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  本計畫主要的目的在協助環保署研擬醫療廢棄物源頭減廢方案及小型產源輔導,本年度之工作項目包括六大部分:(一) 加強宣導最新醫療廢棄物管理法規;(二)輔導中小型醫療機構落實廢棄物管理;(三) 評估國內醫療廢棄物滅菌處理設施效能;(四) 推動含氯塑膠醫療廢棄物減廢工作;(五) 推動醫院含汞廢棄物減害工作;(六) 推動禽流感廢棄物應變準備工作。工作內容摘要如下:

一、加強宣導最新醫療廢棄物管理法規

本計畫於醫療品質雜誌發表「台灣地區醫療廢棄物法規與管理概況」、「醫院汞排放問題、含汞設備與廢棄物之管理」、「解讀法規背後的意義:漫談醫療廢棄物管理相關規定」等三篇文章。藉由環保機關、清理機構及醫療機構三種問卷調查,發放4210份問卷,回收有效問卷1195份,完成醫療廢棄物法規修正意見調查及評析建議。

二、輔導中小型醫療機構落實廢棄物管理

本計畫輔導202家地區醫院與基層診所落實廢棄物管理,輔導其落實醫療廢棄物之分類、標示、合法委託及紀錄申報工作。同時調查及分析其廢棄物委託清理契約之內容,藉此研擬醫療廢棄物委託清理定型化契約參考本及權益指引。

三、評估國內醫療廢棄物滅菌處理設施效能

本計畫測試並評估醫療廢棄物滅菌處理設施之效能,以快速判讀生物指示劑 (Rapid Readout Biological Indicator, RRBI)之挑戰包試驗(challenge pack test)評估醫療棄物滅菌效能,本計畫完成10座商轉規模滅菌鍋評估,結果顯示與袋內RRBI比較,挑戰試驗為較保守之良好效能測試方法。本計畫並辦理2場次滅菌效能評估示範觀摩活動,宣導地方環保機關及醫療機構正確進行設施評估。

四、推動含氯塑膠醫療廢棄物減廢工作

本計畫調查22家醫院及18家醫療器材廠商之使用及販售含PVC醫療器材及其替代產品的現況,根據此調查結果,並參考歐美等國家相關經驗與案例,選出優先推動替代產品的項目為手套以及輸液軟袋。本計畫輔導1家醫學中心試辦含氯塑膠醫療廢棄物之減廢工作,由輔導醫院將血液透析迴流管及點滴輸液管滅菌後,交由清理業者送運至處理單位進行再利用。本計畫另撰寫含氯塑膠醫療廢棄物減廢指引,提供各醫院參考。

五、推動醫院含汞廢棄物減害工作

本計畫蒐集整理歐美國家含汞溫度計、血壓計洩漏意外處理作業標準,撰寫本土化醫院含汞廢棄物洩漏處理指引。本計畫輔導5家醫學中心建立含汞血壓計舊(瑕疵)品維修、汞回收及汞洩漏處理能力,並辦理4場次示範觀摩活動。本計畫調查全國納入評鑑醫院478家之含汞設備,估算國內醫療院所之汞持有量約為1,736至1,879公斤之間,並研擬含汞器材源頭減量及含汞廢棄物清理方案,協助環保署辦理跨部會研商會。以全國牙醫診所5,925家以及設置牙科醫院171家為調查對象,調查使用含汞補牙材現況,估計每年補牙材之汞使用量約為214公斤;製作牙醫減少使用含汞補牙材之文宣,並寄發至全國牙醫診所,宣導減少使用含汞補牙材。

六、推動禽流感廢棄物應變準備工作

本計畫辦理2場次H5N1流感(禽流感)廢棄物防疫作業程序說明會,以強化環保單位對於禽流感廢棄物處理的應變工作,並邀請業務相關之衛生單位與農政單位,共同瞭解權責分工以及應變準備工作。

 

The purpose of this study was on behalf of the Environmental Protection Administration (EPA) to propose viable measures in source reduction of medical waste and conduct onsite investigation for the small generators. This study comprises six categories of tasks: (1) To publicize the latest EPA’s regulations of medical wastes management, (2) To educate the small- and medium generators in wastes management, (3) To evaluate the sterilization performance for medical waste, (4) To push forward with reducing chlorinated plastic medical wastes, (5) To push forward with reducing the hazards of mercury wastes in hospitals, (6) To push forward with emergency measures for the waste of avian influenza.

To educate for medical waste management, this study has published three papers in latest trend of medical waste management, mercury-contained medical equipments and supplies management, and critical analysis of medical waste regulations. We also conducted questionnaire surveys about their opinion on medical waste regulations from environmental protection agencies, waste transporters and treatment facilities, and healthcare providers. A total of 1,195 (28.4%) questionnaires were successfully collected and data were analyzed to strengthen the medical waste regulation. 

We also conduct a site investigation at 202 regional hospitals and clinics about their medical waste management in waste classification, labels, contract-out wastes disposal, and records keeping. The waste transportation and treatment contracts were also analyzed to propose a model contract and legal guideline.

With respects to evaluating the sterilization performance for medical waste autoclaves, this study used a challenge test containing the rapid readout biological indicator (RRBI) with Bacillus stearothermophilus as the indicating organism Ten commercial autoclaves were evaluated for sterilization performance under routine operation conditions with a filling ratio of 60~70%. The results show that the challenge test is more conservative, comparing with those evaluated within the plastic bag. Two conferences were held to demonstrate the performance evaluation procedure for the environmental protection officers and medical waste generators.

This study surveyed 22 hospitals and 18 suppliers in light of PVC-contained medical devices and their alternatives in Taiwan. According to the survey results and case studies from European countries and United States, a priority list of PVC-free alternatives was recommended. It includes gloves and bags. In the reduction plan of medical devices containing chloride plastics, suggestions are given in four aspects: hospital expenditure, environmental concerns, current market, and patient health. This study also advised a medical center in reducing the chlorinated plastic medical wastes by collecting the hemodialysis catheters and IV-catheters, performing sterilization, and delivering to the factory for reuse. This experience was used to compile a guideline for hospitals to reduce chlorinated plastic medical wastes. 

Through collecting and analyzing the standard operating procedures of the mercury spill treatment of mercury-contained thermometers and sphygmomanometers from United States and European countries, a guideline of mercury spill treatment for hospitals in Taiwan was compiled. We thus assist five medical centers to build up their ability in repairing defect mercury-contained sphygmomanometers, recycling mercury and dealing with mercury spill along with four onsite demonstrations. By analyzing the mercury-contained devices in hospitals, we estimated the total amount of mercury in healthcare facilities in Taiwan. We developed a program for sources reduction of mercury-contained devices in healthcare facilities and for transportation and treatment of the mercury waste. We also held a meeting for related governmental departments to discuss important issues. Furthermore, this study investigated the basic facts of mercury dental filling materials as used in dental clinics, and made a DM about the waste reduction and sent to all the dental clinics of Taiwan.

Regarding strengthening the governmental emergency response capability in waste treatment for avian influenza wastes, two meetings were held for related governmental departments to make they realize their responsibilities and authorities in preparedness and response.