Sổ tay hướng dẫn Vận hành hệ thống XLNT và Lò đốt chất thải Y tế cho bệnh viện cấp huyện.pdf

Chng trnh hp taC phat trien Viet nam - an maChtrong lnh VC moi trng (DCe)

2005 - 2010

hp phanKiem soat o nhiem tai cac khu vc ong dan ngheo (pCDa)

SO TAY HNG DANVAN HANH VA QUAN LY HE THONG X LYNC THAI VA LO OT CHAT THAI Y TE

CHO BENH VIEN QUY MO CAP HUYENC quan t van: Cong ty T van va Truyen thong

Van hoa - Giao duc - Moi trng Pi (Pi C&E)

Ha Noi, 2010

3MUC LUC

DANH MUC CAC CH VIET TAT ....................................................... 5

DANH MUC BANG ............................................................................. 6

DANH MUC HNH .............................................................................. 7

M AU............................................................................................. 8

1. TONG QUAN VE CHAT THAI Y TE BENH VIEN QUY MO CAP HUYEN ...................................................................10

1.1. Tong quan ve tai lng va thanh phan nc thai cua benh vien cap huyen .....................................................101.1.1. Thanh phan nc thai benh vien ......................................101.1.2. Tai lng nc thai benh vien cap huyen ........................112.2. Tong quan ve thanh phan chat thai ran y te cua benh vien cap huyen .....................................................132.2.1. Thanh phan chat thai ran y te .........................................132.2.2. Tai lng chat thai ran y te benh vien cap huyen ...........15

2. HNG DAN XAY DNG VA VAN HANH HE THONG X LY NC THAI CHO BENH VIEN QUY MO CAP HUYEN ...........17

2.1. Cac tieu ch la chon cong nghe x ly nc thai cho benh vien quy mo cap huyen ........................................172.1.1. Mot so cong nghe x ly nc thai benh vien ..................172.1.2. Cac tieu ch la chon cong nghe x ly nc thai benh vien cap huyen ........................................272.2. e xuat cong nghe x ly nc thai cho benh vien quy mo cap huyen ........................................30

4 5

DANH MUC CAC CH VIET TAT

BOD - Nhu cau oxy sinh hoa

COD - Nhu cau oxy hoa hoc

HTXL - He thong x ly

SS - Can l lng

TCVN - Tieu chuan Viet Nam

XLNT - X ly nc thai

WHO - To chc Y te The gii

2.3. Quy trnh quan ly va van hanh he thong x ly nc thai benh vien quy mo cap huyen ...............................................332.3.1. Quy trnh thu gom, phan luong nc thai benh vien .......332.3.2. Quy trnh van hanh he thong x ly nc thai benh vien quy mo cap huyen ...........................................................352.3.3. Quy trnh ng pho cac rui ro khi van hanh he thong x ly nc thai benh vien .................................392.3.4. Quy trnh quan ly he thong x ly nc thai benh vien quy mo cap huyen ...........................................42

3. HNG DAN XAY DNG VA VAN HANH LO OT RAC THAI Y TE CHO BENH VIEN QUY MO CAP HUYEN ........................................49

3.1. Cac tieu ch la chon cong nghe x ly chat thai ran y te cho benh vien quy mo cap huyen ........................................493.1.1. Mot so cong nghe x ly chat thai ran y te ......................503.1.2. Cac tieu ch la chon lo ot chat thai ran y te ................563.2. Quy trnh van hanh va quan ly lo ot rac thai y te benh vien quy mo cap huyen ...............................................623.2.1. Quy trnh thu gom, phan loai tai cho ...............................623.2.2. Quy trnh van hanh lo ot rac thai y te benh vien cap huyen ........................................................673.2.3. Quy trnh ng pho cac rui ro khi van hanh lo ot rac thai y te benh vien ..........................................703.2.4. Quy trnh quan ly lo ot rac thai y te benh vien cap huyen ........................................................74

4. CHNG TRNH GIAM SAT MOI TRNG OI VI BENH VIEN QUY MO CAP HUYEN...................................76

4.1. Muc tieu giam sat ................................................................764.2. Cac thanh phan moi trng can giam sat ...........................764.3. Tan suat giam sat ................................................................78

TAI LIEU THAM KHAO ..................................................................79

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DANH MUC HNH

Hnh 1. S o cong nghe cua Phng an 1 .............18

Hnh 2. S o x ly nc thai bang he thong DEWATS .....................................................18

Hnh 3. S o cong nghe cua Phng an 2 .............21

Hnh 4. S o cong nghe x ly nc thai Trung tam y te huyen Pho Yen .................22

Hnh 5. S o cong nghe cua phng an 3 .............24

Hnh 6. S o cong nghe cua he thong x ly nc thai s dung cong nghe x ly gian oan theo me ......................................26

Hnh 7. S o thu gom nc thai va nc ma tai benh vien ...............................................33

Hnh 8. S o he thong thu gom va x ly rac tai benh vien cap huyen ............................66

DANH MUC BANG

Bang 1. ac tnh nc thai benh vien ....................10

Bang 2. Tieu chuan nc cap va lng nc thai benh vien ....................................................12

Bang 3. Thanh phan chat thai y te ........................13

Bang 4. Tai lng va thanh phan chat thai ran nguy hai tai benh vien cap huyen quy mo 60 ging ........................................15

Bang 5. Cac thong so thiet ke cua 4 nhom cong nghe: ............................................................26

Bang 6. Hieu suat x ly cua cac phng an trong ieu kien thc te .........................................27

Bang 7. u nhc iem cua cac cong trnh x ly nc thai s dung phng phap x ly

sinh hoc khac nhau ....................................30

Bang 8. Cac phng phap x ly va tieu huy chat thai y te ..............................................51

Bang 9. u nhc iem chnh cua cac cong nghe x ly chat thai y te .....................................53

9so tay Hng dan van HanH va quan ly He tHong x lync tHai va lo ot cHat tHai y te cHo benH vien quy mo cap Huyen

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g He thong x ly chat thai y te tai Trung tam Y te huyen Pho Yen, tnh Thai Nguyen;

g Cai thien moi trng ch Ba Ren, huyen Que Sn, tnh Quang Nam;

g Cai thien moi trng kenh Chn Te, phng Phu Khng, Thanh pho Ben Tre;

g Xay dng mo hnh x ly chat thai vat nuoi bang ham biogas tai xa a Phc Hoi, huyen Mo Cay, va xa Phu Le, huyen Ba Tri, tnh Ben Tre.

Da tren ket qua cua 4 d an trnh dien, Van phong ho tr Hp phan PCDA a to chc anh gia, rut kinh nghiem va soan thao cac tai lieu hng dan nham nhan rong cac mo hnh nay trong pham vi quoc gia.

Tai lieu Hng dan van hanh va quan ly he thong x ly nc thai va lo ot chat thai y te cho benh vien quy mo cap huyen danh cho cac benh vien tham khao trong qua trnh quan ly va x ly chat thai y te, ac biet tai cac vung xa.

M AU

Chng trnh Hp tac phat trien Viet Nam - an Mach trong lnh vc moi trng (DCE) trong giai oan 2005-2010 c ky ket e ho tr thc hien Chien lc quoc gia ve bao ve moi trng va trien khai s hp tac gia Chnh phu an Mach va Chnh phu Viet Nam trong lnh vc moi trng. Hp phan Kiem soat o nhiem tai cac khu vc ong dan ngheo (PCDA) la 1 trong 5 Hp phan cua Chng trnh DCE c xay dng vi mong muon ho tr Bo Tai nguyen va Moi trng thc hien hieu qua Chien lc bao ve moi trng quoc gia vi trong tam la: 1) nang cao nang lc bao ve moi trng t cap Trung ng en cap a phng; 2) hoan thien cac cong cu phap luat va kinh te; xa hoi hoa thong qua viec nang cao nhan thc va tham gia; 3) nang cao nang lc giam sat moi trng; 4) gop phan thc hien cac muc tieu thien nien ky cua Viet Nam va phu hp vi Chien lc toan dien ve tang trng va giam ngheo. Hp phan PCDA c trien khai tai 4 trong 6 tnh thuoc Chng trnh DCE la Thai Nguyen, Ha Nam, Quang Nam va Ben Tre.

Mot hoat ong quan trong trong Hp phan PCDA la xac nh, thiet ke va thc hien cac d an trnh dien phu hp e nhan rong tai a phng cung nh tai cac tnh khac. en thi iem cuoi nam 2010, bon (4) d an trnh dien a c hoan thanh va cac hoi thao pho bien kinh nghiem a c to chc, o la:

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so tay Hng dan van HanH va quan ly He tHong x lync tHai va lo ot cHat tHai y te cHo benH vien quy mo cap Huyen

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ch tieu hoa ly

gia tr qcvn 28:2010/btnmtmc b

min max trung bnh

Nit Amon (NH4+) (mg/l)PO43- (mg/l)Cl-(mg/l)Coliforms (MPN/100ml)

18,52,182,54x107

35,37,9

151,32x109

255,2127

2x108

1010-

5 x103

Nguon: Bo Tai nguyen va Moi trng. Bao cao e xuat mo hnh trnh dien He thong x ly nc thai va rac thai y te tai

trung tam y te huyen Pho Yen, 2007

T Bang 1 co the thay am o cac ch tieu vi sinh vat ve sinh trong nc thai benh vien rat cao. Viec x ly nc thai trc khi xa thai ra moi trng giup lam giam ang ke nguy c o nhiem, truyen benh trong nc thai benh vien.

1.1.2. Tai lng nc thai benh vien cap huyen

Nc thai benh vien gom ba nguon chnh:

- Nc thai t cac phong ieu tr, t cac phong xet nghiem (giai phau benh, huyet hoc, truyen mau, lau ra sau cac ca mo, khoa lay...). ay la nguon tao ra cac chat thai nguy hai.

- Nc thai cha cac hoa chat (trong o co cac hoa chat oc hai) sinh ra t cac phong dc nh cac loai thuoc, vacxin, huyet thanh, dung moi hu c, hoa chat xet nghiem, cac hp chat vo c...

- Nc thai sinh hoat cua cac phong can bo cong nhan vien, nha bep, nha an cha nhieu chat hu c de phan huy, cac hp chat vo c...

1. TONG QUAN VE CHAT THAI Y TE BENH VIEN QUY MO CAP HUYEN

1.1. Tong quan ve tai lng va thanh phan nc thai cua benh vien cap huyen

1.1.1. Thanh phan nc thai benh vien

Nc thai benh vien ngoai o nhiem thong thng nh nc thai sinh hoat (o nhiem hu c) con co the nhiem nhng hoa chat phat sinh trong qua trnh chuan oan va ieu tr benh nh cac che pham thuoc, cac chat kh trung, cac ong v phong xa. Ben canh o, nc thai benh vien nguy hiem ve phng dien ve sinh dch te bi trong nc thai benh vien co cha cac loai vi trung, ong vat nguyen sinh gay benh, trng giun, virut t mau, dch, m, phan cua ngi mang benh.

Bang 1. ac tnh nc thai benh vien

ch tieu hoa ly

gia tr qcvn 28:2010/btnmtmc b

min max trung bnh

Nhiet o nc thaipHCan l lng - SS (mg/l)Oxy hoa tan (mg/l)BOD5 (mg/l)COD (mg/l)

200C6,91200

120210

310C7,581701,2320450

270C7,151900,5210320

-6,5 - 8,5

100-

50100

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m3/ngay. Vi cac benh vien tuyen huyen co quy mo t hn 80 ging benh, lng nc thai la 50 m3/ngay, con vi benh vien co quy mo tren 80 ging benh th lng nc thai t 100 - 120 m3/ngay.

Lu lng nc thai benh vien dao ong theo gi trong ngay, tap trung nhieu vao cac gi hanh chnh. Lu lng nc thai ln nhat la vao khoang thi gian t 9h - 17h hang ngay. Vao em lu lng nc thai thap.

2.2. Tong quan ve thanh phan chat thai ran y te cua benh vien cap huyen

2.2.1. Thanh phan chat thai ran y te

Chat thai ran y te c thai ra t cac c s y te bao gom chat thai y te nguy hai va chat thai thong thng. Quy che Quan ly Chat thai Y te do Bo Y te ban hanh neu chi tiet cac nhom va loai chat thai y te phat sinh. Can c vao cac ac iem ly hoc, hoa hoc, sinh hoc va tnh chat nguy hai, chat thai trong cac c s y te c phan thanh 5 nhom: chat thai lay nhiem, chat thai hoa hoc nguy hai, chat thai phong xa, bnh cha ap suat va chat thai thong thng.

