10/01/2018
Along with industrialization and modernization of the country, medical environment management has made significant progress. However, the amount of medical waste generated from medical facilities is increasing that requires strengthened management. According to the World Health Organization, about 80% of the waste generated from medical facilities is normal waste and the remaining 20% is hazardous. Therefore, it is necessary to assess the generation, collection and disposal of medical waste to strengthen medical waste management and increase environmental protection.
Regulations on medical hazardous waste management
After the National Assembly enacted the Law on Environmental Protection in 1994, the Government issued Decree 38/2015/ND-CP dated 24/4/2015 on waste and scrap management, in which medical waste is categorized as special waste with seperate and practical regulations. Then the Ministry of Natural Resources and Environment (MONRE) issued Circular 36/2015/TT-BTNMT dated 30/6/2015 on hazardous waste management. In the meantime, MONRE worked with Ministry of Health (MOH) to issue a joint-ministerial circular 58/2015/TTLT-BYT-BTNMT dated 31/12/2015 on medical waste management which provides detailed regulations on classification, collection and transport means of medical waste as well as legal guidance for medical facilities to perform self-treatment of hazardous medical waste treatment, hazardous waste logbooks and environmental records of medical facilities.
According to Clause 4, Article 49 of the Government Decree 38/2015/ND-CP dated 24/4/2015 on waste and scarp management, there are three types of current medical waste treatment.
Centralized treatment: In cities, big residential areas or where hazardous waste treatment facilties are available, medical hazardous waste is collected and treated centralizedly at treatment facilities which meet regulation requirements to ensure that the waste is completely treated causing no pollution. This is a common and effective model in many places. Following this model, hazadous waste treatment facilities shall comply with Circular 36/2015/TT-BTNMT to be eligible for being considered to receive hazardous waste treatment permits from MONRE before their operation.
Clustered treatment: A medical facilitie in the centre provides waste treatment services for other surrounding medical facilities. This is being applied in many places and suitable for small medical facilities which are close to each other. Therefore, it is not subject to complying with hazardous waste treatment procedures. However, it must be approved by Provincial People’s Committees in their plans for hazardous medical waste collection, transport and treatment.
Localized treatment: This is applied in the areas without centralized or clustered treatment facilities or remote, isolated and mountainous areas. Legally, this must be approved by provincial Departments of Natural Resources and Environment (DONREs) in hazardous waste owner permits.
To address local shortcomings and obstacles, Circular 36/2015/BTNMT (Article 23) and Joint-ministerial Circular 58/2015/TTLT-BYT-BTNMT (Article 22) assigned DONREs to take a leading role and cooperate with Departments of Health to submit to People’s Provincial Committees for appoval of plans for hazardous medical waste collection, transport and treatment to tailor local situations and ensure legal compliance. So far, 14 out of 63 provinces and cities have issued plans for hazardous medical waste collection, transport and treatment, contributing to addressing shortcomings and obstacles in hazardous medical waste management at local levels.
Apart from these regulations, waste self-treatment medical facilities shall meet environmental technical standards such as QCVN 02:2012/BTNMT- National Technical Standards on medical waste incinerators, QCVN 55:2012/BTNMT- National Technical Standards on infectious medical waste autoclaving; and QCVN 28:BTNMT- National Technical Standards on medical wastewater.
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| Hazardous medical waste shall be stored separatey before being transported to treatment facilities |
Status of hazardous medical waste treatment outside medical facilities
As of 10/2017, MONRE has issued hazardous waste treatment permits for 107 hazardous waste treatment facilities, of which seven facilities have centralized hazardous medical waste treatment (only treat hazardous medical waste) in Hà Nội, Hải Phòng, Nghệ An, Quảng Nam, Bình Định, Hồ Chí Minh City and An Giang. These facilities mostly collect and treat medical waste generated within their provinces with common treatment capacities of 600-2,000 tons per year. In addition, some hazardous waste treatment facilities providing hazardous medical waste collection and incineration have been issued permits in Hải Dương, Quảng Ngãi and Nam Định with the incinerator capacity ranging from 100 kg/h to 2,000 kg/h. In 2016, licensed facilities treated over 11,600 tons of hazardous medical waste. The rest of hazardous medical waste is treated locally or clustered. The advantage of local and clustered treatment is that the waste can be treated right at source. However, the disadvantage is that if poorly managed, this can lead to pollution and negative impact on human health.
