M U 1 .

Gii thiu chung v Bnh vin Ph sn Trung ng Bnh vin Ph sn Trung ng l n v s nghip trc thuc B Y T c sp xp li theo Ngh nh 49/2003/N CP ngy 15/5/2003 ca Chnh Ph. Bnh vin l tuyn iu tr cao nht ca ngnh Ph sn vi cc chc nng, nhim v nh: khm, cp cu, iu tr chuyn khoa Ph Sn cho ngi bnh tuyn cao nht; nghin cu khoa hc, o to cn b chuyn mn ngnh Ph Sn; ch o tuyn di v chuyn mn k thut; phng bnh v hp tc quc t. Hin nay tng cng kh nng thu nhn bnh nhn, m bo cht lng khm cha bnh, nghin cu khoa hc, o to cn b, quan h quc t cng nh nhu cu v c s vt cht v trang thit b Y t ang l p lc ngy cng gia tng vi bnh vin. Bi vy, tip tc pht huy nhng thnh tu t c v p ng k hoch pht trin n nm 2010 v tm nhn 2020 l xy dng Bnh vin tr thnh mt bnh vin chuyn khoa hon chnh, l mt trung tm y hc pht trin c c s vt cht, trang thit b hin i ngang tm vi cc nc trong khu vc . 2. Cn c php l v ti liu k thut lp n bo v mi trng 2.1. Cn c php l n bo v mi trng ca Bnh vin Ph Sn Trung ng c lp trn c s tun th cc quy nh v lut php Quc gia v khung quy nh ca Vit Nam: - Lut Bo v mi trng ngy 29 thng 11 nm 2005; - Ngh nh s 80/2006/N CP ngy 09 thng 8 nm 2006 ca Chnh Ph v vic quy nh chi tit v hng dn thi hnh mt s iu Lut Bo v mi trng; - Ngh nh s 21/2008/N CP ngy 28 thng 2 nm 2008 ca Chnh Ph v vic sa i b sung mt s iu ca Ngh nh s 80/2006/N CP ngy 09 thng 08 nm 2006 ca Chnh Ph v vic quy hoch chi tit v hng dn thi hnh mt s iu ca Lut Bo v mi trng; - Thng t s 08/2006/TT BTNMT ngy 08 thng 09 nm 2006 ca B Ti nguyn v Mi trng v vic Hng dn v nh gi tc ng mi trng chin lc, nh gi tc ng mi trng v cam kt bo v mi trng. - Thng t s 12/2006/TT BTNMT ngy 09 thng 8 nm 2006 ca B Ti nguyn v Mi trng v hng dn iu kin hnh ngh v th tc lp h s, ng k v qun l cht thi nguy hi; - Thng t s 04/2008/TT-BTNMT ngy 18 thng 09 nm 2008 ca B Ti nguyn v Mi trng hng dn lp, ph duyt hoc xc nhn n bo v mi trng.
1

- Ngh nh s 04/2007/N-CP ngy 08 thng 01 nm 2007 ca Chnh ph v sa i, b sung mt s iu ca Ngh nh s 67/2003/N-CP ngy 13 thng 06 nm 2003 ca Chnh ph v ph bo v mi trng i vi nc thi. - Ngh nh s 59/2007/N-CP ngy 09 thng 04 nm 2007 ca Chnh ph v qun l cht thi rn. - Thng t 07/2007/TT-BTNMT ngy 03 thng 07 nm 2007 ca B Ti nguyn v Mi trng, hng dn phn loi v quyt nh danh mc c s gy nhim mi trng cn phi x l. - Quyt nh s 22/2006/Q-BTNMT ngy 18 thng 12 nm 2006 v vic bt buc p dng tiu chun Vit Nam v mi trng. - Hng dn s 3900/HD TNMTN ngy 25/9/2006 ca S Ti nguyn v Mi trng v Nh t H Ni v nh gi mi trng chin lc, nh gi tc ng mi trng v cam kt bo v mi trng i vi d n u t trn a bn thnh ph H Ni. - Quyt nh s 43/Q BYT ngy 30 thng 11 nm 2007 ca B trng B Y t v vic ban hnh qui ch qun l cht thi y t. - Quyt nh s 02/2005/Q UB ngy 10/1/2005 ca UBND Thnh ph H Ni v vic ban hnh qui nh cc bin php nhm gim bi trong lnh vc xy dng trn a bn Thnh ph H Ni. 2.2. Ti liu k thut - S mt bng, bn v, ti liu k thut ca d n. - Ti liu, s liu thng k v tnh hnh kh tng, thy vn ca khu vc. - Cc s liu kh tng ti H Ni. - S liu, kt qu o c, th nghim, phn tch mu t cht lng mi trng trong khu vc Bnh vin Ph Sn Trung ng; - Ti liu k thut v quan trc kh thi, nc thi, cht thi rn cng nghip; - Ti liu k thut v cng ngh x l kh thi, nc thi, cht thi rn. - Cc tiu chun ca WHO v Vit Nam v phng php o c, thu thp v th nghim mu mi trng. - Cc tiu chun mi trng Vit Nam c s dng so snh, nh gi cht lng mi trng; + TCVN 5937 2005 Tiu chun cht lng khng kh xung quanh + TCVN 5938 2005 Nng ti a cho php ca mt s cht c hi trong khng kh xung quanh.
2

+ TCVN 5939 2005 Tiu chun kh thi cng nghip i vi bi v cc cht v c. + TCVN 5940 2005 Tiu chun kh thi cng nghip i vi mt s cht hu c. + TCVN 5949 1998 Gii hn ti a cho php ting n trong khu vc cng cng v dn c. + TCVN 5942 1995 Tiu chun cht lng nc mt + TCVN5944 1995 Tiu chun cht lng nc ngm + TCVN 7382 2004 Nc thi bnh vin Tiu chun thi + CTVN 5502 2003 Nc cp sinh hot Yu cu cht lng; + Tiu chun v snh nc n ung ban hnh km theo Quyt nh s 1329/2002/BYT Q ngy 18/4/2002 ca B trng B Y T. 2.3. S cn thit lp n Bo v Mi trng Bnh vin Ph sn Trung ng chu trch nhim thc hin lp n Bo v Mi trng cho Bnh vin Ph sn Trung ng H Ni. Cng ty TNHH T vn Mi trng H Ni l n v t vn. Vic lp n Bo v Mi trng c da trn cc c s thng tin, s liu thu thp trong cc t kho st thc a cng vi cc tnh ton ca cc chuyn gia mi trng c kinh nghim kt hp cc ti liu tham kho trong v ngoi nc. 2.4. T chc thc hin Bo co n bo v mi trng Bnh vin Ph sn Trung ng H Ni phi hp vi Cng ty TNHH T vn Mi trng H Ni thc hin. Qu trnh thc hin n bo v mi trng nh sau:

iu tra kho st mi trng, ly mu hin trng mi trng (t, nc,

khng kh) v hin trng nc thi ti khu vc Bnh vin Ph sn Trung ng H Ni.

Phn tch mu mi trng ti Phng th nghim t tiu chun VILAS

ISO/IEC 17025 (VILAS 202).

Tham vn cng ng v mi trng khu vc quanh Bnh vin Ph sn

Trung ng H Ni v ti im x nc thi ca bnh vin.

Xy dng cc hp phn v ni dung bo co.

Danh sch nhng ngi trc tip tham gia lp bo co n bo v mi trng gm c:

TT 1 2

H v tn Trn Quc Vit Phng Th M

3

Chuyn ngnh Ph Gim c Bnh vin Ph Gim c Cng ty TNHH T

TT

H v tn

Chuyn ngnh vn Mi trng H Ni

3 4 5 6 7 8

CN. L Minh o Cao Duy Tin th Thu Hng ThS. Trn th

CN. Ti chnh Tr l Gim c Cn b k thut Thu ThS. Ngnh mi trng CN. Ngnh mi trng CN. Ngnh mi trng

Ngn CN. Trn Quang Hng CN. Nguyn Vit Trung

CHNG 1 4

KHI QUT V QUY M, C IM, CC HOT NG CHNH CA BNH VIN PH SN TRUNG NG C LIN QUAN N MI TRNG 1.1. Cc thng tin chung

Tn c s: Bnh vin Ph sn Trung ng a ch: S 43 Trng Thi Phng Hng Bng - qun Hon Kim Thnh ph H Ni To a l: V 20o5516, Kinh 105o5213 S in thoi: 04.8252161 C quan ch qun: B Y T Loi hnh doanh nghip: Nh nc
1.2. Tm tt qu trnh v hin trng hot ng ca Bnh vin Ph sn Trung ng 1.2.1. Tm tt qu trnh hot ng ca bnh vin

Fax: 04 .8254638

Bnh vin Ph sn Trung ng l Bnh vin chuyn khoa u ngnh v sn ph khoa nm Trung tm thnh ph , thuc qun Hon Kim H Ni vi din tch khong 1,37 ha. V tr khu t c qui hoch nh sau: - Pha Bc, ng Bc gip ng Trng Thi - Pha Ty, Ty Bc gip Bnh vin K - Pha ng gip ng Triu Quc t - Pha Nam gip ng Hai B Trng. Bnh vin Ph sn Trung ng l cng trnh nm trn khu t trng trc y l nh chuyn khoa nay c ph b gii phng mt bng. c UBND thnh ph H Ni, S quy hoch kin trc thnh ph ph duyt chi tit t l:1/500. Cng trnh c xc nh nh sau: Mt trc quay v hng Bc nhn ra trc ng ph Trng Thi, mt sau hng Nam i din vi nh iu tr t nguyn c ni vi nhau bng mt dy hnh lang v mt di cy xanh, mt bn hng ng gip vi khu cng ngh cao 7 tng qua mt khong sn v di cy xanh. Pha Ty gip vi bnh vin K. 1.2.2. Hin trng cng trnh trong bnh vin: Tri qua s pht trin lu di hn 100 nm v c ci to nng cp do B Y T ph duyt cc nm vi din tch t ca Bnh vin PSTW l khng ln (1,37ha) trn gn khu Trung tm H Ni (giao nhau ca ng Trng Thi Hai B Trng Triu Quc t Qun S). Mc d sau khi c trin khai d n nng cp Bnh vin

PSTW nm 2001 do B Y T ph duyt, nhng vi nhu cu hot ng ca bnh vin l rt ln, cng vi cc cng trnh ci to v xy dng mi cha tht ng b v thch hp cho mt Bnh vin Quc Gia hin i u ngnh trong th k XXI, v vy nhu cu hin i ha Bnh vin PSTW trn cc lnh vc: xy dng c bn, trang thit b y t v c bit i ng cn b chuyn mn cng nh qun l m ng c cc nhim v m B Y t v Nh nc giao cho ang l mt thch thc cho ngnh y t ni chung v ngnh Sn ph khoa Vit Nam ni ring. Thc trng Bnh vin cn rt nhiu hn ch trong cng tc m B Y T giao, c bit trong lnh vc khm cha bnh v chm sc bnh nhn. Hn ch ny do mt s nguyn nhn sau: *. Quy hoch tng mt bng Do xy dng trn c s c v nhiu ln sa cha khng ng b t nm 1954 1996 nn hu nh cc c s ny hin ti l hng hon ton. T nm 1996, Bnh vin c mt s ln sa cha v xy dng nhng do u t kh khn nn khng mang c tnh bn vng v ph hp cho tng lai. Sau d n iu chnh u t xy dng ci to m rng nng cp Vin BV&TTSS quy m 400 ging nm 2001 n nay, th c s h tng ca bnh vin thc s c i mi v tch cc ci thin cng tc khm cha bnh cho nhn dn. Nhng bn cnh cng xut hin nhng vn bt hp l trong cc thit k xy dng v cha p ng ht yu cu ca thc tin. Hin ti trn din tch 1,37ha c 8 khi nh, tng din tch sn s dng l 20.258m2 c b tr s dng nh sau:

Nh A: Nh 4 tng , mi c xy dng kt cu b tng ct thp (xy dng nm

2002, din tch sn l 2.130m3) dnh cho khu khm bnh v t vn k hoch ha gia nh v xt nghim (Huyt hc, Sinh ha, Vi sinh, GPB v t bo Di Truyn).

Nh B: Nh 3 tng c, kt cu nh khung b tng ct thp (din tch sn l

1.969m2) gm c 2 khoa bnh l Sn Nhim Khun, Ph Ni Tit v mt s phng ban chc nng nh; NCKH T; TCCB, CT, VPU, VPC v vn phng b mn sn Trng i hc Y H Ni.

Nh D: Nh 3 tng c, kt cu nh khung BTCT (din tch sn l 1.969m2) gm c

2 khoa: Khoa iu tr t nguyn v mt phn ca Trung tm h tr sinh sn quc gia.

Nh G: Nh 7 tng, nh khung BTCT mi xy dng (Xy dng nm 2003, din tch sn l 6.116m2) vi ch trng xy dng thnh khu cng ngh cao, nhng hin nay v mt bng ca bnh vin cn thiu phng c nn b tr mt s khoa iu tr xen k. Sn bnh l, Sn thng, ph ung th xen k vi TTHTSS Quc gia, Hi sc cp cu, phu thut gy m Hi sc, Khoa , khoa s sinh. Trn tng 7 l
6

hi trng ln v th vin Bnh vin. Tng trt l ni xe my cho nhn vin bnh vin.

Nh I: Nh 2 tng, kt cu nh khung BTCT mi xy dng (xy dng nm 2002,

din tch sn l 604m2) c khoa chng nhim khun (gm b phn hp, sy v git l qun o), Kho HCQT v kho vt t k thut.

Nh H: Nh 4 tng kt cu nh khung b tng ct thp mi xy dng (Xy dng

nm 2002, din tch sn l 1.558m2)c Khoa chun on hnh nh (gm c b phn siu m v XQ) c sp xp cng vi phng hnh chnh ca Bnh Vin.

Mt s nh cp 4 mang tnh tm thi: Khu nh n khoa dinh dng, khu xe

my, khu xe t tm thi, khu nh ch cho bnh nhn.

Mt s nh cp 4 mang tnh tm thi: Khu nh n Khu dinh dng, khu xe

my, khu xe t tm thi, khu nh ch cho bnh nhn.

Trm bin p v phng git my pht in, c din tch l 50m2. Khu m xc cha c.
- H thng thot nc ma, thot nc thi v trm x l nc thi c trin khai xy dng. + Tng 1: B tr 2 li vo, 1 li vo dnh cho khu vc cp cu, 1 li vo cho khu vc khm bnh, h thng thang my, thang b nm v hai u ca khi nh. Khai khu vc c lin kt vi nhau bng hnh lang trong. + Tng 2 -11: Ngoi snh v cu thang chnh nm v hai u ca ta nh, cc phng nhn vin phc v cho tng tng nh phng bc s, tim, th thut cng c t gia ca hai dy phng bnh nhn phc v mt cch nhanh chng v hiu qu nht cho khi bnh nhn. Khu vc bn v kho c t v pha bn phi ca cng trnh nm phi sau cng trnh v cui gi thun tin cho vic chuyn ch. Bng 1.1. Quy m cc bung phng ca Bnh vin TT I 1 2 TN N V KHOA CP CU (0,5 TNG) Snh cp cu Snh Ph
7

DIN TCH 780m2 58 m2 35 m2

3 4 5 6 7 8 9 10 11 12 13

Phng trc cp cu Phng s cp cu Phng siu m Phng X quang Phng k thut Phng lu cp cu + trc + WC Phng y t trng Phng bc s Phng y t Phng khu dng c thit b Phng v sinh + tm thay qun o CBCNV KHU VC KHM BNH (0,5 TNG)

15 m2 20 m2 18 m2 18 m2 6 m2 250 m2 15 m2 15 m2 15 m2 15 m2 47 m2

1 2 3 4 5 II 1 2 3 4 5 6 7

Snh khm bnh Trc + ch dn Dch v Snh ngi ch bnh nhn Phng v sinh + tm ca bnh nhn v ngi nh BN KHOA SN THNG 1 TNG Phng khm th thut Phng ra hp Phng chun b Phng tim Phng giao ban + o to Phng bnh nhn phc v khp kn Phng bnh nhn khp kn (5 phng x 58m2)
8

58 m2 15 m2 58 m2 58 m2 47 m2

40 m2 12 m2 12 m2 25 m2 40 m2 35 m2 290 m2

8 9 10 11 12 13 14 15 16 17 18 III 1 2

Phng trc Phng trng khoa Phng Ph khoa Phng y t trng Phng bc s Phng y t nam Phng y t n Kho sch Kho bn Phng v sinh+tm thay qun o CBCNV Phng v sinh+ tm ca bnh nhn v ngi nh BN KHOA ( 1 TNG) Phng bnh nhn ch khp kn (3 phng x 58 m2) Phng bnh nhn lu sau khp kn (2 phng x 58m2) Phng s sinh Phng siu m Phng : 4 bn/phng (3 phng x 58m2) Trc Phng giao ban+o to Kho sch Kho bn Phng v sinh + tm thay qun o CBCNV Phng v sinh+ tm ca bnh nhn v ngi nh BN Phng trng khoa
9

10 m2 15 m2 15 m2 15 m2 15 m2 15 m2 15 m2 20 m2 20 m2 47 m2 47 m2

174 m2 116 m2 30 m2 30 m2 174 m2 20 m2 40 m2 20 m2 20 m2 47 m2 47 m2 17 m2

3 4 5 6 7 8 9 10 11 12

13 14 15 16 17 IV 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Phng y t trng Phng nhn vin Phng y t nam Phng y t n Phng bc s KHOA S SINH (1 TNG) Phng tr (6 phng x 30m2) Phng tr cch ly (2 phng x 30m2) Phng tr din tch nh (1 phng x 15m2) Phng tr din tch ln Phng pha sa Phng my Trc + tip nhn Phng thm tr Phng cng gu ru khp kn (2phng x 30m2) Phng trng khoa Phng y t trng Phng y t nam Phng y t n Phng bc s Kho Phng giao ban Phng ra tit trng Trc + lm hnh chnh giy t Kho sch Kho bn Phng v sinh + tm thay qun o CBCNV
10

17 m2 20 m2 15 m2 15 m2 15 m2

180 m2 60 m2 15 m2 58 m2 30 m2 45 m2 20 m2 15 m2 60 m2 17 m2 17 m2 15 m2 15 m2 15 m2 15 m2 30 m2 30 m2 58 m2 20 m2 20 m2 47 m2

22 V 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Phng v sinh + tm ca bnh nhn v ngi nh BN KHOA SN BNH L (1,5 TNG) Phng bnh nhn khp kn (10 phng x 58m2 ) Phng bnh nhn yu cu khp kn Phng khm th tht ( 2 phng x 40m2 ) Phng ra hp ( 2 phng x 12m2 ) Phng chun b ( 2 phng x 12m2 ) Phng tim Phng trc + tip nhn Phng trng khoa Phng y t trng Phng bc s ( 2 phng x 15m2 ) Phng khm y t nam Phng khm y t n ( 2 phng x 15m2 ) Phng trc nhn vin ( 2 phng x 15m2 ) Phng ph khoa Phng h l Kho Phng in tim Phng siu m Phng giao ban o to Kho sch Kho bn Phng v sinh + tm thay qun o CBCNV Phng v sinh + tm ca bnh nhn v ngi nh
11

