Baocao

Chng M au
1. AT VAN E Ngay nay, van e moi trng ang c cac quoc gia va cong ong tren the gii quan tam. Bi le o nhiem moi trng, s suy thoai va nhng s co moi trng co anh hng trc tiep khong ch trc mat ma con anh hng ve lau dai cho cac the he mai sau. Toan the gii eu a nhan thc c rang: phai bao ve moi trng, lam cho moi trng phat trien va ngay them ben vng. Viec bao ve moi trng cung bao gom: viec giai quyet o nhiem do nhng nguon nc thai, o nhiem do cac chat thai sinh hoat, cong nghiep, sinh hoc, cac chat thai trong y te ... e x ly cac loai chat thai tren la mot van e that s kho khan va nan giai. Vi moi loai chat thai, chung ta can co nhng bien phap x ly khac nhau t nhng khau thu gom en khau tieu huy cuoi cung. Mot trong nhng loai chat thai o th cac chat thai trong y te kha c quan tam la chat thai y te (CTYT) v tnh a dang va phc tap cua chung. Hien tai, chat thai benh vien ang tr thanh van e moi trng va xa hoi cap bach nc ta, nhieu benh vien tr thanh nguon gay o nhiem cho moi trng dan c xung quanh, gay d luan trong cong ong. Dan so Viet Nam ngay cang gia tang, kinh te cung phat trien, dan en nhu cau kham va ieu tr benh gia tang, so benh vien gia tang. T nam 1997 cac van ban ve quan ly chat thai benh vien c ban hanh. Co 843 benh vien tuyen huyen tr len nhng hau het cha c quan ly theo mot quy che chat che hoac co x ly nhng theo cach oi pho hoac cha ung. O nhiem moi trng do cac hoat ong y te ma thc te la tnh trang x ly kem hieu qua cac chat thai benh vien. Viec tiep xuc vi chat thai y te co the gay nen benh tat hoac ton thng. Cac chat thai y te co the cha ng cac yeu to truyen nhiem, la chat oc hai co trong rac y te, cac loai hoa chat va dc pham nguy hiem, cac chat thai phong
Vietnam Water Forum - www.VinaWater.org
xa va cac vat sac nhon Tat ca cac nhan vien tiep xuc vi chat thai y te nguy hai la nhng ngi co nguy c nhiem benh tiem tang, bao gom nhng ngi lam viec trong cac c s y te, nhng ngi ben ngoai lam viec thu gom chat thai y te va nhng ngi trong cong ong b phi nhiem vi chat thai do s sai sot trong khau quan ly chat thai. Nc ta co mot mang li y te vi cac benh vien c phan bo rong khap trong toan quoc. Theo so lieu thong ke cha ay u th cho en nay nganh y te co khoang 12.569 c s kham benh vi 172.642 ging benh. Cac hoat ong kham cha benh, cham soc, xet nghiem, phong benh, nghien cu va ao tao trong cac c s y te phat sinh ra chat thai. Cac chat thai y te di dang ran, long hoac kh co cha cac chat hu c, nhiem mam benh gay o nhiem, benh tat nghiem trong cho moi trng benh vien va xung quanh benh vien, anh hng xau en sc khoe ngi dan. Benh vien Ch Ray Tp.HCM la benh vien a khoa ln nhat pha Nam, co nhieu trang thiet b hien ai, la tuyen cuoi cung nhan benh nhan en t cac tnh, thanh e cham soc va ieu tr. Theo d bao lng chat thai y te se tang nhanh trong thi gian ti. V vay, viec phat sinh va thai bo chat thai y te neu khong c kiem soat chat che se gay nguy hai en moi trng xung quanh va anh hng trc tiep en sc khoe ngi dan. Hien nay, cong tac quan ly chat thai y te benh vien tng oi tot, tuy nhien van con nhng bat cap trong cong tac thu gom, van chuyen. e tai: anh gia hien trang thu gom, van chuyen va quan ly rac y te tai benh vien Ch Ray Tp.HCM se tm hieu k qui trnh thu gom, van chuyen va quan ly rac y te e tm ra nhng mat con han che va a ra bien phap nham giup cho nhng nha quan ly co the quan ly tot rac y te.
2. MUC TIEU E TAI a t lau, y te a ong mot vai tro quan trong trong cuoc song cua tat ca moi ngi. Y te la mot trong cac thanh phan cua s phat trien kinh te- xa hoi cua mot a phng, mot khu vc. Nganh y te a phong va cha benh cac loai benh cua cac sinh vat (con ngi va ong vat) b nhiem benh, trong o co cac benh b gay nen do o nhiem moi trng. The nhng, chnh qua trnh hoat ong cua mnh nganh y te cung a gay nen rat nhieu van e gay o nhiem moi trng va anh hng en sc khoe cua con ngi va hoat ong song cua cac sinh vat. a t rat lau, viec giai quyet s o nhiem moi trng trong cac hoat ong cua nganh y te a la mot van e nhc nhoi cua toan xa hoi va tren the gii. Benh vien Ch Ray cung nh cac benh vien khac ang gap rat nhieu kho khan trong viec quan ly moi trng benh vien va chat thai phat sinh t cac hoat ong y te . Luan van c thc hien nham thc hien cac muc tieu cu the: Nghien cu anh gia hien trang. Xac nh tong khoi lng rac y te cua benh vien t nay en nam 2015. Chat thai y te c thu gom, van chuyen va x ly 100% tranh tnh trang thoat ra ngoai moi trng. Tao ra mot moi trng lam viec tot hn cho cac nhan vien y te, nhan vien ve sinh va mot moi trng song sach ep, xanh ti. 3. NOI DUNG NGHIEN CU Tong quan ve chat thai ran y te. Thu thap thong tin ve benh vien Ch Ray. Hien trang quan ly chat thai y te. anh gia hien trang thu gom, van chuyen chat thai y te tai benh vien. e ra giai phap quan ly rac y te.
4. GII HAN E TAI - Thi gian thc hien: thang 10/07 en 12/07 - Pham vi nghien cu: e tai c gii han trong pham vi: anh gia hien trang thu gom, van chuyen va quan ly rac y te tai benh vien Ch Ray Tp.HCM. 5. PHNG PHAP NGHIEN CU e thc hien c cac noi dung nghien cu tren cac phng phap nghien cu c s dung: Phng phap thu thap thong tin tai lieu: ke tha cac ket qua nghien cu a co san, thu thap phan tch qua cac bao cao, e tai nghien cu, cac bao cao anh gia tac ong moi trng. Phng phap khao sat thc a: khao sat, thu thap so lieu tai benh vien . Phng phap khao sat tai lieu.
Chng 1
TONG QUAN VE CHAT THAI RAN Y TE

1.1 NH NGHA Theo nghien cu cua To chc Y te the gii (WHO) cho thay trong tong so chat thai thong thng tao ra t cac hoat ong y te, gan 80% la chat thai thong thng (tng t nh chat thai sinh hoat) con lai xap x 20% la nhng chat thai nguy hai bao gom chat thai nhiem khuan va chat thai giai phau chiem ti 15%; cac vat sac nhon chiem khoang 1%; cac hoa chat, dc pham het han chiem khoang 3% va cac chat thai oc di truyen, vat lieu co hoat tan phong xa chiem khoang 1%. Theo qui nh ve quan ly chat thai y te cua Bo Y te ban hanh, chat thai y te la chat thai phat sinh trong cac c s y te, t hoat ong kham cha benh, cham soc, phong benh, nghien cu, ao tao, chat thai y te co the dang ran, long, kh. 1.2 PHAN LOAI CHAT THAI Y TE 1.2.1 Chat thai lam sang: gom 5 nhom Nhom A: la chat thai nhiem khuan, bao gom: nhng vat lieu b tham mau, tham dch, cac chat bai tiet cua ngi benh nh bang, gac, bong, gang tay, bot bo, o vai, cac tui hau mon nhan tao, day truyen mau, cac ong thong, day va tui dch dan lu Nhom B: la cac vat sac nhon, bao gom: bm tiem, kim tiem, li va can dao mo, inh mo, ca, cac ong tiem, manh thuy tinh v va moi vat lieu co the gay ra vet cat hoac choc thung, cho du chung co the b nhiem khuan hoac khong nhiem khuan.
Nhom C: la chat thai co nguy c lay nhiem cao phat sinh t cac phong xet nghiem, bao gom: gang tay, lam knh, ong nghiem, tui ng mau, benh pham sau khi sinh thiet/ xet nghiem/ nuoi cay Nhom D: la chat thai dc pham, bao gom: Dc pham qua han, dc pham b nhiem khuan, dc pham b o, dc pham khong con nhu cau s dung. Thuoc gay oc te bao gom cac loai thuoc chong ung th hoac cac thuoc hoa tr lieu ung th. Nhom E: la cac mo va c quan ngi - ong vat, bao gom: tat ca cac mo cua c the (du nhiem khuan hoac khong nhiem khuan); cac c quan, chan tay, rau nhau thai, bao thai, xac suc vat th nghiem. 1.2.2 Chat thai phong xa. Chat thai phong xa sinh ra trong cac c s y te t cac hoat ong chan oan nh v khoi, hoa tr lieu va nghien cu phan tch dch mo c the. Chat thai phong xa ton tai di ca ba dang: ran, long va kh. Chat thai phong xa ran gom: cac vat lieu s dung trong cac xet nghiem, chan oan, ieu tr nh ong tiem, bm tiem, kim tiem, knh bao ho, giay tham, gac sat khuan, ong nghiem, chai lo ng chat phong xa Chat thai phong xa long gom: dung dch co cha nhan to phong xa phat sinh trong qua trnh chan oan, ieu tr nh nc tieu cua ngi benh, cac chat bai tiet, nc xuc ra cac dung cu co cha phong xa Chat thai phong xa kh gom: cac chat kh dung trong lam sang nh 133Xe, cac kh thoat ra t cac kho cha chat phong xa 1.2.3 Chat thai hoa hoc. Chat thai hoa hoc phat sinh chu yeu t cac hoat ong th nghiem, xet nghiem co the chia chung thanh hai loai chu yeu sau:
Chat thai hoa hoc khong gay nguy hai: nh ng, axit beo, va mot so muoi vo c va hu c. Chat thai hoa hoc nguy hai: co ac tnh nh gay oc, an mon, de chay hoac co phan ng gay oc gen, lam bien oi vat lieu di truyen, bao gom: Formadehyde: c s dung trong khoa giai phau benh, loc mau, p xac va dung e bao quan cac mau xet nghiem mot so cac khoa. Cac hoa chat quang hoa hoc: co trong cac dung dch dung co nh va trang phim. Cac dung moi: Cac dung moi dung trong c s y te bao gom cac hp chat halogen nh methylen chlorid, chloroform, freons, trichloro ethylen, cac thuoc me boc hi nh halothan; cac hp chat khong co halogen nh xylen, aceton, isopropanol, toluen, ethyl acetat va acetonitril, Oxit ethylene: c s dung e diet khuan cac thiet b y te, phong phau thuat nen c ong thanh bnh va gan vi cac thiet b diet khuan. Loai kh nay co the gay ra nhieu oc tnh va co the gay ra ung th ngi. Cac chat hoa hoc hon hp: bao gom cac dung dch lam sach va kh khuan nh phenol, dau m va cac dung moi lam ve sinh 1.2.4 Cac bnh cha kh co ap suat. Cac c s y te thng co cac bnh cha kh co ap suat nh bnh ng oxy, CO2, bnh ga, bnh kh dung va cac bnh ng kh dung mot lan. Cac bnh nay de gay chay, no khi thieu ot v vay phai thu gom rieng. 1.2.5 Chat thai sinh hoat. Bao gom: Chat thai khong b nhiem cac yeu to nguy hai, phat sinh t cac buong benh, phong lam viec, hanh lang, cac bo phan cung ng, nha kho, nha
giat, nha an, bao gom: giay bao, tai lieu, vat lieu ong goi, thung carton, tui nilon, tui ng phim, vat lieu goi thc pham, cac loai thc an d tha cua ngi benh va rac quet don t cac san nha. Chat thai ngoai canh: la cay va chat thai t cac khu vc ngoai canh 1.3 NGUON PHAT SINH Toan bo chat thai ran trong benh vien phat sinh t cac hoat ong dien ra trong benh vien, bao gom: Cac hoat ong kham cha benh nh: chan oan, cham soc, xet nghiem, ieu tr benh, phau thuat,(S o 1.1) Cac hoat ong nghien cu, th nghiem trong benh vien. Cac hoat ong hang ngay cua nhan vien benh vien, benh nhan va than nhan.
Khoa dc Cung cap thuoc, y cu can thiet Phong ke hoach tong hp Nha bep Quan ly ho s benh an Dch vu an uong Kham benh Chan oan Xet nghiem Ngi benh BV Phau thuat Cap cu Hoi sc cap cu Tham benh ieu tr ngoai tru ieu tr noi tru tai khoa, phong Xuat vien
Tai kham
S o 1.1 Hoat ong kham va ieu tr cua benh nhan

