目的 调查海南省2013年各级医疗机构的医疗废物管理处置情况,为制定医疗废物管理措施提供依据。方法 采用横断面调查,研究内容包括医疗废物的组织管理、分类收集、暂时贮存和处置。检查医疗机构1830家(三级医疗机构5家,二级医疗机构18家,一级医疗机构235家,一级以下医疗机构1572家)。结果 95.03%制定管理制度和应急方案,89.00%开展工作人员培训,89.78%配备工作人员个人防护,85.79%建立交接登记,76.23%交接登记内容完整,75.90%分类收集,84.97%盛放容器符合要求,68.03%暂存地点符合要求,78.09%暂存时间符合要求,59.95%运送工具清洁消毒符合要求,80.60%采取集中处置;二级以上医疗机构的医疗废物管理处置工作基本符合要求,一级医疗机构存在一定问题,一级以下医疗机构存在问题(组织管理、收集运送、贮存、处置)明显,三者之间有统计学差异(P＜0.05)。结论 医疗机构的级别越低,医疗废物处理的合格程度越低,尤其一级以下医疗卫生机构。此类机构数量最多、不合格项目最多,而且与大众接触的密切程度也最高,应引起高度重视;管理制度建设比较完善,但后续的收集、存储、运送和处理逐渐递减,这可能是卫生监督的关键控制点。另外,探讨应用《医疗废物管理评价计分表》对医疗机构进行量化分级监督,增加后续指标权重的分级量化管理,值得后续深入研究。

Objective To investigate medical waste management by medical institutions at different levels in Hainan Province in 2013 in order to offer evidence and recommendations for better medical waste management. Methods This study involved 1830 medical institutions in Hainan Province, including 5 tertiary hospitals, 18 secondary hospitals, 235 primary hospitals and 1572 ones below the primary level. According to the process of management, the organization and management system, medical waste collection, transportation and storage, disposal of medical waste, and quantitative classification were studied. Results The overall qualified rate of management and emergency plans was 95.03%, that of training of relevant personnel was 88.96% and that of personal protection of the related staff was 89.78%. As for collection, transport and temporary storage, the total qualified rate of transfer registration was 85.79% and 76.23% of the contents of transfer registration were complete. The total qualified rate of was 75.90% for classified collection, 84.97% for containers, 68.03% for temporary storage locations, 78.09% for temporary storage time, and 59.95% for cleaning and disinfection of conveyance. The total waste disposal rate was 80.60%. Conclusion The lower the level of medical institutions, the lower the qualified rate of medical waste disposal. Primary-level health care institutions deserve more attention because of their close contact with the public. There are nearly perfect guidelines, but the subsequent collection, storage, transport and disposal are under loose surveillance, suggesting that medical waste management by medical institutions is "anticlimactic". In addition, increasing the target weights of subsequent hierarchical quantification is worthy of further research.