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M U

1. Xut x ca d n Bnh vin 71 Trung ng c thnh lp nm 1951. Tin thn t 3 n v qun y: Qun y vin 31, Qun y vin 41, An dng ng lin khu III. Theo Ngh nh s 1155 - LB/N ngy 15/11/1955 ca lin b Quc phng - B Y t - B Ti chnh iu chuyn Bnh vin 71 sang B Y T qun l. L mt n v s nghip trc thuc B Y t, bnh vin c cc chc nng khm, cp cu, iu tr, phng bnh, phc hi chc nng cho bnh nhn Lao - Bnh phi, cc bnh v ni khoa, ngoi khoa v chuyn khoa khc, nghin cu khoa hc, tham gia o to cn b chuyn ngnh Lao - Bnh phi, ch o tuyn v hp tc quc t. Do tnh hnh bnh tt ca nhn dn trong tnh ngy cng phc tp, nhu cu khm cha bnh ca nhn dn ngy cng cao, s lng bnh nhn n khm, cha bnh ngy cng ng, trong khi cc c s y t cng u t mi hu nh khng c, v vy hin tng qu ti ti cc bnh vin thng xuyn xy ra. Nht l cc bnh vin tuyn tnh, bnh vin chuyn khoa v mt s bnh vin a khoa tuyn huyn. Trc tnh hnh , ch trng u t xy dng, ci to, nng cp bnh vin 71 Trung ng l iu cn thit v ph hp vi nh hng pht trin s nghip y t ca tnh ta ni ring v ca ngnh y t ni chung. Ngy 05 thng 10 nm 2006 B Y t ra quyt nh s 3929/Q- BYT v vic ph duyt Quy hoch tng th pht trin bnh vin 71 Trung ng n nm 2010 v tm nhn 2020 vi mc tiu xy dng v pht trin bnh vin 71 Trung ng l bnh vin khu vc Bc min Trung v chuyn ngnh Lao - Bnh phi c c s vt cht, trang thit b hin i, i ng cn b khoa hc k thut tng xng vi bnh vin hng I v ngang tm vi cc nc trong khu vc; l c s thc hnh v tham gia o to ca cc trng i hc, cao ng, trung hc y t trong nc v quc t. Ngy12 thng 10 nm 2006 B Y t ra Quyt nh s 4056/Q-BYT v vic cho php chun b u t D n: u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr.

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2. Cn c php lut v k thut ca vic thc hin nh gi tc ng mi trng 2.1. Cc vn bn php lut - Lut Bo v Mi trng sa i nm 2005 c Quc hi nc Cng ha x hi ch ngha Vit Nam kha XI, k hp th 8 thng qua ngy 29/11/2005 v c hiu lc thi hnh t ngy 01/7/2006 (iu 18 quy nh cc i tng phi lp bo co TM); - Ngh nh 80/2006/N-CP, ngy 9/8/2006 ca Th tng Chnh ph v "Hng dn thi hnh Lut Bo v Mi trng"; - Thng t 08/2006/TT-BTNMT ngy 8/9/2006 ca B Ti nguyn v Mi trng hng dn v nh gi mi trng chin lc, nh gi tc ng mi trng v cam kt bo v mi trng; - Ch th 01/ CT-UB ngy 27/2/2001 ca Ch tch UBND tnh Thanh Ho v Tng cng cng tc bo v mi trng; 2.2. Vn bn k thut - Php lnh an ton v kim sot bc x c UB thng v Quc hi thng qua ngy 25/6/1996; - Ngh nh s 50/1998/N-CP ngy 16/7/1998 ca Chnh ph chi tit vic thi hnh php lnh an ton v kim sot bc x; - Thng t lin tch s 2237/1999/TTLT-BKHCNMT- BYT ngy 28/12/1999 ca B KHCN&MT v B y t hng dn vic thc hin an ton bc x trong y t; - Tiu chun ca B Y t v v sinh mi trng ban hnh km theo Quyt nh s 3733/Q - BYT ngy 10/10/2002 ca B Y t; - Cc ti liu nh gi nhanh trn c s h s nhim do T chc y t Th gii thit lp nhm d bo ti lng cc cht nhim; - Quyt nh s 2575/1999/Q-BYT ngy 17/8/1999 ca B trng b Y t v vic ban hnh Quy ch qun l cht thi y t; - Quyt nh s 62/2001/Q-BKHCNMT ngy 21/22/2001 ca B trng B khoa hc, Cng ngh v Mi trng v vic ban hnh k thut i vi l t cht thi y t;
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- Quyt nh s 60/2002/Q-BKHCNMT ngy 07/8/2002 v vic ban hnh hng dn k thut chn lp cht thi nguy hi; - Quyt nh s 35/2002/Q-BKHCNMT ngy 25/6/2002 ca B trng B khoa hc, Cng ngh v Mi trng v vic bt buc p dng 31 tiu chun Vit Nam v mi trng; - Quyt nh S 27/2004/Q-BXD ca b trng B Xy dng v vic ban hnh TCXDVN 320 : 2004 "Bi chn lp cht thi nguy hi - Tiu chun thit k "; - TCVN 5660-2005 l t cht thi rn y t Kh thi l t cht thi rn y t - gii hn cho php; - TCXDVN 365-2007 Tiu chun hng dn thit k bnh vin a khoa; - Quyt nh s 22/2006/Q-BTNMT ngy 18/12/2006 ca B trng B Ti nguyn v mi trng v vic bt buc p dng tiu chun Vit Nam v mi trng; - Quyt nh s 3929/Q- BYT ngy 05 thng 10 nm 2006 ca B Y T v vic ph duyt Quy hoch tng th pht trin Bnh vin 71 Trung ong n nm 2010 v tm nhn 2020; - Quyt nh s 4056/Q-BYT ngy 12 thng 10 nm 2006 ca B Y T v vic cho php chun b u t D n: u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr; - Quyt nh s: 294/Q- UBND ngy 25 thng 01 nm 2007 ca U ban nhn dn tnh Thanh Ho v vic cp giy chng nhn quyn s dng t cho Bnh vin 71 Trung ng ti x Qung Tm, huyn Qung Xng; 3. T chc thc hin bo co TM - Cc thnh vin tham gia lp bo co TM:

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CHNG I
M T TM TT D N 1.1. Tn d n: u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr. 1.2. Ch d n: Bnh vin 71 Trung ng - i din: ng Don Trng Tin Chc v: Gim c

- a ch: X Qung Tm, huyn Qung Xng, tnh Thanh Ho - in thoi: 037. 675701 1.3. V tr a l ca d n Theo chng ch quy hoch s 472/SXD-QH, ngy 22/03/2007 ca Gim c S Xy dng Thanh Ha. V tr d n thuc tha t s 570, x Qung Tm, huyn Qung Xng, Thanh Ha. Din tch khu t khong 75.000m2. - Khu t c ranh gii nh sau: + Pha Bc gip vi ng d kin theo quy hoch. + Pha Nam gip vi ng d kin theo quy hoch. + Pha ng gip vi ng d kin theo quy hoch. + Pha Ty gip vi ng d kin theo quy hoch. Khu t hin ti thuc bnh vin 71 Trung ng ang qun l v s dng, ph hp vi quy hoch chi tit dc hai bn Quc l 47. 1.4. Ni dung ch yu ca d n - Xy dng v pht trin bnh vin 71 Trung ng l bnh vin khu vc Bc min Trung v chuyn khoa Lao - Bnh phi c c s vt cht, trang thit b hin i, tng xng vi bnh vin hng I v ngang tm vi cc nc trong khu vc. 1.4.1. Quy m v khi lng d n a. Quy m d n Quy m d n c chia thnh cc giai on c th sau: - T nm 2006 n 2010:
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Fax: 037.675701

+ Thnh lp cc phng chc nng, cc khoa lm sng v cn lm sng. + u t xy dng cc hng mc, nng cp, m rng bnh vin quy m 500 ging iu tr ni tr. - T nm 2010 n nm 2020: + u t xy dng hon thin c s h tng, h thng t chc bnh vin theo tiu chun bnh vin hng I, quy m 700 ging. + Xy dng hon hin m hnh chm sc sc khe cng ng, m hnh chm sc ton din. - Cc cng trnh chnh bao gm: Nh khm, khu nh m, khoa hi sc cp cu, nh hnh chnh, khoa dc, khoa dinh dng, nh bnh nhn ni tr, khoa chng nhim khun. - Cc cng trnh ph tr: Trm in, trm x l nc cp, trm x l nc thi, khu x l rc, nh tang l, nh xe - ga ra, nh thng trc. - C cu t chc: C cu t chc ca bnh vin c quy nh ti Quyt nh s 2712/Q-BYT, ngy 23/7/2007 ca B trng B y t v vic ban hnh iu l t chc v hot ng ca Bnh vin 71 TW, c th nh sau: Bng 1: C cu t chc ca bnh vin 71 TW
TT C cu phng ban S lng

Cc phng chc nng - Phng k hoch tng hp - Phng t chc cn b - Phng ti chnh k ton - Phng ch o tuyn - Phng hnh chnh qun tr - Phng y t-iu dng - Phng vt t, thit b y t - Phng nghin cu khoa hc v o to Cc khoa lm sng - Khoa khm bnh lao, bnh phi - Khoa khm bnh a khoa - Khoa hi sc cp cu - Khoa thn nhn to - Khoa ngoi tng hp - Khoa iu tr bo him y t - Khoa lao bnh phi lc lng v trang - Khoa ngi cao tui

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- Khoa lao phi - Khoa lao ngoi phi - Khoa h hp - Khoa nhi - Khoa phc hi chc nng - Khoa xng khp - Khoa tim mch - Khoa tit niu - Khoa TMH, RHM - Khoa lao/HIV - Khoa Ung bu Cc khoa cn lm sng - Khoa vi sinh - Khoa sinh ha min dch - Khoa huyt hc - Khoa chun on hnh nh - Khoa dc - Khoa dinh dng - Khoa chng nhim khun - Khoa gii phu t bo

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b. Khi lng d n D n c xy dng trn c s nng cp bnh vin 71 TW hin c. Cc cng trnh trong d n, mt s c xy mi, mt s c ci to v nng cp theo t giai on khc nhau. Bng 2: Thng k cc cng trnh theo quy hoch pht trin tng th Bnh vin 71 Trung ng n nm 2010 v tm nhn 2020
TT Tn cng trnh S tng Din tch sn Din tch xy dng Ghi ch

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Khu phng ban Hi trng Hnh chnh khoa dc Nh sn xut huyt thanh Kho Dc Hnh chnh v lu tr h s Gara t Khoa dinh dng Nh k thut nghip v Cu lc b bnh nhn Khoa Bo him y t Nh thuc Nh xe Trm in, trm bin p

2 1 1 1 1 2 1 1 2 2 1 1 1 1

490 m2 338 m2 85 m2 71,8 m2 649 m2 548 m2 110 m2 671 m2 502 m2 93 m2 276 m2 62 m2 202 m2 65 m2

245 m2 338 m2 85 m2 71,8 m2 324,5 m2 274 m2 110 m2 671 m2 251 m2 93 m2 276 m2 62 m2 202 m2 65 m2

Cc cng trnh c gi nguyn

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15 12 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

Nh cu Nh tang l Cc cng trnh h tng Nh Khm Khu nh m Nh bnh nhn ni tr Nh hnh chnh Nh Bo v Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn ni tr Nh bnh nhn BHYT Nh bnh nhn BHYT Nh bnh nhn BHYT Nh hnh chnh khoa LLVT

1 5 4 5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

1574 m2 67 m2 150 m2 6000 m2 6400 m2 7750 m2 825 m2 49,5 m2 255 m2 260 m2 277 m2 277 m2 277 m2 295 m2 332 m2 277 m2 280 m2 280 m2 345 m2 350 m2 305 m2 136 m2

1574 m2 67 m2 150 m2 1200 m2 1600 m2 1750 m2 825 m2 49,5 m2 255 m2 260 m2 277 m2 277 m2 277 m2 295 m2 332 m2 277 m2 280 m2 280 m2 345 m2 350 m2 305 m2 136 m2

Cng trnh xy dng giai on 1 Cng trnh ci to giai on 1

Cng trnh c gi nguyn

1.4.2. Nhu cu ca d n a. Nhu cu cp nc Theo tiu chun thit k 4513-1998 v cp nc bn trong. i vi bnh vin a khoa v chuyn khoa c h thng cp nc hon chnh, lng nc lnh s dng 300-400 l/ging bnh-ngy, nc nng l trn 60 l/ging bnh/ngy. Tuy nhin, theo thc t hot ng hin nay v xu hng pht trin trong tng lai, lng nc s dng cn ln hn nhiu. Ngoi vic s dng nc cho nhu cu iu tr, cc nhu cu v sinh, git gi, cho cn b cng nhn vin bnh vin... cc nguyn nhn lm cho nc tiu th tng ln l: Bnh nhn v ngi nh bnh nhn qu ng, ngi nh n chm sc bnh nhn, hc sinh, sinh vin thc tp. Nhn chung i vi bnh vin a khoa tuyn tnh, nhu cu cp nc nm mc 600 - 800 l/ging bnh-ngy. i vi cc bnh chuyn khoa, bnh vin TW lng nc c tnh s dng tng i cao c th ln n 1000

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l/ging bnh-ngy[1]. Nh vy, trong mi giai on pht trin ca bnh vin nhu cu cp nc dao ng tng i ln. Bng 3: Nhu cu cp nc sinh hot ca bnh vin 71 TW TT 1 2 Giai on Giai on 2006-2010 Giai on 2010-2020 Nhu cu cp nc thc t (m3/ngy-m) Min Trung bnh Max 300 400 500 420 560 700

Ngun nc ny hin nay v d kin trong tng lai c cung cp t Cng ty TNHH mt thnh vin cp nc Thanh Ha thng qua trm cp nc sch ti Qung Chu. b. Nhu cu s dng in Lng in nng tiu th ph thuc nhiu vo ma trong nm. Theo thng k ca s in lc Thanh Ha v thc t s dng in ti bnh vin 71 TW v mt s bnh vin a khoa, bnh vin chuyn khoa trn a bn tnh cho thy, vi quy m 500 ging bnh th nhu cu s dng in dao ng t 50.000 kWh/thng vo cc thng ma ng v n 75.000 kWh/thng vo cc thng ma h. Lng in nng c cung cp t mng li in TPTH - Sm Sn thng qua trm bin th 250 KVA ca x. c. Nhu cu v lao ng Cn b cng nhn vin ca bnh vin hin c 270 ngi. Trong i ng y bc s c tay ngh cao ch chim 21,85%, dc s mi chim t l khim tn 1,1%. Vi lc lng y bc s mng nh hin nay th cha p ng nhu cu pht trin ca bnh vin. Ngay t by gi, ban gim c bnh vin c ch trng tuyn dng cn b mi, cn b tr, c bit l cc y bc s, dc s c o to chnh quy nhm p ng kp thi nhu cu pht trin trong tng lai.

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Bng 4: S lng cn b cng nhn vin hin c ca bnh vin TT 1 2 3 4 5 6 7 Bc s Dc s i hc Dc s trung hc C nhn kinh t+k s Y t iu dng Cn b khc (H l, li xe, cp dng) Trung hc kt ton Tng cng d. Nhu cu vt t, ha cht tiu hao i tng lao ng S lng (ngi) 59 03 05 13 95 90 12 270

Khi d n i vo hot ng, hng nm nhu cu ha cht, vt t tiu hao phc v cho qu trnh khm cha bnh l tng i ln vi nhiu chng loi mt hnh khc nhau. Trong vt liu, ho cht tiu hao ch yu c chia theo cc nhm c bn sau:
+ Bng, bng, gc y t + Bm tim v bm ht cc loi + Huyt p k, ng nghe + Ch khu, vt liu cm mu + Dao, panh, km, ko v cc dng c phu thut + Dy truyn dch, dy dn lu, cc loi sond, cc loi dy ni + n, bng n v cc ph kin ca n + Gng tay phu thut, khm, xt nghim tit trng, cha tit trng, gng ty chng tia + Ho cht xt nghim t bo, sinh ho, test nhanh th HIV, vim gan, heroin, mi trng nui cy lao, th lao, nhm mu v cc loi ho cht xt nghim khc + Giy in cc loi my v gen tip xc + Phim X-quang v cc vt t, ho cht s dng cho my X-quang + Vt t ngnh xng

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+ Cc loi vt t y t khc

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Ngun vt t, ho cht tiu hao k trn d kin c thu mua t cc nh sn xut v cung ng trn a bn tnh Thanh Ha. Vi nhu cu ngy mt tng, y s l mt tc nhn thc y cc ngnh sn xut, cc nh cung cp dch v trong lnh vc thit b, vt t y t trong tnh pht trin. To sn chi lnh mnh cho cc h kinh doanh trong lnh vc trn, trnh tnh trng c quyn nh hin nay. e. Nhu cu nhin liu, ha cht khc - Xng, du: Ch yu phc v cho qu trnh vn chuyn hng ha, bnh nhn, vn hnh my pht in, vn hnh l t cht thi. - Ha cht phc v qu trnh x l mi trng nh: PACN-95, DW97, BIOWC96, Ch phm vi sinh Enchoi, EM, dung dch Clo, Soda... Nhu cu v nhin liu, ha cht ny nhn chung khng ln, ph thuc nhiu vo quy m hot ng, tnh trng my mc hin c, kh nng v trnh ca ngi cng nhn vn hnh.

