Waste Management 33 (2013) 1958–1961

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Waste Management

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A Glance at the World

Edited by Maria Cristina Lavagnolo

This column comprises notes and info not subjected to peer-review focusing on waste management issues in different corners of the world. Its aimis to open a window onto the solid waste management situation in any given country, major city or significant geographic area that may be ofinterest to the scientific and technical community at large.

Health-care solid waste management in Vietnam

Vietnam is one of the most densely inhabited country in theworld, and its population growth rate is expected to be 1.054%.Approximately 30% of the country’s residents currently live inthe cities; its urbanization annual rate of change was 3%. Accord-ing to statistics of the Ministry of Natural Resources and Environ-ment, by 2008 Vietnam produced over 27.87 million tonnes ofwaste each year from various sources; of which, hazardoushealth-care waste accounted for only a small percentage(0.64%). The total amount (tonnes/year) of hazardous health-carewaste generated is increasing day by day and is estimated to be300 thousand tonnes per year by 2050 (JICA, 2010). Therefore,health-care waste management in Vietnam has been given seri-ous attention at different levels of government, as well as at thecommunity level.

Health-care waste management system

At the national level, health-care waste management is underthe scope of the Ministry of Health, the MONRE, and the Minis-try of Construction. At the local level, it is undertaken by theUrban Environmental Companies, which are directly under theProvincial People’s Committees or the Department of Transportand Public Works or the Department of Construction or theDepartment of Natural Resources and Environment (DONRE).The central administrative bodies and respective departmentsof the provincial, district, and local levels have their own rolesand responsibilities for health-care waste management in theirjurisdictions. Other local agencies and organizations for health-care waste management also share responsibilities of manage-ment, such as collection at source, transportation and treatmentactivities.

As health-care waste is recognized as a hazardous source forhuman health and environmental quality, the Government of Viet-nam has incorporated this issue into several development strate-gies and environmental protection plans with a view to theboosting appropriate management and handling of this source.Several existing legal documents (strategies, development plans,and guidelines) have been issued by the government and relevantcentral ministries for developing and improving the health-care

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waste management system. The development goals and expectedresults by target year 2015 (Decision 2149/2009/QD-TTg, and Deci-sion No.1873/2009/QD-BYT) and 2020 (Decision 2149/2009/QD-TTg, and Decision 30/2008/QD-TTg) have been introduced.

Health-care facilities in Vietnam

In 2009, there were 13,450 health-care facilities with more than232,925 beds (GSO, 2010), including 1002 general and specialtyhospitals, 682 regional clinics, 43 sanatoriums, 10,979 health-careservice units in villages and precincts, 710 health-care service unitsin offices and enterprises, and 34 other facilities. The trend ofhealth-care facilities seems to have increased in recent years asshown in Fig. 1; this is a significant indication of the increasinggeneration of health-care waste in the near future.

Generation and composition

In 2005, the total amount of solid waste arising from health-care establishments was reported to be around 300 tonnes/day,of which 40 tonnes/day are hazardous, poorly treated medicalwaste. In 2010, the total amount of health-care waste generationwas estimated to be 380 tonnes/day, of which about 45 tonnes/day are hazardous. And the figures are expected to grow to approx-imately 600 tonnes/day in 2015 and over 800 tonnes/day in 2020(JICA, 2010).

Waste generation depends on the number of beds, the extentand type of medical technology and the accessibility of people tohealth services. Table 1 shows information on health-care wastegeneration from various central, provincial and district hospitals.

Health-care waste composition is distributed as hazardoushealth-care waste accounts for roughly 26–30% of total health-carewaste. An example of the composition analysis of health-carewaste in Vietnam published by JICA (2010) showed that,health-care waste composition is distributed as general waste(26.8–40.0%), needles and sharps (1.3–2.29%), cotton bandagesstained with blood (4.58–18.1), specimens (1.31–13.8), paper(not determined), plastics (2.63–3.2%), metals (0.64–1.4%), glassand bottles (1.8–2.63%), expired medicines (0.1–1.6%), infectiouswaste (not determined), and others (12.5–26%). The health-carewaste stream information (waste generation rate and waste

Fig. 1. Trend of health-care facilities in Vietnam (GSO, 2010).

