UNIVERSITY ECONOMIC OF HO CHI MINH CITY

DEPARTMENT OF BUSINESS ADMINISTRATION

SUBJECT: OPERATION MANAGERMENT

TOPIC: Research and quality management of medical solids hospital 115, Nghe An province.

Instructor: Dang Huu Phuc

Student: Nguyen Thanh Tung

Class: ADC 06

Student’s number: 31201021380

Contents
PREAMBLE..............................................................................................................................................1
1. Research reason...................................................................................................................................1
2. Objectives of the study........................................................................................................................1
3. Research scope....................................................................................................................................1
4. Research question................................................................................................................................1
5. Research hypothesis............................................................................................................................1
6. Research sample..................................................................................................................................2
RESEARCH CONTENT..........................................................................................................................3
1. Overview of medical solid waste management in Vietnam and Nghe An province.............................3
1.1. Medical waste and its impact on the environment, community health.........................................3
1.1.1. Medical Waste.....................................................................................................................3
1.1.2. Classification of medical waste............................................................................................3
1.2. Impact of medical waste on the environment and public health...................................................4
1.3. Factors affecting medical solid waste management.....................................................................5
1.4. Overall development of Vietnam's health system for the period up to 2010 and a vision to 2021.
6
2. Situation of medical solid waste management at 115 hospital, Nghe An province..............................6
2.1. Current status of research and management of medical solid waste in Nghe An province...........6
2.2. Medical solid waste management at hospital 115, Nghe An province.........................................7
2.2.1. Practice sorting garbage.......................................................................................................7
2.2.2. Methods of storage and treatment of medical waste............................................................8
2.3. Evaluation of medical solid waste management..........................................................................9
2.4. Proposing some solutions to reduce pollution caused by medical solid wasteguiding on medical
waste management...................................................................................................................................9
CONCLUSION........................................................................................................................................11
References................................................................................................................................................12
 PREAMBLE

1. Research reason
Countries and communities all over the globe are paying close attention to environmental
challenges and pollution. Because environmental pollution and environmental incidents have
long-term consequences for future generations, they need a right away impact on people's lives
now. Everyone recognizes the critical necessity of environmental protection and has been
working together to realize the aim of a more sustainable environment. Treatment of pollution
generated by wastewater, residential, industrial, biological, and medical waste... is additionally a
part of environmental protection. we'd like diverse management measures for various sorts of
waste from many stages like collection, categorization, transportation, and destruction to the
ultimate step of destruction. The expansion of companies and services, yet as rising consumer
demand, has resulted in a very significant increase within the amount of hazardous waste
discharged into the environment, particularly medical solid waste. Medical solid waste contains a
larger risk of infecting and injuring people than the other variety of garbage, and it can spread
severe infections to those that are exposed thereto (such as HIV, HBV, HCV).

2. Objectives of the study

The management of medical solid waste right from the planning and investment stages building
and throughout the operation of 115 Nghe An Provincial Hospital.

3. Research scope
 Research object: Medical solid waste in hospital 115 Nghe An province.

 Research scope: Hospital 115 Nghe An province.

4. Research question
 Status of medical solid waste management in local hospitals.

 How is Nghe An province?

 Why is it necessary to manage medical solid waste at 115 Hospital in Nghe An province?

 How to manage hospital solid waste 115?

 5. Research hypothesis
 Status of medical solid waste management in local hospitals Nghe An province is not good.

 Management of medical solid waste at Hospital 115 to avoid environmental pollution and
the spread of diseases to people.

 To overcome the cause, it is necessary to introduce quality control measures medical solid
waste at 115 General Hospital in Nghe An province.

6. Research sample
 Research paper on survey at Nghe An Provincial General Hospital:

 Hospital size: Number of beds, maximum and minimum number of patients, number of
medical wastes in a day and average in a month.

 Process management: How the management process has been implemented?