Bang 3. Thanh phan chat thai y te

nhom loai chat thai

Chat thai lay nhiem

- Chat thai sac nhon (loai A): bm kim tiem, au sac nhon cua day truyen, li dao mo, inh mo, ca, cac ong tiem, manh thuy tinh v va cac vat sac nhon khac s dung trong cac hoat ong y te.- Chat thai lay nhiem khong sac nhon (loai B): La chat thai b tham mau, tham dch sinh hoc cua c the va cac chat thai phat sinh t buong benh cach ly.

Lu lng thai cua cac benh vien trc het phu thuoc vao so ging benh, ieu kien cap nc, mc o hien ai cua benh vien, so lng than nhan cua ngi benh kem theo va theo mua (nong, lanh, thi iem bung phat dch benh). Theo Metcalf va Eddy, tieu chuan thai cua benh vien la 473 - 908 l/ngay (tr so tieu bieu la 625 l/ngay) cho mot ging benh. Viet Nam, lng nc cap cho moi ging benh c s dung cho cac muc ch nh trong Bang 2.

Bang 2. Tieu chuan nc cap va lng nc thai benh vien

quy mo benh vien(so ging benh)

tieu chuan nc cap(lt/ging.ngay)

lng nc thai(m3/ngay)

< 100 700 70

100 - 300 700 100 - 200

300 - 500 600 200 - 300

500 - 700 600 300 - 400

> 700 600 > 400Benh vien ket hp nghien cu va ao

tao > 7001000 > 500

Nguon: Bo Xay dng - Thuyet minh xay dng tieu chuan thiet ke cong trnh x ly nc thai benh vien, 2009

Bao cao ve quan ly va x ly chat thai y te nam trong Khuon kho d an Cham soc sc khoe cho khu vc ngheo 7 tnh mien nui pha Bac do Bo Y te chu tr, khao sat tai 28 benh vien huyen thuoc 7 tnh trong d an cho thay, tai cac benh benh vien tuyen huyen lng nc s dung cho moi ging benh thng t 0,5 - 0,7

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2.2.2. Tai lng chat thai ran y te benh vien cap huyen

Tai cac benh vien tuyen huyen, rac thai y te nguy hai bao gom xi lanh, kim tiem, bong, gac, gang tay, chat thai giai phau ... Qua khao sat tai Trung tam Y te huyen Pho Yen, tnh Thai Nguyen vi quy mo 60 ging benh, tong lng chat thai ran phat sinh hang ngay tai benh vien khoang 100 kg; trong o lng chat thai nguy hai khoang 15 kg (chiem 15% tong lng chat thai ran phat sinh), vi cac thanh phan nh tai Bang 4.

Bang 4. Tai lng va thanh phan chat thai ran nguy hai tai benh vien cap huyen

quy mo 60 ging

loai chat thai lng phat sinh (kg/ngay) ty le (%)

Bong, bang, gac 5 34

Bm tiem nha, day truyen dch 2 13

Gang tay cao su 2 13

Chai lo, ong tiem 2 13

Bo phan cat bo sau phau thuat 1 7

Bot thach cao e bo bot 2 13

Nao hut thai, rau thai 1 7

tong 15 100

Nguon: Bo Tai Nguyen Moi trng - Bao cao e xuat mo hnh trnh dien He thong x ly nc thai va rac thai y te

tai Trung tam Y te Huyen Pho Yen, 2007.

nhom loai chat thai

- Chat thai co nguy c lay nhiem cao (loai C): La chat thai phat sinh trong cac phong xet nghiem nh: benh pham va dung cu ng, dnh benh pham.- Chat thai giai phau (loai D): Bao gom cac mo, c quan, bo phan c the ngi; rau thai, bao thai va xac ong vat th nghiem.

Chat thai hoa hoc nguy hai

- Dc pham qua han, kem pham chat khong con kha nang s dung.- Chat hoa hoc nguy hai s dung trong y te.- Chat gay oc te bao, gom: vo cac chai thuoc, lo thuoc, cac dung cu dnh thuoc gay oc te bao va cac chat tiet t ngi benh c ieu tr bang hoa tr lieu.- Chat thai cha kim loai nang: thuy ngan (t nhiet ke, huyet ap ke thuy ngan b v, chat thai t hoat ong nha khoa), cadimi (Cd) (t pin, ac quy), ch (t tam go boc ch hoac vat lieu trang ch s dung trong ngan tia xa t cac khoa chan oan hnh anh, xa tr).

Chat thai phong xa

Gom cac chat thai phong xa ran, long va kh phat sinh t cac hoat ong chan oan, ieu tr, nghien cu va san xuat.

Bnh cha ap suat

Gom bnh ng oxy, CO2, bnh ga, bnh kh dung. Cac bnh nay de gay chay, gay no khi thieu ot.

Chat thai thong

thng

La chat thai khong cha cac yeu to lay nhiem, hoa hoc nguy hai, phong xa, de chay, no, bao gom:- Chat thai sinh hoat phat sinh t cac buong benh (tr cac buong benh cach ly).- Chat thai phat sinh t cac hoat ong chuyen mon y te nh cac chai lo thuy tinh, chai huyet thanh, cac vat lieu nha, cac loai bot bo trong gay xng kn. Nhng chat thai nay khong dnh mau, dch sinh hoc va cac chat hoa hoc nguy hai.- Chat thai phat sinh t cac cong viec hanh chnh: giay, bao, tai lieu, vat lieu ong goi, thung cac tong, tui nilon, tui ng phim.- Chat thai ngoai canh: la cay va rac t cac khu vc ngoai canh.

Nguon: Tong hp t Quy che Quan ly chat thai ran y te 2007 - Bo Y te

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2. HNG DAN XAY DNG VA VAN HANHHE THONG X LY NC THAI CHO BENH VIEN

QUY MO CAP HUYEN

2.1. Cac tieu ch la chon cong nghe x ly nc thai cho benh vien quy mo cap huyen

Theo cac chnh sach hien tai, moi benh vien phai lap at va van hanh he thong x ly nc thai sao cho nc thai sau x ly ap ng c QCVN 28:2010/BTNMT ve nc thai y te. Hien nay (11/2010) Bo Y te ang soan thao hng dan ve x ly nc thai y te va Bo Xay dng soan thao Tieu chuan Viet Nam ve thiet ke, van hanh va bao dng cong trnh x ly nc thai benh vien.

2.1.1. Mot so cong nghe x ly nc thai benh vien

Do ac tnh cua nc thai benh vien co thanh phan o nhiem chnh la cac chat hu c, vi trung gay benh va ty le BOD5/COD > 0,5 nen phng phap x ly sinh hoc ket hp vi kh trung se mang lai hieu qua tot nhat, am bao phan huy toan bo cac chat o nhiem hu c va tieu diet hau het cac vi trung gay benh.

Cac cong nghe x ly nc thai hien ap dung trong benh vien cua Viet Nam co the chia lam 4 nhom phng an.

Chat thai y te nguy hai la chat thai y te cha yeu to nguy hai cho sc khoe con ngi va moi trng nh de lay nhiem, gay ngo oc, phong xa, de chay, de no, de an mun hoac co ac tnh nguy hai khac neu nhng chat thai nay khong c tieu huy an toan. Khoi lng chat thai ran y te nguy hai phat sinh tai cac benh vien la thong so quan trong giup xac nh cong suat phu hp cua lo ot chat thai ran y te.

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He thong gom bon bc x ly c ban:

- X ly s bo bac mot: Qua trnh lang loai bo cac can l lng co kha nang lang c, giam tai cho cac cong trnh x ly pha sau.

- X ly bac hai: Qua trnh x ly nh cac vi sinh vat k kh e loai bo cac chat ran l lng va hoa tan trong nc thai. Giai oan nay co hai cong nghe c ap dung la be phan ng k kh Baffle Reactor (BF) co cac vach ngan va be lang k kh Anaerobic Filter (AF). Be phan ng k kh vi cac vach ngan giup cho nc thai chuyen ong len xuong. Di ay moi ngan, bun hoat tnh c gi lai va duy tr, dong nc thai vao lien tuc c tiep xuc va ao tron vi lp bun hoat tnh co mat o vi sinh vat k kh cao, nh o ma qua trnh phan huy cac hp chat hu c trong nc thai c dien ra manh me giup lam sach nc thai hieu qua hn cac be t hoai thong thng.

Be loc k kh vi vat lieu loc co vai tro la gia cho cac vi sinh vat phat trien, tao thanh cac mang vi sinh vat. Cac chat o nhiem hoa tan trong nc thai c x ly hieu qua hn khi i qua cac lo rong cua vat lieu loc va tiep xuc vi cac mang vi sinh vat.

Toan bo phan k kh nam di at, khong gian pha tren co the s dung lam san chi, bai e xe... ieu nay rat thch hp vi cac khu vc thieu dien tch xay dng.

- X ly bac ba: Qua trnh x ly hieu kh. Cong nghe ap dung chu yeu cua bc nay la bai loc ngam trong cay dong chay ngang. Ngoai qua trnh lang va loc

Phng an 1:

oi vi nhom cong nghe th nhat, nc thai benh vien c x ly s bo trong be t hoai, be lang va sau o c kh khuan hoac x ly trong ho sinh hoc hay bai loc ngap nc

Hnh 1. S o cong nghe cua Phng an 1

Trong so cac cong nghe thuoc loai nay hien nay pho bien nhat la he thong x ly nc thai phan tan DEWATS.

Hnh 2. S o x ly nc thai bang he thong DEWATS

Nc thai o nhiem cac chat hu c

Song chan rac

Be Biogas/be t hoai

Be x ly k kh dong hng len

Be loc k kh dong hng len

Bai loc trong cay

He thong ao

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tch tng oi ln, khu at e xay he thong nay phai co chat lng tot, khong b sut lun. e cong trnh van hanh hieu qua can 6- 9 thang sau khi cong trnh a vao hoat ong.

Mo hnh nay a uc s dung cho benh vien huyen Kim Bang tnh Ha Nam vi cong suat 125 m3/ngay.

Phng an 2:

Trong nhom cong nghe th hai, nc thai benh vien lan lt trai qua cac qua trnh x ly s bo (trong be t hoai hoac be lang), x ly sinh hoc trong ieu kien nhan tao (trong be loc sinh hoc hoac bun hoat tnh) va kh khuan.

Mo hnh x ly nc thai theo phng an nay c xay dng tai mot so benh vien nh benh vien a khoa Ha Giang (vi khuan sinh trng dnh bam), benh vien a khoa Bac Ninh (vi khuan sinh trng l lng), benh vien Hu Ngh (vi khuan dnh bam).

Nc thi B t hoi

Ngn thu + Song chn rc

Cng trnh x l sinh hc

B lng th cp Kh trng X thi

Hnh 3. S o cong nghe cua Phng an 2

Tai Trung tam Y te huyen Pho Yen, phng an x ly nc thai bang phng phap s dung be loc sinh hoc thong gio t nhien a c la chon vi s o cong nghe nh sau:

tiep tuc xay ra trong bai loc th he thc vat trong trong bai loc gop phan ang ke trong x ly nc thai nh kha nang cung cap o xy qua bo re cua cay xuong bai loc tao ieu kien hieu kh cho cac vi sinh vat lp tren cung cua bai loc. Bo re cua thc vat cung la moi trng song thch hp cho cac vi sinh vat co kha nang tieu thu cac chat dinh dng co trong nc thai, tang hieu qua x ly cua bai loc. Ngoai ra thc vat trong bai loc hap thu cac chat dinh dng nh Nit va Photpho. Nc sau bai loc trong cay thng khong con mui hoi thoi nh au ra cua cac cong trnh x ly k kh. Sau mot thi gian van hanh he thc vat trong bai loc se tao nen mot khuon vien ep cho toan bo he thong x ly.

- Kh trung: ho ch th vi chieu sau lp nc nong c thiet ke e loai bo cac vi khuan gay benh nh bc xa mat tri xuyen qua lp nc trong ho. Tuy nhien, oi vi nc thai co lng vi sinh vat gay benh cao th viec s dung hoa chat kh trung la ieu can thiet.

u iem: am bao c cac ch tieu SS, BOD, cac chat dinh dng nh nit, phot pho va Coliform trong nc thai xa ra moi trng ben ngoai. Mui nc thai se c han che neu dung bai loc ngam co trong cay pha tren. Ngoai ra chi ph xay dng va chi ph van hanh tng oi thap; cong tac ao tao van hanh, chuyen giao cong nghe n gian.