A Glance at the World / Waste Management 33 (2013) 1958–1961 1959

composition) currently was both old and unreliable, but was per-force widely quoted in the absence of alternative data. The demandfor reliable data on waste has grown in recent years in cities ofVietnam for basic researches, planning, and management.

Segregation and storage at generation points

Health-care solid waste is classified into two categories: health-care waste and domestic waste. Health-care staff members segre-gate the hazardous health-care waste, bandages, and swabs inone plastic bin in the main medical examination room. With regardto domestic waste, plastic containers are placed in the treatmentrooms, nursing rooms, or hospital/centre campuses. Health-carestaff members are responsible for the daily collection of hazardoushealth-care waste and domestic waste at source and for transport-ing them to the storage point.

For health-care solid-waste storage, clinical waste is put intospecial yellow plastic bags marked with the biohazard symbol.Chemical and radioactive waste is stored in special black plasticbags with labels indicating the source. Green bags are used for gen-eral waste and compressed air containers. The type, shape, colour,and mark for health-care waste storage were defined and pre-sented in a regulation on health-care waste management by the

Table 1Amount of health-care waste generated at various hospital establishments.

Hospital Total health-care waste generation (kg/bed/day)

Centralhospital

Provincialhospital

Districthospital

Hospital 0.97 0.88 0.73Intensive care 1.08 1.27 1.00Medical ward 0.64 0.47 0.45Paediatrics 0.50 0.41 0.45Surgical ward 1.01 0.87 0.73Maternity 0.82 0.95 0.73Ophthalmology/

otolaryngology0.66 0.68 0.34

Para-clinical 0.11 0.10 0.08

Source: JICA (2010)

MOH (according the Decision No. 43/2007/QD-BYT dated Novem-ber 30, 2007: Promulgating the regulation on healthcare wastemanagement).

Until 2009, 95% of the hospitals in Vietnam segregated thewaste at source; however, some health-care establishments werefound to have wrongly categorized the segregated waste. Fifty-three per cent of the hospitals used professional containers (closedcontainers with covers and wheels) and 53.4% had professionalstorage places (closed rooms with roofs and doors) for health-carewaste (MONRE, 2010). Health-care establishments at the rural-dis-trict level or lower (communes, towns) paid little attention towaste storage and waste segregation (domestic waste and hazard-ous waste).

Collection and transportation

For domestic waste, hospitals usually sign contracts with theservice companies in charge of collection in the locality, for exam-ple The Urban Environmental Companies (URENCO). This waste iscollected, transported and treated as municipal solid waste.

Health-care hazardous solid waste from hospitals is collectedand transported under specific contracts. Health-care waste isstored in specific bins containing professional symbols and trans-ported to treatment sites (landfill sites or incinerators) by specificvans. Waste generated from health-care facilities is transported tothe general waste storage of the facility at least once a day or whennecessary. Some health-care establishments have separate storageareas for such waste with access for waste-collection vehicles. Forhealth-care establishments at rural-district level or lower (com-munes, towns), waste collection and transportation is not yet as fo-cused and concentrated as waste segregation (especially domesticwaste and hazardous waste) at source.

Treatment and disposal

Domestic waste from health-care facilities is collected and trea-ted as municipal solid waste by the respective local URENCOs. Thecommon practices for the treatment and disposal of hazardoushealth-care waste of health-care facilities consist of the followingpractices: (i) Contract with URENCO or other service providers(burying or incinerating at disposal facilities); (ii) Treatment inthe hospital campus: on-site incinerators, needle retraction equip-ment, concretion by cement in a pit, autoclave, chemical disinfec-tion/chemical treatments, neutralization, mixing tank (decayingand dilution); and (iii) Return to supplier.

