Healthcare waste management plan - Central North Region Health Support Project E2264 Public Disclosure Authorized Building up the plan for Healthcare waste management and treatment Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized 18 October, 2009 -1- Healthcare waste management plan - Central North Region Health Support Project Table of contents CHAPTER 1. HEALTHCARE WASTE MANAGEMENT AND LEGISLATIVE FRAMEWORK..........................................................................................................................................4 CHAPTER 4: BUILDING THE PLAN FOR POLLUTION MITIGATION.....................5 CHAPTER 1. HEALTHCARE WASTE MANAGEMENT AND LEGISLATIVE FRAMEWORK..........................................................................................................................................9 1. 1 Introduction.......................................................................................................................9 1.1.1 HCWM ...................................................................................................... 10 1.1.2 Decision No. 43/2007/QD-BYT, November, 30 2007, of the Minister of Health on healthcare waste management................................................................................ 11 1.1.3. Standards................................................................................................... 11 1.1.4. TCVN7380-2004 and TCVN7381-2004 on medical solid waste incinerator ......... 13 1.1.5 Review of requirement on HCWM practices in Vietnam and in the world ............ 13 1.2 Comparison with international standards ..............................................................................13 1.3 Air emission from Healthcare waste incinerators ...................................................................15 1.4. Recommendations for strengthening the legislative framework...............................................15 1.6 Environmental assessments and building HCWM plan team...................................................16 1.7 Methodology.....................................................................................................................16 CHAPTER 2: PROJECT SITES AND STATUS OF HCWM .................................................17 2.1 Description of project sites and HCWM status......................................................................17 2.2. Survey and field trips to investigate the existing HCWM at the project healthcare establishments. .............................................................................................................................................23 2.2.1 Questionnaires on HCWM............................................................................ 23 2.2.2 Assessment of waste generation rate at project healthcare establishments ............. 23 2.2.3. Assessment of the type of waste/group of waste in practices ............................. 24 2.2.4. Waste separation, collection, transportation, storage and treatment HzHCSW at project DGHs..................................................................................................... 25 2.2.5. Assessment of HCWM team, internal guideline, training course in HCWM.......... 27 2.2.6. Assessment of HCSW treatment ................................................................... 30 2.2.7 HCWM assessment ...................................................................................... 30 2.2.8 Assessment of local authorities’ and DPC leader’s proposals on HCWM.............. 30 2.2.9. Infectious liquid waste and waste water treatment (WWT)................................. 31 2.2.10 The needs of spread out regulation on safe discharges of medical waste water..... 31 2.2.11. Assessment of Healthcare waste water management ....................................... 32 2.3. HCWM Budget.................................................................................................................33 2.4 Risk associate with current HCWM practices and role of Provincial DOH in HCWM inspection 33 CHAPTER 3: ENVIRONMENTAL IMPACTED SOURCES FROM MEDICAL WASTE AT THE PROJECT UNITS..............................................................................................34 3.1 Environmental impact caused by medical waste water ............................................................34 3.1.1 Estimation of waste water volume from the preventative DGHs in project area. ... 34 3.1.2 Specific characteristics and components of healthcare waste water ...................... 34 3.2 Raising hospital waste is one environmental impact................................................................36 3.2.1 The discharge of medical solid waste from DGH/DPC in the project sites........... 36 3.2.2 Objective, impacted scale of medical solid waste............................................... 36 3.3 Environmental impact when building the technical house for preventive medical center.............38 3.3.1 Impacts in the preparing and the implementing phase........................................ 38 3.3.2 Environmental impacts in the operation phase ................................................. 39 3.4. Integrated assessment of environmental impacts of the project...............................................40 -2- Healthcare waste management plan - Central North Region Health Support Project CHAPTER 4: BUILDING ENVIRONMENTAL MANAGEMENT PLAN AND MITIGATION SOLUTION ..............................................................................................................42 4.1 Decrease the impact of medical waste by increasing practices HCWM for medical establishments in the project areas. .....................................................................................................................43 4.1.1 Increase guideline of HCWM......................................................................... 43 4.1.2 Regulative development, human resources for HCWM...................................... 43 4.1.3 Building up one specific HCWM Plan for projected district general hospitals........ 44 4.2 HCWM plan and environment impacts mitigation for district general hospitals in the project area. .............................................................................................................................................45 4.2.1 Waste separation at source by group of waste based on HCWM Regulation of HCWM- Q 43/2007/QD-BYT. .......................................................................... 45 4.2.2 Color coding for waste bag, stored bin, waste bin............................................. 46 4.2.3 Responsibility of waste collection, transportation in the medical units. ................ 46 4.2.4 HCW treatment plan of medical units in the project area. .................................. 47 4.2.5. Impact mitigation from radioactive waste ....................................................... 49 4.2.6 Mitigation method of epidemic diseases ......................................................... 49 4.2.7 Other mitigation methods ............................................................................. 50 4.2.8 Preventive and deal with environmental breakdown.......................................... 51 4.2.9 Increasingly monitoring the information of hazardous medical waste................... 51 4.2.10. Increasing individual responsibility of HCWM............................................... 51 4.2.11. Preparing specific financial source for HCWM............................................... 52 4.2.12 Preparing to build treat HCWM based on the assessment and selection of suitable technology for project DGH/DPC. ....................................................................... 52 4.2.13 Implementing, building and treating medical waste for medical units with different source of capital .................................................................................................. 54 4.2.14 Making and creating appropriate budget and encouraging medical waste treatment54 4.3 Mitigation of environmental pollution in the construction phase of the preventive medical center. .............................................................................................................................................54 4.3.1 Mitigation method when preparing construction............................................... 54 4.3.2 Mitigation impacts when preparing the building platform................................... 58 4.3.3. Air pollution mitigation in the construction phase............................................ 58 4.3.4 Mitigation of water pollution in the construction phase ..................................... 59 4.3.5 Mitigation of solid waste in the construction phase....................................................... 59 4.3.6 Safety in construction implementation and protection ....................................... 60 4.4. Air pollution mitigation in the operation of newly built DPC .................................................60 4.4.1. Air pollution mitigation................................................................................ 60 4.4.2 Water pollution mitigation.................................................................................. 60 4.4.3. Mitigaiton method for healthcare solid waste (HCSW)...................................... 60 4.4.4 Sum up the method of MW treatment of preventive medical center .................... 61 CHAPTER V: INVIRONMENTAL MANGEMENT AND MONITORING PROGRAM...............................................................................................................................................63