DTM Benh Vien Trung Uong

8/6/2019 DTM Benh Vien Trung Uong

1/75

M U1. Xut x ca d n

Bnh vin 71 Trung ng c thnh lp nm 1951. Tin thn t 3 n v

qun y: Qun y vin 31, Qun y vin 41, An dng ng lin khu III. Theo Ngh nh s 1155 - LB/N ngy 15/11/1955 ca lin b Quc phng - B Y t- B Ti chnh iu chuyn Bnh vin 71 sang B Y T qun l. L mt ns nghip trc thuc B Y t, bnh vin c cc chc nng khm, cp cu, itr, phng bnh, phc hi chc nng cho bnh nhn Lao - Bnh phi, cc bnv ni khoa, ngoi khoa v chuyn khoa khc, nghin cu khoa hc, tham giao to cn b chuyn ngnh Lao - Bnh phi, ch o tuyn v hp tc quc t

Do tnh hnh bnh tt ca nhn dn trong tnh ngy cng phc tp, nhu cukhm cha bnh ca nhn dn ngy cng cao, s lng bnh nhn n khmcha bnh ngy cng ng, trong khi cc c s y t cng u t mi hu nhkhng c, v vy hin tng qu ti ti cc bnh vin thng xuyn xy ra. Nhl cc bnh vin tuyn tnh, bnh vin chuyn khoa v mt s bnh vin a khtuyn huyn.

Trc tnh hnh , ch trng u t xy dng, ci to, nng cp bnvin 71 Trung ng l iu cn thit v ph hp vi nh hng pht trin nghip y t ca tnh ta ni ring v ca ngnh y t ni chung. Ngy 05 thng 10nm 2006 B Y t ra quyt nh s 3929/Q- BYT v vic ph duyt Quhoch tng th pht trin bnh vin 71 Trung ng n nm 2010 v tm nh2020 vi mc tiu xy dng v pht trin bnh vin 71 Trung ng l bnh vi

khu vc Bc min Trung v chuyn ngnh Lao - Bnh phi c c s vt chtrang thit b hin i, i ng cn b khoa hc k thut tng xng vi bvin hng I v ngang tm vi cc nc trong khu vc; l c s thc hnh vtham gia o to ca cc trng i hc, cao ng, trung hc y t trong nc quc t.

Ngy12 thng 10 nm 2006 B Y t ra Quyt nh s 4056/Q-BYT vvic cho php chun b u t D n:u t xy dng, ci to, m rng,nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr.

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2. Cn c php lut v k thut ca vic thc hin nh gi tc ngmi trng

2.1. Cc vn bn php lut

- Lut Bo v Mi trng sa i nm 2005 c Quc hi nc Cha x hi ch ngha Vit Nam kha XI, k hp th 8 thng qua ngy29/11/2005 v c hiu lc thi hnh t ngy 01/7/2006 (iu 18 quy nh cc tng phi lp bo co TM);

- Ngh nh 80/2006/N-CP, ngy 9/8/2006 ca Th tng Chnh ph v"Hng dn thi hnh Lut Bo v Mi trng";

- Thng t 08/2006/TT-BTNMT ngy 8/9/2006 ca B Ti nguyn v Mitrng hng dn v nh gi mi trng chin lc, nh gi tc ng mtrng v cam kt bo v mi trng;

- Ch th 01/ CT-UB ngy 27/2/2001 ca Ch tch UBND tnh Thanh Hov Tng cng cng tc bo v mi trng;

2.2. Vn bn k thut

- Php lnh an ton v kim sot bc x c UB thng v Quc h

thng qua ngy 25/6/1996;- Ngh nh s 50/1998/N-CP ngy 16/7/1998 ca Chnh ph chi tit vic

thi hnh php lnh an ton v kim sot bc x;

- Thng t lin tch s 2237/1999/TTLT-BKHCNMT- BYT ngy28/12/1999 ca B KHCN&MT v B y t hng dn vic thc hin an to bc x trong y t;

- Tiu chun ca B Y t v v sinh mi trng ban hnh km theo Quynh s 3733/Q - BYT ngy 10/10/2002 ca B Y t;

- Cc ti liu nh gi nhanh trn c s h s nhim do T chc y t Thgii thit lp nhm d bo ti lng cc cht nhim;

- Quyt nh s 2575/1999/Q-BYT ngy 17/8/1999 ca B trng b Y tv vic ban hnh Quy ch qun l cht thi y t;

- Quyt nh s 62/2001/Q-BKHCNMT ngy 21/22/2001 ca B trngB khoa hc, Cng ngh v Mi trng v vic ban hnh k thut i vi l cht thi y t;

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- Quyt nh s 60/2002/Q-BKHCNMT ngy 07/8/2002 v vic ban hnhhng dn k thut chn lp cht thi nguy hi;

- Quyt nh s 35/2002/Q-BKHCNMT ngy 25/6/2002 ca B trngB khoa hc, Cng ngh v Mi trng v vic bt buc p dng 31 tiu chuVit Nam v mi trng;

- Quyt nh S 27/2004/Q-BXD ca b trng B Xy dng v vic bahnh TCXDVN 320 : 2004 "Bi chn lp cht thi nguy hi - Tiu chun thit k

- TCVN 5660-2005 l t cht thi rn y t Kh thi l t cht thi rnt - gii hn cho php;

- TCXDVN 365-2007 Tiu chun hng dn thit k bnh vin a khoa;

- Quyt nh s 22/2006/Q-BTNMT ngy 18/12/2006 ca B trng B Tnguyn v mi trng v vic bt buc p dng tiu chun Vit Nam v mi trn

- Quyt nh s 3929/Q- BYT ngy 05 thng 10 nm 2006 ca B Y Tv vic ph duyt Quy hoch tng th pht trin Bnh vin 71 Trung ong nm 2010 v tm nhn 2020;

- Quyt nh s 4056/Q-BYT ngy 12 thng 10 nm 2006 ca B Y T v

vic cho php chun b u t D n: u t xy dng, ci to, m rng, ncp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr;

- Quyt nh s: 294/Q- UBND ngy 25 thng 01 nm 2007 ca U bannhn dn tnh Thanh Ho v vic cp giy chng nhn quyn s dng t cBnh vin 71 Trung ng ti x Qung Tm, huyn Qung Xng;

3. T chc thc hin bo co TM

- Cc thnh vin tham gia lp bo co TM:

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CHNG I

M T TM TT D N

1.1. Tn d n:u t xy dng, ci to, m rng, nng cp Bnh vin 71

Trung ng quy m 500 ging iu tr ni tr.1.2. Ch d n:Bnh vin 71 Trung ng

- i din:ng Don Trng Tin Chc v: Gim c

- a ch: X Qung Tm, huyn Qung Xng, tnh Thanh Ho

- in thoi:037. 675701 Fax: 037.675701

1.3. V tr a l ca d n

Theo chng ch quy hoch s 472/SXD-QH, ngy 22/03/2007 ca Gimc S Xy dng Thanh Ha. V tr d n thuc tha t s 570, x Qung Tmhuyn Qung Xng, Thanh Ha. Din tch khu t khong 75.000m2.

- Khu t c ranh gii nh sau:

+ Pha Bc gip vi ng d kin theo quy hoch.

+ Pha Nam gip vi ng d kin theo quy hoch.

+ Pha ng gip vi ng d kin theo quy hoch.

+ Pha Ty gip vi ng d kin theo quy hoch.

Khu t hin ti thuc bnh vin 71 Trung ng ang qun l v s dn ph hp vi quy hoch chi tit dc hai bn Quc l 47.

1.4. Ni dung ch yu ca d n

- Xy dng v pht trin bnh vin 71 Trung ng l bnh vin khu vBc min Trung v chuyn khoa Lao - Bnh phi c c s vt cht, trang thithin i, tng xng vi bnh vin hng I v ngang tm vi cc nc trong kvc.

1.4.1. Quy m v khi lng d n

a. Quy m d n

Quy m d n c chia thnh cc giai on c th sau:

- T nm 2006 n 2010:

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+ Thnh lp cc phng chc nng, cc khoa lm sng v cn lm sng.

+ u t xy dng cc hng mc, nng cp, m rng bnh vin quy m 50ging iu tr ni tr.

- T nm 2010 n nm 2020:

+ u t xy dng hon thin c s h tng, h thng t chc bnh vitheo tiu chun bnh vin hng I, quy m 700 ging.

+ Xy dng hon hin m hnh chm sc sc khe cng ng, m hnhchm sc ton din.

- Cc cng trnh chnh bao gm: Nh khm, khu nh m, khoa hi sc cpcu, nh hnh chnh, khoa dc, khoa dinh dng, nh bnh nhn ni tr, khoachng nhim khun.

- Cc cng trnh ph tr: Trm in, trm x l nc cp, trm x l ncthi, khu x l rc, nh tang l, nh xe - ga ra, nh thng trc.

- C cu t chc: C cu t chc ca bnh vin c quy nh ti Quytnh s 2712/Q-BYT, ngy 23/7/2007 ca B trng B y t v vic ban hniu l t chc v hot ng ca Bnh vin 71 TW, c th nh sau:

Bng 1: C cu t chc ca bnh vin 71 TW TT C cu phng ban S lng1 Cc phng chc nng

- Phng k hoch tng hp- Phng t chc cn b- Phng ti chnh k ton- Phng ch o tuyn- Phng hnh chnh qun tr- Phng y t-iu dng- Phng vt t, thit b y t- Phng nghin cu khoa hc v o to

08

2 Cc khoa lm sng- Khoa khm bnh lao, bnh phi- Khoa khm bnh a khoa- Khoa hi sc cp cu- Khoa thn nhn to- Khoa ngoi tng hp- Khoa iu tr bo him y t- Khoa lao bnh phi lc lng v trang- Khoa ngi cao tui

20

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- Khoa lao phi- Khoa lao ngoi phi- Khoa h hp- Khoa nhi- Khoa phc hi chc nng

- Khoa xng khp- Khoa tim mch- Khoa tit niu- Khoa TMH, RHM- Khoa lao/HIV- Khoa Ung bu

3 Cc khoa cn lm sng- Khoa vi sinh- Khoa sinh ha min dch

- Khoa huyt hc- Khoa chun on hnh nh- Khoa dc- Khoa dinh dng- Khoa chng nhim khun- Khoa gii phu t bo

08

b. Khi lng d n

D n c xy dng trn c s nng cp bnh vin 71 TW hin c. C

cng trnh trong d n, mt s c xy mi, mt s c ci to v nng ctheo t giai on khc nhau.

Bng 2: Thng k cc cng trnh theo quy hoch pht trin tng th Bnhvin 71 Trung ng n nm 2010 v tm nhn 2020

TT Tn cng trnh S tngDin tch

snDin tchxy dng

Ghi ch

1 Khu phng ban 2 490 m2 245 m2 Cc cngtrnh c

ginguyn

2 Hi trng 1 338 m2 338 m2

3 Hnh chnh khoa dc 1 85 m2 85 m24 Nh sn xut huyt thanh 1 71,8 m2 71,8 m25 Kho Dc 1 649 m2 324,5 m26 Hnh chnh v lu tr h s 2 548 m2 274 m27 Gara t 1 110 m2 110 m28 Khoa dinh dng 1 671 m2 671 m29 Nh k thut nghip v 2 502 m2 251 m210 Cu lc b bnh nhn 2 93 m2 93 m211 Khoa Bo him y t 1 276 m2 276 m212 Nh thuc 1 62 m2 62 m213 Nh xe 1 202 m2 202 m214 Trm in, trm bin p 1 65 m2 65 m2

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15 Nh cu 1574 m2 1574 m212 Nh tang l 1 67 m2 67 m217 Cc cng trnh h tng 150 m2 150 m218 Nh Khm 5 6000 m2 1200 m2 Cng

trnh xy

dng giaion 1

19 Khu nh m 4 6400 m2 1600 m2

20 Nh bnh nhn ni tr 5 7750 m2 1750 m2 Cngtrnh cito giaion 1

21 Nh hnh chnh 1 825 m2 825 m2

22 Nh Bo v 1 49,5 m2 49,5 m2

23 Nh bnh nhn ni tr 1 255 m2 255 m2

Cngtrnh c

ginguyn

24 Nh bnh nhn ni tr 1 260 m2 260 m225 Nh bnh nhn ni tr 1 277 m2 277 m226 Nh bnh nhn ni tr 1 277 m2 277 m227 Nh bnh nhn ni tr 1 277 m2 277 m228 Nh bnh nhn ni tr 1 295 m2 295 m229 Nh bnh nhn ni tr 1 332 m2 332 m230 Nh bnh nhn ni tr 1 277 m2 277 m231 Nh bnh nhn ni tr 1 280 m2 280 m232 Nh bnh nhn ni tr 1 280 m2 280 m233 Nh bnh nhn BHYT 1 345 m2 345 m234 Nh bnh nhn BHYT 1 350 m2 350 m2

35 Nh bnh nhn BHYT 1 305 m2

305 m2

36 Nh hnh chnh khoa LLVT 1 136 m2 136 m2

1.4.2. Nhu cu ca d n

a. Nhu cu cp nc

Theo tiu chun thit k 4513-1998 v cp nc bn trong. i vi bnvin a khoa v chuyn khoa c h thng cp nc hon chnh, lng nc ls dng 300-400 l/ging bnh-ngy, nc nng l trn 60 l/ging bnh/ngTuy nhin, theo thc t hot ng hin nay v xu hng pht trin trong tnlai, lng nc s dng cn ln hn nhiu. Ngoi vic s dng nc cho ncu iu tr, cc nhu cu v sinh, git gi, cho cn b cng nhn vin bnvin... cc nguyn nhn lm cho nc tiu th tng ln l: Bnh nhn v ngnh bnh nhn qu ng, ngi nh n chm sc bnh nhn, hc sinh, sinhvin thc tp. Nhn chung i vi bnh vin a khoa tuyn tnh, nhu cu cnc nm mc 600 - 800 l/ging bnh-ngy. i vi cc bnh chuyn kho

bnh vin TW lng nc c tnh s dng tng i cao c th ln n 10

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l/ging bnh-ngy[1]. Nh vy, trong mi giai on pht trin ca bnh vinhu cu cp nc dao ng tng i ln.