47 m2

580 m2 15 m2 80 m2 24 m2 24 m2 25 m2 10 m2 15 m2 15 m2 30 m2 15 m2 30 m2 30 m2 15 m2 15 m2 15 m2 15 m2 15 m2 62 m2 20 m2 20 m2 47 m2 47 m2

BN 24 VI 1 2 3 4 5 6 7 8 9 VII 1 2 3 4 5 6 7 8 9 10 11 12 Phng bnh nhn nng khp kn KHOA PHU THUT GY M HI SC (1 TNG) Phng bnh nhn khp kn ( 04 phng x 580m2 ) Phng khm th thut Phng tim Phng in tim Phng ph khoa Phng trng khoa Phng trc nhn vin Phng bc s Phng trc giao ban KHOA PHU THUT GY M HI SC (2,5 TNG) Phng m 1 bn (6 phng x 42m2) Phng mt kp (3 phng x 52m2) Phng m nhim khun Cc phng m + phng chun b ca cc bc s cho 10 phng m Kho vt liu tiu hao Phng y t trng Phng y t nam Phng y t n Phng bc s (2 phng x 15m2) Phng trng khoa Phng ph khoa Phng giao ban
12

58 m2

232 m2 58 m2 25m2 15m2 15m2 15m2 15m2 15m2 58m2

252m2 104m2 52m2 140m2 10m2 12m2 12m2 12m2 30m2 15m2 15m2 58m2

13 14 15 16 17 18 19 20 21 22

Phng o to ging dy Phng ngh Phng hi sc (3 phng x 58m2) Phng hi tnh ln Phng hi tnh nh Phng hi tnh nhim khun Kho sch Kho bn Phng v sinh + tm thay qun o CBCNV Phng v sinh + tm ca bnh nhn v ngi nh BN TRUNG TM H T SINH SN (2 TNG) Khu vc IUI

58m2 15m2 174m2 85m2 52m2 30m2 20m2 20m2 47m2 47 m2

VIII

1 2 3 4 5 6 7 8 9 10 11 12 13

Snh ngi ch Trc tip nhn Cc phng ly tnh cht + WC (3P x 15m2) Phng siu m + v sinh Phng lc ra tinh trng Phng a tinh trng vo t cung + v sinh Phng bnh nhn khp kn (3 phng x 58m2) Phng giao ban Phng ngh nhn vin Phng ph khoa + WC Phng trng khoa + WC Phng ph khun nhn vin Phng m
13

56 m2 10 m2 45 m2 15 m2 40 m2 40 m2 174 m2 58 m2 40 m2 20 m2 20 m2 12 m2 20 m2

14 15 16 17 18 19 20 21 22

Phng ra tay thay qun o Phng t vn Phng tim Phng y t Phng bc s Kho sch Kho bn Phng v sinh + tm thay qun o CBCNV Phng v sinh + tm ca bnh nhn v ngi nh BN Khu vc nui cy (IUF)

12 m2 15 m2 15 m2 15 m2 15 m2 20 m2 20 m2 47 m2 47 m2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Snh ngi ch Trc tip nhn Cc phng ly tnh cht + WC (3P x 15m2) Phng lc ra tinh trng Phng siu m (2P X 15m2) Phng t vn Phng chc non Phng nui cy (2P x 40m2) Phng lu gi phi Phng thit b + v sinh Phng ph khun nhn vin Phng ra tay thay qun o Phng m Phng ra dng c Phng bnh nhn khp kn (2 phng x 58m2) Trc tip nhn
14

58 m2 10 m2 45 m2 30 m2 30 m2 15 m2 40 m2 80 m2 40 m2 30 m2 12 m2 12 m2 20 m2

116 m2 10 m2

17 18 19 20 21 22 23

Phng bc s Phng y t trng Phng y t Kho sch Kho bn Phng v sinh + tm thay qun o CBCNV Phng v sinh + tm ca bnh nhn v ngi nh BN Hnh lang, snh, cu thang

15 m2 15 m2 15 m2 20 m2 20 m2 47 m2 47 m2

1.2.3.1. Cc danh mc my mc, thit b trong bnh vin * Trang thit b y t c ca bnh vin - 5 my X quang tng sng, cha c my CT. Scanner - 7 my siu m en trng v 02 my siu m mu - 2 dn my m ni soi ph khoa - 13 my Monitor theo di sn khoa v nhi khoa - Mt s my chuyn ngnh hin i cho TTHTSS v khi xt nghim chuyn ngnh: KHVVTT, t nui cy sinh hc, dn elisa, my li tm. - My sinh ha, huyt hc nhiu thnng s, phn tch t ng,vv * Cc thit b thng dng khc - Trung tm sy hp git l, kh trng, hon chnh tng i hin i. - Cha c trung tm to O-xy, cung cp O-xy cho nhu cu chuyn mn ca ton bnh vin. - My pht in (KVA/my) c cng sut cung cp cho mt s khoa phng cp cu ca bnh vin khi mt in. - Trm bin p mi c ci to nng cp. - H thng tng i cha c trang b in t t ng nhy s. - H thng my vi tnh c ni mng v thiu hon thin ng b; hin Bnh vin c nhiu my mc sinh hot khc nhau phc v cho nhu cu khm bnh cha bnh ca chuyn mn v nhu cu lm vic ca cn b, ngi lao ng. * nh gi thc trng thit b hin c ca bnh vin
15

a s cc thit b - Thit b y t u thuc th h c

do

nc

ngoi

vin

tr.

- Cn thiu nhiu thit b y t th h mi v cc thit b thng dng hin i * Nguyn, vt liu s dng khc
o

Ngun in cung cp cho Bnh vin Ph sn Trung ng l ngun in 3 pha 4 dy vi in p 380V/220V c cp t trm bin th ni b. Phn cp nc:

Nhu cu dng nc ca Bnh vin TT 1 Tn phng tiu th nc S ngi kin d Tiu chun cp Lu lng 3 nc (m /ngy) 350 70

Cp nc sinh hot 200 cho nhn khi bnh

2 3 4

Cp nc sinh hot 200 cho khi phc v Cp nc sinh hot 80 cho bc s, y t Cp nc sinh hot 200 cho ngi nh bnh nhn

20 50 15

4 4 3

5 6 7 8

Cp nc ti v nhu cu khc Nc d phng Nc cha chy Tng nhu cu dng nc * B nc ngm:

20 20 54 175m3

Dung

tch

cha
3

xc

nh

theo

cng

thc:

Wb=Wh+Wcc=200m 146m3

Trong : Wh: dung tch iu ho ca b bao gm =0,8 (QSH+QK)=

16

Wcc=54m3 Xy dng 1 b cha nc ngm dung tch b cha 200m3 * ng ng cp nc sinh hot: Nc c ly t mng cp nc khu vc D50 dn vo b cha nc ngm t bn ngoi to nh sau dung bm tng p bm nc ln b cha nc trn mi bng ng ng dn y D65. Bm lm vic 1 ngy 3 gi m bo cung cp y cc nhu cu dng nc cho bnh vin. * Phn thot nc H thng thot nc ca bnh vin thit k c lp gm mn thot nc x tiu, nc tm ra, ra sn v nc ma. H thng ng thng hi: cho ng ng, ng nhnh v cho b pht. H thng thot nc ra. Thot nc ra gm nc t cc chu ra, tm, nc t cc sn khu WC thu gom vo ng ng thot nc ra D125, D110 t trong hp k thut ca tng phng ri tp chung vo ng D200 bn ngoi ri thot ra h thng thot nc ngoi nh Nc ra sn, nc s c trong tng hm c dn xung b thu nc tng hm di cng trong tng to nh, t nc c bm ra ngoi. * Thot nc ma Thot nc ma trn mi (vt liu dng ng PVC v ph kin chu p lc cng tc 5kg/cm2<P<8kg/cm2) Lu lng tnh ton thot nc ma trn mi c xc nh theo cng thc Q=k.F.qs/10.000 = 2x1201,5x464,6/10.000=116 l/s Trong : Q : l lu lng nc ma F: din tch mi thu nc 1201,5m2 K: h s ly bng 2 Qs: cng ma l/s.ha tnh ti h ni = 484,6 l/s.ha *Cc cng trnh mi trng: o Khu tp kt rc thi tp trung.
o

Khu x l nc thi tp trung: cng sut thit k 200 m3/ngy m.

17

Trm bm nc sch t nc ging khoan, vi lu lng s dng hin ti khong 130-150 m3/ngy m.

CHNG 2 TNG QUAN V IU KIN T NHIN, KINH T, X HI KHU VC BNH VIN PH SN TRUNG NG
2.1. iu kin t nhin:

2.1.1. iu kin v a l, a cht a. V tr a l Bnh vin Ph sn Trung ng l Bnh vin chuyn khoa u ngnh v sn ph khoa nm Trung tm thnh ph , thuc qun Hon Kim H Ni vi din tch khong 1,37 ha. V tr khu t c qui hoch nh sau: - Pha Bc, ng Bc gip ng Trng Thi - Pha Ty, Ty Bc gip Bnh vin K - Pha ng gip ng Triu Quc t - Pha Nam gip ng Hai B Trng. Hng mc Bnh vin Ph sn Trung ng cng trnh nm trn khu t trng trc y l nh chuyn khoa nay c ph b gii phng mt bng. c UBND thnh ph H Ni, S quy hoch kin trc thnh ph ph duyt chi tit t l:1/500. b. c im a hnh v a cht Bnh vin Ph sn Trung ng c xy dng trn nn a hnh nm khu vc trung tm Thnh ph H Ni vi a hnh tng i bng phng, a tng v tnh cht a k thut ca chng tnh ti su 60,0m nh sau;
-

Lp 1: y l lp t lp, t ph liu xy dng, cht khng u. y l lp

t nm trn cng ph ton b din tch cng trnh. Gp chng caccs su t 1,6 3,2m.
-

c im: Thnh phn thch hc a dng, ch yu l t ln ph liu xy

dng, nn nh c tnh cht a cht cng trnh cng khng ging nhau.
18

Lp 2: St do chy chy: l lp t nguyn th u tin, chiu dy 1,5

2,8m. c im: st c mu xm en ln hu c phn b khng u. Trng thi do chy chy.

-

Lp 3: St do mm trong lp cn xem kp thu knh st chy ln hu c. L

lp t nguyn th th 2, chiu dy 2,0 5,5m. c im: st mu nu g, xm xanh trng thi do mm. Trong lp xen kp thu knh st pha do chy ln hu c.
-

Lp 4: st pha do cng l lp t nguyn th th 3, chiu dy bin thin ln 3

8m. c im: st pha c mu xm xanh, nu vng ln kt vn phn b khng u. Trng thi do cng i ch xen kp st pha do mm.
-

Lp 5:Ct pha xen kp trng thi do: L lp t nguyn th th 4, chiu dy

mng 1-3m. c im: Ct pha xen kp ct mu xm vng m en trng thi do.

-

Lp 6: Ct ht trung ln sn si t cui trng thi cht va: chiu dy 7,8-

11,0m. c im: ct ht trung mu xm vng ln nhiu sn si v t cui kt cu cht va. Sn si l thch anh phn b khng u.
-

Lp 7: ct ht trung ln t sn nh cht: l lp nguyn th th 6, chiu dy 5-

13m. c im: Ct ht trung mu xm vng ln t sn kt cu cht. Sn l thch anh phn b khng u.

-

Lp 8: sn si ln ct th v t ht cui rt cht: l lp t nguyn th th 7,

chiu dy 3,0 13,8m. c im: sn si ln ct th v nhiu ht cui, cui ch yu trong cnh ng knh 2-3m chim t l 10-20% mu xm xanh rt cht. Bnh vin c xc nh nh sau: Mt trc quay v hng Bc nhn ra trc ng ph Trng Thi, mt sau hng Nam i din vi nh iu tr t nguyn c ni vi nhau bng mt dy hnh lang v mt di cy xanh, mt bn hng ng gip vi khu cng ngh cao 7 tng qua mt khong sn v di cy xanh. Pha Ty gip vi bnh vin K 2.1.2. iu kin v kh tng thu vn 2.1.2.1. iu kin kh tng - kh hu S liu v kh tng thy vn khu vc H Ni tham kho theo S liu ca Trm Lng H Ni v Website http://www.vietnamtourism.com. a. Nhit khng kh: - Nhit trung bnh hng nm l 23,60C
19

- Nhit trung bnh cao nht l vo thng 6: 29.80C - Nhit trung bnh thp nht vo thng 1: 17,20C Nhit khng kh trung bnh cc thng trong nm (0C) ti khu vc H Ni c trnh by trong hnh 2.1:
30 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 Es at Wes t N orth

Hnh 2-1: Biu nhit khng kh trung bnh cc thng trong nm (0C)

20

b. m khng kh m tng i trung bnh nm ca khu vc bnh vin t 79% c nh gi l c m tng i trung bnh. Trong thng III, thi tit ang c s giao ma t ma kh chuyn sang ma ma nn khng kh lnh suy yu v thay th cho n l khi khng kh nng m nn to cho khu vc c m cao. Do , ti thng ny m tng i t gi tr ln nht l 87%. Vo thng XI, gi tr m tng i thp nht l 71% v khi gi ma ng bc vo ma ng dn n thi tit hanh kh, gim m khng kh. Cc gi tr m tng i trung bnh cc thng trong nm c th hin trong hnh 2.2:

82 80 78 76 74 72 70 68 66 64 1 2 3 4 5 6 7 8 9 10 11 12

Es at Wes t N orth

c. Nng v bc x - Lng bc x tng cng trung bnh hng nm H Ni l 122,8Kcal/cm 2 vi 1641 gi nng. Lng bc x trung bnh cc thng trong nm c biu din trong bng 2.1: d. Tc gi v hng gi Do khu vc ny nm trong vng kh hu nhit i gi ma dn n s phn s hng gi kh a dng v hng v cng . Hng gi thng tr l hng gi ng bc vo ma ng v hng gi ng nam vo ma h. Tc gi cc i l 20 25 m/s trong ma ma. Ti khu vc bnh vin tc gi ti thi im quan trc thng XI nm 2008 l 1,5 2,1 m/s.

21

Hnh 2-3: Hoa gi ti trm Lng nm 2007 e. Lng ma v lng bc hi Lng ma trung bnh hng nm l 1800mm. Mi nm c khong 114 ngy ma. Lng ma trung bnh cc thng trong nm (mm) c trnh by trong hnh 2.4 Bng 2-3: Lng ma trung bnh thng trong nm 2007 ti trm Lng n v: mm
Thng Lng ma I 3,0 II 25,0 III 29,4 IV 97,5 V 118,1 VI 210,9 VII 286,3 VIII 330,4 IX 388,3 X 145,0 XI 4,8 XII 20,6

Ngun: Trung tm T liu KTTV- Trung tm KTTV Quc gia

22

450 400 350 Lng ma (mm) 300 250 200 150 100 50 0 I II III IV V VI VII VIII IX X XI XII Thng

Hnh 2-5: Lng ma trung bnh thng trong nm 2007 ti trm Lng 2.1.2.2. c im ch thu vn Ch thu vn ca qun Hon Kim khng n thun ch b nh hng bi iu kin kh hu m cn b cc hot ng cng nghip v nng nghip chi phi. Mt khc, do a hnh mng trng nn hin tng ngp ng cng khng trnh khi. Tuy nhin, y cng l mt iu kin thun li pht trin kinh t ca qun Hon Kim, 2.2. iu kin kinh t - x hi 2.2.1. iu kin kinh t - x hi ca thnh ph H Ni Qi I nm 2008, thi tit rt m rt hi ko di him c trong 40 nm tr li y, cng s bin ng phc tp ca gi c - th trng nh hng ti tnh hnh pht trin kinh t x hi ca c nc ni chung v thnh ph H Ni ni ring. Song vi s quyt tm ch o ca Lnh o Thnh ph, pht huy nhng thnh tch v kt qu t c trong xy dng v pht trin kinh t x hi Th nm 2007, s phn u n lc ca cc cp cc ngnh v ton th nhn dn lao ng th , kinh t x hi ca H Ni qu I nm 2008 tip tc pht trin v tng trng so vi cng k nm trc: Tng sn phm ni a (GDP) tng 10,7%, gi tr sn xut cng nghip tng 15,2%, vn u t x hi tng 15,2%, tng mc bn l hng ha v doanh thu dch v tiu dng x hi tng 27,5%, kim ngch xut khu tng 24,9%,tnh hnh an ninh chnh tr v trt t an ton x hi c n nh, i sng nhn dn c m bo . iu kin v kinh t: Tng sn phm ni a (GDP)
23

Tng sn phm ni a (GDP) trn a bn thnh ph H Ni qu I nm 2008 tng 10,7% so vi cng k nm trc (l mc tng kh nht trong 5 nm gn y). - Ngnh cng nghip xy dng: vn duy tr mc tng kh vi gi tr tng thm 11,9% (ng gp 5,7% vo mc tng trung), cc ngnh dch v c gi tr tng them 9,9% (ng gp 5% vo mc tng chung). - Ngnh nng lm thy sn: C gi tr tng them 0,4% (ng gp 0,01% vo mc tng chung). Tc tng GDP qu I so vi cng k mt s nm nh sau; Nm 2004 2005 2006 2007 2008 Tc tng Nng lm Cng nghip GDP (%) thy sn (%) xy dng (%) 10,0 10,4 10,0 10,6 10,7 -0,2 3,9 -3,1 -1,0 0,4 13,6 11,7 12,2 12,8 11,9 Dch v (%) 7,9 9,7 8,9 9,3 9,9

