Chng 5:

Cht thi rn y t

Chng 5:

CHT THI RN Y T

5.1. TNG QUAN V PHT TRIN CC BNH VIN V C S KHM CHA BNH
H thng cac bnh vin, c s khm cha bnh trn ia ban toan quc c phn cp qun l theo tnh cht chuyn khoa. C th, B Y t qun l 11 bnh vin a khoa tuyn trung ng, 25 bnh vin chuyn khoa tuyn trung ng; a phng qun l 743 bnh vin a khoa tuyn tnh/thnh ph, 239 bnh vin chuyn khoa tuyn tnh/thnh ph, 595 bnh vin a khoa qun/huyn/th x v 11.810 trung tm y t cac cp; cc n vi khc qun l 88 Trung tm/Nh iu dng/ bnh vin t nhn. (Cuc Kham cha bnh B Y t, 2009). Mc p ng nhu cu cha tr tnh chung trong c nc tng ln r rt trong nhng nm gn y, nm 2005 l 17,7 ging bnh/1 vn dn, n nm 2009 l 22 ging bnh/1 vn dn (TCTK, 2011). Vic tng s lng ging bnh thc t do tng nhu cu v kham cha bnh ng nghia vi vic tng khi lng cht thai y t cn phai x ly.

5.2. PHT SINH CHT THI RN Y T

(*) Khng tnh s c s khm cha bnh t nhn

5.2.1. Ngun pht sinh cht thi rn y t

Ngun pht sinh cht thi y t ch yu l: bnh vin; cc c s y t khc nh: trung tm vn chuyn cp cu, phng khm sn ph khoa, nh h sinh, phng khm ngoi tr, trung tm lc mu...; cc trung tm xt nghim v nghin cu y sinh hc; ngn hng mu... Hu ht cc CTR y t u c tnh cht c hi v tnh c th khc vi cc loi CTR khc. Cc ngun x cht ly lan c hi ch yu l cc khu vc xt nghim, khu phu thut, bo ch dc (Bang 5.1).

Biu 5.1. S pht trin ca cc iu kin chm sc sc khe

Ngun: TCTK, 2011

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5.2.2. Lng pht sinh cht thi rn y t

Theo nghin cu iu tra mi nht ca Cc Khm cha bnh - B Y t v Vin Kin trc, Quy hoch th v Nng thn - B Xy dng, nm 2009-2010, tng lng CTR y t trong ton quc khong 100-140 tn/ngy, trong c 16-30 tn/ngy l CTR y t nguy hi. Lng CTR trung bnh l 0,86 kg/ging/ ngy, trong CTR y t nguy hi tnh trung bnh l 0,14 - 0,2 kg/ging/ngy. CTR y t pht sinh ngy cng gia tng hu ht cc a phng, xut pht t mt s nguyn nhn nh: gia tng s lng c s y t v tng s ging bnh; tng cng s dng cc sn phm dng mt ln trong y t; dn s gia tng, ngi dn ngy cng c tip cn nhiu hn vi dch v y t.

Bng 5.1. Ngun pht sinh cc loi CTR c th t hot ng y t

Loi CTR Cht thi sinh hot Cht thi cha cc vi trng gy bnh Cht thi b nhim bn Ngun to thnh Cc cht thi ra t nh bp, cc khu nh hnh chnh, cc loi bao gi.. Cc ph thi t phu thut, cc c quan ni tng ca ngi sau khi m x v ca cc ng vt sau qu trnh xt nghim, cc gc bng ln mu m ca bnh nhn.. Cc thnh phn thi ra sau khi dng cho bnh nhn, cc cht thi t qu trnh lau c sn nh... Cc loi cht thi c hi hn cc loi trn, cc cht phng x, ha cht dc... t cc khoa khm, cha bnh, hot ng thc nghim, khoa dc

