Abstract Purpose To further standardize hospital medical waste management. Methods The inspection data from January 2004 to December 2008 were summarized and analyzed, and training was carried out to target weak links to improve the environmental awareness of all hospital employees, patients and caregivers. In combination with the requirements of laws and regulations, a safe and effective environmental protection policy was developed. Preventive measures, complete monitoring. As a result, the environmental awareness of employees, patients and caregivers in the hospital was enhanced, and the goal of standardization and legalization of medical waste management was achieved. Conclusion Only by strengthening publicity and education, everyone participating in medical waste management, and increasing supervision and inspection can we effectively control the process of classified collection, transportation, storage and disposal of medical waste, and truly realize the standardization and legalization of medical waste management.

Keywords medical waste; problems; countermeasures

Medical waste is waste that is directly or indirectly infectious, toxic and generated by medical and health institutions in medical treatment, prevention, health care and other related activities. Other hazardous wastes[1]. In 2003, Premier Wen Jiabao of the State Council issued the "Regulations on Medical Waste Management" [1] and related supporting documents. Medical waste management has rules and laws to follow. The harm of medical waste is that it contains bacteria, viruses, parasite eggs and other harmful substances to varying degrees. A considerable part of the spread of hepatitis and AIDS results from the reuse of disposable medical supplies such as syringes and infusion sets [2]. Some medical waste is mixed with domestic waste, causing "secondary pollution" and seriously threatening people's health. In the 1970s, there was an incident where improper disposal of medical waste caused the spread of hepatitis B [3]. To this end, strengthening the safe management of medical waste, preventing the spread of diseases, protecting the environment, and ensuring human health have become the top priority of hospital management. The problems and countermeasures in the management of medical waste in our hospital are summarized as follows.

1 Problems in medical waste management

1.1 Medical waste is not clearly classified and collected as required

1.1.1 Individual clinical medical staff, logistics, and agencies Staff, some non-clinical staff, and cleaning staff do not have strong awareness of environmental protection. They have insufficient understanding and carelessness. They do not realize the importance of medical waste management. They have not studied enough and do not have a deep understanding of the "Medical Waste Management Regulations" and its supporting documents. This leads to phenomena such as putting infectious waste into domestic waste containers, putting individual pharmaceutical waste into damaging waste, improper handling of chemical waste, and leaving medical waste containers without lids.

1.1.2 When staff use medical waste packaging or containers, in order to reduce costs, the medical waste is overfilled; some are temporarily stored for more than 2 days and are not collected as required.

1.1.3 Due to insufficient publicity and education, patients and attendants, especially outpatient staff, discard cotton swabs or cotton balls that are contaminated by pressing needle holes after intramuscular injections, removal of intravenous needles, and blood collection. Even among domestic garbage, some are discarded on the ground.

1.2 The packaging of medical waste is not standardized. Because the cleaning staff and nurses did not check the contents of the containers, more than 2/3 of the medical waste packaging or medical waste stored in the containers was not conducive to sealing, resulting in improper sealing. Tight and loose, and at the same time lack of understanding of how to fill in labels, resulting in missing or irregular label filling.

1.3 The transfer of medical waste is not carried out in accordance with regulations. Due to the low educational level of the personnel responsible for collection and transfer, frequent personnel changes, and insufficient understanding of the nature of the work and the hazards of medical waste, there is no careful inspection before transportation. Whether the labels and seals of the packaging or containers meet the requirements, the weight of the medical waste is not carefully verified, and the medical waste that does not meet the requirements is transferred to a temporary storage location.

1.4 Irregular registration handover. In order to save time and effort, the cleaning staff estimated the weight based on experience. Seeing that the nurse was busy, he wrote the time and weight in the registration book without waiting for verification, and signed his name. The nurse also did not Pay attention to it and fail to verify it. The nurse's signature on the registration book is often missing or filled in, and the cleaning staff also signs in advance.

1.5 Data preservation does not meet the requirements. Some departments without a head nurse paid attention to filling in the data, but did not know enough about data preservation, resulting in incomplete data for three years.

2 Countermeasures

2.1 Further improve the organizational structure and strengthen supervision. According to the requirements of the "Medical Waste Management Regulations" and supporting documents, our hospital has established a system with the president as the first responsible person. , on the basis of the hospital's medical waste management leading group composed of the vice president of business, director of the hospital's infectious disease department, director of the medical department, director of the nursing department and other relevant personnel, full-time management personnel are equipped to be responsible for medical waste management. Implement a three-level management system consisting of the hospital's medical waste management leadership group - full-time managers - department medical waste management groups, with regular monthly inspections, random inspections at any time, the participation of colleagues, and hierarchical supervision and management to achieve layer-by-layer control and environmental protection. Linked to each other, rewards and punishments are clear, and the effect is good.