Bng 3: Nhu cu cp nc sinh hot ca bnh vin 71 TW

TT Giai on Nhu cu cp nc thc t (m3/ngy-m)Min Trung bnh Max

1 Giai on 2006-2010 300 400 5002 Giai on 2010-2020 420 560 700

Ngun nc ny hin nay v d kin trong tng lai c cung cp tCng ty TNHH mt thnh vin cp nc Thanh Ha thng qua trm cp nsch ti Qung Chu.

b. Nhu cu s dng inLng in nng tiu th ph thuc nhiu vo ma trong nm. Theo thn

k ca s in lc Thanh Ha v thc t s dng in ti bnh vin 71 TWmt s bnh vin a khoa, bnh vin chuyn khoa trn a bn tnh cho thy, vquy m 500 ging bnh th nhu cu s dng in dao ng t 50.000kWh/thng vo cc thng ma ng v n 75.000 kWh/thng vo cc thng

ma h. Lng in nng c cung cp t mng li in TPTH - Sm Sthng qua trm bin th 250 KVA ca x.

c. Nhu cu v lao ng

Cn b cng nhn vin ca bnh vin hin c 270 ngi. Trong i ngy bc s c tay ngh cao ch chim 21,85%, dc s mi chim t l khim t1,1%. Vi lc lng y bc s mng nh hin nay th cha p ng nhcu pht trin ca bnh vin. Ngay t by gi, ban gim c bnh vin c ctrng tuyn dng cn b mi, cn b tr, c bit l cc y bc s, dc s o to chnh quy nhm p ng kp thi nhu cu pht trin trong tng lai.

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Bng 4: S lng cn b cng nhn vin hin c ca bnh vin

TT i tng lao ng S lng (ngi)1 Bc s 592 Dc s i hc 033 Dc s trung hc 054 C nhn kinh t+k s 135 Y t iu dng 956 Cn b khc (H l, li xe, cp dng) 907 Trung hc kt ton 12

Tng cng 270

d. Nhu cu vt t, ha cht tiu haoKhi d n i vo hot ng, hng nm nhu cu ha cht, vt t tiu

hao phc v cho qu trnh khm cha bnh l tng i ln vi nhichng loi mt hnh khc nhau. Trong vt liu, ho cht tiu hao chyu c chia theo cc nhm c bn sau:

+ Bng, bng, gc y t

+ Bm tim v bm ht cc loi+ Huyt p k, ng nghe+ Ch khu, vt liu cm mu

+ Dao, panh, km, ko v cc dng c phu thut

+ Dy truyn dch, dy dn lu, cc loi sond, cc loi dy ni

+ n, bng n v cc ph kin ca n

+ Gng tay phu thut, khm, xt nghim tit trng, cha tit trng, gnty chng tia

+ Ho cht xt nghim t bo, sinh ho, test nhanh th HIV, vim gan,heroin, mi trng nui cy lao, th lao, nhm mu v cc loi ho cht xtnghim khc

+ Giy in cc loi my v gen tip xc

+ Phim X-quang v cc vt t, ho cht s dng cho my X-quang+ Vt t ngnh xng

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+ Cc loi vt t y t khc

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Ngun vt t, ho cht tiu hao k trn d kin c thu mua t cc nh sxut v cung ng trn a bn tnh Thanh Ha. Vi nhu cu ngy mt tng, y sl mt tc nhn thc y cc ngnh sn xut, cc nh cung cp dch v trong lnvc thit b, vt t y t trong tnh pht trin. To sn chi lnh mnh cho cc h

kinh doanh trong lnh vc trn, trnh tnh trng c quyn nh hin nay.e. Nhu cu nhin liu, ha cht khc

- Xng, du: Ch yu phc v cho qu trnh vn chuyn hng ha, bnnhn, vn hnh my pht in, vn hnh l t cht thi.

- Ha cht phc v qu trnh x l mi trng nh: PACN-95, DW97,BIOWC96, Ch phm vi sinh Enchoi, EM, dung dch Clo, Soda...

Nhu cu v nhin liu, ha cht ny nhn chung khng ln, ph thuc nhivo quy m hot ng, tnh trng my mc hin c, kh nng v trnh cngi cng nhn vn hnh.

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CHNG II

IU KIN T NHIN - MI TRNG V KINH T-X HI

2.1. iu kin t nhin v mi trng x Qung Tm

2.1.1. iu kin v a lX Qung Tm c din tch t nhin l 367,68 ha; nm pha ng Bc

huyn Qung Xng, dc theo ng quc l 47A c chiu di 2,5 km.

C ranh gii hnh chnh nh sau:

- Pha Nam gip x Qung Ct.

- Pha Bc v Ty gip x Qung Ph.

- Pha ng gip x Qung Th.

X Qung Tm l trung tm giao lu hng ha v lu thng gia th xSm Sn v Thnh ph Thanh Ho, c th trn Ch Mi v nhiu c quan ntrn a bn nh Bnh vin 71 Trung ng, trng S phm 12+2 Thanh HoTrng Thng mi du lch....

2.1.2. iu kin kh tng thy vn

Theo ti liu ca i kh tng thu vn Thanh Ho giai on (1996 -2006), Bnh vin 71 Trung ng ng trn a bn x Qung Tm nm tivng kh hu ng bng ven bin, c th nh sau:

a. Nhit

Nhit l yu t quan trng nh hng n qu trnh chuyn ho v phtn cht nhim.

Nhit trung bnh thng: 23,60

C Nhit ti cao tuyt i: 40,70C

Nhit ti thp tuyt i: 5,60C

Bin ngy m: 6-70C

Tng nhit nm: 8.500 - 8.6000C. Trong nm 4 thng c nhit trung bnh 200C t thng 12 n thng 3 nm sau, 5 thng c nhit trung bnh

250C t thng 5 n thng 11.

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b. Ma

Ma l mt trong nhng yu t quan trng nh hng n s pht tn v bin i ca cc cht thi t khu vc bnh vin ra mi trng.

Ma trung bnh nm t 1.746mm.Ma ko di: 6 thng k t thng 5 n thng 10.

Lng ma 100mm/thng: 6 thng (t thng 5 n thng 10).

Lng ma 200mm/thng: 3 thng (thng 7, 8, 9).

Lng ma 300mm/thng: 2 thng (thng 8, thng 9).

Khong 90% lng ma hng nm tp trung vo cc thng 6, 7, 8 v 9. Ccthng 12, 1, 2, 3 l cc thng c lng ma thp nht.

Lng ma ngy ln nht l 239,7mm.

Lng ma thng ln nht l 586mm, trung bnh 306,4mm, b nht23,1mm.

c. m khng kh

m khng kh l mt trong nhng yu t quan trng nh hng n qutrnh lan truyn v chuyn ho cc cht nhim.

m trung bnh nm: 85- 86%

m khng kh bin i theo ma nhng s chnh lch m gia cma khng ln.

Ma kh: Vo ma kh m tng i gim nhng khng ng k.

Ma ma m tng i trung bnh khng cao lm.

m tng i nh nht t: 34,3% trong thng c m nh nh29,8 %.

d. Ch gi

Gi l yu t nh hng rt mnh n s pht tn cht nhim ra mtrng khng kh v thng thong kh trong khu vc lm vic.

Tc gi trung bnh nm: 1,5 - 1,8 m/s.

Tc gi mnh nht trong bo: 30-40m/s.

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Tc gi mnh nht trong gi ma ng Bc khng qu 25m/s.

X Qung Tm c hai ch gi thnh hnh hng nm, vo ma h hnggi thnh hnh l hng ng Nam v ng; vo ma ng hng gi thnhhnh l hng Bc v ng Bc.

e. Bo v p thp nhit i

Bnh qun hng nm c 0,63 cn bo/nm b vo Thanh Ho, p thpnhit i c khong 2,49 cn/nm.

f. Nng v bc x

Bc x mt tri l mt trong nhng yu t quan trng nh hng trc tin ch nhit trong vng v bn vng kh quyn, y cng l yu t khu quan trng nh hng n qu trnh pht tn, bin i cc cht gy nhitrong khng kh.

Thanh Ho nm su trong ni ch tuyn nn thi gian chiu nng thay t 11gi - 13 gi. y l iu kin quan trng to ra s ng u gia cc thnv nng lng bc x mt tri n mt t.

- Tng thi gian chiu sng trung bnh nm t: 1.686 gi.

- S gi nng cc i: 1.839 gi.- S gi nng cc tiu: 1346 gi.

- S ngy khng nng: 81,9 ngy.

Cc yu t thi tit, kh hu nh nhit , m, ch gi, ma, c bc x ca mt tri... to nn loi bn vng kh quyn, nh hng t pht tn ca cc cht nhim trong khng gian.

Bng 5: Din bin thi tit hng nm ti trm TP. Thanh Ha [2]Nm 2001 2002 2003 2004 2005 2006

m tng i trung bnh (%) 88,0 87,0 85,0 86,0 84,0 84,0Lng ma hng nm (mm) 1.845,6 1.367,2 1.334,3 1.309,7 1.592,4 1.762,6S gi nng (gi) 1.421,9 1.414,0 1.807,0 1.559,0 1.417,0 1.603,0 Nhit trung bnh (0C) 23,6 23,9 24,4 23,6 23,7 24,2

2.1.3. Hin trng cc thnh phn mi trng t nhin

Bnh vin 71 Trung ng phi hp vi Trung tm Quan trc v Bo vmi trng Thanh Ha (n v t vn lp bo co nh gi tc ng mi trng

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v Chi cc Tiu chun o lng Cht lng Thanh Ha tin hnh quan trc chlng mi trng nn khu vc trin khai d n lm c s xc nh mc nh hng ca d n ti mi trng xung quanh. Cng tc ly mu c chthnh 02 t.

+ t 1:Tin hnh quan trc mi trng nc thi. Thi gian quan trc vo10h15 ngy 20/8/2007. Ti thi im quan trc hot ng khm cha bnh, chot ng khc trong bnh vin din ra bnh thng. H thng x l nc thvn hot ng bnh thng.

+ t 2:Tin hnh quan trc mi trng khng kh, mi trng nc mt,nc ngm, mi trng t. Thi gian quan trc t 8h-11h45 ngy 25/8/2007Trong thi gian quan trc xut hin trn ma ko di trong khong 20 pht, t8h35 - 8h55.

2.1.3.1. Cht lng mi trng nc

a. Cht lng nc mt

Bng 6: Cht lng nc mt (ly mu ngy 25/08/2007)

TT

Tn ch tiun vtnh

Kt quTCVN

5942- 1995

M1 M2 M3 M4 M5 A B1 pH 7,1 7,4 7,1 7,1 7,2 6 - 8,5 5,5-92 Nit tng mg/l 1,4 7,0 2,8 4,2 5,6 - -3 COD mg O2/l 17,7 13,7 8,0 28,9 171,2


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TCVN 5942- 1995: Tiu chun ny quy nh gi tr gii hn cc thng sv nng cho php ca cc nhim trong nc mt.

+ Ct A p dng i vi nc mt c th dng lm ngun cp nc sinhot (nhng phi qua x l theo quy nh);

+ Ct B p dng i vi nc mt dng cho cc mc ch khc.

Nhn xt:

Qua kt qu phn tch cht lng nc mt cho thy.