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CHNG II
IU KIN T NHIN - MI TRNG V KINH T-X HI

2.1. iu kin t nhin v mi trng x Qung Tm 2.1.1. iu kin v a l X Qung Tm c din tch t nhin l 367,68 ha; nm pha ng Bc huyn Qung Xng, dc theo ng quc l 47A c chiu di 2,5 km. C ranh gii hnh chnh nh sau: - Pha Nam gip x Qung Ct. - Pha Bc v Ty gip x Qung Ph. - Pha ng gip x Qung Th. X Qung Tm l trung tm giao lu hng ha v lu thng gia th x Sm Sn v Thnh ph Thanh Ho, c th trn Ch Mi v nhiu c quan ng trn a bn nh Bnh vin 71 Trung ng, trng S phm 12+2 Thanh Ho, Trng Thng mi du lch.... 2.1.2. iu kin kh tng thy vn Theo ti liu ca i kh tng thu vn Thanh Ho giai on (1996 2006), Bnh vin 71 Trung ng ng trn a bn x Qung Tm nm tiu vng kh hu ng bng ven bin, c th nh sau: a. Nhit Nhit l yu t quan trng nh hng n qu trnh chuyn ho v pht tn cht nhim. Nhit trung bnh thng: 23,60C Nhit ti cao tuyt i: 40,70C Nhit ti thp tuyt i: 5,60C Bin ngy m: 6-70C

Tng nhit nm: 8.500 - 8.6000C. Trong nm 4 thng c nhit trung bnh 200C t thng 12 n thng 3 nm sau, 5 thng c nhit trung bnh 250C t thng 5 n thng 11.

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b. Ma Ma l mt trong nhng yu t quan trng nh hng n s pht tn v bin i ca cc cht thi t khu vc bnh vin ra mi trng. Ma trung bnh nm t 1.746mm. Ma ko di: 6 thng k t thng 5 n thng 10. Lng ma 100mm/thng: 6 thng (t thng 5 n thng 10). Lng ma 200mm/thng: 3 thng (thng 7, 8, 9). Lng ma 300mm/thng: 2 thng (thng 8, thng 9). Khong 90% lng ma hng nm tp trung vo cc thng 6, 7, 8 v 9. Cc thng 12, 1, 2, 3 l cc thng c lng ma thp nht. Lng ma ngy ln nht l 239,7mm. Lng ma thng ln nht l 586mm, trung bnh 306,4mm, b nht 23,1mm. c. m khng kh m khng kh l mt trong nhng yu t quan trng nh hng n qu trnh lan truyn v chuyn ho cc cht nhim. m trung bnh nm: 85- 86% m khng kh bin i theo ma nhng s chnh lch m gia cc ma khng ln. Ma kh: Vo ma kh m tng i gim nhng khng ng k. Ma ma m tng i trung bnh khng cao lm. m tng i nh nht t: 34,3% trong thng c m nh nht: 29,8 %. d. Ch gi Gi l yu t nh hng rt mnh n s pht tn cht nhim ra mi trng khng kh v thng thong kh trong khu vc lm vic. Tc gi trung bnh nm: 1,5 - 1,8 m/s. Tc gi mnh nht trong bo: 30-40m/s.
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Tc gi mnh nht trong gi ma ng Bc khng qu 25m/s. X Qung Tm c hai ch gi thnh hnh hng nm, vo ma h hng gi thnh hnh l hng ng Nam v ng; vo ma ng hng gi thnh hnh l hng Bc v ng Bc. e. Bo v p thp nhit i Bnh qun hng nm c 0,63 cn bo/nm b vo Thanh Ho, p thp nhit i c khong 2,49 cn/nm. f. Nng v bc x Bc x mt tri l mt trong nhng yu t quan trng nh hng trc tip n ch nhit trong vng v bn vng kh quyn, y cng l yu t kh hu quan trng nh hng n qu trnh pht tn, bin i cc cht gy nhim trong khng kh. Thanh Ho nm su trong ni ch tuyn nn thi gian chiu nng thay i t 11gi - 13 gi. y l iu kin quan trng to ra s ng u gia cc thng v nng lng bc x mt tri n mt t. - Tng thi gian chiu sng trung bnh nm t: - S gi nng cc i: - S gi nng cc tiu: - S ngy khng nng: 1.686 gi. 1.839 gi. 1346 gi. 81,9 ngy.

Cc yu t thi tit, kh hu nh nhit , m, ch gi, ma, cng bc x ca mt tri... to nn loi bn vng kh quyn, nh hng ti s pht tn ca cc cht nhim trong khng gian. Bng 5: Din bin thi tit hng nm ti trm TP. Thanh Ha [2]
Nm m tng i trung bnh (%) Lng ma hng nm (mm) S gi nng (gi) Nhit trung bnh (0C) 2001 88,0 1.845,6 1.421,9 23,6 2002 87,0 1.367,2 1.414,0 23,9 2003 85,0 1.334,3 1.807,0 24,4 2004 86,0 1.309,7 1.559,0 23,6 2005 84,0 1.592,4 1.417,0 23,7 2006 84,0 1.762,6 1.603,0 24,2

2.1.3. Hin trng cc thnh phn mi trng t nhin Bnh vin 71 Trung ng phi hp vi Trung tm Quan trc v Bo v mi trng Thanh Ha (n v t vn lp bo co nh gi tc ng mi trng)
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v Chi cc Tiu chun o lng Cht lng Thanh Ha tin hnh quan trc cht lng mi trng nn khu vc trin khai d n lm c s xc nh mc nh hng ca d n ti mi trng xung quanh. Cng tc ly mu c chia thnh 02 t. + t 1: Tin hnh quan trc mi trng nc thi. Thi gian quan trc vo 10h15 ngy 20/8/2007. Ti thi im quan trc hot ng khm cha bnh, cc hot ng khc trong bnh vin din ra bnh thng. H thng x l nc thi vn hot ng bnh thng. + t 2: Tin hnh quan trc mi trng khng kh, mi trng nc mt, nc ngm, mi trng t. Thi gian quan trc t 8h-11h45 ngy 25/8/2007. Trong thi gian quan trc xut hin trn ma ko di trong khong 20 pht, t 8h35 - 8h55. 2.1.3.1. Cht lng mi trng nc a. Cht lng nc mt
Bng 6: Cht lng nc mt (ly mu ngy 25/08/2007)
T T 1 2 3 4 5 6 7 TCVN 5942- 1995

Tn ch tiu
pH Nit tng COD BOD5 Cht rn l lng E.Coli Coliform

n v tnh
mg/l mg O2/l mg O2/l mg/l
MPN/100ml MPN/100ml

Kt qu M1
7,1 1,4 17,7 11,5 90,0 3500 5300

M2
7,4 7,0 13,7 8,9 80,0 2300 4600

M3
7,1 2,8 8,0 5,2 70,0 75 1100

M4
7,1 4,2 28,9 18,8 135,0 6400 9300

M5
7,2 5,6 171,2 111,3 829,0 7500
13.000

A
6 - 8,5 <10 <4 20 5.000 5.000

B
5,5-9 <35 <25 80 10.000 10.000

Ghi ch: + M1: Mu nc ao khu vc pha ng Bc Bnh vin. + M2: Mu nc ti cng thi tp trung pha Ty Nam Bnh vin. + M3: Mu nc ging khi nh ng Bi S Trc, thn Ph Qu pha ng Nam Bnh vin. + M4: Mu nc ao khu vc dn c pha Ty Bc Bnh vin. + M5: Mu nc rung la pha Ty Nam Bnh vin. Tiu chun so snh:

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TCVN 5942- 1995: Tiu chun ny quy nh gi tr gii hn cc thng s v nng cho php ca cc nhim trong nc mt. + Ct A p dng i vi nc mt c th dng lm ngun cp nc sinh hot (nhng phi qua x l theo quy nh); + Ct B p dng i vi nc mt dng cho cc mc ch khc. Nhn xt: Qua kt qu phn tch cht lng nc mt cho thy. + Ch tiu pH ti tt c cc im o u t TCCP. + COD ti im o M3 t TCCP. Cc im o cn li u c ch s vt TCCP t 1,37 - 17,12 ln so vi ct A. Ti im M5 ch s COD vt 4,89 ln so vi ct B. + BOD5 ti tt c cc im o u vt t 1,3 - 27,825 ln so vi ct A. Ti im o M5 ch s BOD5 vt TCCP 4,452 ln so vi ct B. + Cht rn l lng ti tt c cc im o u vt t 3,5 - 41,45 ln so vi ct A v vt t 1,125 - 10,36 ln so vi ct B. + E.coli ti hai im o M4, M5 c ch s vt TCCP t 1,28 - 1,5 ln so vi ct A. + Coliform ti cc im M1. M4, M5 c ch s vt TCCP t 1,06 2,6 ln so vi ct A. Ti im o M5 ch s Coliform vt TCCP 1,3 ln so vi ct B. b. Cht lng nc thi
Bng 7: Cht lng nc thi sau khi qua h thng x l nc thi tp trung (ly mu ngy 20/08/2007) TT 1 2 3 4 5 6 7 Tn ch tiu pH PO43COD BOD5 Cht rn l lng Nit tng Coliform n v tnh mg/l mg O2/l mg O2/l mg/l mg/l MPN/100 ml Kt qu 7,1 0 30,4 19,79 90,0 20,3 8 TCVN 5945-2005 (Ct B) 5,5 9 0,5 80 50 80 30 3.000

Tiu chun so snh:

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16

TCVN 5945-2005: Tiu chun ny quy nh gi tr gii hn cc thng s v nng cc cht nhim trong nc thi ca c s sn xut, ch bin, kinh doanh dch v,... (gi tt l nc thi cng nghip). Nhn xt: Cc ch s phn tch u t TCCP, ring cht rn l lng c ch s vt TCCP mc nh. c. Cht lng nc ngm
Bng 8: Cht lng nc ngm (ly mu ngy 25/08/2007) TT
1 2 3 4 5 6

Tn ch tiu

n v tnh

Kt qu N1 N2 N3

TCVN 5944 - 1995

pH NO3COD BOD5 SS Coliform mg/l mg O2/l mg O2/l mg/l MPN/100ml

7,1 0,12 2,4 1,6 26,0 48

6,9 2,50 1,2 0,8 57,0 75

6,8 17,2 3,4 2,2 55,0 93

6,5 - 8,5 45 750 - 1500 3

Ghi ch: + N1: Mu nc ging khoan nh ng o nh Xng, thn Ph Qu, x Qung Tm. + N2: Mu nc ging khoan nh ng Nguyn Vn Thanh khu pha Ty Nam Bnh vin. + N3: Mu nc ging khoan nh ng Nguyn Vn Dng, i 6 thn Ph Qu, Qung Tm. Tiu chun so snh: TCVN 5944-1995: Tiu chun ny quy nh gii hn cc thng s v nng cho php ca cc cht nhim trong nc ngm. Nhn xt:

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17

Cc mu nc ging khoan nhn chung u c cc ch tiu nm trong gii hn TCCP. Ring Coliform ti tt c cc im o u c ch s vt TCCP t 16 n 31 ln. 2.1.3.2. Cht lng mi trng khng kh
Bng 9: Cht lng mi trng khng kh (o ngy 25/08/2007) Kt qu phn tch T T
1 2 3 4

TCVN 5937-2005 M5
27,5 95,3
0,24 1,3

Cc ch tiu N C m, % Vn tc gi, m/s Bi l lng,


0

M1
27,1 97,9 0,2 130,0
454 55

M2
26,9 97,9
0,24 1,5

M3
27,3 97,8
0,34 1,6

M4
27,7 96,9
0,34 1,5

5938-2005 5949-1998
300 75 (50*) 200 42 100 350 30.000 200

g/m3 5 Ting n, dBA 6 NH3, g/m3 7 H2S, g/m3 8 Cl2, g/m3 9 SO2 g/m3 10 CO, g/m3 11 NO2, g/m3

110,0
404 50

135,0
404 45

160,0
504 65

210,0
554 70

75,9 15,2 950,8 145,0 312,5 105,0

379,5 35,6 633,9 171,4 375,0 143,5

506,0 17,5 792,4 72,5 625,0 52,5

126,5 30,2 316,9 285,7 345,0 102,6

189,7 37,5 570,5 590,0 1250,0 210,0

Ghi ch: + M1: Khu vc sn, pha trc dy vn phng Bnh vin. + M2: Khu vc x l cht thi ca Bnh vin. + M3: Khu dn c pha Ty Nam Bnh vin. + M4: Khu dn c pha ng Nam Bnh vin. + M5: Khu dn c pha ng Bc Bnh vin. Tiu chun so snh: TCVN 5937-2005: Cht lng khng kh - Tiu chun cht lng khng kh xung quanh. TCVN 5938-2005: Cht lng khng kh - Nng ti a cho php ca mt s cht c hi trong khng kh xung quanh. TCVN 5949-1998: m hc - Ting n khu vc cng cng v dn c - Mc ti a cho php.
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18

- 50*: Quy nh mc m tng ng ti a i vi cc khu vc cn s yn tnh (Bnh vin, th vin, trng hc...) Nhn xt: + Nhit ti thi im o dao ng trong khong 26,9 - 27,7 oC. m cao t 95,3 - 97,9%. Vn tc gi t t 0,2 - 1,6 m/s. + Nng bi l lng ti tt c cc im o u t TCCP. + Ting n ti cc khu vc dn c (M3. M4, M5) c ch s u t TCCP. i vi khu vc cn s yn tnh (trong bnh vin) th ti im o M1 mc n tng ng cao nht vt TCCP mc nh. + Cc ch tiu hi kh c H2S, CO ti tt c cc im o u t TCCP. + Ti im o M5 ch s NO2, SO2 u vt TCCP (NO2 vt 1,05 ln; SO2 vt 1,68 ln). Cc im o cn li u c gi tr t TCCP. + Hi kh Clo ti tt c cc im o u vt TCCP t 3,169 - 9,5 ln. + Hi kh NH3 ti mu M2 vt qu TCCP 1,89 ln; ti mu M3 vt qu TCCP 2,53 ln. Cc im o cn li u t TCCP. 2.1.3.3. Cht lng mi trng t
Bng 10: Cht lng mi trng t (ly mu ngy 25/08/2007) TT Tn ch tiu n v tnh
% % % %

M1

V tr ly mu M2

M3

1 2 3 4 5

pHKCl Ni t tng P2O5 K2O Hu c

6,12 0,09 0,16 0,08 1,53

7,92 0,14 0,11 0,06 2,28

7,12 0,06 0,08 0,04 0,79

Ghi ch: + M1: t canh tc nh b Nguyn Th Loan-Thn Thanh Kin x Q.Tm + M2: t rung la khu vc pha Ty Nam bnh vin.
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19

+ M3: t canh tc khu vc pha Nam bnh vin. Tiu ch so snh: Phn loi t theo ch tiu nng ho ca t chc FAO-UNESCO. Nhn xt: + Cc mu t u khng chua (pHKCl >5,5). + Hm lng Nit tng trong mu t M1, M2 mc trung bnh; trong mu M3 mc ngho. + Hm lng P2O5 trong mu t M1 mc giu, trong mu M2 mc trung bnh, trong mu M3 mc ngho. + Hm lng K2O trong mu t M2, M3 mc ngho; trong mu M1 mc trung bnh. 2.1.4. Hin trng cnh quan v cng tc qun l mi trng a. Hin trng cnh quan mi trng T lu nay cp chnh quyn a phng v ngi dn trong x vn c truyn thng trng cy xanh vo mi dp l tt, chnh v th hin nay thc trng cy xanh trong x phong ph c v cht lng v s lng, c tnh bnh qun khong 2,3 m2/ngi. Cy xanh c ngi dn trng thng l X C, Keo, Thng, Bch n, Xoan v mt s cy n qu khc. Ngoi vic lm p khu dn c, to cnh quan mi trng c o mang m nt ring ca mt vng qu ven bin, cy xanh cn ng vai tr quan trng trong vic ci thin kh hu, ci thin mi trng thng qua c ch hp th cc cht c hi, gim bc x nhit, gim nhit khng kh, gim nng bi... b. Hin trng qun l mi trng Qung Tm Cng tc qun l mi trng c cp y, chnh quyn v cc on th quan tm, th hin qua cc chnh sch nh h tr kinh ph thu gom v x l rc thi, tuyn truyn v hng dn cc h trong vic xy dng v s dng h rc gia nh, nh k t chc dn v sinh ng lng ng xm mi thng mt ln, xy dng quy ch x pht v khen thng trong vic bo v mi trng. Phi hp vi cc nh trng trong vic gio dc thc v sinh mi trng cho hc sinh, sinh vin.