Cht thi c bit

Bng 5.2. Khi lng cht thi y t ca mt s a phng nm 2009

Loi th Tnh c th loi I Tnh/Tp. k Lk Khnh Ha Lm ng Nam nh Ngh An An Giang Tnh c th loi II C Mau ng Nai Ph Th Lng CTR y t (tn/nm) 276,3 365 209,3 488 187,6 320,1 159,5 430,8 126,54 Tnh c th loi III Loi th Tnh/Tp. Bc Liu Bnh Dng in Bin H Giang H Nam Hu Giang Kin Giang Long An Qung Nam Lng CTR y t (tn/nm) 134,8 1.241 79,1 405 967 634,8 (*) 642,4 369 602,25 Loi th Tnh c th loi III th loi c bit Tnh/Tp. Qung Tr Sc Trng Sn La Tr Vinh Vnh Long Yn Bi H Ni Tp. H Ch Minh Lng CTR y t (tn/nm) 272,116 266,7 175 400 (**) 340,26 108,542 ~5000 2800(**)

Ghi ch: (*) S liu nm 2006; (**) S liu nm 2007 Ngun: Bo co Hin trng mi trng a phng 2006-2010, S TN&MT cc a phng, 2010

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Tnh ring cho 36 bnh vin thuc B Y t qun l, theo khao sat nm 2009, tng lng CTR y t pht sinh trong 1 ngay la 31,68 tn, trung binh la 1,53 kg/ging/ ngay. Lng cht thai phat sinh tinh theo ging bnh cao nht la bnh vin Ch Ry 3,72 kg/ging/ngay, thp nht la bnh vin iu dng - Phc hi chc nng Trung ng va bnh vin Tm thn Trung ng 2 vi 0,01 kg/ging/ngay.
Biu 5.2. Gia tng cht thi y t ca mt s a phng giai on 2005 - 2009
Ngun: S TN&MT cc a phng, 2010

Lng CTR y t pht sinh trong ngy khc nhau gia cc bnh vin ty thuc s ging bnh, bnh vin chuyn khoa hay a khoa, cc th thut chuyn mn c thc hin ti bnh vin, s lng vt t tiu hao c s dng... (Bang 5.3).

Bng 5.3. Lng cht thi pht sinh ti cc khoa trong bnh vin
Tng lng cht thi pht sinh (kg/ging/ngy) BV TW Bnh vin Khoa hi sc cp cu Khoa ni Khoa nhi Khoa ngoi Khoa sn Khoa mt/TMH Khoa cn lm sng Trung bnh 0,97 1,08 0,64 0,50 1,01 0,82 0,66 0,11 0,72 BV Tnh 0,88 1,27 0,47 0,41 0,87 0,95 0,68 0,10 0,7 BV Huyn 0,73 1,00 0,45 0,45 0,73 0,74 0,34 0,08 0,56 0,86 Trung bnh Tng lng cht thi y t nguy hi (kg/ging/ngy) BV TW 0,16 0,30 0,04 0,04 0,26 0,21 0,12 0,03 0,14 BV Tnh 0,14 0,31 0,03 0,05 0,21 0,22 0,10 0,03 0,13 BV Huyn 0,11 0,18 0,02 0,02 0,17 0,17 0,08 0,03 0,09 0,14 Trung bnh

Khoa

Ngun: Quy hoach quan ly cht thi y t, B Y t, 2009

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5.2.3. Thnh phn cht thi rn y t

Hu ht cc CTR y t l cc cht thi sinh hc c hi v mang tnh c th so vi cc loi CTR khc. Cc loi cht thi ny nu khng c phn loi cn thn trc khi x chung vi cc loi cht thi sinh hot s gy ra nhng nguy hi ng k. Xt v cc thnh phn cht thi da trn c tnh l ha th t l cc thnh phn c th ti ch l kh cao, chim trn 25% tng lng CTR y t, cha k 52% CTR y t l cc cht hu c. Trong thnh phn CTR y t c lng ln cht hu c v thng c m tng i cao, ngoi ra cn c thnh phn cht nha chim khong 10%, v vy khi la chn cng ngh thiu t cn lu t trit v khng pht sinh kh c hi.
Biu 5.3. Thnh phn CTR y t da trn c tnh l ha
Ngun: Kt qu iu tra ca d n hp tc gia B y t v WHO, 2009