+ Ch tiu pH ti tt c cc im o u t TCCP.

+ COD ti im o M3 t TCCP. Cc im o cn li u c ch s v

TCCP t 1,37 - 17,12 ln so vi ct A. Ti im M5 ch s COD vt 4,89 lso vi ct B.

+ BOD5 ti tt c cc im o u vt t 1,3 - 27,825 ln so vi ct ATi im o M5 ch s BOD5 vt TCCP 4,452 ln so vi ct B.

+ Cht rn l lng ti tt c cc im o u vt t 3,5 - 41,45 ln so vct A v vt t 1,125 - 10,36 ln so vi ct B.

+ E.coli ti hai im o M4, M5 c ch s vt TCCP t 1,28 - 1,5 ln sovi ct A.

+ Coliform ti cc im M1. M4, M5 c ch s vt TCCP t 1,06 2,6 lnso vi ct A. Ti im o M5 ch s Coliform vt TCCP 1,3 ln so vi ct B.

b. Cht lng nc thi

Bng 7: Cht lng nc thi sau khi qua h thng x l nc thi tp trung (ly mu ngy 20/08/2007)

TT Tn ch tiu n v tnh Kt qu TCVN 5945-2005 (Ct B)1 pH 7,1 5,5 92 PO43- mg/l 0 0,53 COD mg O2/l 30,4 804 BOD5 mg O2/l 19,79 505 Cht rn l lng mg/l 90,0 806 Nit tng mg/l 20,3 307 Coliform MPN/100 ml 8 3.000

Tiu chun so snh:

TTQT&BVMT 16


17/75

TCVN 5945-2005: Tiu chun ny quy nh gi tr gii hn cc thng s vnng cc cht nhim trong nc thi ca c s sn xut, ch bin, kdoanh dch v,... (gi tt l nc thi cng nghip).

Nhn xt :

Cc ch s phn tch u t TCCP, ring cht rn l lng c ch s vTCCP mc nh.

c. Cht lng nc ngm

Bng 8: Cht lng nc ngm (ly mu ngy 25/08/2007)

TT Tn ch tiu n v tnhKt qu TCVN

5944 - 1995N1 N2 N31 pH 7,1 6,9 6,8 6,5 - 8,5

2 NO3- mg/l 0,12 2,50 17,2 45

3 COD mg O2/l 2,4 1,2 3,4 -

4 BOD5 mg O2/l 1,6 0,8 2,2 -

5SS mg/l 26,0 57,0 55,0 750 - 1500

6 Coliform MPN/100ml 48 75 93 3

Ghi ch :

+ N1: Mu nc ging khoan nh ng o nh Xng, thn Ph Qu, xQung Tm.

+ N2: Mu nc ging khoan nh ng Nguyn Vn Thanh khu pha Ty Nam Bnh vin.

+ N3: Mu nc ging khoan nh ng Nguyn Vn Dng, i 6 thn PhQu, Qung Tm.

Tiu chun so snh:

TCVN 5944-1995: Tiu chun ny quy nh gii hn cc thng s v nng cho php ca cc cht nhim trong nc ngm.

Nhn xt :

TTQT&BVMT 17


18/75

Cc mu nc ging khoan nhn chung u c cc ch tiu nm trong gihn TCCP. Ring Coliform ti tt c cc im o u c ch s vt TCCP t n 31 ln.

2.1.3.2. Cht lng mi trng khng kh Bng 9: Cht lng mi trng khng kh (o ngy 25/08/2007)

TT

Cc ch tiu

Kt qu phn tch TCVN5937-20055938-20055949-1998

M1 M2 M3 M4 M5

1 N 0C 27,1 26,9 27,3 27,7 27,5 -2 m, % 97,9 97,9 97,8 96,9 95,3 -3 Vn tc gi, m/s 0,2 0,24 1,5 0,34 1,6 0,34 1,5 0,24 1,3 -

4Bi l lng,g/m 3

130,0 110,0 135,0 160,0 210,0 300

5 Ting n, dBA 454 55 404 50 404 45 504 65 554 70 75 (50*)6 NH3, g/m 3 75,9 379,5 506,0 126,5 189,7 2007 H2S, g/m 3 15,2 35,6 17,5 30,2 37,5 428 Cl2, g/m 3 950,8 633,9 792,4 316,9 570,5 1009 SO2 g/m 3 145,0 171,4 72,5 285,7 590,0 35010 CO, g/m 3 312,5 375,0 625,0 345,0 1250,0 30.00011 NO2, g/m 3 105,0 143,5 52,5 102,6 210,0 200

Ghi ch:

+ M1: Khu vc sn, pha trc dy vn phng Bnh vin.

+ M2: Khu vc x l cht thi ca Bnh vin.

+ M3: Khu dn c pha Ty Nam Bnh vin.

+ M4: Khu dn c pha ng Nam Bnh vin.

+ M5: Khu dn c pha ng Bc Bnh vin. Tiu chun so snh:

TCVN 5937-2005: Cht lng khng kh - Tiu chun cht lngkhng kh xung quanh.

TCVN 5938-2005: Cht lng khng kh - Nng ti a chophp ca mt s cht c hi trong khng kh xung quanh.

TCVN 5949-1998: m hc - Ting n khu vc cng cng vdn c - Mc ti a cho php.

TTQT&BVMT 18


19/75

- 50 *: Quy nh mc m tng ng ti a i vi cckhu vc cn s yn tnh (Bnh vin, th vin, trng hc...)

Nhn xt:+ Nhit ti thi im o dao ng trong khong 26,9

- 27,7 oC. m cao t 95,3 - 97,9%. Vn tc gi t t 0,2 - 1,6m/s.

+ Nng bi l lng ti tt c cc im o u t TCCP.

+ Ting n ti cc khu vc dn c (M3. M4, M5) c ch su t TCCP. i vi khu vc cn s yn tnh (trong bnh

vin) th ti im o M1 mc n tng ng cao nht vt TCCP mc nh.

+ Cc ch tiu hi kh c H 2S, CO ti tt c cc im ou t TCCP.

+ Ti im o M5 ch s NO 2, SO2 u vt TCCP (NO2 vt1,05 ln; SO 2 vt 1,68 ln). Cc im o cn li u c gi trt TCCP.

+ Hi kh Clo ti tt c cc im o u vt TCCP t3,169 - 9,5 ln.

+ Hi kh NH 3 ti mu M2 vt qu TCCP 1,89 ln; ti mu M3vt qu TCCP 2,53 ln. Cc im o cn li u t TCCP.

2.1.3.3. Cht lng mi trng t Bng 10:C ht lng mi trng t (ly mu ngy 25/08/2007)

TT Tn ch tiu n v tnh V tr ly muM1 M2 M31 pHKCl 6,12 7,92 7,122 Ni t tng % 0,09 0,14 0,063 P2O5 % 0,16 0,11 0,084 K 2O % 0,08 0,06 0,045 Hu c % 1,53 2,28 0,79

Ghi ch :

+ M1: t canh tc nh b Nguyn Th Loan-Thn Thanh Kin x Q.Tm+ M2: t rung la khu vc pha Ty Nam bnh vin.

TTQT&BVMT 19


20/75


21/75

Cng trnh v sinh trong cc h gia nh ang c cc cp, cc ngnhquan tm vn ng xy dng, mi h gia nh u c 3 cng trnh v sinm bo tiu chun hp v sinh.

i vi cc c s sn xut kinh doanh, dch v trn a bn x, bt bucam kt v tun th ni quy bo v mi trng chung trong x.

2.2. iu kin kinh t - x hi

2.2.1. iu kin kinh t

X Qung Tm nm pha bc huyn Qung Xng, dc theo ng qul 47A c chiu di 2,5km. Cch khu du lch bin Sm Sn khong 8km v phng, th trn Ph Mi hin l trung giao lu hng ha v lu thng gia Thnh

Ph Thanh Ha v th x Sm Sn. X hin c 8 thn v 1 khu dn c mi thnhlp vi tng s h dn l 1.440 h. Tng s nhn khu l 7.400 khu, trong lao ng chnh l 2.650 ngi chim 35,8% [3]. y l nhng im thun lcho vic lu thng hng ho v pht trin kinh t x hi ca x.

Bng 9: Mt s ch tiu t c trong nm 2006[3]

TT Ni dung ch tiun vtnh

Kt qut c

1 Tng thu nhp x hi T 412 Tc tng trng % 10,73 Tng sn lng lng thc Tn 2133,54 Thu nhp bnh qun u ngi Triu 5,555 T trng thu nhp t nng nghip % 406 T trng thu nhp t dch v, th cng nghip % 60

C cu cy trng7 Tng din tch gieo cy 3 v Ha 512,68 Sn xut v ng Ha 1409 Cy ng ng Ha 8010 Cy rau mu Ha 6011 Cnh ng 50 triu 70 triu Ha 10

C cu chn nui12 n tru b Con 33913 n ln Con 4.33814 n gia cm Con 30.00015 C nc ngt Tn 39

Tng thu ngn sch ng 3.681.177.119Chi ngn sch ng 3.867.940.400

16 Chi cu cng giao thng thu li Triu 140

TTQT&BVMT 21


22/75

17 Chi b tng ho ng giao thng nng thn Triu 75018 Chi xy dng c bn 3 khi trng T 2,519 H tr xy dng nh Vn ha thn Triu 50

a. Nng nghip

- Su thng u nm 2007 tuy thi tit c nhiu kh khn song sn xutnng nghip tip tc c quan tm, cc loi ging c nng sut cao v n nc a vo sn xut nhiu n v.

Nng sut bnh qun c t 45 t/ha, gim 15 t/ha so vi cng k. Tron: nng sut ng t 60 t/ha, nng sut lc t 24 t/ha.

Tng sn lng t 823 tn, gim hn 200 tn so vi cng k v t 34,4k hoch nm.

Tng n tru b n 30/6/2007 l 346 con, gim 14 con so vi cng k.n ln 4.600 con tng 180 con trong c 350 ln hng nc. n gia cmthu cm c 16.489 con tng 1.489 con so vi cng k.

Sn xut nng nghip tip tc c s chuyn dch theo hng nng cao hiqu sn xut, tng sn lng hng ho trong nng nghip, a vo sn xut cloi cy con c gi tr kinh t cao nh da, t, th. .. Khuyn khch mnh d

chuyn i phn din tch trng la nng sut thp sang nui trng thu sn.b. Kinh t dch v v kinh t hp tc x

Cc nghnh ngh kinh doanh dch v tip tc c duy tr v pht trinMt s h dn hin c mc thu nhp kh v n nh, tp trung vo cc h gnh kinh doanh nh tr cc thn Quang Trung, Ph Qu, Ph Mi.

Nhng nm ngn y Ch Mi c nng cp, sa cha to iu ki

thun li cho cc h vic kinh doanh lm n bun bn. M hnh hp tc x vqu tn dng nhn dn hot ng n nh, an ton, gp phn khng nh vo snghip pht trin kinh t chung ca ton x.

Tng thu ti chnh 6 thng t: 1.265.503.000 .

Trong thu ngn sch t: 865.085.900 .

Tng chi 6 thng : 1.000.230.000 .

Trong chi ngn sch : 762.111.000 .2.2.2. iu kin x hi

TTQT&BVMT 22


23/75

a. Vn ho x hi - Y t, gio dc

Thc hin tt cng tc thng tin tuyn truyn nhn cc ngy l ln ca nc v phc v cng tc bu c i biu quc hi kho XII, tuyn truyn thhin cc nhim v chnh tr ti a phng.

Duy tr thng xuyn cng tc kim tra v x l v sinh mi trng chung cc n v, tnh hnh v sinh mi trng 6 thng qua c bn c t chc thhin tt, ngn chn vic ly lan dch bnh.

Cc nh trng t chc dy v hc theo k hoch, cht lng vn ho quan tm. T l hc sinh ln lp t trn 90%, thi tuyn vo cp 3 chnh quy 43%.

T l pht trin dn s 6 thng u nm l 0,3 %. T l sinh con th 3 mc 10%. Cc hot ng phc v chng trnh sinh sn KHHG, chm sc skho sinh sn cho ch em, cu lc b v thnh nin v thanh nin c hiu quSu thng u nm b sung 109 th KCB cho tr em di 6 tui theo quy nh.

b. Cng tc An ninh - Quc phng

Tnh hnh an ninh chnh tr c bn n nh v c gi vng, khng c nth khiu kin vt cp xy ra. Cng tc gio dc chnh tr cho lc lng dqun, i tng l cn b, hun luyn qun s theo k hoch t cht lng Tham gia bn n tht, trin khai thc hin Quyt nh 290 cho hn 50 tng dn qun thi chng M cu nc theo k hoch bo m nguyn tc.