Sn xut cng nghip: D kin qu I nm 2008, gi tr sn xut cng nghip trn a bn thnh ph H Ni tng 15,2% so vi cng k nm trc, trong kinh t Nh nc tng 5,8% (kinh t nh nc Trung ng tng 4%, kinh t nh nc a phng tng 11,2%, kinh t ngoi nh nc tng 15,1% v khu vc c vn u t nc ngoi tng 23,3%). Sn xut cng nghip nh nc trung ng D kin qu I nm 2008, gi tr sn xut cng nghip Nh nc Trung ng tng 4% so vi cng k nm trc vi 15/20 ngnh sn xut tng, trong mt s ngnh sn xut tng kh: Khai thc than (tng 21,8%), sn xut da (tng 26,4%), xut bn in, (tng 23,4%), sn xut ti vi , thit b thng tin (tng 21,4%), sn xut xe c ng c (tng 32,3%), sn xut ging t khc (tng 45,5%), Sn xut cng nghip Nh nc a phng Ga tr sn xut cng nghip Nh nc a phng qu I nm 2008 tng 11,2% so vi cng k nm trc vi 13/17 ngnh sn xut, trong mt s ngnh sn xut tng kh: xut bn in (tng 31,2%), sn xut khong phi kim loi (tng 35,1%), sn xut dng c chnh xc (tng 31,2%), sn xut khong phi kim loi (tng 35,1%), sn xut dng c chnh xc (tng 27,3%),4/17 ngnh sn xut gim l: cng nghip dt (gim 0,5%), sn
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xut trang phc (gim 15,4%), sn xut kim loi (gim 3,2%)v sn xut tivi thit b thng tin (gim 40,2%). Sn xut cng nghip ngoi Nh nc D kin qu I nm 2008, gi tr sn xut cng nghip ngoi Nh nc tng 15,1% so vi cng k nm trc, trong Cng ty TNHH t nhn tng 15,2%, Cng ty c phn khc tng 18,9%, doanh nghip t nhn tng 15,4%, hp tc x tng 0,8% v h sn xut c th tng 2,4%. Sn xut cng nghip khu vc c vn u t nc ngoi Ga tr sn xut cng nghip khu vc c vn u t nc ngoi tng 23,3% so vi cng k nm trc vi 16/19 ngnh sn xut tng, trong c mt s ngnh sn xut tng kh: sn xut trang phc (tng 185,1%), sn xut da tng 161,8%, sn xut giy v sn phm t giy (tng 122,35), ch to thit b my mc (tng 117,9%), sn xut cao su plasitic (tng 60,9%), sn xut dng c chnh xc (tng 60,8%),3/19 ngng sn xut gim l ch bin thc phm (gim 21,6%), ch bin g lm sn (gim 37,4%) v sn xut khong phi kim loi (gim 13,7%). Xy dng c bn: Thc hin vn u t xy dng c bn ngn sch Nh nc a phng: 3 thng u nm t 1480,3 t ng t 22,8% k hoch nm. u t trc tip nc ngoi: d kin qu I nm 2008, h ni thu ht c 72 d n (c cp mi v tng vn) vi tng s vn ng k l 542 triu USD. So vi cng k nm trc, s d n thu ht bng nhau, s vn u t tng 162%. Tng vn u t x hi trn a bn H Ni qu I nm 2008 d kin t 8.340 t ng tng 15,2% so vi cng k nm trc, trong vn trong nc t 6.440 t ng tn 12,2%, chim 77,2% tng vn u t. Trong tng s vn trong nc vn u t ca nh nc tng 22,2%, doanh nghip Nh nc t u t tng 5,6%, cc thnh phn kinh t ngoi nh nc u t tng 14%, vn ca dn t u t tng 7,9%. Vn nc ngoi l 1.900 t ng tng 26,7%, chim 22,8% tng vn u t. Thng mi dch v: + Ni thng: 3 thng u nm 2008, d kin tng mc bn hng ha v doanh thu dch v tiu dng x hi trn a bn H Ni tng 27,5% so vi cng k nm trc, trong bn l tng 29,6%. Ni thng H Ni t c tc tng kh cao do c h thng bn l pht trin nhanh chng vi mng li ca hng v siu th tri rng khp ni, c quy m ngy cng pht trin, thu ht ngi tiu dng; Mt khc yu t tng gi qu I nm 2008 cao hn hn tc tng gi cc nm trc cng l mt nguyn nhn y doanh thu thng mi dch v tng ln nhiu so vi cng k nm trc.
25

+ Ngoi thng: D kin qu I nm 2008, kim ngch xut khu trn a bn t 1226,3 triu USD tng 24,9% so vi cng k nm trc, trong xut khu a phng 711,5 triu USD tng 37,7%. Cc mt hng xut khu ch yu u tng: hng nng sn tng 5,6% hng dt may tng 17,4%, giy dp tng 2,7% hng in t tng 13%, my in phun tng 51,7%, hng th cng m ngh tng 3,1%, xng du tm nhp ti xut tng 19,1% v hng khc tng 35,3% + Kim ngch nhp khu qu I nm 2008 trn a bn H Ni t 4368,5 triu USD tng 33,3% so vi cng k nm trc, trong nhp khu a phng 1479,9 triu USD tng 30,6%. Mt hng ch yu nhp khu l my mc thit b ph tng tng 35,9%, vt t nguyn liu tng 32,2%, xng du tng 39,9% hng tiu dng tng 17,8%. + Du lch: Khch Quc t n H Ni qu I c khong 326 ngn khch, khng tng so cng k; khch ni a n H Ni khong 1.438 ngn khch, tng 12,7% doanh thu khch sn n hnh tng kh. Doanh thu du lch qu I nm 2008 tng 23,2% so cng k nm trc. + Ga c th trng: Ch s gi tiu dng thng 3 nm 2008 tng 1,9% so vi thng trc vi hu ht cc ngnh hng u tng, trong hng lng thc tng 17,85% l tc tng ln nht ca hng lng thc trong nhiu nm gn y. Cc ngnh hng khc tng nh. Ring hng thc phm gim 0,88% so thng trc., do thng ny cc thc phm ti sng (tht, g, c, trng,) ng gi mc cao, rau xanh do thi tit m pht trin tt, gi gim mnh. Gi vng thng 3 tng 2,55% so thng trc vi mc gi ph bin l 1.900 ngn ng/1ch vng 99,99. Gi la m gim 4,95% so thng trc. + Ch s gi tiu dng qu I nm 2008 tng 15,3% so cng k nm trc. Ch s gi tiu dng thng 3 nm 2008 so thng 12 nm 2007 tng 9,33%, tc tng gi bnh qun 1 thng trong qu l 3.02% thng. Ch s gi vng qu I nm 2008 so cng k tng 38,37%, ch s gi vng thng 3 nm 2008 so thng 12 nm 2007 tng 14,28%. Ch s gi la M qu I nm 2008 gim 1,71% so cng k nm trc, ch s gi la m thng 3 nm 2008 gim 5,17% so thng 12 nm 2007. Vn ti: D kin qu I nm 2008 so cng k nm trc, khi lng hng ha vn chuyn tng 6,2%, khi lng hng ha lun chuyn tng 10,8%, doanh thu vn chuyn hng ha tng 28,4%, khi lng hnh khch vn chuyn tng 15%, khi lng hnh khch lun chuyn tng 15,5%, doanh thu vn chuyn hnh khch tng 18,6%. Bu chnh, vin thng Bu chnh: D kin qu I nm 2008, doanh thu bu chnh t 223,9 t ng, tng 12,3% so cng k nm trc.
26

Vin thng: S thu bao tng thm trong qu I nm 2008 l 58.740 thu bao in thoi v 31.220 thu bao Internet. Doanh thu vin thng t 643,4 t ng, tng 13,8% so cng k nm trc. Sn xut nng nghip: Kt qu sn xut v ng 2008. n nay, ton thnh ph thu hoch song cy trng v ng v ang tin hnh gieo trng cy v Xun. Tng din tch gieo trng v ng t 11.980ha, tng 6,55% so cng k nm trc (tng 738ha). Din tch, nng xut mt s cy v ng nm nay so vi cng k nh sau; Ng din tch 6.617ha (tng 10,4%), nng sut 30,4t/ha (tng 5,5%); khoai lang din tch 1.308ha (tng 16,4%), nng sut 66,93t/ha (gim 0,1%); rau cc loi din tch 2.962ha (gim 1,4%), nng sut 176 t/ha (tng 7,1%); u tng din tch 314ha (gim 21,8%), nng sut 10,9t/ha (tng 2,4%) Chn nui, thy sn Chn nui gia sc nhn chung n nh, khng c dch v bnh xy ra. S ln git m trong dp tt Nguyn n Mu T l 49.720 con (gim 1,27% so cng k nm trc) vi sn lng tht hi 3.368 tn (gim 0,4%). c tnh n ln c mt sau tt l 315,6 ngn con (gim 4,7% so cng k nm trc). D kin n gia cm ton thnh ph qu I nm 2008 tng nh so cng k nm trc. Sn lng c thu hoch nm 2007 t 10.774 tn, tng (5,85% so nm trc), sn lng tm 28 tn (gim 9,68%) Lm nghip Thc hin phong tro Tt trng cy Xun Mu T nm 2008, ton thnh ph trng c 89 ngn cy lm nghip v cy n qu. n v trng c nhiu nht l ng Anh (44.286 cy), Gia Lm (14.985 cy), Thanh Tr (11.554 cy)S cy trng mi ch yu cc trc ng mi m, cc khu th, khu dn c mi thnh lp, trng hc Tn dng, ngn sch D kin n cui thng 3 nm 2008, tng ngun vn huy ng ca cc t chc trn a bn H Ni t 369.092 t ng, tng 1,61% so thng trc v tng 0,01% so cui nm 2007, trong tin gi dn c tng 1,55% v tng 3,27%, tin gi ca cc t chc kinh t tng 1,65% v gim 0,17%. Tng d n cho vay thng 3 t 211.360 t ng, tng 1,06% so thng trc v tng 10,52% so cui nm 2007, trong d n ngn hn tng 0,81% v tng 17,18%, d n trung v di hn tng 1,52% v tng 0,31%. iu kin v x hi + Vn ha x hi: Hot ng vn ha thng tin th dc th thao v l hi dp tt nguyn n Mu T 2008 c t chc tt vi nhiu hnh thc phong ph: Thnh ph t
27

chc thm hi, chc tt, tng qu v tr cp cho cc i tng chnh sch v cc i tng khc chu o, m bo mi nh, mi ngi u c tt. + Trt t an ton x hi: Hai thng u nm 2008, trn a bn thnh ph H Ni pht hin v xy ra 582 v phm php hnh s (gim 24% so cng k nm trc) vi 461 i tng b bt gi theo lut (gim 13%). Tng s v bun bn, tng tr, vn chuyn ma ty trong 2 thng u nm 2008 l 375 v (tng 50% so cng k nm trc) bt gi 450 i tng (tng 60%). Hai thng u nm 2008, ton thnh ph H Ni xy ra 88 v tai nn giao thng (gim 29% so cng k nm trc)lm b thng 41 ngi (gim 43%) v lm cht 57 ngi (gim 23%). S v chy n xy ra trong 2 thng l 35 v (gim 5 v so cng k) lm 1 ngi cht, 2 ngi b thng (bng s ngi cht v b thng cng k nm trc) v lm thit hi ti sn khong 381 triu ng (gim 1,5 t ng). 2.2.2. iu kin kinh t - x hi ca qun Hon Kim. a. iu kin v kinh t Phn u t tc tng trng gi tr sn xut bnh qun hng nm giai on 2001 2010 khong 11% nm. Trong giai on 2006 2010 khong 11% nm. Trong : * Dch v: - Xy dng Hon Kim thnh trung tm dch v, bn bun v bn l hng ha v du lch ln ca Th . Phn u t tc tng trng gi tr sn xut cc ngnh dch v bnh qun hng nm giai on 2001 -2010 khong 11% nm. - Tng bc chuyn dch c cu kinh t theo hng tng nhanh cc ngnh dch v trnh cao, cht lng cao, pht trin mnh cc dch v ti chnh, ngn hng, thng tin, t vn - Tp trung khai thc th mnh ca Qun, pht trin hot ng du lch, ch trng cc loi hnh du lch l hi, tham quan di tch vn ha , lch s v kin trc. Kt hp pht trin du lch vi bo tn, tn to cc di tch v danh lam thng cnh. - C bn xa b cc hot ng dch v trn va h, tr mt s tuyn ph chuyn kinh doanh trong khu ph c.. To lp phong cch vn minh hin i trong cc hot ng dch v. - Hnh thnh mt s ta nh a nng: khch sn, vn phng cho thu, phng hi ngh, trn khu vc ph c. - Nghin cu xy dng h thng siu th chuyn mt s truyn thng thnh siu th. - Hnh thnh cc tuyn ph chuyn kinh doanh trong khu vc ph c. * Cng nghip:
28

- Phn u t tc tng trng gi tr sn xut cng nghip m rng, bnh qun hng nm giai on 2001 2010 khong 8,7% nm. - Chuyn dch c cu ngnh: t cng nghip sang dch v, c cu sn phm cng nghip: t sn phm th sang cc sn phm tinh v khng nhim mi trng ti cc c s sn xut cng nghip trn a bn Qun. - Gim quy m sn xut cng nghip vi cc sn phm th, tn nng lng, nguyn liu v c nhiu ph thi. Pht trin cng nghip tinh xo, hin i ha mt s ngh tiu th cng nghip truyn thng theo hng to bn sc ha c o cho ph c. b. Pht trin v vn ha x hi * Gio dc o to: - Gi vng v tr hng u v cht lng gio dc o to; xy dng trng ra trng, lp ra lp. m bo mi bc tiu hc v trung hc c s c t 2-3 trng t chun quc gia. n 2010 c phng hc kin c cho 100% s trng tiu hc; c 100% hc sinh tiu hc v 50% hc sinh trung hc c s c hc 2 bui /ngy - Nng t l lao ng c o to ln 80-90% vo nm 2010. * Vn ha Thng tin: - Duy tr v nng cao cht lng cuc vn ng ton dn on kt xy dng i sng vn ha nng cao cht lng cc hot ng vn ha, ngh thut, xy dng v b tr hp l cc im vui chi gii tr, cc cng vin, tng i trn a bn. - u t tn to, nng cp mt s di tch tiu biu, bo v v tn to mt s khu ph c, khai thc c hiu qu cc danh lam thng cnh: khi phc v duy tr tt cc l hi truyn thng. * Th dc th thao: y mnh phong tro th dc th thao qun chng, kt hp pht trin th thao thnh tch cao mt s mn ph hp. -u t xy dng cc c s phc v cc hot ng luyn tp v thi u trn a bn v nng cp khu th thao Long Bin. * Y t: - Thc hin tt cc chng trnh y t quc gia, kim sot v x l kp thi cc dch bnh, khng xy ra cc dch bnh ln. Nng cp v hon thin h thng y t c s, thc hin ci to, nng cp cc trm y t ca 18 phng. c. Pht trin h thng h tng k thut * H thng giao thng
29

- Thc hin theo quy hoch chi tit qun Hon Kim, H Ni t l 1/2000 (phn quy hoch t v giao thng) c UBND thnh ph ph duyt. * Thng in; - Tp trung nng cao cht lng cp in, thc hin ci to h thng ng dy trung th, in p 6KV v 10KV thnh ng dy c in p 22KV. u t xy mi mt s ng dy trung th 22KV. - Ci to v xy mi h thng cc trm bin p m bo cung cp in mt cch n nh v cng sut phc v sn xut v tiu dng. - Thc hin ngm ha h thng ng dy h th; xy dng mt s tuyn dy h th. * Cung cp nc sch: - m bo cung cp nc sch cho nhu cu sinh hot v sn xut ca nhn dn vi tiu chun 170 lt/ngi/ngy m. - Hon thnh lp t h thng ng truyn dn 2 phng ngoi ; phng Phan Chu Trinh, phng Trn Hng o. - B sung ngun nc cp m bo cp nc n nh v p lc nc cp. *H thng thot nc Hon thnh d n ci to h thng thot nc ca Thnh ph giai on1 trn a bn qun.

CHNG 3 HIN TRNG MI TRNG KHU VC B TC NG TIU CC TRC TIP T HOT NG CA BNH VIN PH SN TRUNG NG 30

 nh gi hin trng cht lng mi trng khu vc Bnh vin Ph sn Trung ng, Bnh vin Ph sn Trung ng phi hp vi Cng ty TNHH t vn Mi trng H Ni tin hnh kho st, ly mu, phn tch cc thng s mi trng khng kh, nc v t khu vc bnh vin. S v tr quan trc hin trng mi trng khu vc Bnh vin Ph sn Trung ng v kt qu kho st c th s c trnh by di y. 3.1. Hin trng cht lng mi trng khng kh V tr quan trc Hin trng cht lng mi trng khng kh khu vc quanh Bnh vin Ph sn Trung ng c nh gi da trn kt qu quan trc ti 3 im nh m t trong bn v tr cc im quan trc v thng tin cc im quan trc c trnh by bng 3-1. im KK1 c o Gia nh B v C, v y cng l ngun gy nhim khng kh chnh cho bnh vin.im KK2 Cnh nh G, KK3 c o Gia nh C v nh D ti khu vc trong bnh vin , KK4 Gip bnh vin K gn nh n , KK5 Cng ra vo, cnh nh A ti Bnh vin v KK6 Gia nh G v nh E Bng 3-1: Cc im quan trc cht lng mi trng khng kh K hiu KK1 KK2 KK3 KK4 KK5 KK6 Ta Kinh 105o5113 105o5111 105o5117 105o5114 105o5112 105o5115 Ch tiu quan trc -

V 20o5516 20o5517 20o5516 20o5519 20o5517 20o5518

M t v tr quan trc Gia nh B v C Cnh nh G Gia nh C v nh D Gip bnh vin K gn nh n Cng ra vo, cnh nh A Gia nh G v nh E

Ch tiu quan trc iu kin vi kh hu: khng kh, nhit m biu t, m khng kh, tc gi Ch tiu quan trc cht lng khng kh: bi l lng, nng cc cht nhim trong khng kh NO2, SO2, CO. o c mc n: Leq, L10, L9
31

Phng php quan trc Phng php ly mu, o c v phn tch ph hp vi tiu chun Vit Nam hin hnh. Kt qu quan trc a. Hin trng cht lng khng kh Hin trng cht lng mi trng khng kh c nh gi da trn kt qu o nhanh ngoi hin trng v kt qu phn tch trong phng th nghim. Tng hp kt qu phn tch cht lng mi trng khng kh c trnh by bng 3-2. Bng 3-2: Kt qu hin trng cht lng mi trng khng kh n v KK1 KK2 KK3 KK4 KK5 KK6 TCVN 59372005 (1 gi) Vi kh hu 1 2 3 4 5 6 7 8 9 10 1 2 Nhit
0

TT

Thng s

15,8 20,5 51,2 N 0,9

14,1 21,6 51,5 N 2,5 0,37 0,10 0,13 0,05

14,7 21,4

17,1

16,8

14,5 21,4

Nhit (*C) m biu t m % khng kh Hng gi Tc gi CO NO2 SO2 NH3 VOCs Ting n Bi m/s

45,3 50,7 N 2,0 0,48 0,12 0,18 0,12 N 1,2 0,34 0,14 0,20 0,09

44,4 51,1 N 1,5 0,52 0,15 0,25 0,05 N 2.2 0,43 0.11 0,16 0,09 30 0,2 0,35 -

Cht lng khng kh mg/m3 0,35 mg/m3 0,12 mg/m3 0,15 mg/m3 0,06

mg/m3 KHP KHP dBA mg 61,2 0,16 58,3 0,15

KHP KHP KHP KHP 60,1 0,28 60,2 0,15 64,3 0,26 59,4 0,21 0,3

Ting n v bi

Ngun: Cng ty TNHH T vn Mi trng H Ni (thi gian ly mu v quan trc, 10/09/2009) Ghi ch:

32

TCVN 5937-2005: Cht lng khng kh. Tiu chun cht lng khng kh xung quanh. Nhn xt v nh gi
-

Kt qu quan trc iu kin vi kh hu cho thy: m khng kh trung bnh

l 78% gn ging vi l m trung bnh trong khu vc (77%), nhit trung bnh 24,6oC, tc gi trung bnh 1,8 m/s. Kt qu quan trc cht lng khng kh cho thy:

Tt c cc thng s quan trc cht lng mi trng khng kh khu vc bnh vin u nm trong gii hn cho php so vi TCVN 5937-2005 (quan trc trong 1gi).

