T U " N G H I E N C Q U D E N T R I E N K H A I - S A N X U A T
Kir ly chat thai ran y te
bang cdng nghe than thien moi trirong
NGUYEN MINH TUAN - Vu Trang thiet bi va cong trinh y te
CAO THj VAN DIEM, PHAM MINH QUAN - Vien Trang thiet bj va cong trinh y te Bo Y te Viec ap dung cac cdng nghe than thien vdi mdi trddng de xd ly chat thai y te, dac biet la chat thai rin y te (CTRYT) ludn phu htfp vdi chu trudng cua Nha ntfdc ta. De gdp phan nang cao hieu qua cua cdng tac xtf ly CTRYT hien nay, rat can cd nhtfng nghien cud chuyen sau phan tich, danh gia va so sanh cac cdng nghe, thiet bj xd ly CTRYT, ttf dd Ida chon md hinh va cdng nghe tdi tfu cd the nhan rdng.
T r e n the gidi, viec xtf ly CTRYT chu' yeu van dung cong nghe Id dot. Tuy nhien, ben canh mot sd ifu diem, cdng nghe nay ngay cang trd nen khdng phu htfp do phat thai cac chat nguy hai tiem an, gia ca lai ddt do va thieu hieu qua kinh te. Be giai quye't cac van de nay, cac nha cdng nghe da nghien cdu va phat trien nhtfng cong nghe khdng ddt phu hop vdi khuyen cao cua cac td chdc mdi trddng qudc te nhu ChUtfng trinh Mdi trudng cua Lien Hup Qudc (UNEP), Quy Mdi trUdng toan cau (GEF); Td chdc Y te the gidi (WHO), To chdc ThUc hanh y te khong gay hai (HCWH). Mdt so nude da han che va dan dan ngdng sd dung Id dot chat thai y te va lua chon nhdng cdng nghe mdi than thien mdi trUdng.
Theo HCWH, cong nghe khong dot dUq'c ap dung hien nay bao gdm: Cdng nghe sd dung hda chat, cdng nghe vi sinh, cdng nghe nhiet khd va cdng nghe nhiet am. Trong dd, cdng nghe
nhiet am thong dung nhat do chi phi dau tu thap hon va it tao ra cac chat d nhiem. Trong sd cdng nghe nhiet am, cac nUdc tren the gidi chu yeu sd dung 2 loai cdng nghe chinh de khd khuan chat thai y te lay nhiem, dd la cdng nghe hap bang hoi nddc (dung hoi ndng am) hay nhiet ddt va cdng nghe vi sdng (microwave).
Cong nghe hdp bdng hoi ntfdc thuan tuy da ddgc ap dung td nhdng nam 70 cua the ky trddc nhdng hieu qua khd khuan khdng dn dinh va chi phi thie't ke, ldp dat, bao dddng rat cao. Vdi the he tien tien nhat, cdng nghe nay thddng ddi hdi phai cat nhd chat thai trddc khi xd ly khd khuan de dam bao hieu qua theo yeu cau. Mpt so hang che' tao thie't bi cat dpc lap hoan toan vdi thie't bi ha'p khd khuan, trong khi mdt sd hang khac thie't ke' may cat gdp chung vdi thie't bi ha'p khd khuan thanh mpt he thd'ng. Loai sd dung thie't bi cat hoan toan dpc lap trddc khi khd khuan cd nhdgc diem ndi bat la gay nguy co lay nhiem benh trong khu vUc
cat, khdng an toan cho ngUdi van hanh va gay phdc tap hon do yeu cau phai ve sinh thie't bi cat rat thddng xuyen. Loai thiet bi hop khdi ddng nhat nghien cat trong thiet bi khd khuan du giai quyet ddpc van de ngan chan lay benh trong khu vdc xd ly, dam bao an toan ve sinh cho ngddi van hanh nhung lai cd nhugc diem la khdng phU hpp cdng suat gida hai loai chdc nang (gay lang phi), khdng dn dinh, chi phi cao do thie't bi cat hay bi hong, phai ddng de thay the sda chda. Khi lddi cat va may cat bi hong hoac khdng dat yeu cau chat ldpng thi bat budc phai thay the nhanh chdng de bao dam thdc hien nhiem vu khd khuan ddOc lien tuc (giam td'i da thdi gian ldu trd chat thai lay nhiem). Bieu nay lam cho chi phi duy tri he thd'ng xd ly tang cao, ddng thdi keo theo nguy co d dpng chat thai y te de khdng ddgc xd ly khd khuan kip thdi, trd thanh ngudn lay nhiem benh tat va d nhiem mdi trUdng ngay tai dd. Ghep ndi hai he thdng thie't bi con lam cho tinh linh
o c nuat uuuy , .
d b KHOA HOC S o t h a n g 7 2 0 1 1
T I / N G H I E N C L / U D E N T R I E N K H A I - S A N X U A T
hoat ve cong suat giam di, thdi gian xd ly tang len. Ngoai ra, viec cat trddc chat thai se khdng thuan lgi cho cdng tac phan loai de tai che.