Ch ng xy dng k hoch chun b lc lng v vt t phc v cng phng chng bo lt, gim nh thin tai trong ma ma bo, tham gia o pt d tr hon thnh k hoch trn giao.

TTQT&BVMT 23


24/75

CHNG IIINH GI CC TC NG MI TRNG

3.1. Ngun gy tc ng

Do d n m rng v nng cp vi 2 giai on, nn vic xc nh ccngun thi cho tng giai on v cc yu t gy nhim l cn c cn thit cvic la chn cc gii php gim thiu v hn ch ti a nhim mi trnghot ng ca d n gy ra.

3.1.1. Giai onxy dng c bn

Trong giai on xy dng c bn, ngun thi v cc yu t gy nhim ch

yu pht sinh t cc ngun sau: Bng 12: Ngun thi v cc yu t gy nhim trong giai on XD c bn

TT Ngun gc nhim Cht ch th nhim

1Giai on chun b mt bng, no vt b mt

- Bi, CO, SO2, NO2- Ting n, rung.

2Vn chuyn t ct, nguynvt liu.

- Bi cun t ng, t ct ri vi- Kh thi ca xe t vn chuyn: CO, SO2,

NO2, THC, hi xng du

3

o xc ti mt bng: oh, o cng rnh, mngcng trnh

- Bi t- Ting n, rung- Nc thi sinh hot t ln tri ca cng nhnxy dng- Rc thi sinh hot ca cng nhn xy dng

4

Xy dng cng trnh, nhca vn phng v cc cngtrnh h tng khc nh cngthot nc, ng giaothng ni b.

- Bi, CO, SO2, NO2- Ting n, rung- Nc thi sinh hot t ln tri cng nhnxy dng- Rc thi sinh hot ca cng nhn xy dng

5Mt s hot ng khc nhxe chy, my mc xydng

- Ting n, bi, CO, SO2, NO2, THC, hixng du

TTQT&BVMT 24


25/75

a. Ngun pht sinh bi, ting n.

Ting n, rung v mt lng ln bi, t ri vi s phtsinh t qu trnh vn chuyn t ct san lp mt bng,vn chuyn nguyn vt liu, vn hnh my mc thi cng trncng trng (my i, my san nn...), trong cng on no vt,o h, o cng rnh, mng cng trnh... Ngun nhimny nh hng trc tip ti ngi cng nhn, nhng vi tn sutkhng cao, thi gian thi cng ngn nn loi nhim ny thngkhng gy tc ng ln. iu ng quan tm trong giai onny hn c l nh hng ca ting n, bi ti ngi bnh angiu tr ni tr. Nhng tc ng tng nh n gin ny c thko di thm thi gian iu tr ca ngi bnh, nh hng ti vtcht, tinh thn ca ngi bnh v gia nh ngi bnh.

b. Ngun pht sinh kh thi.

Kh thi pht sinh t hot ng ca cc phng tin vnchuyn nguyn vt liu xy dng, my mc thi cng trn cngtrng... ch yu l CO, SO 2, NOx, THC, hi xng du. Ngun

nhim ny khng tp trung, thng b phn tn v vi nng khng ln, hn na qu trnh thi cng thc hin trn mi trngrng, thong, thi gian thi cng ngn nn loi nhim ny th-ng c coi l ngun nhim th cp.

Bng 13: H s ti lng bi v kh thi trong giai on xy dng d n [4]

Hot ngnv(U)

TSP(kg/U)

SO2(kg/U)

NOx(kg/U)

CO(kg/U)

VOC(kg/U)

1. Xe ti, my i, mythi cng (1400 -2000cc)

Tn NL

0,86 0,03 22,02 194,7 27,65

2. Nu bp tp th, tcht thi tng hp

(khng c h thng xl)

Tn

NL50 0,0 2 62 21

TTQT&BVMT 25


26/75

c. Ngun pht sinh nc thi

Ngun nc thi ch yu pht sinh t cc qu trnh sau:

- Qu trnh sinh hot ca cng nhn trc tip thi cng.

- Pht sinh t nc ma chy trn.- T cc khu tn gi nhin liu, vt liu xy dng

Loi nhim ny thng nh, t quan trng. Bn cnh vi cch qun l ph hp ca ch u t, tin cng trnh c y nhanh, vic xy dng tuth theo ng quy trnh v tiu chun xy dng hin hnh nn c th lm hch ti a ngun nc thi pht sinh ny.

d. Ngun pht sinh cht thi rn

Cht thi rn pht sinh ch yu l cht thi rn sinh hot ca cng nhtrc tip thi cng trn cng trng nh: Bao b, ph liu inh st, dy thp, lca, v hp, thc n tha, ti nilon, nha... v cht thi rn trong xy dn(gch, ngi v, vt liu tha, t ...). Nu khng c cc bin php thu gom phn loi v b tr tp trung hp l chng s gy ra nhng nh hng xu tmi trng xung quanh, gy tm l bt n i vi cng nhn trc tip xy dn

bnh nhn, ngi nh bnh nhn v cc y bc s.3.1.2. Giai on d n i vo hot ng

Khi d n i vo hot ng s lm pht sinh cc cht gy nhim mitrng, ch yu bao gm: Cht thi kh, nc thi, cht thi rn, cht thi phx v cc cht thi nguy hi khc. Ngun gc pht sinh c trnh by khi qutrong bng sau:

Bng 14: Ngun thi v cc yu t gy nhim khi d n i vo hot ng

STT Yu t nhim Ngun gc pht sinh1 nhim khng kh: mi,

cc cht hu c bay hi,SO2, NOx, CO, vi kh hu,ting n, vi khun trongkhng kh, Dioxin...

+ Do s phn hy sinh hc cc cht huc.+ Qu trnh khm v iu tr bnh nhn cdng mt s ha cht hu c bay hi(alcol, Ete...)

+ Qu trnh t nhin liu do bp nu v t i li trong v ngoi bnh vin.

TTQT&BVMT 26


27/75

+ Do bi dn truyn cc vi khun khu trti cc bung bnh.+ Qu trnh vn hnh l t cht thi y t

2

nhim nc: Cht rn l

lng, BOD, COD, vi sinhvt, ha cht, cht khngsinh, tng Nit, Photpho...

Nc thi sinh hot ca cn b cng nhn

vin, bnh nhn v ngi nh bnh nhn;nc thi sinh ra trong qu trnh khm vcha bnh; nc t khu phu thut v xtnghim; nc ma chy trn.

3

nhim t: nh hng ncc vi sinh vt c li trongt, thoi ha t, thay i

thnh phn c l, ha cat, thay i mc ch sdng t

Do nc thi ca bnh vin thi ra mitrng khng c x l. Rc thi khngc thu gom x l trit

4

nhim do cht thi rn: bnh phm, bng, gc, bmkim tim, ng thuc v rcthi sinh hot

+ T khm, cha v iu tr bnh.+ Gii phu, xt nghim, pha ch thuc tikhoa dc...+ T qu trnh sinh hot ca cn b cng

nhn vin, bnh nhn v ngi nh thmnui bnh nhn, khch vng lai.

5 nhim phng x: Bc xGamma

Pht sinh trong qu trnh vn hnh thit bchiu, chp X-quang.

a. Ngun pht sinh kh thi

Cc cht hu c bay hi nh: Aceton, este, Formandehit, phenol, Benzen,Clo, Iot, HCl... pht sinh t qu trnh khm cha bnh, lu gi bnh phm, x

nghim, kh trng, lu gia ha cht xt nghim v cc cng tc khc.Cc kh CO, NOx, SO2, Dioxin... pht sinh trong qu trnh s dng l t

rc thi y t, s dng cc my nn kh, my pht in d phng, do hot nt nhin liu l t rc v cc xe vn chuyn ca bnh vin.

Cc cht hu c c trong nc thi b phn hu di tc ng ca vi sinvt hiu kh v ym kh tu theo iu kin ti nhng ni thu gom, vn chuynsinh ra cc kh c hi khc nhau nh CH4, NH3, H2S... Pht sinh mi hi thi.ng thi cc vi sinh vt gy bnh nh: trc khun lao, siu vi khun cm, si

TTQT&BVMT 27


28/75

vi khun gy bnh si... pht trin mnh bm vo cc Sol kh, ht bi thekhng kh lan to khp ni c th l ngun ly lan bnh dch.

b. Ngun pht sinh nc thi

Khi bnh vin i vo hot ng s c nhiu ngun pht sinh nc thi. Tunhin c th phn loi chng theo hai nhm chnh sau:

i) Nc ma chy trn

Ngun nc ma chy qua b mt khun vin ca bnh vin. Lu ldng thi xut bin khng u v tn ti trong thi gian ngn vi khong dng ln, ph thuc vo cc ma trong nm. Vo ma kh lng thi t hn svi ma ma. Ti trng cc cht nhim c trong nc ma chy trn c

tnh trong bng sau: Bng 15: Ti lng nhim trong nc ma chy trn [4]

Ngun thi n vTng Nit

Tng photpho

BOD COD TSSTng

Colifrom(MPN/100 ml)

Nc ma chytrn

Kg/km2/nm 875 1054,72

531,15

064,05 58.000

Nh vy vi din tch khu vc d n l 7,5 x 10-3 km2, nu khng c bin php x l ngun thi ny, hng nm s a vo mi trng mt lng cht thsau:

Tng nit: 875 x 7,5 x 10-3 =6,56 kg/nm.

Tng photpho: 105 x 7,5 x 10-3 = 0,7875 kg/nm.

BOD: 4,725 x 7,5 x 10-3 = 0,0354 kg/nm.

COD5: 31,15 x 7,5 x 10-3 = 0,234 kg/nm.TSS: 64,05 x 7,5 x 10-3 = 0,48 kg/nm.

ii) Nc thi bnh vin

Bao gm nc thi pht sinh t qu trnh sinh hot ca cn b cng nhnvin, bnh nhn v ngi nh bnh nhn. Nc thi pht sinh t qu trnh itr, t khu phu thut, khoa dc, cc labo xt nghim, phng chun b m

trng, chun b mu v ha cht, kho vt phm...

TTQT&BVMT 28


29/75

Xt v ngun gc pht sinh, nc thi bnh vin ni trn gn ging nhnc thi sinh hot. Nhng v kha cnh v sinh v dch t, nc thi bnh vcha nhiu loi vi khun gy bnh c ngun gc t ngi bnh v cc cht hi khc hnh thnh trong qu trnh iu tr. Ngun nc thi ny khi thi v

ngun nc mt s gy nhim bn v lm lan truyn bnh dch.Theo s liu nghin cu, thng k v nc thi bnh vin a khoa v c

bnh vin chuyn khoa trong nc v trong khu vc cho thy lng nc thca bnh vin ni chung chim 80% lng nc cp [1]. Nh vy vi lnc cp trung bnh nh tnh trn [tr8] th lng nc thi trung bnh ca bnh vin 71 TW l 320 cho quy m 500 ging bnh(giai on 1)v 448 choquy m 700 ging bnh(giai on 2).

Thnh phn ngun nc thi ny rt a dng, ph thuc c th vo quy mhot ng ca tng khoa, phng, s lng bnh nhn v ngi nh bnh nhn.

+ Nc thi sinh hot:Cha cc thnh phn ch yu l cn b, cc chthu c, cc cht dinh dng v vi sinh vt. Khi vo vc nc s gy nhingun nc, nh hng n i sng ca ng vt thu sinh v cht lng n

sinh hot ca ngi dn xung quanh.Theo tnh ton thng k ca t chc Y t th gii ti nhiu Quc gia an

pht trin, khi lng cc cht nhim trong nc thi sinh hot do mi nga vo mi trng (nu khng qua x l) nh sau [4]:

Bng 16: Khi lng cc cht nhim c trong nc thi sinh hot Ch tiu nhim Khi lng (g/ngi/ngy)

BOD5 45 - 55COD 72 - 102Cht rn l lng (SS) 70 - 145Du m 10 - 30Tng Nit 6 - 12Amoni 2,8 - 4,8Tng Phospho 0,8 - 4,0Vi sinh vt: MPN/100 mlTng coliform 106 - 109Fecal coliform 105 - 106

Trng giun sn 103

TTQT&BVMT 29


30/75

+ Ti cc labo xt nghim: Nc thi sinh ra t cc labo xt nghim c lulng khng ln nhng li cha nhiu vi sinh vt gy bnh, cht khng sinh td, ha cht xt nghim, kim loi nng.

+ Ti khu phu thut v cc khoa lm sng:Trong thnh phn nc thithng cha cc vi khun gy bnh, cc hp cht hu c, cc cht dinh dng

Bng 17: T l % vi khun gy bnh phn lp t m vt m [5]

TTTng s

bnh phmT cuvng

Trc khun Gram (-)E.Coli Enterosp Alka Pseudo Proteus

1 454 137 80 81 15 82 732 304 97 53 72 25 58 49

3 214 67 18 81 16 35 48 Tngcng

972 301 151 234 56 175 170

T l(%)

31 15,5 24 5,8 18 17,5

+ Ti cc khoa cn lm sng: Thnh phn nc thi chanhiu cc hp cht hu c nh Glucoza, sacaroza, lactoza,

sulphat amon phosphoran.... Cc hp cht v c, hot phngx anpha, beta thng cao hn mc cho php.

