vi cht thi nhim khun: ...........................................................................9
b) i vi vt sc nhn: ...........................................................................................10
c) i vi cht thi ha hc v dc phm: ...........................................................10
d) i vi thuc gy c t bo: ..............................................................................10
e) i vi cht thi phng x:..................................................................................11
f) Tnh nhy cm ca cng ng i vi rc thi bnh vin .................................11
1.1.4 Ngun gc pht sinh rc thi bnh vin ..............................................................11
1.1.5 Phn loi cht thi y t: ........................................................................................12

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

vi

GVHD: TS.BS.Hunh Tn Tin

1.1.5.1 Cht thi ly nhim:......................................................................................12

1.1.5.2 Cht thi phng x:......................................................................................12
1.1.5.3 Cht thi ho hc nguy hi:..........................................................................13

1.1.5.4 Cc bnh cha kh c p sut.......................................................................14

1.1.5.5 Cht thi thng thng:...............................................................................14
1.1.6 Tc hi ca rc thi bnh vin:.......................................................................15
1.1.7 Mc gy nhim ca rc thi bnh vin i vi mi trng:................16
1.2.T CHC QUN L RC THI BNH VIN ....................................................17
1.2.1 Cc khi nim v t chc qun l rc thi bnh vin.........................................17
1.2.2 ngha v tm quan trng v vic qun l rc thi bnh vin .........................18
1.2.3 Ni dung t chc qun l rc thi bnh vin ......................................................19
1.2.3.1 H thng qun l hnh chnh ......................................................................19
1.2.3.2 H thng qun l k thut ...........................................................................20
1.2.4.Cc phng php x l rc thi bnh vin hin nay ca Vit Nam
v Th gii......................................................................................................................21
1.2.4.1 Khi nim x l rc thi:...............................................................................21
1.2.4.2 Cc phng php x l chnh .......................................................................22
a) Phng php kh trng......................................................................................22
b) Phng php chn lp........................................................................................23
c) Phng php thiu t rc .................................................................................24
1.2.4.3 M hnh, cng ngh x l v tiu hy cht thi rn y t.............................24
a) M hnh ...............................................................................................................25
b) Cng ngh x l v tiu hy cht thi y t nguy hi ........................................25
c) Phng php x l ban u cht thi c nguy c ly nhim ca ......................25
d) Cc phng php x l v tiu hy cht thi ly nhim..................................25
e) Phng php x l, tiu hy cht thi ha hc ................................................26

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

vii

GVHD: TS.BS.Hunh Tn Tin

f) X l v tiu hy cht thi dc phm .............................................................26

g) X l v tiu hy cht thi gy c t bo........................................................26
h) X l v tiu hy cht thi cha kim loi nng:...............................................26
i) X l v tiu hy cht thi phng x.................................................................27
j) X l v tiu hy cc bnh p sut ....................................................................27
k) X l v tiu hy cht thi rn thng thng ...................................................27

Chng 2: HIN TRNG RC THI BNH VIN A KHOA KHU

VC TH C

2.1.GII THIU S LC V BNH VIN A KHOA KHU VC TH C ...28

2.1.1.Lch s hnh thnh v pht trin bnh vin:........................................................28
2.1.1Chc nng nhim v : ........................................................................................28
2.1.3.Nhn s - c cu t chc ca bnh vin..............................................................29
2.2. HIN TRNG QUN L RC THI TI BNH VIN TH C..............33
2.2.1.Tnh hnh rc thi bnh vin Th c ................................................................33
2.2.1.1 Ngun gc rc thi tai bnh vin Th c ................................................33
2.2.1.2 Hin trng phn loi ,thu gom,vn chuyn ,bo qun v x l rc thi ...36
a) Rc sinh hot.........................................................................................................36
b) Rc y t nguy hi ..................................................................................................37
2.2.2. Chi ph x l rc thi ............................................................................................43
2.2.2.1 i vi rc sinh hot....................................................................................43
2.2.2.2 i vi rc Y t............................................................................................44
2.2.3. H thng qun l rc thi ti bnh vin Th c..............................................44
2.2.3.1 H thng qun l hnh chnh ......................................................................44
a) Phn cng trch nhim, t chc thc hin - gim st ........................................44