O cac nirdc phat trien (Anh, Phap, My, Ddc...), cdng nghe khil khudn sd dung vi song da ddgc sd dung td khoang 20 nam trd lai day. Cd 2 nhom chinh: Khd khuan d dieu kien ap suat thdng thddng va d dieu kien ap suat cao (2 va 3 bar). Cac thiet bi cua cdng nghe nay thddng dat cac tieu chuan khat khe ve hieu qua khd khuan, dp an toan, tieu chuan mdi trddng va cac tieu chuan ky thuat bat budc khac, dupe chdng nhan va cdng nhan bdi cac td chUc cd uy tin va cd gia tri tren toan cau. Ddng thdi, nhdng thiet bi nay thddng cd dp ben cao, giup giam chi phi cho co sd sd dung.
Nguyen ly va mpt sd thdng sd ky thuat cua quy trinh xd ly CTRYT theo cdng nghe khd khuan sd dung vi sdng ket hop hoi nude bao hda ap suat cao - cdng nghe tien tien nhat hien nay nhu sau: Qua trinh hut khdng khi tao ra mdi trUdng
chan khdng trong khoang xd ly chda CTRYT trddc khi cap hoi nUdc cd tac dung lam hoi nddc tham sau va lam ddt mpi be mat chat thai, ke ca trong long khdi chat thai la cac vat the cd cau true phdc tap, nhd, dai va hep nhd kim tiem. Viec lam am be mat nay cd tac dung giup nang luong nhiet do vi sdng tao ra lam ndng chat thai td ben treng, ket hop vdi nhiet dp va ap suat cao se cd tac dung pha huy ca'u true te bao va tieu diet tat ca cac loai mam benh (vi khuan, virus, nha bao, ky sinh trUng...) cd trong chat thai. Nhd dd, sau khi dupe xd ly, chat thai lay nhiem se trd thanh chat thai thdng thudng ma khdng bi pha huy, rat thich hgp cho viec tan dung de tai che. Toan bp quy trinh hoat dpng cua cdng nghe nay deu khdng tao ra khdi bui, khdng xa ra nUdc thai, cung khong sd dung hoa chat khd, tiet trung.
Nude ta hien cd khoang 1.050 benh vien vdi tdng so hon 140.000 giudng benh va hon 10.000 tram y te xa, hang chuc ngan phdng kham tu nhan, co sd nghien cdu, dao tao... hang ngay
Xd ly CTRYT bang Id ddt thai ra lupng chat thai y te rat Idn, trong dd gan 1/10 la loai chat thai nguy hai. Nam 2010, lugng chat thai y te phat sinh la khoang 500 tan/ngay, trong dd cd 60-70 tan chat thai nguy hai can phai xd ly. Ket qua khao sat cho thay, 94% so benh vien thdc hien phan loai chat thai ngay tai ngudn, 93% so' benh vien thu gom rieng vat sdc nhpn, 85% so benh vien sd dung cac phuong tien thu gom, van chuyen (tui, thung, xe day) theo dung ma mau quy dinh (mau vang - chat thai lam sang, mau xanh - chat thai sinh hoat, mau den - chat thai hoa hpc, phdng xa). Nhieu benh vien da xay ddng khu lUu gid chat thai tap trung tai benh vien theo dung quy che.
Theo nghien cdu cua Vien Trang thie't bi va cdng trinh y te, nUdc ta hien dang sd dung Id ddt CTRYT chu yeu la Id dot nhap ngoai va Id ddt san xuat trong nUdc cua mpt so cdng ty, co sd nghien cdu ve mdi trUdng. Tuy nhien, qua khao sat cho thay, nhieu Id dot hien chua dam bao thdi gian luu chay cua khdi trong budng dot thU cap - day la mpt trong nhdng thdng so quan trpng nha't dam bao hieu suat ddt chay rac va phan huy dioxin cua Id dot. Nhieu cP sd y te khong ddpc
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So thang 7.2011K H O A HOC 3
T L J N G H I E N C L / U D E N T R I E N K H A I - S A N X U A T
trang bi day du kien thdc va phdOng tien de cd the kiem soat chat che viec van hanh Id dot chat thai. Cac Id dot chat thai y te' tot nhat cung da cu, xudng cap va bi hong hoc, nhieu thiet bi khdng the sda chda dupe.