Nhn chung, c trng ch yu ca ngun nc thi bnhvin ni chung c hm lng COD, BOD, Amoni, Coliform cao hnnhiu so vi tiu chun nc mt hin hnh. Ngoi ra trongngun nc thi ny cn cha nhiu vi khun gy dch bnh nh:

Trc khun l, trc khun thng hn, giun sn... Kt qu iutra phn tch thnh phn v tnh cht ca nc thi bnh vinkhu vc min Trung v min Bc nc ta trong nhng nm trcc cho trong bng sau.

Bng 18. Ch tiu nhim trong nc thi bnh vin [1]

TT Ch tiuGi t

TCVN 5945-2005

Min TB Max (CtA)

(Ct B)

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1 PH 6,2 7,4 8,1 6 - 9

2 NH4+ (mg/l) 8,0 14 25 5 10

3 BOD5 (mg/l) 110 150 250 30 50

4 COD(mg/l) 140 200 300 50 80

5 Cn l lng(mg/l) 100 160 220 50 100

6 Coliform(MPN/100 ml) 106 107 109 3000 5000

c. Ngun pht sinh cht thi rn

Cht thi rn pht sinh t cc hot ng chuyn mn phcv cng tc khm cha bnh, nghin cu v o to cn b, tqu trnh sinh hot ca bnh nhn, thn nhn, khch vng laiv nhn vin y t.

c trng ca cht thi rn ca bnh vin c cha mt lngnht nh cc vt t y t tiu hoa, vt phm y t cng vi cccht thi khc nh rc thi sinh hot. Nhiu loi vt phm y t th-ng mang cc vi khun, vi trng gy bnh hoc l mt mi tr-ng rt thun li cho cc vi sinh vt pht trin. Do vy, nu rcthi khng c qun l hoc x l thch hp s l ngun ly lanbnh tt ra mi trng xung quanh.

Bng 19: nh mc rc thi ti bnh vin [6]

TT

Tuyn bnh vinCht thi trung bnh

ca bnh vin

(kg/ging bnh/ngy m)

Cht thi nguy hi(kg/ging bnh/ngy

m)1

Bnh vin tuyntnh

1,23 0,35

2Bnh vin tuynhuyn, th x,thnh ph

1,02 0,20

Trung bnh 1,13 0,23

Nh vy, vi quy m 700 ging bnh, lng rc thi ca bnhvin 71 TW thi ra hng ngy trung bnh khong 791 kg/ngy

TTQT&BVMT 31


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m. Trong chim 23% l rc thi nguy hi tng ng 182kg/ngy m.

- Cht thi rn nguy hi: Theo Quyt nh s2575/1999/Q-BYT ngy 17/8/1999 ca B trng b Y t vvic ban hnh Quy ch qun l cht thi y t, cht thi c hica bnh vin c chia thnh cc nhm nh sau:

Nhm A: Bao gm cc loi bng, bng, gng tay, rc thinhim bn trong qu trnh bng, b bt c tip xc vi vtm, c dnh mu. c bit l cc cht thi t cc ca bnhtruyn nhim nh bnh phm sinh thit, mu, phn, nc tiu vcc m t c th bnh nhn, cc chi, rau thai...v cc m tcc phng xt nghim.

Nhm B: L cc cht thi rn bao gm: bm kim tim, l,ng thuc, cc tim, thy tinh, li dao m v cc dng c cngkhc.

Nhm C: Cc cht thi pht sinh t cc labo xt nghim vnh i th (khng thuc nhm A ).

Nhm D: Cc cht thi dc v ha hc (thuc, vc xin, ccdung mi hu c, ha cht xt nghim, cc hp cht v c...).

Nhm E: Cc loi vi nh: ga tri ging thanh l, l ngnc tiu, ti O 2, m c khng s dng c...

- Cht thi rn sinh hot: L cht thi khng b nhimcc yu t nguy hi. Ngun cht thi ny pht sinh t cc bung

bnh, phng lm vic, hnh lang, cc b phn cung ng, nhkho, nh git, nh n... bao gm: giy bo, ti liu, vt liung gi, thng ct tng, ti nilon, ti ng phim, vt liu githc phm, thc n d tha ca ngi bnh.

d. Ngun pht sinh phng x

Pht sinh ch yu t hot ng chun on hnh nh,iu tr tch cc v nghin cu. Pht sinh trong qu trnh vnhnh my chiu, chp X-quang, ct lp CT (CT-Scanner), cnghng t (MRI), cht thi phng x...TTQT&BVMT 32


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- Cht thi phng x rn gm: cc vt liu s dng trongkhu xt nghim, chun on hnh nh, iu tr nh: ngtim, bm tim, kim tim, knh bo h, giy thm, gc st khun, ng nghimchai l ng cht phng x...

- Cht thi phng x lng:dung dch c cha nhn phng x pht sinhtrong qu trnh chun on, iu tr nh nc tiu ca ngi bnh, cc cht btit, nc xc ra cc dng c c cha cht phng x...

- Cht thi phng x kh gm:cc cht kh khng dng trong lm sng nh133Xe, cc kh thot ra t cc kho cha cht phng x ...

Bng 20: Cc ht nhn phng x s dng trong cc c s y t

Ht nhn phng x Cc ht pht sinh Thi gian bn hu ng dng3H Ht beta 12,3 nm Nghin cu14C Ht beta 5730 nm Nghin cu32P Ht beta 14,3 ngy Tr liu

51Cr Tia gamma 27,8 ngy Chn on in vitro57Co Ht beta 270 ngy Chn on in vitro59Fe Ht beta 45,5 ngy Chn on in vitro67Ga Tia gamma 72 gi Chn on hnh

nh75Se Tia gamma 120 ngy Chn on hnh

nh123

I Tia gamma 13 gi Chn on hnhnh

125I Tia gamma 60 ngy Chn on hnhnh

131I Ht beta 8 ngy Tr liu, nghincu

133Xe Ht beta 5,3 ngy Chn on hnh

nh3.2. D bo nhng ri ro v s c mi trng do d n gy ra

TTQT&BVMT 33


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Lng nc thi pht sinh ln khi d n i vo hot ng nu khng c bin php x l hiu qu c kh nng gy hin tng ph dng ti cc khu vtip nhn nc thi gy nhim mi trng trn din rng. c bit ti cc kvc c cc ngun pht sinh nhim phng x nu khng c qun l cht ch

v xy dng khng ng quy chun s gy nh hng rt ln ti sc khe ca bc s, ngi bnh v ngi dn quanh vng.

Vic khoan thm d a cht trong qu trnh kho st s gy nhim ngunnc ngm. Nu ch d n khng c bin php lp h khoan hp l v ng kthut, th ti cc l khoan ny c th xut hin cc hin tng st ln b mthm ch c th lm thay i mc nc ngm.

Trong giai on thi cng xe vn chuyn nguyn vt liu ra vo thngxuyn, s lm nhim mi trng khng kh, ting n ti khu vc d n; c thgy tai nn, dn n thit hi v ngi v ti sn.

3.3. i tng, quy m b tc ng

- Tc ng trc tip:Cc ngun cht thi pht sinh trong qu trnh thi cngv hot ng ca d n nu khng c x l trit s nh hng trc tipcc thnh phn mi trng nh:

+ Mi trng khng kh xung quanh.+ Mi trng nc.

+ Mi trng t.

+ Mi trng kinh t x hi.

Tuy nhin, bn cnh vic a d n vo hot ng s ci thin chlng chm sc sc kho cng ng, nng cao cht lng cuc sng ca ngdn a phng. Tng bc lm thay i c cu kinh t trn a bn x QunTm.

- Tc ng gin tip:Cc thnh phn mi trng c bn khi b nhim sgin tip tc ng xu ti sc khe ngi dn quanh vng. nh hng ti th bo v mi trng chung ca ngi dn.

Nhng tc ng tim tng nu trn c quy m rng, thi gian tc ng ko

di trong sut qu trnh hot ng ca d n. V vy, ch u t cn xy dnk hoch hn ch nhim mi trng mt cch c th, hp l v bn vng.

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3.4. nh gi tc ng3.4.1. Giai on xy dng c bna. Tc ng n mi trng khng kh - Bi, t v hi kh c

Khi thi cng d n, mt khi lng ln vt liu xy dng, my mc thcng c chuyn n khu vc d n phc v cho cng tc san nn v xdng c bn. Ko theo l mt lng ln bi thi, t ri vi v hi kc.

Bi, t v hi kh pht sinh trong giai on ny nu khng c kimsot th s gy nh hng khng nh ti cnh quan mi trng, sc khe ng

dn, y bc s trong bnh vin v bnh nhn ang iu tr ni tr. c bit lnhng ngi cng nhn thi cng trn cng trng. Tuy c thi gian tip xc vcc tc nhn nu trn khng di nhng vi nng cao cng c th gy ra ms bnh v ng h hp (mi, hng, ph qun, kh qun...), cc bnh ngoi(nhim trng da, lm kh da, vim da ); cc bnh v mt (vim mi mt, vimgic mc mt...), cc bnh v ng tiu ha v.v...

Bi nhim ny cn c tc dng xu n h thc vt trong khu vc, biu hithng thy l cy ci trong khu vc ln cn thng b ph mt lp bi trn l, tgy cn tr qu trnh quang hp ca cy, cy ci s chm pht trin, l a vng, hng ti qu trnh sinh trng pht trin v m hoa kt tri ca cy trng.

- Ting n: Pht sinh t hot ng xy dng s gp phn nh hng xu tmi trng khng kh xung quanh, mi trng lao ng ca ngi cng nhn vmi trng lm vic cng nh iu tr ca y bc s trong bnh vin. Khi tip xlu di vi ting n mc cao, ngi tip xc trc tip c th mc cc bnhtai (thng mng nh, tai, ic ...). i vi ngi bnh ang iu tr cn s ytnh tuyt i th ting n trong giai on ny l tc nhn gy nh hng rt xn qu trnh u tr.

- Nc thi: Vic ngp ng do nc ma, nc thi sinh hot trong qutrnh ny l c th xy ra. Ti cc khu vc ngp ng lu ngy s pht sinh chi kh khng mong mun nh H2S, NH3 lm nhim mi trng xung quanh.

b. Tc ng n mi trng nc

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- Nc thi:Ch yu l nc thi sinh hot ca cng nhn trc tip thicng v nc ma chy trn.

+ Nc thi sinh hot bnh qun khong t 60 - 80 lit/ngi/ngy m [7]tuy nhin lng thi ny cng thay i theo thi gian trong qu trnh thi cng Nc thi sinh hot ch yu cha cn b, cht rn l lng, cht hu c, cc dinh dng v vi sinh vt.

+ Nc ma chy trn ph thuc rt nhiu vo ch thi tit, kh htrong khu vc. Nc ma chy trn c hm lng cht l lng v bn t cangoi ra cn nhiu tp cht khc nh du, m...

Tc ng d nhn thy nht ca nc ma chy trn trong giai on ny

s ngp ng cc b gy nhim mi trng khng kh xung quanh. Ngoi rvi thnh phn nhim nh trn, ngun nc thi ny khi thi trc tip vo mtrng tip nhn m khng qua khu x l s b no s lm tng mc nhim nc mt khu vc xung quanh.

Do y l vng t ct nn tc thm ca nc l rt cao. Khi ngunc thi ny c kh nng gy nhim ngun nc ngm tng nng do trong qtrnh t thm chng ko theo cc hp cht v c, hp cht hu c, vi sinh vt.

- Bi, t thi v cht thi rn:t thi v bi pht sinh c th gytc cc ng ng dn nc thi, thot nc ma trong bnh vin. Gp phntng kh nng ngp ng cc b, ng thi nc r rc vi cc thnh phn nhihu c cao cng s lm tng nng cht nhim trong ngun nc thi chuny. y l ngun thi c nguy c gy nhim nc mt v nc ngm tng nn

c. Tc ng ti sc khe ngi cng nhn

- nhim khng kh, ting n l nhng nhn t quan trng nh hngtrc tip ti sc khe ngi cng nhn, nh hng ti kh nng tp trung cvic, gim hiu qu sn xut ca cng nhn v tng nguy c tai nn trong lng.