TTQT&BVMT

20

Cng trnh v sinh trong cc h gia nh ang c cc cp, cc ngnh quan tm vn ng xy dng, mi h gia nh u c 3 cng trnh v sinh m bo tiu chun hp v sinh. i vi cc c s sn xut kinh doanh, dch v trn a bn x, bt buc cam kt v tun th ni quy bo v mi trng chung trong x. 2.2. iu kin kinh t - x hi 2.2.1. iu kin kinh t X Qung Tm nm pha bc huyn Qung Xng, dc theo ng quc l 47A c chiu di 2,5km. Cch khu du lch bin Sm Sn khong 8km v pha ng, th trn Ph Mi hin l trung giao lu hng ha v lu thng gia Thnh Ph Thanh Ha v th x Sm Sn. X hin c 8 thn v 1 khu dn c mi thnh lp vi tng s h dn l 1.440 h. Tng s nhn khu l 7.400 khu, trong lao ng chnh l 2.650 ngi chim 35,8% [3]. y l nhng im thun li cho vic lu thng hng ho v pht trin kinh t x hi ca x. Bng 9: Mt s ch tiu t c trong nm 2006[3] TT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Ni dung ch tiu Tng thu nhp x hi Tc tng trng Tng sn lng lng thc Thu nhp bnh qun u ngi T trng thu nhp t nng nghip T trng thu nhp t dch v, th cng nghip C cu cy trng Tng din tch gieo cy 3 v Sn xut v ng Cy ng ng Cy rau mu Cnh ng 50 triu 70 triu C cu chn nui n tru b n ln n gia cm C nc ngt Tng thu ngn sch Chi ngn sch Chi cu cng giao thng thu li n v tnh T % Tn Triu % % Ha Ha Ha Ha Ha Con Con Con Tn ng ng Triu Kt qu t c 41 10,7 2133,5 5,55 40 60 512,6 140 80 60 10 339 4.338 30.000 39 3.681.177.119 3.867.940.400 140 21

TTQT&BVMT

17 18 19

Chi b tng ho ng giao thng nng thn Chi xy dng c bn 3 khi trng H tr xy dng nh Vn ha thn a. Nng nghip

Triu T Triu

750 2,5 50

- Su thng u nm 2007 tuy thi tit c nhiu kh khn song sn xut nng nghip tip tc c quan tm, cc loi ging c nng sut cao v n nh c a vo sn xut nhiu n v. Nng sut bnh qun c t 45 t/ha, gim 15 t/ha so vi cng k. Trong : nng sut ng t 60 t/ha, nng sut lc t 24 t/ha. Tng sn lng t 823 tn, gim hn 200 tn so vi cng k v t 34,4% k hoch nm. Tng n tru b n 30/6/2007 l 346 con, gim 14 con so vi cng k. n ln 4.600 con tng 180 con trong c 350 ln hng nc. n gia cm thu cm c 16.489 con tng 1.489 con so vi cng k. Sn xut nng nghip tip tc c s chuyn dch theo hng nng cao hiu qu sn xut, tng sn lng hng ho trong nng nghip, a vo sn xut cc loi cy con c gi tr kinh t cao nh da, t, th. .. Khuyn khch mnh dn chuyn i phn din tch trng la nng sut thp sang nui trng thu sn. b. Kinh t dch v v kinh t hp tc x Cc nghnh ngh kinh doanh dch v tip tc c duy tr v pht trin. Mt s h dn hin c mc thu nhp kh v n nh, tp trung vo cc h gia nh kinh doanh nh tr cc thn Quang Trung, Ph Qu, Ph Mi. Nhng nm ngn y Ch Mi c nng cp, sa cha to iu kin thun li cho cc h vic kinh doanh lm n bun bn. M hnh hp tc x v qu tn dng nhn dn hot ng n nh, an ton, gp phn khng nh vo s nghip pht trin kinh t chung ca ton x. Tng thu ti chnh 6 thng t: 1.265.503.000 . Trong thu ngn sch t: 865.085.900 . Tng chi 6 thng : 1.000.230.000 . Trong chi ngn sch : 762.111.000 . 2.2.2. iu kin x hi
TTQT&BVMT

22

a. Vn ho x hi - Y t, gio dc Thc hin tt cng tc thng tin tuyn truyn nhn cc ngy l ln ca t nc v phc v cng tc bu c i biu quc hi kho XII, tuyn truyn thc hin cc nhim v chnh tr ti a phng. Duy tr thng xuyn cng tc kim tra v x l v sinh mi trng chung cc n v, tnh hnh v sinh mi trng 6 thng qua c bn c t chc thc hin tt, ngn chn vic ly lan dch bnh. Cc nh trng t chc dy v hc theo k hoch, cht lng vn ho c quan tm. T l hc sinh ln lp t trn 90%, thi tuyn vo cp 3 chnh quy t 43%. T l pht trin dn s 6 thng u nm l 0,3 %. T l sinh con th 3 mc 10%. Cc hot ng phc v chng trnh sinh sn KHHG, chm sc sc kho sinh sn cho ch em, cu lc b v thnh nin v thanh nin c hiu qu. Su thng u nm b sung 109 th KCB cho tr em di 6 tui theo quy nh. b. Cng tc An ninh - Quc phng Tnh hnh an ninh chnh tr c bn n nh v c gi vng, khng c n th khiu kin vt cp xy ra. Cng tc gio dc chnh tr cho lc lng dn qun, i tng l cn b, hun luyn qun s theo k hoch t cht lng tt. Tham gia bn n tht, trin khai thc hin Quyt nh 290 cho hn 50 i tng dn qun thi chng M cu nc theo k hoch bo m nguyn tc. Ch ng xy dng k hoch chun b lc lng v vt t phc v cng tc phng chng bo lt, gim nh thin tai trong ma ma bo, tham gia o p t d tr hon thnh k hoch trn giao.

TTQT&BVMT

23

CHNG III NH GI CC TC NG MI TRNG 3.1. Ngun gy tc ng Do d n m rng v nng cp vi 2 giai on, nn vic xc nh cc ngun thi cho tng giai on v cc yu t gy nhim l cn c cn thit cho vic la chn cc gii php gim thiu v hn ch ti a nhim mi trng do hot ng ca d n gy ra. 3.1.1. Giai onxy dng c bn Trong giai on xy dng c bn, ngun thi v cc yu t gy nhim ch yu pht sinh t cc ngun sau: Bng 12: Ngun thi v cc yu t gy nhim trong giai on XD c bn TT 1 2 Ngun gc nhim Cht ch th nhim Giai on chun b mt - Bi, CO, SO2, NO2 bng, no vt b mt - Ting n, rung. Vn chuyn t ct, nguyn - Bi cun t ng, t ct ri vi vt liu. - Kh thi ca xe t vn chuyn: CO, SO2, NO2, THC, hi xng du o xc ti mt bng: o - Bi t h, o cng rnh, mng - Ting n, rung 3 cng trnh - Nc thi sinh hot t ln tri ca cng nhn xy dng - Rc thi sinh hot ca cng nhn xy dng Xy dng cng trnh, nh - Bi, CO, SO2, NO2 ca vn phng v cc cng - Ting n, rung 4 trnh h tng khc nh cng - Nc thi sinh hot t ln tri cng nhn thot nc, ng giao xy dng thng ni b. - Rc thi sinh hot ca cng nhn xy dng Mt s hot ng khc nh - Ting n, bi, CO, SO2, NO2, THC, hi 5 xe chy, my mc xy xng du dng

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24

a. Ngun pht sinh bi, ting n. Ting n, rung v mt lng ln bi, t ri vi s pht sinh t qu trnh vn chuyn t ct san lp mt bng, vn chuyn nguyn vt liu, vn hnh my mc thi cng trn cng trng (my i, my san nn...), trong cng on no vt, o h, o cng rnh, mng cng trnh... Ngun nhim ny nh hng trc tip ti ngi cng nhn, nhng vi tn sut khng cao, thi gian thi cng ngn nn loi nhim ny thng khng gy tc ng ln. iu ng quan tm trong giai on ny hn c l nh hng ca ting n, bi ti ngi bnh ang iu tr ni tr. Nhng tc ng tng nh n gin ny c th ko di thm thi gian iu tr ca ngi bnh, nh hng ti vt cht, tinh thn ca ngi bnh v gia nh ngi bnh. b. Ngun pht sinh kh thi. Kh thi pht sinh t hot ng ca cc phng tin vn chuyn nguyn vt liu xy dng, my mc thi cng trn cng trng... ch yu l CO, SO2, NOx, THC, hi xng du. Ngun nhim ny khng tp trung, thng b phn tn v vi nng khng ln, hn na qu trnh thi cng thc hin trn mi trng rng, thong, thi gian thi cng ngn nn loi nhim ny thng c coi l ngun nhim th cp. Bng 13: H s ti lng bi v kh thi trong giai on xy dng d n [4] n Hot ng 1. Xe ti, my i, my thi cng (1400 2000cc) 2. Nu bp tp th, t cht thi tng hp (khng c h thng x l)
TTQT&BVMT

v
(U)

TSP
(kg/U)

SO2
(kg/U)

NOx
(kg/U)

CO
(kg/U)

VOC
(kg/U)

Tn NL Tn NL

0,86

0,03

22,02

194,7

27,65

50

0,0

62

21

25

c. Ngun pht sinh nc thi Ngun nc thi ch yu pht sinh t cc qu trnh sau: - Qu trnh sinh hot ca cng nhn trc tip thi cng. - Pht sinh t nc ma chy trn. - T cc khu tn gi nhin liu, vt liu xy dng Loi nhim ny thng nh, t quan trng. Bn cnh vi cch qun l ph hp ca ch u t, tin cng trnh c y nhanh, vic xy dng tun th theo ng quy trnh v tiu chun xy dng hin hnh nn c th lm hn ch ti a ngun nc thi pht sinh ny. d. Ngun pht sinh cht thi rn Cht thi rn pht sinh ch yu l cht thi rn sinh hot ca cng nhn trc tip thi cng trn cng trng nh: Bao b, ph liu inh st, dy thp, li ca, v hp, thc n tha, ti nilon, nha... v cht thi rn trong xy dng (gch, ngi v, vt liu tha, t ...). Nu khng c cc bin php thu gom, phn loi v b tr tp trung hp l chng s gy ra nhng nh hng xu ti mi trng xung quanh, gy tm l bt n i vi cng nhn trc tip xy dng, bnh nhn, ngi nh bnh nhn v cc y bc s. 3.1.2. Giai on d n i vo hot ng Khi d n i vo hot ng s lm pht sinh cc cht gy nhim mi trng, ch yu bao gm: Cht thi kh, nc thi, cht thi rn, cht thi phng x v cc cht thi nguy hi khc. Ngun gc pht sinh c trnh by khi qut trong bng sau: Bng 14: Ngun thi v cc yu t gy nhim khi d n i vo hot ng STT Yu t nhim Ngun gc pht sinh 1 nhim khng kh: mi, + Do s phn hy sinh hc cc cht hu cc cht hu c bay hi, c. SO2, NOx, CO, vi kh hu, + Qu trnh khm v iu tr bnh nhn c ting n, vi khun trong dng mt s ha cht hu c bay hi khng kh, Dioxin... (alcol, Ete...) + Qu trnh t nhin liu do bp nu v t i li trong v ngoi bnh vin.
TTQT&BVMT

26

+ Do bi dn truyn cc vi khun khu tr ti cc bung bnh. + Qu trnh vn hnh l t cht thi y t nhim nc: Cht rn l Nc thi sinh hot ca cn b cng nhn lng, BOD, COD, vi sinh vin, bnh nhn v ngi nh bnh nhn; 2 vt, ha cht, cht khng nc thi sinh ra trong qu trnh khm v sinh, tng Nit, Photpho... cha bnh; nc t khu phu thut v xt nghim; nc ma chy trn. nhim t: nh hng n Do nc thi ca bnh vin thi ra mi cc vi sinh vt c li trong trng khng c x l. Rc thi khng 3 t, thoi ha t, thay i c thu gom x l trit thnh phn c l, ha ca t, thay i mc ch s dng t nhim do cht thi rn: + T khm, cha v iu tr bnh. bnh phm, bng, gc, bm + Gii phu, xt nghim, pha ch thuc ti 4 kim tim, ng thuc v rc khoa dc... thi sinh hot + T qu trnh sinh hot ca cn b cng nhn vin, bnh nhn v ngi nh thm 5 nui bnh nhn, khch vng lai. nhim phng x: Bc x Pht sinh trong qu trnh vn hnh thit b Gamma a. Ngun pht sinh kh thi Cc cht hu c bay hi nh: Aceton, este, Formandehit, phenol, Benzen, Clo, Iot, HCl... pht sinh t qu trnh khm cha bnh, lu gi bnh phm, xt nghim, kh trng, lu gia ha cht xt nghim v cc cng tc khc. Cc kh CO, NOx, SO2, Dioxin... pht sinh trong qu trnh s dng l t rc thi y t, s dng cc my nn kh, my pht in d phng, do hot ng t nhin liu l t rc v cc xe vn chuyn ca bnh vin. Cc cht hu c c trong nc thi b phn hu di tc ng ca vi sinh vt hiu kh v ym kh tu theo iu kin ti nhng ni thu gom, vn chuyn s sinh ra cc kh c hi khc nhau nh CH4, NH3, H2S... Pht sinh mi hi thi. ng thi cc vi sinh vt gy bnh nh: trc khun lao, siu vi khun cm, siu chiu, chp X-quang.

TTQT&BVMT

27

vi khun gy bnh si... pht trin mnh bm vo cc Sol kh, ht bi theo khng kh lan to khp ni c th l ngun ly lan bnh dch. b. Ngun pht sinh nc thi Khi bnh vin i vo hot ng s c nhiu ngun pht sinh nc thi. Tuy nhin c th phn loi chng theo hai nhm chnh sau: i) Nc ma chy trn Ngun nc ma chy qua b mt khun vin ca bnh vin. Lu lng dng thi xut bin khng u v tn ti trong thi gian ngn vi khong dao ng ln, ph thuc vo cc ma trong nm. Vo ma kh lng thi t hn so vi ma ma. Ti trng cc cht nhim c trong nc ma chy trn c c tnh trong bng sau: Bng 15: Ti lng nhim trong nc ma chy trn [4] Ngun thi Nc ma chy trn n v Kg/km2/nm Tng Tng BOD Nit photpho 875 105 4,72 5 COD 31,15 0 TSS 64,05 Tng Colifrom
(MPN/100 ml)

58.000

Nh vy vi din tch khu vc d n l 7,5 x 10-3 km2, nu khng c bin php x l ngun thi ny, hng nm s a vo mi trng mt lng cht thi sau: Tng nit: Tng photpho: BOD: COD5: TSS: 875 x 7,5 x 10-3 =6,56 kg/nm. 105 x 7,5 x 10-3 = 0,7875 kg/nm. 4,725 x 7,5 x 10-3 = 0,0354 kg/nm. 31,15 x 7,5 x 10-3 = 0,234 kg/nm. 64,05 x 7,5 x 10-3 = 0,48 kg/nm.

ii) Nc thi bnh vin Bao gm nc thi pht sinh t qu trnh sinh hot ca cn b cng nhn vin, bnh nhn v ngi nh bnh nhn. Nc thi pht sinh t qu trnh iu tr, t khu phu thut, khoa dc, cc labo xt nghim, phng chun b mi trng, chun b mu v ha cht, kho vt phm...