Nhc iem: Do phai xay dng bai loc trong cay nen he thong x ly nay oi hoi benh vien phai co dien

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g Nc thai tiep tuc t chay sang be lang ng t 2, phan ln bun se c lang xuong trong be nay, sau o c bm ve be u bun. Nc t be u bun chay tr lai be tap trung.

g Nc thai sau x ly c kh trung bang hon hp nc clo - ozon ieu che bang cac thiet b anolit trc khi xa ra moi trng ben ngoai.

g Vat lieu be loc sinh hoc bang chat deo tong hp co dien tch be mat tiep xuc khoang 200 - 250 m2/m3, o rong la 90%, co kha nang chu c nhiet o 6 - 300C ma khong mat o ben. Gia the vi sinh at tieu chuan TC02-2006CEEN.

g Be loc sinh hoc nho giot c thiet ke thanh 2 n nguyen, di dang be ch nhat, co thanh be, san loc va san be. San loc co khe h e o vat lieu loc.

g Be c thong gio t nhien, thc hien qua cac ca thong gio bo tr eu khap be mat thanh be (chu yeu trong pham vi san loc, san be).Tong dien tch thong gio trong pham vi san be va san loc lay 1- 5% dien tch be loc.

g Viec phan phoi nc thai tren be mat vat lieu loc c thc hien bang mang phan phoi t lat va he thong mang (ong) ti co nh.

u iem:

- Chi ph van hanh he thong thap, co the ket hp t ong hoan toan hoac ban t ong. Chi ph ao tao va boi dng nhan lc van hanh thap, ton t nhan lc.

- Tiet kiem c quy at cua benh vien.

Hnh 4. S o cong nghe x ly nc thai Trung tam y te huyen Pho Yen

1. Be t hoai; 2. Be tap trung nc thai ket hp song chan rac; 3. May bm nc thai; 4. Thiet b phan phoi nc thai len cac be loc sinh hoc; 5. Be loc sinh hoc thong gio t nhien co vat lieu loc bang khoi chat deo; 6. Be lang t hai; 7. Be kh trung; 8. Thiet b ieu che hoa chat kh trung; 9. Be u bun.

g Nc thai t ong dan chnh se c dan vao qua he thong song chan rac e loai bo rac c ln se b, sau o c dan sang ho lang cat tai ay toan bo cat lan trong nc thai c loai bo.

g Toan bo nc thai c tap trung va bm ieu hoa len be loc sinh hoc nho giot cap kh t nhien bang he thong ca thong gio xung quanh tng, x ly BOD cua nc thai en mc yeu cau.

24 25



u iem:

- Cong nghe x ly la cong nghe hien ai bao gom ay u cac quy trnh x ly hoa ly, hoa hoc va sinh hoc.

- Cac thiet b c che tao theo nguyen ly modul, hp khoi, t ong, gon nhe chiem t khong gian va dien tch, phu hp vi moi ieu kien c s.

- Lap at thiet b n gian, gon nhe va thuan tien. Cong suat x ly toi a cua moi thiet b hp khoi la 120 -150m3/ngay.em, tuy thuoc vao tong lu lng nc thai ma co so modul thiet b hp khoi. Cu the tai ben vien a khoa huyen Tuyen Hoa vi lu lng thai la 100m3/ngay.em nen lap at 1 cum thiet b.

- Hieu qua x ly cao.

Nhc iem:

- Chi ph au t, chi ph van hanh bao dng cao (do phai s dung he thong cap kh cng bc).

- Che o van hanh nghiem ngat, oi hoi cong nhan van hanh phai co trnh o.

Mot so c s ap dung phng phap nay la: Benh vien Kien An Hai Phong, Trung tam y te Vnh Bao - Hai Phong, Trung tam y te Than Vang Danh, Benh vien a khoa Ngoc Hoi, Benh vien a khoa Cam Pha

Phng an 4:

Nhom cong nghe th t bao gom cac cong nghe mi nhap vao Viet Nam trong nhng nam gan ay v du nh X ly gian oan theo me hay cong nghe co ten AAO (Yem kh - thieu kh - hieu kh).

- Thiet b theo mo hnh hp khoi, co the lap rap tng cum, hoac xay ngam tai cho, khong anh hng en kien truc xung quanh.

Nhc iem:

- Hieu qua x ly tai be loc khoang 60%.

- Mui nc thai va ruoi co the xuat hien.

- Co kha nang xay ra hien tng tac be loc.

- Kho khan trong viec tang cong suat x ly khi m rong quy mo cua benh vien.

Phng an 3:

Trong nhom cong nghe th ba, nc thai c x ly s bo trong cong trnh hp khoi, x ly tiep theo trong mo-dun thiet b x ly sinh hoc va c kh khuan trc khi xa thai ra moi trng. Cac cong trnh x ly nc thai s dung phng an hp khoi va theo mo-dun nh CN2000, V69 a c xay dng Viet Nam t 1998.

Nc thi

Song chn rc

Ngn thu nc thi

B iu ha v x l s b

X thi

H bm v cc bm chm

Ngn bn

B x l th cp

Thit b x l aerolift aeroten vi vt liu lc sinh hc

cao ti

Thit b kh trng

H thng hp khi

Modun thit b

Hnh 5. S o cong nghe cua phng an 3

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Bang 6. Hieu suat x ly cua cac phng an trong ieu kien thc te

bod5 codtong

ntong

p sstong cong

phng an 1

au vao 129.9 183.1 16.56 1.76 36.0

au ra 83.5 116.1 12.37 1.09 22.9

Hieu suat x ly 35.72 36.59 25.3 38.07 36.39 38.2

phng an 2

au vao 179.2 221.5 12.29 1.23 53.3

au ra 140.7 186.2 7.23 0.28 29.6

Hieu suat x ly 21.48 15.94 41.17 77.24 44.47 49.61

phng an 3

au vao 118.6 172.0 17.08 1.60 28.4

au ra 89.6 142.9 12.75 1.65 28.5

Hieu suat x ly 24.45 16.92 25.35 - - 27.63

phng an 4

au vao 165.7 227.5 17.23 1.95 37.8

au ra 94.8 130.8 9.09 1.05 14.8

Hieu suat x ly 42.79 42.51 47.24 46.15 60.85 53.84

Nguon: Bo Y te. Bao cao quan ly cac nguy c moi trng. D an Ho tr x ly chat thai benh vien, 11/2009

2.1.2. Cac tieu ch la chon cong nghe x ly nc thai benh vien cap huyen

ac iem cua cac benh vien cap huyen thng nam cac khu vuc tap trung ong dan c, va cac khu vc nay cha co he thong x ly nc thai sinh hoat at tieu

Nc thi My lc rc B lng v b

iu ha X l sinh hc gin on

theo m

Kh trng bng Ozon X thi

Hnh 6. S o cong nghe cua he thong x ly nc thai s dung cong nghe x ly gian oan theo me

Bang 5. Cac thong so thiet ke cua 4 nhom cong nghe:

phng an 1

phng an 2

phng an 3

phng an 4

Tai lng BOD

(kg/m3/ngay)0.4 0.8 - 1 0.6 1.8 - 3

Chat ran l lng (mg/l) 400 - 500

5000 - 7000

400 - 1000

10000 - 12000

Kha nang thch nghi bun

hoat tnh

Khong on nh

Thch nghi trung

bnh

Thch nghi trung

bnh

Cao, on nh

Thi gian lu Thap Trung bnhTrung bnh Cao

Hieu suat x ly chat ran l

lng

67% - 70%

85% - 95%

80% - 87%

90% - 97%

Hieu suat x ly chat hu c 75%

85% - 95% 90% > 96%

Hieu suat x ly nit Thap Kha Kha Rat tot

Hieu suat kh khuan

Trung bnh Tot Tot Tot

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- He thong thu gom x ly nc thai phai ap ng c Quy che quan ly chat thai y te 2007 cua Bo Y te: co he thong thu gom rieng nc be mat va nc thai t cac khoa, phong, he thong cong thu gom nc thai phai la he thong ngam hoac co nap ay; he thong x ly nc thai benh vien phai co quy trnh cong nghe phu hp, x ly nc thai at tieu chuan moi trng, cong suat phu hp vi lng nc thai phat sinh cua benh vien, ca xa nc thai phai thuan li cho viec kiem tra, giam sat, bun thai t he thong x ly nc thai phai c quan ly nh chat thai ran y te, nh ky kiem tra chat lng x ly nc thai, co so quan ly van hanh va ket qua kiem tra chat lng lien quan;

- Nc thai benh vien xa vao moi trng phai c x ly at cac ch tieu neu trong QCVN 28:2010/BTNMT - Quy chuan ky thuat quoc gia ve nc thai y te va QCVN 14:2008/BTNMT - Quy chuan ky thuat quoc gia ve nc thai sinh hoat;

- Cac cong trnh x ly nc thai xay dng khong phc tap, de hp khoi va chi ph au t khong cao;

- He thong x ly nc thai than thien vi moi trng, khong gay o nhiem khong kh, lan truyen benh dch cung nh anh hng xau en canh quan benh vien;

- Cong nghe x ly nc thai phai on nh, cong trnh de quan ly, chi ph van hanh va bao dng thap, phu hp vi ieu kien kinh te a phng;

- He thong x ly nc thai phu hp ve cong nghe, xay dng va van hanh bao dng cho cac benh vien tuyen huyen khu vc ong dan ngheo.

chuan hoac neu co th he thong thoat nc chung cua khu vc cha an toan oi vi ngi dan. e am bao an toan moi trng va an toan oi vi khu vuc song xung quanh benh vien, nc thai benh vien phai c x ly cuc bo trc khi thai vao cong trnh thoat nc chung.

Day chuyen cong nghe ap dung cho tram x ly nc thai la to hp cac cong trnh trong o nc thai c lam sach theo tng bc. Viec la chon day chuyen cong nghe la mot bai toan kinh te phc tap, phu thuoc vao nhieu yeu to:

- Lu lng nc thai au vao vi cac ac iem cua no nh lu lng trung bnh, he so ieu hoa...

- Thanh phan tnh chat cua nc thai au vao, ac iem tnh chat cua nguon thai.

- Yeu cau ve mc o lam sach.

- ieu kien a hnh, nang lng, tnh chat at ai.

- Dien tch khu vc xay dng cong trnh.

- Nguon von au t.

Cac benh vien tuyen huyen thng la nhng benh vien co quy mo nho, lai nam trong vung ong dan ngheo, ieu kien kinh te co han, do o khi xay dng he thong x ly nc thai benh vien, can co lo trnh phat trien quy mo he thong x ly theo s phat trien ve quy mo benh vien. Nh vay se va am bao s dung tot cong suat thiet ke, va ap ng nhu cau x ly khi benh vien c m rong, va giam nhe au t ban au. Do o he thong x ly nc thai tai cac benh vien tuyen huyen can ap ng c cac tieu ch sau:

30 31



cong nghe u iem nhc iem

X ly sinh hoc trong ieu kien t nhien (ho sinh hoc, bai loc ngap nc )

- Chi ph au t thap (300 USD/m3)- Chi ph van hanh va bao dng thap (0.05 USD/m3) - De van hanh va bao dng- Khong oi hoi cong nhan co trnh o cao

- Chiem nhieu dien tch

Bun hoat tnh

- Hieu qua x ly cao oi vi cac chat hu c (BOD, COD) va ammonia - Cau truc cua thiet b x ly n gian - Chi ph au t thap (400 - 600 USD/m3 tuy theo mc o x ly)

- Qua trnh lang bun b can tr co the lam giam hieu qua x ly va tnh on nh cua he thong. e giai quyet van e nay, benh vien can co ngi van hanh co trnh o. - Tieu thu nhieu ien nang cho qua trnh thong kh cng bc, lam tang chi ph van hanh (0.9 USD/m3), khong the van hanh khi mat ien- Qua trnh thoi kh phat sinh tieng on va co the phat tan mam benh ra khong kh- Chiem nhieu dien tch

Loc sinh hoc (nho giot hoac vat lieu chm)

- X ly hieu qua nc thai co mc o o nhiem trung bnh - Cau truc n gian, de lap at- Chi ph au t khong cao (khoang 400-500 USD/m3)- De van hanh va bao dng, - Chi ph van hanh thap (khoang 0.07 USD/m3

- Khong phu hp e x ly nc thai co mc o o nhiem hu c va nit cao - oi hoi be ieu hoa nc thai au vao, oi hoi be th cap - Khong the van hanh neu mat ien

2.2. e xuat cong nghe x ly nc thai cho benh vien quy mo cap huyen

Cac benh vien khu vc nong thon co quy at u ln (> 0.5 ha) va khoang cach ve sinh toi thieu ti nha dan va cong trnh benh vien xung quanh > 200 met nen ap dung s o x ly ket hp cac cong trnh x ly bac 1 phan tan va cong trnh x ly sinh hoc tap trung trong ieu kien t nhien (Phng an 1).