- Cht thi rn pht sinh nu khng c qun l v thu gom hiu qu smi trng c nguy c cao i vi ngi cng nhn. Lng cht thi ny chyu l cht thi rn sinh hot ca cng nhn (bao b, v hp, ti nilon ) v

cht thi rn trong xy dng (bao b xi mng, t ri vi, thp vt litha ). Chng c khi lng khng ln, tuy nhin rt kh kim sot do khng

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tp trung v thi quen trong sinh hot. Vic ri vi cc vt liu tha nh: ist, dy km g, li ca... c th gy nh hng n cng nhn thi cng, cn bcng nhn vin, bnh nhn v ngi nh bnh nhn khi dm phi. Tu vo m, nh hng c th a n bnh un vn, rt nguy him n tnh mng.

3.4.2. Giai on d n i vo hot ng.

3.4.2.1. Tc ng n cc thnh phn mi trng.

a. Tc ng n mi trng khng kh.

Cc hi kh c, mi l pht sinh t nhiu ngun khc nhau vi s phn bnng khng u theo khng gian v thi gian lm nh hng xu ti chlng mi trng khng kh. Ti cc khu lm vic v khu iu tr, trong ikin thng kh km, cc tc nhn ny lm gim cht lng khng kh gy nhhng trc tip ti sc khe ca bnh nhn, ngi nh bnh nh v y bc s.

Vi kh nng pht tn nhanh trn din rng, mt s hi kh c v mi lSol kh v cc vi khun gy bnh c bit trong cc khu kh trng, x l nthi, x l cht thi rn... gp phn lm gim cht lng mi trng khng dn c xung quanh.

Mi trng khng kh b nhim bn s nh hng trc tip ti sc khe cngi v vt nui. C th k ra y tc ng xu ca mt s hp cht hu cc v vi khun gy bnh khi chng tn ti trong khng kh.

+ Bi:Khi ngi phi bi c hc vo phi, phi s b kch thch v pht sinhnhng phn ng gy x ho phi to nn cc bnh v h hp.

+ Kh CO:Kh CO l mt loi kh c do c phn ng rt mnh vi hng

cu trong mu v to ra Cacboxy hemoglobin (COHb) lm hn ch s trao v vn chuyn oxy ca mu i nui c th. i lc ca CO i vi hng cu g200 ln so vi oxy. Hm lng COHb trong mu t 2-5% bt u c du hinh hng n h thn kinh trung ng. Khi hm lng COHb trong mu tn10-20% cc chc nng hot ng ca cc c quan trong c th b tn thn Nu hm lng COHb tng n hn 60% c nguy c gy t vong cao.

+ Kh SO2: L kh d ho tan trong nc v c hp th rt nhanh khi ht

th bu khng kh nhim SO2. Kh SO2 nng thp (1-5 ppm) xut hin sco tht tm thi ti cc c mm, nng cao hn, SO2 gy xut tit nc nhy

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v vim ty thnh kh qun, lm tng sc cn i vi s lu thng khng kh cng h hp v gy kh th.

+ Cc kh N O x : L cht c hi c tc hi gy bnh vim x phi mn tnh.V mc c hi th kh NO2 c tc ng cao nht so vi cc kh , NO, N2O5.

Kh NO2 gy cc tc ng ti con ngi tu thuc vo nng v thi giantip xc [8].

Nng NO2 (ppm) Thi gian tip xc Hu qu

500 48 gi T vong

300-400 2-10 ngy Gy vim phi v t

vong150-200 3-5 tun Vim x cung phi

50-100 6-8 tun Vim cung v mngphi

+ Kh HCl: Khi tip xc vi c th kh HCl s to thnh AxitClohidrit c tnh ph hu cao. Ht th kh HCl vi nng thpgy ho, nght th, vim mi, hng v phn pha trn ca hh hp. Khi tip xc vi kh HCl nng cao gy ph phi, tlit h tun hon v dn n t vong. Kh HCl tip xc vi dac th gy mn , cc thng tn hay bng nghim trng vcng c th gy m mt.

+ Dioxin: L tn gi chung ca mt nhm cc hp cht hohc tn ti bn vng trong mi trng cng nh trong c th con

ngi v cc sinh vt khc. Trong nhm cc hp cht ho hcthnh phn c nht l TCDD (2,3,7,8-tetrachlorodibenzo-p-dioxin). Dioxin c nguy c tc ng ton cu, c c tnh bn vng rt cao vkh nng lm nhim bn nc ngm, khng kh, lng thc thc phm... Thch nng rt thp, Dioxin cng c kh nng gy ri lon ni tit, ph hcn bng min dch, gy ung th, qui thai, d dng, thiu nng tr tu...

+ Vi khun gy bnh:Yu t gy nhim mi trng khng kh c trngca bnh vin l cc loi vi khun trong khng kh. S tn ti ca cc loi khun ph thuc rt ln vo mi trng: Nhit , m, khng kh Mt s

TTQT&BVMT 38


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vi khun gy bnh c thi gian tn ti rt lu trong khng kh, trong nhng nm t, ti tm v c th pht trin mnh trong iu kin nhit l 370C.

Bng 21: Thi gian tn ti ca mt s VK gy bnh thng c trong khng kh [7STT Loi vi khun Thi gian tn ti

1 Ph cu 4 - 5 thng2 Lin cu khun tan huyt 2,5 - 6 thng3 T cu vng 3 ngy4 Trc khun dch hch 8 ngy5 Trc khun bch cu 30 ngy6 Trc khun lao Bacillus Koch 70 ngy

Cc ngun pht sinh vi khun t bnh phm, cht thi ngi bnh rt xm nhp lm nhim khng kh, dn n kh nng ly lan mm bnh cho congi do ht phi khng kh nhim khun. Cc vi khun c kh nng pht tmnh trong mi trng khng kh nh: trc khun lao, siu vi khun cm, siuvi khun gy bnh si, u ma, quai b

b. Tc ng n mi trng nc

- Nc ma chy trn

Nc ma chy trn trong khun vin ca bnh vin s cun theo cc ch

cn b, cc cht hu c v t ct xung cng thot nc. Lm tc cc cnthot nc t tch t cc cht bn pht sinh mi hi thi, to iu kin thuli cho vi sinh vt, vi trng pht trin.

Tc ng ln nht do nc ma chy trn gy ra l do nng cht rn lng, tng nit v photpho cao... khi iu kin v sinh cng s khng sch, cntc qun l cht thi rn khng hp l, qu trnh vn chyn cht thi lng khkn s l nguyn nhn gy nhim ngun nc ma chy trn. Khi ngun n

thi ny c thi vo mi trng s gy c ngun nc mt, gy bi lng vnc, lu di c th gy hin tng ph dng dn ti bn ha cc khu vnc nng, iu ny nh hng rt ln n mi trng sng ca sinh vt thsinh.

- Nc thi bnh vin

+ Nc thi sinh hot, nc thi t cc khoa lm sng, cn lm sng (t ckhoa iu tr, phng phu thut, nh i th, lau ra phng m, v sinh bun bnh...) mang lng ln vi trng, ch yu l virut ng tiu ho, bi lit, cloi k sinh trng, amip v cc loi nm. Ngoi ra, trong thnh phn ca nTTQT&BVMT 39


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thi cn c ho cht pht sinh t cc loi thuc, vcxin qu hn, cc dung mhu c, cc ho cht xt nghim... Nu khng c x l m thi trc tip lnc thi ny ra mi trng s lm nhim nghim trng ngun nc mnc ngm v nguy him hn l nh hng n sc kho ca con ngi. B

cnh , lng khng sinh tn d trong nc thi s lm cht cc vi sinh ct cth trong nc, do gy mt cn bng gia cc h sinh vt trong nc.

Cc cht hu c c trong nc thi lm gim lng oxy ho tan trong nnh hng ti i sng ca ng, thc vt thu sinh. S phn hu cc cht hc cng sinh ra mt hm lng ln ion sunfat trong nc. Trong iu kin hikh, cc ion sunfat ny s b phn hu sinh hc gii phng kh H2S, sinh ra mikh chu v c hi cho con ngi.

Ngoi ra do d tha cc cht dinh dng Nit, photpho c th gy ra hintng ph dng ko theo s pht trin ca cc loi to khng mong mun tcc vng tip nhn nc thi. Cc loi to s pht trin rt nhanh trong ma ckhi m lu lng nc trao i (pha long) gim xung v kh nng t lm sca nc km i. Bn cnh , qu trnh phn hy sinh hc cc cht hu ccng s lm gim nng xi ha tan trong nc. Khi nng xi ha tantrong nc xung thp, cc loi thy sinh vt s gim. Ti khu vc c nng xi ha tan xung qu thp th thng sy ra qu trnh phn hy k kh lp bny, pht sinh mi hi thi. y l mi trng khng thun li cho cc sinh vsng di nc. Ngc li nm v vi khun pht trin mnh nh s phn hcc cht hu c lm tng hm lng NH4+, pht sinh cc kh c hi, c mi khchu, nh hng trc tip n cc sinh vt sng di nc v mi trng khkh xung quanh.

+ Nc thi t cc labo xt nghim tuy c lu lng t, tuy nhin trongngun nc thi ny c cha cc ho cht xt nghim, cht khng sinh, cc kimloi nng. Nu thi chung vi cc dng thi hoc thi trc tip v mi trnggy c ch qu trnh hot ng ca vi sinh vt c li, dn n hiu qu xtrong h thng x l nc thi v qu trnh t lm sch nc ca t nhin gim xung.

c. Tc ng n mi trng t.

Cc tc nhn gy nhim mi trng t chnh yu l nc thi, kh thv cht thi rn. Nc thi v kh thi c cha cc hp cht gy nhim khi

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vo mi trng t s lm bin i tnh cht ha l, c hc ca t. Nng cht nhim trong t cng cao th nng oxi trong t cng thp, iu gnh hng trc tip ti mi trng sng ca cc loi sinh vt trong t.

Mi trng t l ni tip nhn cui cng cc dng thi, c bit l chthi rn. i vi cc cht thi rn pht sinh t hot ng ca d n di mi hthc, d x l hay cha x l u c tip nhn bi mi trng t (chn l b mt). nhng ni tp trung nng cc cht gy nhim cao, thnh phn cht nhim phc tp s lm thay i kh nng t phc hi ca t, nh hn cc tc ng gia t - nc - khng kh, thay i mi trng sng ca cloi ng thc vt trong khu vc, t lm mt cn bng sinh thi vng.

Ngoi cc yu t gy nhim ch yu l nc thi; kh thi v cht thrn, th cc vi sinh vt gy bnh cng c tc ng lm nhim mi trng Mt s vi sinh vt gy bnh gy nhim mi trng t ch yu l:

+ Trc khun l:Trc khun l cht rt nhanh trong phn ti, nhngsau khi ty u phn th chng c th tn ti lu nh c cht hu c trong Trc khun l thng b cc tia bc x mt tri tiu dit.

+ Trc khun thng hn v ph thng hn:t trng l mi trng

khng thun li cho cc vi khun thng hn v ph thng hn pht trinChng s cht sau mt thi gian tn ti trong t. Tuy nhin, tu theo mc nhim bn v loi t (nhit , m, d tr cht hu c, pH, khun lckhun i khng...) trc khun thng hn v ph thng hn c th tn ti klu trong t.

+ Phy khun t:Tn ti trong t khng qu 1 thng, kh nng sinh tnca n chu nh hng ca nhiu nhn t. t b nhim khun bi phn ti,

cht hu c ko di, thi gian tn ti ca phy khun t c th tng ln t 5thng. Kh nng sinh tn ca vi khun ny cn b nh hng bi thnh phn chc ca t, cc vi khun i khng v cc nhn t sinh hc.

+ K sinh trng (giun sn):K sinh trng c truyn qua t, nht lt b nhim phn, t mang kn amip.

Nhng vng t b nhim bn bi cht thi ni chung nu dng vo vichn nui gia sc, gia cm hay trng hoa mu, cc cht nhim s qua nthc vt m nh hng ti sc khe con ngi qua chui thc n bi qu trntch t sinh hc gy c hi ln .TTQT&BVMT 41


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TTQT&BVMT 42


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d. Tc ng dch t hc ca cht thi bnh vin.

Trong cht thi bnh vin cc vi sinh vt rt a dng v chng loi v nguy c gy bnh cao nh:

- Cc vi khun Salmonella, Shigella, Vbrrio, Coliform, t cu, lin cu,Preudomonas... thng khng vi nhiu loi khng sinh, gy rt nhiu kh khtrong qu trnh iu tr.

- Cc vi rt ng tiu ha nh Echo, Coxsakie, Rotavirut.. c th gycc bnh v ng tiu ha nh t, l, thng hn...

- Trong cht tht thi bnh vin, c bit l nc thi cn cha rt nhik sinh trng nh Amip, trng giun sn, cc loi nm h ng... virut vim gaB, C. Chng c th gy cc bnh v ng tiu ha, bnh ngoi da, bnh v m bnh ph khoa, vim gn siu vi trng.. tng i cao.