Ben canh cdng nghe Id dot, viec xd ly chat thai y te bang phuong phap khdng dot cung da dupe ap dung d nude ta, td each thu cong den cdng nghe xd ly hien dai. O Benh vien Da khoa 1 tinh Lao Cai, chat thai y te lay nhiem sau khi ddpc phan loai va thu gom dupe chuyen den nha xd ly trong Benh vien. Tai day, rac ddpc dda vao thung de ngam trong dung dich khd trUng Cloramin B khoang 1 ngay, sau dd dda vao thie't bi khd khuan chuyen dung trong khoang 1 gid.
Luc nay, rac dupe dUa ra ngoai va xd ly nhU rac thdng thudng (chon lap tai bai rac). Cong nghe xd ly chat thai y te bang vi sdng ket hpp hoi nude bao hda da dupe sd dung tai Trung tam Y te VietSov (Ba Ria - Vung Tau) td cuoi nam 2003. Cdng nghe nay cho thay tinh hieu qua cao ve mdi trddng, kinh te va xa hpi. He thdng bao gdm 1 thie't bi khd khuan bdng cong nghe vi sdng ket hpp hoi nddc bao hda, mpt thiet bi nghien cat chat thai sau khi khu khuan. Ca hai thiet bi dupe ket ndi ngudn dien don gian. rieng thiet bi khd khuan cd ket ndi them dud'ng nddc cap va dng nddc thai ra he thdng nude thai chung cua benh vien. Thiet bi nho gon (chiem dien tich hon 1 m-), de di chuyen, sd dung it nang lupng va khong can he thdng cap ho'i nude ben ngoai. Vat tu tieu hao la tui rac chiu nhiet, giay in bao cao ket qua tu dpng va nUdc thorn khd mui. Viec van hanh chi can
Thiet bi xu ly CTRYT bang vi song ket hap hoi nude bao hoa tai VietSov 1 ngudi, thao tac don gian. He
thdng cdng nghe nay cung dang duoc trien khai ap dung d mpt sd benh vien khac nhU: Lao va benh phdi Trung UOng, C Da Ndng, Benh vien 198, 199 Bp Cong An...
Tuy nhien, hien nay trong nUdc chua cd mdt cdng trinh nao di sau nghien cdu ve cdng nghe xd ly chat thai y te bdng vi sdng de cd the' ket luan duoc tinh Uu viet va kha nang thay the' cdng nghe xd ly truyen thdng la phuong phap dot. Nham dap dng yeu cau tim hieu ve van de nay, Vien Trang thie't bi va cdng trinh y te dang thdc hien de tai cap bp:
"Nghien cdu danh gia thie't bi xd ly CTRYT dpc hai bang phuong phap vi sdng ket hop hoi nUdc bao hoa" do KS Cao Thi Van Diem lam chu nhiem. Be tai dang khao sat cdng nghe xd ly chat thai y te bang vi sdng, dac biet la loai su dung cdng nghe vi sdng ket hop hoi nUdc bao hda tai 5 co so y te d Ha Ndi, Da Ndng va Ba Ria - Vung Tau. Qua dd, xay
dUng cac tieu chuan, quy trinh danh gia thiet bi, cdng nghe su dung vi sdng xd ly CTRYT; do va phan tich cac chi tieu ky thuat mdi trUdng cua thiet bi xd ly CTRYT bang cdng nghe dot; do chi tieu mdi trUdng xung quanh khu vUc xd ly chat thai cua mpt so thiet bi sd dung vi sdng; do chi tieu ky thuat cua thie't bi sd dung vi sdng. De tai cung nghien cdu, danh gia cac chi tieu kinh te - xa hdi ciia hai loai thiet bi xd ly CTRYT bang cdng nghe dot va khdng ddt; chi phi thu gom, van hanh, xd ly, quan ly thiet bi; quy trinh thu gom... De tai se gdp phan thdc hien chu trdong cua Bp Y te' trong viec giai quye't cac van de bat cap cua cdng tac xd ly CTRYT, ddng thdi la co sd cho viec xay dUng md hinh va Ida chpn cong nghe xd ly CTRYT •
38 Hoatddng
KHOA HO CS 6 t h a n g 7 2 0 1 1