Phn loai va lu gi CTR y t tai mt s bnh vin

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Khung 5.1. Thng k mc phn loi, thu gom cht thi trong cc bnh vin
C 95,6% bnh vin thc hin phn loi cht thi trong 91,1% s dng dng c tch ring vt sc nhn. Theo bo co kim tra ca cc tnh v nhn xt ca on kim tra lin B, cn c hin tng phn loi nhm cht thi, mt s loi cht thi thng thng c a vo cht thi y t nguy hi gy tn km trong vic x l. C 63,6% s dng ti nha lm bng nha PE, PP. Ch c 29,3% s dng ti c thnh dy theo ng quy ch. Cht thi y t c cha trong cc thng ng cht thi. Tuy nhin, cc bnh vin c cc mc p ng yu cu khc nhau, ch c mt s t bnh vin c thng ng cht thi theo ng quy ch (bnh vin trung ng v bnh vin tnh). Hu ht cc bnh vin (90,9%) CTR c thu gom hng ngy, mt s bnh vin c din tch cht hp nn gp kh khn trong vic thit k li i ring vn chuyn cht thi. Ch c 53% s bnh vin cht thi c vn chuyn trong xe c np y. C 53,4% bnh vin c ni lu gi cht thi c mi che, trong c 45,3% t yu cu theo quy ch qun l cht thi y t.
Ngun: Kt qua khao sat 834 bnh vin ca Vin Y hc Lao ng v V sinh Mi trng nm 2006 va bo co cua cac S Y t t cac ia phng t 2007-2009

5.3. PHN LOI, THU GOM V VN CHUYN CHT THI RN Y T

Cng tc thu gom, lu tr CTR y t ni chung c quan tm bi cc cp t Trung ng n a phng, th hin mc thc hin quy nh cc bnh vin kh cao. Cht thi y t pht sinh t cc c s khm cha bnh trc thuc s qun l ca B Y t, phn ln c thu gom v vn chuyn n cc khu vc lu gi sau c x l ti cc l thiu t nm ngay trong c s hoc k hp ng vn chuyn v x l i vi cc c s x l cht thi c cp php ti a bn c s khm cha bnh . i vi cc c s khm cha bnh a phng do cc S Y t qun l, cng tc thu gom, lu gi v vn chuyn CTR cha c ch trng, c bit l cng tc phn loi v lu gi cht thi ti ngun (cht thi y t thng thng, cht thi y t nguy hi...). Trong vn chuyn CTR y t, ch c 53% s bnh vin s dng xe c np y vn chuyn cht thi y t nguy hi; 53,4% bnh vin c mi che lu gi CTR... y l nhng yu t m bo an ton cho ngi bnh v mi trng.

Bng 5.4. Hin trng thu gom, phn loi cht thi y t ti cc bnh vin trn a bn thnh ph H Ni nm 2010
Cc yu cu theo quy ch qun l CTYT Ti ng cht thi ng quy cch v b dy v dung tch Ti ng cht thi ng quy cch v mu sc Ti ng cht thi ng quy cch v buc ng gi Hp ng vt sc nhn ng quy cch Thng ng c np y Thng ng c ghi nhn Hp ng vt sc nhn ng quy cch T l tun th (%) 66,67 30,67 81,33 93,9 58,33 66,67 93,9
Ngun: S liu thng k trung binh ca S Y t t kt qua khao sat 74 bnh vin Ha Ni nm 2009-2010

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Phng tin thu gom cht thi cn thiu v cha ng b, hu ht cha t tiu chun. Nguyn nhn do c rt t nh sn xut quan tm n mt hng ny, do vy mua sm phng tin thu gom CTR ng tiu chun ca cc bnh vin gp kh khn. Theo bao cao cua JICA (2011), cac c s y t cua 5 thanh ph in hinh la Hai Phong, Ha Ni, Hu, a Nng va thanh ph H Chi Minh, hu ht cc bnh vin s dng thng nha c bnh xe, xe tay, cc dng c vn chuyn bng tay khc. Mt s khu vc lu tr CTR trc khi x l ti ch hoc ti cc khu vc x l bn ngoi c trang b iu ho v h thng thng gi theo Quy nh. Nhin chung cac phng tin vn chuyn cht thi y t cn thiu, c bit l cc xe chuyn dng. Hoat ng vn chuyn cht thi y t nguy hi t bnh vin, c s y t n ni x l, chn lp hu ht do Cng ty mi trng th m nhim, khng co cac trang thit bi am bao cho qua trinh vn chuyn c an toan.