RESEARCH CONTENT
1. Overview of medical solid waste management in Vietnam and Nghe An province
1.1. Medical waste and its impact on the environment, community health
1.1.1. Medical Waste

Medical waste includes waste from medical facilities, examination and treatment activities,
patient care, testing, disease prevention, and research. It may be garbage produced by patients in
hospitals, medical research facilities, and clinics... Medical waste comes in three different forms:
solid, liquid, and gaseous. Biomedical waste, clinical waste, and unsafe medical waste are all
terms wont to describe medical waste.

Hazardous medical solid waste is defined as medical waste that contains materials that are
hazardous to human health and therefore the environment, like infectious, dangerous, nuclear,
combustible, explosive, corrosive, or has specific characteristics. If these wastes aren't disposed
of properly, they'll cause a range of problems.

1.1.2. Classification of medical waste

There are generally 4 different types of medical waste: infectious, hazardous, radioactive,
and general.

Infectious waste is just any waste that gives a risk of infection to people. Human or
tissue, blood-soaked bandages, surgical gloves, cultures, stocks, or swabs wont to inoculate
cultures are all samples of this. Infectious Waste, which incorporates any waste that will include
germs, may also be designated as infectious waste.

Hazardous waste is defined as anything that has the potential to harm humans in non-
infectious ways. this could include chemicals (both medicinal and industrial), outdated
medications, and sharps (needles, scalpels, lancets, etc.). Hazardous waste must be handled with
caution and by an expert disposal firm.

Radioactive waste is generated as a results of medical specialty treatments, cancer

therapies, and medical equipment that utilises radioactive isotopes. Any pathological waste that's
additionally polluted with radioactive substances is usually handled as radioactive material.
Radiation caries a range of possible health problems and will only be removed by a competent
medical waste public mover.

The majority of medical waste goes into the overall category and is not any different
from regular household or business garbage. Paper, plastics, liquids, and the rest that does not
fall under the preceding three categories are samples of general waste..

1.2. Impact of medical waste on the environment and public health

Medical waste is extremely dangerous if it's not managed properly or isn't treated in the slightest
degree. It not only pollutes the environment, but it also has a control on public health, urban
aesthetics, and socioeconomic development.

For the environment: When medical waste isn't properly disposed of (by burying or
incinerating it in accordance with norms and guidelines), it pollutes the soil, water, and air,
affecting human health and ecosystems directly or indirectly.

 If untreated health care wastes are disposed of in landfills, they will contaminate
drinking, surface, and ground waters if the landfills aren't adequately constructed.
 If medical waste is treated with chemical disinfectants, chemical compounds is also
released into the environment if the waste isn't managed, stored, and disposed of in an
ecologically responsible manner.
 Waste incineration has been widely practiced, however insufficient incineration or
burning of inappropriate materials leads within the release of pollutants into the air and
therefore the creation of ash residue. Incinerated materials containing or handled with
chlorine can produce dioxins and furans, which are human carcinogens that are linked
to a range of negative health consequences. The incineration of heavy metals or
products containing a high metal content (particularly lead, mercury, and cadmium)
may end up within the spread of harmful metals within the environment.
 Only contemporary incinerators running at 850-1100 °C and equipped with
sophisticated gas-cleaning equipment can meet international dioxin and furan emission
regulations.
 Alternatives to incineration, like autoclaving, microwaving, and steam treatment
integrated with internal mixing, that reduce the formation and release of chemicals or
 hazardous emissions, should be considered in settings where sufficient resources are
available to control and maintain such systems and get rid of the treated waste.

For health: Sharp objects (such as needles) in medical waste can cause illness or injury to
the body, cutting, stabbing, or infecting the wound. As a result, sharp objects are regarded a
hazardous waste since they cause double damage (both damaging and causing infectious diseases
like viral hepatitis, HIV...). Through the alimentary tract, hospital effluent can potentially
"supply" disease-causing germs. When using this water for irrigation, dining, etc., it's especially
dangerous for people and animals. Health-care waste contains potentially hazardous
microorganisms that may infect hospital patients, health-care employees, and members of the
final public. Drug-resistant bacteria that spread from health care facilities into the environment
are another possible threat.