Existing problems of treatment and disposal facilities wereidentified. Firstly, health-care establishments at the rural-districtor lower level (communes, towns) apply unsanitary treatmentpractices (open burning, simple brick incinerators, or open

Hazardous health-care waste generation (kg/bed/day)

Average Centralhospital

Provincialhospital

Districthospital

Average

0.86 0.16 0.14 0.11 0.141.12 0.30 0.31 0.18 0.260.52 0.04 0.03 0.02 0.030.45 0.04 0.05 0.02 0.040.87 0.26 0.21 0.17 0.210.83 0.21 0.22 0.17 0.200.56 0.12 0.10 0.08 0.10

0.10 0.03 0.03 0.03 0.03

1960 A Glance at the World / Waste Management 33 (2013) 1958–1961

burying) in their campuses. These burning practices emit toxicpollutants causing serious environmental damage and may endan-ger human health. The existing unsanitary landfill sites have alsocaused negative environmental impacts. Secondly, the health-carewaste has low calorific value and heterogeneous composition; thesecause incinerator start-up problems because fuel has to be addedconstantly to maintain the combustion process. The incineratorscannot meet the standards for temperature and gas emissions duringthe combustion process. Thirdly, health-care waste treatment anddisposal practices have been managed and assessed by the govern-ment (proper institutions) with respect to technical standards,leachate quality, gas emissions. Moreover, the operational cost ofthese practices is very high. Meanwhile, the daily operation of thesepractices remains uncontrolled, because almost all health-careestablishments treat waste and operate disposal practicesthemselves.

Financial aspects

The treatment cost of hazardous health-care waste is higherthan that for domestic waste and the treatment costs are differentfrom city to city. Approximately 70% of all health-care waste can bedisposed of through regular municipal waste disposal methods orsent for recycling, as in the case of other domestic waste. Theremainder (30% of all health-care waste) is potentially infectious.Without source segregation and recycling activities in place, hospi-tals are forced to dispose of general waste along with the infectiouswaste, thereby resulting in unwanted disposal. A proper recyclingand source segregation system can still reduce the amount ofwaste classified as infectious/hazardous. Therefore, the treatmentcost could also be decreased.

Final remarks

Poor health-care waste management results in possible effectson the environment and public health. Health-care waste has be-come a serious environmental concern for Vietnam. The trend forhealth-care facilities seems to have increased in recent years; thisis a significant indication for the increased generation of health-care waste in the near future. Furthermore, health-care waste isheterogeneous in composition and the categorization of the wastecomposition is not standardized. Unfortunately, the data-streamon waste information is currently both old and unreliable, but is,perforce, widely quoted in the absence of alternative data. There-fore, reviewing the evaluation, understanding of the currenthealth-care waste management system, and recommending ofstrategic actions, improvements, and master plans addressing avariety of aspects, such as the quantity and composition of wastegeneration, operational management, and the legal system, as wellas financial aspects is indispensable for proper waste managementand planning.

References

GSO, 2010. Statistical Yearbook. General Statistical Office – Statistical PublishingHouse, Ha Noi, Vietnam.

JICA, 2010. The Study on Urban Environmental Management in Vietnam, vol. 06.Study Report on Solid Waste Management in Vietnam. <http://www.nea.gov.vn/VN/tintuc/tinnoibo/Documents/PrR2_Vol_06_SWM%20withAnnex.pdf>.

Nguyen Phuc ThanhCollege of Environment and Natural Resources,

Can Tho University, Viet Nam

Fig. 1. The components that make up the daily waste generation of Rasht in2005–2010.