Cac phng thc chuyn ch va vn chuyn CTR y t tai mt s bnh vin

Bng 5.5.Thc trang cac trang thit bi thu gom lu gi CTR y t tai mt s thanh ph
Loi th Thnh ph S lng n v tr li phiu iu tra 61 51 20 17 23 172 Dng c thu gom ti ch Xe tay 32 30 9 2 1 74 Thng c Khc bnh xe 25 27 5 4 14 75 15 7 6 11 0 39 C iu ho v thng gi 24 38 2 1 1 66 Lu tr cht thi Khng c iu ho v thng gi 13 11 13 3 5 45 Phng chung 15 1 2 8 5 31 Khng c khu lu tr 9 1 3 5 12 30

th loi H Ni c bit Tp.HCM th loi I Nng Hi Phng Hu Tng

Ngun: Nghin cu Qun l mi trng th ti Vit Nam - Tp 6. Nghin cu v qun l CTR Vit Nam, JICA, thang 5 - 2011.

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5.4. X L V TI CH CHT THI RN Y T THNG THNG

CTR y t khng nguy hi hu ht cc tnh, thnh ph u do Cng ty mi trng th thu gom, vn chuyn v c x l ti cc khu x l CTR tp trung ca a phng. Hoat ng thu hi va tai ch CTR y t tai Vit Nam hin ang thc hin khng theo ung quy ch quan ly CTR y t a ban hanh. Cha co cac c s chinh thng thc hin cac hoat ng thu mua va tai ch cac loai cht thai t hoat ng y t Vit Nam. Quy ch Qun l cht thi y t (2007) b sung ni dung ti ch CTR y t khng nguy hi lm cn c cc c s y t thc hin. Tuy nhin, nhiu a phng cha c c s ti ch, do vy vic qun l ti ch cc CTR y t khng nguy hi cn gp nhiu kh khn. Mt s vt liu t cht thi bnh vin nh: chai dch truyn cha dung dch huyt thanh ngt (ng glucose 5%, 20%), huyt thanh mn (NaCl 0,9%), cc dung dch acide amine, cc loi mui khc; cc loi bao gi nilon v mt s cht nha khc; mt s vt liu giy, thu tinh hon ton khng c yu t nguy hi, c th ti ch hn ch vic thiu t cht thi gy nhim. Nm 2010, pht hin nhiu hin tng a CTR y t ra ngoi bn, ti ch tri php thnh cc vt dng thng ngy. Vic tai s dung cac gng tay cao su, cac vt liu nha a va ang tao ra nhiu rui ro cho nhng ngi trc tip tham gia nh cac nhn vin thu gom, nhng ngi thu mua va nhng ngi tai ch ph liu.

