Objective: The aim is to understand the status of rural medical waste management and problems and to make recommendations. Methods: The questionnaire survey, interviews and comparative analysis are used. Results: Compared with urban medical waste management, rural medical waste management is weaker in classification, unified recycle, disposals, protect measures of related personnel, regulations and policies of awareness. Conclusion: It is recommended to improve policies and regulations of rural medical waste management, strengthen rural infrastructures and facilities, improve supervision and innovates means of supervision.
According to statistics of World Health Organization, 10% - 25% of medical waste is infectious, they bring potential environmental hazards and public health risks which have caused worldwide concern; Abdul [
Through the questionnaire survey and interviews, medical waste management problems were found in developing countries and poor countries of abroad, Patience A. [
Several studies have proposed in our country. Zhang [
In summary, there are more researches abroad literature of medical waste management and less domestic literature which focused on the urban areas. Different with the existing, this paper takes rural medical institutions in Henan Province as the object and investigates problems in order to provide evidence for improvement the medical waste management system.
On the basis of questionnaire of medical waste management of World Health Organization [
200 questionnaires were given in random in 2014, 136 valid questionnaires were returned, the recovery was 68%, including 22 provincial and municipal hospitals, 38 county hospitals, 26 township-level hospitals and 50 village clinics. Descriptive statistical analysis of data is used by SPSS software.
(1) Descriptive statistics of typical issues
It can be seen from
(2) The questionnaire question classification
1) Classification, collection, storage and disposal of medical waste
It can be seen from
For medical waste disposal, incineration accounted for 72% in village clinics, uniform recycling accounted for 24%, which not met the requirements of 24 hours. Uniform recycling rate was 53.85% in Township hospitals
| Hospitals’ type | Village 50 | Township 26 | County 38 | Province 22 |
|---|---|---|---|---|
| Medical waste ① infection ② injury ③ drug-induced ④ pathological ⑤ chemical | options include ① 34% | ① 61.53% | ① 73.68% | ① 92% |
| Protective measures or special gloves ① yes ② no | ① 74%, ② 26% | ① 57.69%, ② 42.31% | ① 55.26%, ② 44.74% | ① 45.45%, ② 54.55% |
| Treatment: ① nearby landfill ② dumping ③ nearby incineration ④ uniform recycling | ① ② 91%, ③ 9% | ① ② 19.23%, ③ 19.23%, ④ 61.53% | ① 26.32%, ④ 73.68% | ④ 100% |
| Management person: ① yes ② no | ① 17%, ② 83% | ① 42.3%, ② 57.7% | ① 76.32%, ② 23.68% | ① 100% |
| Newly trained staff ① yes ② no | ① 57%, ② 43% | ① 34.62%, ② 65.38% | ① 44.74%, ② 55.26% | ① 85%, ② 15% |
| Awareness waste regulations ① yes ② no | ① 34%, ② 66% | ① 19.23%, ② 80.77% | ① 21.05%, ② 78.95% | ① 40%, ② 60% |
| Manual or guide ① yes ② no | ① 100% | ① 11.54%, ② 88.46% | ① 42.11%, ② 57.89% | ① 35%, ② 65% |
| Long-term plan of management ① yes ② no | ② 100% | ② 100% | ① 5.26%, ② 94.74% | ① 38.56, ② 61.44% |
| Teams ① yes ② no | / | ② 100% | ① 15.79%, ② 84.21% | ① 45.45%, ② 54.54% |
| Internal supervisory staff ① yes ② no | ① 48%, ② 52% | ① 23.08%, ② 76.92% | ① 39.47%, ② 60.53% | ① 37%, ② 53% |
| External supervisory staff ① yes ② no | ① 34%, ② 66% | ① 42.3%, ② 57.7% | ① 34.21%, ② 65.79% | ① 37%, ② 53% |
| Questions type | Village n = 50 (%) | Township n = 26 (%) | Country n = 38 (%) | Province n = 22 (%) |
|---|---|---|---|---|
| Classification | 16 (32) | 12 (46.15) | 18 (47.37) | 12 (54.55) |
| Label in container | 6 (12) | 4(15.38) | 6 (15.79) | 12 (54.55) |
| Tool in the tool box | 6(12) | 4 (15.38) | 8(21.05) | 18 (81.82) |
| Disposal Nearby landfill Nearby incineration Dumping Uniform recycling Correct recycle time | 10(20) 36 (72) 12 (24) 12 (24) 0 (0) | 2 (7.69) 4 (15.38) 6 (23.08) 14 (53.85) 2 (7.69) | 0 (0) 10 (26.32) 0 (0) 28 (73.68) 12 (31.58) | 0 (0) 0 (0) 0 (0) 22 (100) 22 (100) |
and only 7.69% of the medical waste recycling was the stipulated time. Due to the distance and other factors, ratio of county hospitals did not reach 100%.