TTQT&BVMT

28

Xt v ngun gc pht sinh, nc thi bnh vin ni trn gn ging nh nc thi sinh hot. Nhng v kha cnh v sinh v dch t, nc thi bnh vin cha nhiu loi vi khun gy bnh c ngun gc t ngi bnh v cc cht c hi khc hnh thnh trong qu trnh iu tr. Ngun nc thi ny khi thi v ngun nc mt s gy nhim bn v lm lan truyn bnh dch. Theo s liu nghin cu, thng k v nc thi bnh vin a khoa v cc bnh vin chuyn khoa trong nc v trong khu vc cho thy lng nc thi ca bnh vin ni chung chim 80% lng nc cp [1]. Nh vy vi lng nc cp trung bnh nh tnh trn [tr8] th lng nc thi trung bnh ca bnh vin 71 TW l 320 cho quy m 500 ging bnh (giai on 1) v 448 cho quy m 700 ging bnh (giai on 2).

Thnh phn ngun nc thi ny rt a dng, ph thuc c th vo quy m hot ng ca tng khoa, phng, s lng bnh nhn v ngi nh bnh nhn. + Nc thi sinh hot: Cha cc thnh phn ch yu l cn b, cc cht hu c, cc cht dinh dng v vi sinh vt. Khi vo vc nc s gy nhim ngun nc, nh hng n i sng ca ng vt thu sinh v cht lng nc sinh hot ca ngi dn xung quanh. Theo tnh ton thng k ca t chc Y t th gii ti nhiu Quc gia ang pht trin, khi lng cc cht nhim trong nc thi sinh hot do mi ngi a vo mi trng (nu khng qua x l) nh sau [4]: Bng 16: Khi lng cc cht nhim c trong nc thi sinh hot Ch tiu nhim BOD5 COD Cht rn l lng (SS) Du m Tng Nit Amoni Tng Phospho Vi sinh vt: Tng coliform Fecal coliform Trng giun sn Khi lng (g/ngi/ngy) 45 - 55 72 - 102 70 - 145 10 - 30 6 - 12 2,8 - 4,8 0,8 - 4,0 MPN/100 ml 106 - 109 105 - 106 103

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29

+ Ti cc labo xt nghim: Nc thi sinh ra t cc labo xt nghim c lu lng khng ln nhng li cha nhiu vi sinh vt gy bnh, cht khng sinh tn d, ha cht xt nghim, kim loi nng. + Ti khu phu thut v cc khoa lm sng: Trong thnh phn nc thi thng cha cc vi khun gy bnh, cc hp cht hu c, cc cht dinh dng. Bng 17: T l % vi khun gy bnh phn lp t m vt m [5]
TT Tng s bnh phm T cu vng Trc khun Gram (-) E.Coli Enterosp Alka Pseudo Proteus

1 2 3 Tng cng T l (%)

454 304 214 972

137 97 67 301 31

80 53 18 151 15,5

81 72 81 234 24

15 25 16 56 5,8

82 58 35 175 18

73 49 48 170 17,5

+ Ti cc khoa cn lm sng: Thnh phn nc thi cha nhiu cc hp cht hu c nh Glucoza, sacaroza, lactoza, sulphat amon phosphoran.... Cc hp cht v c, hot phng x anpha, beta thng cao hn mc cho php. Nhn chung, c trng ch yu ca ngun nc thi bnh vin ni chung c hm lng COD, BOD, Amoni, Coliform cao hn nhiu so vi tiu chun nc mt hin hnh. Ngoi ra trong ngun nc thi ny cn cha nhiu vi khun gy dch bnh nh: Trc khun l, trc khun thng hn, giun sn... Kt qu iu tra phn tch thnh phn v tnh cht ca nc thi bnh vin khu vc min Trung v min Bc nc ta trong nhng nm trc c cho trong bng sau. Bng 18. Ch tiu nhim trong nc thi bnh vin [1] Gi t TT Ch tiu Min TB Max TCVN 59452005 (Ct (Ct B) A)
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30

1 2 3 4 5 6

PH NH4+ (mg/l) BOD5 (mg/l) COD (mg/l) Cn l lng (mg/l) Coliform (MPN/100 ml)

6,2 8,0 110 140 100 106

7,4 14 150 200 160 107

8,1 25 250 300 220 109

6-9 5 30 50 50 3000 10 50 80 100 5000

c. Ngun pht sinh cht thi rn Cht thi rn pht sinh t cc hot ng chuyn mn phc v cng tc khm cha bnh, nghin cu v o to cn b, t qu trnh sinh hot ca bnh nhn, thn nhn, khch vng lai v nhn vin y t. c trng ca cht thi rn ca bnh vin c cha mt lng nht nh cc vt t y t tiu hoa, vt phm y t cng vi cc cht thi khc nh rc thi sinh hot. Nhiu loi vt phm y t thng mang cc vi khun, vi trng gy bnh hoc l mt mi trng rt thun li cho cc vi sinh vt pht trin. Do vy, nu rc thi khng c qun l hoc x l thch hp s l ngun ly lan bnh tt ra mi trng xung quanh. Bng 19: nh mc rc thi ti bnh vin [6]
T T Tuyn bnh vin Cht thi trung bnh ca bnh vin
(kg/ging bnh/ngy m)

Cht thi nguy hi


(kg/ging bnh/ngy m)

Bnh vin tuyn tnh Bnh vin tuyn th x, thnh ph Trung bnh

1,23 1,02 1,13

0,35 0,20 0,23

2 huyn,

Nh vy, vi quy m 700 ging bnh, lng rc thi ca bnh vin 71 TW thi ra hng ngy trung bnh khong 791 kg/ngy
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31

m. Trong chim 23% l rc thi nguy hi tng ng 182 kg/ngy m. - Cht thi rn nguy hi: Theo Quyt nh s 2575/1999/Q-BYT ngy 17/8/1999 ca B trng b Y t v vic ban hnh Quy ch qun l cht thi y t, cht thi c hi ca bnh vin c chia thnh cc nhm nh sau: Nhm A: Bao gm cc loi bng, bng, gng tay, rc thi nhim bn trong qu trnh bng, b bt c tip xc vi vt m, c dnh mu. c bit l cc cht thi t cc ca bnh truyn nhim nh bnh phm sinh thit, mu, phn, nc tiu v cc m t c th bnh nhn, cc chi, rau thai...v cc m t cc phng xt nghim. Nhm B: L cc cht thi rn bao gm: bm kim tim, l, ng thuc, cc tim, thy tinh, li dao m v cc dng c cng khc. Nhm C: Cc cht thi pht sinh t cc labo xt nghim v nh i th (khng thuc nhm A ). Nhm D: Cc cht thi dc v ha hc (thuc, vc xin, cc dung mi hu c, ha cht xt nghim, cc hp cht v c...). Nhm E: Cc loi vi nh: ga tri ging thanh l, l ng nc tiu, ti O2, m c khng s dng c... - Cht thi rn sinh hot: L cht thi khng b nhim cc yu t nguy hi. Ngun cht thi ny pht sinh t cc bung bnh, phng lm vic, hnh lang, cc b phn cung ng, nh kho, nh git, nh n... bao gm: giy bo, ti liu, vt liu ng gi, thng ct tng, ti nilon, ti ng phim, vt liu gi thc phm, thc n d tha ca ngi bnh. d. Ngun pht sinh phng x Pht sinh ch yu t hot ng chun on hnh nh, iu tr tch cc v nghin cu. Pht sinh trong qu trnh vn hnh my chiu, chp X-quang, ct lp CT (CT-Scanner), cng hng t (MRI), cht thi phng x...
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32

- Cht thi phng x rn gm: cc vt liu s dng trong khu xt nghim, chun on hnh nh, iu tr nh: ng tim, bm tim, kim tim, knh bo h, giy thm, gc st khun, ng nghim, chai l ng cht phng x... - Cht thi phng x lng: dung dch c cha nhn phng x pht sinh trong qu trnh chun on, iu tr nh nc tiu ca ngi bnh, cc cht bi tit, nc xc ra cc dng c c cha cht phng x... - Cht thi phng x kh gm: cc cht kh khng dng trong lm sng nh 133 Xe, cc kh thot ra t cc kho cha cht phng x ... Bng 20: Cc ht nhn phng x s dng trong cc c s y t Ht nhn phng x Cc ht pht sinh Thi gian bn hu
3

ng dng Nghin cu Nghin cu Tr liu Chn on in vitro Chn on in vitro Chn on in vitro Chn on hnh nh Chn on hnh nh Chn on hnh nh Chn on hnh nh Tr liu, nghin cu Chn on hnh nh

H C P

Ht beta Ht beta Ht beta Tia gamma Ht beta Ht beta Tia gamma Tia gamma Tia gamma Tia gamma Ht beta Ht beta

12,3 nm 5730 nm 14,3 ngy 27,8 ngy 270 ngy 45,5 ngy 72 gi 120 ngy 13 gi 60 ngy 8 ngy 5,3 ngy

14

32 51 57

Cr

Co Fe

59 67

Ga Se I I I

75

123

125

131

133

Xe

3.2. D bo nhng ri ro v s c mi trng do d n gy ra


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33

Lng nc thi pht sinh ln khi d n i vo hot ng nu khng c bin php x l hiu qu c kh nng gy hin tng ph dng ti cc khu vc tip nhn nc thi gy nhim mi trng trn din rng. c bit ti cc khu vc c cc ngun pht sinh nhim phng x nu khng c qun l cht ch v xy dng khng ng quy chun s gy nh hng rt ln ti sc khe ca y bc s, ngi bnh v ngi dn quanh vng. Vic khoan thm d a cht trong qu trnh kho st s gy nhim ngun nc ngm. Nu ch d n khng c bin php lp h khoan hp l v ng k thut, th ti cc l khoan ny c th xut hin cc hin tng st ln b mt, thm ch c th lm thay i mc nc ngm. Trong giai on thi cng xe vn chuyn nguyn vt liu ra vo thng xuyn, s lm nhim mi trng khng kh, ting n ti khu vc d n; c th gy tai nn, dn n thit hi v ngi v ti sn. 3.3. i tng, quy m b tc ng - Tc ng trc tip: Cc ngun cht thi pht sinh trong qu trnh thi cng v hot ng ca d n nu khng c x l trit s nh hng trc tip ti cc thnh phn mi trng nh: + Mi trng khng kh xung quanh. + Mi trng nc. + Mi trng t. + Mi trng kinh t x hi. Tuy nhin, bn cnh vic a d n vo hot ng s ci thin cht lng chm sc sc kho cng ng, nng cao cht lng cuc sng ca ngi dn a phng. Tng bc lm thay i c cu kinh t trn a bn x Qung Tm. - Tc ng gin tip: Cc thnh phn mi trng c bn khi b nhim s gin tip tc ng xu ti sc khe ngi dn quanh vng. nh hng ti thc bo v mi trng chung ca ngi dn. Nhng tc ng tim tng nu trn c quy m rng, thi gian tc ng ko di trong sut qu trnh hot ng ca d n. V vy, ch u t cn xy dng k hoch hn ch nhim mi trng mt cch c th, hp l v bn vng.
TTQT&BVMT

34

3.4. nh gi tc ng 3.4.1. Giai on xy dng c bn a. Tc ng n mi trng khng kh - Bi, t v hi kh c Khi thi cng d n, mt khi lng ln vt liu xy dng, my mc thi cng c chuyn n khu vc d n phc v cho cng tc san nn v xy dng c bn. Ko theo l mt lng ln bi thi, t ri vi v hi kh c. Bi, t v hi kh pht sinh trong giai on ny nu khng c kim sot th s gy nh hng khng nh ti cnh quan mi trng, sc khe ngi dn, y bc s trong bnh vin v bnh nhn ang iu tr ni tr. c bit l nhng ngi cng nhn thi cng trn cng trng. Tuy c thi gian tip xc vi cc tc nhn nu trn khng di nhng vi nng cao cng c th gy ra mt s bnh v ng h hp (mi, hng, ph qun, kh qun...), cc bnh ngoi da (nhim trng da, lm kh da, vim da); cc bnh v mt (vim mi mt, vim gic mc mt...), cc bnh v ng tiu ha v.v... Bi nhim ny cn c tc dng xu n h thc vt trong khu vc, biu hin thng thy l cy ci trong khu vc ln cn thng b ph mt lp bi trn l, t gy cn tr qu trnh quang hp ca cy, cy ci s chm pht trin, l a vng, nh hng ti qu trnh sinh trng pht trin v m hoa kt tri ca cy trng. - Ting n: Pht sinh t hot ng xy dng s gp phn nh hng xu ti mi trng khng kh xung quanh, mi trng lao ng ca ngi cng nhn v mi trng lm vic cng nh iu tr ca y bc s trong bnh vin. Khi tip xc lu di vi ting n mc cao, ngi tip xc trc tip c th mc cc bnh v tai (thng mng nh, tai, ic ...). i vi ngi bnh ang iu tr cn s yn tnh tuyt i th ting n trong giai on ny l tc nhn gy nh hng rt xu n qu trnh u tr. - Nc thi: Vic ngp ng do nc ma, nc thi sinh hot trong qu trnh ny l c th xy ra. Ti cc khu vc ngp ng lu ngy s pht sinh cc hi kh khng mong mun nh H2S, NH3 lm nhim mi trng xung quanh. b. Tc ng n mi trng nc

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35

- Nc thi: Ch yu l nc thi sinh hot ca cng nhn trc tip thi cng v nc ma chy trn. + Nc thi sinh hot bnh qun khong t 60 - 80 lit/ngi/ngy m [7], tuy nhin lng thi ny cng thay i theo thi gian trong qu trnh thi cng. Nc thi sinh hot ch yu cha cn b, cht rn l lng, cht hu c, cc cht dinh dng v vi sinh vt. + Nc ma chy trn ph thuc rt nhiu vo ch thi tit, kh hu trong khu vc. Nc ma chy trn c hm lng cht l lng v bn t cao, ngoi ra cn nhiu tp cht khc nh du, m... Tc ng d nhn thy nht ca nc ma chy trn trong giai on ny l s ngp ng cc b gy nhim mi trng khng kh xung quanh. Ngoi ra vi thnh phn nhim nh trn, ngun nc thi ny khi thi trc tip vo mi trng tip nhn m khng qua khu x l s b no s lm tng mc nhim nc mt khu vc xung quanh. Do y l vng t ct nn tc thm ca nc l rt cao. Khi ngun nc thi ny c kh nng gy nhim ngun nc ngm tng nng do trong qu trnh t thm chng ko theo cc hp cht v c, hp cht hu c, vi sinh vt. - Bi, t thi v cht thi rn: t thi v bi pht sinh c th gy tc cc ng ng dn nc thi, thot nc ma trong bnh vin. Gp phn ln tng kh nng ngp ng cc b, ng thi nc r rc vi cc thnh phn nhim hu c cao cng s lm tng nng cht nhim trong ngun nc thi chung ny. y l ngun thi c nguy c gy nhim nc mt v nc ngm tng nng. c. Tc ng ti sc khe ngi cng nhn - nhim khng kh, ting n l nhng nhn t quan trng nh hng trc tip ti sc khe ngi cng nhn, nh hng ti kh nng tp trung cng vic, gim hiu qu sn xut ca cng nhn v tng nguy c tai nn trong lao ng. - Cht thi rn pht sinh nu khng c qun l v thu gom hiu qu s l mi trng c nguy c cao i vi ngi cng nhn. Lng cht thi ny ch yu l cht thi rn sinh hot ca cng nhn (bao b, v hp, ti nilon) v cht thi rn trong xy dng (bao b xi mng, t ri vi, thp vt liu tha). Chng c khi lng khng ln, tuy nhin rt kh kim sot do khng
TTQT&BVMT