Cac benh vien thanh th va khong co quy at u ln c khuyen cao ap dung s o x ly ket hp x ly bac 1 phan tan vi x ly sinh hoc tap trung trong ieu kien cng bc (Phng an 2). Cac benh vien nay co the la chon cac he thong x ly co giai phap hp khoi, tron goi.

Lu y benh vien ch xay lap cong trnh hoac thiet b x ly bun tai cho (san phi bun, thiet b lam kho bun) ch khi khoang cach ve sinh ti nha dan hoac cong trnh benh vien ln hn 100 met. Cac cong trnh x ly sinh hoc e m ra ngoai tri nh kenh oxy hoa hay be aeroten tron cung ch c ap dung khi khoang cach ve sinh at 100 met.

Bang 7. u nhc iem cua cac cong trnh x ly nc thai s dung phng phap x ly sinh hoc

khac nhau


- X ly hieu qua nc thai co mc o o nhiem thap va trung bnh

- Khong phu hp vi nc thai benh vien co mc o o nhiem cao

32 33



2.3. Quy trnh quan ly va van hanh he thong x ly nc thai benh vien quy mo cap huyen

2.3.1. Quy trnh thu gom, phan luong nc thai benh vien

Nc thai sinh ra t hoat ong cua benh vien can c x ly ap ng mc II cua TCVN 7382 - 2004 trc khi xa ra moi trng. Viec phan luong dong nc thai phai tuan theo quy che quan ly chat thai y te: Benh vien phai co he thong thu gom rieng nc be mat va nc thai t cac khoa, phong. He thong cong thu gom nc thai phai la he thong ngam hoac co nap ay.

S o thu gom nc thai va nc ma tai benh vien c mo ta trong Hnh 7.

Nc ma chy trn

Nc thi khu v sinh cc khoa

Nc thi y t

H ga + Song chn rc

B t hoi

H thng XLNT

CNG THOT NC

CHUNG

Nc thi t thit b x l kh thi

Hnh 7. S o thu gom nc thai va nc ma tai benh vien


nc thai) bi v he thong tieu thu t ien nang - Khong oi hoi ngi van hanh co trnh o. - Chiem t dien tch hn cong nghe bun hoat tnh

- Co the gay phat sinh mui trong trng hp van hanh khong hp ly

He thong x ly hp khoi s dung cong nghe thong kh tiep xuc

- X ly hieu qua cac chat hu c va nit. Chat lng nc sau x ly tot va on nh - Van hanh n gian va on nh hn cong nghe bun hoat tnh - Chiem t dien tch hn cong nghe bun hoat tnh

- Chi ph au t cao v can co vat lieu loc sinh hoc (khoang 800 USD/m3)- Chi ph van hanh cao (0,12 USD/m3) bi v tieu thu nhieu hoa chat va ien nang cho thong kh cng bc; - Khong the van hanh neu mat ien - Co the phat sinh tieng on va mui hoi neu van hanh va bao dng khong am bao

He thong hp khoi co s dung cong nghe AAO (K kh - Thieu kh - Hieu kh)

- X ly hieu qua nc thai co mc o o nhiem cao - Lap at linh hoat - Chi ph van hanh va bao dng khong cao (0,09 VND/m3 nc thai) - Chiem t dien tch, co the lap at chm di at, khong gay mui.

- Chi ph au t cao (1200 USD/m3 nc thai)- Mang loc phai c bao dng hang nam va thay the sau 10 nam- oi hoi nhan vien co trnh o


34 35



cung vi chat thai ran cua benh vien. Sau o nc thai c a vao ng ong chung dan ra tram x ly nc thai. Tai ay nc thai c x ly theo phng phap sinh hoc va kh trung at QCVN 28:2010/BTNMT, mc B.

2.3.2. Quy trnh van hanh he thong x ly nc thai benh vien quy mo cap huyen

Van hanh he thong ng ong thu gom va cac ho ga:

- Nc thai c thu vao cac ho ga theo ng ong cong vat lieu HDPE dan qua he thong song chan rac roi t chay vao be tap trung nc thai. Cac ho ga phai co nap ay be tong cot thep va khong thu nc ma vao.

- Khong e cho rac, gie, bong bang ve sinh xuong ho ga chay trong ng ong. Tien hanh nao vet bun at cac ho ga 3 thang/lan tranh tac ong.

Van hanh cac be cua he thong x ly

e thiet b lam viec co hieu qua, trc khi van hanh cac bo phan, ngi van hanh phai kiem tra quan sat lng nc thai c gom ve be ieu hoa, nguon ien, kiem tra cac van cua may bm nc thai, may thoi kh.

- Be ieu hoa c cap kh lien tuc e tranh qua trnh yem kh xay ra. Viec cung cap kh cho be tap trung nc thai nh may thoi kh co the hoat ong hai che o: che o t ong va che o ieu khien bang nhan cong. che o t ong, may kh hoat ong tren c s mc nc co trong be ieu hoa nh bo van phao. Trc khi van hanh may thoi kh, can kiem

Nc ma chay tran:

Nc ma chay tran qua pham vi benh vien co lan cac tap chat ran, at, cat.. So vi nc thai, nc ma kha sach. Thu gom toan bo lng nc ma chay tran bang he thong mng thoat nc bao quanh toan bo khu vc benh vien. Mng thoat nc c xay bang gach, nap an be tong cot thep. Nc ma c dan qua ho ga co at song chan rac e lang can va tach rac co kch thc ln trc khi thoat ra cong thoat nc chung.

S o he thong thoat nc ma nh sau:

Nc ma Cng thot chung

H ga + Song chn rc

Nc thai t khu ve sinh cac khoa

Nc thai toilet cua tat ca cac phong trong mot khu nha c thu gom bang he thong ng ong noi bo va c x ly bang be t hoai gom 4 ngan co bo sung them ngan loc k kh (vat lieu loc la than, soi).

Nc thai y te va nc ra t be t hoai:

Nc thai y te co cha cac tac nhan lay nhiem phai c kh trung bang cac tac nhan hoa hoc (CaOCl, chloramines B) trc khi a vao he thong x ly nc thai. Nc thai be t hoai sau khi qua he thong be phot c thu gom chung vi nc thai t cac nguon khac cua benh vien. Sau o nc thai i qua song chan rac e loai bo rac co kch thc ln. Phan rac b chan lai bi song chan rac c kiem tra hang ngay, vt thai bo

36 37



- Cac thiet b trong he thong x ly nc thai phai c van hanh ung ky thuat va kiem tra bao dng nh ky.

+ May thoi kh: n Nguyen ly cua may thoi kh la co tieng thoi kh

ln gay tieng on ln. May thoi kh can co he thong giam on va ng ong thoat phai thoang e cap kh thoi vao cac ngan cua thiet b tranh hien tng qua tai cua may.

n Khi van mot chieu co tieng lach cach can lu y la do kh thoi cha u ap lc thang lc can cua nc chen canh chan cua van kh o ta tap trung kh cho vao mot iem can thoi hoac xa e khong kh trong ong va nc sau van hoac m kiem tra canh chan cua van b ket ban can m nap van, lau sach va chnh vt canh van cho khoi r, roi van vao nh cu.

n Thng xuyen nh ky bo sung dau tranh het dau gay chet may.

n Kiem tra tnh trang hoat ong cua quat, mo t moi ngay mot lan xem co b nong v khong.

+ May bm:n Chu y khi bm hoat ong can m van thoat au

ay cua bm trc khi bat cong tac bm.n nh ky kiem tra khong e chat x bam kn lo bm.n Neu bm b nong hoac phat tieng keu la, phai

kiem tra xem bm co b hong hoc hay hoat ong bat thng khong.

tra he thong van kh v tr m. Neu van hanh may khi cac van eu ong se gay ra hien tng qua tai cho ong c may thoi kh dan en chay ong c.

- Khi nc thai trong ngan thu cua be ngap ng ong dan nc thai vao th cho may bm chm bm nc thai hoat ong (hieu qua nhat la lap van phao t ong) e may bm t ong bm nc thai len be x ly. Khi ti mc nc thap nhat (min) th cho bm dng lai (hoac bm t ong ngat do van phao).

- Toan bo nc thai c tap trung va bm ieu hoa len be loc sinh hoc nho giot cap kh t nhien bang he thong cua thong gio xung quanh tng, x ly BOD cua nc thai en mc yeu cau. Viec phan phoi nc thai tren be mat vat lieu loc c thc hien bang mang phan phoi t lat va he thong mang (ong) ti co nh. Gau t lat tiep nhan nc thai en khi ay va o vao he thong mang rang ca hoac ong khoan lo e ti eu tren toan bo be mat be. Theo nh ky, cac ngan cua be loc c ti eu nc thai sau o ngng e thong kh, roi lai tiep nhan nc thai e thc hien chu ky x ly sau.

- Nc thai tiep tuc t chay sang be lang ng t 2, phan ln bun se c lang xuong trong be nay, sau o c bm ve be u bun. Nc t be u bun chay tr lai be tap trung.

- Khi bm nc thai lam viec th bm nh lng hon hp nc Clo - ozone cung hoat ong e bm dung dch Clo vao ho ga cuoi be va c hoa tron trc khi o ra ngoai.

38 39



n Neu hop ieu khien co hien tng hong hoc phai goi ngi co chuyen mon ve ien en x ly.

n Tat nguon trc khi sa cha, khi he thong chay khong tai can chu y nguon ien khong c cung cap qua phu tai, tranh s co.

2.3.3. Quy trnh ng pho cac rui ro khi van hanh he thong x ly nc thai benh vien

Nc thai sau khi x ly va xa ra moi trng phai ap ng nhng yeu cau moi trng. Do vay phai quan ly tot e cac cong trnh lam viec c bnh thng. e quan ly tot cac cong trnh ngi ta phai thng xuyen theo doi, kiem tra cac qua trnh cong nghe. Trong qua trnh van hanh, co the xuat hien cac rui ro, la nguyen nhan chu yeu pha huy che o lam viec bnh thng cua tram x ly:

- Cac cong trnh b qua tai.

- Lng nc thai ot xuat chay vao qua ln.

- Nguon cung cap ien b ngat.

- Lu lut toan bo hoac mot vai cong trnh b ngap.

- Can bo, cong nhan quan ly khong tuan theo quy tac quan ly ky thuat ke ca ky thuat an toan.

Cac cong trnh b qua tai.

Qua tai co the do lng nc thai chay vao tram vt qua lng tnh toan, do phan phoi nc va can khong ung va khong eu gia cac cong trnh, hoac do mot bo phan cong trnh phai ngng e ai tu hoac sa cha bat thng.

n Vi may bm nc thai, khong c e may bm chay khong co nc, nh ky moi tuan mot lan kiem tra xem mc phao t ong co ung chuan khong.

n Neu bm khong hoat ong th co the do ong c hong hoac phao bm t ong b hong. Bien phap khac phuc la sa cha hoac thay mi.

n Bm khong ra nc hoac lng nc qua t co the do:

Canh quat hut nc b tac nghen Ve sinh ben trong, loai bo d vat.

Phao bm t ong khong hoat ong do khong u khong gian cho phao.

ng ong hoac li chan rac b tac Ve sinh ben trong, loai bo d vat.

Canh quat b hong Sa lai au noi.

+ Be loc sinh hoc: Trong qua trnh hoat ong cua be qua thi gian lng can ong lai tai cac lp vat lieu loc gay cho toc o trong be loc cham va chat lng x ly nc kem th phai tien hanh thay ra be bang cach ra tng ngan cua be loc. Can co thiet b e xa can va e ra ay be loc sinh hoc khi can thiet.