As a result, so as to avoid the risks of medical waste to people's health and therefore the
environment, further on safeguard those that are in frequent touch with medical waste, the health
sector must devote greater resources to the task. Treatment of medical waste, medical facility
administrators must design medical waste management plans, invest in projects, and improve
infrastructure for his or her units' medical waste management. Simultaneously, purchase and
provide sufficient specialized facilities, and work with environmental agencies and native waste
treatment facilities to properly treat and eliminate medical waste in compliance with legislation.
Medical staff should be capable of collecting and classifying waste at the purpose of generation,
also as properly storing it in line with rules. Patients should be cognizant of general hygiene
when visiting medical institutions for medical evaluation and treatment.

1.3. Factors affecting medical solid waste management

Natural weather conditions

The distribution of pollutants within the air is influenced by air temperature and humidity.
Because Vietnam incorporates a tropical monsoon climate, which is hot and humid, organic
chemicals in medical waste breakdown quickly, polluting the environment. As a result, this
aspect must incline special consideration throughout the gathering, storage, and transportation of
medical solid waste.

Perception in humans
To adjust to legislation and within the proper sequence, medical staff and waste management
departments must comprehend the regulations on medical solid waste management. If you're
subjective in management, you may have adverse affects like pollution of the environment,
which is able to have a control on human health.

1.4. Overall development of Vietnam's health system for the period up to 2010 and a
vision to 2021.

A network of preventive medical services, primary health care, medical, treatment, and
rehabilitation, likewise as a production, circulation, and distribution network, are all a part of this
plan's health system, drug distribution and provide.

 Common Goals:

Reduce morbidity, death rates, and illness, increase lifetime, and improve quality of life; meet
the increasing and diverse needs of the people in terms of health protection, care, and
improvement; achieve and exceed the targets embarked on within the Strategy for people's health
care and protection for the amount 2001-2010.

 Detail goal:

To reduce morbidity and mortality caused by infections and illness, invest in establishing a
preventive health network capable of forecasting, monitoring, identifying, and controlling
epidemics.

Invest in and reorganize the checkup, treatment, and rehabilitation network within the direction
of development, while minimizing the impact on people and therefore the environment.

Improve people's access to vital health services by consolidating and completing the grassroots
health network.

To make the pharmaceutical business a number one economic and technological enterprise.
Invest heavily within the pharmaceutical business, increase local drug production capacity, and
prioritize high-tech dosage forms..

2. Situation of medical solid waste management at 115 hospital, Nghe An province

 2.1. Current status of research and management of medical solid waste in Nghe An
province

According to data, the total amount of hazardous medical waste generated in Nghe An province's
hospitals and medical centers is expected to be 2.2 tons/13.4 tons of medical waste every day.
Infectious hazardous waste accounts for around 2 tons per day, while non-infectious hazardous
waste accounts for more than 200 kg per day. There are no particular and accurate figures on the
volume of medical waste created by tiny waste sources. The volume of hazardous medical waste
created in Nghe An province is expected to grow at a rate of about 5% per year.

With the above condition, if no proper and timely treatment measures are adopted, the problem
of medical waste creating pollution in the environment would worsen. There are numerous
challenges, especially when it comes to medical solid waste management. The effects include
putting species' lives in jeopardy in a polluted environment, increasing disease risks, and
impacting socioeconomic and even human existence. A number of issues must be addressed in
order to ensure the quality of the medical examination and treatment environment, as well as to
properly handle medical waste.

The province People's Committee of Nghe An has issued a plan for the collection, transportation,
and treatment of hazardous medical waste in the province for the years 2020 and 2025. Damage
in the area has been deployed to strengthen the management of hazardous medical wastes. As a
result, ideal conditions will be created in the collection, transportation, and treatment activities,
ensuring environmental cleanliness and community safety. In compliance with the legislation, all
hazardous medical waste generated in the province is collected, transported, and treated to satisfy
environmental standards.