Hm lng trung bnh ca CO; NO2; SO2 tng ng l 1.648; 10; 14 mg/m3 thp hn rt nhiu so vi tiu chun cho php. Hm lng bi trung bnh trong 1 gi l 69 g/m3 cng thp hn nhiu so vi tiu chun so php. Cc thng s quan trc ti v tr KK5 cao hn 4 v tr cn li l do v tr quan trc nm gn cng ra vo, cnh nh A Bnh vin c lu lng xe lu thng ln.

Theo kt qu o bng 3.2. th nng cc cht kh c hi nh CO, SO2, NO2, NH3, VOCs c xc nh trong khu vc bnh vin u c gi tr nh hn gii hn cho php (GHCP) so vi tiu chun Vit Nam 5937 2005 v cht lng khng kh Tiu chun cht lng khng kh xung quanh (trung bnh trong mt gi ) v TCVN 5938 2005 v cht lng khg kh Nng ti a cho php ca mt s cht c hi trong khng kh xung quanh (trung bnh trong 1 gi) 3.2. Hin trng cht lng mi trng nc 3.2.1. Hin trng cht lng mi trng nc mt Bng 3.3. Cht lng nc mt ti ga thot nc mt trong bnh vin TT Ch tiu phn tch n v Kt qu TCXD 188 1996 (loi B) 5-9 40 50

1 2 3 4 5

pH Nhit dn DO BOD5

7,7 19,2 74 1,6 220

33

mS/m mg/l mgO2/l

6 7 8 9 10 11 12 13

COD SS Tng Nit Tng pht pho As Du m Ag Colifom

mgO2/l mg/l mg/l mg/l mg/l mg/l mg/l

227 171 68,0 5,0 0,02 3,5 <0,002

100 100 0,1 1,0 10.000

MPN/100ml 6,3.105

i chiu vi tiu chun TCXD 188-1996 v gi tr gii hn cho php ca cc cht nhim trong nc thi th - Tiu chun thi (loi B) cho thy cc ch tiu phn tch nh BOD5, COD, hm lng cht rn l lng (SS), Coliform, oxi ha tan (DO) u khng m bo tiu chun cho php. Gi tr DO thp (1,6 <2) lm gim qu trnh t lm sch ca nc. Gi tr COD, BOD vt tiu chun cho php nhiu ln (>2,27 4,4 ln) chng t trong nc c cha lng cht hu c ln. Gi tr SS, Coliform u cao hn TCVN kh nhiu (SS ln hn 1,71 ln; Coliform ln hn 63 ln tiu chun cho php). Nh vy, c th thy rng: nc mt trong bnh vin ang b ln dng nc thi. y l nguy c tim n tc ng tiu cc ti cht lng ngun nc tip nhn t h thng thot nc ca thnh ph. Vic ngun nc mt trong bnh vin c ln nc thi c th gii thch c l do trc y h thng thot nc ca bnh vin l h thng thot nc chung cho c nc thi v nc mt. Ti thi im ny, mng li thu gom ring nc thi ca bnh vin ang c hon thin nn mt s im thot nc thi ca cc khu nh cha c u ni hon ton do vy h thng thot nc mt vn c ln nc thi t cc khu nh ny chy vo. Phng php quan trc Phng php ly mu theo TCVN: TCVN 5992-1995: Cht lng nc. Ly mu. Hng dn k thut ly mu. TCVN 5993-1995: Cht lng nc. Ly mu. Hng dn bo qun v x l mu. TCVN 5996-1995: Cht lng nc ly mu. Hng dn ly mu sng v sui.

34

Cc yu t nh nhit , pH, DO, c, dn in, mui c o nhanh ngay ti hin trng. Mu nc c ly vi dung tch 01 lt v c bo qun theo tiu chun hin hnh ca Vit Nam. Mu nc c ng trong bnh nha, mu vi sinh c ng trong l thy tinh c v trng. Thit b o c c s dng my o cht lng nc ca Nht Bn (TOA) c kim nh trc khi s dng. Cc thng s cht lng nc khc c ly mu mang v phng Th nghim phn tch theo cc phng php chun hin hnh ca th nghim mi trng. Ghi ch: TCVN 5942-1995: Cht lng nc. Tiu chun cht lng nc mt 3.2.2. Hin trng mi trng nc cp sinh hot: Bng 3.4. Cht lng nc cp sinh hot trong bnh vin TT Thng s n v Nc cp sinh hot NSH1 NSH2 NSH3 Quyt nh 1329/2002/Q - BYT 6,5 -8,5 300 1,5

Ph 6,6 6,6 6,6 cng mg CaCO3/l 157 158 157 Amni mg/l <0,01 <0,1 <0,06 (NH4+) 4 St (Fe) mg/l <0,1 <0,1 <0,1 0,5 5 Mangan mg/l <0,1 <0,1 <0,1 0,5 6 Asen (AS) mg/l 0,010 0,005 0,007 0,01 7 Nitrat (NO3 ) mg/l 0,47 0,48 0,48 50 8 Nitrit (NO2 ) mg/l <0,01 <0,01 <0,01 3 9 Clorua (Cl-) mg/l 7,8 7,8 7,7 250 10 Florua (F-) mg/l 0,38 0,38 0,38 0,7 1,5 11 E.Coli MPN/100ml 0 0 0 0 12 Tng MPN/100ml 0 0 0 0 Coliform Ghi ch: - Mu NSH1: Nc cp sinh hot ti nh n - Mu NSH2: Nc cp sinh hot ti nh A - Mu NSH3: Nc cp sinh hot ti nh E i chiu vi tiu chun v sinh nc n ung ban hnh km theo Quyt nh s 1329/2002/BYT Q ngy 18/4/2002 ca B trng B Y t th cc ch tiu phn tch trong mu nc cp sinh hot ti Bnh vin Ph sn Trung ng u nm trong gii hn cho php. 3.3. Mi trng t; Bng 3.5. Cht lng t khu vc d n TT Thng s n v 1
35

1 2 3

Kt qu phn tch 2

1 2 3 4 5 6 7

m Mn Hm lng (SiO2) Hm lng (Fe2O3) Hm lng (MgO) Hm lng (CaO) Hm lng anhydrit sunfuric (SO3)

% % % % % % %

24,9 1,65 66,0 7,19 1,35 2,45 0,13

16,0 2,39 63,1 5,99 1,40 4,90 0,26

20,45 2,02 64,55 6,59 1,38 3,7 0,2

Ghi ch: - Mu 1: Mu t gia nh C v nh D - Mu 2: Mu t khu trng cy, cnh nh C - Mu 3: Mu t cnh nh B t trn khu vc bnh vin ch yu l cho mc ch s dng, nh , bn hoa. Hot ng ca D n hu nh khng c nh hng ng k n mi trng t

CHNG 4 THNG K, NH GI CC NGUN TC NG TIU CC I VI MI TRNG T HOT NG CA BNH VIN PH SN TRUNG NG Cc cht thi bnh vin hu ht l cht thi nguy hi, kh nng lan truyn dch bnh v ly nhim cao. Cc ngun pht sinh cht thi bnh vin tng i khc so vi cc c s sn xut kinh doanh v ph thuc ch yu vo cc phng khoa chc nng. 4.1. i vi kh thi, ting n v rung 4.1.1. Ngun pht sinh
36

Cc ngun pht sinh kh thi, ting n v rung ti Bnh vin Ph sn Trung ng trong qu trnh hot ng bao gm:
-

Cc b pht v h thng thot nc thi ca bnh vin. Kh sinh ra ch yu l H2S, CO2, CH2, do qu ttrnh phn hy cc cht hu c.

Cc cht kh, hi pht sinh t cc phng xt nghim, kho ha cht, dc phm. Hi ha cht t cc dung mi lm v sinh, ty ra sn. Cc phng tin giao thng ra vo tng hm (ch yu l t, xe my). Tc nhn gy nhim gm bi, SOX, NOx, CO, HC, ting n.

Kh thi do hot ng ca my pht in d phng Ting n v rung Mi sinh ra trong qu trnh khm v cha bnh, ty trng Phng x t hot ng ca cc phng chp X-quang Tia phng x pht sinh t cc my chp phim X Quang, cc thi b Laser, cc my scan.

a. Kh thi do hot ng ca my pht in d phng Trong qu trnh hot ng, bnh vin ch yu s dng in thp sng v vn hnh cc thit b, my mc chuyn khoa nn khi c s c v in hoc mt in, bnh vin s s dng my pht in (cng sut 100 KVA) duy tr hot ng. Ngun nhin liu cn cho hot ng ca my pht in l du DO. Khi my pht in hot ng s pht sinh ra kh thi, trong c cc thnh phn nhim bi, SO2, SO3, NOx, CO, VOCs. Tuy nhin, my pht in d phng ch hot ng khi mt in nn vn nhim khng kh t ngun pht sinh ny khng ng lo ngi. b. Kh thi t phng tin giao thng Phng tin giao thng bao gm xe cu thng, xe hi, xe gn my ra vo trong khun vin bnh vin ch yu s dng nhin liu l xng, du DO. Khi nhin liu b t chy s pht sinh cc cht nhim l: bi, SO2, NO2, CO. Tuy nhin, lng xe c php lu thng trong bnh vin rt t nn ti lng nhim t ngun ny khng ng k v khng c kh nng gy nhim mi trng trn din rng. c. Ting n v rung
37

Bnh vin c th ni l mt trong nhng mi trng i hi yn tnh cao nht, do cc hot ng bn trong bnh vin lun hng ti vic gim thiu ting n n mc thp nht c th, thm ch ngay c vic giao tip gia cn b nhn vin bnh vin v bnh nhn, thn nhn thm nui bnh v gia cc thn nhn thm nui bnh vi nhau. Mc d vy, xt mt cch tng th, hot ng ca bnh vin vn c mt s ngun gy ra ting n vi cc mc n khc nhau. Cc ngun gy n in hnh nht trong bnh vin c th k l: - Hot ng ca my pht in trong nhng trng hp in li quc gia b mt. - Hot ng ca cc phng tin lu thng c php lu hnh trong bnh vin nhng ch nhng khu vc qui nh (xe cu thng, xe ch hng ha vo kho, xe t, v.v.). - S va chm ca cc dng c y khoa trn cc xe y chuyn dng trong cc khu iu tr bnh v gia cc hnh lang lin kt. Hot ng ca cc my mc thit b phc v cho cc cng trnh ph tr (cc loi my bm, my thi kh cho phc v trm x l nc thi tp trung, v.v).
-

Hot ng ca con ngi trong bnh vin.

Cc ngun gy n k trn, ngoi tr ngun t my pht in v my thi kh phc v trm x l nc thi, cc ngun cn li u c mc n rt thp v thc t khng gy nh hng n mi trng bn trong bnh vin cng nh mi trng xung quanh. d. Mi sinh ra trong qu trnh khm v cha bnh, ty trng Mi, hi sinh ra t dung mi kh trng nh Cloramin, cn, ete, foocmon khu vc phng thanh trng, phng xt nghim, mi thuc khng sinh, mi cc dch v, mi do s phn hu cht hu c, mi hi ca nc thi, rc thi bnh vin, nh xc cht bnh nhn, v.v. Ring hi x t cc l hp nhit 250 oC tiu dit cc vi trng gy bnh. Tuy vy, hi x ra t l hp vn cn kh nng gy nh hng xu n nhn vin lm vic ti y do nng bc v mi hi. e. Phng x t hot ng ca cc phng chp X-quang Nguyn l lm vic ca my X-quang l to ra ngun chiu x l tia R-ghen, tia ny c tc dng chiu chp chun on tnh trng c th nhng ng thi n c kh nng ph hu t bo, kch thch mt s phn ng c hi trong c th v ngoi mi trng gy ra nhng tc ng c hi mang tnh cht tim tng 4.1.2. Tc ng do nhim mi trng khng kh

38

Ngun nhim khng kh trong qu trnh hot ng ca Bnh vin ch yu l kh thi my pht in d phng v cc mi hi thi bc ra t khu tp trung rc, khu x l nc thi. Tc nhn gy ra nhim mi trng khng kh trong trng hp ny l cc sn phm chy ca du DO (hn hp cc kh SOx, NOx, CO, CO2, v.v.). Ngoi ra cn c cc kh gy mi nh H2S, NH3, CH3SH v cc kh khc nh CH4, CO2 phng thch do s phn hu k kh vt cht hu c c trong rc v nc thi. Tt c cc loi kh thi, bi v cc cht gy mi ny u c kh nng gy nh hng n mi trng v sc kho cng ng, mc tc ng s cn ph thuc vo nng ca chng trong khng kh, thi gian tc dng v c im vi kh hu ti khu vc bnh vin. Xt c th cc cht nhim khng kh chnh do Bnh vin thi vo kh quyn, c th nh gi c mt s tc ng chnh nh sau: a. Tc ng i vi sc kho con ngi Cc cht nhim khng kh c th tc ng ln sc kho cng ng trong vng chu nh hng ca cc ngun thi t bnh vin, c bit l nhng i tng chu tc ng gn khu vc gy nhim. Cc tc hi i vi sc kho ph thuc vo cc cht nhim c th nh sau: Kh SOx: l nhng cht gy nhim kch thch, thuc vo loi nguy him nht trong s cc cht kh gy nhim khng kh. nng thp SO 2 c th gy co git c trn ca kh qun. Mc ln hn s gy tng tit dch nim mc ng h hp trn. Cao hn na lm sng nim mc. Tc hi ca SO3 cn mc cao hn v khi c c SO2 v SO3 cng tc dng th tc hi li cng ln. SO2 c th gy nhim c da, lm gim ngun d tr kim trong mu, o thi amoniac ra nc tiu v kim tra nc bt. c tnh chung ca SO2 th hin ri lon tiu chuyn ha protein ng, thiu cc vitamin B v C, c ch enzym oxydaza. S hp th lng ln SO2 c kh nng gy bnh cho h to huyt v to ra methemoglobin, tng cng qu trnh oxy ha Fe(II) thnh Fe(III). Nhng vng dn c xung quanh cc ngun thi kh SOx thng c t l dn chng mc cc bnh h hp cao.
-

Kh NO2: l mt kh kch thch mnh ng h hp. Khi ng c cp tnh b ho d di, nhc u, gy ri lon tiu ha. Mt s trng hp gy ra thay i mu, tn thng h thn kinh, gy bin i c tim. Tip xc lu di c th gy vim ph qun thng xuyn, ph hu rng, gy kch thch nim mc. nng cao 100 ppm c th gy t vong.
-

Oxit cacbon CO: y l mt cht gy ngt, do c i lc vi Hemoglobin trong mu mnh hn oxy nn n chim ch ca oxy trong mu, lm cho vic cung cp oxy cho c th b gim. nng thp CO c th gy au u, chng mt. Vi nng bng

39

10 ppm c th gy gia tng cc bnh tim. nng 250 ppm c th gy t vong. Con ngi sng trong cc khu vc nhiu CO thng b xanh xao, gy yu. b. Tc ng i vi ng, thc vt v cng trnh i vi ng vt: ni chung cc cht nhim c tc hi i vi con ngi u c tc hi i vi ng vt hoc trc tip qua ng h hp hoc gin tip qua nc ung hoc cy c b nhim bi cc cht nhim khng kh. Cc nghin cu v vn ny cha nhiu c th khng nh l cc kh SO2, NO2, cc axit, kim, v.v. u gy tc hi cho ng vt v vt nui.
-

i vi thc vt: cc nghin cu cho thy r hn nh hng ca cc cht gy nhim khng kh i vi thc vt. C th:
o

SO2 lm nh hng ti s pht trin ca cy ci khi c nng trong khng kh bng 3 ppm. nng cao hn c th gy rung l v gy cht cy.

o CO nng 100 ppm-10.000 ppm lm rng l hoc gy bnh xon l, cy non cht yu. o Bi bm trn b mt l lm gim kh nng h hp v quang hp ca cy. - i vi cc cng trnh v ti sn: khi thi cha cc cht NO 2, SO2, H2S, v.v. khi gp kh tri m t to nn cc axit tng ng gy n mn cc kt cu cng trnh, thit b my mc, lm gim tui th ca chng. Kh CO2 khi tc dng vi hi m to nn H2CO3 c th n mn da. c. Tc ng n vi kh hu Trong s cc kh thi ni trn c mt s kh c tc ng xu ti kh hu nh SO 2, NO2, v.v. c th to nn cc m ma axit. Khi NO x gp phn lm thng tng ozon, CO2 gy hiu ng nh knh, lm tng nhit , lm tng mc nc bin, v.v. Cc loi kh, mi pht tn nhanh trong khng kh cng vi vi trng gy bnh s tc ng trc tip n sc kho bnh nhn, thn nhn, cn b cng nhn vin v lm tng nng cc cht nhim trong mi trng. Nhn xt: Nh cp phn trn, trong s cc ngun thi kh, n, rung ca Bnh vin Ph sn Trung ng, th cc ngun nhim kh, bi chim phn rt nh v hu nh khng gy tc ng n mi trng v sc kho cng ng khu vc xung quanh bnh vin. Mt s ngun gy ra nhim khc nh mi, n, phng x t nh hng n mi trng v sc kho cng ng do bnh vin c nhng bin php gim thiu c th xem chng 5 d. Tc ng do tia phng x, in t trng
40