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

viii

GVHD: TS.BS.Hunh Tn Tin

b) o to nhn vin qun l, gim st vic thc hin...........................................47

c) An ton trong cng tc qun l rc thi ..............................................................47
2.2.3.2 H thng qun l k thut .............................................................................48
a) Phn loi rc thi ngay ti ngun pht sinh: ......................................................48
b) Thu gom: .............................................................................................................48
c) X l s b ban u: ...........................................................................................49
d) Vn chuyn: .........................................................................................................49
e) Bo qun: .............................................................................................................49
f) X l:.....................................................................................................................50
2.2.4 nh gi thc trng qun l rc thi ti bnh vin a khoa khu vc
Th c...........................................................................................................................52
2.2.4.1 Mt tch cc...................................................................................................52
2.2.4.2 Mt s tn ti cn khc phc .....................................................................53

Chng 3 : KIN NGH MT S GII PHP NHM NNG CAO

HIU QU QUN L RC THI TI BNH VIN A KHOA KHU
VC TH C

3.1. Hon thin h thng qun l hnh chnh...................................................................55

3.1.1.Cng c v hon thin mng li qun l rc thi bnh vin ...........................55
3.1.2. Phn cng, b tr nhn s r rng trong t chc thc hin gim st
qun l rc thi ...............................................................................................................56
3.1.3. Tng cng t chc o to nhn vin qun l, gim st h thng
qun l rc thi v nhn vin thc hin ........................................................................56
3.1.4. Ban lnh o,nhn vin qun l ,gim st phi thng xuyn kim tra,
gim st h thng qun l rc thi.................................................................................58

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

ix

GVHD: TS.BS.Hunh Tn Tin

3.1.5. Xy dng bo co thng k rc ti cc khoa, phng.........................................59

3.1.6. S dng hiu qu kinh ph u t cho vic qun l rc thi .............................59
3.2. Hon thin h thng qun l k thut .....................................................................60
3.2.1. Cng c cng tc phn loi rc thi ...................................................................60
3.2.2. Cng c cng tc thu gom...................................................................................60
3.2.3. Cng c cng tc vn chuyn .............................................................................60
3.2.4. Ni lu tr rc y t. .............................................................................................61

3.3

Kt qu t c do p dng 1 s gii php...........................................................61

PHN BA: KT LUN

TI LIU THAM KHO .................................................................................. xii

PH LC 1 ..................................................................................................... xiii
PH LC 2..................................................................................................................... xiv
PH LC 3 ...................................................................................................... xv
PH LC 4..................................................................................................................... xvi
PH LC 5.................................................................................................................... xvii
PH LC 6................................................................................................................... xviii
PH LC 7..................................................................................................................... xix

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

BV

: Bnh vin

BG

: Ban Gim c

CLS

: Cn lm sng

CBCC

: Cn b cng chc

CBNV

: Cn b nhn vin

CTYT

: Cht thi Y t

HCQT

: Phng Hnh Chnh Qun Tr

KL

: Khi lng

KHTH

: Phng K Hoch Tng Hp

LS

: Lm sng

PG

: Ph Gim c

QLRT

: Qun l rc thi

RTBV

: Rc thi bnh vin

RTYT

: Rc thi Y t

GVHD: TS.BS.Hunh Tn Tin

UBND TPHCM : y ban nhn dn TP. H Ch Minh

W.H.O

: World Health Organization ( T chc Y t Th gii )

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

STT
1.

xi

NI DUNG

Lng cht thi rn Y t thay i theo

GVHD: TS.BS.Hunh Tn Tin

TN

TRANG

Bng 1.1

Bng 1.2

Bng 1.3

Bng 2.1

29

Bng 2.2

35

Bng 2.3

42

thu nhp tng nc

2.

Lng cht thi rn Y t theo tng loi

bnh vin

3.

Lng cht thi rn Y t theo tng khoa

phng

4.