+ He thong hut bun can: Be hut bun c hut nh ky 6 thang 1 lan

+ He thong ieu khien: nh ky moi tuan mot lan:n Kiem tra cong tac khong co day cau ch xem co b

nhay do qua tai hay chap mach khong.n Kiem tra cong tac ien t co b nhay do chap

mach hay qua tai khong.

40 41



- Khong thng xuyen co ra kenh mng dan nc ti cac cong trnh gay lang ong can doc kenh mng tao nen hien tng ong tam thi.

e khac phuc hien tng tren th cong nhan quan ly he thong x ly nc thai phai thc hien cac quy nh sau:

- ieu chnh che o bm cho phu hp vi cong suat cua tram x ly.

- Tien hanh tay ra kenh mng eu an.

- e tranh b ngat nguon ien, tram x ly nen dung hai nguon ien oc lap.

Lu lut toan bo hoac mot vai cong trnh b ngap.

Vi s co nay co nhng bien phap ng pho sau:

- Tat ngay nguon ien hop ieu khien e phong h ien.

- Di di quat gio va may bm ti cho cao, tranh e ngap nc gay hong hoc.

- Ch nc rut dung thuoc tay pha loang (t le 99:1) ra ben ngoai va khu vc xung quanh be.

- Lien lac vi nha cung cap e c giup ve ky thuat.

Can bo, cong nhan quan ly khong tuan theo quy tac quan ly ky thuat ke ca ky thuat an toan:

- Ngi thao tac may moc, thiet b ien khong thanh thao khong c tuy y van hanh may.

- Viec sa cha bao dng nen giao cho nhng ngi co chng ch ao tao chuyen mon am nhan, tranh xay ra nhng trng hp ang tiec.

Phai co tai lieu hng dan ve s o cong nghe cua toan bo tram x ly va cau tao cua tng cong trnh.Trong o ngoai cac so lieu ve ky thuat con phai ch ro lu lng thc te va lu lng thiet ke cua cong trnh.

Khi xac nh lu lng toan bo cac cong trnh phai ke en trang thai cong tac tang cng - tc la mot phan cac cong trnh ngng e ai tu hoac sa cha. Phai am bao khi ngng hoat ong mot cong trnh th so con lai phai cang ang vi lu lng trong gii han cho phep.

e tranh qua tai lam pha huy che o lam viec cua cac cong trnh phong ch ao ky thuat cong nghe cua tram x ly phai tien hanh kiem tra mot cach he thong ve thanh phan tnh chat cua nc thai theo cac ch tieu ve so lng va chat lng. Neu la hien tng vi pham quy tac quan ly th phai kp thi chan chnh ngay.

Khi cong trnh b qua tai mot cach thng xuyen do tang lu lng va nong o cua nc thai th phai bao cao len cap tren va c quan thanh tra ve sinh e co bien phap x ly. Trong khi ch i, co the e ra che o quan ly tam thi cho en khi co bien phap mi nham giam tai trong oi vi cong trnh.

Lng nc thai ot xuat chay vao qua ln.

Nc thai chay vao tram vi lu lng ln bat bnh thng co the do nhng nguyen nhan sau ay :

- Nc thai chay vao mot cach rat khong eu, tc la do che o xa nc khong eu hoac do che o bm khong hp ly.

42 43



oan a cong trnh vao hoat ong hay con goi la quan ly th.

- e a cong trnh vao hoat ong phai thanh lap mot to chc ac biet gom ai dien cua nganh kinh te cong cong va cac lnh vc cong nghiep khac nhau.To chc nay se nh che o lam viec toi u cua tng cong trnh e am bao chat lng nc sau khi x ly, ma gia thanh x ly lai thap.

- Trong suot giai oan a cong trnh vao hoat ong phai tien hanh kiem tra va ieu chnh che o lam viec cua tng cong trnh. Luc au khi ieu chnh, oi vi a so cac cong trnh ngi ta dung nc sach e am bao cac ieu kien ve sinh khi can sa cha lai.

- oi vi song chan rac, be lang cat, be lang, san phi bun th thi gian a vao hoat ong tng oi ngan. Trong thi gian o tien hanh ieu chnh va cho cac bo phan c kh, van khoa va cac thiet b o lng, phan phoi vao hoat ong.

- oi vi cac cong trnh x ly, trong o dien ra cac qua trnh sinh hoa th giai oan a vao hoat ong oi hoi tng oi dai, u e vi sinh vat phat trien vi mot lng can thiet va e qua trnh x ly dien ra c tot, ngha la cac cong trnh x ly phai c chn muoi. Do o giai oan a cong trnh vao hoat ong con goi la giai oan chn muoi va la giai oan quyet nh, nen oi hoi phai lu y va hang ngay phai kiem tra hieu qua lam viec cua cong trnh.

- Giai oan a vao hoat ong c bat au t luc thay ra be loc e loai bo rac, cat va cac vat dnh

- Tat nguon ien trc khi sa cha, bao dng may moc, thiet b ien.

2.3.4. Quy trnh quan ly he thong x ly nc thai benh vien benh vien quy mo cap huyen

Nghiem thu cong trnh

e nghiem thu cong trnh x ly sau khi a xay dng xong phai thanh lap mot tieu ban co ai dien cua c quan thanh tra ve sinh Nha nc tham gia. Noi dung nghiem thu bao gom :

- Kiem tra cong trnh co c xay ung vi thiet ke a duyet khong.

- Kiem tra so lng va qui cach lap at cac thiet b, ke ca d tr.

- Kiem tra chat lng thi cong: dung nc sach e kiem tra s ro r cua cong trnh; kiem tra s hoat ong cua may moc thiet b; v tr tng quan ve cao o gia cac cong trnh, o doc co am bao e nc t chay hay khong

- oi vi cac cong ngam va cac cong trnh ngam khac phai co u bien ban va chng t cua moi giai oan thi cong e thong qua tieu ban nghiem thu.

- Quy tac ve nghiem thu ky thuat a co trong quy pham do Bo Xay dng ban hanh.

- Quan ly cong trnh x ly cung tien hanh theo quy trnh Quan ly Ky thuat cac he thong cap thoat nc.

Giai oan a cong trnh vao hoat ong

- Sau khi nghiem thu cong trnh th bc sang giai

44 45



Kiem tra theo doi che o lam viec cua cac cong trnh x ly

- e tram x ly lam viec bnh thng th phai thng xuyen kiem tra che o cong tac cua tng cong trnh va cua toan tram.

- Thc hien kiem tra theo cac ch tieu sau:g Lng nc thai chay vao toan tram va tng cong

trnh.g Lng cat, can, bun hoat tnh va hi kh thu c.g Lu lng khong kh, hi nong va nc nong.g Nang lng ien tieu thu.g Hieu suat cong tac cua cac cong trnh theo so lieu

phan tch hoa hoc va vi sinh vat cua nc thai trc va sau khi x ly.

- ieu kien quan trong la phai xem lu lng thc te co ung vi lu lng thiet ke khong.

- Nen tien hanh o lu lng nc thai bang cac dung cu thiet b t ghi qua bang t ghi co the biet c lu lng tong cong va s dao ong cua lu lng theo gi trong ngay em.

- Viec phan tch nh vay phai tien hanh thng xuyen hang ngay, oi vi moi cong trnh phai co so ghi rieng. Trong o ghi tat ca cac so lieu ve phan tch ac trng cho hieu suat x ly cung nh tat ca cac hien tng bat bnh thng xay ra.

- Song song vi cac ieu khien t xa va t ong hoa cac cong trnh x ly, van phai duy tr s ieu khien

vao vat lieu loc, b gi lai be lang 2 roi xa i. Sau khi ra be loc vai ngay, ngi ta bat au cho nc thai chay vao vi lu lng nho e tren hat vat lieu loc tao thanh mang sinh vat vi mot lng u e lam sach nc thai. Toc o tang trng cua mang phu thuoc vao nhiet o cua nc thai trong than be loc. Vi nhiet o 9 - 10oC qua trnh tang trng dien ra cham; vi nhiet o 5-6oC th qua trnh hau nh b nh tre. Do o cac nc x lanh ngi ta thng cho be Biophin vao hoat ong vao mua am khi nhiet o cua nc thai chay vao tram x ly khong di 17-18oC.

- Ban au ti vi lu lng bang 1/10 en 1/4 lu lng tnh toan. C the cho ti khi xuat hien Nitrat vi 50% lng muoi amoni(chng 15-20 mg/l) trong nc ra khoi be.

- Sau o tang dan lu lng va khoang sau mot thang tang ti lu lng tnh toan.

- e tang nhanh qua trnh tang trng cua mang vi sinh vat trong be Biophin ngi ta co the cho them vao be Biophin khong c chiem qua 10% the tch vat lieu loc (tnh theo the tch can sau khi lang mot gi).

- Song song vi nghiem thu va a cong trnh vao hoat ong can to chc cho cong nhan quan ly hoc tap ve cong nghe x ly nc thai va cac quy tac quan ly cung nh ky thuat an toan lao ong.

- Sau khi nghiem thu va a cong trnh vao hoat ong, can thiet lap ho s hng dan quan ly tng cong trnh va s o cau tao cua chung, cung nh cac bien phap khac phuc khi gap sai sot, s co trong quan ly.

46 47



6. To chc cho cong nhan hoc tap ky thuat e nang cao tay nghe va lam viec cho quan ly cong trnh c tot hn, ong thi cho ho hoc tap ve ky thuat an toan lao ong.

- Ky thuat an toan.g Khi nhan cong nhan mi vao lam viec phai ac

biet lu y ho ve an toan lao ong. Phai hng dan, giang day cho ho ve cau tao, chc nang cua cac cong trnh, ky thuat quan ly va an toan; hng dan cach s dung cac may moc thiet b va tranh cho ho tiep xuc trc tiep vi nc thai va can.

g Moi cong nhan phai c trang b quan ao va cac phng tien bao ho lao ong khac. nhng ni lam viec cac cong trnh phai co chau ra, tam va thung nc sach. oi vi cong nhan tay ra can cac cong trnh, ra vat lieu loc Biophin, phai co nha tam nc nong. Cac cong viec lien quan en clo nc, clorua voi th phai co nhng hng dan va quy tac ac biet.

Thong ke cong nghe ve hoat ong cua he thong x ly

e anh gia ve kinh te ky thuat phai lap thong ke cong nghe ve hoat ong cua tng cong trnh va toan bo tram x ly. so cong tac ngoai cac ch tieu c ban con phai ghi tat ca nhng hien tng sai lech bat thng cua cac thiet b va cong trnh. Tren c s thong ke cac so lieu o ngi ta lap ban tong ket.

Hang thang theo quy cach a nh, da vao cac bang o ngi ta lam bao cao ky thuat ve che o lam

thu cong e am bao cho cac cong trnh van hanh lien tuc trong nhng luc co s co ve nguon ien hoac mot bo phan t ong nao o b hong.

To chc quan ly va ky thuat an toan

- To chc quan ly .g Quan ly cac tram x ly nc thai c thc hien

di s ch ao trc tiep cua c quan quan ly he thong thoat nc toan thanh pho hoac vung dan c. C cau lanh ao, thanh phan can bo ky thuat, so lng cong nhan moi tram tuy thuoc vao cong suat cua tram, mc o x ly nc thai, cac ac iem ky thuat khac va ca mc o c gii, t ong hoa cua tram.

g Nhiem vu chc nang cua cac ca nhan, phong ban phai c cong bo ro rang. Phong ky thuat co trach nhiem:

1. Quan ly ve cac mat: ky thuat an toan, phong hoa va cac bien phap tang nang suat.

2. Tat ca cac cong trnh phai co ho s san xuat. Neu co nhng thay oi ve che o quan ly cong trnh th phai kp thi bo sung vao ho s o.

3. oi vi tat ca cac cong trnh phai gi nguyen khong c thay oi ve che o cong nghe.