36

tp trung v thi quen trong sinh hot. Vic ri vi cc vt liu tha nh: inh st, dy km g, li ca... c th gy nh hng n cng nhn thi cng, cn b cng nhn vin, bnh nhn v ngi nh bnh nhn khi dm phi. Tu vo mc , nh hng c th a n bnh un vn, rt nguy him n tnh mng. 3.4.2. Giai on d n i vo hot ng. 3.4.2.1. Tc ng n cc thnh phn mi trng. a. Tc ng n mi trng khng kh. Cc hi kh c, mi l pht sinh t nhiu ngun khc nhau vi s phn b nng khng u theo khng gian v thi gian lm nh hng xu ti cht lng mi trng khng kh. Ti cc khu lm vic v khu iu tr, trong iu kin thng kh km, cc tc nhn ny lm gim cht lng khng kh gy nh hng trc tip ti sc khe ca bnh nhn, ngi nh bnh nh v y bc s. Vi kh nng pht tn nhanh trn din rng, mt s hi kh c v mi l, Sol kh v cc vi khun gy bnh c bit trong cc khu kh trng, x l nc thi, x l cht thi rn... gp phn lm gim cht lng mi trng khng kh dn c xung quanh. Mi trng khng kh b nhim bn s nh hng trc tip ti sc khe con ngi v vt nui. C th k ra y tc ng xu ca mt s hp cht hu c, v c v vi khun gy bnh khi chng tn ti trong khng kh. + Bi: Khi ngi phi bi c hc vo phi, phi s b kch thch v pht sinh nhng phn ng gy x ho phi to nn cc bnh v h hp. + Kh CO: Kh CO l mt loi kh c do c phn ng rt mnh vi hng cu trong mu v to ra Cacboxy hemoglobin (COHb) lm hn ch s trao i v vn chuyn oxy ca mu i nui c th. i lc ca CO i vi hng cu gp 200 ln so vi oxy. Hm lng COHb trong mu t 2-5% bt u c du hiu nh hng n h thn kinh trung ng. Khi hm lng COHb trong mu tng 10-20% cc chc nng hot ng ca cc c quan trong c th b tn thng. Nu hm lng COHb tng n hn 60% c nguy c gy t vong cao. + Kh SO2: L kh d ho tan trong nc v c hp th rt nhanh khi ht th bu khng kh nhim SO2. Kh SO2 nng thp (1-5 ppm) xut hin s co tht tm thi ti cc c mm, nng cao hn, SO2 gy xut tit nc nhy
TTQT&BVMT

37

v vim ty thnh kh qun, lm tng sc cn i vi s lu thng khng kh ca ng h hp v gy kh th. + Cc kh NOx: L cht c hi c tc hi gy bnh vim x phi mn tnh. V mc c hi th kh NO2 c tc ng cao nht so vi cc kh , NO, N2O5. Kh NO2 gy cc tc ng ti con ngi tu thuc vo nng v thi gian tip xc [8]. Nng NO2 (ppm) 500 300-400 150-200 50-100 Thi gian tip xc 48 gi 2-10 ngy 3-5 tun 6-8 tun T vong Gy vim phi v t vong Vim x cung phi Vim cung v mng phi + Kh HCl: Khi tip xc vi c th kh HCl s to thnh Axit Clohidrit c tnh ph hu cao. Ht th kh HCl vi nng thp gy ho, nght th, vim mi, hng v phn pha trn ca h h hp. Khi tip xc vi kh HCl nng cao gy ph phi, t lit h tun hon v dn n t vong. Kh HCl tip xc vi da c th gy mn , cc thng tn hay bng nghim trng v cng c th gy m mt. + Dioxin: L tn gi chung ca mt nhm cc hp cht ho hc tn ti bn vng trong mi trng cng nh trong c th con ngi v cc sinh vt khc. Trong nhm cc hp cht ho hc thnh phn c nht l TCDD (2,3,7,8-tetrachlorodibenzo-pdioxin). Dioxin c nguy c tc ng ton cu, c c tnh bn vng rt cao v kh nng lm nhim bn nc ngm, khng kh, lng thc thc phm... Thm ch nng rt thp, Dioxin cng c kh nng gy ri lon ni tit, ph hy cn bng min dch, gy ung th, qui thai, d dng, thiu nng tr tu... + Vi khun gy bnh: Yu t gy nhim mi trng khng kh c trng ca bnh vin l cc loi vi khun trong khng kh. S tn ti ca cc loi vi khun ph thuc rt ln vo mi trng: Nhit , m, khng kh Mt s
TTQT&BVMT

Hu qu

38

vi khun gy bnh c thi gian tn ti rt lu trong khng kh, trong nhng ni m t, ti tm v c th pht trin mnh trong iu kin nhit l 370C. Bng 21: Thi gian tn ti ca mt s VK gy bnh thng c trong khng kh [7] STT 1 2 3 4 5 6 Loi vi khun Ph cu Lin cu khun tan huyt T cu vng Trc khun dch hch Trc khun bch cu Trc khun lao Bacillus Koch Thi gian tn ti 4 - 5 thng 2,5 - 6 thng 3 ngy 8 ngy 30 ngy 70 ngy

Cc ngun pht sinh vi khun t bnh phm, cht thi ngi bnh rt d xm nhp lm nhim khng kh, dn n kh nng ly lan mm bnh cho con ngi do ht phi khng kh nhim khun. Cc vi khun c kh nng pht tn mnh trong mi trng khng kh nh: trc khun lao, siu vi khun cm, siu vi khun gy bnh si, u ma, quai b b. Tc ng n mi trng nc - Nc ma chy trn Nc ma chy trn trong khun vin ca bnh vin s cun theo cc cht cn b, cc cht hu c v t ct xung cng thot nc. Lm tc cc cng thot nc t tch t cc cht bn pht sinh mi hi thi, to iu kin thun li cho vi sinh vt, vi trng pht trin. Tc ng ln nht do nc ma chy trn gy ra l do nng cht rn l lng, tng nit v photpho cao... khi iu kin v sinh cng s khng sch, cng tc qun l cht thi rn khng hp l, qu trnh vn chyn cht thi lng khng kn s l nguyn nhn gy nhim ngun nc ma chy trn. Khi ngun nc thi ny c thi vo mi trng s gy c ngun nc mt, gy bi lng vc nc, lu di c th gy hin tng ph dng dn ti bn ha cc khu vc nc nng, iu ny nh hng rt ln n mi trng sng ca sinh vt thu sinh. - Nc thi bnh vin + Nc thi sinh hot, nc thi t cc khoa lm sng, cn lm sng (t cc khoa iu tr, phng phu thut, nh i th, lau ra phng m, v sinh bung bnh...) mang lng ln vi trng, ch yu l virut ng tiu ho, bi lit, cc loi k sinh trng, amip v cc loi nm. Ngoi ra, trong thnh phn ca nc
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39

thi cn c ho cht pht sinh t cc loi thuc, vcxin qu hn, cc dung mi hu c, cc ho cht xt nghim... Nu khng c x l m thi trc tip lng nc thi ny ra mi trng s lm nhim nghim trng ngun nc mt, nc ngm v nguy him hn l nh hng n sc kho ca con ngi. Bn cnh , lng khng sinh tn d trong nc thi s lm cht cc vi sinh ct ch th trong nc, do gy mt cn bng gia cc h sinh vt trong nc. Cc cht hu c c trong nc thi lm gim lng oxy ho tan trong nc, nh hng ti i sng ca ng, thc vt thu sinh. S phn hu cc cht hu c cng sinh ra mt hm lng ln ion sunfat trong nc. Trong iu kin him kh, cc ion sunfat ny s b phn hu sinh hc gii phng kh H2S, sinh ra mi kh chu v c hi cho con ngi. Ngoi ra do d tha cc cht dinh dng Nit, photpho c th gy ra hin tng ph dng ko theo s pht trin ca cc loi to khng mong mun ti cc vng tip nhn nc thi. Cc loi to s pht trin rt nhanh trong ma cn khi m lu lng nc trao i (pha long) gim xung v kh nng t lm sch ca nc km i. Bn cnh , qu trnh phn hy sinh hc cc cht hu c cng s lm gim nng xi ha tan trong nc. Khi nng xi ha tan trong nc xung thp, cc loi thy sinh vt s gim. Ti khu vc c nng xi ha tan xung qu thp th thng sy ra qu trnh phn hy k kh lp bn y, pht sinh mi hi thi. y l mi trng khng thun li cho cc sinh vt sng di nc. Ngc li nm v vi khun pht trin mnh nh s phn hy cc cht hu c lm tng hm lng NH4+, pht sinh cc kh c hi, c mi kh chu, nh hng trc tip n cc sinh vt sng di nc v mi trng khng kh xung quanh. + Nc thi t cc labo xt nghim tuy c lu lng t, tuy nhin trong ngun nc thi ny c cha cc ho cht xt nghim, cht khng sinh, cc kim loi nng. Nu thi chung vi cc dng thi hoc thi trc tip v mi trng s gy c ch qu trnh hot ng ca vi sinh vt c li, dn n hiu qu x l trong h thng x l nc thi v qu trnh t lm sch nc ca t nhin b gim xung. c. Tc ng n mi trng t. Cc tc nhn gy nhim mi trng t chnh yu l nc thi, kh thi v cht thi rn. Nc thi v kh thi c cha cc hp cht gy nhim khi i
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vo mi trng t s lm bin i tnh cht ha l, c hc ca t. Nng cc cht nhim trong t cng cao th nng oxi trong t cng thp, iu gy nh hng trc tip ti mi trng sng ca cc loi sinh vt trong t. Mi trng t l ni tip nhn cui cng cc dng thi, c bit l cht thi rn. i vi cc cht thi rn pht sinh t hot ng ca d n di mi hnh thc, d x l hay cha x l u c tip nhn bi mi trng t (chn lp, b mt). nhng ni tp trung nng cc cht gy nhim cao, thnh phn cc cht nhim phc tp s lm thay i kh nng t phc hi ca t, nh hng n cc tc ng gia t - nc - khng kh, thay i mi trng sng ca cc loi ng thc vt trong khu vc, t lm mt cn bng sinh thi vng. Ngoi cc yu t gy nhim ch yu l nc thi; kh thi v cht thi rn, th cc vi sinh vt gy bnh cng c tc ng lm nhim mi trng t. Mt s vi sinh vt gy bnh gy nhim mi trng t ch yu l: + Trc khun l: Trc khun l cht rt nhanh trong phn ti, nhng sau khi ty u phn th chng c th tn ti lu nh c cht hu c trong t. Trc khun l thng b cc tia bc x mt tri tiu dit. + Trc khun thng hn v ph thng hn: t trng l mi trng khng thun li cho cc vi khun thng hn v ph thng hn pht trin. Chng s cht sau mt thi gian tn ti trong t. Tuy nhin, tu theo mc nhim bn v loi t (nhit , m, d tr cht hu c, pH, khun lc, vi khun i khng...) trc khun thng hn v ph thng hn c th tn ti kh lu trong t. + Phy khun t: Tn ti trong t khng qu 1 thng, kh nng sinh tn ca n chu nh hng ca nhiu nhn t. t b nhim khun bi phn ti, cc cht hu c ko di, thi gian tn ti ca phy khun t c th tng ln t 5-7 thng. Kh nng sinh tn ca vi khun ny cn b nh hng bi thnh phn c hc ca t, cc vi khun i khng v cc nhn t sinh hc. + K sinh trng (giun sn): K sinh trng c truyn qua t, nht l t b nhim phn, t mang kn amip. Nhng vng t b nhim bn bi cht thi ni chung nu dng vo vic chn nui gia sc, gia cm hay trng hoa mu, cc cht nhim s qua ng thc vt m nh hng ti sc khe con ngi qua chui thc n bi qu trnh tch t sinh hc gy c hi ln .
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d. Tc ng dch t hc ca cht thi bnh vin. Trong cht thi bnh vin cc vi sinh vt rt a dng v chng loi v c nguy c gy bnh cao nh: - Cc vi khun Salmonella, Shigella, Vbrrio, Coliform, t cu, lin cu, Preudomonas... thng khng vi nhiu loi khng sinh, gy rt nhiu kh khn trong qu trnh iu tr. - Cc vi rt ng tiu ha nh Echo, Coxsakie, Rotavirut.. c th gy cc bnh v ng tiu ha nh t, l, thng hn... - Trong cht tht thi bnh vin, c bit l nc thi cn cha rt nhiu k sinh trng nh Amip, trng giun sn, cc loi nm h ng... virut vim gan B, C. Chng c th gy cc bnh v ng tiu ha, bnh ngoi da, bnh v mt, bnh ph khoa, vim gn siu vi trng.. tng i cao. - Ngoi ra, cht thi bnh vin nu khng c x l trit cn l c tr, ngun cung cp thc n, mi trng thun li cho cc vecto truyn bnh pht trin nh: chut, b, ri mui... Do , cht thi bnh vin nht thit c kim tra, phn loi v x l theo mt qua trnh nghim ngt trc khi thi vo mi trng. e. Mt s tc ng khc. - Tc ng ca cht thi rn: Cht thi rn pht sinh trong qu trnh sinh hot ca cn b cng nhn vin, bnh nhn v ngi nh bnh nhn tc ng trc tip n cc thnh phn mi trng nh pht sinh mi hi, ngn cn dng chy ca h thng cp thot nc to iu kin thun li cho cc vi khun, cc loi vt gm nhm chut, b sinh si v pht trin. c trng ca cht thi rn ca bnh vin l cha cc vt phm y t mang cc vi khun, vi trng gy bnh. Cc tc nhn gy bnh ny c th xm nhp vo c th con ngi qua vt try xc trn da, qua cc nim mc, qua ng h hp, ng tiu ho. Loi cht thi ny mang nhiu yu t c tc ng trc tip lm nhim mi trng nc, t, khng kh. Ngoi ra, cht thi rn y t c kh nng lan truyn bnh tt, do rui mui, cn trng v pht tn cc bnh nh:

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thng hn, t l, st xut huyt, st rt, st pht ban, vim gan A v cc bnh truyn nhim khc.

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c bit i vi mt s cht thi cht thi rn nguy hi: cht thi rn nhim phng x, cc l ng ha cht gy c t bo, cc l ha cht nguy hi ht hn... nu khng c bin php x l ring khi thi vo mi trng s gy nhim moi trng khng kh, mi trng t, mi trng nc. Khi tip xc trc tip qua da hoc qua ng h hp chng c th gy t bin gen, ung thu v cc bnh nguy him khc c tnh di truyn i vi con ngi ng thc vt xung quanh. - Tc ng ca bc x Gamma: Bc x Gamma pht sinh trong qu trnh vn hnh s dng thit b chiu, chp X-quang, my siu m, my in tim nh hng ca bc x Gamma ti sc kho ca con ngi da trn liu lng, thi gian tip xc, khong cch v phng thc chiu. Khi bc x Gamma i vo c th chng s tng tc vi cc cht trong c th v to ra cc in t th cp. Cc in t th cp ny l cc ht nhn mang in gy ra hin tng ion ho dn n s ph hu cc t bo sng trong c th c th l nguyn nhn ca cc loi bnh nan y. 3.4.2.2. Tc ng n tnh hnh kinh t-x hi. + Sc khe cng ng: D n nng cp v m rng bnh vin 71 Trung ng p ng c nhu cu khm cha bnh v nng cao cht lng chm sc sc khe cng ng; gp phn hon thin h thng h tng x hi v y nhanh mc tiu pht trin kinh t x hi ca a phng. Hn ch tnh trng nhim mi trng do cht thi bnh vin gy ra, nng cao cht lng cuc sng ca nhn dn. + Kinh t x hi: Qu trnh hnh thnh v s hot ng ca d n c mt ngha kinh t x hi rt to ln cho x Qung Tm ni ring v tnh Thanh Ho ni chung. Trc tin l vic gp phn to cng n vic lm, mi trng lm vic hin i, nng cao tay ngh cho i ng y bc s trong vic khm v iu tr bnh cho ngi dn. Vic a d n vo hot ng s l ngun thu ht (gin tip v trc tip) lao ng ln v gii quyt vic lm khng ch cho ngi dn a phng. iu ny cng gp phn lm tng dn tr v thc vn minh th cho nhn dn trong khu vc. Tuy vy, bn cnh cc mt tch cc l cc mt tiu cc i km: t ai cho cy xanh v cnh quan thin nhin b thu hp, nhim mi trng ngy cng tng cng gy nh hng trc tip ti cht lng cuc sng ca nhn dn.
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+ Giao thng vn ti: D n cng s gp phn cng vi cc hot ng khc trong khu vc lm cho tnh trng mt v sinh ng ph, bi tng ln do cc phng tin vn chuyn. Mt giao thng trong khu vc tng ln lm nh hng n nhu cu i li ca nhn dn. Tuy vy, chnh s pht trin ca d n s gp phn ci thin h thng ng giao thng cng nh thc y qu trnh cng nghip ha trong khu vc nhanh hn, mnh hn. 3.4.3. nh gi v phng php s dng. + Phng php nh gi nhanh: tnh ton ti lng v nng nhim trung bnh cho tng giai on thc hin d n, chng ti s dng phng php nh gi nhanh c t chc Y t th gii a ra. Hin nay phng php ny c chp nhn v s dng ti nhiu quc gia trn th gii. Vit Nam, phng php ny cng c gii thiu v ng dng trong nhiu nghin cu TM. Lu lng v thnh phn cht thi ph thuc vo nhiu thng s, ti lng L ca cht nhim j c th c th hin dng ton hc nh sau Lj = f Trong f: Dng ngun thi, quy m ngun, quy trnh cng ngh, hiu qu h thng x l, nguyn liu v nhin liu s dng, iu kin mi trng xung quanh... xc nh c Lj trc ht cn xc nh c h s ti lng thi ej i vi cht nhim j qua phng trnh.

