Nghin cu kho st hin trng nc thi bnh vin, cng ngh v xut ci thin

TS. Ng Kim Chi Vin ha hc cc hp cht thin nhin Vin Khoa hc v Cng ngh Vit Nam Tm tt Qun l nc thi v dch thi lng pht sinh ti cc bnh vin (BV) c u tin hng u trong kim sot dch bnh v an ton v sinh ngh nghip. Tuy vy, thc hnh qun l dch thi v nc thi bnh vin ti Vit Nam cha c cc hng dn chi tit, tp hun, thc hnh phn tch v x l cc dng thi lng nguy hi ngay ti ngun pht sinh. Bn cnh , thc trng u t v hot ng ca cc h x l nc thi (XLNT) cn c ci thin v cng ngh, ngun kinh ph duy tu vn hnh v o to cn b vn hnh. Bi vit a ra kt qu iu tra c th BV, dch thi lng v nc thi BV, tnh hnh s dng v thi nc, x l nc thi, dch thi, hin trng cc h x l nc thi (XLNT), cng ngh, xut u t, vn hnh. xut ban u ci thin cc hng dn k thut XLNT, la chn cng ngh XLNT theo hng bn vng v cc kha cnh lin quan n XLNT BV. I. M u Cht thi lng truyn nhim t cc phng xt nghim, phu thut, dch lng t c th ngi bnh, c bit l dch, mu thi phi c kh trng ti khu xt nghim, phng phu thut, iu tr, bung bnh trc khi x vo h thng nc thi chung. Nc thi BV cha BOD, COD, SS, Tng N, Tng P, v tng coliform, H2S cao, cn c x l ti h XLNT p ng tiu chun x thi. Cng ngh x l nc thi BV vi c th nhim vi sinh vt, nhim cc cht hu c v dinh dng cn c kh trng v gim st trc khi x thi. t c hiu qu kh trng cao th cc ch tiu nh BOD, COD v c bit hm lng amoni phi mc thp cho php. Bn cnh , yu cu phn tch ring tng dng thi x l chuyn bit, va m bo v sinh mi trng (VSMT), m bo h XLNT BV hot ng hiu qu, chi ph x l thp. V vy, cn phi c nghin cu nh gi hin trng, xut cc bin php ci thin. II. Gii quyt vn C 172/205 BVca 5 TP: H Ni (61BV), Hi Phng (17BV), Hu (23BV), Nng (20BV), TP. H Ch Minh (51BV) tham gia iu tra. Kho st qun l nc thi BV v cng ngh x l c thc hin vi s gip ca cc S y t a phng v hp tc ca cc BV trong vic in phiu iu tra v nh gi thc hnh, xem xt cng ngh XLNT BV trong mi lin quan cng ngh, chi ph duy tu, bo dng, cht lng ca dng thi. Thi gian kho st t thng 5 n thng 10/2010. III.Kt qu v tho lun

1. M t v bnh vin tham gia nghin cu Trong 172 bnh vin kho st c 108 bnh vin a khoa c cng v t lp chim 62,8%, 64 bnh vin chuyn khoa cng, t, ngnh chim 38,2% (trong 85,6% bnh vin cng lp.) S ging bnh (g.) trung bnh/c s y t ti TP.H Ch Minh cao nht, tip n l H Ni, Nng, Hi Phng, Hu ln lt l: 434,3; 341,9; 254,2; 221,2; 157,3 ging/c s. Cc BV u hot ng qu ti so vi ging bnh (g.) k hoch. T l qu ti trung bnh l 14,2%, qu ti BV a khoa l 19,8%, khu vc Nng v Hu tnh trng qu ti cao n 49,6% v 28,6%. 2. S dng nc v ti lng nc thi qua h XLNT Nc thi BV cha vi khun ly bnh, nhng khng phi BV no cng x l theo QCVN 28-2010 ngy 16/12/2010 B TN&MT hay tiu chun trc . Hi Phng, c 3/17 s BV c h XLNT v 3/17 s BV c h x l khng hot ng, 11/17 BV khng c XLNT; H Ni c 36/61 BV khng c h XLNT, 22 BV c h XLNT, 3 h XLNT khng hot ng. TP. H Ch Minh, c 5 bnh vin khng c h XLNT; 40 h XLNT; 6 h khng hot ng/XLNT khng t yu cu. Nng: 4 BV khng c h XLNT, 16 h ang hot ng. 14 BV khng c h XLNT ti Hu. Tt c 52,3% (90/172) BV c h XLNT, cn li 40,7% khng c XLNT, 7,0% BV XLNT khng hot ng, bng 1. Nhiu h XLNT ang hot ng qu ti, ch yu cc h XLNT xy lp bng ngn sch nh nc (86,7%). Bng 1. Kt qu iu tra h XLNT BV S phiu tr li v h XLNT Hot ng Khng hot khng t Tng phiu tr li ng yu cu 0 4 20 6 5 51 3 36 61 3 11 17 0 14 20 12; 70; 172; 7% 40,7% 100%