4. Tien hanh sa cha, ai tu ung ky han theo ke hoach a duyet.

5. Nhac nh nhng cong nhan thng trc ghi ung so sach va kp thi sa cha sai sot.

48


49

3. HNG DAN XAY DNG VA VAN HANHLO OT RAC THAI Y TE CHO BENH VIEN

QUY MO CAP HUYEN

3.1. Cac tieu ch la chon cong nghe x ly chat thai ran y te cho benh vien quy mo cap huyen

Theo quy che quan ly chat thai y te ban va van ban so 7164/BYT-KCB ngay 20/10/2008 cua Bo trng Bo Y te, cac benh vien va c s y te c phep ap dung mot trng cac mo hnh x ly nh sau:

n thanh pho trc thuoc trung ng ni tap trung nhieu benh vien va c s te, ieu kien giao thong thuan li, benh vien co the ap dung mo hnh x ly chat thai ran nguy hai tap trung, mot c s x ly tat ca chat thai y te nguy hai trong thanh pho e giam chi ph au t va van hanh.

n cac tnh va thanh pho khac, benh vien co the ap dung mo hnh x ly theo cum e x ly chat thai ran nguy hai cho cac benh vien, c s y te nam trong hoac xung quanh thanh pho hoac th tran (khoang cach ti c s x ly di 30 km).

n Benh vien, c s y te khu vc xa xoi, giao thong kho khan co the ap dung mo hnh x ly tai cho vi cong nghe phu hp.

viec cua cac cong trnh. Kem theo bao cao ky thuat la thuyet minh ngan gon phan tch che o lam viec cua cac cong trnh theo cac so lieu a co. Trong bao cao ky thuat ghi tat ca nhng nhc iem va thanh tu quan ly va phan anh cac ket qua cong tac nghien cu khoa hoc, ng dung cong nghe mi va cac phng phap tien tien. Da vao bao cao hang thang lap bao cao tong ket hang nam. Trong o a ra nhng giai oan cong tac chu yeu la cac ch tieu kinh te.

Hieu suat cong tac cua cac cong trnh x ly phai c anh gia bang cac ch tieu kinh te va gia thanh. Tren c s cac bao cao hang quy, hang nam phai co nhng con so ve ch tieu san xuat, thu nhap nc thai, nhan lc, chi ph trc tiep, chi ph ai tu, n gia va tieu chuan tieu thu n v ve ien, nc, v.v...

50 51



n May cat hoac may huy kim tiem; n Ho chon xi mang danh cho chat thai sac nhon va

chat thai giai phau; n ong ran, bao goi ap dung cho chat thai hoa hoc

va chat thai dc pham; n Lu gi an toan e phan huy chat thai phong xa; n Tra lai nha cung cap chat thai hoa hoc hoac bnh

cha kh nen; n Ky hp ong vi n v co giay phep e van

chuyen va x ly ben ngoai.

Mot cong nghe khong ot ch phu hp vi mot so loai chat thai nhat nh, nh mo ta trong Bang 8, trong khi o Bang 9 a ra mot so u iem cua tng cong nghe. V the, benh vien can phoi hp nhieu cong nghe khong ot e x ly an toan tat ca cac loai chat thai benh vien. Quy che Quan ly chat thai nguy hai cua Bo Y te a a ra gi y ve nhng cong nghe khong ot co the ap dung c cho nhng loai chat thai y te khac nhau.

Bang 8. Cac phng phap x ly va tieu huy chat thai y te

lo ot 2

buong

lo hap (kh

khuan nhiet)

lo vi song

Hoa chat

chon lap an toan

ong ran

trung hoa Khac

chat thai lay nhiemSac nhon Co Co Co Co Co Khong Khong -

3.1.1. Mot so cong nghe x ly chat thai ran y te

Cong nghe thieu ot

Bo trng Bo Y te a co cong van so 7164/BYT-KCB ngay 20/10/2008 yeu cau cac benh vien han che lap at lo ot mi, cung cap thiet b kiem soat o nhiem khong kh cho lo ot hien co va khuyen khch ng dung cong nghe khong ot than thien vi moi trng. Theo d thao Chien lc quan ly chat thai y te, cong nghe x ly rac thai y te can than thien vi moi trng, co the loai tr c mam benh trong chat thai lay nhiem va khong gay ra o nhiem th phat.

Chnh phu Viet Nam a ban hanh nhieu tieu chuan ve lo ot chat thai ran y te, trong o co TCVN 7380:2004: lo ot chat thai ran y te - yeu cau ky thuat; TCVN 7381:2004: Lo ot chat thai ran y te - phng phap anh gia va tham nh; QCVN 02:2008/BTNMT: Quy chuan quoc gia - yeu cau ky thuat cua kh thai lo ot chat thai ran y te.

Chi ph van hanh lo ot tai cho la ton kem, trong khi o chi ph van chuyen ra ngoai va x ly theo cum lai da tren thoa thuan gia cac benh vien.

Cac cong nghe khong ot

Cac cong nghe khong ot co the c la chon bao gom:

n Kh khuan nhiet t (thiet b hap), vi song, kh khuan hoa hoc e x ly chat thai lay nhiem;

n May nghien e lam giam the tch chat thai;

52 53



Bang 9. u nhc iem chnh cua cac cong nghe x ly chat thai y te


chi ph (thi iem

2010)cong nghe khong ot

May cat kim tiem

- Ngan nga tai s dung kim tiem- De van hanh, chi ph thap- Xi lanh co the tai che

- Kim tiem can c x ly tiep sau khi cat va phan loai

- Chi ph au t: 2-80 USD- Van hanh c 200.000 lan cat

May huy kim tiem

- Kh khuan va pha huy kim tiem bang ien- De van hanh, chi ph thap- Xi lanh co the tai che

- Can co ien- Goc kim tiem van con sau khi huy

- Chi ph au t: 100 - 150 USD

ong ran

- Co the ap dung cho chat thai hoa hoc va chat thai dc pham- De van hanh, chi ph thap

- Khong ap dung cho cac loai chat thai khac

- Chi ph au t cho xi mang va cat

Ho chon xi mang

- Co the ap dung cho chat thai sac nhon va chat thai benh pham- De van hanh, chi ph thap

- oi hoi at va khoang trong - Tiem an nguy c gay o nhiem nc ngam neu thiet ket va xay dng khong am bao

- Chi ph au t: 100-200 USD/m3

Chon lap hp ve sinh

- Tng oi an toan neu han che c tiep can va tham thau qua thanh ho chon- Chi ph au t va van hanh thap

- Ch ap dung cho benh vien mien nui hoac nong thon

- Chi ph au t: nhan cong, mai che, hang rao

lo ot 2

buong

lo hap (kh

khuan nhiet)

lo vi song

Hoa chat

chon lap an toan

ong ran

trung hoa Khac

Khong sac

nhon Co Co Co Co Co Khong Khong -

Lay nhiem

caoCo Co Co Co Co Khong Khong -

Giai phau Co Khong Khong Khong Co Khong Khong -

chat thai hoa hoc

Dc pham

So lng nho

Khong Khong Khong Co Co Co

Tra nha cung cap

Gay oc te bao

Khong Khong Khong Khong Khong Co Co

Hoa chat nguy hai

So lng nho

Khong Khong Khong Khong Khong Co

Bnh cha

kh nenKhong Khong Khong Khong Co Khong Khong

Chat phong

xaKhong Khong Khong Khong Khong Khong Khong Lu gi

Nguon: Bo Y te. D an Ho tr x ly chat thai benh vien, 11/2010

54 55



Kh khuan hoa hoc

- Hieu suat kh khuan cao, ac biet la chat thai lay nhiem dang long - Giam the tch chat thai neu kem theo may nghien - Mot so hoa chat kh khuan khong at

- Khong phu hp oi vi chat thai giai phau, chat thai sac nhon, chat thai dc pham va chat thai hoa hoc - oi hoi nhan cong co trnh o - Hoa chat nguy hai co the gay o nhiem moi trng

- Chi ph van hanh cho hoa chat kh khuan

cong nghe thieu otLo ot mot buong

- Hieu suat kh khuan tot- Giam ang ke the tch va khoi lng chat thai - Khong can cong nhan van hanh co trnh o

- Phat sinh kh thai gay o nhiem khong kh - Khong hieu qua oi vi cac hoa chat va thuoc chu c nhiet o cao

- Chi ph au t: 1.000 - 15.000 USD- Chi ph van hanh: 0,6 USD/kg hoac at hn

Lo ot hai buong (lo ot nhiet phan)

- Phu hp vi tat ca chat thai lay nhiem, hau het chat thai hoa hoc va chat thai dc pham - Giam ang ke khoi lng va the tch chat thai

- Khong pha huy c toan bo chat thai gay oc te bao - Chi ph au t tng oi cao - Chi ph van hanh cao- oi hoi cong nhan co trnh o - Phat sinh kh thai gay o nhiem khong kh neu van hanh va bao dng khong am bao

- Chi ph au t: 20.000 - 100.000 USD- Chi ph van hanh: 0,6 USD/kg hoac at hn


Kh khuan bang hi nc (lo hap)

- Hieu suat kh khuan cao - Giam c the tch chat thai neu co may nghien- Chi ph van hanh thap - Than thien vi moi trng- Cong nghe pho bien trong benh vien

- Khong phu hp oi vi chat thai giai phau, chat thai dc pham va chat thai hoa hoc va nhng chat thai khong the hap - oi hoi nhan cong co trnh o - Chi ph au t cao

- Chi ph au t: 500 - 50.000 USD- Chi ph van hanh: 0,33 USD/kg

Kh khuan bang vi song

- Hieu suat kh khuan cao - Giam c the tch chat thai neu co may nghien- Chi ph van hanh thap - Than thien vi moi trng

- Khong phu hp oi vi chat thai giai phau, chat thai dc pham va chat thai hoa hoc va nhng chat thai khong the hap - oi hoi nhan cong co trnh o - Chi ph au t cao, oi hoi tui chu nhiet

- Chi ph au t: 70.000 - 50.000 USD- Chi ph van hanh: 0,33 USD/kg

Kh khuan bang hi nc ket hp vi song

- Hieu suat kh khuan cao - Giam c the tch chat thai neu co may nghien- Chi ph van hanh thap - Than thien vi moi trng

- Khong phu hp oi vi chat thai giai phau, chat thai dc pham va chat thai hoa hoc va nhng chat thai khong the hap - oi hoi nhan cong co trnh o - Chi ph au t cao, oi hoi tui chu nhiet

- Chi ph au t: 180.000 - 250.000 USD- Chi ph van hanh: 0,33 USD/kg

56 57



- Lo ot s dung cong nghe, thiet b than thien moi trng, phu hp vi ieu kien cua mot benh vien tuyen huyen vung ong dan ngheo, de thao tac, van hanh; s dung nhien lieu ot thong dung;

- Chi ph au t xay dng phu hp vi ieu kien cua benh vien tuyen huyen; viec bao tr n gian;

- Lo ot co cong suat nho, phu hp vi benh vien tuyen huyen quy mo 50 - 200 ging benh. Viec la chon cong suat phu hp co tnh en cong suat d phong khi quy mo benh vien m rong;

- Lo ot co hieu qua x ly cao, tuoi tho thiet b cao; kch thc phu hp vi khuon vien benh vien;

- He thong ieu khien co o tin cay cao va an toan, van hanh thuan tien;

- La chon cac nha cung cap dch vu thc hien ao tao, hng dan cho can bo van hanh lo ot tai cho va co che o bao dng, bao hanh tot.

- Can c theo Tieu chuan Viet Nam TCVN 7380 : 2004 ve lo ot chat thai ran y te - yeu cau ky thuat, lo ot phai ap ng cac yeu cau ky thuat sau:

- Cau tao lo ot:n Lo ot phai co t nhat 2 buong ot: buong ot s

cap va buong ot th cap. Buong ot phai c cau tao e sao cho kh chay c phan bo eu trong khong gian buong ot.

n Vo lo phai bang kim loai (hoac vat lieu khac) ben vng di tac dung cua nhiet va cua moi trng xung quanh lo ot va nhiet o mat ngoai buong ot (vo lo) khong vt qua 500C.

3.1.2. Cac tieu ch la chon lo ot chat thai ran y te

Do tnh chat nguy hai cua chat thai y te nen t khau thu gom, van chuyen en x ly phai tuan thu chat che theo Quy che quan ly chat thai y te sa oi nam 2007 do Bo Y te ban hanh. Viec xay dng va lap at lo ot rac e x ly rac thai y te nguy hai la can thiet.