1.4 TNH CHAT CUA CHAT THAI Y TE 1.4.1 Tnh chat vat ly Thanh phan vat ly: o bong vai si: gom bong gac, bang, quan ao cu, khan lau, vai trai o giay: hop ng dung cu, giay goi, giay thai t nha ve sinh o thuy tinh: chai lo, ong tiem, bong tiem, thuy tinh, ong nghiem, o nha, hop ng, bm tiem, day truyen mau, tui ng, o kim loai: kim tiem, dao mo, hop ng, Benh pham, mau mu dnh bang gac, Rac ri, la cay, at a ,. Theo ket qua phan tch cua EPA (1991) thanh phan chat thai thong thng va chat thai nhiem khuan c trnh bay nh sau: Thanh phan chat thai thong thng.(rac sinh hoat y te) + Giay va cac loai giay tham: 60% + Plastic: 20%. + Thc pham tha: 10% + Kim loai thuy tinh va cac hp chat vo c: 7% + Cac loai hon hp khac: 3% Thanh phan cua chat thai nhiem khuan la: + Giay va quan ao: 50 70% + Plastic: 20 60% + Thuy tinh: 10 20% + Chat dch: 1 10% Ket qua tren 80 benh vien trong pham vi ca nc ve thanh phan chat thai y te c chia ra nh sau (bang 1.1)
Bang 1.1 : Thanh phan rac thai benh vien trung bnh Viet Nam STT 1 2 3 4 5 6 7 8 9 Thanh phan Giay cac loai va carton Kim loai, vo hop o thuy tinh va o nha (V du: kim tiem, lo thuoc, bm tiem) Bong bang, bo bot (vat lieu hap thu chat lay nhiem) Tui nha cac loai: PE, PP, PVC Benh pham Rac hu c Cac vat sac nhon (kim tiem, dao keo mo, cac dung cu cat got,..) Cac loai khac Ty le (%) 2,9 0,7 3,2 8,8 10,1 0,6 52,7 0,4 20,6
(Nguon: Bao cao hoi thao quan ly chat thai y te Ha Noi, 1998)
1.4.2 Tnh chat hoa hoc Thanh phan hoa hoc: Nhng chat vo c, kim loai, bot bo, chai lo thuy tinh, soi a, hoa chat, thuoc th, Nhng chat hu c: o vai si, giay, phan c the, o nha,.. Neu phan tch nguyen to th thay gom nhng thanh phan C, H, O, N, S, Cl va mot phan tro,.. Trong o: Thanh phan hu c: phan vat chat co the bay hi sau khi c nung nhiet o 950oC. Thanh phan vo c (tro) la phan tro con lai sau khi nung rac 950oC Thanh phan phan tram cac nguyen to c xac nh e tnh gia tr nhiet lng cua chat thai y te. Nhiet tr: 1.400 2.150 Kcal/ Kg.
1.5 ANH HNG CUA CHAT THAI Y TE EN MOI TRNG VA SC KHOE CONG ONG 1.5.1 Anh hng en moi trng. Theo quy nh cua luat, cac chat thai y te phai c x ly at tieu chuan moi trng xung quanh, nhng thc te hien nay lai khac. Chat thai y te ac biet la chat thai nguy hai phan ln cha c x ly hay x ly khong at tieu chuan quy nh a va ang la van e ang lo ngai cho moi trng. Hien tai khong t benh vien rac thai y te c nhap chung vao rac thai thanh pho e x ly hoac x ly theo phng phap ot thu cong tai benh vien thng hieu qua x ly kem va gay o nhiem moi trng khong kh, tham ch chat thai y te tai mot so benh vien c chon lap ngay trong benh vien va thng tai cac bai chon lap nay eu khong at tieu chuan ve sinh cung la nguon ong gop khong nho trong nguyen nhan gay o nhiem nguon nc ngam, o nhiem mui va la nguon truyen benh rat nguy hiem. Theo thong ke th ty le vao vien do cac benh truyen nhiem qua chat thai va nc thai chiem 15% trong tong so ca benh, ac biet vao mua he benh truyen nhiem qua chat thai con nghiem trong hn nhieu. 1.5.2 Anh hng cua chat thai y te oi vi sc khoe cong ong Tat ca nhng ngi phi nhiem vi chat thai y te nguy hai eu la oi tng co nguy c. Ho co the la nhan vien va ngi benh trong cac c s y te lam phat sinh ra chat thai, nhng ngi trc tiep tham gia x ly, tieu huy chat thai va nhng ngi dan trong cong ong dan c trong trng hp chat thai cha c x ly chnh ang. Nhom ngi nguy c chnh bao gom: bac s, y ta, nhan vien, ngi benh, nhan vien thu gom, cong ong dan c. 1.5.2.1 Anh hng cua loai chat thai truyen nhiem va cac vat sac nhon Benh truyen nhiem co nguy c lay truyen rat ln qua rac thai va nc thai benh vien. Rac thai benh vien co cha cac mam benh nh: cac vi khuan, vi rut, k sinh trung va nam vi mot lng u e gay benh. Nhng ngi de b
anh hng nhat la y ta, bac s va nhng ngi thu gom rac, bi rac. Cac tac hai cua rac thai benh vien la lam tang nhiem khuan va khang thuoc tai benh vien, ton thng trc tiep cho ngi thu gom rac, lay nhiem benh cho nhan dan song trong vung lan can, anh hng ti tam ly va tham my o th. Nc thai benh vien co cha nhieu vi khuan gay benh, cac chat oc hoa hoc, chat phong xa. Nhng ieu nguy hiem hn la nc thai benh vien thng thai vao cac nguon nc mat, tham xuong at lam o nhiem at, o nhiem nguon nc ngam gan khu vc sinh song cua dan c ma ay la nguon nc sinh hoat chnh. Nh nam 1990, WHO a cho biet co ti 80% benh tat cua ngi lien quan en nc vi so ging benh chiem 50% so ging benh cua cac benh vien. Trong cac nguon nc thai cua benh vien, nc thai t khoa lay la nguy hiem nhat. Neu trong nc thai sinh hoat khu vc dan c t le vi khuan gay benh/tong so trc khuan ng ruot la 1/104-106 th trong nc thai cua khoa lay t le nay la 1/102-103, gap t 100-1000 lan. Ngi ta con nhan thay, trung bnh trong mot lt nc thai benh vien co t 5.000 10.000 vi rut gay benh, 10 15 trng giun ua. Trong mot lt nc thai cua benh vien lao co the co t 106-109 trc khuan lao co sc e khang cao ngoai canh, tham ch con tm c trc khuan lao cach ni thai nc cong benh vien xa ti 500 met. trong nc vi khuan thng han co kha nang song t 2-93 ngay, vi khuan l song t 12-15 ngay, vi khuan ta song t 4-28 ngay. oi vi nhng benh nguy hiem do virut gay ra nh HIV/AIDS; Viem gan B hoac C, nhng nhan vien y te, ac biet la cac y ta la nhng ngi co nguy c nhiem cao nhat qua nhng vet thng do cac vat sac nhon b nhiem mau benh nhan gay nen, nhng ngi van hanh quan ly chat thai xung quanh benh vien cung co nguy c lay nhiem ang ke, nh nhng nhan vien quet don, nhng ngi bi rac tai cac bai o rac (mac du nhng moi nguy c nay khong co tai lieu ang tin cay chng minh).
Mot bao cao cua c quan Bao ve Moi trng Hoa Ky (EPA) tai hoi ngh chat thai y te a anh gia so trng hp nhiem virut viem gan B va C hang nam do ton thng gay ra bi cac vat sac nhon trong so cac nhan vien y te va cac nhan vien quan ly chat thai. So nhiem virut viem gan B hang nam My do tiep xuc vi chat thai y te vao khoang t 162 en 321 ca so vi tong so 300.000 trng hp moi nam. Trong bat ky mot c s y te nao, y ta va nhng benh nhan quan ly tai benh vien la nhng nhom nguy c chnh b ton thng, ty le ton thng hang nam cua nhng oi tng nay vao khoang 10-20 phan nghn. Ty le hang nam My la 180 phan nghn. Van co mot t le ang ke cac ton thng la cac vet cat, thung do cac vat sac nhon b loai bo gay ra. 1.5.2.2 Anh hng cua loai chat thai hoa hoc va dc pham a co nhieu vu ton thng hoac nhiem oc do viec van chuyen hoa chat va dc pham trong benh vien khong am bao. Cac dc s, bac s gay me, y ta, ky thuat vien, can bo hanh chnh co the co nguy c mac benh ng ho hap, benh ngoai da do tiep xuc vi cac loai hoa chat long bay hi, dang phun sng va cac dung dch khac. e han che ti mc thap nhat la nguy c nghe nghiep nay nen thay the giam lng hoa chat oc hai xuong bat c luc nao co the va cung cap cac phng tien bao ho cho nhng ngi tiep xuc vi hoa chat. Nhng ni s dung va bao quan loai hoa chat nguy hiem cung nen c thiet ke he thong thong gio phu hp, huan luyen cac bien phap phong ho va cac trng hp cap cu cho nhng ngi co lien quan. 1.5.2.3 Anh hng cua loai chat thai gay oc gen Can phai co mot thi gian e thu thap nhng d lieu va anh hng lau dai oi vi sc khoe cua cac chat thai gay oc gen trong y te, bi v rat kho anh gia anh hng cua loai oc chat phc tap nay len moi nguy c oi vi con ngi. Mot nghien cu c tien hanh Phan Lan a tm ra mot dau hieu lien quan gia xay thai trong 3 thang au cua thai ky va tiep xuc nghe nghiep
vi cac thuoc chong ung th, nhng cac nghien cu tng t tai Phap va My lai khong xac nhan ket qua nay. Co rat nhieu nghien cu c xuat ban a ieu tra kha nang ket hp gia nguy c oi vi sc khoe va viec tiep xuc vi chat chong ung th, bieu hien bang s tang ot bien cac thanh phan trong nc tieu nhng ngi a tiep xuc va tang nguy c xay thai. Mot nghien cu gan ay a chng minh, nhng nhan vien quet don trong benh vien phai tiep xuc vi yeu to nguy c th co lng nc tieu tang vt troi so vi nhng y ta va cac dc s trong benh vien o. Them na, nhng ngi nay thng t y thc c moi nguy hiem va do vay t ap dung cac bien phap phong ho hn. Mc o tap tung cac thuoc gay oc gen trong bau khong kh ben trong benh vien cung a c xem xet trong mot so nghien cu thiet ke e anh gia cac anh hng ve sc khoe lien quan vi viec tiep xuc vi cac yeu to nguy c. Hien van cha co mot an pham khoa hoc nao ghi nhan nhng hau qua bat li oi vi sc khoe do cong tac quan ly yeu kem oi vi cac chat thai gay oc gen. 1.5.2.4 Anh hng cua loai chat thai phong xa Nhieu tai nan c ghi nhan do viec thanh toan va x ly cac nguyen lieu trong tr lieu hat nhan cung vi so lng ln nhng ngi b ton thng do tiep xuc vi moi nguy c. Brazil, a phan tch va co ay u tai lieu chng minh mot trng hp anh hng cua ung th len cong ong co lien quan en viec ro r chat thai phong xa trong benh vien. Mot benh vien chuyen ve tr lieu bang phong xa trong khi chuyen a iem a lam that thoat tai a iem cu mot nguon xa tr a c niem phong; mot ngi dan chuyen en a iem nay a nhat c no va mang ve nha. Hau qua la a co 249 ngi tiep xuc vi nguon phong xa nay, nhieu ngi trong so o hoac a chet hoac gap hang loat cac van e ve sc khoe. Ngoai tr bien co xay ra tai Brazil, con lai khong co d lieu khoa hoc ang tin cay nao co gia tr ve anh hng cua chat
thai phong xa benh vien. Co the a co nhieu trng hp tiep xuc vi chat thai phong xa benh vien co lien quan en cac van e ve sc khoe, song khong c ghi nhan. Ch co nhng bao cao cac vu tai nan co lien quan en viec tiep xuc vi cac chat phong xa ion hoa trong cac c s ieu tr do hau qua t cac thiet b X-quang hoat ong khong an toan, do viec chuyen ch cac dung dch xa tr khong am bao hoac thieu cac bien phap giam sat trong xa tr lieu. 1.6 HIEN TRANG QUAN LY CHAT THAI Y TE CUA CAC NC TREN THE GII 1.6.1 Quan ly chat thai y te tai Vng quoc Anh 1.6.1.1 Phan loai chat thai y te nh ngha chat thai y te nc Anh da tren cac quy nh ve rac thai co kiem soat nam 1992 nh sau: Bat ky chat thai nao ma gom toan bo hoac mot phan c the ngi, mo ong vat, mau hoac cac dch c the, chat bai tiet, biet dc ma khong an toan co the gay oc hai cho ngi khi tiep xuc vi no. Cac rac thai khac bat nguon t y te, chat thai ma gay ra truyen nhiem cho ngi khi tiep xuc vi no. Chat thai y te nam trong pham vi nh ngha nay c chia thanh 8 loai nhom bao gom: Mo ngi va chat truyen nhiem; Cac vat sac nhon; Mam benh va cac chat thai phong th nghiem; Cac chat thai biet dc; Nc tieu, phan va cac san pham ve sinh; Cac chat thai Cytotoxic; Cac chat thai phong xa; Cac biet dc b kiem soat. 1.6.1.2 Cong nghe tieu huy chat thai y te hien nay Tai Anh, cac phan tach chat thai ran y te c thiet lap mot cach hp ly, ien hnh trong cac benh vien, phong kham va cac c s y te khac, cac to chc y te co quy nh bat buoc ve phap ly e quan ly chat thai. Thieu huy tat ca chat thai y te la he thong tieu huy pho bien nhat, oi khi kem theo ca x
ly s bo ban au cho cac thanh phanh oc hai ac biet nh kh trung tai benh vien. ien hnh nc Anh cac phng tien thieu huy la Sector rieng va e at c tiet kiem cac he thong, c cap cho tng khu vc. Tuy nhien, mot so benh vien hien ang hoat ong nh Hospital trusts cung tieu huy chat thai ran y te bang cach t thieu huy hoac ho k hp ong vi ben th 3 e thieu huy. Trong thc te, khong phai tat ca rac thai c thieu huy. Chon lap c s dung cho loai chat thai ran y te t oc hai hn (rac thai khong gay benh truyen nhiem). La chon phng phap tieu huy cuc bo phai da tren ieu kien thc te va kha nang tieu huy co san. Tuy vay, cach thc tieu huy cuc bo hien nay cung t c ap dung. Theo truyen thong, cac lo ot quy mo nho c phep thc hien cac tieu chuan moi trng thap hn, lam chung co tnh hieu qua theo chi ph (v chi ph lam sach kh la 50-60%). Tuy nhien, phng phap nay co van e khi lng kh thai nho hn, nhng nong o cc ai tai mat at co the cao hn so vi cac lo ot quy mo ln, v vay mc o rui ro cho sc khoe sinh ra t lo ot quy mo nho va lo ot quy mo ln la nh nhau. Khi tieu chuan gii han phat thai oi vi cac lo ot quy mo nho c that chat hn, th nhieu lo ot nho tai cac benh vien se b ong ca. Khi o benh vien phai ky hp ong thu gom va thieu huy vi cong ty dch vu. 1.6.1.3 Chien lc tieu huy chat thai Tai Anh, chien lc toi u cho tieu huy chat thai y te la thieu huy nhiet o cao vi thiet b lam sach kh thai hp ly e thoa man cac tieu chuan Chau Au ve kiem soat chat phat thai. Chien lc nay a c ap dung trong qua kh va se tiep tuc c ap dung trong tng lai. Khoi lng chat thai ran y te c chon lap se giam. Trong khi o cac bien phap tieu huy thch hp khac luon luon san sang ap ng u cong suat theo yeu cau. Mot phng phap x ly rac thai y te la kh trung bang nhiet a c e xuat tai Anh va a c c quan moi trng chap thuan nh la mot giai phap e giai quyet
van e nay. Ben canh o bien phap tieu huy o sac nhon tai nguon (la tai cac benh vien va phong kham t) vi chi ph thap cung c phat trien nc Anh. 1.6.2 Quan ly chat thai y te tai Hong Kong 1.6.2.1 Phan loai chat thai y te Tai Hong Kong phan loai chat thai y te chia thanh 7 nhom bao gom: Nhom 1 : Cac o sac nhon a nhiem ban Nhom 2 : Rac thai phong th nghiem Nhom 3 : Mo te bao ngi va ong vat Nhom 4 : Chat gay nhiem benh Nhom 5 :Thuoc m boi vet thng a b ban, cac bong gac va tat ca chat thai khac t cac lan ieu tr Nhom 6 : Cac chat thai Cytotoxic: Cac thuoc biet dc Cytotoxic trong bnh va tat ca cac ong thuoc tiem hoac cac bnh cha biet dc Cytotoxic sau khi s dung Nhom 7 : Cac chat thai biet dc va chat thai hoa hoc 1.6.2.2 Cong nghe tieu huy chat thai y te hien nay au tien, nam 1990 cac chat thai y te c tieu huy nh ket hp thieu trong cac lo ot nho at trong cac benh vien va tieu huy bang cach chon lap. Cac lo ot nho khong at c cac tieu chuan quoc te ve nnhiet o cao, thi gian lu tr dai va co thiet b lam sach kh thai. Hn na, cac lo ot nho c lap at tai cac khu vc ong dan c va gan cac toa nha cao tang. S phat thai cac chat oc hai t cac lo ot chat thai y te vao kh quyen se gay tac hai ti sc khoe cua ngi dan song khu vc lan can. Trc s gia tang cac vu khieu nai cua cong chung va s gia tang so ngi hp nhiem benh. Chnh phu Hong Kong a giao nhiem vu cho cac nha khoa hoc nghien cu, anh gia va e xuat cac giai phap tieu huy chat thai y te trong tng lai.
Vao nam 1993, To chc Y te Hong Kong (HKMA) a gii thieu hng dan quan ly chat thai y te nham am bao cach thc phan loai thch hp trong cac benh vien va c quan y te va cac hoat ong nha khoa. ieu nay cang c ap dung hieu qua hn tai cac benh vien, tai cac c y te ni ma can bo co chuyen mon cao, co nhieu kinh nghiem, co trang thiet b ay u nham kiem soat s lan truyen o nhiem. Tuy vay, cho en nay van co mot so han che lien quan en cach thc tieu huy chat thai y te. Chat thai y te c phan tach ngay tai nguon nh s dung he thong ma mau cho cac tui nha va cac thung cha theo hng dan cua HKMA. Tat ca cac loai chat thai ran y te va chat thai sinh hoat a c tieu huy trong cac bai chon lap rac hp ve sinh ky thuat cao Hong Kong. Cac lo ot quy mo nho cac benh vien a b ong ca do kiem soat kh thai kem hieu qua. Co 5 thanh phan phat thai chu yeu ang c xem xet cung vi kiem soat chat thai ran y te Hong Kong nh sau: Phan loai chat thai ran y te ra khoi o phe thai. Phan loai cac loai chat thai ran y te khac nhau thanh tng loai. Kiem soat chat thai ran y te t cac nguon khong phai t benh vien. Quan ly chat thai ran y te sinh ra trong ao Outlying. Tieu huy cac xac chet ong vat t nguon benh vien. 1.6.2.3 Chien lc tieu huy chat thai Tai Hong Kong, co mot he thong kiem soat hp phap e quan ly va tieu huy chat thai y te. Cac hng cu the cua luat tieu huy chat thai hien nay, ac biet luat ve chat thai hoa hoc la phu hp vi chat thai y te. Tuy nhien, cac ieu khoan nay khong thoa man c cac yeu cau cua cac tieu chuan quoc te. e thoa man cac tieu chuan tieu huy nay, s o kiem soat chat thai y te ang c phat trien hoan thien e bao am rang tat ca cac dang va cac kieu
chat thai y te sinh ra c phan loai tai nguon thai; am bao an toan trong qua trnh lu tr, van chuyen, thu gom, thieu huy va x ly. Chien lc tieu huy chat thai y te tai Hong Kong la phat trien cac phng tien tieu huy tap trung (CIF) ap ng cac tieu chuan quoc te cao nhat ve lam sach kh thai va cac tieu ch thiet ke khac. Phng tien nay c xay dng khu vc ngoai thanh, xa cac khu vc nhay cam. am bao an toan ve ve sinh trong qua trnh chuyen ch chat thai y te t cac benh vien va cac c s y te ti ni tieu huy tap trung la mot van e chnh can quan tam. 1.6.3 Quan ly chat thai y te tai Srilanka 1.6.3.1 Phan loai chat thai y te Tai Srilanka, viec phan loai chat thai y te ang c quan ly Colombo, thu o Srilanka. nh ngha chung ve chat thai y te la bat ky chat thai nao ma gom toan bo mot phan c the ngi hoac mo ong vat, mau, dch c the, cac chat bai tiet, thuoc, dc pham co the phan thanh 6 loai: Chat thai y te thong thng, o vat sac nhon, biet dc, thuoc va cac dc pham, cac vat gay mam benh, nhau va mo bao thai, chat thai cytotoxic. 1.6.3.2 Cong nghe tieu huy chat thai y te hien nay Srilanka, chat thai y te c tieu huy nh s ap dung to hp phng phap sau: ot chay trong cac lo ot s bo: Chat thai y te thng b lan vi rac thai sinh hoat cua benh vien, c ot can ban. Phng phap nay a gap nhieu kho khan trong viec x ly vi o am cua rac thai, dan ti h hong trong bo phan t cap nhien lieu chay. Ket qua cac kh t nhien can c s dung lam nhien lieu bo sung, dan ti cac chi ph vt troi va khong co bat ky he thong lam sach kh hoac kiem soat phu hp nao tren toan bo ieu kien ot chay.
ot chay trong la tren mat at hoac trong ham: Cac loai chat thai ran y te a c chon loc, ac biet cac vat sac va cac dc pham, mot so chat thai rac y te thong thng, c ot chay lo thien. La co the c ot chay tren mat at hoac trong ham mo ma sau o c phu at len. ot chay lo thien c tien hanh di s giam sat. Chon cat tai cho: Cac loai rac benh vien a c chon loc c chon tai cho, ac biet la nhau va mam benh. Chon lap tai cho c thc hien di s giam sat. o rac tai cho: Ni benh vien co khu at thch hp, o rac tai cho xuat hien tren mat at hoac trong ham rong, va sau o c phu at len. Cac ong rac oi khi c ot chay, ot chay rac nham bao toan kha nang thieu huy. o rac tai cho c thc hien di s giam sat. Thieu huy tai bai chon lap rac o th: Chat thai ran y te thong dung c thieu huy tai bai chon lap rac o th. Chat thai ran y te co the oc chon lan vi rac thai sinh hoat loai rac thai sinh ra benh vien hoac trong qua trnh thu nhap hoac trong giao thong. Tai bai chon lap rac o th, chat thai c tieu huy theo cach giong nh rac thai sinh hoat trong cong ong. 1.6.3.3 Chien lc tieu huy Vao nam 1994, Chnh phu e ra nhiem vu nghien cu kha thi e ieu tra cach phan huy chat thai ran y te Colombo. Trong qua trnh nghien cu mot so cach tieu huy e tieu huy chat thai y te c xem xet. Cac ket qua nghien cu ch cho rang, mac du tnh phc tap cao va chi ph cao nhng thieu huy rac c xem la phng phap tin cay, am bao va hieu qua cao, loai bo c moi nguy c truyen nhiem t tat ca cac loai chat thai y te. Do o phng phap nay c xem la cach tot nhat e tieu huy chat thai ran y te trong tng lai Colombo. Yeu cau ve thi gian e co c phng tien hoac cac phng tien
thieu huy chat lng cao, ong thi co the c chap nhan ve mat moi trng Colombo th chien lc tieu huy tat ca chat thai y te nh sau: Trc mat: o rac co kiem soat vao cac ong rac trong o th, bang cac bien phap kiem soat quan ly a tang tien o o rac nhanh nh khi no c thieu huy. Lau dai: Qua trnh thieu huy do mot hoac nhieu chuyen gia tien hanh, cac phng tien thieu huy c s dung. Qua trnh ot chay lo thien chat thai ran y te a thc hien Srilanka khong c xem la cach thay the co the chap nhan c cho qua trnh thieu huy hien ai. Cac phng tien thieu huy cuc bo c thiet ke cho nhom hoat ong va c lap at cac v tr khac nhau (co the tai benh vien), khong tnh en hieu qua oi vi chi ph neu cac phng tien nay c yeu cau phai thc hien nh mot mo hnh trnh dien. Tuy nhien, neu cac phng tien nay c phep ap ng cac tieu chuan moi trng t chat che hn th phat trien cac lo ot nho hn se kinh te hn. Bang 1.2 Lng chat thai phat sinh tai cac nc tren the gii
Tuyen benh vien Tong lng chat thai y te (Kg/ging benh/ngay) Chat thai y te nguy hai (Kg/ging benh/ngay)
Benh vien Trung ng Benh vien Tnh Benh vien Huyen
4,1 8,7 2,1 4,2 0,5 1,8
0,4 1,6 0,2 1,1 0,1 0,4
(Nguon: Hoi thao quan ly moi trng trong nganh y te 5-6/03/2002)
1.7 HIEN TRANG QUAN LY CHAT THAI Y TE TAI VIET NAM 1.7.1 Tnh hnh chung Phan ln cac benh vien Viet Nam c xay dng trong giai oan at nc con ngheo, lai mi trai qua chien tranh, nhan thc ve van e moi trng
cha cao nen cac benh vien eu khong co he thong x ly chat thai nghiem tuc, ung quy trnh ky thuat. C s vat chat ky thuat e x ly triet e cac loai chat thai oc hai con b thieu thon nghiem trong. Ben canh o, cong tac quan ly con long leo va cha co quy trnh x ly triet e. Mat khac, so lng benh vien va c s kham cha benh rat ln, lai thieu von, nen so lng benh vien at tieu chuan moi trng con rat t. Bao ve moi trng tai cac benh vien khong ch la van e cua rieng cac benh vien ma can co s quan tam cua Chnh phu va toan xa hoi. Trong nhng nam qua cac c quan quan ly moi trng a to chc nhieu t tuyen truyen, van ong can bo quan ly, can bo chuyen mon, nhan vien y te, benh nhan va than nhan e thay ro trach nhiem trong van e thu gom, phan loai va x ly s bo, giam thieu oc hai gay ra do chat thai y te. Tuy nhien, nhan thc cua cong ong ve nhng nguy c tiem an trong chat thai y te van con yeu. Chat thai y te c cac Cong ty Moi trng o th thu gom, x ly hoac c x ly bang cac lo ot tho s, khong at tieu chuan ve sinh moi trng hoac c ngam trong Formandehyt roi tap trung chon lap tai cac ngha trang, trong cac khuan vien benh vien. Rat nhieu loai chat thai lay nhiem, oc hai c xa trc tiep ra bai rac, thai ra he thong thu gom nc thai thanh pho ma khong qua bat ky mot khau x ly can thiet nao. Thay ro c yeu cau cap thiet phai hoan thien cong tac quan ly chat thai y te tai cac c s kham cha benh cua nganh, nam 1998 Bo Y te a thanh lap ban ch ao x ly chat thai benh vien vi nhiem vu giup Bo trng trong cong tac ch ao, xay dng quy hoach he thong x ly chat thai benh vien trong pham vi toan quoc. Tren c s o, ngay 27/8/1999 Bo trng Bo Y te a ban hanh Quy che quan ly chat thai y te, en nam 2002 Bo trng Bo Y te ban hanh tiep Quy
che bao ve moi trng tai cac c s y te. Trong thi gian qua nhieu chng trnh nghien cu th iem cac lo ot, chng trnh xay dng quy hoach tong the he thong cac lo ot tren toan quoc a va c trien khai. 1.7.2 Cong nghe x ly chat thai y te
Bo Y te a nhap 25 lo ot chat thai y te ky hieu Hoval va lap at cho mot so a phng, TP. Ho Ch Minh cung a nhap lo ot rac y te cong suat 7 tan/ngay e thieu huy toan bo chat thai ran y te phat sinh t cac benh vien trong thanh pho. (Xem bang 1.3) Bang 1.3 Lo ot rac a lap at cho cac benh vien-trung tam Y te trong nc STT Ky hieu lo Nc san xuat 01 02 03 04 05 06 07 08 Hoval MZ2 Hoval MZ2 Hoval MZ2 Hoval MZ4 Hoval M22 Macroburu RET 20 RET 20 Thuy Sy Thuy Sy Thuy Sy Ao Ao Nam Phi Viet Nam Viet Nam Cong suat (kg/h) 200-300 200-300 200-300 400 300 200 50 20 BVK Quang Ngai BVK Sa ec Vien Lao & Benh phoi BVTW Hue BV Ba Ra Vung Tau BV C a Nang BV Soc Trang TT Lao & Benh phoi Tien Giang 09 10 11 VH 118 TSH 20 G TT Nghien cu CN HBK TP.HCM 12 TT Cong nghe moi trng TP.HCM
Ni lap at
Viet Nam Viet Nam Viet Nam
20 20
BV Gang Thep TN BV 175 TP.HCM BVK Cu Lao MinhBen Tre
Viet Nam
BVK TT tnh Phu Yen
13
TB Vien vat ly
Viet Nam
400
TT lao & benh phoi Quang Ngai
14
L 45 (N-001)
Viet Nam
TTYT huyen Trung Khanh tnh Cao Bang
15
TT Nghien cu CN HBK TP.HCM
Viet Nam
TTYT huyen Mang Tht Tnh Vnh Long