Bng phng php thng k, t chc Y t Th gii (WHO) xy dng bng nh gi nhanh, xc nh ch s ej v t xc nh c lng thi Lj. + Phng php thng k: y l mt trong nhng phng php n gin thng c s dng trong cc bo co TM. Vic d on cc thnh phn cht thi, lng thi, nguyn liu v nhin liu s dng trong d n qua vic thng k t cc n v c iu kin v quy m hot ng tng t s cho ta s liu c chnh xc tng i cao v ng tin cy.

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CHNG IV BIN PHP GIM THIU TC NG XU, PHNG NGA V NG PH S C MI TRNG 4.1. Cc bin php gim thiu tc ng xu n mi trng. 4.1.1. Giai on xy dng c bn. 4.1.1.1. Gim thiu nhim mi trng khng kh. Trong giai on xy dng c bn, cc ngun pht thi lm nhim mi trng khng kh l khng lin tc do thi gian thi cng ngn. Tuy nhin, do d n c thc hin nm trong khun vin ca bnh vin v th ngoi nhng tc ng n cng nhn trc tip lm vic trn cng trng, n cn tc ng n khu vc iu tr, khm cha bnh hin c ca bnh vin. Cc bin php gim thiu nhim mi trng khng kh trong qu trnh xy dng c bn: - Cc hng mc cng trnh thi cng c che chn, m bo ng quy nh v xy dng. - Cc xe vn chuyn nguyn vt liu, t phi c ph kn bng bt, thng xe ng kn, khng ch nguyn vt liu vt qu khi lng quy nh. - Cc xe vn chuyn nguyn vt liu, phng tin thi cng khng hot ng trong gi ngh ngi, trong khu vc iu tr bnh nhn. - Khng s dng cc xe t, my mc qu c vn chuyn nguyn vt liu v thi cng cng trnh, c bo dng nh k nhm m bo an ton trong thi cng v m bo cc tiu chun v mi trng nh: tiu chun kh thi, tiu chun mc n, rung. - to m, gim nng pht tn bi ti khu vc cng trng xy dng v trn tuyn ng vn chuyn nguyn vt liu, BQL d n s ch phun nc trong nhng ngy thi tit nng, nng v kh hu hanh kh. - Ban qun l d n d n phi hp vi n v thi cng lp k hoch thi cng cc hng mc cng trnh xy lp hp l gim thiu bi, kh c, n, rung. 4.1.1.2. Gim thiu nhim mi trng nc.
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- i vi nc thi sinh hot ca cng nhn thi cng trn cng trng s c qun l cht ch bng cch m bo y cc cng trnh v sinh ln tri nh: nh v sinh, h thng thot nc, nh tm, ni cha rc... Nc thi sinh hot s c x l bng h thng x l cht thi lng v cht thi rn hin c ca bnh vin. - Khng vt liu xy dng gn cc ngun nc; ng thi qun l du m v vt liu c hi do cc phng tin vn chuyn v thi cng gy ra. - Bn t khi san nn, lm ng c thu gom v c vn chuyn n ni quy nh, khng xy ra tnh trng ngp ng, ly li. - Ban qun l d n phi hp vi n v thi cng thu dn cc cht ri vi trong khi san lp, o mng hn ch cc cht ri vi b cun theo nc ma lm nhim ngun nc. 4.1.1.3. Gim thiu tc ng ca cht thi rn. - Cht thi rn ch yu l vt liu h hng, gch v, xi mng cht, g copha hng... s c thu gom tp trung x l hoc tn dng san lp mt bng. - Cht thi rn sinh hot c thu gom tp trung ti cc ni quy nh tin x l. Cc cng nhn lm vic ti cng trng s c tp hun v thu gom rc thi. 4.1.1.4. An ton trong thi cng v bo v cng trnh. - Ban qun l d n kim tra thng xuyn cc n v thi cng. Thc hin che chn chng bi v vt ri trn cao xung, chng n v rung ng qu tiu chun: TCVN 3985-85, phng chng chy TCVN 3254-89, an ton n TCVN 3255-86...trong qu trnh thi cng. - Trn cng trng cc khu vc thi cng nguy him c bo v bng ro chn, cm y bin bo. Cc khu vc thi cng, ng giao thng s c n chiu sng ban m. - Khi thi cng mng cho cc cng trnh, cc n v thi cng xem xt la chn thit b thi cng thch hp hn ch rung ng, khi, bi, ting n v nh hng ti khu vc iu tr v khm cha bnh hin c ca bnh vin.
- bo m an ton cho phng tin cng nh ngi tham gia giao thng,

c bit l i vi cc phng tin vn chuyn nguyn, vt liu phc v xy


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dng d n, yu cu: cc phng tin thi cng kim tra thng xuyn v h thng phanh v cc b phn chuyn ng, cc li xe phi cam kt khng ung ru bia, lun lm ch tc trong khi iu khin phng tin. - Ban qun l yu cu v thng xuyn kim tra vic thc hin cc bin php m bo iu kin v sinh mi trng, phng chng chy n v an ton lao ng trn cng trng ca cc n v thi cng theo quy nh chung. 4.1.2. Giai on d n i vo hot ng. 4.1.2.1. Gim thiu nhim mi trng khng kh. - Thng xuyn v sinh bnh vin, phun cc cht st khun ti cc nh v sinh, thay th nhng np cng hng, nh k tin hnh no vt cng rnh thot nc hn ch s pht tn mi ra mi trng xung quanh. - Cc phng khm, iu tr, chun on c h thng ca s, h thng thng kh ng b v c thit k m bo s ln trao i khng kh t nhin v nhn to theo cc tiu chun thit k chun ngnh. - S dng cc ch phm vi sinh x l v hn ch pht sinh mi l nh: Enchoice, EM... Cc ch phm vi sinh ny c phun trc tip vo cc ngun c kh nng pht sinh mi, khu tp kt cht thi, cc khu v sinh chung, khu x l nc thi. - i vi khoa ly v cc labo xt nghim, kho ho cht, dc phm c lp t h thng thng kh v bc x l kh c. - Thng xuyn kim tra v nh k bo dng cc xe ca bnh vin, khng ch qu ti trng quy nh. S dng nhin liu ng vi thit k ca ng c. 4.1.2.2. Gim thiu nhim mi trng nc. Gii php gim thiu nhim mi trng nc c thit k theo nguyn tc phn lung nh sau:

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S 1: Nguyn tc phn lung x l nc thi trong bnh vin 71 TW

Nc ma chy trn

Song chn rc H gas

H thng 1

Dng 1 Nc thi Sinh hot Dng 2

Kh trng tp trung H thng 2 B t hoi


03 ngn

Khu x l nc thi tp Dng 1 trung a. H thng 1: Dnh ring cho thot nc ma. H thng ny bao gm cc mng, lm sng nc kn (lp t cc song chn rc). Mng li ny c Nc thi rnh thot H thng 2 cn lm sng xy dng bng b tng ct thp vi h thng ging thm ng b. dc cng ti thiu: 1/D (ng knh HTtnhl D x bng mm). Ging thm c b tr ti cc cc b Dng 2 im thay i ng knh, ch ngot v vi khong cch trung bnh 20 - 40m. Kt cu cng dng cng trn b tng ct thp, su t cng im u nh nht l 0,5m. H thng ny s tp trung nc ma t trn mi nh xung v dn n h thng cng ngm thot nc ma dc theo ng ni b trong bnh vin. Nc ma trn cc khu vc sn trng s chy vo cc ging thu nc ma, t cng vi nc ma trn mi chng c dn n cng thot nc ma chung v thi ra mi trng.
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Mng thot nc thi chung khu dn c

b. H thng 2: Dnh ring cho nc thi sinh hot ca cn b nhn vin, bnh nhn v ngi nh bnh nhn. Nc thi sinh hot c tch lm 2 dng: - Dng 1: Nc t nhu cu tm ra, git r ca bnh nhn, ngi nh bnh nhn v khch vng lai... lng nc ny chim t trng ln (70- 80%) nc thi sinh hot, nng cc cht nhim li khng cao nn c th thi ra mi trng sau khi qua h thng thu gom tp trung, kh trng. - Dng 2: Nc thi t nh v sinh (h tiu, h tiu) c nng cc cht nhim, vi sinh vt gy bnh cao, nn c gii php x l hu hiu. Hin nay, c rt nhiu phng php x l nc thi v sinh ny, nhng do tnh cht, khi lng ca nc thi, c im kh hu, a hnh nn phng php ph hp nht m d n la chn l phng php x l bng b t hoi. B t hoi l cng trnh x l nc thi ng thi lm cc chc nng: lng phn hu cn lng v lc. Cn lng gi trong b t 6 - 8 thng, di tc dng ca vi sinh vt k kh, cc cht hu c b phn hu, mt phn to thnh cc cht kh, mt phn to thnh cc cht v c ho tan. Nc thi c lng trong b lng sau c a v h thng x l nc thi tp trung trc khi thi vo mi trng. Th tch b t hoi ph thuc v c im ca tng khoa, ph hp vi s lng cn b nhn vin trc tip v gin tip lm vic, s lng bnh nhn v ngi nh bnh nhn. Th tch b t hoi c xc nh da v tiu chun thi v s ngi tham gia s dng cng trnh. V = A x N x T/1000 (m3) Trong : V: Th tch b t hoi (m3) A: Tiu chun thi (lt/ngi/ngy: trung bnh 20 lt) N: S ngi s dng nh v sinh t hoi. T: Thi gian nc thi lu li b t hoi (20 - 50 ngy). Do iu kin kh hu nhit i nng, m ca Vit Nam nn c th chn thi gian lu nc thi trong b l 20 ngy v vi s lng ging bnh trung bnh cho mi khoa l 40 ging (Theo TCXDVN 365-2007). S lng b t hoi cn xy dng c tnh l 02 b, phc v cho khong 80 ngi (40 bnh nhn, 40 ngi nh bnh nhn). Nh vy th tch mi b khong 16m3.

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c. H thng 3: Dnh ring cho nc thi sinh ra trong qu trnh iu tr ti cc khoa lm sng, cn lm sng, nc thi t khu phu thut, cc labo xt nghim... Nc thi h thng ny c chia thnh 02 dng khc nhau: - Dng 1: Nc thi t cc qu trnh iu tr (Tr nc thi t cc Labo xt nghim). Loi nc thi ny c thu gom v vn chuyn bng h thng ring n trm x l nc thi tp trung. - Dng 2: Nc thi t cc labo xt nghim. Ngun nc thi ny c thu gom v x l s b trc khi i vo h thng x l nc thi tp trung. S 2: H thng x l cc b nc thi t cc labo xt nghim
Cht tr keo t NT t labo xt nghim

B cha

Keo t + lng

HT x l nc thi tp trung

Thi vo MT tip nhn

Phi bn Ghi ch: Dng nc thi Dng bn thi

HT l t

- Thuyt minh h thng x l nc thi cc b: Nc thi t cc labo xt nghim c thu gom vo b cha. Sau nh k c bm sang b kt hp keo t v lng 2, ti y nc thi c b xung cc cht tr lng nh PACN, DW97 nhm kt ta cc kim loi nng v cc mt phn hp cht hu c khc. Nc thi sau khi lng s c a v h thng x l nc thi tp trung thng qua h thng vn chuyn nc thi dng 1. Lng bn thi sau c no vt, phi kh v tin hnh t ti l t cht thi rn ca bnh vin. d. H thng x l nc thi tp trung. Hin ti, bnh vin 71 Trung ng c h thng x l nc thi bnh vin vi cng sut 120m3/ngy. H thng x l nc thi theo theo phng php b Aeroten, kt hp lng v kh trng nc thi. Mt bng trm x l nc thi c th hin trn hnh sau:

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Hnh 1: Mt bng trm x l nc thi hin c ca bnh vin 71 TW

Trong tng lai vi quy m nng cp ln 700 ging bnh, lng nc thi ca bnh vin hng ngy dao ng t 320 - 448 m3/ngy, ln hn cng xut trm x l nc thi hin ti. x l hiu qu ngun nc ny, d n tin hnh u t xy dng thm mi mt h thng x l nc thi trn c s tn dng h thng x l hin c. H thng nc thi bnh vin c thit k nhm m bo cc tiu chun v mt k thut, ph hp vi kh nng u t ca bnh vin v c nh hng m rng trong tng lai. Trn c s , ch u t chn xy dng h thng x
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l nc thi theo cng ngh x l hp khi CN2000. S h thng x l nh sau: S x l nc thi bng thit b x l sinh hc, c m vi sinh v hp khi CN2000.