2.2. Medical solid waste management at hospital 115, Nghe An province

2.2.1. Practice sorting garbage

According to the report, the implementation of garbage classification at hospital 115 in Nghe An
province performed relatively well in terms of medical solid waste classification and collection.
Hazardous medical solid waste is categorized at the outset, not mixed in with regular waste, and
deposited in safe boxes and colored bags according to Ministry of Health requirements.
In addition to using carton boxes with solid walls and bottoms that are not punctured, suitable in
size, and waterproof in accordance with Ministry of Health regulations, the hospital also uses
other cartons. The hospital used the correct color bags in accordance with the Ministry of
Health's classification regulations, and the hospital updated and distributed to medical staff the
following decision: "Decision No. 44/2018/QD - People's Committee regulations Regulations on
classification of domestic solid waste at source in Ho Chi Minh City" with the following
contents:

 Infectious waste: stored in bags or bins lined with yellow bags;

 Non-infectious hazardous waste: stored in bags or bins lined with black bags;
 Ordinary waste for recycling purposes: put in bags or bins lined with white bags;
 Non-recycling general waste is classified into 2 types:
 Degradable organic waste (leftover food, leaves, ...): stored in bags or bins lined with
green bags.
 Remaining waste (plastic bags, food packaging, ...): stored in bags or bins lined with gray
bags.

The hospital has classified and organized rubbish bags and containers at the point of generation,
according to strict requirements on medical waste classification, and maintaining a clean,
hygienic, and aesthetic environment. Specifically, provide biodegradable organic waste bags or
waste bins at the canteen (leftover food), green areas (leaf waste), or waiting areas for diseases
(where eating is generated). The hospital has also requested that the cleaning service firm
provide waste bins and bags in the exact color and placement as specified.

After being classified at the source, medical solid waste will be delivered to the storage location
by garbage collectors and medical teams in boxes with trolleys, boxes without trolleys, hand-
carried, and so on. Medical solid waste that can be recycled is collected in a designated area for
sanitation personnel or in a convenient location within a medical facility for resale to a recycling
plant. Before being destroyed, hazardous medical solid waste shall be collected and stored in
separate rooms, sections, or departments responsible for medical waste management.

2.2.2. Methods of storage and treatment of medical waste

Medical solid waste is kept in a rubbish dump that is not air conditioned. Domestic waste is
stored in a separate warehouse or on handcarts for collection by the garbage collection firm,
whereas infectious and hazardous waste is placed in plastic bins with wheels.

The city's environmental company transports medical waste to the incinerator, where it is burned
every day. Waste is usually burned the same day or held for no more than 48 hours.

There is a waste transportation record: there is a system of books to track the quantity of waste
generated daily, as well as a sheet to track the amount of rubbish transported and destroyed on a
daily basis. The volume of garbage generated, the volume of waste carried and destroyed, and
the name and signature of the sender, recipient, and waste disposer are all listed on the
transportation note.

2.3. Evaluation of medical solid waste management

There is always a department in charge of medical waste management at the hospital, which
includes officials and employees who manage, collect, and treat medical waste. Management is
organized into various departments. Under the Department of Infection Prevention, the hospital
also established an infection control committee and an infection control group to develop and
disseminate the process of classifying, collecting, transporting, treating, and destroying medical
waste. One to two employees will be in charge of the treatment and destruction of hazardous
medical solid waste, as well as the operation and management of the incinerator. It is clear that
the organization, management, and human resources for medical solid waste management at
hospital 115 in Nghe An province have been well and completly implemented. It can be seen that
the management of medical solid waste at hospital 115 is very egood, in accordance with
Ministry of Health regulations, has a good awareness of the classification of sharp objects,
understands the level of dangers of poor segregation at source, and risks from needles and sharp
objects. Besides that, training courses organized by the Ministry of Health have been organized
to raise awareness among officials, medical staff, and the team in charge of medical solid waste
management. Furthermore, as well as opening classes on capacity building in medical solid
waste management for medical staff and regulations in accordance with the Ministry of Health's
Decision No. 43/2007/QD. -BYT dated November 30, 2007, the facilities.
 2.4. Proposing some solutions to reduce pollution caused by medical solid
wasteguiding on medical waste management
 Technological solutions

For provincial and private hospitals: Construct a centralized treatment area and treat hazardous
medical solid waste with autoclave technology. Outside of the medical facility, refrigerated
vehicles are required to transport hazardous medical solid waste.