(Nguon: S tai nguyen & Moi trng)
1.7.3 Hien trang chat thai y te TP. Ho Ch Minh Hien nay, tong khoi lng chat thai ran y te trung bnh cua Tp.HCM la 7 9 tan/ngay. Benh vien la mot trong nhng oi tng thc hien viec phan loai chat thai ran tot nhat. Theo o, ngay t khau thu gom chat thai ran t cac phong, khoa chat thai ran a c phan lam 2 loai la tai s dung c va khong tai s dung c. Phan tai s dung c se do benh vien, trung tam y te ky ket hp ong ban cho n v tai che chat thai. Phan ln chat thai khong tai s dung c hay con goi la chat thai nguy hai th c chuyen en kho cha va ky ket hp ong thu gom vi Cong ty Moi trng o th Tp.HCM thu gom. Nh vay, S TN-MT ch chnh thc quan ly loai chat thai nay t khau thu gom tai kho cha, sau o van chuyen en lo ot Bnh Hng Hoa, quan Bnh Tan e tieu huy. Thc hien Quy che quan ly chat thai y te, ket qua khao sat, anh gia trong so 700 benh vien c kiem tra chat thai a co 95,6% benh vien thc hien phan loai rac thai. Trong o cac benh vien trung ng, benh vien tnh va benh vien t nhan thc hien phan loai chat thai ngay tai nguon tot hn benh vien huyen va cac trung tam y te.
Bang 1.4 Ket qua phan tch thanh phan rac y te (trong tui vang) tai cac benh vien Thanh pho Ho Ch Minh STT 1 2 3 4 5 6 7 8 Thanh phan Thuy tinh Plastic cac loai Cao su Vai Kim loai Giay Thc pham cac loai o am (nc) Khoi lng (%) 9,5 9,5 21 1,5 1,5 7,5 7,5 4,0
(Nguon: D an Vet Nam-Australia quan ly CTR, 5/2000 Tp.HCM)
Bang 1.5 Khoi lng rac cac benh vien trong nam 2006
Khoi lng rac Khoi lng rac 6 6 thang au thang cuoi nam nam 2006 2006
Bnh Vin A. Trung ng TP 1.BV Ch Ry 2.BV Thng Nht 3.BV Pasteur 4.BV Rang Ham Mat 5.Khoa RHM H Y Dc 6.BV H Y Dc TPHCM 7.Khoa Y Hc C Truyn 8.BV GTVT Q8 B. BV Quan oi-Cong An 9.Quan Y Vin 7A 10.BV Quan Dan Mien ong 11.Quan Y Vin 175
243513 147934 13167 5101 4283 2198 20401 173 110 25573 8911 2087 11239
280835 160398 14141 6138 7532 3516 26177 127 125 31340.5 10050 3926 14497.5
Tng cng 524348 308332 27308 11239 11815 5714 46578 300 235 56913.5 18961 6013 25736.5
12.BV 30/4 C. BV Thanh Pho 13.BV T D 14.TTCS. Sc Kho Sinh Sn 15.BV Mt 16.BV Da Liu 17.BV Nhi ng 2 18.BV Tai Mi Hng 19.BV Nhan Dan Gia nh 20.BV Ung Bu 21.BV Y Dc Dan Toc 22.BV Y Hc C Truyn 23.a Khoa Sai Gon 24. BV Bnh Dan 25.BV Bnh Dan Khu KT cao 26.TT Hin Mau Nhan ao 27.BV Phm Ngc Thch 28.BV TMHH I 29.BV Nguyn Tri Phng 30.BV Nguyn Trai 31. BV Hung Vng 32.BV An Bnh 33.BV Chn Thng Chnh Hnh 34.BV Nhit i 35.TTYT D Phong 36.BV Nhi ng 1 37.BV Nhan Dan 115 38.Vin Tim 39.BV Trung ng 40.BV Rng Ham Mt 41.TT Chun oan y Khoa 42.BV iu Dng TP 43.BV.TTHH I
2336 1065720 192073 3304 5885 12730 22193 8804 34977 139700 1231 760 6114 13006 581.5 175522 6613 12268 11931 79661 79661 7002 27173 115376 511 20466 19052 16153 18167 5213 2991 7393 7240
2867 1127173.5 219269 2806 6008 15965 23541 11027 39842 142177 1337 906 6741 22578 3131 648.5 200370 6277 12716 14089.5 94893 7764 24467 134434 588 24264 33936 15462 21143 5794 8553 5754 6476
5203 2192893.5 411342 6110 11893 28695 45734 19831 74819 281877 2568 1666 12855 35584 3712.5 176170.5 206983 18545 24647 93750.5 174554 14766 51640 249810 1099 44730 52988 31615 39310 11007 11544 13147 13716
44.PK.a Khoa Bu i n 45.TT Dinh Dng Tr em 46. BV Tam Thn 47.BV Ch Hoa 48.TTGDDN Nh Xuan 49.TTKHHGD&CSSKS 50.TTNDBTTE Tam Bnh 51.BV Bu in II 52.TTGDDN Thanh Thiu Nien II 53.BV Bnh Triu 54.TTGDDN Ph N 55.TT Ngi Bnh Tam Thn Th c 56.TTTVDVDSGDTE 57.Lang Thiu Nien Th c 58.TTNDBTTE Tam Bnh-Ba Giang TNG
133.5 385.5 51 143 1235 270 34 6681 171 1361 1061 213 69 5 155.5 1334806
150 429 56 177 1290 216 10.5 9446 170 979 724 282 86.5 0.5 200 1439349
283.5 814.5 107 320 2525 486 44.5 16127 341 2340 1785 495 155.5 5.5 355.5 2774155
TT Y T - BV t nhan 1. Qun 1 2. Qun 2 3. Qun 3 4. Qun 4 5. Qun 5 6. Qun 6 7. Qun 7 8. Qun 9 9. Qun 10 10. Qun 12 11. Qun Tan Bnh 12. Qun Tan Phu
Khi lng rac 6 Khi lng rac S lng cac thang au nm 6 thang cui c s 2006 nm 2006 31 29767 36076 3 933 794 13 16012 7728 2 13 21 8 1074 1409 53 61 1 21246 35298 2 4 21 39 7 2274 8674 3 26 91 7 5969 6637 5 1026 1636
Tng cng 65843 1727 23740 34 2483 114 56544 60 10948 117 12606 2662
13. Qun Bnh Tan 14. Qun Bnh Thnh 15. Qun Phu Nhun 16. Qun Th c 17. Qun Go Vp TNG
8 1552 4099 5651 2 552 1562 2114 4 771 9924 10695 10 242 704 946 1 9 11 20 81540 114764 196304 111 (Nguon : Cong ty Moi trng o th Tp.HCM, nam 2006)
1.8 MOT SO PHNG PHAP X LY CHAT THAI Y TE
Co nhieu phng phap co the ap dung e x ly va tieu huy chat thai y te. Moi phng phap eu co u va nhc iem nhat nh. Viec ap dung cac phng phap nay con tuy thuoc vao hoan canh va ieu kien cua moi quoc gia, a phng, cac c s y te. 1.8.1 Phng phap kh trung Phng phap nay c ap dung e kh trung oi vi chat thai y te co nguy c lay nhiem cao nham han che xay ra tai nan cho nhan vien thu gom, van chuyen va x ly rac. Kh trung bang hoa chat: Clo, Hypoclorite ay la phng phap re tien, n gian nhng co nhc iem la thi gian tiep xuc t khong tieu huy het vi khuan trong rac. Vi khuan co kha nang ben vng vi hoa chat, nen x ly khong hieu qua. Hoa chat ban than a nguy hiem, can nghien nho hoa chat thai e giam the tch. Kh trung bang nhiet ap suat cao: ay la phng phap at tien, oi hoi che o van hanh, bao dng cao, x ly kim tiem khi nghien nho, lam bien dang. Nhc iem cua phng phap la tao mui hoi nen vi benh vien co lo ot th kim tiem ot trc tiep. Kh trung bang sieu cao tang: phng phap co hieu qua kh trung tot, nang suat cao. Tuy nhien, oi hoi ky thuat cao, thiet b at tien va yeu cau co chuyen mon, la phng phap cha pho bien.
1.8.2 Chon lap chat thai ran y te Trong hau het cac benh vien huyen chat thai y te c chon lap tai bai cong cong hay chon lap trong khu at cua mot so benh vien. Trng hp chon lap trong benh vien, chat thai c chon vao trong cac ho ao va lap at len, nhieu lp at phu tren qua mong khong am bao ve sinh. Tai cac benh vien khong co lo ot tai cho, bao thai, nhau thai va bo phan c the b cat bo sau phau thuat c thu gom e em chon trong khu at benh vien hoac chon trong ngha trang tai a phng. Nhieu benh vien hien nay gap kho khan trong viec tm kiem dien tch at e chon. Vat sac nhon cung c chon lap cung vi cac chat thai y te khac tai khu at benh vien hay tai bai rac cong cong, de gay rui ro cho nhan vien thu gom, van chuyen chat thai va cong ong. Hien tai, con mot so benh vien, chat thai nhiem khuan nhom A van c tron lan vi chat thai sinh hoat ma khong c x ly ac biet g trc khi tieu huy va c thai ra bai rac cua thanh pho, gay o nhiem nghiem trong cho moi trng cua cong ong song gan bai rac. 1.8.3 Thieu ot chat thai ran y te. Phng phap thieu ot la mot ky thuat c ap dung khi mot lng ln cac chat thai nguy hai can c thieu huy. Phng phap nay am bao kha nang phan huy chat thai co hieu qua cao oi vi hau het cac chat thai hu c va lng kh thai sinh ra vi lng nho co the kiem soat c. ot chat thai la qua trnh oxy hoa chat thai bang oxy cua khong kh nhiet o cao bang oxy khong kh. Bang cach ot chat thai nguy hai ta co the giam the tch cua no en 80-90 %. Neu nhiet o lo ot < 800oC dioxin va furan se hnh thanh. Nhiet o lo ot t 900-1200oC hp chat PCB la hp chat hu c cha Cl se chay het. San pham cuoi cung cua qua trnh ot phai la cac chat khong nguy hai nh H2O, CO2
X ly bang phng phap ot co y ngha quan trong la lam giam ti mc nho nhat chat thai cho khau x ly cuoi cung, neu x ly cong nghe tien tien con co y ngha cao bao ve moi trng. ay la phng phap x ly rac ton kem nhat so vi phng phap chon lap hp ve sinh th chi ph ot 1 tan rac cao hn khoang 10 lan. Tuy nhien, ot rac y te bao gom nhieu chat khac nhau sinh khoi oc va de sinh dioxin neu giai quyet viec x ly khoi khong tot (phan x ly khoi la phan at nhat trong cong nghe ot rac). Nang lng phat sinh co the tan dung cho cac lo hi, lo si hoac cac cong nghiep can nhiet va phat ien. Moi lo ot phai c trang b mot he thong x ly kh thai rat ton kem nham khong che o nhiem khong kh do qua trnh ot co the gay ra. Cong nghe ot co u iem: Loai tr cac chat oc hai co the gay benh ung th (carcinogens), mot so chat thai co cac mam benh ma chung co the gay ra cac benh truyen nhiem, cac chat thai co hoat tnh sinh hoc co kha nang gay ra nhng tac ong bat li en cac qua trnh x ly khac. Cong nghe nay cho phep x ly c toan bo chat thai ma khong can nhieu dien tch at s dung lam bai chon lap rac. Mot lng ln nhiet lng sinh ra co the s dung cho cac muc ch khac. Nhc iem chu yeu cua phng phap nay la: Van hanh day chuyen phc tap, oi hoi nang lc ky thuat va tay nghe cao. Gia thanh au t ln, chi ph tieu hao nang lng va chi ph x ly cao. Nhng tiem nang tac ong en con ngi va moi trng co th xy ra. Mot so chat o nhiem khong kh co the hnh thanh trong qua trnh ot nh: HCl, SO2, CO, NOx, kim loai nang va bui co the gay ra cac tac ong bat li.
Chng 2
TONG QUAN VE BENH VIEN CH RAY