Thnh ph Nng TP. H Ch Minh H Ni Hi Phng Hu Tng phiu, %

C h XLNT 16 40 22 3 9 90; 52,3%

Trung bnh h XLNT cng sut 0,45m3/g. thc t/ngy, lng nc s dng l 0,65m3/g. thc t/ngy, cng sut thit k h XLNT l 0,93 m 3/g.k hoch/ngy. Con s trung bnh ny TP. H Ch Minh l 0,6; 0,66m3/g. thc t/ngy, 0,7m3/g. k hoch/ngy, cc h XLNT u chy ht cng sut. BV Hi Phng s dng t nc hn vi cc s liu l 0,32; 0,33m3/g.thc t/ngy, 0,51m3/g.k hoch/ngy v Nng l 0,46, 0,63m3/g. thc t/ngy, 0,87m3/g.k hoch/ngy, nhiu hn Hu vi 0,44 m3/g.thc t/ngy, 0,49m3/g./ngy, v 0,72m3/g.k hoch/ngy th hin bng 2. Bng 2. Nc s dng v lu lng nc thi ti h XLNT Hi Thnh ph H Ni HCM Hu Phng Nng Nc s dng m3/g/ngym3/g/ngym3/g/ngy m3/g/ngy m3/g/ngy S bnh vin tr li h XLNT 22 40 5 14 2 2

Nc thc t qua XLNT (m3/g t.t/ngy) Nc s dng v thi (m3/g t.t/ngy) Cng sut thit k XLNT (m3/g. k.h/ngy) 3. Cng ngh XLNTBV:

0,448 0,644 0,925

0,604 0,661 0,698

0,322 0,332 0,513

0,459 0,625 0,872

0,443 0,489 0,722

Bng 3. Cng ngh XLNT BV Vit Nam. Loi Loi I Tn cng ngh H thng sc kh thng thng L phn ng sinh hc vi CN 2000 M t cng ngh 1a: Nc thi-Thu gom- Chn rc Lng (c hoc khng c keo t) B sc kh bn hot tnh - Lng -Kh trng Thi nc, quay vng bn 1b: Gom nc thi Chn rc - Lng - Lc sinh hc nh git - Lc - Kh trng. Nc thi-Chn rc-B iu ha-Tin x lB x l sinh hc x l kt hp thit b CN2000Lng-Kh trng -X