La chon lap at lo ot chat thai y te can xem xet en nhieu yeu to: t chi ph au t, van hanh, a iem lap at ti cac yeu cau ky thuat ap ng cac tieu chuan, quy chuan ban hanh. Hn na, do lo ot chat thai y te luon c van hanh trong ieu kien nhiet o cao, viec san co cac dch vu duy tr, bao dng cung nh cac linh kien thay the d phong ong vai tro quan trong trong viec la chon loai lo ot phu hp. La chon cong nghe lo ot rac thai y te cho benh vien quy mo cap huyen phai ap ng cac tieu ch can ban sau:

- Phu hp vi Quy che quan ly chat thai y te do Bo Y te ban hanh;

- Tuan thu TCVN 7380 : 2004 - Tieu chuan Viet Nam ve lo ot chat thai ran y te - Yeu cau ky thuat;

- Tuan thu TCVN 7381 : 2004 - Tieu chuan Viet Nam ve lo ot chat thai ran y te - Phng phap anh gia tham nh;

- Lo ot phai i kem vi thiet b x ly e x ly triet e lng khoi thai, kh axit, bui, mui thai ra t qua trnh ot rac; chat lng kh thai t lo ot ra moi trng ap ng QCVN 02 : 2008 - Quy chuan ky thuat quoc gia ve kh thai lo ot chat thai ran y te;

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- Mc on: mc on cua he thong lo ot khi thong gio (do quat, do cac ong c keo quat, hoac do chuyen ong cua gio, kh thai ) khong vt qua 85 dBA tai iem o cach nguon gay on 1m, xac nh theo TCVN 3985 : 1999

- Tro x: Buong ot s cap phai cau tao sao cho tro x sinh ra sau moi lan ot lo phai c thu gom de dang, khong lam ri vai tro x xung quanh lo ot. Ham lng cac chat co the gay chay c trong tro x khong vt qua 0,5% khoi lng tro.

- Ong khoi: n Ong khoi phai c che tao bang vat lieu ben

vng di tac dung cua nhiet va chong an mon kh thai.

n Lo ot phai co ong khoi cao hn t nhat 3 m so vi noc ngoi nha cao nhat trong pham vi cach lo ot 40 m tai ni mi lap at lo ot. Trong trng hp khong co ngoi nha nao trong pham vi o th ong khoi phai cao t nhat 8 m tnh t mat at.

n Toc o kh thai ra khoi mieng ong khoi khi lo ot lam viec on nh cong suat nh mc khong c di 15 m/s.

- Nc thai: Nc thai cua he thong x ly kh thai bang phng phap t cua lo ot (neu co) th thong so va nong o cac chat o nhiem phai at gia tr gii han cho phep theo QCVN 24:2008/BTNMT. Hien tai, theo quy nh nc thai benh vien va cac c s cham soc y te phai tuan thu TCVN 7382 : 2004 ve Chat lng nc - Nc thai benh vien - Tieu chuan thai.

n Lo ot phai kn, khong e x h kh chay ra xung quanh.

n Ca nap chat thai phai de dang thao tac khi ong m va phai kn khi lo ot lam viec.

n Phai am bao ap suat lam viec trong buong ot la ap suat am.

- Nhiet o lo otn Nhiet o buong ot s cap khong thap hn 8000C.n Nhiet o buong ot th cap khong thap hn 10500C.n Nhiet o kh thai mieng ong khoi khong cao

hn 2500C.

- Thi gian lu chay: Thi gian lu chay cua kh chay trong buong ot th cap khong thap hn 1.5 giay

- Thong gio: Thong gio cho lo ot phai la thong gio cng bc

- Kh thai: Gii han toi a cho phep cua cac thong so o nhiem trong kh thai cua lo ot khong c vt qua quy nh theo TCVN 6560 : 1999 ve chat lng khong kh - kh thai lo ot chat thai ran y te - gii han cho phep. Tuy nhien, tai thi iem hien tai, TCVN 6560: 1999 a c thay the bang Quy chuan Viet Nam QCVN 02: 2008/BTNMT - Quy chuan ky thuat quoc gia ve lo ot chat thai ran y te quy nh gia tr toi a cho phep cua cac thong so o nhiem trong kh thai lo ot chat thai ran y te. Do vay, kh thai t lo ot chat thai y te phai tuan thu theo quy chuan mi QCVN 02: 2008/BTNMT

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quy mo ging benh, theo tng mc 50, 100, 150, 200 ging.

Cac tieu ch ky thuat c ban cho lo ot rac thai y te Trung tam Y te huyen Pho Yen:

- Cong suat : 15-20 kg/h.

- Cong nghe ot : ot a vung, lo ot gom buong ot s cap chay trc tiep rac a vao lo ot nhiet o t 700-8000C; buong ot th cap ot cac kh sinh ra t buong s cap nhiet o t 950-10000C. Thi gian lu khoi khoang 1 giay.

- au ot (voi phun): la loai RL20, 2 cap ieu chnh tien tien, hien ai.

- Nhien lieu ot: dau iezen (DO).

- He thong cap gio : Cap trc tiep cho buong ot s cap va buong ot th cap. Lu lng gio c ieu chnh bang cac van ieu khien.

- Vat lieu chu nhiet : gach Trung Quoc, Cau uong; va chu la theo TCVN 4710-89 (chu nhiet en 16500C).

- X ly khoi thai: khoi thai c x ly theo cac cong oan sau:n Lam nguoi khoi trc khi i vao he thong kh bui

bang khong kh va nc;n Tach bui ra khoi khoi thai bang thiet b kh bui

kieu thap rong co phun nc;n Hap thu kh SO2 va cac chat kh oc hai khac

bang thiet b phun nc (scrupper);n Quat khoi thai khoi ra moi trng ben ngoai.

- Nang lng cap cho lo ot: ch cho phep thiet ke che tao lo ot s dung nhien lieu long, nhien lieu kh hoac ien nang lam nguon nang lng cung cap cho cac qua trnh ot cua lo ot. Khong cho phep thiet ke che tao cac lo ot s dung nhien lieu ran lam nhien lieu cho lo ot.

- Yeu cau ve an toan: Lo ot phai ap ng yeu cau ve an toan ien va an toan phong chong chay no theo cac quy nh hien hanh.

- Thiet b kiem soat hoat ong cua lo ot: lo ot phai co u cac thiet b kiem soat lien tuc nhiet o buong ot s cap va buong ot th cap trong suot qua trnh lam viec cua lo; canh bao khi nhiet o trong buong ot th cap xuong thap hn 10000C va vt qua 12000C; co thiet b bao an toan cho phep m ca lo.

Ben canh o, do lo ot chat thai y te cho benh vien tuyen huyen co cong suat nho, qua trnh ot c thc hien theo me nen can chu y en mot so tieu ch sau:

- Dung tch buong ot s cap phai u ln do chat thai y te nguy hai co ty trong thap (khoang 0,13 tan/m3); e co the thc hien ot rac trong thi gian u dai nham tiet kiem nang lng do giai oan gia nhiet khi ong va giai oan lam lanh ton nhieu nang lng, thi gian.

- Nen la chon phng phap x ly t e loai bo kh thai va bui t qua trnh ot do phng phap nay chi ph au t, van hanh re hn so vi phng phap x ly kho, de thc hien hn.

- Viec tnh toan cong suat lo phu hp nen da theo

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n Chat thai phat sinh t cac cong viec hanh chnh: giay, bao, tai lieu, vat lieu ong goi, thung cac tong, tui nilon,...

- Chat thai ran y te x ly bang lo ot, bao gom:n Chat thai lay nhiem sac nhon (loai A): La chat

thai co the gay ra cac vet cat hoac choc thung, co the nhiem khuan, bao gom: bm kim tiem, au sac nhon cua day truyen, li dao mo, inh mo, ca, cac ong tiem, manh thuy tinh v va cac vat sac nhon khac s dung trong cac hoat ong y te.

n Chat thai lay nhiem khong sac nhon (loai B): La chat thai b tham mau, tham dch sinh hoc cua c the (bong, gac, bang, gang tay, bot bo...) va cac chat thai phat sinh t buong benh cach ly.

n Chat thai co nguy c lay nhiem cao (loai C): La chat thai phat sinh trong cac phong xet nghiem nh: benh pham va dung cu ng, dnh benh pham (gang tay, lam knh, ong nghiem, tui ng mau).

n Chat thai giai phau (loai D): Bao gom cac mo, c quan, bo phan c the ngi; rau thai, bao thai va xac ong vat th nghiem.

n Chat thai hoa hoc nguy hai: Dc pham qua han, kem pham chat, khong con kha nang s dung; chat thai hoa hoc nguy hai s dung trong y te (Phu luc 1 - Quy che Quan ly chat thai y te).

- Cac bnh cha ap suat.

Quy trnh thu gom, van chuyen, lu gi tai cho

He thong phan loai, thu gom va van chuyen chat thai benh vien phai c thc hien ngay t nguon xa

3.2. Quy trnh van hanh va quan ly lo ot rac thai y te benh vien quy mo cap huyen

3.2.1. Quy trnh thu gom, phan loai tai cho

Quy trnh thu gom, phan loai chat thai y te cua benh vien cap huyen phai tuan thu cac quy nh trong Quy che Quan ly chat thai y te benh vien (sa oi nam 2007) do Bo Y te ban hanh.

Quy trnh phan loai

Cac thanh phan nguy hai va khong nguy hai cua chat thai ran y te phai c tach loai ngay t nguon phat sinh, va c at trong cac thung co ma so theo mau sac quy nh trc khi thu gom. Ngi lam phat sinh chat thai phai thc hien phan loai ngay tai ni phat sinh chat thai.

Chat thai ran phai c phan loai ngay tai nguon theo cac nhom:

- Chat thai sinh hoat, bao gom:n Rac thai sinh hoat phat sinh t cac buong benh -

tr buong benh cach lyn Chat thai ngoai canh: la cay va rac t khu vc

ngoai canh

- Chat thai co kha nang tai che, bao gom:n Chat thai phat sinh t cac hoat ong chuyen mon

y te nh cac chai lo thuy tinh, chai huyet thanh, cac vat lieu nha, cac loai bot bo trong gay xng kn. Nhng chat thai nay khong dnh mau, dch sinh hoc va cac chat hoa hoc nguy hai.

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chat thai phai co loai thung thu gom tng ng.

- Ni at thung ng chat thai phai co hng dan cach phan loai va thu gom.

- S dung thung ng chat thai theo ung tieu chuan quy nh va phai c ve sinh hang ngay.

- Tui sach thu gom chat thai phai luon co san tai ni chat thai phat sinh e thay the cho tui cung loai a c thu gom chuyen ve ni lu gi tam thi chat thai cua c s y te.

- Tai cac khu vc hanh lang, ni benh nhan ch kham cha benh, bo tr cac thung ng rac thai sinh hoat cho ong ngi, thuan tien cho viec bo rac.

Thu gom: Ho ly hoac nhan vien c phan cong hang ngay chu trach nhiem thu gom cac chat thai y te nguy hai va chat thai thong thng t ni chat thai phat sinh ve ni tap trung chat thai cua khoa t nhat 1 lan trong ngay va khi can.

Van chuyen:

- Chat thai phat sinh tai cac khoa/phong phai c van chuyen rieng ve ni lu gi chat thai cua benh vien/c s y te t nhat mot lan mot ngay va khi can.

- Quy nh ng van chuyen va gi van chuyen chat thai, tranh van chuyen chat thai qua cac khu vc cham soc benh nhan va cac khu vc sanh khac.

- Van chuyen bang xe chuyen dung; khong c lam ri, vai chat thai, nc thai va phat tan mui hoi trong qua trnh van chuyen.

thai. He thong nay phai am bao han che toi a cac tac ong ti cong ong. Viec xay dng s o he thong vi viec ch ro v tr cac thung rac tai cac khoa, phong trong benh vien cung nh v tr thu gom, khu vc lu tr rac, quy nh ro rang ng van chuyen va thi gian van chuyen rac la can thiet.

Dung cu thu gom:

Tuan thu cac tieu chuan cac dung cu bao b ng va van chuyen chat thai ran trong cac c s y te (chng III - Quy che Quan ly chat thai y te nam 2007):

- S dung cac tui/thung mau vang (ng chat thai lay nhiem), mau en (ng chat thai gay oc te bao hoac chat thai phong xa) va mau xanh (ng chat thai sinh hoat) e ng rac phan loai.

- Cac thung van chuyen rac co nap ay, banh xe ay.

- Chat thai co kha nang tai che ng trong tui/thung mau trang.

- Cac dung cu thu gom chat thai de lam sach, tay ue, lam kho.