2.1 QUA TRNH HNH THANH VA PHAT TRIEN Ten benh vien: Benh vien Ch Ray Ten quoc te: ChoRay Hospital a ch: 201B Nguyen Ch Thanh - Q5, Thanh pho Ho Ch Minh ien thoai: (84 - 8) 855 4137 855 4138 Fax: (84 - 8) 855 7267 Email: bvchoray@hcm.vnn.vn
www.choray.org.vn
Benh vien Ch Ray c thanh lap nam 1900 vi ten chnh thc la Hospital Municipal de Cholon, roi lan lt benh vien c oi ten thanh Hospital Indegene de Cochinchine vao nam 1919; Hospital Lalung Bonnaire vao nam 1938; va Hospital 415 (1945). Sau o, benh vien c tach ra lam 2 phong kham la Ham Nghi va Nam Viet. Hai phong kham nay sat nhap lai vao nam 1957 e tr thanh Benh vien Ch Ray cho ti ngay nay. Trong thc te, ngi dan van dung ten Ch Ray e goi benh vien t ngay thanh lap. Nam 1971, benh vien Ch Ray c tai xay dng tren mot dien tch 53.000m2 vi trang thiet b hien ai e tr thanh mot trong nhng benh vien ln nhat ong Nam A. Cong trnh c hoan thanh vao thang 6/1974 bang vien tr khong hoan lai cua chnh phu Nhat Ban.
Hnh 2.1 : Benh vien Ch Ray vao nam 1919
Hnh 2.2 : Benh vien Ch Ray vao nam 1938
Bang 2.3 Benh vien Ch Ray ngay nay