C cu nhn s theo trnh hc vn ti

bnh vin a khoa khu vc Th c

5.

Ngun gc v phn loi rc thi ti bnh

vin Th c

Khi lng RYT trong 4 qu ca nm

2008 v 2 qu u nm 2009

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

xii

GVHD: TS.BS.Hunh Tn Tin

STT

NI DUNG

TN

TRANG

Ngun gc v phn loi rc thi bnh

Hnh 1.1

15

S tm tt ngha v tm quan

Hnh 1.2

19

Hnh 1.3

21

trng ca cng tc qun l rc thi

bnh vin
3

H thng qun l k thut rc thi

bnh vin

T l ngun nhn lc theo trnh

hc vn

Biu 2.1

30

S ngun pht sinh rc thi bnh

Hnh 2.1

39

Hnh 2.2

40

Biu 2.2

43

vin
6

Quy trnh thu gom rc y t

Khi lng RYT trong 4 qu nm

2008 v 2 qu u nm 2009

Quy trnh x rc y t

Hnh 2.3

51

Quy trnh x l rc sinh hot

Hnh 2.4

52

10

Mng li Qun l RTBV

Hnh 3.1

58

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

xiii

GVHD: TS.BS.Hunh Tn Tin

1. B Y T - Quy ch bnh vin.NXB Y hc H Ni

2. B Y T - Qun l bnh vin.NXB Y hc H Ni
3. B Y T ,Vin Y hc lao ng v v sinh mi trng Qun l cht thi bnh vin
cc nc pht trin
4. Bo co s kt cng tc thu gom ,vn chuyn,x l rc thi rc ca cc c s Y t
nm 2003 Cty Mi trng th
5. Ti liu hng dn cch x l cht thi Phng iu dng Bnh vin a khoa khu
vc Th c
6. Ti liu hng dn thc hnh Qun l cht thi Y t - B Y T,V iu tr
7. Quy ch qun l cht thi Y t - B Y T, ban hnh ngy 30 thng 11 nm 2007
8. Bng xc nhn khi lng RYT nm 2008 v 6 thng u nm 2009 ca Bnh vin
a khoa khu vc Th c do phng HCQT cung cp

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

xiv

GVHD: TS.BS.Hunh Tn Tin

PH LC 1
S Y T TP.H Ch Minh
BV:

CNG HA X HI CH NGHA VIT NAM

c lp- T do Hnh phc

BNG THEO DI CNG VIC

Nhn
vin
thc
hin
H v
tn

Ch
c
v
K tn

SVTH: Trn L Phng Tho

Ni
lm
vic

Ngy Thc GHI Nhn

lm
hin CH vin
vic cng
gim st
vic
H tn
K tn

Lp 05QB

Kha lun tt nghip i hc

GVHD: TS.BS.Hunh Tn Tin

xv

PH LC 2
MU PHIU THM D KIN NHN VIN SAU CC CHNG TRNH
O TO

1. Ni dung no trong kha hc anh ( ch) cho l ph hp nht

( A: 3 , B:2, C: 1)
A

2. Ni dung no trong kha hc anh ( ch) cho l khng ph hp

A

3. Ni dung no trong kha hc anh ( ch) cho l khng cn thit

A

4. Anh ( ch ) c hi lng sau kha hc

Rt hi lng

Hi lng

Khng hi lng

Theo anh( ch) cn a thm ni dung no vo o to

......................................................................................
......................................................................................
......................................................................................

Tng im:

SVTH: Trn L Phng Tho

Tng im:

Lp 05QB

Kha lun tt nghip i hc

xvi

GVHD: TS.BS.Hunh Tn Tin

PH LC 3
MU PHIU THNG K LNG RC THI TI CC KHOA ,PHNG
Tn khoa

Ngy

Khi lng
RYT(kg)

SVTH: Trn L Phng Tho

Khi lng
RSH(kg)