Loi II Loi III

Mng sinh hc Nc thi-Chn rc-B iu ha - B x l sinh hc (MBR) cc vt -MBRLng - Kh trng liu lc khc nhau Tin x l n Loi Nc thi - Thu gom - B lng v b k kh Keo gin-k kh/t hoi IV t/ha cht Kh trng (Cl2, UV, O3) - x l ha - l Nc thi-Lng-Tin x l vi cng ngh AAO: b x l k kh - b thiu kh - b oxy ha lc - kh CN tin tin trng-x. Thit b Kobuta, Jokushu. Loi V AAO, SBR, lc than hot tnh X l sc kh Lng- Lc bng cacbon hot tnh SBR cng ngh phn ng theo m Nc thi BV c cc ch s c trng BOD: 180-280mg/l, COD: 250-500mg/l, SS: 150-300mg/l, H2S: 6-8mg/l, T-N: 50-90mg/l, T-P: 3-12(mg/l), Coliform: 106-109 MNP/100ml. Cng ngh bn hot tnh, b lc sinh hc, tip xc sinh hc, mng sinh hc (MBR), b phn ng theo m (SBR) l cng ngh ph bin cho XLNT BV ti Vit Nam v phn thnh cc nhm: sc kh bn hot tnh v x l sinh hc nh git sau lc (Nhm 1), CN2000 x l hu c ti trng cao (l loi mng sinh hc ci tin- Nhm 2), sc kh tip xc mng sinh hc (MBR), lc sinh hc Biofor, V69, FBR (nhm 3), cng ngh AAO, SBR v kh trng O3, UV (Nhm 5), x l s b + ym kh/b t hoi (Nhm 4). Phng php kh trng hin cc BV s dng l dng Hypochlorite calcium (CaOCl2), chloruamin B, ozone, tia cc tm. Cha c BV no kh trng cng ngh lc mng ngn cc vi khun, vi rt v khng s dng ha cht. Loi cng ngh x l, nhm I chim u th hn (56,9%) do chi ph u t thp, TP HCM t l ny l 60,9%. Loi II x l sinh hc cao ti (CN2000 mi u t, c nhiu Nng) v H Ni 10,8% (11/102). Tuy nhin, nc thi BV Vit c (H Ni), BV E (H Ni) khng p ng yu cu amoni theo QCVN 28-2010, mc 2. Cc h x l nc thi lc mng sinh hc (MBR) loi III chim 9,8% hay (10/102), Hi

Phng c 5 BV (5,75%) trang b loi cng ngh ny vi tn V69. Bn cnh cn mt s tn gi thit b khc l BIOX1, BIO sinh hc, FBR. C 15,7% bnh vin s dng cng ngh loi IV n gin, u t thp, 6,9% BV c u t h x l cng ngh AAO, cng ngh SBR (loi 5) v mt s khc vi sut u t cao hn, bng 3,4. Nhiu n v cho bit, chi ph XLNT khong 2500 /m3/ngy. Cng ngh bn hot tnh sinh nhiu bn hn (0,012% m3 bn/cng sut nm) so vi cng ngh khc nh mng sinh hc hoc lc sinh hc cao ti. Bng 4. S BV c h XLNT v cc nhm cng ngh XLNT p dng
Nng TP. HCM H Ni Hi Phng Hu Tng XLNT % XLNT % XLNT % XLNT % XLNT % XLNT % Nhm I 14 87,5 28 60,9 13 52 1 16,7 2 22 58 56,9 Nhm II 2 12,5 1 2,2 8 32 11 10,8 Nhm III 5 10,9 1 4 4 66,7 10 9,8 Nhm IV 7 15,2 1 4 1 16,7 7 77,8 16 15,7 Nhm V 5 10,9 2 8 7 6,9 Tng 16 100 46 100 25 100 6 100 9 100 102 100

Cc BV c h XLNT nhng khng hot ng cho bit, nguyn nhn l do h XLNT chc nng km, khng sa cha khc phc c; x l khng t tiu chun, qu cng sut x l. C 66/90 BV cho bit, khng ngn sch hot ng, thiu cn b chuyn mn c kin thc Bng 5: X l dch lng ti bnh vin vn hnh v khc phc s c. Thnh Tch ring Trn X l Khng ph N HCM HN HP Hu Tng s % +XLNT 0 12 8 0 2 22 12.79 ln 15 17 36 9 8 85 49.42 ring 0 17 2 1 6 26 15.12 thi 5 5 15 7 7 39 22.67 2