Toa nha mi cua benh vien Ch Ray ngay nay gom 11 tang va chia thanh cac khu nh sau: Khu A: Khu cap cu va phong kham Khu B1 va B3: Khu ieu tr noi va ngoai khoa Khu B2: Khu thang may Khu C1: Khu vat ly tr lieu Khu C2: Khu xet nghiem, X quang, phong mo Khu C3: Khoa tham do chc nang va tiep lieu thanh trung Khu D1: Hoi trng
Khu D2: Nha an
2.2 C CAU TO CHC Tong so can bo y te va nhan vien lao ong ve sinh benh vien la 2174 ngi trong o so can bo thuoc bien che chnh thc cua benh vien la 1713 ngi. 2.3 HOAT ONG CHUYEN MON Benh vien Ch Ray la c quan ch ao cao nhat ve chuyen mon ky thuat cho cac benh vien khac, c s tuyen trc trong khu vc mien Nam la benh vien a khoa gom mot so chuyen khoa (S o 2.1) Noi khoa (Tim mach, Than, Phoi, Noi tiet, Huyet ho, Sot ret ) Ngoai khoa ( Ngoai long ngc, Ngoai tim mach, Ngoai tong quat, Ngoai than kinh, Ngoai tiet nieu, Mat, Tai mui hong ) Chnh hnh va khoa phong
Ngoai chc nang chnh la ieu tr cho benh nhan, benh vien Ch Ray con chu trach nhiem giang day sinh vien y khoa, ao tao sau ai hoc, nghien cu khoa hoc va ch ao tuyen. Benh vien Ch Ray hang nam nhan tren 2500 sinh vien y khoa en thc tap va hn 300 bac s en tham d cac khoa sau ai hoc.
Benh vien Ch Ray la mot benh vien thuoc tuyen trung ng co 1250 ging ke hoach va 1688 ging thc ke vi tren 600.000 benh nhan ngoai tru va 80.000 benh nhan noi tru hang nam. Ch Ray la benh vien tuyen cao nhat cua mien Nam va c s ch ao trc tuyen cua Bo Y te. Benh vien Ch Ray ieu tr cho benh nhan 37 tnh thanh pha Nam ke ca thanh pho Ho Ch Minh vi tong so dan hn 40 trieu ngi. Can cu phap ly: - Quyet nh ban hanh ieu le to chc va hoat ong so 4175/Q BYT cua benh vien Ch Ray do Bo Y Te cap ngay 22/11/2004 - Quyet nh giao at so 6446/Q UB QLT do uy ban nhan dan thanh pho Ho Ch Minh cap cho benh vien Ch Ray vao ngay 28/11/1998 2.4 C S HA TANG C s ha tang cua benh vien Ch Ray c xay dng kha hien ai vi cac khoa, phong kham va ieu tr benh c trang b may moc, thiet b y te ay u. Hien nay, benh vien ang c quy hoach lai tong the mat bang en nam 2020 e m rong va nang cap ha tang c s nham ap ng cho nhu cau kham, cha benh va cham soc sc khoe cua ngi dan. Ngoai ra, benh vien co khuon vien rong va trong kha nhieu cay xanh nen ieu kien kh hau ay rat tot, bao am moi trng trong lanh cho benh nhan phuc hoi sc khoe. 2.5 HOAT ONG BAO VE MOI TRNG TAI BENH VIEN 2.5.1 Quy che Bo Y te (Phu luc 1) 2.5.2 Quy che benh vien (Phu luc 2) 2.5.3 Cac van ban phap luat (Phu luc 3) 2.5.4 Cong tac kiem soat o nhien moi trng Thc hien ve sinh canh quan benh vien: phan au benh vien Xanh-Sachep
ng i lai sach, khong co rac, khong ong nc. Co he thong cong ranh thoat nc thong thoat.
Trong cay xanh, bong mat, hoac co vn hoa cay canh c cham soc quet don thng xuyen.
Khu nha an, hanh quan c phep cua benh vien phai tap trung lai mot ni quy nh. Khu ai the, nha tang le, khu tap trung chat thai ran, khu x ly nc thai tach rieng vi khu ieu tr.
nh ky co ke hoach va kinh ph quet voi, sn ca bao am ve sinh va tao nen canh quan moi trng sach ep.
ng i lai gia cac khoi nha, ni benh nhan ngoi i co at thung rac co nap ay va c thu gom hang ngay.
Nghiem cam ngi nha benh nhan nau nng thc an tai hanh lang, ngoai vn, trong buong benh.
Trat t ve sinh khoa va buong benh phai theo ung Quy che chong nhiem khuan benh vien (trong Quy che benh vien).
Ngoai ra, hanh lang can c chieu ay u t 100 lux, tng quet voi mau sang e tang phan chieu anh sang khu vc i lai.
Khong c e cay canh trang tr trong phong tiem, tieu phau thuat (trong at co nha bao vi khuan )
Khi trong buong benh co rep, gian phai to chc diet chung. Co noi quy trat t ve sinh buong benh, hng dan benh nhan va ngi nha tham nuoi thc hien.
ANG UY
GIAM OC
CONG OAN
PHO GIAM OC
OANTHANH NIEN CS HCM
PHO GIAM OC
PHO GIAM OC
HOI ONG
KHOA HOC KY THUAT
THUOC VA IEU TR
NGOAI KHOA VA PHAU THUAT
GHEP THAN
CHONG NHIEM KHUAN
MUA SAM TRANG THIET B
GIAM NH Y KHOA
KHOI PHONG CHC NANG
KHOI LAM SANG
KHOI CAN LAM SANG
S o 2.1 S o to chc benh vien