For district hospitals: Regular maintenance is essential to guarantee that the technical
characteristics of the incinerator are maintained. Before being buried in cement landfills, sharp
items are sterilized or toughened with cement. Furthermore, because mercury is a dangerous
metal for humans and the environment, all forms of it must be replaced and eradicated
(thermometers, dental materials, etc.). If these thermometers are burnt or incorrectly disposed of,
mercury will be released into a stream.

 Management solutions

Development of institutional and human resources for medical waste management.

Strengthen medical waste management advice for medical facilities on the basis of fostering best
practices in medical waste management.

Increase information about the adverse consequences of waste on health to ministries, medical
professionals, patients, and those with high exposure to medical waste.

A Technical Manual in Medical Solid Waste Management is required; this will be the first way
for health facilities of all levels to self-implement safe medical solid waste management and
reproduce it in accordance with their own standards its fundamental criteria.
 CONCLUSION
In practice, research shows that the health sector and each individual require optimal measures to
manage medical waste in order to improve the health sector's quality. At the same time, it
contributes to environmental protection by implementing solutions synchronously and beginning
with the planning stage. First and foremost, environmental planning must be integrated with
hospital construction planning. Furthermore, evaluate the current state of medical waste
management in Vietnam and around the world to determine the need for appropriate solutions for
each specific situation. Strengthen training to improve waste management knowledge, with a
focus on classifying medical waste into the appropriate group and color coding, waste group
symbols in accordance with regulations, and a focus on providing knowledge and skills. Practice
handling and responding to incidents involving medical waste and occupational safety. Organize
the supervision of the practice of classification, collection, and transportation of medical waste at
the departments in order to take timely corrective measures and improve the practical skills of
the hospital's medical staff. To ensure the conditions for the classification of medical waste,
equip the media and leaflets guiding the classification of medical waste, as well as the means of
medical waste collection according to regulations. Facilities that must manage hospitals under
their jurisdiction should establish clear internal regulations, mechanisms, and policies, as well as
assign specific responsibilities. To encourage employees to voluntarily participate in and handle
waste treatment medical waste, hospital directors to staff who collect and transport waste
operating wastewater treatment stations and incinerators should have strict regulations, reward
and punishment regimes.
References
MOI TRUONG, (12/2018), “Nghe An: Phan dau 100% luong chat thai y te se duoc thu gom, xu
ly dat chuan”. Retrieved from:

https://baotainguyenmoitruong.vn/nghe-an-phan-dau-100-luong-chat-thai-y-te-se-duoc-thu-gom-
xu-ly-dat-chuan-249292.html

WHO, (11/2011), “Wastes from healthcare activities”. Retrieved from:

http://www.who.int/mediacentre/factsheets/fs253/en/

BWS, (07/2019), “Classifications for Medical Waste”. Retrieved from:

https://bwaste.com/resources/the-knowledge-center/articles-insights-and-updates/classifications-
medical-waste

Pham Gia Khiem, (07/2006), “Quy hoach tong the phat trien he thong y te Viet Nam giai doan
den nam 2010 va tam nhin den nam 2020”. Retrieved from:

https://nhandan.vn/van-ban-moi/Quy-ho%E1%BA%A1ch-t%E1%BB%95ng-th%E1%BB%83-
ph%C3%A1t-tri%E1%BB%83n-h%E1%BB%87-th%E1%BB%91ng-y-t%E1%BA%BF-Vi
%E1%BB%87t-Nam-giai-%C4%91o%E1%BA%A1n-%C4%91%E1%BA%BFn-n%C4%83m-
2010-v%C3%A0-t%E1%BA%A7m-nh%C3%ACn-%C4%91%E1%BA%BFn-n%C4%83m-
2020-491784/

Evangelos A. Voudrias, (09/2015), “Technology selection for infectious medical waste treatment
using the analytic hierarchy process”. Retrieved from:

https://www.tandfonline.com/doi/full/10.1080/10962247.2016.1162226