我国各类医疗机构部分医疗废物分类处置现状

Current status of classification and disposal of medical waste in different medical institutions in China

摘要:

目的 了解我国医疗机构部分医疗废物分类、处置的现状，为提高医疗废物分类、处置的可操作性，实现医疗废物减量化、无害化、资源化提供科学依据。 方法 采用分层抽样的方法对1 574所医疗机构医疗废物分类、处置现状进行问卷调查，对调查结果进行核查和统计分析。 结果 共回收有效问卷1 345份，问卷有效回收率85.45%。病原体培养物、标本、菌种、毒种保存液以及传染病患者或者疑似传染病患者产生的生活垃圾的处置合格率分别为93.75%（1 261/1 345）和98.66%（1 327/1 345）；人体组织器官交由医疗废物处置单位的医疗机构占68.21%（826/1 211），普通产妇胎盘签订同意书后医院统一处置或自行带走的占97.45%（916/940），死胎交殡仪馆处置的占72.13%（678/940）；仅55.74%（510/915）的医疗机构将批量过期的化疗药物或细胞毒性药物交给有资质的机构处理，少量剩余疫苗主要按普通感染性废物处置（88.34%，932/1 055）；批量废弃的病理性废液、消毒剂、化学试剂交由专业危废中心处置的分别占30.38%（322/1 060）、25.42%（257/1 011）、35.57%（350/984）；人体组织器官、死胎、批量过期的化疗药物或细胞毒性药物、批量废弃的病理性废液在不同级别医疗机构中处置方式分布不同，差异有统计学意义（均P < 0.05）。普通患者的氧气湿化瓶，一次性止血带、消毒剂、化学试剂空瓶、一次性鞋套、固定石膏、一次性被罩、床单、枕套主要作为医疗废物处理；纸、塑料类外包装以及普通患者的尿不湿、卫生巾主要作为生活垃圾处理；将一次性输液瓶（袋）和一般青霉素等玻璃药瓶作为可回收废物的医疗机构分别占77.18%和45.21%。 结论 病理性、药物性、化学性医疗废物分类处置问题突出，医疗机构其他常见废弃物，如未被污染的氧气湿化瓶、一次性用品、试剂空瓶、固定石膏等废弃物的分类处置方式未统一，需要进一步规范。

Abstract:

Objective To understand the current status of classification and disposal of partial medical waste in medical institutions (MIs) in China, provide scientific evidence for improving the operability of classified disposal of medical waste and realizing the reduction, harmlessness and recycling of medical waste. Methods By stratified sampling method, questionnaires were used to investigate the status of classification and disposal of medical waste in 1 574 MIs, investigation results were checked and statistically analyzed. Results A total of 1 345 qualified questionnaires were collected, with the effective recovery rate of 85.45%. The qualified disposal rates of pathogen culture, specimen, strain, virus preservation solution and household garbage produced by patients with infectious di-seases or suspected infectious diseases were 93.75%(1 261/1 345) and 98.66% (1 327/1 345) respectively; 68.21% (826/1 211) of MIs send human tissues and organs to medical waste disposal centers, 97.45% (916/940) of MIs disposed non-infected placentas or non-infected placentas were taken away by puerpera after signing consent, and 72.13% (678/940) of MIs handed over dead fetus to the funeral home for disposal, only 55.74% (510/915) of MIs handed over batches of expired chemotherapeutic drugs or cytotoxic drugs to qualified institutions for disposal, and a small amount of residual vaccines were mainly disposed of as common infectious waste (88.34%, 932/1 055); 30.38% (322/1 060), 25.42% (257/1 011) and 35.57% (350/984) of MIs respectively disposed the pathological waste liquid, disinfectant and discarded batches of chemical reagent by professional hazardous waste disposal centers. Disposal modes of human tissues and organs, dead fetus, batches of expired chemotherapeutic drugs or cytotoxic drugs and batches of discarded chemical reagents were different in all levels of MIs(all P < 0.05). Oxygen humidification bottles, disposable tourniquets, empty bottles of chemical reagent and disinfectant, disposable shoe co-vers, fixed gypsum, disposable quilt covers, bed sheets and pillowcases of non-infectious patients were mainly disposed as medical waste; outer packaging of paper and plastic, diapers and sanitary napkins of non-infectious patients were mainly disposed as household waste; infusion bottles (bags) and glass medicine bottles such as penicillin bottles were as recyclable waste in 77.18% and 45.21% of MIs respectively. Conclusion The problem of classified disposal of pathological, pharmaceutical and chemical medical waste is prominent, the classified disposal methods of other common waste in MIs, such as uncontaminated oxygen humidification bottles, disposable articles, empty reagent bottles and fixed gypsum, are not unified, which needs to be further standardized.