- So lng va dung tch thung ng chat thai phu thuoc vao lng rac thai phat sinh hang ngay.

- Tui ng chat thai c x ly bang phng phap thieu ot nen s dung tui PE hoac PP e tranh tao chat o nhiem trong qua trnh ot.

Ni at thung ng chat thai:

- Moi khoa, phong phai nh ro v tr at thung ng chat thai y te cho tng loai chat thai, ni phat sinh

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3.2.2. Quy trnh van hanh lo ot rac thai y te benh vien cap huyen

Chat thai y te a vao lo ot phai phu hp vi TCVN 7380 : 2004 va tuan thu nghiem ngat quy nh, quy trnh van hanh, bao dng lo ot cua nha san xuat lo.

Quy trnh chuan b chat thai e ot:

- am bao lu rac x ly bang phng phap lo ot trong nha lu gi chat thai, tranh e ngoai tri ma gio lam tang o am trong rac, gay o nhiem moi trng. Nha lu gi chat thai phai co mai che, co hang rao bao ve, co ca va co khoa. Khong e suc vat, cac loai gam nham va ngi khong co nhiem vu t do xam nhap

- Theo TCVN 7380: 2004, lo ot chat thai ran y te ch ap dung e tieu huy chat thai ran y te thuoc loai chat thai lam sang bao gom cac chat thai nhiem khuan, cac vat sac nhon, chat thai co nguy c lay nhiem cao, nhom dc pham qua han, dc pham b nhiem khuan, dc pham b o, dc pham khong con nhu cau s dung va cac mo - c quan ngi va ong vat. Khong ap dung e ot chat thai y te khong the ran, chat thai oc vi te bao, chat thai phong xa, cac bnh ap suat, chat thai nha clo hoa, chat thai co cha ham lng cao cac kim loai nang, chat thai ran sinh hoat. ieu nay phu thuoc vao cong oan phan loai va thu gom rac thai tai nguon phai thc hien theo ung quy trnh hng dan.

- am bao khoi lng rac nap cho moi me ot theo ung quy nh cua nha san xuat lo, phu hp vi cong suat cua lo.

- Cac phng tien van chuyen phai c co ra va tay ue ngay sau khi van chuyen chat thai.

Lu gi chat thai ran trong benh vien:

- Benh vien phai co nha lu gi tam thi chat thai y te nguy hai se c x ly bang phng phap lo ot. V tr nha c bo tr hp ly, tuan thu theo ieu 16 trong Quy che quan l chat thai ran y te 2007.

- Thi gian lu gi chat thai trong benh vien khong qua 48 gi. Neu benh vien/c s y te co lng chat thai y te nguy hai phat sinh di 5 kg/ngay, thi gian thu gom x ly toi thieu hai lan trong mot tuan.

- Tro thai sau qua trnh ot x ly nh chat thai sinh hoat.

Hnh 8. S o he thong thu gom va x ly rac tai benh vien cap huyen

Nguon: Bo Y te. D an Ho tr x ly chat thai benh vien, 11/2010

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thap hn gii han cho phep theo cac tieu chuan, quy chuan hien hanh.

- Qua trnh chay trong cac buong ot phu thuoc vao loai chat thai ran y te nguy hai a vao ot cung nh quy trnh van hanh lo ot. Kinh nghiem cho thay anh hng cua nhiet o ti kha nang loai bo chat gay o nhiem hu c quan trong hn thi gian lu chay kh trong buong ot th cap. ot chay ioxin/furan buong ot th cap tren 10000C, ong thi phai am bao nhiet o khoi thai qua ong khong qua cao e tranh tnh trang tai hnh thanh ioxin/furan. Do vay, khi van hanh lo ot can am bao nhiet o theo ung yeu cau ky thuat trong qua trnh ot.

- oi vi mot so lo ot, viec cap chat thai c thc hien thu cong bang tay. Lng bui va cac khoi thai sinh ra thap hn tieu chuan cho phep phu thuoc chu yeu vao so lan cap chat thai, che o cap khong kh co ieu chnh trong moi me ot, thanh phan chat thai cap vao. Do vay can tuan thu nghiem ngat cac quy nh cua nha san xuat lien quan ti qua trnh ot va u lo, gia nhiet, cap chat thai cho lo ot; ieu chnh lng khong kh cap vao, lng dau can phun, ieu chnh s lam viec cua quat gio va bm nc, hieu chnh, ong m cac van khoa tren ng ong v.v...

- Tuan thu nghiem ngat hng dan s dung (thi gian gia nhiet, theo doi lng nhien lieu, khong kh va chat thai a vao, s gia tang nhiet o).

- am bao thi gian ot ung quy nh.

- am bao an toan lao ong trong qua trnh van hanh lo ot.

- am bao o am tng oi/ lng nc cho phep trong rac thai tuan thu quy nh cua nha san xuat lo. Mot so lo ot co bo phan ep rac nham giam o am cua rac trc khi ot. oi vi nhng lo khong co thiet b nay, can thc hien tach nc trong cac chat thai giai phau trc khi a vao lo ot.

- am bao cac dung cu lao ong can thiet: moc sat can go, choong sat, bo c le, dung cu thao m bu long, cha khoa ieu chnh cac van dau thuy lc, xa khi can thiet, can khoi lng, nhat ky van hanh.

- Cong nhan phai s dung ay u cac trang thiet b lao ong phong ho a c trang b: quan, ao budong dai tay, giay e cng, khau trang loc oc, gang tay da dai, knh, dung cu lam viec.

Quy trnh ot

- Kiem tra cac thiet b an toan cua lo ot, cac en bao tnh trang bnh thng, cac ca xa tro, nap thai phai ong kn, ch so tai cac cap ong ho bao nhiet o phai tng ng.

- Khi ong cac he thong, thc hien giai oan ham nong lo ot.

- Qua trnh ot chay chat thai ran y te nguy hai xay ra trong buong ot rat phc tap v nhiet o chay cao, thanh phan va o am chat thai a vao ot khong on nh, ap suat khoi thai trong buong ot thay oi... Do vay can tien hanh ot th nghiem, o ac va hieu chnh che o lam viec cua lo ot ngay t au e cac ch tieu ve bui va cac chat oc hai co trong khoi thai thai ra t ong khoi cua lo ot phai

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Qua trnh van hanh lo ot rac thai y te co the gap phai mot so rui ro do:

- La chon lo ot quy mo khong phu hp: Benh vien tuyen huyen co quy mo nho, lng chat thai ran y te nguy hai can x ly bang phng phap ot khong nhieu, neu khong c tnh ung lng chat thai ran y te can phai x ly thai ra hang ngay, dan ti viec la chon lo ot vi cong suat khong phu hp se dan ti viec lo ot khong s dung het cong suat va chi ph cao. ieu nay se gay kho khan cho cac benh vien/c s y te trong viec van hanh, duy tr va bao dng hoat ong cua lo ot rac y te.

- Thieu kinh ph: Viec thieu kinh ph cho viec duy tr va bao dng lo ot dan ti viec lo ot c van hanh khong ung quy chuan ky thuat. Nhc iem cua cong nghe ot la neu ky thuat van hanh khong ung ky thuat va khong co he thong x ly kh thai se lam tang nguy c phat sinh nhng chat oc hai nh dioxin, furan gay o nhiem moi trng th phat trong qua trnh van hanh.

Viec thieu kinh ph cho viec van hanh lo ot con co the dan ti viec thai y te se b thai bo va x ly lan vi chat thai sinh hoat thong thng, la nguon gay o nhiem moi trng va la nguon gay benh tiem tang cho cong ong xung quanh.

Nguon kinh ph cho cac hoat ong cua benh vien tuyen huyen con nhieu kho khan. Chi ph au t xay dng mi hoac cai tao he thong lo ot; chi ph van hanh, bao dng thng xuyen cho he thong la rat ln.

Quy trnh x ly sau ot:

- Tro sau qua trnh ot a chuyen en khu tap trung rac thai thong thng va c x ly nh rac thai sinh hoat.

- Ra cac thung ng rac va a vao v tr qui nh.

- Ket thuc ca lam viec, ve sinh cac thiet b cua lo.

- Ve sinh ca nhan va phng tien lam viec.

- Thc hien ve sinh lo ot rac nh ky theo quy nh cua nha san xuat lo.

Mot so lu y:

- Tuyet oi nghiem cam lam au, lam tat cac bc khong theo quy trnh hng dan van hanh may tranh anh hng hoac gay s co cho thiet b.

- Khi van hanh lo (s dung ien), neu mat ien phai nhanh chong thao tac theo cac hng dan e gi an toan cho thiet b.

- Trc khi x ly ot neu phat hien cac chat thai khong ung quy nh ot th phai x ly theo quy trnh am bao ve sinh moi trng.

- Khi van hanh x ly phai tuan thu nghiem ngat quy trnh, quy nh, giam sat chat che cac cong oan, han che toi a bao, tui b rach, v, dch chay ra trong qua trnh nap chat thai.

3.2.3. Quy trnh ng pho cac rui ro khi van hanh lo ot rac thai y te benh vien

Cac rui ro khi van hanh lo ot rac thai y te

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Bien phap ng pho

e giam thieu cac rui ro khi van hanh lo ot, can thc hien cac bien phap sau:

- La chon lo ot co cong suat nho, phu hp vi benh vien tuyen huyen quy mo 50 - 200 ging benh. Viec la chon cong suat phu hp co tnh en cong suat d phong khi quy mo benh vien m rong.

- La chon lo ot s dung cong nghe, thiet b than thien moi trng, phu hp vi ieu kien cua mot benh vien tuyen huyen vung ong dan ngheo, de thao tac, van hanh, bao tr, bao dng; s dung nhien lieu ot thong dung.

- Tap huan nang cao trnh o, nhan thc cho nhan vien van hanh lo ot; oi ngu can bo nhan vien tham gia quan ly chat thai y te (phan loai, thu gom, van chuyen). Bao am lo ch s dung e tieu huy chat thai ran y te thuoc loai chat thai lam sang bao gom cac chat thai nhiem khuan, cac vat sac nhon, chat thai co nguy c lay nhiem cao, nhom dc pham qua han, dc pham b nhiem khuan, dc pham b o, dc pham khong con nhu cau s dung va cac mo - c quan ngi va ong vat.. Khong ap dung e ot chat thai y te khong the ran, chat thai oc vi te bao, chat thai phong xa, cac bnh ap suat, chat thai nha clo hoa, chat thai co cha ham lng cao cac kim loai nang, chat thai ran sinh hoat.

- La chon lo ot co he thong ieu khien co o tin cay cao va an toan; tuan thu nghiem ngat cac quy nh ve an toan khi van hanh lo ot. Nhan vien van

So lng can bo lam cong tac quan ly chat thai y te, cung nh trang thiet b x ly chat thai y te cac c s y te cha am bao. Trong khi o dan so va nhu cau cham soc ve y te cua ngi dan ngay cang tang len, lam cho cac c s luon trong tnh trang qua tai, dan en qua tai ve chat thai y te, nhat la cac c s y te tuyen tnh.

Hien tai, chi ph van hanh cua lo ot rac lay t nguon chi thng xuyen cua c s y te. Nguon chi nay, theo quy nh a c khoan. Neu s dung nhieu vao van hanh lo ot se lam giam kinh ph cho cac hoat ong khac.

- Trnh o cua can bo con nhieu han che, nhan thc cha cao: anh hng ti kha nang tiep thu thiet b, cong nghe mi cung nh cong tac bao tr sau nay. Viec phan loai rac khong theo ung quy nh, ot rac khong c phep cho lo ot, van hanh khong ung yeu cau ky thuat co the lam giam tuoi tho cua thiet b va gay o nhiem moi trng.

- Lo ot c van hanh khong ung quy nh: loai chat thai, nhiet o, thi gian, cong suat...anh hng ti chat lng ot, giam tuoi tho thiet b, gay o nhiem moi trng

- Bao tr, bao dng: do lo ot c van hanh cac benh vien tuyen huyen xa trung tam, kinh ph han che nen viec bao tr, bao dng gap nhieu kho khan.

- An toan lao ong: s co chay, no; nhiem khuan, nhiem oc oi vi nhan vien van hanh t cac chat thai nguy hai

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- am bao so nhan vien co u ky nang van hanh, bao tr lo ot chat thai y te. Yeu cau ben cung cap thiet b lo ot ao ta

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