Hng dn qun l cht thi lng l mi quan tm hng u trong XLNT. Vic tch ring cc dng thi lng khng c quan tm ch trng, khng nhn thc c cc dng thi c c tnh khc nhau v trn ln nc thi vo h thng thot, khng tch v x l ti ngun (49,2%). Pha trn ln nhau, chi ph x l s tng v kh t tiu chun mi trng. Tuy nhin, 15,12% bnh vin tr li k hp ng vi nh thu bn ngoi; 22,67% bnh vin tr li khng thi nhng dng thi (thuc c hi, bc x/ng v, ha cht quang hc, ha cht khc). Mt s BV(12,79) bit, phng php x l cht thi lng nhng khng y (bng 5). Mt s BV (12,79%) bit cch x l dch thi lng. Ch c 20 BV TP. H Ch Minh cho bit, h x l dng thi lng ring theo tnh cht dng thi (axit/kim, dung mi, cht lng c kim loi nng, cht quang ha, cht st trng, phng x, khc). Kt lun Cc quy nh nghim ngt v x cht lng, thm ch mu, dch mu lng t trong phng th nghim, cht lng hoc mu s lng ln phi c kh trng theo quy nh. Thc trng l thi cht thi lng nhim bnh hay cht thi lng nguy hi Vit Nam cha c cc hng dn chuyn bit theo tnh cht nguy hi ca tng loi dng
th 1: Cc bnh vin trong kho st

thi. H thng b t hoi v h XLNT nu c thit k hp l v cc chc nng m bo th kh hot tnh cc tc nhn gy bnh truyn nhim v tin x l ti ch cc cht lng nhim v vi khun ly nhim trong nc thi BV trc khi x l khu cui nhm m bo h XLNT p ng yu cu x thi theo quy nh trong tiu chun Vit Nam TCVN 7382-2004, quy nh mi QCVN28-2010. Nu h XLNT c thit k ng cc ngn chc nng ca tng phn hot ng tt l: iu ha, oxy ha, nitrat ha v nitrat ha, lng, lc trong, s cho hiu qu x l tt. Hot ng XLNT cn bn vng: Mt h XLNT c vn hnh thng xuyn khng nhng m bo x l nc thi m cn m bo cho cc chc nng ca h thng hot ng tt. C 12/90 h XLNT trong khu vc nghin cu khng hot ng, trn 31,3% trong s khng th hot ng do chc nng km v kh sa. C 41,67% h XLNT cha t TCVN 7382-2004 thng l ch tiu amoni (khi ch tiu amoni cao dn n hiu qu kh trng km v tn nhiu ha cht), 40,7% s bnh vin c kho st khng c h XLNT. Cn to dng ngn sch v ngun vn c bit cho XLNT cc BV c th t chc kho st lp k hoch thit k, xy dng v trnh vay cc ngun tn dng u u t XLNT v duy tu vn hnh. Bn cnh , vic tp hun nhn vin XLNT BV cng rt quan trng, duy tr nht k hot ng h XLNT, hiu kt qu phn tch, lu tr kt qu phn tch, trnh by bo co, lu cc ti liu cn thit. Cn chun b cc ti liu, d liu y thng tin v lun sn sng cung cp cho cng chng v cn b qun l hoc c quan hu quan khi cn thit. Nhng trong thc t, truy cp cc thng tin v BVMT ca cc BV khng phi l d dng ti hu ht cc bnh vin c kho st. Ti liu tham kho: 1.
2.

B Y t (2012). Quy ch qun l cht thi y t (Q47/Q-BYT).

B Ti nguyn v Mi trng (2010) Quy chun nc thi bnh vin QCVN 28-2010 ngy 16/12/2010. 3. http://www.cdc.gov/niosh/docs

The study on hospital waste water management, technology and suggests improvements TS. Ngo Kim Chi Institute of Natural Products Chemistry- Vietnam Academy of Science and Technology Summary Wastewater management and liquid waste generated in hospitals is a top priority in disease control and occupational safety. However, management practices and waterwaste service hospital in Vietnam do not have the detailed instructions, the training and practice to separate and right treatment at genenation sources. Besides, the status of investment and operation of the system hospital wastewater treatment in Vietnam need the improvements in technology, funding resources and operation and maintenance training. This paper, a study resulted in wastewater management, water use and wastewater treatment, and the specifics of hospitals in the study, wastewater treatment technology, the investment, operation and liquid waste management services. Preliminary recommendations to improve the guidelines, the selection of technology toward sustainable treatment and other aspects related to wastewater treatment hospital are presented.