2.2 Repeated training to raise awareness, self-protection education and education on laws and regulations are basic education that hospital employees must receive. A variety of methods are used to create a learning atmosphere to prevent medical waste pollution throughout the hospital, and regular and irregular training is organized to study the "Medical Waste Management Regulations" and supporting documents based on the characteristics of different departments. Improve everyone's environmental awareness and "standard precautions" awareness, and encourage people to actively cooperate with medical waste management.

2.2.1 Medical staff are trained in the form of multimedia lectures, centralized training and self-study by distributing materials, regular examinations, questions at any time, strict operating procedures, and good medical waste from generation to classification and collection in accordance with regulations. , transshipment, storage and disposal of the entire process management. Integrate medical waste management knowledge into continuing education programs.

2.2.2 In the training of interns and trainees, medical waste management knowledge should be included in the hospital’s pre-job training content, and based on the characteristics and actual conditions of each department, the department director or head nurse should review the knowledge related to medical waste. Strengthen training and serve as one of the assessment contents for interns.

2.2.3 Training for logistics, agency and non-clinical personnel. Based on the use of multimedia lectures for centralized training and self-study by jointly distributing materials, on-site guidance is provided to carry out knowledge on relevant laws, regulations, medical waste classification, etc. Focus on organizing, printing and binding into a volume, one copy for each person, and then conduct a questionnaire to investigate the learning effect.

2.2.4 Training of cleaning staff. Due to the low educational level of cleaning staff, frequent replacement, and lack of understanding of the dangers of medical waste, on the basis of unified training in the hospital, full-time managers have repeatedly organized The training of cleaning staff and collection and transfer personnel enables them to fully realize the importance of medical waste management and actively and consciously cooperate with the work. At the same time, the collection and transfer personnel are required to comply with the "four no-handovers", namely: "no handover or no-handling if the nurse is not present; no handing-over or no-handling if the nurse is not present; no handing-over or no-handling if the container is overfilled; no handing-over or no-handling if the nurse does not verify the weight No handover or acceptance."

2.2.5 Training of patients and attendants Medical waste management is not only a matter within medical and health institutions, but also a matter for the whole society. Raising public awareness is the most important. However, the public knows very little about medical waste management. A survey conducted by an author on outpatients and medical staff showed that 95% of patients did not know that medical waste and domestic waste cannot be mixed, and 90% of medical staff believed that the government and news The media does not adequately publicize the knowledge and hazards associated with medical waste. Therefore publicity and education is very important. First of all, responsible nurses are responsible for publicity and education when patients are admitted to the hospital, in the inpatient room, and when they are discharged; secondly, an outpatient guide is responsible for publicity and education, so that people entering the hospital understand where medical waste is stored, and inform everyone about the storage containers and labels. , teach how to discard various types of garbage, let patients and caregivers know how to deal with waste, understand the harm to the public when medical waste flows into society, and create a good atmosphere for everyone to participate in environmental protection.

2.3 Strictly standardize the management process of all aspects of medical waste

2.3.1 The hospital formulates the management process of all aspects of medical waste.

2.3.2 Fixed collection and transfer personnel, and full-time management personnel to supervise the whole process.

2.3.3 Strictly classify waste at each site to avoid expanding the scope of medical waste and increasing unnecessary capital investment.

2.3.4 The staff must perform signature procedures when handing over to the collection and transfer personnel, and strictly implement the "four no-handover" regulations.

2.3.5 When handling medical waste contaminated by patient blood, body fluids, and excreta, operators must take personal protection.

2.3.6 Medical items used by patients with infectious diseases and confirmed or suspected infectious diseases must be placed separately in special packaging bags after preliminary treatment.

2.3.7 The packaging material for medical waste must be waterproof, leak-proof, and puncture-proof, so that medical waste does not fall to the ground when collected, is not exposed when stored, is cleared daily, and is processed promptly and thoroughly.

3 Summary

Medical waste is highly hazardous waste and seriously threatens human health. By taking effective continuous improvement measures, our hospital has formed a good atmosphere in which everyone participates in protecting the environment, enabling our hospital's medical waste management to achieve the expected goals, and realizing the standardization and legalization of medical waste management.

References

[1] The State Council of the People's Republic of China. Medical Waste Management Regulations, 2003.

[2] Li Yuedong. Medical Waste Management. Chinese Journal of Hospital Infectious Diseases, 2000, 10(2): 139.

[3] Zhang Yi. Analysis of current status and countermeasures of medical waste disposal. Chinese Journal of Modern Medicine, 2003, 13(5): 154.