Tia phng x, in t trng c th pht tn ra t cc thit b cng hng t, in t mch rn, mch IC v k thut vi x l, thit b chun on, thit b y t o v iu tr chuyn bit, cc thit b X-quang nh my X quang c sng, X quang cao tn, Xquang k thut s, my X quang v thit b laser, laser bn dn, c bit, tia phng x ch yu l pht tn ra t phng X Quang c thit k s dng vt liu, ph vt liu cch in, bin php chng tia phng x. An ton i vi cc khu vc ln cn. Vic p dng cc bin php m bo an ton bc x hn ch s nh hng ca tia phng x i vi mi trng v con ngi. Do vy, s nh hng ca tia phng x, sng in t l khng gy nh hng ng k 4.2. i vi nc thi 4.2.1. Ngun pht sinh nc thi Nc thi bnh vin bao gm 03 ngun: nc thi y t, nc thi sinh hot v nc ma chy trn. a. Nc thi y t Nc thi y t pht sinh t cc phng khm, phng phu thut, phng th nghim, xt nghim v cc khoa trong bnh vin. Ngoi ra, ngun nc thi y t cn pht sinh t phng thanh trng dng c y khoa vi nhit lng cao, t nh git ty, v.v. Nc thi ny cha nhiu vi khun, mm bnh, mu, cc ha cht, dung mi trong dc phm, l ngun ly lan dch bnh c bit nguy him nu khng c x l trc khi thi ra mi trng, nht l i vi nc thi c x ra t nhng bnh vin hay nhng khoa truyn nhim, ly nhim. b. Nc thi sinh hot Nc thi sinh hot pht sinh t cc hot ng sinh hot ca bnh nhn v cn b, cng nhn vin ang iu tr v lm vic ti bnh vin nh tm ra, git gi, nc t cc nh bp, nh v sinh, v.v. Loi nc thi ny c cha cc cht cn b, cc cht rn l lng (SS), cc hp cht hu c d phn hu sinh hc, cc hp cht dinh dng (N, P), BOD, coliform, vi khun, v.v. c. Nc ma chy trn Nc ma chy trn trn ton b din tch mt bng khun vin bnh vin, trong qu trnh chy trn b mt c th ko theo mt s cc cht bn, bi, v.v., tuy nhin nc ma chy trn c tnh cht nhim nh v qui c sch cho nn nc c thot qua h thng thot nc thi ca bnh vin.
41

Nc ma chy trn trn khu vc Bnh vin Ph sn Trung ng theo tnh ton khong 189m3/thng, cc hng mc nh sn, ng u c tri btng nn hu nh khng c t hay rc b cun theo nc ma vo h thng thot nc mt ca bnh vin. Do vy hu nh khng c nhng tc ng do nc ma chy trn i vi h thng thot nc mt ca Bnh vin c trng ca nc ma chy trn ph thuc vo nhiu yu t khc nhau nh hin trng qun l cht thi rn, tnh trng v sinh, h thng thu gom nc thi, v.v. Nng cc cht nhim trong nc ma chy trn c khong 0,5 1,5 mgN/l, 0,004 0,03 mgP/l, 10 20 mgCOD/l, 10 20 mg TSS/l. 4.2.2. Tc ng ca nc thi n mi trng Nc thi bnh vin c lit vo danh mc cht thi c bit nguy hi bi cc cht ho hc v cc ch phm pht sinh trong qu trnh chun on v iu tr. Cc cht gy nhim trong nc thi y t bao gm cc cht hu c, vi khun, cht bn khong v hu c c th nh cc ch phm thuc, cc cht kh trng, cc dung mi ha hc, d lng thuc khng sinh, cc ng v phng x c s dng trong qu trnh chun on v iu tr bnh, cc loi ha cht iu tr ung th v cc sn phm chuyn ha. a. Tc ng n mi trng nc Khi thi ra mi trng nc mt, ch cn mt hp phn gy nhim c trong nc thi bnh vin cng gy nhim mi trng nc mt tip nhn n v gin tip gy nh hng n cc thnh phn mi trng khc xung quanh nh cc thu vc ln cn. ng thi mt phn khng nh ca nc thi bnh vin theo con ng mao dn thm thu vo nc ngm gy nhim mi trng nc ngm. Cc ngun pht sinh khc nhau s c c tnh nc thi khc nhau v t c tc ng khc nhau n mi trng nc. b. Tc ng do nc thi sinh hot Trong thnh phn ca nc thi sinh hot c cha cc hp cht nhim rt c trng v in hnh BOD, fecal coliform cao. Dng ny cha ch yu cc cht cn b, cht rn l lng, cc cht hu c, du m, vi sinh vt gy bnh, khi i vo mi trng nc mt s gy ra cc tc ng ch yu: - Nc thi sinh hot i vo ngun tip nhn gy cn kit ngun oxy ca ngun nc ti v tr x, nh hng n thu vc v h sinh thi khu vc. - Trong nc thi sinh hot c cha mt lng cht rn l lng lm cho cc ngun sng sui nhn nc thi b bi lng. Cc cht dinh dng N, P l nguyn nhn gy ra hin tng ph dng. Tc ng do nc thi y t pht sinh trong qu trnh khm v iu tr bnh
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Nc thi y t pht sinh trong qu trnh khm v tr bnh c cha cc vi khun c kh nng gy bnh t m, dch tit t c th ngi bnh, v.v. Cc cht ny khi phn hu s lm tng BOD ca nc, cc vi khun gy bnh s pht tn vo mi trng theo dng nc mt chy y bnh dch i xa hn v quy m ln hn. Tng t vi cc cht c hi, cht phng x v cc yu t gy hi khc trong nc thi bnh vin. - Nc thi y t cha ng cc loi vi trng t mu, nc tiu, dch m, v.v. ca ngi bnh, cc loi vi trng nguy hi ny c th tn ti nhiu tun trong mi trng bn ngoi. Nu x nc thi y t trc tip vo ngun nc mt nh sng, h, ao, v.v. chng s c thi gian truyn bnh khi tip xc vi con ngi v ly lan thnh bnh dch. Mt s loi virus nguy him c kh nng ly nhim cao nh Adenovirus, Poliovirus (gy bnh bi lit v nhiu bnh khc), Echovirus, Hepatitis A virus (bnh vim gan siu vi A), Rotavirus (bnh tiu chy). - Nhiu loi vi khun tn ti trong cht thi ca bnh nhn c th gy nn cc dch bnh nguy him nh dch t, kit l, thng hn, tiu chy, v.v. Nhng loi bnh ny c bit nguy him, c th gy cht ngi v c tnh ly lan nhanh. - Cc loi ha cht iu tr ung th v cc sn phm chuyn ha nu x thng ra mi trng nc khng qua x l s c kh nng tch lu, gy bin chng lu di nh qui thai, ung th cho nhng ngi tip xc vi chng nh cng nhn no vt cng thot nc. Tc ng do nc thi pht sinh t cc cng trnh ph tr (phng git l, khu ty ra, v sinh, v.v.) - X phng - cht ty ra - cht hot ng b mt c gi chung l cc cht hot tnh b mt. Khi ho tan vo ngun nc ao, h, sng sui, s c mt ca chng trong nc thi y t s lm gim ho tan ca oxy trong mi trng nc, nh hng n mi trng sng ca cc h ng thc vt thu sinh, lm gim tr lng loi. - Nc thi c cha cc cht kh trng pht sinh t cc phng git l, khu ty ra, v sinh khi thi vo ngun nc mt s lm gim kh nng t lm sch ca nc. 4.2.3. Hin trng nc thi Bnh vin Ph sn Trung ng Hin ti h thng thu gom nc thi v trm x l nc thi ca Bnh vin Ph sn Trung ng (cng sut 400-450m3/ng.) * H thng thot nc: Tuyn cng thot nc bn v trm x l c xy dng v lp t bng cng b tong ct thp D300 v ng PVC D200, b tr kiu ng t chy theo dc thit k. * Trm x l nc thi: S dy truyn cng ngh x l nc thi ti Bnh vin c trnh by nh hnh 4.1.
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B hp khi

R chn rc

Ngn thu nc thi

Ngn x l hiu kh s b

Ngn bn

Kh trng

B lng lamen

Cm thit b x l CN -2000

Hnh 4.1. S dy chuyn cng ngh x l nc thi ca Bnh vin Thuyt minh cng ngh: Vic thu gom v vn chuyn nc thi t cc khoa, phng, bun bnh c tp trung vo cc b pht ca mi khoa phng v thng qua mng li thot nc n b hp khi gm: ngn thu nc thi c lp t r chn rc, ngn x l hiu kh s b, ngn thu bn. R chn rc l cng on x l u tin nhm cn cc vt ln i qua c th gy nn tc nghn trong cc cng trnh tip sau, m bo cho bn ca thit b, my mc. Nc thi qua r chn rc tp trung vo ngn thu nc v c bm sang ngn x l hiu kh s b. Ti y nc thi c trn vi cc ch phm vi sinh DW97 vi nng 23mg/l, bng phng php sc kh li dng nhng vi sinh vt c sn trong nc thi duy tr trng thi l lng, oxi ha hp cht hu c thnh nhng cht n nh thun li cho cc giai on x l tip theo. Mi trng hiu kh trong b t c do s dng my thi kh loi chm cung cp vi kch thc bt kh trung bnh. Thip theo nc thi c bm ln thit b x l hp khi dng thp, thit b x l aerofill aeroten c m vi sinh CN 2000 (m vi sinh c ch to t vt liu nha hoc vt liu hu c khc c thng s; rng .90%, b mt ring 200 250m 2/m3). Ti y thc hin 3 qu trnh x l vi sinh sau: + Aerofil (trn kh cng bc) cng cao bng vic dng khng kh thi cng bc ht v y nc thi. + Aeroten kt hp biofilter dng xui c lp m vi sinh ngp trong nc. + Anareobic dng ngc vi vi sinh l lng.
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Sau , nc thi cng bn hot ha chuyn qua b lng lamen (m la men c thng s: rng >95%, b mt ring 150 200m2/m3) tch bn hot ha v cn l lng hu c khc, ti b ny c ng cp ha cht keo t PACN 95 (5-8mg/l) nhm to bng keo t v nng cao hiu sut lng. Phn nc trong c chy sang b kh trng dit tr cc vi trng vi khun gy bnh bng dung dch Hypochloride Natri hoc Can xi (NaOCl hoc Ca (OCl)2) nng 3gCl2/m3 nc thi. Cui cng nc c x l t tiu chun mc II TCVN 7382:2004 c thi ra mi trng. Phn bn, cn lng ngn lng v tng ngn x l sinh hc c my bm hi lu bn hi lu mt phn bn hot ha tr li thit b sinh hc m bo c nng x l cn phn bn d tha c bm v b cha bn. Ti y di tc dng ca vi khun ym kh, cc cht c trong cn bn s phn hy thnh kh Metan (CH4), H2S v b bn. Kch thc ca khi cng trnh - B iu ha x l s b: Kch thc chung ca khi b 15,0 x4x3,6 (m). Cu to b bng b tong ct thp. - Thit b CN 2000: (03 thp); kch thc D=2,5m; H = 5,5m. Vt liu ch to bng Inox SUS 304. - B lng kh trng: Kch thc chung ca khi b 3,5x3,0x3,1 (m) - Cc mc v thit b ph tr: my bm nc thi, my thi kh chm; my thi kh cn; my bn v h thng bm nh lng. Bng 4.1. Cht lng nc thi trong bnh vin TT 1 2 3 4 5 6 7 8 9 Ch tiu phn tch pH BOD5 COD NO3SS n v mgO2/l mgO2/l mg/l mg/l Nc thi 8,7 78 122 0,5 76 6,12 30,0 9,5 4,3.105 TCVN 7382 - 2004 Mc I Mc II 6,5 8,5 6,5 8,5 20 30 30 50 1,0 10 4 1.000 30 100 1,0 10 6 5.000

Sunfua (tnh theo mg/l H2S) + NH4 Tnh theo N mg/l PO43Coliform mg/l MPN/100ml

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i chiu vi nc thi bnh vin TCVN 7382 2004 (mc II) mu nc thi ti ngm thu nc thi u vo ca Bnh vin Ph Sn Trung ng c cc ch tiu pH, BOD5, Amni, Sunfua, Pht pht v Coliform vt tiu chun cho php, cc ch tiu phn tch cn li t tiu chun cho php. 4.2.3.1. Lu lng nc thi Trong qu trnh hot ng ca bnh vin Ph sn trung ng ngun pht sinh nc thi ch yu l t hot ng sinh hot v hot ng khm cha bnh ca cc phng khoa trong bnh vin. + Thnh phn cc cht nhim: Cc cht nhim trong nc thi bnh vin ch yu cha nhiu cht nhim hu c c kh nng phn hy sinh hc, hm lng cht rn l lng, cc cht ty ra, d lng dc phm v mt s cht c hi c trng t qu trnh chun on, xt nghim bnh nhn c bit l s xut hin ca nhiu loi vi khun gy bnh. Thnh phn cc cht bn trong nc thi bnh vin Ph sn c m t trong bng 3.7 Bng 3.7. cc ch tiu nhim trong nc thi bnh vin Cc ch tiu phn tch pH Cht rn l lng c BOD5 COD DO NH4+ Tng pht pht Tng s Coliform + Ti lng: Vi quy m 400 ging bnh v vi lng nc sch cp cho ton bnh vin l: Qtng = 175m3/ngy. Lng nc thi chim khong 90% lng nc cp (do tht thot) => lu lng nc thi ca bnh vin trong mt ngy m s l 175 x 90% = 157,5 (m3/ng.) Ti lng cc cht nhim trong nc thi ca bnh vin c trnh by trong bng sau:
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n v mg/l NTU mg/l mg/l mg/l mg/l mg/l MPN/100ml

Ga tr 7,2 132 180 240 452 1,40 12,5 3 630.104

Bng 3.8. Ti lng cc cht nhim trong nc thi ca bnh vin ph sn Trung ng. TT 1 2 3 4 5 Thng s nhim Tng cht rn (TSS) BOD5 COD NH4Tng pht pht Ti lng (kg/ngy) 20,79 37,8 71,19 1,969 0,473

Lu lng nc thi t bnh vin Ph sn Trung ng vo khong 157,5m3/ngy. Vi tnh cht nc thi nh trong bng 3.7. cho thy cc ch tiu BOD5, hm lng cht l lng (SS), NH+4, Coliform u vt tiu chun cho php rt nhiu, BOD5 (240mg/l) vt 8 ln tiu chun cho php, cht rn l lng (SS=132mg/l) vt qu 2,64 ln NH+4 (12,5 mg/l), vt 1,25 ln v Coliform 630.104 MPN/100ml vt tiu chun cho php 1260 ln. Nh vy nu ngun nc thi ny khng c x l m thi thng ra mi trng s lm tng c, gy bc mi hi thi trong h thng cng thot. c bit trong nc thi c cha nhiu vi khun gy bnh nh Somonella, Leptospira, Vibrio Choleral, Mycobacterium, Tuberculosis,nn nguy c nhim vi rt ng tiu ha, viruts bi lit SHCO, Coxachu,nhim cc loi k sinh trung, amip, trng giun v nm h ng n con ngi thng qua ngun nc tip nhn rt d xy ra. Do ton b h thng thu gom v x l nc thi Bnh vin c xy dng hon chnh (c tnh n qui m 500 ging bnh giai on 2007 2010 ca bnh vin), nn ton b lng nc thi ca bnh vin c thu gom v a v trm x l nc thi x l m bo TCVN 7382 2004, mc II trc khi thi ra mi trng. V vy, nhng tc ng do ngun nc thi nhim ca bnh vin s c gim thiu hon ton. Di y nu tc hi ca mt s yu t nhim trong nc thi n sc khe con ngi v mi trng sinh thi.

Cht rn l lng: l cc cht rn c bn cht v c hay hu c, kch thc nh tn ti

dng l lng trong nc khng lng c.Chng lm gim trong ca nc, gim kh nng quang hp ca thc vt thy sinh, gy bi lng cho ngun tip nhn.

Cht hu c: Cc cht hu c l cc hp cht ca C,H v mt s nguyn t khc nh

O, P , N , Cl. Cc hp cht hu c rt a dng c th c dng mch di, nhnh hay mch vng, c khi lng phn t thp hay cao, dng ha tan hay rng rn l lng. Cc cht hu c ty thuc vo bn cht v nng c th gy c trc tip cho cc sinh vt sng trong mi trng nc. Mt khc, cht hu c c th tc ng gin tip ln cc sinh vt
47

hiu kh do cc cht hu c khi phn hy s tiu th oxi ha tan trong mi trng nc lm gim nng xi ha tan cung cp cho cc sinh vt, c th gy cht cho cc sinh vt. Nng cht hu c trong nc c th hin gin tip qua ch tiu COD, BOD5. Cc ch tiu ny c gi tr cng ln th nng cht hu c cng cao. Trong , nu t l BOD5/COD cng cao s chng t t l cc cht hu c d b vi sinh vt phn hy trn tng lng cht hu c trong mi trng nc ccao v ngc li.

