The overall objective of Hospital Waste Management Support Project (HWMSP), funded by World Bank, is to reduce the environmental pollution caused by medical waste from hospitals in Vietnam, contributing to improving the health of the people.
Toward the aforementioned general objective, the project set out 03 short-term objectives: 1. Improve the policy system related to health care waste management in Vietnam; 2. Support investment in construction and installation of solid waste (SW) treatment system and liquid waste for 200 - 250 hospitals in Vietnam (at least 150 hospitals), with a priority to hospitals in urgent need for waste treatment at central and provincial levels, inter-district general hospitals, some large-scale district hospitals in disadvantaged provinces in the northern mountainous region and the delta region. The Mekong River, Central Highlands and some other localities; 3. Improve the capacity of management, operation, monitoring, and inspection of treatment system of waste water treatment and medical wastewater.
There are 03 components as follows: 1. Strengthen the policy base and institutional capacity for HWM; 2. Support to improve hospital waste treatment; 3. Manage and support the implementation of the project. Among these, the EEI Consortium collaborate with the Center of Environmental Engineering and Chemical Safety to carry out the 1A sub-component consultancy package - "Proposal to amend two National Technical Regulation (NTR) on medical wastewater, incinerators solid medical waste and the development of new National Technical Regulation on Microwave solution for Contagious Diseases" as a part of Component 1, under the supervision of the Hospital Waste Management Project Management Unit (HWMSP), the Ministry of Health.
There are 03 products of this Consultant Package:
1. Report on the results of survey, survey, analysis and summary of domestic and international information and data relating to the development and application of technical regulations related to medical wastewater, solid medical waste burner and microwave equipment processing hospital waste infection;
2. Draft 03 technical regulations enclosed with explanatory report, including: Draft National Technical Regulation on medical wastewater based on amendment and supplementation of QCVN 28: 2010/BTNMT; Draft national technical regulation on medical incinerators based on the amendment and addition of QCVN 02: 2012/BTNMT; Draft national technical regulation on microwave ovens for treating infected infectious diseases;
3. A summary of comments on the draft technical regulations mentioned above.
These 03 products are created by the method of collecting and reporting the results of investigation, survey, analysis and summary of domestic and international information and data.
Survey Conduction
08 provinces and cities across 6 regions of the country were selected as the survey area. The purpose of this survey is to investigate the situation and management of HW in the surveyed facilities that are representative of the type (general hospital, specialized hospital, clinic, district health center, commune health stations, research units, etc.) and the scale of activities (ministerial, provincial, district and commune levels). The research team conducted field trips to management agencies and health facilities, and collected, measured and analyzed samples (including wastewater, sludge and ash samples) to evaluate the effectiveness of the waste water treatment, solid medical incinerator and microwave medical treatment equipment. In addition, the delegation held meetings with leaders of the Department of Health, Department of Medicine, Department of Planning and Finance and representatives of some major health centers in provinces and cities.
Sample collection and analysis (April – May 2017)
Based on the survey on the scale, type of treatment system and wastewater characteristics of each facility, the research team decided on the number of samples to be taken and the location of sampling accordingly. Sampling sites in each facility include: wastewater treatment area, sludge storage area for wastewater treatment, medical SW, Infection and SW in storage area. Samples collection and analysis were carried out and monitored according to standard, with an assurance and control of sample quality obtained in the field and in the laboratory.
Survey results
In general, survey results and discussions with representatives of management agencies including the two departments directly involved in the management/processing of health programs in the provinces and cities, the Department of Health and the Department of Natural Resources and Environment, as well as the health facilities, has shown that the quality of health management has been paid much attention by the health sector, during medical examination and treatment. The classification, collection and storage of medical SW at health facilities have been implemented in accordance with regulations. All health facilities have had different levels of medical wastewater treatment.
However, in practice, the implementation of HWM in the 8 provinces surveyed still faces many difficulties due to capacity constraints, lack of awareness, funding sources and the ability to apply technology, as well as infrastructure degradation.
Based on the above analyzes and actual survey results, the Consultant Group proposed to retain the structure of NTR 28: 2010/BTNMT with the exclusion of medical facilities from the scope of application (as such). "Medical wastewater" may be renamed "hospital wastewater", and it is proposed to add the "Total Surface Active Substances" standard to the specified threshold of 5 mg/l in column A and 10 mg/l in column B, which is equivalent to that in QCVN 14: 2008 / BTNMT (due to the use of soap/detergent, detergents and sanitizer during washing and cleaning). It is also proposed to amend the regulation of surface active agent before introducing the centralized wastewater treatment system so as not to affect the micro-organism of the treatment system. For QCVN 02: 2012/BTNMT, the Consultative Group proposed the revised standard only apply to incinerators operating within the control of the health facility, not to the medical waste incinerators at the facilities that conduct hazardous waste treatment. The consultant team also proposed a draft NTR on microwave treatment for infectious diseases.
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