H thng x l trn c vn hnh tun theo cc nguyn l c bn sau: Nguyn l Modul: Vi lng nc thi ca Bnh vin khong 300 - 500 m3/ngy m. H thng x l nc thi ca bnh vin c thit kt thao cng ngh hp khi vi 2 ti 3 modul, mi modul c thit k cho cng sut c th t 200 300 m3/ng. (vi 20h hot ng). Nh vy cho php vn hnh cc thit b mt cch ti u, m bo tn dng trit cng sut ca h thit b x l ngay c trong trng hp lu lng nc thi bin i theo thi im ph thuc v ngun thi nhm gim th tch b iu ho, gim chi ph in v chi ph vn hnh thit b lc cao im v nhng thi gian bnh thng. Nguyn l hp khi: Nguyn l ny cho php thc hin kt hp nhiu qu trnh c bn x l nc thi bit trong mt khng gian thit b ca mi modul tng hiu qu v gim chi phi vn hnh x l nc thi. Thit b x l hp khi cng mt lc
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thc hin ng thi qu trnh x l sinh hc ym kh v cc qu trnh hiu kh nh Biofin, Biofor, Aeroten qua lp m. Vic kt hp nhiu lp ny s to mt mng vi sinh ti a m khng gy tc cc lp m, ng thi thc hin oxy ho mnh v trit cc cht hu c trong nc thi. Thit b hp khi cn p dng c ch lng c lp bn mng (Lamen) cho php tng b mt lng ng thi rt ngn thi gian lu. Nguyn l t ng: Vic vn hnh cc my bm nc thi, my bm bn, cc my thi kh v bm cc ch phm vi sinh, keo t c thc hin t ng tu thuc vo lu lng nc thi thng qua cc phao bo t ng lp trong cc ngn b. Nguyn l ny cho php tit kim in v ho cht ng thi vn m bo duy tr cp kh nui vi sinh hiu kh v thc hin x l nc thi. Cc ch phm vi sinh s dng trong h thng + Ch phm vi sinh BIOWC96 v DW97: y l ch phm phn gii (thu phn) nhanh cc cht thi hu c phc tp t trong cc b pht ca bnh vin, to iu kin phn gii kh trit cc cht thi hu c phc tp thnh cc thnh phn d phn hu trc khi bt u qu trnh oxy ho trong thit b x l sinh hc. Do , qu trnh phn hu cc cht hu c trong cc thit b xy ho sinh hc sinh hc din ra nhanh hn ( tc phn hu tng 7-9 ln) nh vy gim c s qu ti ca cc b pht, gim kch thc thit b, tit kim chi ph ch to, chi ph vn hnh cng nh din tch mt bng cho h x l. Gi thnh chi ph x dng DW 97 l 45/m3 s lm tng hiu qu lm sch, gim chi ph in nng + Cht keo t tc cao PACN 95 (Cho trng hp c ca ngun tng t ngt), cho php gim kch thc thit b lng mt cch ng k, t gim chi ph xy dng v vn hnh tit kim nng lng m vn m bo tiu chun u ra ca nc thi. + Ch phm vi sinh Enchoice Solutions: y l sn phm hu c a Enzyme, t phn hu 100%, khng c hi ti con ngi, mi trng v cc h sinh thi. Dung dch Enchoice Solutions x l mi bng cc c ch khc nhau dn n hiu qu kh mi cao: c ch ho tan, c ch m, v c ch xc tc cc phn ng ho hc kh cc hp cht gy mi.Tc dng ca Enchoice:
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* Kh mi hi pht sinh do s phn hu cc cht hu c trong nc thi. * Khng ch cn trng rui, mui. * y nhanh qu trnh phn hu sinh hc cc cht hu c gp phn lm gim BOD, COD trong nc thi. Thuyt minh cng ngh x l. + X l s b bc 1: Nc thi t cc ngun khc nhau theo h thng cc ng ng ring chy vo b gom, b ny c xy dng ti mt v tr thun li cho vic gom nc thi ton bnh vin. Ti y, tt c cc rc th c kch thc ln nh: giy, bao nilon, que, g c gi li h tch bng li inox 5 v c a ti im tp trung rc bnh vin. T b thu gom, nc thi chy ra b iu ho nhm cn bng lu lng v nng cc cht nhim ng thi thc hin qu trnh lm thong s b. Ti y, nh k mt ln mt tun nc thi c b sung vo mt lng BIOWC96 hoc DW97 nhm thu phn s b cc cht hu c to iu kin thun li cho qu trnh xy ho tip theo. nng cao mc ng u cc cht hu c trong nc thi, trnh lng cn v to mi trng thun li cho vi sinh vt hot ng, trong b iu ho c lp h thng sc kh. Nc thi c bm thng xuyn ln container x l vi mt lng n nh khng i bng bm. bo m qu trnh x l c lin tc cn lp thm mt bm d phng cng cng sut. + X l bc 2: X l bc hai l qu trnh x l quan trng kt hp cc cng on x l khc nhau c thc hin trong container thit b. Nc thi c bm vo thit b trc tin i vo ngn x l vi sinh ym kh. Nc thi c dn qua lp m vi sinh c cu to c bit hnh thnh dng nc lan to i cc nhnh trong lp m to mng vi sinh ti a phn b ng u trong lp m. Do cu to nh vy qu trnh phn hu sinh hc ym kh din ra ng u vi hiu sut x l cao. Ngoi ra, vic cp thm ch phm vi sinh c hiu DW-97H (2-3 mg/lt) s gip cho vic phn hy c thc hin nhanh hn. Thi gian lu ca nc thi
TTQT&BVMT

56

trong ngn x l sinh hc ym kh khong 1-1,5h. Hiu sut x l nc thi ti ngn x l sinh hc ym kh ny c th t ti 40 45% theo BOD. Tip theo ngn x l sinh hc ym kh nc thi c i qua ngn x l sinh hc hiu kh. Ngn ny c thit k theo phng n kt hp mt lc nhiu nguyn l thit b Biofin, Biofor, Aeroten, to b mt tip xc ln gia nc thi v khng kh. Thi gian lu ca nc thi trong ngn thit b ny l 2 2,5h, qua 3 qu trnh x l vi sinh, c thc hin hp khi trong mt thit b nh sau: Aerolif (Trn kh cng bc) cng cao bng vic dng khng kh thi cng bc ht v y nc thi. Aeroten dng ngc (hoc dng xui) c lp m vi sinh bm. Lc sinh hc dng xui vi vt liu lc. Vi c ch nh vy, cc vi sinh vt hiu kh hot ng tt hn nn qu trnh x l din ra nhanh chng, hiu qu v trit . tng cng qu trnh x l, mt phn bn hot ho sau khi qua container c bm tun hon tr li, ho trn vi nc thi t b iu ho, hoc vi tng ngn ca cc Modul nhm tng cng ti a hiu ng ca bn hot ho cho qu trnh x l. Vic cung cp xy c thc hin nh my thi kh cng bc trong mi modul thit b. Hiu qu x l ca quy trnh x l ny t 70 75% theo BOD. nng cao hiu qu x l BOD ca cc qu trnh x l sinh hc hiu kh ln 90 95%, trong thit b cn lp thm ngn x l sinh hc dng biphin nh git. Nc thi sau khi cc qu trinh x l hiu kh kt hp nu trn s c bm ln nh ca ngn lc sinh hc, t y nc thi s chy qua lp m lc sinh hc c cc mng vi sinh bm. Ngn lc sinh hc c thit k vi cc khe ht gi trn thnh thit b, do khng kh s c ht vo ngn lc v b cun cng vi nc thi qua cc ngch ca lp m, to iu kin tt cho cc vi sinh vt hiu kh hot ng v gim chi ph in nng dng cho cp kh. Qu trnh tch bn hot ho v cn l lng hu c khc trong nc c thc hin nh ngn lng trong cng thit b ny. Ngn lng c thit k theo
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57

kiu lng bn mng (Lamen) cho php tng b mt lng ng thi rt ngn thi gian lu. Ngoi ra, Ti y nc thi c b sung cht keo t PACN-95 (nng 5-8mg/lt) c tc dng to bng cn to, tng tc lng, gip cho qu trnh tch bng bn din ra nhanh chng v gim kch thc thit b. Nc thi qua x l sinh hc v c lng trong nhng vn cn cha mt lng nht nh cc vi khun gy bnh, do cn c dn sang ngn kh trng dit tr vi khun trc khi x ra mi trng. Hiu qu v trit nht l kh trng bng dung dch Chlorine. Dung dch Hypochloride Na hoc Ca (NaOCl, hoc Ca(OCl)2) c pha trn v bm nh lng vi nng 4 6mg Cl2/m3 nc thi. Vic nh lng Clo hot tnh cn thit cho kh trng nh cc thit b trn, thit b pha Cl2, v cc bm nh lng Cl2 c lp ng b trong modul thit b hp khi. Nc thi sau khi c kh trng c chy vo h cha nc thi x l trc khi thi v mng thot nc chung ca khu dn c. + X l bn. Bn, cn lng ngn lng v tng ngn x l sinh hc s c bm v b cha bn. Ti y, di tc dng ca qu trnh ln men ym kh, phn ln ca cn s c khong ho cng vi s to thnh mt s sn phm ph ca qu trnh ln men ym kh CH4, NH3, H2O, H2S., th tch ca bn gim mt cch ng k. Mt khc, ti y d lng ca men BIOWC96 hoc DW97 c b sung s y mnh nhanh qu trnh phn hu bn v dit tr cc trng giun sn cng nh vi khun gy bnh cha trong bn trc khi chy ra mi trng. Bn sau khi x l c ht nh k bng xe v sinh a n khu x l tp trung thng qua hp ng vi Cng ty Mi trng v th. 4.1.2.3. Gim thiu tc ng ca cht thi rn. a. Phn loi cht thi rn. Vic phn loi cht thi rn c tin hnh ngay t ngun ngay ti ngun: vi cc nguyn tc c bn sau: - Tin hnh phn loi ngay thi thi im cht thi pht sinh v ng cc cht thi trong cc ti, thng theo ng quy nh.

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58

- Cc cht thi rn y t nguy hi khng c ln trong cht thi sinh hot. - Ti v thng mu xanh quy nh ng cc cht thi sinh hot. - Ti v thng mu vng quy nh ng cc cht thi lm sng khc. - Ti v thng mu en quy nh ng cc cht thi ha hc, cht thi phng x, cht gy c t bo. Cc loi cht thi ny sau s c vn chuyn bng xe chuyn dng ti khu cha ch x l, thi gian lu cht thi ny khng qu 48 ting. Cht thi rn sau khi c thu gom vn chuyn n phng ch c phn thnh 02 loi v c lu li trong cc khoang cha ring bit, bao gm: + Loi 1 - Cht thi rn c php thiu hy: Cht thi rn loi ny c lu trong khoang lnh nhm hn ch hot ng ca cc vi khun gy bnh. Chng ch yu l cht thi rn sinh hot, cht thi rn lm sng, cht thi rn ha hc v mt phn cht thi rn nguy hi. + Loi 2 - Cht thi rn khng c php thiu hy: Cht thi rn loi ny c cha trong cc khoang c b tng ha, ch yu gm cht thi rn cha hp cht Halogel, cht thi phng x, cht thi c kh nng gy chy ni. Sau khi phn loi, hai loi cht thi rn nu trn c tin hnh x l theo cc phng php khc nhau. b. X l cht thi rn. Tng lng cht thi rn theo c tnh ban u khong khong 565 kg/ngy-m cho quy m 500 ging bnh (giai on 1) v 791 kg/ngy-m cho quy m 700 ging bnh (giai on 2) [tr30]. Trong cht thi rn khng c php thiu hy trung bnh ch chim mt phn rt nh khong 0,25% [1], tng ng vi 1,4 kg/ngy-m (giai on 1) v 1,98 kg/ngy - m. Nh vy, cht thi rn c php thiu hy vn s vt xa cng xut l t cht thi rn hin ti ca bnh vin vn ch c 15 kg/h (360 kg/ngy-m). x l trit ngun cht thi ni trn, bnh vin quyt nh ci tin, nng cp l t ln quy m 45 kg/h theo cng ngh l t L45 ci tin. - Phng php thiu hy cht thi rn loi 1. S cng ngh x l cht thi rn
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59

rc thi loi 1

Khoang lnh

Np liu

X l tro x

t rc thi trong bung t s cp (800-1.2000C)

Mt phn kh nng tun hon

Thi vo mi trng

Ghi ch: + M t cng ngh l thi rn Dng cht t:

t rc thi trong bung t th cp (1.050-1.1000C)

Kh thi

Xyclon mng t

L t L45 l loi l nhit cao, c kim sot lung kh, ng dng k Dng kh nng thut t 02 ln. Rc ph thi c a vo l t bun s cp (nhit t Dng kh thi 800-1.2000C). Kh thi ra l t s cp c t li ln hai bun th cp c nhit t 1.050-1.1000C. Khng kh cung cp cho qu trnh t t h thng qut ly tm v cc ng ng c van kim sot lung kh. + Quy trnh vn hnh l t: Nhin liu c cp vo bn cha, sau cc van du c m nhin liu t chy vo thit b t. t thi gian hot ng cho hai thit b t, cc rle s phn cp thi gian theo tng bung t. Thi gian thch hp cho bung t s cp t khong 60 pht, cho bung t th cp v qut gi khong 6 giy. Khi h thng vn hnh ti cc bung t tng ng s c ng h bo nhit . Quan st nhit ti cc bung: khi nhit ti bung t s cp t n nhit t 850-1.100 0C thit b t s tng ng ngng hot ng; khi nhit h xung n 8000C thit b t tng ng s hot ng tr li. + X l kh thi l t:

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60

Kh thi l sn phm cui cng ca l t, thnh phn chnh ch yu g: CO, bi (thng c ng knh khong t 3 n 100 m), SO2, HCl, NOx, HF,
kim loi nng (Cu, As, Ni, Pb, Cd, Hg...), Dioxin v Furan... Lng kh thi ny

c x l bng phng php Xyclon mng nc vi h thng gm 02 xyclon mng nc ni tip. Mi xyclon c chiu cao khong 1,0 - 2,0m, ng knh 0,6m, hot ng theo nguyn l cng chiu v ngc chiu (nc vi trong c p lc phun thnh cc tia nh i cng chiu v ngc chiu vi lung kh). Ti y bi, kh c c hp th v theo dng nc i ra khi lung kh vo h thng lng ng, ng thi mt s kh c cng b nc vi hp th v chuyn thnh nhng ho cht t c hi hn theo cc phn ng: SO2 + Ca(OH)2 = CaSO3 + H2O 4NO2 + O2+ 2H2O = 4HNO3 2HNO3 + Ca(OH)2 = Ca(NO3)2 + 2H2O CO2 + Ca(OH)2 = CaCO3 + H2O
Sau khi x l, kh thi l t m bo khng mu, khng mi, khng cha kh thi c hi v t TCVN 6560-2005.

Nc thi t h thng xyclon mng nc em theo cc kt ta i vo b lng pha di, cc cht kt ta c nh k no vt em chn lp ti ni quy nh. Phn nc sau cho qua b nc sa vi b sung Ca(OH) 2 v s dng quay vng ti s dng. + X l tro x: Tro v x pht sinh sau khi t c tp trung v em chn lp ti ni quy nh ca bnh vin cng vi cc cht kt ta trong khu x l kh thi l t. - Phng php lm tr ha cht thi rn loi 2. Cht thi loi ny s c lu gi trong cc khoang cha ring c dung tch cha <1m3 (DxRxC: 1,2x0,8x1m). Thnh v mng cc khoang cha c kin c bng b tng ct thp # 300, dy 30 cm, np b lm bng thp tm (d=3mm) bn trong m tr. Khi b cha y bnh vin s c Cng vn ngh S Ti nguyn v Mi trng Thanh Ho v cc c quan c thm quyn c bin php x l hiu qu. 4.1.2.4. Gim thiu tc ng phng x. Vic xy dng, b tr cc thit b c kh nng bc x c hi ti con ni c tun th nghim ngt theo tiu chun thit k cuyn ngnh c quy nh
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61

ti quyt nh s 32/2005/Q-BYT, ngy 31/10/2005 v vic ban hnh tiu chun thit k khoa chun on hnh nh. Cc thit b chp X-quang, CT-Scanner, MRI phi c xut x r rng (m hiu my, ni sn xut, nm sn xut). Cc thit bi ny c nh k mi nm kim tra mt ln, quy trnh kim tra phi da trn vn bn ca Tng cc Tiu chun-o lng-Cht lng LVN 41:1999. Trang b y phng tin bo v lao ng cho ngi vn hnh my, trang b cc thit b che chn thch hp nh knh ch che chn tuyn gip. Nhn vin iu khin my X-quang phi c trang b liu k c nhn v c khm nh k. 4.1.2.5. Cc bin php gim thiu ly lan dch bnh. - Nghim cm a ra khi bnh vin nhng hng ho, vt phm, thc phm, ung c kh nng truyn dch bnh. - Nghim cm tuyt i cc bnh nhn sinh hot bn ngoi bnh vin, c bit i vi cc bnh nhn iu tr cc khoa ly nhim. - Thc hin thng xuyn cng tc ty u, dit khun, v sinh mi trng 01 ln/tun. - Nghim cm khng cho bnh nhn ra khi bnh vin, tip xc vi ngi ngoi khi ang trong qu trnh iu tr ni. - Nghim cm tuyt i a ngi v phng tin vo ni c kh nng ly lan dch bnh; trong trng hp c bit cn trang b y cc dng c phng h theo ng quy nh ca B Y t. 4.1.3. Cc gii php khc. - Trng cy xanh trong khun vin bnh vin v xung quanh hng ro to cnh quan, chng bi, n, cc loi kh v lm trong sch mi trng. Chn cc loi cy cao, l to, nhiu tng nh: Cy g h u, keo tai tng, bch n khong cch cc cy t 5 - 10 m. - Xy dng cc bin php bo v ngi lao ng trong khu x l nc thi, trnh kh nng b nh hng ti sc khe do tip xc vi khng kh c mang vi sinh vt, bi. nh k khm sc kho, c bit l cc bnh nhim khun h hp, d ng tai mi hng, d ng ngoi da. 4.2. Cc bin php phng nga, ng ph vi s c mi trng.
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62

- Xy dng b cha nc, trang b cc thit b cha chy y phng chy, cha chy theo ng quy nh v theo tiu chun phng chng chy TCVN 3254-89. - Lp t h thng bo chy t ng ti cc ni quan trng v c kh nng xy ra chy n cao. - Xy dng ni quy an ton s dng in, s dng bnh oxy ph bin ti cc v tr lm vic. - i vi cc cp in c t trn cao c automat t ct khi xy ra chp in, cu dao in c thit k ph hp v c t trong hp quy nh. - Hun luyn cho cn b cng nhn vin cc phng thc v bin php x l trong trng hp c s c xy ra, theo ng nguyn tc an ton lao ng. - m bo an ton lao ng, bnh vin trang b y cc phng tin bo h lao ng v yu cu cn b cng nhn vin thc hin nghim tc trong cng vic. - phng trnh s c do st: Bnh vin lp t h thng chng st nhng v tr cao tng v cc thit b bng kim loi c cao theo Quy nh 76/VT ngy 2/3/1983 ca B Vt t. Lp t h thng li chng st cho cc cng trnh khng phi kim loi c cao >15m gm cc ct thu li b tr quanh mi.