N, P: Cc cht N, P l cc cht dinh dng cn thit cho cc sinh vt, nhng nu

nng cc cht ny trong mi trng nc qu cao s gy nn hin tng ph dng. Khi hin tng ny xy ra cc loi thc vt trong nc nht l to s pht trin mnh, cnh tranh oxi vi cc ng vt trong nc. Tip , khi nng oxi trong nc gim, chnh cc loi to ny cng b cht, sinh khi b phn hy gy nhim mi trng nc, lm cht hng lot cc ng vt trong nc.

nc ma chy trn Nc ma chy trn trn khu vc Bnh vin Ph sn Trung ng theo tnh ton khong 189m3/thng. Cc hng mc nh sn, ng u c trI b tng nn hu nh khng c t hay rc b cun theo nc ma vo h thng thot nc mt ca bnh vin. Do vy hu nh khng c nhng tc ng do nc ma chy trn i vi h thng thot nc mt ca bnh vin. - Xy dng h thng thot nc v vch tuyn phn vng thot nc ma. Cc tuyn thot nc m bo tiu thot trit , khng gy ng ngp v khng gy nh hng n kh nng thot nc thI ca bnh vin. - Cc tuyn thot nc ma c thc hin ph hp vi quy hoch thot nc ca ton bnh vin. - Khng tp trung cc oi nguyn vt liu gn, cnh cc tuyn thot nc ngn nga tht thot r r vo ng thot thi - Thng xuyn kim tra no vt, khi thng khng ph thi xy dng xm nhp vo ng thot nc gy tc nghn, ng nc. Nhn xt:
48

Vic p dng c bin php gim thiu nu trn s gip cho cc ngun nc xung quanh khu vc khng b gy nhim v m bo cht ng ca cc ngun nc ny lun nm trong gii hn cho php ca TCVN 5942 2005.
4.2.4. H thng thu gom v x l nc thi bnh vin 4.2.4.1. H thng thu gom nc thi - Vic thu gom v vn chuyn nc thi t cc phng trong Bnh vin c tp trung vo b pht ca khu nh v thng qua mng li thoat nc gm nhng cng c ng knh D200 D300mm (mi c xy dng) chy vo trm x l nc thi hp khi ca Bnh vin. - Thng xuyn kim tra, no vt, khng bn t, rc xm nhp vo ng thot nc thi. - Thc hin tt cc cng tc v sinh cng cng gim bt nng cc cht bn trong nc ma. 4.2.4.2. Cng ngh x l nc thi p dng v hiu qu x l Hm lng nhim ca cc thng s BOD5; COD; SS; tng P; tng N; Clo t do; Coliform u vt TCVN 5945-2005 ct B tng ng l 7; 5; 3,1; 1,1; 3,3; 5,5; 9300 ln. Chnh v vy bnh vin u t xy dng h thng x l nc thi nm 2001 cng sut 200 m3/ngy vi tng gi tr u t l 1,4 t ng m bo nc thi ra mi trng t tiu chun thi. H thng ny c xy dng khng ch gii quyt nhu cu x l nc thi hin c ca Bnh vin m trong tng lai khi m rng bnh vin h thng x l nc thi ny vn c th p ng c. Chnh v th sau khi xy dng v cho n nay hai ln bnh vin tng s ging bnh, c th nm 2003 tng ln 170 ging v hin nay l 270 ging v h thng x l nc thi ny vn kh nng x l ton b lu lng nc thi ca bnh vin. Vi tnh cht ca nc thi Bnh vin l cha nhiu cht hu c v vi trng gy bnh. Do vy cng ngh c la chn v ang p dng x l nc thi ca bnh vin l cng ngh x l kt hp cc qu trnh x l c hc, x l sinh hc v kh trng. S dy chuyn cng ngh x l nc thi ti bnh vin Ph sn Trung ng (cng sut 400 450m3/ng.) c trnh by c th trong mc 2.13 chng II ca n. Cng ngh la chn c da trn c s kt hp gia 2 phng php truyn thng ( b aeroten v b lc biofilter) v c mt s ci tin t hiu qu x l cao. Kt hp qu trnh x l vi sinh dnh bm v vi sinh l lng bng cch dm ton b khi vt liu ngp trong nc. Tn dng c tnh nng ca c 2 loi vi sinh trn cng mt n v th tch thit b.
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Thay th vt liu tr thng thng bng loi vt liu m c rng cao, b mt nhm tng b mt tip xc vi nc thi, khng kh v vi sinh bm dnh d dng. Kt hp phng php x l hiu kh v thiu kh kh NO3 bng vi khun ca qu trnh denitrification. Tng qung ng i ca nc thi qu trnh pht trin ca vi sinh c hiu qu, t nng cao hiu sut x l. Qa trnh x l din ra theo chiu bc hn c th l kh BOD, COD, NH4 , NO3, N2. Cc thit b c ch to theo nguyn l modul, hp khi, t ng, gn nh chim t khng gian v din tch, ph hp vi iu kin ca bnh vin. Lp t thit b n gin, gn nh v thun tin, chi ph vn hnh hp l. Hiu qu x l:

Cng ngh x l nc thi bnh vin ny c p dng rt nhiu bnh vin trong c nc. Kt qu phn tch cht lng nc thi sau x l u p ng c yu cu mc II TCVN 7382 2004 v nc thi Bnh vin Tiu chun thi. Ha cht s dng:

Ch phm vi sinh DW97: nng 2-3mg/l, gip y nhanh qu trnh thy phn s b cc cht thi hu c, x l mt phn BOD, COD trong nc thi. Ha cht keo t PACN 95: nng 5-8mg/l, thc hin qu trnh keo t, nng cao hiu sut lng Ha cht kh trng NaOCl hoc Ca(OCL)2: nng 3 mg/l thc hin qu trnh kh trng tiu dit cc vi trng, vi khun gy bnh c trong nc thi trc khi x ra mi trng. Bn thi t trm x l:

Ch to ra t qu trnh x l nc thi theo cng ngh ny ch yu l bn hot tnh. Lng bn tnh ton c theo l thuyt vo khong 55,944kg/ngy. Lng bn ny s c phn hy ym kh mt phn ti b cha bn trong h thng. Trn thc t, cng ngh ny c p dng thnh cng nhiu bnh vin trn ton quc v cho thy, qua qu trnh vn hnh lng bn tch t ti b cha bn ca h thng x l ny l rt t hng nm c ht i bng xe ht bn ca Cng ty mi trng th 2 n 3 ln ty vo cng sut x l nc thi ca bnh vin

Thuyt minh cng ngh: quy trnh x l nc thi bnh vin qua cc cng on
sau: Cng on x l c hc
50

- Ton b nc thi bao gm nc thi y t, nc thi sinh hot v nc ma c thu gom n b gom, trc khi vo b cc loi rc th c kch thc > 5 mm c tch ra nh song chn rc t ti ca cng trc khi vo b gom. Rc c vt th cng ri a thu gom cng rc thi y t ca bnh vin. - Nc thi sau khi tch rc c bm ln b iu ha. ngn nga hin tng lng ng cn l lng v iu kin ym kh (thiu kh) xy ra. Trong b iu ha lp t h thng phn phi kh dng bt mn lm tng hiu qu khuy trn v tng hiu sut hp th Oxy. Cng on x l sinh hc y l cng on x l chnh, s dng chng vi sinh vt hiu kh phn hy cht thi. Trong b ny, cc vi sinh vt (cn gi l bn hot tnh) tn ti dng l lng s hp th Oxy v cht hu c (cht nhim) v s dng cht dinh dng l Nit & Photpho tng hp t bo mi, CO2, H2O v gii phng nng lng. Ngoi qu trnh tng hp t bo mi, tn ti phn ng phn hy ni sinh (Cc t bo vinh sinh vt gi s t phn hy) lm gim s lng bn hot tnh. Tuy nhin qu trnh tng hp t bo mi vn chim u th do trong b duy tr cc iu kin ti u v vy s lng t bo mi to thnh nhiu hn t bo b phn hy v to thnh bn d cn phi c thi b nh k Cc phn ng chnh xy ra trong b AEROTEN trong qu trnh x l: Cht hu c + O2 " CO2 + H2O + nng lng (Qu trnh Oxy ha v phn hy cht hu c)
-

Cht hu c + O2 + NH3 " T bo vi sinh vt +CO2 + H2O + nng lng (Qu trnh tng hp t bo mi)
-

C5H7O2N + O2 " CO2 + H2O + NH3 +Energy (Qu trnh phn hy ni sinh) (C5H7O2N - Cng thc ha hc ca vi sinh vt)
-

Nng bn hot tnh duy tr trong b Aeroten: 3500 mg/l, t l tun hon bn 70%. Cc thng s iu khin ch vn hnh b AEROTEN: DO, pH, nng bn hot tnh, thi gian lu thy lc, tui bn. Sau khi thc hin qu trnh phn ng hiu kh hn hp nc thi/bn hot tnh c dn qua ngn lng th cp tch cc bng bn sinh hc v nc trong ring ra. Nc trong t chy sang b kh trng. Bn lng xung y c bm Airlift bm tun hon li, mt phn thi c ht sang b phn hu bn. Kh trng Nc thi sau qu trnh lng th cp c kh trng bng Clorine nhm m bo tiu chun v sinh X l bn sinh hc
51

Bn d t qu trnh x l sinh hc c bm nh k bng bm kh nn v b phn hu bn. Ti b ny thc hin qu trnh thng kh theo chu k, cc t bo vi sinh vt s b phn hu bng qu trnh h hp ni bo lm gim th tch bn thi. Th tch cn li ca bn c chim 10-15% lng bn ban u. 4.3. i vi cht thi rn v cht thi nguy hi Theo quy ch Qun l cht thi y t km theo Quyt nh s 43/2007/Q-BYT ngy 30/11/2007 ca B Y t, cht thi trong Bnh vin Ph sn Trung ng c phn thnh 05 nhm chnh cn c vo c im l hc, ha hc, sinh hc v tnh cht nguy hi gm c: - Cht thi Rn y t ly nhim sc nhn: nh bm kim tim, li dao m, ng tim, mnh thy tinh v t khoa cp cu, khoa phu thut gy m hi sc. - Cht thi rn khng ly nhim sc nhn: nh bng, gc thm mu, thm dch t cc khoa sn thng, khoa , khoa sn bnh l. - Cht thi rn gii phu: nh rau thai, bo thai,..t cc khoa , khoa phu thut gy m hi sc. Bnh cha p sut nh cc bnh ng oxy, bnh kh dung, bnh ga.

- Cht thi rn thng thng gm: Cht thi rn sinh hot pht sinh t cc bung bnh; cc chai l thy tinh, chai huyt thanh, cc vt liu nha khng dnh mu, dnh dch sinh hc v cc cht ha hc nguy hi pht sinh t cc hot ng chuyn mn y t; cht thi pht sinh t cc cng vic hnh chnh nh: giy bo,ti liu, vt liu ng gi, thng cc tong, ti ninng, ti ng phim, 4-2). Cht thi ha hc nguy hi Cht thi phng x Cc loi cht thi ny c pht sinh t nhng ngun chnh sau (xem hnh

52

Bung tim Phng m Phng xt nghim v ra phim Phng cp cu

Phng bnh nhn khng ly lan Phng bnh nhn truyn nhim Khu bo ch dc Khu vc hnh chnh ng thi chung

Ghi ch:

Cht thi ly nhim Cht thi sinh hot Cht thi phng x Bnh p sut Cht thi ho hc

Hnh 4-2: Ngun pht sinh cht thi rn v cht thi nguy hi Ti lng v thnh phn cht thi: Theo thng k cht thi rn y t cho 1 ging bnh bnh vin a khoa, trung tm y t trung bnh l 1,05kg/ging/ngy. Do vy vi quy m khong 400 ging bnh th lng cht thi rn y t to ra khong 1,05 x 400 = 283,5kg/ngy. 4.3.1. Hin trng rc thi y t ti Bnh vin Ti lng c th ca cc thnh phn c trong rac thi y t pht sinh c trnh by trong bng 3.9 Bng 3-9: Thnh phn cht thi rn y t TT Thnh phn cht thi rn y t 1 Cc cht hu c . 2 Chai nha PVC, PE, PP . 3 Bng bng T l (%) 52,9 C/Khng c thnh phn cht thi nguy hi Khng

10,1

8,8

53

TT

Thnh phn cht thi rn y t

T l (%)

C/Khng c thnh phn cht thi nguy hi Khng

4 V hp kim loi . 5 Chai l xi lanh, ng thuc thu tinh . 6 Kim tim, ng tim . 7 Giy . 8 Cc bnh phm sau m . 9 t ct, snh s v cc cht rn khc . Tng

2,9

2,3

0,9

0,8

Khng

0,6

20,9

Khng

100

Ngun: Qun l cht thi rn Tp 1 Cht thi rn th - GS.TS Trn Hiu Nhu Cht thi truyn nhim Cht thi sc nhn (loi A): l cht thi c th gy ra cc vt ct hoc chc thng, c th nhim khun, bao gm: bm kim tim, u sc nhn ca dy truyn, li dao m, inh m, ca, cc ng tim, mnh thu tinh v v cc vt sc nhn khc s dng trong cc loi hot ng y t. - Cht thi ly nhim khng sc nhn (loi B): l cht thi b thm mu, thm dch sinh hc ca c th v cc cht thi pht sinh t bung bnh cch ly. Cht thi c nguy c ly nhim cao (loi C): l cht thi pht sinh trong cc phng xt nghim nh: bnh phm v dng c ng, dnh bnh phm. - Cht thi gii phu (loi D): bao gm cc m, c quan, b phn c th ngi; rau thai, bo thai v xc ng vt th nghim. Cht thi ha hc nguy hi

54

Dc phm qu hn, km phm cht khng cn kh nng s dng.

Cht ha hc nguy hi s dng trong y t: formaldehyd, ho cht quang hc, cc dung mi, ho cht dng tit khun y t v dung dch lm sch, kh khun, cc ho cht dng trong kh trng, ty u, thanh trng, v.v. Cht gy c t bo, gm: v cc chai thuc, l thuc, cc dng c dnh thuc gy c t bo v cc cht tit t ngi bnh c iu tr bng ha tr liu. Cht thi cha kim loi nng: thu ngn (t nhit k, huyt p k thu ngn b v, cht thi t hot ng nha khoa), cadimi (Cd) (t pin, c quy), ch (t tm g bc ch hoc vt liu trng ch s dng trong ngn tia x t cc khoa chun on hnh nh, x tr). Cht thi phng x - Cht thi phng x: gm cc cht thi phng x rn, lng v kh pht sinh t cc hot ng chun on, ho tr liu v nghin cu nh ng tim, bm tim, giy thm, gc st khun c s dng hoc b nhim cc ng v phng x. - Cht thi phng x rn bao gm: cc vt liu s dng trong cc xt nghim, chun on, iu tr nh ng tim, bm tim, kim tim, knh bo h, giy thm, gc st khun, ng nghim, chai l ng cht phng x, v.v. - Cht phng x lng bao gm: dung dch c cha nhn phng x pht sinh trong qu trnh chun on, iu tr nh nc tiu ca ngi bnh, cc cht bi tit, nc sc ra cc dng c c cha phng x, v.v.
- Cht thi phng x kh bao gm: cc cht kh dung trong lm sng nh
133

Xe,

cc kh thot ra t cc kho cha cht phng x, v.v. Cht thi rn thng thng Cht thi rn thng thng l cht thi khng cha cc yu t ly nhim, ha hc nguy hi, phng x, d chy, n, bao gm: - Cht thi sinh hot pht sinh t cc bung bnh (tr cc bung bnh cch ly). Cht thi pht sinh t cc hot ng chuyn mn y t nh cc chai l thu tinh, chai huyt thanh, cc vt liu nha, cc loi bt b trong gy xng kn. Nhng cht thi ny khng dnh mu, dch sinh hc v cc cht ha hc nguy hi.

55

Cht thi pht sinh t cc cng vic hnh chnh: giy, bo, ti liu, vt liu ng gi, thng cc tng, ti nilon, ti ng phim. Cht thi ngoi cnh: l cy v rc t cc khu vc ngoi cnh 4.3.2. Ngun pht sinh Cht thi truyn nhim + Cht thi sc nhn
+Cht thi ly nhim khng sc nhn

+ Cht thi c nguy c ly nhim cao + Cht thi gii phu Cht thi ha hc nguy hi + Dc phm qu hn + Cht ha hc nguy hi s dng trong y t + Cht gy c t bo + Cht thi cha kim loi nng Cht thi phng x + Cht thi phng x + Cht thi phng x rn + Cht phng x lng + Cht thi phng x kh Cht thi rn thng thng + Cht thi sinh hot pht sinh t cc bung bnh + Cht thi pht sinh t cc hot ng chuyn mn y t + Cht thi pht sinh t cc cng vic hnh chnh 4.3.3. Tc ng ca cht thi rn y t n mi trng v sc kho con ngi Cht thi rn y t bao gm mt lng ln cc cht thi ni chung v mt lng nh cc cht thi c tnh nguy hi cao. Nhn chung, cht thi rn y t c th to nn nhng mi nguy c cho mi trng v sc kho cng ng. Vic tip xc vi cc cht thi rn y t c th gy nn bnh tt hoc tn thng do trong cht thi
56

rn y t c th cha ng cc yu t truyn nhim, cht c hi, cc loi ha cht v dc phm nguy him, cc cht thi phng x, cc vt sc nhn, v.v. Nhng i tng c th tip xc vi cc loi cht thi rn y t: tt c cc c nhn tip xc vi cht thi rn y t l nhng ngi c nguy c tim tng, bao gm nhng ngi lm vic trong cc c s y t, nhng ngi ngoi cc c s y t lm nhim v vn chuyn cc cht thi y t v nhng ngi trong cng ng b phi nhim vi cc cht thi do hu qu ca s sai st trong khu qun l cht thi. Nhm nguy c bao gm: bc s, y t, h l, nhn vin hnh chnh ca bnh vin, bnh nhn iu tr ni tr hoc ngoi tr; khch ti thm hoc ngi nh bnh nhn; nhng cng nhn lm vic trong cc dch v h tr phc v cho cc c s khm cha bnh v iu tr. a. Tc ng ca cht thi truyn nhim Cc vi khun gy bnh trong cht thi rn truyn nhim xm nhp vo mi trng v t i vo c th con ngi thng qua 2 con ng trc tip v gin tip: da (qua mt vt thng, try sc hoc vt ct trn da), cc nim mc (mng nhy), ng h hp (do xng, ht phi), ng tiu ha, v.v. c bit, cc cht thi truyn nhim c kh nng ly truyn cc bnh nguy him nh HIV v virus vim gan B, C, v.v. Nhng virus ny thng lan truyn qua vt tim hoc cc tn thng do kim tim c nhim mu ngi bnh. Chng c th ly lan t ngi ny sang ngi khc thnh dch bnh nghim trng nu khng tun th cc iu kin v sinh v cc quy trnh y t. Trong cc c s y t, tnh khng ca vi khun i vi cc loi thuc khng sinh v cc ha cht st khun cng c th gp phn to ra nhng mi nguy c do s qun l yu km cc cht thi rn y t. Mt trong nhng mi nguy c tim n su sc i vi sc khe con ngi gy ra do cht thi rn truyn nhim l do s tp trung ca cc tc nhn gy bnh v cc vt sc nhn b nhim cc vi sinh vt gy bnh (c bit l nhng mi kim tim qua da). y c coi l mt loi rc thi rt nguy him bi n gy nhng tn thng kp: khng ch l nhng nguyn nhn gy ra cc vt ct, vt m thng m cn gy nhim trng cc vt thng nu n b nhim cc tc nhn gy bnh (do chng thng dnh mu bnh nhn). Chng c nguy c tr thnh ngun gy e da nghim trng n sc khe con ngi nu khng tun th cht ch cc quy nh v an ton lao ng trong y t. b. Tc ng ca cht thi rn ha hc nguy hi
57

Nguy c t cc ha cht v dc phm d tha Nhiu loi ha cht v dc phm c s dng trong cc c s y t l nhng mi nguy c e do sc kho con ngi (cc c dc, cc cht gy c gen, cht n mn, cht d chy, cc cht gy phn ng, gy n, gy sc phn v, v.v.). Cc loi cht ny thng chim s lng nh trong cht thi rn y t, vi s lng ln hn c th tm thy khi chng qu hn, d tha hoc ht tc dng cn vt b. Chng c th gy nhim c do tip xc cp tnh v mn tnh, gy ra cc tn thng nh bng. S nhim c ny c th l kt qu ca qu trnh hp th ha cht hoc dc phm qua da, qua nim mc, qua ng h hp hoc ng tiu ha. Vic tip xc vi cc cht n mn, cc ha cht gy phn ng (formaldehyd v cc cht d bay hi khc) c th gy nn nhng tn thng ti da, mt hoc nim mc ng h hp. Cc tn thng ph bin nht l cc vt bng. Cc cht kh trng l nhng thnh phn c bit nht ca nhm ny chng thng c s dng vi s lng ln v thng l nhng cht n mn. Cng cn phi lu rng nhng loi ha cht gy phn ng c th hnh thnh nn cc hn hp th cp c c tnh cao. Cc sn phm ha cht c thi trc tip vo h thng cng thi c th gy nn cc nh hng bt li ti hot ng ca h thng x l nc thi sinh hc hoc gy nh hng c hi ti h sinh thi t nhin nhn c s ti tiu bng ngun nc ny. Nhng vn tng t nh vy cng c th b gy ra do cc sn phm ca qu trnh bo ch dc phm bao gm cc khng sinh v cc loi thuc khc, do cc kim loi nng nh thu ngn, phenol v cc dn xut, cc cht kh trng v ty u. Nhng nguy c t cht thi gy c gen (genotoxic) i vi cc nhn vin y t chu trch nhim tip xc v x l loi cht thi gy c gen, mc nh hng ca nhng mi nguy c b chi phi bi s kt hp gia bn cht ca cht c v phm vi, khong thi gian tip xc vi cht c . Nhng phng thc tip xc chnh l ht phi dng bi hoc dng phun sng qua ng h hp, hp th qua da, qua ng tiu ha do n phi thc phm nhim thuc, ha cht hoc cht bn c tnh c. Mi nguy him c th xy ra khi tip xc vi cc loi dch th v cc cht tit ca nhng bnh nhn ang c iu tr bng ha tr liu.