Tai ch va tai s dung gng tay khm bnh bn

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5.5. CHT THI Y T NGUY HI

5.5.1. Pht sinh cht thi y t nguy hi
Trong CTR y t, thnh phn ng quan tm nht l dng CTNH, do nguy c ly nhim mm bnh v ha cht c cho con ngi. Lng CTNH y t pht sinh khng ng u ti cc a phng, ch yu tp trung cc tnh, thnh ph ln. Xt theo 7 vng kinh t trong c nc (trong vng ng Bc v vng Ty Bc Bc B c gp chung vo 1 vng), vng ng Nam B pht sinh lng thi nguy hi ln nht trong c nc (32%), vi tng lng thi l 10.502,8 tn/nm, tip n l vng ng bng sng Hng (chim 21%). Cc tnh c mc thi CTNH ln (> 500 tn/nm) tnh trong c nc theo th t nh sau: Tp. H Ch Minh, H Ni, Thanh Ha, ng Nai, Vnh Phc, Nng, Khnh Ha, Tha Thin Hu, An Giang, Cn Th, Ngh An, Ph Th, Hi Phng, Long An. Lng CTNH y t pht sinh khc nhau gia cc loi c s y t khc nhau. Cc nghin cu cho thy cc bnh vin tuyn trung ng v ti cc thnh ph ln c t l pht sinh CTNH y t cao nht. Tnh trong 36 bnh vin thuc B Y t, tng lng CTNH y t cn c x ly trong 1 ngay la 5.122 kg, chim 16,2% tng lng CTR y t. Trong , lng CTNH y t tinh trung binh theo ging bnh la 0,25 kg/ ging/ngay. Chi co 4 bnh vin co cht thai phong xa la bnh vin Bach Mai, bnh vin a khoa Trung ng Hu, bnh vin a khoa Trung ng Thai Nguyn va Bnh vin K. Cc phng php x l c bit i vi CTNH y t t hn rt nhiu so vi cc CTR sinh hot, do vy i hi vic phn loi cht thi phi t hiu qu v chnh xc. Theo s liu iu tra ca Cc Khm cha bnh - B Y t v Vin Kin trc, Quy hoch

Biu 5.4. Mc pht sinh CTNH y t theo cc vng kinh t

Ngun: Cc Khm cha bnh, B Y t; Vin Kin trc, Quy hoch th v nng thn, B Xy dng, 2010

Bang 5.6. S bin ng v khi lng cht thi y t nguy hai phat sinh tai cac loai c s y t khac nhau
VT: kg/ging bnh/ngy

Loai bnh vin

Nm 2005

Nm 2010 0,42 0,28-0,35 0,35 0,21-0,35 0,21-0,28

Bnh vin a khoa TW 0,35 Bnh vin chuyn khoa 0,23-0,29 TW Bnh vin a khoa tnh 0,29 Bnh vin chuyn khoa 0,17-0,29 tnh Bnh vin huyn, ngnh 0,17-0,22

Ngun: B Y t, 2010

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th v Nng thn - B Xy dng thc hin nm 2009 - 2010, cng nh s liu tng kt ca T chc Y t th gii (WHO) v thnh phn CTR y t ti cc nc ang pht trin c th thy lng CTR y t nguy hi chim 22,5%, trong phn ln l CTR ly nhim (Biu 5.5). Do , cn xc nh hng x l chnh l loi b c tnh ly nhim ca cht thi.
1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0
tn/ngy

Qung Qung Bnh Nng Nam Ngi nh

Ph Yn

Khnh Ninh Bnh Ho Thun Thun

Duyn hi Nam Trung b

Ty Nguyn

ng Nam B

ng bng sng Cu Long Biu 5.5. Pht sinh cht thi y t nguy hi ti mt s tnh, thnh ph qua cc nm
Ngun: TCMT, 2011

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5.5.2. X l v tiu hy cht thi y t nguy hi

Khi lng CTR y t nguy hi c x l t tiu chun chim 68% tng lng pht sinh CTR y t nguy hi trn ton quc. CTR y t x l khng t chun (32%) l nguyn nhn gy nhim mi trng v nh hng ti sc khe cng ng. Cc thnh ph ln nh Tp. H Ch Minh v H Ni c x nghip x l CTR y t nguy hi vn hnh tt, t chc thu gom v x l, tiu hu CTR y t nguy hi cho ton b c s y t trn a bn. CTR y t nguy hi ca cc tnh, thnh ph khc hin c x l v tiu hu vi cc mc khc nhau: mt s a phng nh Thi Nguyn, Hi Phng, Cn Th tn dng tt l t trang b cho cm bnh vin, ch ng chuyn giao l t cho cng ty mi trng th t chc vn hnh v thu gom x l CTR y t nguy hi cho ton tnh, thnh ph; Ngh An c l t t ti bnh vin tnh x l CTR y t nguy hi cho cc bnh vin khc thuc a bn thnh ph, th x. Mt s thnh ph ln b tr l t CTR y t nguy hi tp trung ti khu x l chung ca thnh ph. T l l t CTR y t phn tn c vn hnh tt ch chim khong xp x 50% s l c trang b, c vng ch t 20%. Nu xt mc x l ca cc c s y t theo tuyn trung ng v a phng, cc s s trc thuc B Y t c mc u t x l CTR y t nguy hi cao hn hn cc c s tuyn a phng. Bn cnh l do v cng ngh v trnh qun l, th thiu kinh ph vn hnh l yu t quan trng dn n cc l t hot ng phn tn khng t hiu qu.