- Ngoi ra, cht thi bnh vin nu khng c x l trit cn l c trngun cung cp thc n, mi trng thun li cho cc vecto truyn bnh phtrin nh: chut, b, ri mui...

Do , cht thi bnh vin nht thit c kim tra, phn loi v x

theo mt qua trnh nghim ngt trc khi thi vo mi trng.e. Mt s tc ng khc.

- Tc ng ca cht thi rn:

Cht thi rn pht sinh trong qu trnh sinh hot ca cn b cng nhn vin bnh nhn v ngi nh bnh nhn tc ng trc tip n cc thnh phn mtrng nh pht sinh mi hi, ngn cn dng chy ca h thng cp thot nto iu kin thun li cho cc vi khun, cc loi vt gm nhm chut, b ssi v pht trin.

c trng ca cht thi rn ca bnh vin l cha cc vt phm y t mcc vi khun, vi trng gy bnh. Cc tc nhn gy bnh ny c th xm nhp vc th con ngi qua vt try xc trn da, qua cc nim mc, qua ng hhp, ng tiu ho. Loi cht thi ny mang nhiu yu t c tc ng trc tilm nhim mi trng nc, t, khng kh. Ngoi ra, cht thi rn y t c k

nng lan truyn bnh tt, do rui mui, cn trng v pht tn cc bnh nh

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thng hn, t l, st xut huyt, st rt, st pht ban, vim gan A v cc bntruyn nhim khc.

TTQT&BVMT 44


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c bit i vi mt s cht thi cht thi rn nguy hi: cht thi rn nh phng x, cc l ng ha cht gy c t bo, cc l ha cht nguy hi hhn... nu khng c bin php x l ring khi thi vo mi trng s gy nhim moi trng khng kh, mi trng t, mi trng nc. Khi tip xtrc tip qua da hoc qua ng h hp chng c th gy t bin gen, ung thv cc bnh nguy him khc c tnh di truyn i vi con ngi ng thc vxung quanh.

- Tc ng ca bc x Gamma:

Bc x Gamma pht sinh trong qu trnh vn hnh s dng thit b chiuchp X-quang, my siu m, my in tim nh hng ca bc x Gamma t

sc kho ca con ngi da trn liu lng, thi gian tip xc, khong cch phng thc chiu. Khi bc x Gamma i vo c th chng s tng tc vi ccht trong c th v to ra cc in t th cp. Cc in t th cp ny l cc nhn mang in gy ra hin tng ion ho dn n s ph hu cc t bo sntrong c th c th l nguyn nhn ca cc loi bnh nan y.

3.4.2.2. Tc ng n tnh hnh kinh t-x hi.

+ Sc khe cng ng:D n nng cp v m rng bnh vin 71 Trungng p ng c nhu cu khm cha bnh v nng cao cht lng chm ssc khe cng ng; gp phn hon thin h thng h tng x hi v y nhamc tiu pht trin kinh t x hi ca a phng. Hn ch tnh trng nhimi trng do cht thi bnh vin gy ra, nng cao cht lng cuc sng cnhn dn.

+ Kinh t x hi:Qu trnh hnh thnh v s hot ng ca d n c mt ngha kinh t x hi rt to ln cho x Qung Tm ni ring v tnh Thanh Ho nchung. Trc tin l vic gp phn to cng n vic lm, mi trng lm vihin i, nng cao tay ngh cho i ng y bc s trong vic khm v iu tr bncho ngi dn. Vic a d n vo hot ng s l ngun thu ht (gin tip vtrc tip) lao ng ln v gii quyt vic lm khng ch cho ngi dn phng. iu ny cng gp phn lm tng dn tr v thc vn minh th chonhn dn trong khu vc. Tuy vy, bn cnh cc mt tch cc l cc mt tiucc i km: t ai cho cy xanh v cnh quan thin nhin b thu hp, nhimmi trng ngy cng tng cng gy nh hng trc tip ti cht lng cuc sca nhn dn.

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+ Giao thng vn ti:D n cng s gp phn cng vi cc hot ng khctrong khu vc lm cho tnh trng mt v sinh ng ph, bi tng ln do c phng tin vn chuyn. Mt giao thng trong khu vc tng ln lm nhng n nhu cu i li ca nhn dn. Tuy vy, chnh s pht trin ca d s gp phn ci thin h thng ng giao thng cng nh thc y qu trcng nghip ha trong khu vc nhanh hn, mnh hn.

3.4.3. nh gi v phng php s dng.

+ Phng php nh gi nhanh: tnh ton ti lng v nng nhimtrung bnh cho tng giai on thc hin d n, chng ti s dng phng phnh gi nhanh c t chc Y t th gii a ra. Hin nay phng php ny

c chp nhn v s dng ti nhiu quc gia trn th gii. Vit Na phng php ny cng c gii thiu v ng dng trong nhiu nghin cTM.

Lu lng v thnh phn cht thi ph thuc vo nhiu thng s, ti lL ca cht nhim j c th c th hin dng ton hc nh sau

L j = f

Trong f: Dng ngun thi, quy m ngun, quy trnh cng ngh, hiuqu h thng x l, nguyn liu v nhin liu s dng, iu kin mi trxung quanh...

xc nh c L j trc ht cn xc nh c h s ti lng thi e ji vi cht nhim j qua phng trnh.

Bng phng php thng k, t chc Y t Th gii (WHO) xy dn bng nh gi nhanh, xc nh ch s e j v t xc nh c lng thi L j.

+ Phng php thng k: y l mt trong nhng phng php n ginthng c s dng trong cc bo co TM. Vic d on cc thnh phn chthi, lng thi, nguyn liu v nhin liu s dng trong d n qua vic thngt cc n v c iu kin v quy m hot ng tng t s cho ta s liu c chnh xc tng i cao v ng tin cy.

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CHNG IV

BIN PHP GIM THIU TC NG XU,

PHNG NGA V NG PH S C MI TRNG

4.1. Cc bin php gim thiu tc ng xu n mi trng.4.1.1. Giai on xy dng c bn.

4.1.1.1. Gim thiu nhim mi trng khng kh.

Trong giai on xy dng c bn, cc ngun pht thi lm nhim mtrng khng kh l khng lin tc do thi gian thi cng ngn. Tuy nhin, do dn c thc hin nm trong khun vin ca bnh vin v th ngoi nhng t

ng n cng nhn trc tip lm vic trn cng trng, n cn tc ng khu vc iu tr, khm cha bnh hin c ca bnh vin.

Cc bin php gim thiu nhim mi trng khng kh trong qu trnhxy dng c bn:

- Cc hng mc cng trnh thi cng c che chn, m bo ng quy nhv xy dng.

- Cc xe vn chuyn nguyn vt liu, t phi c ph kn bng bthng xe ng kn, khng ch nguyn vt liu vt qu khi lng quy nh.

- Cc xe vn chuyn nguyn vt liu, phng tin thi cng khng hot ntrong gi ngh ngi, trong khu vc iu tr bnh nhn.

- Khng s dng cc xe t, my mc qu c vn chuyn nguyn vliu v thi cng cng trnh, c bo dng nh k nhm m bo an totrong thi cng v m bo cc tiu chun v mi trng nh: tiu chun kh thtiu chun mc n, rung.

- to m, gim nng pht tn bi ti khu vc cng trng xdng v trn tuyn ng vn chuyn nguyn vt liu, BQL d n s ch phnc trong nhng ngy thi tit nng, nng v kh hu hanh kh.

- Ban qun l d n d n phi hp vi n v thi cng lp k hoch thcng cc hng mc cng trnh xy lp hp l gim thiu bi, kh c,

rung.4.1.1.2. Gim thiu nhim mi trng nc.

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- i vi nc thi sinh hot ca cng nhn thi cng trn cng trng sc qun l cht ch bng cch m bo y cc cng trnh v sinh ln nh: nh v sinh, h thng thot nc, nh tm, ni cha rc... Nc thi sihot s c x l bng h thng x l cht thi lng v cht thi rn hi

ca bnh vin.- Khng vt liu xy dng gn cc ngun nc; ng thi qun l d

m v vt liu c hi do cc phng tin vn chuyn v thi cng gy ra.

- Bn t khi san nn, lm ng c thu gom v c vn chuyn ni quy nh, khng xy ra tnh trng ngp ng, ly li.

- Ban qun l d n phi hp vi n v thi cng thu dn cc cht ri v

trong khi san lp, o mng hn ch cc cht ri vi b cun theo nc ma l nhim ngun nc.

4.1.1.3. Gim thiu tc ng ca cht thi rn.

- Cht thi rn ch yu l vt liu h hng, gch v, xi mng cht, g cohng... s c thu gom tp trung x l hoc tn dng san lp mt bn

- Cht thi rn sinh hot c thu gom tp trung ti cc ni quy nh ti

x l. Cc cng nhn lm vic ti cng trng s c tp hun v thu gom rthi.

4.1.1.4. An ton trong thi cng v bo v cng trnh.

- Ban qun l d n kim tra thng xuyn cc n v thi cng. Thc hinche chn chng bi v vt ri trn cao xung, chng n v rung ng qu tichun: TCVN 3985-85, phng chng chy TCVN 3254-89, an ton n TCVN3255-86...trong qu trnh thi cng.

- Trn cng trng cc khu vc thi cng nguy him c bo v bng rchn, cm y bin bo. Cc khu vc thi cng, ng giao thng s c chiu sng ban m.

- Khi thi cng mng cho cc cng trnh, cc n v thi cng xem xt la chnthit b thi cng thch hp hn ch rung ng, khi, bi, ting n v nh hti khu vc iu tr v khm cha bnh hin c ca bnh vin.

- bo m an ton cho phng tin cng nh ngi tham gia giao thngc bit l i vi cc phng tin vn chuyn nguyn, vt liu phc v x

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dng d n, yu cu: cc phng tin thi cng kim tra thng xuyn v hthng phanh v cc b phn chuyn ng, cc li xe phi cam kt khng unru bia, lun lm ch tc trong khi iu khin phng tin.

- Ban qun l yu cu v thng xuyn kim tra vic thc hin cc bi php m bo iu kin v sinh mi trng, phng chng chy n v an ton lng trn cng trng ca cc n v thi cng theo quy nh chung.

4.1.2. Giai on d n i vo hot ng.

4.1.2.1. Gim thiu nhim mi trng khng kh.

- Thng xuyn v sinh bnh vin, phun cc cht st khun ti cc nh vsinh, thay th nhng np cng hng, nh k tin hnh no vt cng rnh thonc hn ch s pht tn mi ra mi trng xung quanh.

- Cc phng khm, iu tr, chun on c h thng ca s, h thng thnkh ng b v c thit k m bo s ln trao i khng kh t nhin v nhto theo cc tiu chun thit k chun ngnh.

- S dng cc ch phm vi sinh x l v hn ch pht sinh mi l nhEnchoice, EM... Cc ch phm vi sinh ny c phun trc tip vo cc ngun c

kh nng pht sinh mi, khu tp kt cht thi, cc khu v sinh chung, khu x nc thi.

- i vi khoa ly v cc labo xt nghim, kho ho cht, dc phm lp t h thng thng kh v bc x l kh c.

- Thng xuyn kim tra v nh k bo dng cc xe ca bnh vinkhng ch qu ti trng quy nh. S dng nhin liu ng vi thit k ca c.

4.1.2.2. Gim thiu nhim mi trng nc.

Gii php gim thiu nhim mi trng nc c thit k theo nguytc phn lung nh sau:

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S 1: Nguyn tc phn lung x l nc thi trong bnh vin 71 TW

a. H thng 1:Dnh ring cho thot nc ma. H thng ny bao gmcc mng, rnh thot nc kn (lp t cc song chn rc). Mng li ny

xy dng bng b tng ct thp vi h thng ging thm ng b. dc cti thiu: 1/D (ng knh D tnh bng mm). Ging thm c b tr ti cim thay i ng knh, ch ngot v vi khong cch trung bnh 20 - 40mKt cu cng dng cng trn b tng ct thp, su t cng im u nhnht l 0,5m. H thng ny s tp trung nc ma t trn mi nh xung dn n h thng cng ngm thot nc ma dc theo ng ni b trong bvin. Nc ma trn cc khu vc sn trng s chy vo cc ging thu nc m

t cng vi nc ma trn mi chng c dn n cng thot nc mchung v thi ra mi trng.