58

Nhiu loi thuc c c tnh gy kch thch cao v gy nn nhng hu qu hu hoi cc b sau khi tip xc trc tip vi da hoc mt. Chng cng c th gy chng mt, bun nn, au u hoc vim da. Cn phi c bit cn thn trng vic s dng v vn chuyn cht thi genotoxic, vic o thi nhng cht thi nh vy vo mi trng c th gy nn nhng hu qu sinh thi thm khc. c. Tc ng ca cht thi phng x Loi bnh gy ra t cc cht thi phng x c xc nh bi loi cht thi v phm vi tip xc. N c th l au u, hoa mt, chng mt v nn nhiu bt thng. Bi cht thi phng x cng nh cc cht thi dc phm l mt loi c hi gen, n cng c th nh hng n cc yu t di truyn. Tip xc vi cc ngun phng x c hot tnh cao nh t cc phng tin chun on (my chp ct lp, my X-quang) c th gy ra mt lot cc tn thng nh ph hu cc m t dn n vic loi b mt s b phn trn c th. Cc nguy c t nhng loi cht thi c hot tnh thp c th pht sinh do s nhim x trn phm vi b mt ca cc vt cha do phng thc hoc khong thi gian lu gi loi cht thi ny. Cc nhn vin y t hoc nhng ngi lm nhim v thu gom v vn chuyn rc thi tip xc vi loi cht thi phng x ny l nhng ngi thuc nhm nguy c cao. d. Tc ng ca cht thi rn sinh hot - Cht thi rn sinh hot c cha thnh phn hu c cao, l mi trng sng tt cho cc vi trng gy bnh, l ngun thc n cho rui mui, v.v. l vt trung gian truyn bnh cho ngi, v c th pht trin thnh dch. Hn na, cht hu c trong cht thi rn sinh hot lu ngy b phn hu nhanh to ra cc sn phm trung gian, sn phm phn hu bc mi hi thi. - Cht thi rn sinh hot nu khng c chn lp hp v sinh s d dng thm xung tng nc ngm gy suy thoi tng nc ngm trong vng v lan ra cc vng xung quanh.
- Cht thi rn sinh hot c thnh phn d phn hu sinh hc, cng vi iu

kin kh hu c nhit v m cao nn sau mt thi gian ngn chng s b phn hu k kh hay hiu kh sinh ra cc kh c hi v c mi hi thi kh chu gm CO2, CO, CH4, H2S, NH3, v.v. ngay t khu thu gom, vn chuyn n chn lp.

59

Tc ng ca rc thi ti mi trng v c bit l sc kho cng ng l rt ln, nhng bnh vin gim thiu cc tc ng ny bng cc bin php kim sot v x l (xem phn 5.1.3) trit rc thi bnh vin thi ra hng ngy. Nh , nh hng ca rc thi ti mi trng v sc kho cng ng khu vc quanh bnh vin l gn nh khng c. 4.4. S c chy n 4.4.1. Ngun gy ra s c chy n c im hot ng ca bnh vin i hi phi s dng mt s cht kh, dung mi v nhin liu nh kh oxygen (ng trong cc bnh cha kh oxygen chuyn dng), cn y t, te, nhin liu t (du DO cha trong cc bn du hoc thng), nhin liu dng cho cc ng c xe hi (xng). Cc loi kh, dung mi v nhin liu ny u rt d bt la v gy ra chy, n. Ngoi ra, bnh vin cn s dng v tng tr mt s lng tng i ln cc vt dng d chy khc nh chn mn, nm, bng chn, v.v. cc loi bao b giy, g, rc cng l nhng vt liu d bt la v gy chy. Cc nguyn nhn dn n chy, n c th do: - Vn chuyn nguyn vt liu v cc cht d chy nh xng, du, cn, te qua nhng ni c ngun pht sinh nhit hay qu gn nhng tia la. - Tn tr cc loi dung mi, nhin liu v bnh cha kh oxygen khng ng qui nh. - Vt ba tn thuc hay nhng ngun la khc vo khu vc cha bnh oxygen, chn mn, bng bng, v.v. - Tn tr cc loi rc ri, bao b, nilon trong khu vc c la hay nhit cao. - S c v cc thit b in nh dy trn, dy in, ng c, qut, v.v. b qu ti trong qu trnh vn hnh, pht sinh nhit v dn n chy, hoc do chp mch khi gp ma dng to.
-

S c st nh c th dn n chy n, v.v.

4.4.2. Tc ng ca cc s c ti mi trng
-

Gy thit hi n tnh mng v ti sn Mi trng khng kh b nhim do cc sn phm chy

60

- nhim mi trng nc do nc cha chy c ln xng du v cht nhim khc. Hu hoi ti nguyn sinh vt khu vc chy n

Tc ng ca s c chy n n mi trng v con ngi l rt ln, bnh vin trin khai cc bin php phng nga nhm hn ch cc tc ng ny c th trong chng 5

CHNG 5 CC GII PHP TNG TH, CC HNG CNG TRNH BO V MI TRNG V K HOCH THC HIN 5.1. Cc bin php bo v mi trng thc hin 5.1.1. i vi kh thi, ting n, rung Do hot ng ca bnh vin hu nh khng pht thi kh thi nhiu, nn bnh vin khng xy dng h thng x l kh thi ring. i vi nhng ni c kh nng xy ra nhim, bnh vin c nhng bin php c th ngay t qu trnh thit k, xy dng v vn hnh m bo khng gy ra nhim mi trng khng kh trong bnh vin. a. Khng ch nhim mi, nhit Thng gi Ti khu vc dng bnh thng xuyn m cc ca n gi.

-Trang b h thng thng gi bng cc qu cu nhit, qut ht thng gi nhm to iu kin thng thong tt gip cho bnh nhn mau chng hi phc.

61

-Trnh hin tng vi khun tn ti trong mi trng xung quanh bnh nhn, gy ra tnh trng ti nhim cng nh ly sang cc ngi khc cng phng bnh. Cy xanh Mt trong nhng bin php gim thiu tc ng tiu cc n mi trng hiu qu li t tn km chnh l cy xanh. Cy xanh va c tc dng che nng, gim nhit khng kh v to cm gic mt m cho bnh nhn, ngi thm nui v cn b cng nhn vin bnh vin, v.v. va c tc dng iu ha iu kin vi kh hu trong khu vc bnh vin. Ngoi ra, cy xanh cn c kh nng ci thin mi trng khng kh, hn ch kh nng pht tn bi, ting n, v.v. Cy xanh va c ngha ln trong vn bo v mi trng va lm p cnh quan. Vi cc nhn thc nu trn v tc dng ca cy xanh, bnh vin tn dng cc khu vc t trng xung quanh trng cy xanh. Ngoi ra, mi hi c khc phc bng cc bin php sau: T chc thu gom rc thi lin tc khng tng tr trong cc phng khm v phng iu tr (1 gi/ln). X l nc thi nhm lm tng kh nng thot nc nhanh, khng gy phn hu cht hu c trong thi gian lu tr trong cng thot. Thc hin ng quy nh k thut bnh vin v v khun, kh khun, bao gm cc dng c y t, v sinh ngoi cnh, v sinh khoa, phng, v sinh c nhn, v sinh an ton thc phm, v.v. b. Bin php gim thiu ting n, rung Cc bin php gim thiu v khc phc ting n v rung t my pht in v t my thi kh ca khu x l nc thi tp trung. My pht in 100 KVA

o Gn thm m chng rung; o nh k kim tra, bo dng; o Xy dng tng bao quanh cch m v t cui hng gi; o S dng nhin liu, cng sut my theo ng hng dn ca nh sn xut. My thi kh t khu x l nc thi tp trung

o Cch l v b tr vt liu cch m;

62

o Gn l xo n hi trn b my kin c. Cc bin php ny c bnh vin khc phc trit ngay t khi xy dng bnh vin v xy dng h thng x l nc thi tp trung. c. Bin php m bo an ton bc x Mt s phng chuyn mn trong khu chun on hnh nh ca bnh vin i hi phi s dng cc tia in t, cc cht phng x. Cc cht ny rt nguy hi i vi mi trng v sc kho cng ng. V th ti cc phng t my X-quang c thit k theo tiu chun quy nh ca ngnh y t: Phng t thit b bc x:

t xa cc khu vc ng ngi, khu vc khoa sn v khoa nhi, cc khoa

khc ca bnh vin khng c lin quan trc tip n bc x v cch xa li i cng cng;

Phng X-quang c kch thc theo quy nh ca tiu chun Vit Nam, ca s
thng kh khng thp hn 2m so vi sn pha ngoi;

Phng x tr t xa c din tch khng nh hn 30m2, chiu rng khng c

hn 4m, chiu cao khng thp hn 3m, phi c h thng nh sng v thng gi tt;

Thit b c che chn liu gii hn hng nm i vi nhn vin vn hnh

my khng vt qu 20mSv. B tr thit b bc x

Mi phng t 1 my thit b bc x; T iu khin thit b bc x t ngoi, st phng t thit b, c phng tin

quan st bnh nhn, phng tin thng tin gia ngi iu khin v bnh nhn. Phng t thit b x tr lp dng c kim tra t ng bo ng v tnh trng bt thng khi s dng thit b. Tn hiu cnh bo:

t pha trn ca ra vo phng thit b bc x mt n , pht sng khi thit

b bc x bt u hot ng;

t trn ca ra vo phng thit b bc x mt bin cnh bo bc x.

63

5.1.2. i vi nc thi bnh vin Ton b lng nc ma, nc thi sinh hot cng nh nc thi y t c thu gom tp trung ti vo b gom qua h thng cng thot nc ca bnh vin sau qua h thng x l nc thi tp trung trc khi thi ra mi trng. H thng ng cng bng b tng c kch thc: chiu rng x chiu cao = 0,5m x 0,5m. Ton b cc cng thu nc ny u c y kn bng cc tm an b tng. H thng x l nc thi tp trung ca bnh vin c cng sut 200 m3/ngy m . 5.1.3. i vi cht thi rn Bnh vin Ph sn Trung ng dnh ring mt khu tp trung rc thi v mt cng ph m ring thun tin cho vic xe ra vo chuyn ch i phn loi, x l v khng gy nhim mi trng bnh vin. Cht thi y t v cht thi nguy hi c lu ring, cch ly nhau. Bnh vin thng xuyn phun cc loi thuc chng rui mui vi liu lng thch hp vo khu vc ny. i vi rc thi thng thng Trong tng khoa ca bnh vin u c trang b cc thng (ti rc mu xanh) ng rc c np y ng rc thi thng thng ca bnh nhn v thn nhn thm bnh. Cc thng ny c thu gom theo lch trnh nht nh (t nht l mi ngy mt ln), sau chuyn n cc thng ln rc mu en (c np y) t ni tp kt rc thi ca bnh vin, dng ng cht thi ha hc nguy hi cht thi phng x. Thng rc mu vng ng cht thi ly nhim, v thng raccs mu trng ng cht thi ti ch. Khu rc thi thng thng c cch ly vi khu vc cht thi nguy hi. Cc ti, hp v thng ng c cc mu trn ch c s dng ng cht thi v khng s dng vo cc mc ch khc. + Ti mu vng v mu en phi lm bng nha PE hoc PP, khng dng nha PVC. +Ti ng cht thi em i t phai c kch thc ph hp (ti a l 0,1m3). Bn ngoi ti phi c ng k ngang mc3/4 ti v c dng ch khng c ng qu vch ny. + Cc hp ng cc vt sc nhn phi lm bng cc vt liu cng, khng b xuyn thng, khng b r r c np ng m r rng. Hp ng s c quai v nm dn kn li khi thng y . Hp c mu vng, c nhn Ch ng vt nhn sc

64

v c vch bo hiu mc3/3 hp v c dng ch khng c ng qu vch ny. i vi cht thi y t nguy hi Cht thi y t nguy hi cng c phn loi ti ngun. Kim tim v cc vt sc nhn c phn loi vo cc hp khng thng bng giy; bnh phm, bng gc thm mu, dy truyn dch, v.v. c kh khun ban u bng Cidex sau ng trong cc ti mu mu vng tp trung v kho cha rc thi nguy hi. Cc thng cha rc thi nguy hi u c np y ring v c t ti khu rc thi nguy hi c mi che ngn chn kh nng lan truyn dch bnh c bit l khi c ma. Sau khong 1-2 ngy lng rc thi ny c X nghip x l cht thi Cng nghip Y t chuyn i x l. Thu gom, vn chuyn cht thi ti ni pht sinh. - H l hng ngy chu trch nhim thu gom cc cht thi y t nguy hi v cht thi sinh hot t ni cht thi pht sinh v ni tp trung cht thi ca mi tng trong khu nh. - Cht thi pht sinh ti cc tng s c vn chuyn v ni lu gi cht thi chung ca bnh vin t nht mt ngy mt ln v buc kn ming. - Buc cc ti nilon cha cht thi th cc ti cha t ti th ch quy nh 2/3 ti. Khng c dng ghim dp lm kn min ti. - Cc cht thi y t phi c vn chuyn theo tuyn c qui nh, trnh vn chuyn qua cc khu vc bnh nhn v cc khu vc sch khc. - Bnh vin s c phng tin vn chuyn cht thi t ni tp trung ca cc khoa/phng n ni lu gi cht thi ca bnh vin. Cc phng tin ny ch vn chuyn cht thi v phi c ra, ty u sau khi vn chuyn v phi c thit k sao cho: d cho cht thi vo, d ly chat thi ra, d lm sch, d ty u d lm kh. 5.1.4. Bin php phng chng v ng cu s c hn ch ti mc thp nht nhng s c xy ra trong qu trnh hot ng c th dn n s c mi trng, bnh vin s p dng cc gii pho k thut cng nh nng cao nng lc qun l nh: Phi t cc kho cha nhin liu (xng, du), ha cht ti khu vc ring bit, c hng ro cch ly.

65

Cc thit b chuyn ch cc cht d gy chy n phi c giy php chng nhn an ton v c kim nh an ton thng xuyn. nh k kim tra mc tin cy ca cc thit b an ton ( bo chy, cha chy, chng st, aptomat) v c bin php thay th kp thi. Lp t thit b an ton cho ng dy ti in v thit b tiu th in. Trang b tt h thng bo chy, n hiu, ci cu ha hot ng bng u cm bin in t. Tuyn truyn gio dc v cc bin php phng chng v ng cu s c cho ngi bnh, ngi nh bnh nhn v cc cn b trong bnh vin. C i cha chy c hun luyn tt v lun trng thi thng trc. T chc cc bui din tp khc phc s c chy n cho bnh vin. a. Bin php chung C kh ha, t ng ha cc khu nguy him m bo cc thit b, khng r r nhin liu, ha cht gy chy Cch ly cc cng on d chy xa cc khu vc khc

- Gim ti mc thp nht lng cht chy n trong khu vc khm cha bnh. b. Khu vc kho ha cht nhin liu hoc nguyn liu d chy Ti cc kho cha ha cht, dung mi, te, cn nht nh, v cc cht d chy nh dung mi hoc l bng, vi, g, v.v., bnh vin thc hin cc bin php c th nh sau: Khng xp cng kho cc loi ha cht k nhau; Cc khu bc d, cp pht, vn chuyn c c gii ha;

- T chc thng gi cho cc kho tt trnh tch t nng n mc nguy him; - Ch s dng nh sng t nhin hoc n phng chy n trong cc kho d chy n; - Nhng vn ny u c thc hin theo ng quy nh v phng chy cha chy do B Ni v ban hnh; c. Phng chy cc thit b in

66

- Cc thit b in c tnh ton dy dn c tit din hp l vi cng dng. C thit b bo v qu ti.

- Nhng khu vc nhit cao, dy dn c i ngm hoc c bo v k. d. H thng chng st - i vi h thng chng st, ct thu li c lp t ti v tr cao nht ca mt cng trnh trong bnh vin. - Lp t h thng li chng st cho cc cng trnh trong bnh vin c cao > 15m bao gm cc ct thu li b tr quanh mi nh.
-

in tr tip t xung kch ca h thng chng st phi 10 /cm2

khi in tr sut ca t 50.000 /cm2 v 10 /cm2 khi in tr sut ca t 50.000 /cm2. 5.1.5. Cc bin php bo v mi trng khc V sinh mi trng Thng xuyn kh trng khu vc phng bnh tiu dit cc mm bnh cn st li khng ly lan sang ngi khc, phng khc, trnh tnh trng pht trin bnh thnh dch. Cn b, cng nhn vin bnh vin khi tin hnh cng tc khm v cha bnh cho bnh nhn phi mang khu trang, eo bao tay, mc o blouse. Thng xuyn dn dp v sinh, khu vc tp trung cha cht thi rn lm sng phi c kh trng bng Chlorine. m bo vic khng ch v gim thiu mi hi, bnh vin s c i ng chuyn trch cng vic di ra, v sinh, kh trng bnh vin. Bnh vin tin hnh thc hin ch v sinh nh k hng ngy cc my mc, thit b, phng tin cha tr theo di sc kho ca bnh nhn. - Kim tim, bm tim, ng truyn dch c thay mi sau mi ln s dng. phng tai nn lao ng Trong bnh vin phi thit lp bng ni quy v an ton lao ng cho tng khu v tng cng on.
67

Phi hp vi cc c quan chuyn mn t chc cc bui hun luyn v k thut an ton lao ng. Trang b y cc trang thit b bo h lao ng cho cng nhn vin khi lm vic ti nhng khu i hi an ton cao. Cc trang thit b bo h lao ng c th k n nh: knh phng h mt, mt n chng hi kh c, gng tay, khu trang, giy ng, qun o bo h lao ng, thit b gim m, v.v. Cc bin php h tr bo v mi trng Ngoi cc gii php k thut v cng ngh l ch yu v c tnh cht quyt nh lm gim nh cc nhim gy ra cho con ngi v mi trng, cc bin php h tr cng gp phn hn ch nhim v ci to mi trng nh: Gio dc thc v sinh mi trng v v sinh cng nghip cho bnh nhn v cc cn b cng nhn vin trong bnh vin, thc hin thng xuyn v c khoa hc cc chng trnh v sinh, qun l cht thi nguy hi ca bnh vin. Cng vi cc b phn khc trong khu vc ny, tham gia thc hin cc k hoch hn ch ti a cc nhim, bo v mi trng theo cc quy nh v hng dn chung ca cc cp chuyn mn v thm quyn ca thnh ph. n c v gio dc cc cn b cng nhn vin trong bnh vin thc hin cc quy nh v an ton lao ng, phng chng chy n. Thc hin vic kim tra sc kho, kim tra y t nh k.