Khung 5.2. Cng tc x l CTR y t nguy hi ti 7 vng trong c nc

Vng ng bng sng Hng c 244 c s khm cha bnh cp a phng trong 98 c s c trang b l t CTR y t (chim 40%), s l t cn hot ng tt l 63 (chim 64%). i vi cc c s y t cha c trang b l t, hoc l t khng hot ng, CTR y t nguy hi x l tp trung ti khu x l CTR chung. C 8/11 tnh ca vng b tr x l CTR y t ti khu x l CTR chung, s c s y t cp a phng x l ti khu x l tp trung chim 65%. Ti 3 tnh Bc Ninh, H Nam v Vnh Phc 100% CTR y t x l phn tn ti cc bnh vin. Vng ng Bc v Ty Bc Bc B c 209 c s khm cha bnh cp a phng 93 c s c trang b l t CTR y t (chim hn 44%), s l t cn hot ng tt l 42 (chim trn 45%). C 9/15 tnh ca vng b tr x l CTR y t ti khu x l CTR chung ca tnh v thnh ph. Ch c 31 c s y t x l ti cc khu x l CTR chung, tng ng gn 15%. Mt s tnh c khu vc x l CTR y t chung nhng rt t c s vn chuyn n nh Cao Bng, Bc Kn Phn ln CTR y t cc tnh nh Bc Kn, in Bin, Lai Chu, Sn La... c x l ti ch, khng t yu cu. Vng Bc Trung B v Duyn hi min Trung c 236 c s khm cha bnh cp a phng trong 168 c s c trang b l t CTR y t (chim 50%), s l t cn hot ng tt l 79 (chim 47%). C 12/14 tnh b tr x l CTR y t ti khu x l CTR chung ca tnh; 47% s c s y t x l ti khu x l ti khu x l CTR tp trung. i vi bnh vin tuyn Trung ng tp trung ti Nng th 100% CTR y t nguy hi c a v l t CTR ti khu x l Khnh Sn. Vng Ty Nguyn c 32/74 c s khm cha bnh cp a phng trang b l t CTR y t (43 %), trong 23 l cn hot ng tt (chim 72%). Vi 4/5 tnh b tr x l CTR y t ti khu x l CTR chung ca tnh v thnh ph. 38 c s (51%) x l ti khu x l CTR tp trung. Vng ng Nam B c 34/100 c s khm cha bnh cp a phng c trang b l t CTR y t (chim 34%), trong c 7 l t hot ng tt (20%). Ti Tp. H Ch Minh 100% CTR y t nguy hi c a v l t CTR ca thnh ph. Vng ng bng sng Cu Long c 110/164 c s khm bnh cp a phng (chim 67%), s l t hot ng tt l 64 l (58%). C 10/13 tnh b tr x l CTR y t ti khu x l CTR chung ca tnh v thnh ph. Vi 74 c s (45%) s c s x l ti khu x l CTR tp trung.
Ngun: Quy hoch tng th h thng x l CTR y t nguy hi n nm 2025 - B Xy dng, 2010.