To treat hazardous medical waste, the facilities often apply two tier incinerators (primary and secondary). Using this method, hazardous medical waste is treated completely at the high temperature of 650-1,050oC. The emission is cooled down, transferred through dust filtering cyclone and pollutant absorbing towers. Some equipment has additional active carbon absorption towers. These incinerators must meet requirements of National Technical Standards QCVN 02:2012/BTNMT on medical waste incinerators.
In addition, some medical facilities or waste treatment facilities use non-incineration technologies to treat medical waste, include autoclave or microwave. These technologies are environmentally friendly and promoted to minimize toxic emissions such as dioxin and furan due to incineration. Furthermore, these methods reduce investment and operation costs compared to incineration. After being disinfected, the medical waste is treated as normal waste. As big hospitals have microbiology departments, autoclaving method can be easily controlled and applied compared with incineration. However, the disadvantage of this method is that the medical waste is not completely treated. The solid waste needs to be treated as normal waste. At present, one centralized medical waste treatment facility applies this method and has received MONRE’s permits of hazardous waste treatment.
Although medical waste management has been promoted and achieved some good results, some shortcomings remain
- It remains difficult for medical facilities to clarify and comply with regulations on normal medical waste management, in particular on recyclable materials after being autoclaved. In addition, it is unclear whether environmental impact assessment is needed for clustered waste treatment facilities. So is the requirement for additional environmental impact assessment for installing environmental protection works for medical waste treatment of the medical facilities.
- Budgets for constructing medical waste treatment facilities are limited while demand for this investment is high. In addition, budgets for regular operation and maintenance for medical waste treatment are in shortage. Specific regulations and cost norms for medical waste treatment have not been issued.
- Medical waste management is facing difficulties due to a large number of medical facilities (over 13,000 medical facilities at all levels and in various forms). Medical waste treatment staff in many places is part-time and have not met requirements. Regulations on medical waste have not been adequately disseminated.
- Awareness of patients and patients’ family members on keeping public places clean and collecting medical waste is limited. In some cases, hazardous medical waste is mixed with normal medical waste. Some medical facilities transfer their waste to non-competent treatment facilities.
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| Treating medical waste using microwaves to ensure meeting environmental standards by the General Hopsital of Cao Bằng Province |
Proposed solutions for medical waste management in the future
To enhance medical waste management in the future, ministries and local authorities need to take the following measures comprehensively
- Continuing developing and completing regulations on medical waste management, in particular regulations on normal medical waste treatment, recycling and reuse of autoclaved medical waste, environmental records of clusters of medical waste treatment facilities and other technical regulations such as national technical regulations on medical waste treatment using microvaves.
- Developing enabling policies to encourage investment in environmentally friendly waste treatment technologies, supporting medical waste treatment in public partnership modalities to improve medical waste treatment capacity.
- Local authorities quickly develop and complete plans for hazaroud medical waste collection, transport and treatment base on their local planning and economic and environmental conditions.
- Enhancing medical waste minimization and source classification to ensure that hazardous and normal medical wastes are separately treated.
- Increasing propaganda and public awareness of governments, medical facilities and the public on medical waste management.
- Enhancing supervision, inspection and proper punishment on individual and organizations who violate medical waste regulations, in particular the discharge of untreated medical waste.
MSc. Nguyễn Thượng Hiền, MSc. Đỗ Tiến Đoàn
Department of Waste Management and Environment Promotion
Vietnam Environment Administration