Chng 3
HIEN TRANG QUAN LY VA CONG TAC THU GOM - VAN CHUYEN CHAT THAI Y TE TAI BENH VIEN CH RAY
3.1 AC IEM CHAT THAI RAN Y TE 3.1.1 Nguon phat sinh Chat thai ran y te cua benh vien chu yeu phat sinh t cac nguon sau: khau kham cha benh nh bong bang, gac, kim tiem, tui nha, dao mo, phim chup X-quang, dc pham, benh pham, ong thuy tinh, lo, gang tay cao su, khan giay. Nhn chung, viec phan loai chat thai va xac nh nguon thai cua benh vien Ch Ray c tom tat trong (bang 3.1) Bang 3.1: Phan loai chat thai va xac nh nguon thai tai benh vien Ch Ray Chat thai ran y te Nguon thai T phong mo: cac c quan, bo phan c the benh Chat thai khong sac Chat thai lam sang Chat thai sac nhon nhon nhan sau khi phau thuat, cua ong vat sau khi lam th nghiem, bot bo co dnh mau benh nhan. Bang gat hay bat c dung cu nao co dnh mau, m, nc bot cua benh nhan Cac vat sac nhon va cac vat b gay, v co dnh mau trong khi mo, cac vat lieu s dung trong qua trnh kham cha benh. Ong ng mau nuoi cay trong phong th nghiem. Chat thai ac biet
(Nguon: Benh vien Ch Ray 6/2002)
Chat thai phong xa, hoa hoc.
3.1.2 So lng chat thai phat sinh tai benh vien Theo so lieu thong ke cua benh vien, lng chat thai y te t nam 2003 en 6 thang au nam 2007 c the hien nh sau: Bang 3.2 Lng chat thai t nam 2003 6 thang nam 2007 Tong so benh Nam nhan nhap vien (ngi) So ging thc ke
Kg/gingbenh/ngay Tan/nam
Lng chat thai y te
2003 2004 2005 2006 6th-2007
74.505 82.257 89.000 96.758 49.120
1469 1677 1702 1702 1702
0,56
257 293 297 308 160
0,56 0,56 0,58 0,6
(Nguon: Benh vien Ch Ray)
3.1.3 O nhiem do chat thai tai benh vien Ket qua nghien cu t nam 2000 cho en nay tnh hnh nhan vien y te phi nhiem nghe nghiep tai benh vien Ch Ray nh sau (nguon khoa chong nhiem khuan, 3/2005) - 34% ieu dng ton thng qua da do vat sac nhon - 32% bac sy noi va 53% phau thuat vien b kim am - 18% ieu dng ton thng qua niem mac (vang mau) - 40% ieu dng ton thng qua mat Ngoai ra cac trng hp lay nhiem khac nh viem gan sieu vi B, C, viem ng ho hap, lao cha co nghien cu nao xac nh cu the mc o phi nhiem nghe nghiep trong nganh y te.
3.2 TNH HNH QUAN LY CHAT THAI Y TE TAI BENH VIEN CH RAY Xa hoi ngay cang phat trien, viec bao ve moi trng ngay cang c quan tam, quan ly chat thai benh vien la mot trong nhng khau quan trong trong viec bao ve moi trng benh vien v lng chat thai y te benh vien phat sinh hang ngay rat ln va cha nhieu thanh phan nguy hai. Do o oi hoi phng thc quan ly bao gom he thong phan loai, thu gom phai am bao o nhiem khong gia tang va khong gay o nhiem moi trng. Tai benh vien, c tnh lng chat thai y te benh vien phat sinh hang ngay vao khoang 2500kg 3500kg, trong o cac thanh phan c trnh bay trong bang 3.3 Bang 3.3 c tnh lng chat thai y te phat sinh hang ngay tai benh vien Chat thai nhiem khuan (A) Vat sac nhon (B)
Chat thai lam sang
Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay
210 40 120 20 10 5 10 0 25003500
Chat thai phong xet nghiem (C) Chat thai dc (D) Chat thai mo benh (E)
Chat thai phong xa Chat thai hoa hoc Bnh cha kh co ap suat Tong lng c tnh
(Nguon: Khoa chong nhiem khuan benh vien Ch Ray, 9/2002)
3.2.1 He thong quan ly hanh chnh trong quan ly chat thai benh vien He thong quan ly hanh chnh trong cong tac quan ly chat thai tai benh vien Ch Ray bao gom s phoi hp cua cac phong ban trong benh vien, gom ban lanh ao benh vien, khoa chong nhiem khuan, phong quan tr va tat ca cac khoa phong trong benh vien. Trong o, khoa chong nhiem khuan chu trach nhiem
chnh trong viec theo doi, giam sat, ieu tra viec thc hien quy che quan ly chat thai, ve sinh moi trng va quy che x ly chat thai benh vien. 3.2.2 He thong quan ly ky thuat chat thai benh vien 3.2.2.1 Quy trnh thu gom, phan loai chat thai 3.2.2.1.1 Quy trnh thu gom chat thai tai benh vien c thc hien nh sau:
Rac y te Thu gom
(Tui mau vang)
Van chuyen
Nha cha rac
Bao quan
Cty MTT
3.2.2.1.2 Phan loai chat thai ngay tai nguon phat sinh. Benh vien a phan loai chat thai y te nguy hai va chat thai sinh hoat ngay tai nguon phat sinh chat thai ung theo quy che cua Bo Y te e giam thieu toi a lng chat thai y te nguy hai. Tai moi khoa lam sang eu c trang b cac loai tui va thung rac vi nhng mau khac nhau: Thung, tui nylon mau xanh (Hnh 3.1): ng chat thai sinh hoat thong thng bao gom: giay, bao, tai lieu, khan, gac, cac o dung va cac vat lieu y te cham soc ngi benh khong dnh mau thc an tha, vat lieu ong goi, hoa, la cay, rac quet don t cac san nha (tr chat thai thu gom t cac buong cach ly) va t cac khu vc ngoai canh. Thung, tui nylon mau vang (Hnh 3.1): e thu gom cac loai chat lam sang khong sac nhon(hnh3.2). Thung, hop nha mau vang ng cac vat sac nhon, ben ngoai co bieu tng ve nguy hai sinh hoc (Hnh 3.3): e thu gom cac chat thai lam sang sac nhon nh: kim tiem, bm tiem kem kim tiem, dao mo, pipet Pasteur, cac lam knh xet nghiem, a nuoi cay bang thuy tinh, cac lo thuy tinh dnh mau hay cac vat sac nhon khac
Khoa can lam sang con co them thung, tui mau en: e thu gom cac chat thai hoa hoc va chat thai phong xa, thuoc gay oc te bao. Chat thai hoa hoc: kim, lo thuy tinh ng chat thai hoa hoc, thuoc hoa tr. Chat thai phong xa: cac dung cu co dnh chat phong xa phat sinh trong qua trnh chan oan va ieu tr nh kim tiem, ong nghiem, chai lo ng chat phong xa, dung cu cha nc tieu cua ngi benh ang ieu tr chat phong xa.
Hnh 3.2: Chat thai khong sac nhon
Hnh 3.1: Tui va thung ng chat thai sinh hoat va chat thai y te
Hnh 3.3: Thung nha cha kim tiem va vat nhon
Tren xe tiem va xe lam thu thuat cung phai c trang b ay u phng tien e thu gom chat thai sinh hoat, lam sang va chat thai sac nhon (hnh 3.4, hnh 3.5).
Hnh 3.4: Thung ng chat thai sac nhon tren xe tiem
Hnh 3.5: Tui va thung ng chat thai sinh hoat va chat thai y te tren xe tiem
Ngoai viec quy nh ve mau sac cua tui, hop va thung ng chat thai nh tren, benh vien con a ra mot so tieu chuan khac theo Quy che quan ly cua Bo Y te danh cho viec phan loai chat thai nh sau: Cac tui, hop va thung ng cac mau tren ch s dung ng chat thai va khong dung vao cac muc ch khac. oi vi tui ng chat thai: phai la tui nha PE hoac PP, thanh tui day, kch thc phu hp vi lng chat thai phat sinh, the tch toi a cua tui la 0,1m3, khong c dung tui nha PVC v khi ot se tao ra nhieu chat gay o nhiem. Ben ngoai co ng ke ngang mc 2/3 tui va co dong ch Khong c ng qua vach nay. Hop ng vat sac nhon: lam bang vat lieu cng, khong b xuyen thung, khong ro r va co the thieu ot c. Dung tch hop co kch thc khac nhau (t 2.5 lt, 6 lt, 12 lt, 20 lt) e phu hp vi yeu cau cu the tai cac khoa phong. Co thiet ke sao cho bo thuan li ca bm va kim tiem, khi di chuyen khong o ra ngoai, co quai va nap e dan kn lai khi a ay 2/3. Hop co nhan e Ch ng vat sac nhon, co vach bao mc 2/3 hop. Thung ng chat thai ran: Lam bang nha Poly Etylen co ty trong cao, thanh thung day va cng, co nap ay, co chan ap va de co ra. Nhng thung thu gom co dung tch ln can co banh xe ay. Thung c lot cac tui nha co mau quy nh nh a noi tren. Dung tch thung tuy vao khoi lng chat thai phat sinh, co the t 10 lt en 250 lt. Ngoai ra, cac thung thu gom chat thai khu vc buong benh phai luon kho rao va c co ra thng xuyen. Moi nhan vien y te phai phan loai va bo chat thai vao trong cac tui, thung, hop thu gom chat thai thch hp, khong c bo trc tiep cac
chat thai vao cac thung thu gom chat thai cha c at tui nylon ben trong. 3.3 CONG TAC THU GOM, VAN CHUYEN RAC Y TE TAI BENH VIEN 3.3.1 Cong tac thu gom chat thai Rac c cho vao cac thung co cac mau khac nhau nh a noi tren, khi rac ay ti vach quy nh 2/3 tui ng chat thai, nhan vien ve sinh (ho ly hoac nhan vien cua cac cong ty lam sach) chu trach nhiem thu gom chat thai t ni phat sinh ti ni tap trung chat thai cua khoa phong. Khi rac ay moi thung rac, nhan vien ve sinh cot tui, mang vao mot khu vc cha rac cua khoa. Khi rac ay moi khoa, ho ly chu trach nhiem se cot tui lai mang vao mot khu vc cha rac cua khoa, trong qua trnh thu gom rac tranh khong e chat thai b vng vai ra ngoai. Cac khu vc doc theo cong vien, khu hanh chnh, khu kham benh eu co at them cac thung rac va c thu gom theo quy nh nh tai cac khoa, phong. 3.3.2 Van chuyen chat thai tai benh vien Hang ngay oi ve sinh cua benh vien en nhan rac, mang rac i bang xe keo tay ay kn en nha cha rac tap trung cua benh vien. Xe van chuyen rac t cac khoa, phong en ni thu gom chat thai theo ung gi quy nh (5gi sang, 11gi30 tra, 18gi toi). Chat thai c thu gom va van chuyen bang xe chuyen dung, co xe van chuyen rieng cho tng loai rac thai (gom 2 loai): xe rac sinh hoat (hnh 3.6) va xe rac y te (hnh 3.7). Cac tui rac y te c nap vao cac thung rac 240 lt tai nha thu gom rac cua benh vien (hnh3.8). Mot so quy nh ve van chuyen rac tai benh vien: Co quy nh ng van chuyen, va gi van chuyen chat thai. Tranh van chuyen chat thai qua cac khu vc cham soc ngi benh va cac khu vc sach khac.
Cac phng tien van chuyen phai c co ra, tay ue ngay sau khi van chuyen chat thai va phai co logo ung theo quy nh (hnh3.9). Nhan vien van chuyen chat thai phai mang bao ho theo ung quy nh. Rac y te nguy hai phai c ong goi trong cac thung hoac trong cac hop carton trong qua trnh van chuyen ra ngoai benh vien.
Hnh 3.6: Xe rac sinh hoat
Hnh 3.7: Xe rac y te