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Khung 5.3. Cng ngh x l CTR y t nguy hi cc thnh ph ln Ti H Ni s dng l t cht thi y t DELMONEGO cng sut 200 kg/h Cu Din do Cng ty TNHH Nh nc Mt thnh vin Mi trng th (URENCO) qun l x l cht thi y t trong a bn H Ni. Ti Nng, s dng l t HOVAL cng sut 200 kg/h khu x l cht thi rn Khnh Sn do Cng ty Mi trng th qun l x l cht thi y t trong a bn thnh ph (CITENCO). Ti Tp. H Ch Minh, s dng hai l t HOVAL cng sut 150 kg/h v 300 kg/h t ti Nh my x l cht thi rn y t v cng nghip do Cng ty Mi trng thnh ph qun l x l cht thi y t nguy hi cho cc c s y t trong v ngoi thnh ph.
Ngun: Cc Qun l cht thi v Ci thin mi trng, TCMT, 2010

n nm 2006, hn 500 l t c lp t ti cc c s y t ti Vit Nam, tp trung ch yu cc thnh ph ln. Tuy nhin, trong s c ti hn 33% s l khng c hot ng do nhiu l do khc nhau. Thng k v tnh hnh qun l v x l cht thi y t ca Cc Qun l Mi trng Y t (nm 2009) cho thy, i vi cc c s y t nm trong danh sch Quyt nh 64/2003/ Q-TTg th cng tc thu gom, x l cht thi y t c quan tm, u t kinh ph vn hnh vi cc l t cht thi hin i, c kim sot cht lng... Vi tuyn y t cp tnh, CTR y t phn ln c thu x l (ri ro, nguy c gy nhim mi trng cao, kh kim sot cht lng), cng tc t x l bng l t ch chim s lng khng nhiu. Cn vi tuyn y t cp huyn, cng tc x l cht thi y t ht sc a dng, phong ph vi nhiu loi hnh khc nhau v kh c th kim sot (Biu 5.6).

Biu 5.6. Thnh phn cht thi y t nguy hi

Ngun: Cc Khm cha bnh; B Y t; Vin Kin trc, Quy hoch th v nng thn, B Xy dng, 2010

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79 c s y t nm trong Quyt nh 64/2003/Q-TTg

Cc c s y t tuyn tnh

Cc c s y t tuyn huyn

Biu 5.7. Tnh hnh x l cht thi y t ca h thng c s y t cc cp

Ngun: Cc Qun l Mi trng Y t, 2009

Nhin chung cac lo t CTR y t nguy hai cn nhiu han ch, tp trung vao cac vn sau: Chi ph u t, hiu sut vn hnh, chi ph x l kh thi ln. Gi nhin liu qu cao dn n nhiu c s khng t hoc t khng m bo. Thiu phn tch nhng yu t nh hng n hiu sut t v cht thi (kh, tro, nc thi t bn ngng t x l kh). Hn na, do cht t thng c s dng l du Diezel nn rt kh m bo v ng yu cu nhit khi vn hnh (nhit tr ca du thp, v bt buc phi lu thng kh khi t). Nu phn loi rc khng ng s gy tn km khi t c rc thng, khng kim sot c kh thi l t, dn n ph x l kh thi ln.

Khi thai gy nhim mi trng

Khng kim soat c tro thai Minh hoa v han ch cua cng ngh t cht thai y t nguy hai

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Hin nay c hai loi cng ngh thn thin vi mi trng ch yu c la chn thay th cc l t cht thi y t l cng ngh kh khun bng nhit m (autoclave) v cng ngh c s dng vi sng. Trong , cng ngh s dng vi sng kt hp hi nc bo ha l loi cng ngh tin tin nht hin nay bi co hiu qu kh tit khun cao v thi gian x l nhanh, hin ang c p dng ti Trung tm y t Viesovpetro Vung Tau. nh hng trong tng lai s hn ch vic s dng cc l t x l cht thi y t nguy hi, tng bc thay th chng bng cc thit b s dng cng ngh kh khun bng nhit t, vi sng hoc cc phng php tin tin khc.

Ap dung vi sng kt hp hi nc bo ha x l cht thi y t nguy hai

Trung tm y t Viesovpetro Vung Tu - Cng sut 20 kg/gi

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