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63

CHNG V
CAM KT THC HIN BIN PHP BO V MI TRNG

Bnh vin 71 Trung ng l n v ch u t d n u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr, cam kt phi hp cng cc c quan chc nng thc hin nghim tc cc gii php bo v mi trng nu chng 4 ca bo co cng nh cc quy nh chung v bo v mi trng c lin quan n qu trnh trin khai, thc hin d n.

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64

CHNG VI CC CNG TRNH X L MI TRNG CHNG TRNH QUN L V GIM ST MI TRNG

6.1. Danh mc cc cng trnh x l nhim mi trng Trn c s cc gii php x l mi trng nu chng 4 Bnh vin 71 Trung ng s u t, xy dng cc thit b, hng mc cng trnh nhm x l hiu qu cc cht nhim sau: Bng 17: Danh mc cc cng trnh x l nhim mi trng
TT Danh mc cng trnh x l mi trng I H thng x l cht thi rn 1 Khoang lnh cha CTR c php thiu hu 2 Khoang BTCT cha CTR khng c php tiu 3 4 II 5 6 7 8 9 hu H thng thu gom rc thi y t Ti nilon Thng nha Xe y thu gom rc thi sinh hot H thng x l nc thi Mng li thot nc ma B t hoi 3 ngn B thu gom nc thi tp trung B thu gom v lc rc B x l theo nguyn l modun hp khi B x l ym kh B x l hiu kh B lng B kh trng B x l bn H sinh hc H thng thu gom x l nc thi cc phng S lng 01 khoang 01 khoang 01 h thng 02 ci 01 h thng 10 b 01 b 01 b 01 h thng

10 11 12

01 b 01 h 01 h thng

labo xt nghim III H thng x l kh 13 Phng x l kh bng tia t ngoi 14 H thng phun nc ng giao thng ni b H thng cyclon mng t 15 Kho ho cht dit khun, kh trng 16 Bm phun dit khun IV H thng khc 17 H thng cy xanh 18 H thng chng chy 19 H thng chng st
TTQT&BVMT

01 phng 01 h thng 01 h thng 01 kho 05 ci 01 h thng 01 h thng 01 h thng

65

6.2. Chng trnh qun l v gim st mi trng Chng trnh qun l mi trng m bo cho cc bin php bo v mi trng xut trong bo co TM c thc thi, cc bin php qun l mi trng, t chc qun l, thc hin cc bin php phng trnh, cng tc quan trc, ng cu khi c tai bin mi trng phi m bo cc nguyn tc sau: 6.2.1. Qun l mi trng Khi d n i vo hot ng, Ch d n s thc hin nghim chng trnh qun l mi trng, bao gm: - Xy dng k hoch qun l mi trng khu vc. - ra chng trnh quan trc mi trng. - Xy dng quy trnh p ng khn cp v tai bin mi trng. - C k hoch qun l, trin khai cc cng tc bo v mi trng tng ng cho cc giai on: chun b mt bng thi cng cng trnh v vn hnh cng trnh. - Qun l cht thi rn, nc thi v kh c hi sinh ra 6.2.2. Chng trnh gim st, quan trc mi trng Chng trnh gim st, quan trc mi trng c tin hnh mt cch lin tc trong sut qa trnh hot ng ca d n v xc nh c cc ni dung sau: - i tng, ch tiu quan trc mi trng. - Thi gian v tn sut gim st. - D tr kinh ph cho quan trc mi trng. a. Gim st cht lng mi trng khng kh Ch tiu gim st Vi kh hu Nng bi Ting n NH3 H2S SO2 NO2 CO CO2 Tn sut gim st 04ln/nm a im gim st Gm 6 v tr: 01 im trc phng khm bnh. 01 im ti khu hnh chnh bnh vin. 01 im ti trung tm bnh vin. 02 im ti khu dn c gn bnh vin

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66

CH4 THC - Tiu chun p dng:

u ng khi ca l t cht thi rn

+ TCVN 5937; 5938 - 2005 Cht lng khng kh - Tiu chun cht lng khng kh xung quanh. + Tiu chun ca B Y t v v sinh mi trng ban hnh km theo Quyt nh s 3733/Q - BYT ngy 10/10/2002 ca B Y t. + TCVN 6560-1999: Cht lng khng kh i vi l t rc thi y t. b. Gim st ting n: - Cc im gim st: 02 im trong khun vin Bnh vin. 04 im khu dn c ngoi tng ro bnh vin. - Tiu chun p dng: TCVN 5949 - 1998 - Ting n khu vc cng cng v khu dn c - Mc n ti a cho php. - Tn sut gim st: 04 ln/nm. c. Kim sot an ton bc x: - Tn sut gim st: 04 ln/nm. - V tr gim st ti khu vc khoa chun on hnh nh d. Gim st cht lng mi trng nc Ch tiu gim st PH NO3SO42Tng N Tng P Cht rn l lng BOD5 COD Coliorm - Tiu chun p dng:
TTQT&BVMT

Tn sut gim st

a im gim st Gm 03 v tr:

04 ln/nm

+ Nc thi sau h thng x l + 03 im nc ging nh dn + 03 im nc mt khu vc

67

+ TCVN 5942 - 1995: Gi tr gii hn cho php ca cc thng s v nng cc cht nhim trong nc mt. + TCVN 5944 - 1995: Gi tr gii hn cho php ca cc thng s v nng cc cht nhim trong nc ngm. + TCVN 6772: 2000 - Cht lng nc - Nc thi sinh hot - Gii hn nhim cho php. 6.2.3. Quan trc v sinh mi trng lao ng iu kin v sinh mi trng lao ng s c quan trc ti cc v tr c kh nng chu nh hng ca cc yu t bt li i vi sc khe con ngi: Nhit , m, ting n, chiu sng v sut liu lng phng x, hi kh c. Cc v tr gim st l cc khoa, phng, khu iu tr, bung chp X-quang. Hng nm, bnh vin s lp k hoch gim st cht lng mi trng vi cc c quan chuyn mn ly mu, phn tch, o c, nh gi cc thng s cn thit. Cc s liu s c lu gi lm c s theo di hin trng mi trng bnh vin. Ngoi ra, bnh vin c chng trnh kim tra sc khe nh k cho cn b cng nhn vin. y l mt cng vic rt quan trng nhm pht hin kp thi bnh ngh nghip iu tr hoc bi dng, phc hi sc khe

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68

CHNG VII
D TON KINH PH CHO CC CNG TRNH MI TRNG - Cn c lp d ton: + D ton xy dng cng trnh. + n gi XDCB ban hnh km theo quyt nh s 2992/2006/Q-UBND ngy 19/10/2006 ca UBND tnh Thanh Ha + n gi XDCB ban hnh km theo quyt nh s 2993/2006/Q-UBND ngy 19/10/2006 ca UBND tnh Thanh Ha + nh mc d ton xy dng c bn ban hnh km theo quyt nh s 24/2005/Q-BXD ngy 29/07/2005 ca B trng B xy dng + nh mc chi ph t vn u t theo Q s 10/2005/Q-BXD ngy 15/04/2005 ca B xy dng + Thng bo gi Qu II nm 2007 ca lin S Xy dng - S TC tnh Thanh Ha + Thng bo gi thit b x l mi trng ca trung tm cng ngh x l mi trng - B t lnh ha hc v cc n v khc. + V cc vn bn hin hnh khc. - Gi tr d ton: c tnh l 7.166.000.000 vn, bao gm co hng mc sau: + Xy dng h thng x l cht thi rn: 249.000.000 vn + Xy dng h thng x l nc thi: 6.125.000.000 vn + H thng x l kh: 702.000.000 vn + H thng x l khc: 90.000.000 vn Bng 23: D ton ti chnh xy dng cc cng trnh x l mi trng () T T I

1 2 3 4

Danh mc cng trnh x l mi S trng lng H thng x l cht thi rn Khoang lnh cha CTR c php 01 thiu hy khoang B cha cht thi rn khng c 01 B php tiu hu H thng thu gom rc thi y t 01 HT Ti nilon Thng nha Xe y thu gom rc thi sinh hot 02 ci

D tr kinh ph
50.000.000 75.000.000 50.000.000

Thnh tin 249.000.000


50.000.000 75.000.000 50.000.000

2.000.000

4.000.000 69

TTQT&BVMT

5 II

6 7 8 9 10

11 12 13
III

Ci tin nng cp l t ln 45kg/h H thng x l nc thi Mng li thot nc ma B t hoi 3 ngn B thu gom nc thi tp trung B thu gom v lc rc B x l theo nguyn l modun hp khi B x l ym kh B x l hiu kh B lng B kh trng B x l bn H sinh hc H thng thu gom v x l nc thi labo xt nghim H thng x l kh

01 HT 10 b 01 b 01 b 01 HT

1.500.000.000

200.000.000 300.000.000 200.000.000


1.500.000.000

70.000.000 6.125.000.000 1.500.000.000 2.000.000.000 300.000.000 200.000.000 1.500.000.000

01 b 01 h 01 HT 01 phng 01 HT 01 HT 01 Kho 05 ci 01 HT 01 HT 01 HT

50.000.000 500.000.000 75.000.000

50.000.000 500.000.000 75.000.000 702.000.000

14 Phng x l kh bng tia t ngoi 15 16 17 18


IV

500.000.000 150.000.000 30.000.000 20.000.000 400.000 50.000.000 15.000.000 10.000.000 15.000.000

500.000.000 150.000.000 30.000.000 20.000.000 2.000.000 90.000.000 50.000.000 15.000.000 10.000.000 15.000.000 7.166.000.000

19 20 21 22

H thng phun nc ng giao thng ni b H thng Cyclon mng t Kho ha cht dit khun, kh trng Bm phun dit khun H thng khc H thng cy xanh H thng chng chy H thng chng st Ph gim st mi trng Tng cng

(Bng ch: By t, mt trm su mi su triu ng)

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CHNG VIII
THAM VN KIN CNG NG

Trong qu trnh thc hin lp bo co TM, ch u t l Bnh vin 71 Trung ng cng nhm chuyn gia ca c quan t vn tin hnh t chc tham vn kin cng ng x Qung Tm, huyn Qung Xng, tnh Thanh Ho. Nhng ni dung chnh m Ban qun l d n cp xin kin tham vn bao gm: 1. D n tc ng n kinh t - x hi: - Thc y s pht trin kinh t - x hi. - Lm chm qu trnh pht trin kinh t - x hi. - Nhng tc ng khc. 2. D n xy dng h thng x l nc thi tc ng n y t, sc kho, gio dc, vn ho, di tch lch s. 3. D n xy dng h thng x l nc thi tc ng ti i sng, vic lm v thu nhp ca nhn dn. 4. Tc ng ca d n ti cc thnh phn mi trng v mi trng sng ca dn c khu vc xung quanh. T nhng ni dung trn U ban nhn dn, U ban Mt trn T quc x Qung Tm v i din ngi dn cho kin v d n u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr. (C km theo phn ph lc).

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CHNG IX
CH DN NGUN CUNG CP S LIU, D LIU V PHNG PHP NH GI

9.1. Ngun cung cp s liu, d liu


1. Nin gim thng k tnh Thanh Ha nm 2006 - Cc thng k tnh Thanh Ho - Nxb Thng K, H Ni - 2007. 2. Bo co KT-XH nm 2006 v 6 thng u nm 2007 ca UBND x Qung Tm, huyn Qung Xng, tnh Thanh Ho 3. Bo co hin trng mi trng tnh Thanh Ha nm 2006. 4. Gio trnh Thot nc v x l nc thi. NXB Khoa hc v K thut H Ni nm 2001. 5. nhim khng kh v x l kh thi. NXB Khoa hc v K thut H Ni nm 2000. 6. Tiu chun Vit Nam TCVN - 2005 ban hnh km theo Quyt nh s 22/206/Q-BTNMT ngy 18/12/2006 ca B trng B Ti nguyn v Mi trng v vic bt buc p dng Tiu chun Vit Nam v mi trng, gm cc tiu chun sau: - TCVN 5942 - 1995. Gi tr gii hn cho php ca cc thng s v nng cc cht nhim trong nc mt. - TCVN 5944 - 1995. Gi tr gii hn cho php ca cc thng s v nng cc cht nhim trong nc ngm. - TCVN 5937 - 2005 v TCVN 5938 - 2005. Cht lng khng kh - Tiu chun cht lng khng kh xung quanh. - TCVN 5939 : 2005. Tiu chun kh thi cng nghip i vi bi v cc cht v c. - TCVN 5949 - 1995. m hc - Mc n ti a cho php khu vc cng cng v khu dn c.

9.2. Phng php p dng trong qu trnh TM


- Phng php nh gi nhanh trn c s h s nhim do T chc Y t Th gii thit lp nhm c tnh ti lng cc cht nhim t cc hot ng ca d n.
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- Phng php thng k: Phng php ny nhm thu thp v x l cc s liu kh tng thu vn, kinh t x hi ti khu vc d n. - Phng php nghin cu, kho st thc a ly mu ngoi hin trng v phn tch trong phng th nghim nhm xc nh cc thng s v hin trng cht lng mi trng khng kh, mi trng nc, n ti khu vc d n. - Phng php iu tra x hi hc c s dng trong qu trnh phng vn lnh o v nhn dn a phng ti khu vc d n. - Phng php so snh dng nh gi cc tc ng trn c s cc tiu chun mi trng do Nh nc ban hnh.

9.3. Nhn xt v mc chi tit, tin cy ca cc nh gi


Qua nghin cu thc t, tham kho ti liu chuyn ngnh v tham vn kin ca cc chuyn gia cc lnh vc c lin quan n d n, cc nh gi tc ng mi trng nu trong bo co m bo tnh khch quan, chnh xc v tin cy cao.

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KT LUN V KIN NGH

1. Kt lun Thanh Ha hin c 7 bnh vin tuyn tnh (2 bnh vin a khoa, 5 bnh vin Chuyn khoa), 26 Trung tm y t tuyn huyn, th x, thnh ph. Vi s ging bnh hin nay l 4520 ging, ch mi t 12,48 ging bnh/01 vn dn (ton quc t 16,5 ging bnh/01 vn dn). Qua cho thy h thng chm sc sc khe cng ng ca tnh Thanh Ha hin ti cha t c mc bnh qun so vi c nc, ng thi cng cha p ng c nhu cu khm, cha bnh ngy cng tng cao ca nhn dn trong tnh. D n u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr l hon ton ph hp, p ng ch chng thu ht u t ca Nh nc. D n ra i v i vo hot ng s p ng nhu cu khm cha bnh, chm sc sc kho khng nhng cho ngi dn a phng m cn cho ngi dn ca khu vc Bc min Trung. ng thi d n cng gp phn hon thin c s h tng, y nhanh tin hon thnh mc tiu pht trin kinh t x hi ca a phng. Trong qu trnh thi cng cng nh vn hnh d n s khng trnh khi nhng tc ng xu n mi trng nh nu trong bo co. Vi vic thc r trch nhim bo v mi trng v s gip ca cc ngnh, cc c quan chc nng, ch d n s hon thin cc h thng x l nc thi, kh thi, cht thi rn nh nu trong bo co. Thc hin Lut Bo v mi trng v nhng vn bn php quy ca Nh nc v Bo v mi trng, bo co nh gi tc ng mi trng ca d n u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr nu y cc tc nhn gy nhim tc ng n mi trng cng vi cc bin php x l gim thiu nhim mi trng v chng trnh gim st cht lng mi trng v cam kt thc hin nghim chnh nhng iu ni trn. 2. Kin ngh Cc gii php gim thiu nhim mi trng trong bo co c trnh by y c s khoa hc, c tnh kh thi cao.
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ngh UBND tnh Thanh Ha xem xt v sm ph duyt bo co nh gi tc ng mi trng d n u t xy dng, ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr.

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