2) Personnel protective measures and training of medical waste
For protective measures, such as
3) Regulations and policies of medical waste
For regulatory awareness, as shown in
| Questions type | Village n = 50 (%) | Township n = 26 (%) | Country n = 38 (%) | Province n = 22 (%) |
|---|---|---|---|---|
| protection and gloves | 34(68) | 14 (53.85) | 20 (52.63) | 18 (81.82) |
| Training | 26 (52) | 10 (38.46) | 16 (42.11) | 14 (63.64) |
| Training of new staff | 28 (56) | 12 (46.15) | 16 (42.11) | 18 (81.82) |
| Job duties description | 22 (44) | 14 (53.85) | 18(47.37) | 12 (54.55) |
| Questions type | Village n = 50 (%) | Township n = 26 (%) | Country n = 38 (%) | Province n = 22 (%) |
|---|---|---|---|---|
| List regulations and policies | 22 (44) | 8 (30.77) | 10 (26.32) | 12 (54.55) |
| Manual or guide Country rule Hospital rule | 32 (64) 11 (44) 10 (20) | 12 (46.15) 10 (38.46) 2 (7.69) | 24 (63.16) 12 (31.58) 12 (31.58) | 20 (90.9) 12 (54.55) 10 (45.4) |
| Long time plan | 0 (0) | 0 (0) | 6 (15.79) | 8 (36.36) |
| Management team | 2 (4) | 2 (7.69) | 6 (15.79) | 14 (63.64) |
| Internal supervision staff | 10 (20) | 6 (23.08) | 12 (31.58) | 12 (54.55) |
| external supervision staff | 12 (24) | 8 (30.77) | 10 (26.32) | 12 (54.55) |
it is 54.55% and the ratio is not too high; external supervision of village, township and county supervision were 20%, 23% and 31.58% ; external supervision of provincial is relatively high 63.64%.
Because original records of medical management lacked especially in rural instantiations, the results were got only by workers. Perhaps a few data could not be received.
Taken “reduce, reuse, recycle” as the goal, from recycling systems sustainable development of rural medical waste, reducing pollution and hazard, focusing on improving the scientific, normative and systemic management of medical waste, We propose the following recommendations.
(1) Improve the rural medical waste management policies and regulations to enhance operability
Compared to rural and urban areas, rules and regulations of medical waste management are relative lack, rural medical institutions have not their own rules and regulations, specific job responsibilities are not be requested for medical waste management staff and professional knowledge is lack.
On the basis of “Medical Waste Management Regulations” in 2003 and “To further strengthen supervision of hazardous waste and medical waste Work” in 2011, government should promote legislation of rural medical waste management, emphasize on rural medical waste classification and recycling and develop implemented management measures. Owning to classification, registration, emergency programs of rural medical waste, local governments and medical institutions should improve the complete set of implementation rules, guidelines and guidance, and increase regulations operability.
(2) Strengthen infrastructure and supporting facilities of rural medical waste
Compared with the urban hospitals, there are a few problems of rural medical waste classification, container labeling of infectious medical waste and tools into special containers, especially in village clinics. Owning to the final disposal, there are some problems such as disposal itself and non-standard disposal and no uniform recycling especially in village institutions, which free to deal in medical waste and random dumping phenomenon exist. Some disposable infusion bottles are unauthorized traded in township hospitals.
We should accelerate construction of the temporary storage. It is the key problem in rural medical waste recycling system that rural medical institutions are far apart and uniform recycling is more difficult, so to complete the build rural medical storage soon as possible; while the government should strengthen constructions medical waste facilities such as recycling containers.
So we should to build the temporary storage in rural medical institutions as soon as possible, at the same time, the government and hospitals should strengthen the establishment of medical waste facilities, such as recovery special containers.
(3) Strengthen supervision, improve the supervision mechanism and innovate means of supervision
We should strengthen supervision and improve the supervision mechanism. Local governments, environmental protection departments, health authorities and medical institutions should further clarify the relevant functional orientation and well-defined power and responsibility, format a supervision and management system of government-led cooperation with each other, improve the relevance and validity checking and increase management efficiency of rural medical waste; while supervision and inspection should be normalized and strengthened efforts and we should implement evaluation mechanisms and take the qualification rate of medical waste management into performance assessment indicators of local government environment.
Government should innovate means of supervision, build information technology platform of rural medical waste management using information technology such as the Internet of things, two dimensional barcode, camera, GPS, and improve files of rural medical institutions and management company and emergency decision system, realize electronic tracking supervision in the whole process from classification, collection, transportation to the final disposal as soon as possible and improve the efficiency of supervision. Government should regularly announce inspect results, promote information disclosure of the enthusiasm of public participation in supervisions and promote the supervision of public opinions.
Scientific Research Fund of Xinxiang Medical University (No. 2013QN202).
LiNie,HuanWu, (2016) Investigation and Analysis of Rural Medical Waste Management. Journal of Environmental Protection,07,93-98. doi: 10.4236/jep.2016.71009