5.2. Cc bin php bo v mi trng cn tn ti, cha thc hin trong qu trnh hot ng ca Bnh vin Cn c vo Lut bo v Mi trng nm 2005, Ngh nh 80/2006/N-CP ca Chnh ph ngy 09/08/2006 v vic quy nh chi tit v hng dn thi hnh mt s iu ca Lut bo v mi trng, Ngh nh 21/2008/N-CP ca Chnh ph ngy 28/02/2008 v sa i, b sung mt s iu ca Nghi nh s 80/2006/N-CP, Thng t 08/2006/TT-BTNMT ca B Ti nguyn v Mi trng ngy 08/09/2006 Hng dn v nh gi mi trng chin lc, nh gi tc ng mi trng v cam kt bo v mi trng, v Thng t 04/2008/TT-BTNMT ca B Ti nguyn v Mi trng ngy 18/09/2008 Hng dn lp, ph duyt hoc xc nhn n bo v mi trng v kim tra, thanh tra vic thc hin n bo v mi trng.
Bnh vin ph sn Trung ng xin cam kt:

68

- S nghim tc thc hin cc bin php v cng trnh khng ch cc ngun nhim mi trng t cc hot ng ca d n theo ng phng n k thut c nu trong n Bo v Mi trng. - Thc hin nghim chnh Lut Bo v mi trng ca Nh nc Cng ha x hi ch ngha Vit Nam, m bo khng gy tn hi n mi trng khng kh, nc , t cng nh mi trng kinh t, x hi sc khe cng ng ca khu vc ln cn. - Chu trch nhim trc php lut Vit Nam nu hot ng ca Bnh vin vi phm cc Cng c Quc t, cc Tiu chun Vit Nam v xy ra s c gy nhim mi trng. - m bo s thu gom trit cc cht thi rn pht sinh v s hp ng vi Cng ty Mi trng th H Ni n hu gom em i x l theo ng qui trnh x l cht thi nguy hi. - m bo x l cht thi t tiu chun mi trng Vit Nam v kh thi, nc thi, cht thi rn cng nh cc qui nh v v sinh mi trng, an ton lao ng, phng chng s c ca B Y t, B Lao ng thng binh x hi, m bo x l cht thi trc khi a vo mi trng theo ng cc tiu chun mi trng Vit Nam c lit k ti phn trn, thc hin chng trnh gim thiu nhim v gim st mi trng nh ng k trong n ny. 5.3. Cc hng mc cng trnh bo v mi trng s thc hin b sung v k hoch xy lp hoc lp t cng trnh x l TRANG 95 tng hiu qu hot ng ca bnh vin cng nh bo v mi trng khu vc, bnh vin s thc hin b sung mt s bin php trong qun l v x l cc cht thi m bnh vin to ra. a. H thng thot nc v x l nc thi - Lp t nh v sinh di ng - Xy dng mi hon chnh h thng thu gom thot nc ma v nc thI ca bnh vin. H thng thot nc ma s c u ni vi h thng thot nc mt chung ca bnh vin. H thng thu gom nc thI s c u ni vo tuyn cng thu gom nc thI hin c ca bnh vin a v trm x l nc thi. - Xy dng cc b t hoi ti cc khu nh x l s b nc thI trwocs khi a chy v trm x l.
69

- Tin thi cng: t thng 10 nm 2008 n thng 3 nm 2010 b. X l cht thI rn - u t mi cc trang thit b thu gom, thng cha rc, vn chuyn rc bng xe y.. - Tin mua sm v lp t trang thit b: t thng 10/2009 6/2010 c. X l kh thi - Vic lp t h thng qut ht, h thng thng gi, t ht kh c gim thiu kh thI nhim t mt s khu vc nh cc phng xt nghim, kho cha ho cht, dc phm s c tin hnh song song trong giai on hon thin, lp t thit b trong cc khu nh - Tin thi cng , lp t n ht 2010 d. D tr kinh ph ci tin h thng x l nc thi ci tin TT I 1 2 3 Hng mc Chi ph trc thu Chi ph thit b x l chnh Chi ph thit b in, iu khin Chi ph vt t iu khin t ng Tng chi ph trc thu 4 II III Thu VAT 10% Chi ph sau thu Chi ph o to, chuyn giao cng ngh Tng cng (II + III) Gxl Gtb Gvt Gt 402.600.000 58.410.000 26.000.000 487.010.000 Cch tnh Gi (VN) tr

VAT=Gt*10% 48.701.000 Gt + VAT 535.711.000 15.000.000 550.711.000

e. Bin php khc phc trong trng hp h thng gp phi s c khng hot ng c

70

Trong trng hp h thng x l nc thi gp s c th ton b phn nc thi sinh hot v nc thi y t c a thng vo b kh trng, sau khi kh trng nc thi c bm ra ngoi mi trng. Nc thi ra ngoi m bo sch khun. 5.3.2. i vi cht thi rn Bnh vin Ph sn Trung ng tin hnh phn loi rc thnh 3 loi ring (rc thng thng, rc ti ch, rc nguy hi), nhng nhiu ch rc cha c bin bo c th cho tng loi cng nh cha c du hiu cnh bo theo quy nh ti Quyt nh s 43/2007/Q-BYT. Tt c cc loi rc thi s c theo di, phn loi ngay ti ngun pht sinh rc thi cc khoa khm cha bnh trc khi c chuyn n khu tp kt rc thi tp trung v c cc n v chc nng x l, c th Cng ty Mi trng th H Ni vn chuyn v x l rc thi thng thng, X nghip x l cht thi Cng nghip Y t vn chuyn v x l rc thi nguy hi. Rc thi nguy hi s c theo di cht ch theo S qun l cht thi nguy hi do S Ti nguyn v Mi trng H Ni cp. Bnh vin cng s c gng gim thiu, ti ch v ti s dng rc thi n mc c th bng cch: - Gim ti ngun: la chn mua bn vt t s dng t gy rc thi hay pht sinh t rc thi nguy hi, ngn nga lng ph vt t. - Qun l kho ho cht v dc phm: t hng vi s lng va phi, c hn s dng lu. 5.4. Chng trnh qun l v gim st mi trng 5.4.1. Chng trnh qun l mi trng Thng xuyn kim tra h thng x l nc thi y t; kp thi pht hin cc s c sa cha nhm m bo tnh hiu qu ca h thng, khng gy nhim ti mi trng. Chng trnh Lp s qun l cht thi y t, s theo di vn hnh h thng x l nc thi. - Hon thin v thc hin nghim chnh ni quy bn trong khu vc hot ng ca tng khoa v bnh vin: o V sinh mi trng o Quy nh an ton lao ng
71

o Quy nh phng chng chy n v ng cu s c, ri ro Thc hin kim tra sc kho v y t nh k cho cn b, cng nhn vin bnh vin. Nng cao nhn thc v bo v mi trng cho cn b cng nhn vin trong bnh vin. T chc b my nhn s cho cng tc qun l mi trng ni chung v qun l cht thi, khc phc, ng cu khi xy ra s c v mi trng ni ring. o Mt ph gim c chu trch nhim qun l chung cc vn mi trng ca Bnh vin; o Mt nhn vin chuyn trch gim st cc vn mi trng theo s ch o ca ph gim c bnh vin. Nhn vin gim st mi trng ny s chu trch nhim qun l, gim st cng vic ca: o Hai cng nhn vn hnh h thng x l nc thi;
o

Hai cng nhn chu trch nhim theo di lng rc thi ca bnh vin: 01 ngi chu trch nhim v rc thi sinh hot ca bnh vin, 01 ngi chu trch nhim v rc thi y t nguy hi.

5.4.2. Chng trnh gim st mi trng Vic gim st cht lng mi trng s c bnh vin phi hp vi cc c quan chc nng tin hnh o c, quan trc, phn tch mu thng xuyn ti mt s im bn trong v bn ngoi Bnh vin nhm nh gi cht lng mi trng, cung cp thng tin cho S Ti nguyn, Mi trng v nh t H Ni, gp phn vo cng tc qun l mi trng chung cho ton quc. a. Gim st cht thi Trong qu trnh hot ng, bnh vin s ch trng n vic gim st cc loi cht thi m bnh vin pht sinh nh c cp di y. Gim st nc thi Ngun nc thi:
-

Thng s quan trc: pH, BOD5, NO3-, SS, H2S, PO43-, NH4+, du m thc phm v Tng Coliform V tr quan trc: Trong khu vc Trm x l nc thi ca Bnh vin: 01 mu nc thi trc x l v 01 mu nc thi sau x l.
72

Tn sut quan trc: 4 ln/nm, trung bnh 3 thng tin hnh 1 ln

+ Thit b v phng php phn tch : Theo TCVN tng ng Tiu chun so snh: Tiu chun cht lng nc- Nc thi bnh vin Tiu chun thi: TCVN 7382 2004.

- D tr kinh ph gim st nc thi o TT Chi ph phn tch mu cho mt ln quan trc. Thng s S lng 1 2 3 4 5 6 7 8 9 pH TSS BOD5 COD Amoni NH4+ Nit tng P tng Coliform Vi khun gy bnh rut 10 Tng hot phng Alpha 11 Tng hot phng x Beta Tng 2.260.000 02 300.000 600.000 x 02 300.000 600.000 ng 02 02 02 02 02 02 02 02 02 n gi (VND) 30.000 50.000 80.000 80.000 50.000 60.000 60.000 60.000 60.000 Thnh tin (VND) 60.000 100.000 160.000 160.000 100.000 120.000 120.000 120.000 120.000

Bng 5-1: Chi ph phn tch mu cho mt ln quan trc

73

o o

Chi ph nhn cng: 200.000 VND/ngi/ln. Nh vy, tng chi ph quan trc: 2.260.000 + 200.000 =

2.460.000 ng.
o

Chi ph quan trc cht lng nc thi trong mt nm (2

ln quan trc): 4.920.000 ng.

Gim st cht thi rn Cc vn cn gim st

o Thu gom v phn loi ngay ti ngun pht sinh cc khoa; o Tng lng rc thi sinh hot v cht thi nguy hi; o Thnh phn cht thi, phn trm tng loi cht thi nguy hi; o Cch thc phn loi v lu gi rc thi sinh hot, rc thi khng nguy hi v rc thi nguy hi trong bnh vin; o Gim st nhn vin thu gom ca cc cng ty dch v mi trng c trch nhim mang cht thi tp trung v khu vc quy nh c ng thi gian, c vng vi rc thi trn ng giao thng ni b bnh vin. - Tn sut gim st: nh k 06 thng/ln, ch ngun thi cht thi nguy hi lp bo co v tnh hnh pht sinh v qun l cht thi nguy hi gi S Ti nguyn v Mi trng (theo Thng t 12/2006/TT-BTNMT). b. Gim st mi trng xung quanh Gim st cht lng khng kh Thng s gim st: bi l lng, nng cc cht nhim trong khng kh (NO2, SO2, CO); mc n (Leq, L10, L90)
-

V tr gim st: 3 v tr

o Trc cng bnh vin, cnh ng quc l 1A c; o Gia bnh vin, khu vc i phun nc; o Trong khun vin bn ngoi bnh vin . Tn sut gim st:

74

o 4 ln/nm, trung bnh 3 thng tin hnh mt ln i vi cc thng s quan trc trong bnh vin. o 2 ln/nm, trung bnh 6 thng tin hnh mt ln i vi cc thn s quan trc bn ngoi Bnh vin. - Phng php ly mu, o c v phn tch theo tiu chun Vit Nam hin hnh. Tiu chun i chiu: kh xung quanh. o TCVN 5949-1998: m hc. Ting n khu vc cng cng v dn c. Mc n ti a cho php. D tr kinh ph gim st

o TCVN 5937-2005: Cht lng khng kh. Tiu chun cht lng khng

o Chi ph o c/phn tch mu cho mt ln quan trc. Bng 5-1: Chi ph o c/phn tch mu cho mt ln quan trc TT Thng s S ln g n gi (VND) Thnh tin (VND)

Cht lng khng kh CO NO2 SO2 Bi l lng 3 3 3 3 300.000 300.000 300.000 100.000 900.000 900.000 900.000 300.000

Mc n Leq L10 L90 Tng o Chi ph nhn cng: 200.000 VND/ngi/ln 3 3 3 30.000 30.000 30.000 90.000 90.000 90.000 3.270.000

75

o Nh vy, tng chi ph quan trc mt ln: 3.270.000 + 200.000 = 3.470.000 ng.
o

Chi ph quan trc cht lng khng kh trong mt nm (2 ln quan trc): 6.940.000 ng.

Gim st cht lng nc mt o

Thng s gim st: pH, SS, BOD5, COD, Nit tng, Coliform, amoni, tng P, , Fe, Mn, mu, As, Amoni, Nitrat, Nitrit, vi khun gy bnh ng rut, tng hot phng x Alpha v Beta.

o Lu lng nc thi. V tr gim st:

Ly ti b cha nc cp ca Bnh vin : 02 mu Tn sut gim st: 02ln/nm, trung bnh 6 thng tin hnh mt ln. Phng php thu mu v phn tch: ly mu; o TCVN 5993-1995: Cht lng nc Ly mu. Hng dn bo qun v x l mu; o TCVN 5999-1995: Cht lng nc Ly mu. Hng dn ly mu nc thi Tiu chun i chiu: thi. D tr kinh ph gim st.

o TCVN 5992-1995: Cht lng nc Ly mu. Hng dn k thut

o TCVN 7382-2004: Cht lng nc. Nc thi bnh vin. Tiu chun

o Chi ph phn tch mu cho mt ln quan trc. Bng 5-1: Chi ph phn tch mu cho mt ln quan trc TT 1 2 Thng s pH TSS S lng 02 02
76

n (VND)

gi Thnh (VND)

tin

30.000 50.000

60.000 100.000

TT

Thng s

S lng

n (VND)

gi Thnh (VND)

tin

3 4 5 6 7 8 9

BOD5 COD Amoni NH4+ Nit tng P tng Coliform Vi khun gy bnh ng rut Tng hot phng x Alpha Tng hot phng x Beta Tng

02 02 02 02 02 02 02

80.000 80.000 50.000 60.000 60.000 60.000 60.000

160.000 160.000 100.000 120.000 120.000 120.000 120.000

10

02

300.000

600.000

11

02

300.000

600.000 2.260.000

Chi ph nhn cng: 200.000 VND/ngi/ln.

o o

Nh vy, tng chi ph quan trc: 2.260.000 + 200.000 = 2.460.000 ng. Chi ph quan trc cht lng nc thi trong mt nm (2 ln quan trc): 4.920.000 ng.

5.4.3. Ch bo co Cn c vo chng trnh qun l v gim st t ra trn, Bnh vin cam kt kt qu thc hin cng tc bo v mi trng v kt qu gim st mi trng c lu gi ti Bnh vin Ph sn Trung ng v nh k gi bo co v c quan ph duyt n bo v mi trng (S Ti nguyn v Mi trng H Ni) kim tra, gim st. Tn sut bo co 02 ln/nm (trc ngy 15 thng 6 v ngy 15 thng 12 hng nm). 5.5. Cam kt thc hin n bo v mi trng Bnh vin Ph Sn Trung ng cam kt kim sot mi trng c th nh sau:
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Thc hin nghim chnh Lut BVMT ca Nc Cng ha X hi Ch ngha Vit Nam, m bo khng gy tn hi n mi trng khng kh, nc, t cng nh mi trng kinh t, x hi sc khe cng ng ca khu vc ln cn. X l nc thi t tiu chun mi trng TCVN 7382-2004 (Cht lng nc. Nc thi bnh vin. Tiu chun thi), mc I vo thng 10/2009 Qun l cht thi rn sinh hot, cht thi rn khng nguy hi v cht thi nguy hi theo Quy ch qun l cht thi y t ban hnh km theo Quyt nh s 43/2007/Q-BYT ngy 30/11/2007 ca B Y t v Thng t s 12/2006/TTBTNMT ngy 26/12/2007 ca B Ti nguyn v Mi trng v Hng dn iu kin hnh ngh v th tc lp h s, ng k, cp php hnh ngh, m s qun l cht thi nguy hi. Xin cp giy php khai thc nc ngm, x thi vo ngun v xin cp s ng k ch ngun thi cht thi nguy hi chm nht l thng 3/2009. Thc hin tt cng tc phng chng chy n theo Lut phng chy v cha chy nm 2001 v cc an ton lao ng theo Chng IX An ton lao ng, v sinh lao ng, B lut Lao ng sa i nm 2002. Thc hin chng trnh qun l v gim st mi trng nh trnh by trong bo co ny. Cam kt s bi thng nhng thit hi khi c s c, ri ro do hot ng ca bnh vin gy ra cho cc c s/ngi dn ln cn. Chu trch nim trc php lut Vit Nam nu hot ng ca Bnh vin vi phm cc Cng c quc t, cc tiu chun Vit Nam v xy ra s c gy nhim mi trng. m bo s thu gom trit cc cht thi rn pht sinh v s hp ng vi Cng ty Mi trng th H Ni n thu gom em i x l theo ng qui trnh x l cht thi nguy hi. m bo x l cht thi t Tiu chun mi trng Vit Nam v kh thi, nc thi, cht thi rn cng nh cc qui nh v v sinh mi trng, an ton lao ng, phng chng s c ca B Y t, B Lao ng thng Binh X hi; m bo x l cht thi trc khi a vo mi trng theo ng cc tiu chun mi trng Vit Nam c lit k ti phn trn, thc hin chng trnh gim thiu nhim v gim st mi trng nh ng k trong n ny. Trong qu trnh hot ng, nu c yu t mi trng no pht sinh hoc s c lin quan n mi trng, Bnh vin s trnh bo ngay vi c quan qun l mi trng a phng x l ngay ngun nhim ny. ng thi s hon thnh vic
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xy dng v lp t cc cng trnh x l nh xut. Bnh vin cam kt hon ton chu trch nhim trc php lut Vit Nam, nu vi phm cc cng c quc t, cc tiu chun Vit Nam v nu xy ra cc s c gy nhim mi trng nghim trng. H Ni, ngy thng nm 2009

BNH VIN PH SN TRUNG NG (K tn, ng du)

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