Hnh 3.8: Thung cha rac y te tai nha cha rac
Hnh 3.9: Nhan dan vao thung e phan biet cac loai rac (2 nhan)
3.3.3 Hoat ong lu tr chat thai Rac c gi lai tai nha cha rac cua benh vien trong luc ch Cong ty Moi trng o th Thanh pho en lay. Nha cha rac cua benh vien am bao c mot so quy che nh: Cach xa ni chuan b o an, xa ni cong cong va loi i. Co lu gi chat thai y te rieng biet vi chat thai sinh hoat (hnh 3.10). Co tng xay xung quanh, co mai che, co ca va co khoa (hnh 3.11). Co trang b ay u phng tien ra tay, bao ho ca nhan, co cac vat dung va hoa chat can thiet e lam ve sinh va x ly s bo chat thai. Co may ieu hoa khong kh va co ien chieu sang. 3.3.4 Cong tac x ly s bo chat thai tai benh vien Chat thai benh vien va la nguon lay o nhiem moi trng va la nguon lay benh, v vay viec x ly va kiem soat nghiem ngat chat thai la nhiem vu quan trong hang au cua benh vien. oi vi cac chat thai y te nguy hiem co nguy c lay nhiem cao t phong xet nghiem, phong ieu tr ngi benh truyen nhiem (gang tay, lam knh, ong nghiem sau khi xet nghiem, m tai khoa cua benh nhan lao, ), benh vien eu thc hien x ly ban au bang hoa chat hay bang autoclave (noi hap) trc khi thu gom en ni tap trung chat thai. ac biet, chat thai phong xa phai c thu gom va x ly theo ung phap lenh an toan va kiem soat bc xa theo cac quy nh hien hanh cua nha nc. Cac chat thai phong xa dang ran nh bm tiem, lo, gang tay co phong xa c phan lam 2 nhom theo thi gian ban ra, c e rieng bao quan trong kho i qua t 8 - 10 chu ky ban ra cua loai ong v o va sau o c huy nh chat thai lam sang.
Hnh 3.10: Rac y te tai nha cha
Hnh 3.11 Nha cha rac
3.4 GIAM SAT QUI TRNH THU GOM, PHAN LOAI CHAT THAI VA CONG TAC VE SINH TRONG BENH VIEN Tai BVCR, cong tac nay c thc hien thng qui, co kiem tra, theo doi, bao gom cac van e: Qui trnh ky thuat phan loai chat thai ran y te tai nguon Qui trnh thu gom, lu tr, van chuyen Ve sinh dung cu sau khi cong viec ket thuc Van hanh cac trang thiet b Phong ho nhan vien y te 3.5 GIAM SAT TNH HNH NHIEM KHUAN TAI BENH VIEN Benh vien Ch Ray trong nhng nam gan ay a co nhieu phat trien vt bac vi trang thiet b ky thuat cao, phng tien chan oan va ieu tr hien ai, thu hut mot khoi lng ong ao benh nhan en kham va cha benh. Thc trang nay nay sinh ra nhu cau can thiet phai tang cng cac bien phap kiem soat, ngan chan nhiem khuan benh vien v: Viec ng dung phng tien chan oan va ieu tr hien tai co the lam tang nguy c nhiem khuan benh vien nen can co cac bien phap chong nhiem khuan chuyen sau. Tnh trang qua tai benh nhan dan en nhieu kho khan trong cong tac chong nhiem khuan nh khong gian moi trng chat hep lam kho thc hen ung viec cach ly, chong lay nhiem cheo; dung cu phai kp thi co san e s dung ngay cho benh nhan, oi hoi quy trnh kh, tiet khuan ung quy cach. Trc thc trang nay, muc tieu benh vien at ra la can to chc cong tac kiem soat nhiem khuan benh vien hoan chnh, trien khai cac bien phap chong nhiem khuan nham giam en mc toi a nhiem khuan benh vien cho benh nhan cung
nh cho ca nhan vien y te; vi muc ch chung nhat la nang cao chat lng kham va cha benh. 3.5.1 Tam quan trong cua cong tac kiem soat nhiem khuan Nhiem khuan mac phai trong benh vien hay thng goi la nhiem khuan benh vien (NKBV) la mot trong nhng thach thc va la moi quan tam hang au tai Viet Nam cung nh tren toan the gii. NKBV co the c xem nh la benh gay ra bi benh vien, v ay la nhng nhiem khuan mac phai ch trong thi gian benh nhan nam vien. Nhng nghien cu cho thay rang NKBV lam tang ty le t vong, keo dai thi gian nam vien, tang viec s dung khang sinh, tang e khang khang sinh va chi ph ieu tr. Co the ngan nga NKBV qua nhng chng trnh kiem soat NKBV. Chng trnh kiem soat NKBV tot a nhng chuan mc ve chat lng cham soc vao trong nhng thc hanh lam sang. Kiem soat NKBV nh the co y ngha thiet thc gop phan nang cao chat lng ieu tr va nang cao hieu qua kinh te. Viec kiem soat va d phong NKBV hieu qua c xem nh la mot tieu chuan quan trong e anh gia chat lng kham cha benh cua benh vien. 3.5.2 Hoat ong kiem soat nhiem khuan tai benh vien Khoa chong nhiem khuan benh vien Ch Ray Nham quan ly tat ca cac hoat ong kiem soat nhiem khuan, t nam 2000 benh vien a xay dng mot bo khung quan ly cong tac kiem soat NKBV, bao gom hoi ong chong nhiem khuan, khoa chong nhiem khuan va mang li chong nhiem khuan. Hoi ong nhiem khuan ong vai tro quan trong trong xay dng chng trnh kiem soat nhiem khuan. Khoa chong nhiem khuan chnh thc hoat ong t au nam 2001. Khoa chong nhiem khuan khong xay dng tren nen cua n v tiep lieu thanh trung hay mot bo phan ve sinh ma c xay dng t mot oi ngu cac bac s, ieu dng hoat ong toan thi gian cho cong tac chong nhiem khuan. Bo phan
tiet khuan la mot bo phan nhanh cua khoa chong nhiem khuan, co hoat ong oc lap nhng chu s quan ly chuyen mon cua khoa chong nhiem khuan. Khoa chong nhiem khuan la hat nhan quan trong trong hoi ong, truyen at cac thong tin ve NKBV cho hoi ong chong nhiem khuan va truyen at cac chnh sach en cac khoa phong, huan luyen nhan vien va theo doi viec thc hien cac hoat ong va chnh sach chong nhiem khuan. Mang li chong nhiem khuan trai eu en tng khoa phong. Tai moi khoa phong eu co mot bac s va mot ieu dng trng chu trach nhiem ve cong tac chong nhiem khuan tai khoa phong mnh. Cac bac s va ieu dng nay eu c tap huan ve cong tac kiem soat NKBV moi nam hai lan. C cau to chc Hoi ong chong nhiem khuan dc thanh lap nham quan ly tat ca cac hoat ong trong benh vien bao gom kiem soat nhiem khuan, ngan nga o nhiem, qui trnh thc hanh tiet khuan, kh khuan, qui trnh ve sinh, cong tac quan ly chat thai, quan ly o vai e thc hien muc tieu bao ve moi trng, nang cao chat lng ieu tr cho benh nhan, an toan cho nhan vien y te. BO Y TE Ban kiem soat nhiem khuan cua Bo Y te
S Y TE
Ban kiem soat nhiem khuan cua S Y te tnh/thanh pho
BENH VIEN/ TRUNG TAM Y TE
Hoi ong chong nhiem khuan cua benh vien/TTYT Khoa chong nhiem khuan Mang li chong nhiem khuan tng khoa
S o 3.1: Mang li kiem soat nhiem khuan quoc gia
HOI ONG CHONG NHIEM KHUAN Chu tch: Giam oc
Khoa chong nhiem khuan
Phong ke hoach tong hp Phong ieu dng Khoa vi sinh Khoa dc
Khoa hoi sc cap cu Khoa phau thuat Khoa quan tr Khac
TH KY THNG TRC Trng khoa chong nhiem khuan
Mang li chong nhiem khuan tai tng khoa S o 3.2: To chc kiem soat nhiem khuan benh vien
Nhiem vu cua khoa chong nhiem khuan benh vien Ch Ray Giam sat, ieu tra NKBV, thong qua viec kiem tra cac khoa phong, kiem tra ho s benh nhan, xem lai cac ket qua vi sinh va tnh hnh benh nhan nhap vien. Thu thap va phan tch nhng thong tin ve giam sat NKBV bao cao cho hoi ong chong nhiem khuan. San sang co mat e tra li nhng thac mac ve chong nhiem khuan cho cac khoa phong va phat hien nhng iem yeu hoac khong an toan trong cac bien phap phong chong nhiem khuan ma cac khoa phong ang ap dung. Xay dng, kiem tra va ap dung nhng chnh sach va quy trnh chong nhiem khuan nham duy tr s tuan thu theo quy che chong nhiem khuan cua cac khoa phong.
Tong ket va thong bao nhng bien phap phong nga va kiem soat NKBV cho tat ca nhan vien y te co lien quan. Xay dng va tham gia vao chng trnh giao duc cho nhan vien y te ve phong nga chuan, ve bien phap phong nga va kiem soat NKBV. Theo doi phi nhiem cho nghe nghiep hay benh nghe nghiep cho nhan vien y te. Trien khai nhng ieu tra ac biet e phat hien dch trong benh vien, phoi hp bao cao nhng benh co kha nang lay nhiem cua benh vien en S Y te hoac Bo Y te. Phoi hp chat che vi cac bo phan lien quan trong benh vien nh phong ke hoach tong hp, phong ieu dng, vi sinh.
Chng 4
ANH GIA, D BAO TNH HNH QUAN LY CHAT THAI RAN Y TE TAI BENH VIEN EN NAM 2015
4.1 ANH GIA HIEN TRANG QUAN LY CHAT THAI RAN Y TE 4.1.1 Nhan xet tnh hnh phan loai. Thc te khao sat tai benh vien cho thay: cong tac phan loai chat thai y te benh vien a ung quy cach, khong o nhiem, khong boc mui hoi. Tuy nhien, con nhng ton tai chnh trong viec thc hien cong tac quan ly chat thai tai benh vien: Mot so benh pham cha c phan loai ung theo tng chung loai, co khi bo lan rac y te trong rac sinh hoat anh hng en moi trng. Do thieu kinh ph nen thung rac tai cac khoa, phong con thieu va khong ong bo gay kho khan cho benh nhan va than nhan trong viec phan loai chat thai. Ngoai ra, trong khi i tiem chch, ieu dng thng khong mang theo bao rac y te va hop ng vat sac nhon nen khong thc hien c phan loai rac ngay tai xe tiem. Nhan thc cua quan chung trong vec quan ly chat thai cha cao. Benh nhan va than nhan cha co thoi quen bo rac ung ni quy nh. 4.1.2 Nhan xet tnh hnh thu gom van chuyen Thu gom: Tuy a c lay ba lan trong ngay nhng rac van con ong lai nhieu tai cac khoa. Do dien tch han che, cac khu gom rac tai cac khoa phong khong cach xa khu vc benh nhan va ni lam viec.
Nhan vien cua cac cong ty lam sach thng e chat thai vt qua vach quy nh cua tui ng rac mi en thu gom. Ben canh o, cac nhan vien cua cac cong ty lam sach khi thu gom chat thai t ni phat sinh ve ni tap trung rac thai cua khoa oi luc lay rac vao gi benh nhan an, va gi lam chuyen mon cua cac nhan vien y te. Thc te hien nay la nhieu khi nhan vien thu gom cha y thc cao trong viec mang bao ho lao ong, khong chu mang khau trang, thiet b bao ho lao ong do ho cam thay vng vu, kho th khi thao tac thu gom. Van chuyen: Xe lay rac y te hien tai con thieu. Ngoai ra, xe lay rac thng c e ay ap rac nen du xe co nap nhng t khi c ay kn. 4.1.3 Nhan xet tnh hnh lu tr Nhan vien cua cac cong ty lam sach khi ep cac bao cha chat thai vao thung cha thng ep rat manh. Viec lam o de lam cac bao cha chat thai b be, oi luc con gay ra nhieu nguy hiem neu bao cha chat thai la rac y te nguy hiem b be. Hien nay, cong tac lu tr chat thai tai benh vien a c thc hien tot, ap ng c cac tieu chuan c ban ve an toan ve sinh nh: Thc hien lu cha rac y te tach rieng vi rac sinh hoat. am bao nhiet o on nh (19oC) cho viec lu tr rac nh trang b may lanh cho nha lu cha. Thc hien nh ky cong tac kiem tra bang cac ky thuat phu hp. Bo tr khoang cach ly hp ly gia nha lu cha vi khu vc kham benh.
4.2 D BAO TAI LNG PHAT SINH CHAT THAI Y TE TAI BENH VIEN EN NAM 2015 Khi xa hoi phat trien th viec au t cho kham cha benh cua nhan dan se tang theo. Trong nhng nam va qua so ging benh cua benh vien tuy tang trng nhng khong eu, theo nhan nh cua tac gia th ty le so ging benh nay se tang trng vao nhng nam tiep theo va ty le tang se cao hn nhng nam trc. Nhng nam tiep theo se phat trien manh va au t hien ai trang thiet b, d bao en nam 2015 so ging benh tang khoang 30% (2216 ging benh). ong thi he so phat thai cung se tang theo thu nhap bnh quan cua ngi dan. Cung vi s phat trien kinh te viec au t cho kham cha benh cung tang theo, do o lng chat thai tnh theo ging benh cung se tang theo. Mot so cong trnh nghien cu a a ra nhan nh chung, cho rang he so phat thai chat thai ran y te nc ta vao nam 2015 se tang 1,25 lan so vi hien nay. Theo he so nay th c tnh lng chat thai ran y te vao nam 2015 tren a ban benh vien Ch Ray la: 2216 ging benh * 0.6 kg/ging benh/ngay * 1,25 = 1662 kg/ngay
Chng 5
E XUAT CAC GIAI PHAP QUAN LYCHAT THAI Y TE TAI BENH VIEN CH RAY
5.1. XAY DNG HE THONG QUAN LY MOI TRNG 5.1.1. C cau to chc GIAM OC
BAN BAO VE MOI TRNG
KHOI PHONG CHC NANG
KHOI LAM SANG
KHOI CAN LAM SANG
S o 5.1 He thong quan ly bao ve moi trng 5.1.2 Nhiem vu cua Ban moi trng Giam oc: La Trng Ban moi trng ch ao va chu trach nhiem cao nhat ve he thong quan ly moi trng, e ra chnh sach moi trng va cam ket thc hien chnh sach o. Thanh vien Ban moi trng: La cac trng khoa, pho khoa trong benh vien Chu s phan cong cua Trng Ban moi trng lap ke hoach phu trach cu the cong tac quan ly moi trng trong o bao gom quan ly chat thai, nc thai, kh thai, nhiem khuan benh vien, benh nghe nghiep, ve sinh moi trng tai cac khoa trong benh vien nh cong tac thu gom, van chuyen va lu cha chat thai
D tr kinh ph mua sam trang thiet b phuc vu cho cong tac bao ve moi trng
To chc huan luyen cho nhan vien nhan thc ve cong tac bao ve moi trng
To chc kiem tra anh gia nh ky hang quy hoac hang nam va e xuat khen thng oi vi tap the n v hoan thanh tot.
5.1.3 ao tao nhan thc ve cong tac bao ve moi trng Phong ao tao co ke hoach a cac chng trnh giao duc tuyen truyen cho nhan vien y te, benh nhan va than nhan benh nhan y thc hn trong viec bao ve moi trng benh vien. ay la muc tieu quan trong nham trang b kien thc ve moi trng va nhng anh hng do o nhiem moi trng gay ra giup cho ho biet c vai tro trach nhiem cua mnh e giup cho viec bao ve moi trng c hieu qua hn. 5.2 GIAI PHAP PHONG NGA O NHIEM MOI TRNG CHO BVCR 5.2.1 He thong quan ly hanh chanh 5.2.1.1 Kiem soat o nhiem do chat thai Khoa Chong Nhiem Khuan thc hien viec giam sat cac hoat ong nh: - Cong tac phan loai rac tai nguon cac khoa. - Phng thc quan ly (phan loai, thu gom, van chuyen, lu tr, x ly va thai bo) c tien hamh chat che trong benh vien. 5.2.1.2 Tang cng phap che oi vi cac trng hp vi pham Ban Moi trng ap dung hnh thc khien trach, tr iem thi ua Trng khoa va cac hnh thc che tai nh phat tien theo mc o vi pham cua tng vu viec oi vi cac Trng khoa khong hng dan nhan vien tuan thu theo quy nh ve cong tac x ly chat thai, cong tac ve sinh moi trng benh vien do Ban moi trng e ra. Trong khoa nhan vien vi pham se b khien trach va co hnh thc x phat theo cap va mc o tai khoa.
5.2.1.3 Nang cao trnh o nhan thc Ban Moi trng co ke hoach giao cho Khoa Chong Nhiem Khuan to chc thc hien cac lp hoc cho bac s va ieu dng ve cong tac bao ve moi trng, ngan nga o nhiem va nhiem khuan benh vien. Muc tieu ao tao: Nang cao trnh o kien thc khi trien khai cong tac quan ly moi trng. To chc, cung co nang lc quan ly moi trng cho can bo y te trong benh vien. Cai thien chng trnh dch vu va trach nhiem hoat ong cua cac hoat ong tai benh vien. Nang cao nhan thc va phng cach phoi hp trien khai cong tac bao ve moi trng benh vien. 5.2.2 He thong quan ly ky thuat 5.2.2.1 Phan loai chat thai tai nguon e nang cao hieu qua cong tac phan loai chat thai tai nguon, benh vien a thc hien ung quy che cua Bo Y te ve phan loai chat thai. Tuy nhien, e giam thieu chi ph cho van e x ly, benh vien can thc hien mot so phng cach nh: Chat thai phong xa va chat thai hoa hoc co nhieu ac iem khac nhau va anh hng en moi trng khac nhau, v vay can c x ly khac nhau. Do o, nen phan biet hai loai rac thai nay bang cac thung tui khac nhau ch khong nen nhap chung nh hien tai. Quy trnh x ly chat thai phong xa va hoa hoc c the hien di dang s o 5.2 Hien tai, cac loai rac co the tai che c nh vat lieu nha, chai lo thuy tinh, ba carton chiem t le kha cao. Cac loai rac thai nay eu c x ly ban au bang Clo hay ozon trc khi tai che lai. V vay, viec phan them loai rac co the tai che th benh vien at them nhng
thung tui rac co mau sac khac vi nhng mau a qui nh tai cac khoa, phong. Trong benh vien khong nen s dung bao tay, ao choang, khan trai, bang chat deo nhan tao nh PVC ma c thay the bang chat deo nhan tao Polieste nh t visco,
Chat thai phong xa
Chat thai hoa hoc
Ran Sac nhon Khong sac nhon Thung ng vat sac nhon Bao rac en
Long
Nguy hai
Khong nguy hai
Hoat tnh cao Hoat tnh thap Lu gi e phan ra
Bao rac o
Thieu ot
Tai s dung Tieu huy nh rac sinh hoat
Nha cha rac phong xa Chon
S o 5.2 Quy trnh x ly chat thai phong xa va hoa hoc
Chat thai phong xa phai c thu gom va x ly theo ung phap lenh an toan va kiem soat bc xa theo cac quy nh hien hanh cua nha nc. Cac chat thai phong xa dang ran nh bm tiem, lo, gang tay co phong xa c phan lam 2 nhom theo thi gian ban ra, c e rieng va bao quan trong kho i qua t 8 10 chu ky ban ra cua loai ong v o va sau o c huy nh chat thai sinh hoat. Cac dung moi thong thng trong benh vien nh benzen, toluene, xylen co the c s dung lai qua he thong chng cat phan am. Tang cng au t cho khau phan loai chat thai ngay tai nguon phat sinh (tang so lng thung cha, v tr at thuan li cho tng khoa, phong). Nghiem cam viec thai bo chat thai cha cac chat truyen nhiem va nguy hai vao rac thai sinh hoat. Mot so loai chat thai co tnh nguy hai cao can phai c kh trung bang hoa chat Clo hay ozon trc khi em en nha cha rac benh vien nham giam thieu nguy c nhiem khuan cho nhan vien thu gom, van chuyen. Trang b ay u cac thiet b bao ho lao ong nh gang tay, ung, khau trang, cho tat ca cac nhan vien tham gia trc tiep vao cong viec phan loai rac. Thng xuyen kiem tra viec s dung cac thiet b bao ho lao ong trong cac can bo, nhan vien y te. > Neu lam c mot so viec can ban tren, benh vien a han che c phan nao tnh trang o nhiem, giam thieu lng chat thai va mc o oc hai cua chung va nhat la giam thieu c chi ph ieu hanh. > Sau het, vi s tham gia ung mc cua cac thanh phan nhan s trong benh vien t nhan vien quan ly en nhan vien y te, cung benh nhan se
chng minh mc o thanh cong cua chng trnh giam thieu chat thai noi chung. 5.2.2.2 Cong tac thu gom. Cai thien c s ha tang phuc vu cho cong tac thu gom tai khoa bang cach sap xep phong cha rac va dung cu ve sinh. Thay the kp thi cac thung rac b h hong nhan ghi tren moi thung rac. Chuyen nghiep hoa bo phan thu gom rac. Tang cng cac hng dan, quy nh, yeu cau cho cac nhan vien ve sinh khi thu gom rac phai va ung vach 2/3 cua bao cha chat thai, khong e qua ay, tranh ri vai ra ngoai. Khi thu gom chat thai t ni phat sinh en ni tap trung cua khoa, phong nen han che thu gom vao gi an cua benh nhan va gi lam viec chuyen mon. 5.2.2.3 Cong tac van chuyen Tang cng cac loai xe chuyen dung s dung trong viec thu gom, van chuyen rac. Vi qui mo ging benh nh BVCR nen tang so lan lay rac trong ngay. Cac xe lay rac khong nen lay qua ay, khi van chuyen rac t cac ni tap ket cua khoa phong en nha cha rac nen ay kn e tranh ri vai. Quy nh thi gian van chuyen theo tuyen thu gom hp ly, benh vien can bo tr loi i rieng cho xe van chuyen rac, tranh i qua cac khu vc cham soc ngi benh. Kiem tra nh ky an toan cua cac thiet b. Thng xuyen lam ve sinh phng tien van chuyen bang xa phong va cac chat tay ra khac co tnh tiet trung cao. ao tao nang cao nhan thc ve an toan trong hoat ong quan ly chat thai y te cho nhan vien van chuyen.
5.2.2.4 Cong tac lu tr chat thai Thc hien kiem tra nh ky cac thiet b ng rac thai y te trong benh vien, phat hien va thay the kp thi cac thung cha b nt, thung, Can co cac hng dan, quy nh, yeu cau cho cac nhan vien ve sinh khi bo rac vao thung tai nha cha rac, khong nen ep cac bao rac qua manh e tranh bao b be, gay nguy hiem cho mnh va lam o nhiem moi trng. Can duy tr hoat ong on nh cua nha cha rac lanh (19oC), tien hanh bao dng thng xuyen oi vi cac thiet b lam lanh rac, tranh tnh trang may lanh hoat ong khong ung vi cong suat thiet ke. 5.3 GIAI PHAP CHO CONG TAC BAO VE MOI TRNG BVCR 5.3.1 Quan ly tot noi vi ay la nhom giai phap ngan nga o nhiem de thc hien nhat nham nang cao hieu qua cong tac kham cha benh tai benh vien. Da vao cac tieu ch sau: Y thc trach nhiem cua hau het nhan vien lam viec trong benh vien. Cai tien va hp ly hoa hoat ong chuyen mon tai benh vien. Tang cng cong tac bao ve moi trng benh vien.
5.3.2 Giai phap kinh te Hien tai BVCR khong co kinh ph hang nam cho cong tac bao ve moi trng, ngan nga o nhiem, giam t le nhiem khuan benh vien, an toan cho nhan vien y te. Tat ca cac hoat ong phuc vu benh nhan trong BVCR eu phai ch kinh ph t Bo Y te e sa cha c s vat chat hay mua sam dung cu, may moc, trang thiet b. Do thng xuyen thieu kinh ph, cac yeu cau cap bach at ra luon b cham tre, kho thc hien thanh cong. 5.3.3 Giai phap keu goi au t Tang cng hp tac quoc te vi cac nc trong khu vc va cac nc tren the gii. Tch cc nghien cu khoa hoc, uc ket va rut kinh nghiem lam sang,
ap dung co hieu qua cac phng phap ieu tr tien tien tren the gii vao BVCR, tranh thu s giup cua cac oi tac, thiet lap nhieu moi quan he cho cac d an au t ve c s ha tang trang thiet b, cong tac bao ve moi trng benh vien, ngan nga o nhiem, cong tac chong nhiem khuan, an toan cho nhan vien y te. 5.4 E XUAT GIAI PHAP X LY CHAT THAI Y TE TAI BVCR Hien tai toan bo rac y te cua benh vien Ch Ray c Cong ty Moi trng o Th Thanh pho Ho Ch Minh thu gom va x ly an toan tai lo thieu Bnh Hng Hoa vi cong suat 7 tan/ngay. Nhn chung, cong tac x ly rac y te cua benh vien Ch Ray ang c thc hien tot, khong anh hng en moi trng khong kh. Benh vien ch quan tam khau thu gom, lu cha ma khong phai tien hanh x ly. Trong nhng nam ti viec chu ong x ly rac y te cua benh vien Ch Ray can phai c at ra, ac biet khi khoi lng rac nguy hai cua cac benh vien thanh pho se tang cao nhng nam ti, dan en kha nang qua tai cua lo thieu Bnh Hng Hoa hoac trong trng hp lo thieu gap s co khong hoat ong c. V vay, theo tac gia, ngay t bay gi benh vien Ch Ray nen phoi hp vi cac benh vien khac trong quan (Benh vien ai hoc Y Dc, benh vien Nguyen Tri Phng, benh vien Hung Vng, benh vien Pham Ngoc Thach, Trung Tam Y te quan 5, ) xay dng mot he thong lo ot rac e chu ong hn trong viec x ly chat thai ran y te. Rac y te phat sinh trong cac benh vien quan co nhng thanh phan va tnh chat giong nhau nen rat thuan li trong qua trnh x ly rac theo hnh thc x ly tap trung. Van e au t von xay dng cua cac benh vien se da vao ty le khoi lng rac thai ra cua cac benh vien trong quan. Ben canh o, giai phap tren phai c s quan ly chat che cua Bo Y te. oi vi benh vien Ch Ray, ngoai thc hien giai phap tren benh vien con phoi hp phan loai rac thai tai nguon theo ung quy nh cua Bo Y te va ket hp
tai che rac thai sach khong b nhiem khuan. Tap hp rac thai sach e tai che em lai li ch cho benh vien ma khong anh hng en Luat Bao ve Moi trng.
Chng 6
KET LUAN VA KIEN NGH
6.1 KET LUAN Rac y te la rac thai nguy hai nen nhan vien ve sinh lam viec trong qua trnh thu gom - van chuyen va x ly rac y te tai benh vien thng gap nguy hiem ve van e sc khoe va nguy c lay nhiem cao. Do vay viec lam ung qui trnh va nghiem tuc trong trang phuc bao ho lao ong la bat buoc va la ieu kien tien quyet trong benh vien. Cong tac phan loai, thu gom va van chuyen chat thai tai nguon tng oi tot, ung theo quy nh cua Bo Y te. Y thc trach nhiem cua hau het nhan vien y te lam viec trong benh vien thc hien tng oi tot va lam ung theo quy nh trong benh vien. S ket hp chat che gia Trng Ban Moi trng vi cac khoa, phong trong viec giai quyet chat thai benh vien mot cach ong bo, lam cho chat lng ve sinh benh vien ngay c nang cao. Mac khac, van e dch benh ngay cang gia tang, moi trng song luon b e doa, o nhiem moi trng khong ch rieng la noi lo au oi vi nganh y te ma con anh hng en phat trien kinh te toan xa hoi. O nhiem moi trng benh vien la mot trong nhng nguyen nhan gay nhiem khuan benh vien, anh hng en viec cham soc ngi benh, benh nghe nghiep tang cao, la ieu kien cho cac nhom vi khuan a khang phat trien, song cong sinh trong moi trng benh vien. Do o, viec gi cho benh vien sach, ep, ve sinh an toan la muc tieu phan au cua benh vien Ch Ray noi rieng va cua nganh Y te noi chung. Cong tac bao ve moi trng neu c thc hien tot se at c mot so ket qua nh:
- Moi trng benh vien sach ep se mang lai an tng ban au tot ep cho benh nhan, than nhan benh nhan en kham cha benh ma con the hien nep song van hoa va trnh o quan ly cua oi ngu can bo benh vien. - S sach se cua benh vien se tac ong trc tiep vao chat lng ieu tr va cham soc ngi benh, han che nguy c lay cheo trong benh vien va cong ong dan c song chung quanh benh vien. - Lam tot cong tac bao ve moi trng trong o cong tac quan ly chat thai c chu trong se giup cho viec cham soc, ieu tr benh nhan at ket qua tot. - Nang cao cac chuan mc ve sinh nham em lai hieu qua cao trong khi ng dung cong nghe ky thuat cao. 6.2 KIEN NGH au t xay dng them khu ieu tr cho benh nhan tai BVCR. Can thc hien sm giai phap x ly rac theo hnh thc a a ra. Can trang b them cac dung cu thu gom , van chuyen rac y te. Can co can bo chuyen trach cho lnh vc moi trng tai BVCR. Thc hien cong viec tai che rac mot cach co ky luat.