Nhn vin
thng k
H v tn

K tn

Lp 05QB

Kha lun tt nghip i hc

xvii

GVHD: TS.BS.Hunh Tn Tin

PH LC 4
CHT HA HC NGUY HI THNG C S DNG TRONG Y T
(Ban hnh km theo Quyt nh s 43/2007/Q-BYT ngy 30 thng 11 nm 2007 ca
B
Trng B Y t)
Formaldehyde
Cc cht quang ha hc:
hydroquinone;
kali hydroxide;
bc;
glutarldehyde.
Cc dung mi:
Cc hp cht halogen: methylene chloride, chlorofom, freons, trichloro ethylene v
1,1,1-tricholoromethane
Cc thuc m bc hi: halothane (Fluothane), enflurane (Ethrane), isoflurane
(Forane)
Cc hp cht khng c halogen: xylene, acetone, isopropanol, toluen, ethyl acetate,
acetonitrile, benzene
Oxite ethylene
Cc cht ha hc hn hp:
phenol
du m
cc dung mi lm v sinh
cn ethanol; methanol
acide

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

xviii

GVHD: TS.BS.Hunh Tn Tin

PH LC 5
MT S THUC GY C T BO THNG S DNG TRONG Y T
V NHIT TI THIU TIU HY THUC GY C T BO
(Ban hnh km theo Quyt nh s 43/2007/Q-BYT ngy 30 thng 11 nm 2007 ca
B trng B Y t)
Thuc
Asparaginase
Bleomycin
Carboplatin
Carmustine
Cisplatin
Cyclophosphamide
Cytarabine
Dacarbazine
Dactinomycin
Daunorubicin
Doxorubicin
Epirubicin
Etoposide
Fluorouracil
Idarubicin
Melphalan
Metrotrexate
Mithramycin
Mitomycin C
Mitozantrone
Mustine
Thiotepa
Vinblastine
Vincristine
Vindesine

SVTH: Trn L Phng Tho

Nhit ph hy (oC)
800
1000
1000
800
800
900
1000
500
800
700
700
700
1000
700
700
500
1000
1000
500
800
800
800
1000
1000
100

Lp 05QB

Kha lun tt nghip i hc

xix

GVHD: TS.BS.Hunh Tn Tin

PH LC 6
DANH MC CHT THI C PHP THU GOM
PHC V MC CH TI CH
(Ban hnh km theo Quyet nh s 43/2007/Q-BYT ngy 30 thng 11 nm 2007 ca
B trng B Y t)
Cc vt liu thuc cht thi thng thng khng dnh, cha cc thnh phn nguy him
(ly nhim, cht ha hc nguy hi, cht phng x, thuc gy c t bo) nc php
thu gom phc v mc ch ti ch, bao gm:
a. Nha:
Chai nha ng cc dung dch khng c cht ha hc nguy him nh: dung dch
NaCl 0,9%, glucose, natri bicacbonate, ringer lactat, dung dch cao phn t, dch
lc than v cc chai nha ng dung dch khng nguy hi khc.
Cc vt liu nha khc khng dnh cc thnh phn nguy hi.
b. Thy tinh:
Chai thy tinh ng cc dung dch khng cha cc thnh phn nguy hi.
L thy tinh ng thuc tim khng cha cc thnh phn nguy hi.
c. Giy: Giy, bo, ba, thng cc-tng, v hp thuc v cc vt liu giy.
d. Kim loi: cc vt liu kim loi khng dnh cc thnh phn nguy hi.

SVTH: Trn L Phng Tho

Lp 05QB

Kha lun tt nghip i hc

xx

GVHD: TS.BS.Hunh Tn Tin

PH LC 7
Thit b vn chuyn: Xe vn chuyn rc chuyn dng ca cng ty mi trng th.

Formatted: Font: 12 pt, Bold

Hnh 1: Xe ch rc y t ca cng ty mi trng th

Formatted: Font: 12 pt, Bold

Formatted: Left
Formatted: Font: 12 pt, Bold, Italic
Formatted: Font: 12 pt, Bold

Hnh 2: Xe thu gom rc thi bng inox chuyn dng ca Bnh

vin a khoa khu vc Th c

SVTH: Trn L Phng Tho

Lp 05QB