Six-year research of the quantity of waste genera-tion and evaluation of environmental recycling ofpaper and cardboard aspects from Rasht city waste(April 2005 to March 2010)

Based on a physical analysis of municipal solid waste in Iran,about 10.9% of waste includes paper and board. Studies done bySalhofer and colleagues in 2007 showed that recycling paper ratherthan burying it produces 60 percent less CO2 emissions in atmo-sphere (Salhofer et al., 2007). Considering the importance of recy-cling issue, in this study, the environmental aspects of paper andcardboard recycling from Rasht city waste with an average popula-tion of 886,457 people from 2005 to 2010 was evaluated.

Materials and methods

Study area. Rasht city, with an area of about 136 km2, is one ofIran’s coastal towns and represents a tourist and political centerof the Gilan province, which is located in the southern CaspianSea. The current landfill in the city of Rasht is located 24 km farfrom transfer station in Saravan and now waste is buried, whichis detrimental to human health.

Survey method. This is a field study carried out in Rasht from2005 to 2010. In this survey the waste composition and physicalanalysis of the cargo transported by a few trucks at mid monthwas studied in controlled conditions. First, discharged waste wasdivided into four parts, and one part was then divided into fourparts. The division into four parts was continued until a mixtureof 150 kg of waste was obtained before the samples were analyzedphysically. Gathering information about recycling paper and card-board recycling was carried out through interviews with agency

officials, field observations and office Municipal Services. The ori-gin of paper and cardboard consumption of each citizen in Rashtfrom 2005 to 2010 was determined together with the percentagerecovery. These figures were obtained by referring to statisticsbased on the amount of paper and cardboard present in the sepa-rated municipal waste collection for paper and cardboard. In recentyears, the official census has been conducted twice in the years1996 and 2006 by the Statistical Center of Iran. Statistics basedon the population growth rate and the population of Rasht in2005, 2006, 2008, 2009 and 2010 are calculated by the formulaNt = N0ert where Nt is the number of population at time t, N0 popu-lation at the time t0, e, Neper’s number, r, the growth rate and t, isthe time to comment on. Additionally the environmental benefitsof recycling and recovery of current and recycling 50% and optimalrecovery 100% were evaluated.

A Glance at the World / Waste Management 33 (2013) 1958–1961 1961

Results. To calculate available paper and cardboard in Rasht mu-nicipal waste, information about the total amount of collectedwaste in a year and physical composition of waste is essential. Aswe can see from Fig. 1, the average amount of daily productionof waste increased from 300 ton in 2005 to 593 ton in 2010, andthe per capita production increased from 132 kg per year in 2005to 239 kg in 2010. During this 6-year period, approximately91,152 tons of paper and cardboard in Rasht was used, 10% ofwhich was recycled. Based on a physical analysis of Rasht citywaste from 2005–2010, wet and dry waste were on average65.3% and 34.7% weight percent of the city’s waste. Of the drywaste generated during this period, the amount of paper and card-board production has always been highest after plastic, averagingat a rate of 9.6% of city waste from 2005 to 2010.

Conclusions

The amount of time per capita paper and cardboard productionin Rasht, implies changing trends in consumption related to an in-creased level of public welfare. Considering that 65.3% of the totalproduced waste in the city of Rasht are perishable materials, theuse of an organic fertilizer production system as an appropriatemethod for disposal of municipal solid waste should be consideredto reduce the health problems of waste burying, from the sale ofgenerate fertilizer municipal income.

Reference

Salhofer, S., Schneider, F., Obersteiner, G., 2007. The ecological relevance oftransport in waste disposal systems in Western Europe. Waste Management27, 47–57.

Mohammad Hosein Sinka KarimiYoung Researchers Club, Nour Branch, Islamic Azad University,

Nour, Iran

Ali Reza PourkhabbazDepartment of Environmental Science,Agriculture Faculty, Birjand University,

Birjand, Iran

Mohsen AhmadpourYoung Researchers Club,

Qaemshahr Branch, Islamic Azad University,Qaemshahr, Iran

Hamid Reza SoltaniEnvironmental Science Alumnus from

Mazandaran University, Babolsar, Iran