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Chng M au

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TONG QUAN VE CHAT THAI RAN Y TE

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S o 1.1 Hoat ong kham va ieu tr cua benh nhan

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Benh vien Trung ng Benh vien Tnh Benh vien Huyen

4,1 8,7 2,1 4,2 0,5 1,8

0,4 1,6 0,2 1,1 0,1 0,4

(Nguon: Hoi thao quan ly moi trng trong nganh y te 5-6/03/2002)

Viet Nam Viet Nam Viet Nam

BV Gang Thep TN BV 175 TP.HCM BVK Cu Lao MinhBen Tre

BVK TT tnh Phu Yen

TT lao & benh phoi Quang Ngai

TTYT huyen Trung Khanh tnh Cao Bang

TT Nghien cu CN HBK TP.HCM

TTYT huyen Mang Tht Tnh Vnh Long

Vietnam Water Forum - www.VinaWater.org

(Nguon: D an Vet Nam-Australia quan ly CTR, 5/2000 Tp.HCM)

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1.8 MOT SO PHNG PHAP X LY CHAT THAI Y TE

TONG QUAN VE BENH VIEN CH RAY

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Hnh 2.1 : Benh vien Ch Ray vao nam 1919

Hnh 2.2 : Benh vien Ch Ray vao nam 1938

Bang 2.3 Benh vien Ch Ray ngay nay

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OANTHANH NIEN CS HCM

KHOA HOC KY THUAT

NGOAI KHOA VA PHAU THUAT

CHONG NHIEM KHUAN

MUA SAM TRANG THIET B

KHOI PHONG CHC NANG

KHOI LAM SANG

KHOI CAN LAM SANG

S o 2.1 S o to chc benh vien

Chat thai phong xa, hoa hoc.

Lng chat thai y te

2003 2004 2005 2006 6th-2007

74.505 82.257 89.000 96.758 49.120

1469 1677 1702 1702 1702

257 293 297 308 160

0,56 0,56 0,58 0,6

(Nguon: Benh vien Ch Ray)

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Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay Kg/ngay

210 40 120 20 10 5 10 0 25003500

(Nguon: Khoa chong nhiem khuan benh vien Ch Ray, 9/2002)

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Nha cha rac

Hnh 3.2: Chat thai khong sac nhon

Hnh 3.3: Thung nha cha kim tiem va vat nhon

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Hnh 3.4: Thung ng chat thai sac nhon tren xe tiem