TTQT&BVMT 50

Nc machy trn

Nc thi

Sinh hotB t hoi

03 ngn

H thng 1

H thng 2

Mngthotn

cthichungkhudnc

Song chn rcH gas

Kh trngtp trung

Dng 1

Dng 2

Nc thi lm sng

cn lm sngHT x lcc b

H thng 2

Dng 1

Dng 2

Khu xl ncthi tptrung


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b. H thng 2:Dnh ring cho nc thi sinh hot ca cn b nhn vin, bnh nhn v ngi nh bnh nhn. Nc thi sinh hot c tch lm 2 dng

- Dng 1:Nc t nhu cu tm ra, git r ca bnh nhn, ngi nh bnh nhn v khch vng lai... lng nc ny chim t trng ln (70- 80%

nc thi sinh hot, nng cc cht nhim li khng cao nn c th thimi trng sau khi qua h thng thu gom tp trung, kh trng.

- Dng 2:Nc thi t nh v sinh (h tiu, h tiu) c nng cc ch nhim, vi sinh vt gy bnh cao, nn c gii php x l hu hiu. Hin nay, crt nhiu phng php x l nc thi v sinh ny, nhng do tnh cht, khlng ca nc thi, c im kh hu, a hnh nn phng php ph hp nhm d n la chn l phng php x l bng b t hoi.

B t hoi l cng trnh x l nc thi ng thi lm cc chc nng: ln phn hu cn lng v lc. Cn lng gi trong b t 6 - 8 thng, di tc dca vi sinh vt k kh, cc cht hu c b phn hu, mt phn to thnh cc chkh, mt phn to thnh cc cht v c ho tan. Nc thi c lng trong lng sau c a v h thng x l nc thi tp trung trc khi thi vmi trng.

Th tch b t hoi ph thuc v c im ca tng khoa, ph hp vi lng cn b nhn vin trc tip v gin tip lm vic, s lng bnh nhn vngi nh bnh nhn. Th tch b t hoi c xc nh da v tiu chun thv s ngi tham gia s dng cng trnh.

V = A x N x T/1000 (m3)

Trong :V: Th tch b t hoi (m3)

A: Tiu chun thi (lt/ngi/ngy: trung bnh 20 lt) N: S ngi s dng nh v sinh t hoi.T: Thi gian nc thi lu li b t hoi (20 - 50 ngy).

Do iu kin kh hu nhit i nng, m ca Vit Nam nn c th chthi gian lu nc thi trong b l 20 ngy v vi s lng ging bnh tru bnh cho mi khoa l 40 ging (Theo TCXDVN 365-2007). S lng b thoi cn xy dng c tnh l 02 b, phc v cho khong 80 ngi (40 b

nhn, 40 ngi nh bnh nhn). Nh vy th tch mi b khong 16m3.

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c. H thng 3:Dnh ring cho nc thi sinh ra trong qu trnh iu tr ticc khoa lm sng, cn lm sng, nc thi t khu phu thut, cc labo xnghim... Nc thi h thng ny c chia thnh 02 dng khc nhau:

- Dng 1:Nc thi t cc qu trnh iu tr(Tr nc thi t cc Labo xt nghim).Loi nc thi ny c thu gom v vn chuyn bng h thng rinn trm x l nc thi tp trung.

- Dng 2: Nc thi t cc labo xt nghim. Ngun nc thi ny c thugom v x l s b trc khi i vo h thng x l nc thi tp trung.

S 2: H thng x l cc b nc thi t cc labo xt nghim

- Thuyt minh h thng x l nc thi cc b:Nc thi t cc labo xtnghim c thu gom vo b cha. Sau nh k c bm sang b kt hkeo t v lng 2, ti y nc thi c b xung cc cht tr lng nh PACDW97 nhm kt ta cc kim loi nng v cc mt phn hp cht hu c kh Nc thi sau khi lng s c a v h thng x l nc thi tp trung thqua h thng vn chuyn nc thi dng 1. Lng bn thi sau c nvt, phi kh v tin hnh t ti l t cht thi rn ca bnh vin.

d. H thng x l nc thi tp trung.

Hin ti, bnh vin 71 Trung ng c h thng x l nc thi bnvin vi cng sut 120m3/ngy. H thng x l nc thi theo theo phng php b Aeroten, kt hp lng v kh trng nc thi. Mt bng trm x l nc tc th hin trn hnh sau:

TTQT&BVMT 52

B cha Keo t + lng HT x l ncthi tp trung

Cht tr keo t

NT t laboxt nghim

Thi vo MTtip nhn

Phi bn HT l t

Dng bn thi

Dng nc thiGhi ch:


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Hnh 1: Mt bng trm x l nc thi hin c ca bnh vin 71 TW

Trong tng lai vi quy m nng cp ln 700 ging bnh, lng nc thca bnh vin hng ngy dao ng t 320 - 448 m3/ngy, ln hn cng xuttrm x l nc thi hin ti. x l hiu qu ngun nc ny, d n thnh u t xy dng thm mi mt h thng x l nc thi trn c s tdng h thng x l hin c.

H thng nc thi bnh vin c thit k nhm m bo cc tiu chv mt k thut, ph hp vi kh nng u t ca bnh vin v c nh hm rng trong tng lai. Trn c s , ch u t chn xy dng h thng

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l nc thi theo cng ngh x l hp khi CN2000. S h thng x l nsau:

S x l nc thi bng thit b x l sinh hc, c m vi sinh v hp khi

CN2000.

H thng x l trn c vn hnh tun theo cc nguyn l c bn sau:

Nguyn l Modul:

Vi lng nc thi ca Bnh vin khong 300 - 500 m3/ngy m. H thngx l nc thi ca bnh vin c thit kt thao cng ngh hp khi vi 2 tmodul, mi modul c thit k cho cng sut c th t 200 300 m3/ng. (vi20h hot ng). Nh vy cho php vn hnh cc thit b mt cch ti u, bo tn dng trit cng sut ca h thit b x l ngay c trong trng hlu lng nc thi bin i theo thi im ph thuc v ngun thi nhm gth tch b iu ho, gim chi ph in v chi ph vn hnh thit b lc cao iv nhng thi gian bnh thng.

Nguyn l hp khi:

Nguyn l ny cho php thc hin kt hp nhiu qu trnh c bn x l n

thi bit trong mt khng gian thit b ca mi modul tng hiu qu gim chi phi vn hnh x l nc thi. Thit b x l hp khi cng mt l

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thc hin ng thi qu trnh x l sinh hc ym kh v cc qu trnh hiu khnh Biofin, Biofor, Aeroten qua lp m. Vic kt hp nhiu lp ny s to m mng vi sinh ti a m khng gy tc cc lp m, ng thi thc hin oxho mnh v trit cc cht hu c trong nc thi. Thit b hp khi cn

dng c ch lng c lp bn mng (Lamen) cho php tng b mt lng ng trt ngn thi gian lu.

Nguyn l t ng:

Vic vn hnh cc my bm nc thi, my bm bn, cc my thi kh v bm cc ch phm vi sinh, keo t c thc hin t ng tu thuc vo llng nc thi thng qua cc phao bo t ng lp trong cc ngn b. Nguyl ny cho php tit kim in v ho cht ng thi vn m bo duy tr ckh nui vi sinh hiu kh v thc hin x l nc thi.

Cc ch phm vi sinh s dng trong h thng

+ Ch phm vi sinh BIOWC96 v DW97:y l ch phm phn gii (thu phn) nhanh cc cht thi hu c phc tp t trong cc b pht ca bnh vi

to iu kin phn gii kh trit cc cht thi hu c phc tp thnh cc th phn d phn hu trc khi bt u qu trnh oxy ho trong thit b x l sinhc. Do , qu trnh phn hu cc cht hu c trong cc thit b xy ho sinhhc sinh hc din ra nhanh hn ( tc phn hu tng 7-9 ln) nh vy gic s qu ti ca cc b pht, gim kch thc thit b, tit kim chi ph cto, chi ph vn hnh cng nh din tch mt bng cho h x l. Gi thnh ch ph x dng DW 97 l 45/m3 s lm tng hiu qu lm sch, gim chi ph in

nng+ Cht keo t tc cao PACN 95(Cho trng hp c ca ngun tng

t ngt), cho php gim kch thc thit b lng mt cch ng k, t gichi ph xy dng v vn hnh tit kim nng lng m vn m bo tiu chuu ra ca nc thi.

+ Ch phm vi sinh Enchoice Solutions:y l sn phm hu c a Enzyme,t phn hu 100%, khng c hi ti con ngi, mi trng v cc h sinh thDung dch Enchoice Solutions x l mi bng cc c ch khc nhau dn hiu qu kh mi cao: c ch ho tan, c ch m, v c ch xc tc cc phng ho hc kh cc hp cht gy mi.Tc dng ca Enchoice:TTQT&BVMT 55


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* Kh mi hi pht sinh do s phn hu cc cht hu c trong nc thi.* Khng ch cn trng rui, mui.* y nhanh qu trnh phn hu sinh hc cc cht hu c gp phn lm

gim BOD, COD trong nc thi.

Thuyt minh cng ngh x l.+ X l s b bc 1:

Nc thi t cc ngun khc nhau theo h thng cc ng ng ring chvo b gom, b ny c xy dng ti mt v tr thun li cho vic gom nthi ton bnh vin. Ti y, tt c cc rc th c kch thc ln nh: giy, bnilon, que, g c gi li h tch bng li inox 5 v c a ti i

tp trung rc bnh vin.T b thu gom, nc thi chy ra b iu ho nhm cn bng lu lng

nng cc cht nhim ng thi thc hin qu trnh lm thong s b. Ty, nh k mt ln mt tun nc thi c b sung vo mt lng BIOWChoc DW97 nhm thu phn s b cc cht hu c to iu kin thun li cqu trnh xy ho tip theo.

nng cao mc ng u cc cht hu c trong nc thi, trnh lcn v to mi trng thun li cho vi sinh vt hot ng, trong b iu hc lp h thng sc kh. Nc thi c bm thng xuyn ln containerx l vi mt lng n nh khng i bng bm. bo m qu trnh xc lin tc cn lp thm mt bm d phng cng cng sut.

+ X l bc 2:

X l bc hai l qu trnh x l quan trng kt hp cc cng on x lkhc nhau c thc hin trong container thit b. Nc thi c bm vo thi b trc tin i vo ngn x l vi sinh ym kh. Nc thi c dn qua lp vi sinh c cu to c bit hnh thnh dng nc lan to i cc nhnh trong lm to mng vi sinh ti a phn b ng u trong lp m. Do cu to nhvy qu trnh phn hu sinh hc ym kh din ra ng u vi hiu sut xcao. Ngoi ra, vic cp thm ch phm vi sinh c hiu DW-97H (2-3 mg/lt) sgip cho vic phn hy c thc hin nhanh hn. Thi gian lu ca nc th

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kiu lng bn mng (Lamen) cho php tng b mt lng ng thi rt ngn thgian lu. Ngoi ra, Ti y nc thi c b sung cht keo t PACN-95 (nn 5-8mg/lt) c tc dng to bng cn to, tng tc lng, gip cho qu trntch bng bn din ra nhanh chng v gim kch thc thit b.

Nc thi qua x l sinh hc v c lng trong nhng vn cn chmt lng nht nh cc vi khun gy bnh, do cn c dn sang ngn ktrng dit tr vi khun trc khi x ra mi trng. Hiu qu v trit nhkh trng bng dung dch Chlorine. Dung dch Hypochloride Na hoc Ca(NaOCl, hoc Ca(OCl)2) c pha trn v bm nh lng vi nng 4 6mgCl2/m3 nc thi. Vic nh lng Clo hot tnh cn thit cho kh trng nh c

thit b trn, thit b pha Cl2, v cc bm nh lng Cl2 c lp ng b trongmodul thit b hp khi.

Nc thi sau khi c kh trng c chy vo h cha nc thi xl trc khi thi v mng thot nc chung ca khu dn c.

+ X l bn.Bn, cn lng ngn lng v tng ngn x l sinh hc s c bm v

cha bn. Ti y, di tc dng ca qu trnh ln men ym kh, phn ln ccn s c khong ho cng vi s to thnh mt s sn phm ph ca qtrnh ln men ym kh CH4, NH3, H2O, H2S., th tch ca bn gim mt cchng k. Mt khc, ti y d lng ca men BIOWC96 hoc DW97 b sung s y mnh nhanh qu trnh phn hu bn v dit tr cc trng giusn cng nh vi khun gy bnh cha trong bn trc khi chy ra mi trngBn sau khi x l c ht nh k bng xe v sinh a n khu x l tp trun

thng qua hp ng vi Cng ty Mi trng v th.4.1.2.3. Gim thiu tc ng ca cht thi rn.

a. Phn loi cht thi rn.

Vic phn loi cht thi rn c tin hnh ngay t ngun ngay ti nguvi cc nguyn tc c bn sau:

- Tin hnh phn loi ngay thi thi im cht thi pht sinh v ng c

cht thi trong cc ti, thng theo ng quy nh.

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+ M t cng ngh l t:

L t L45 l loi l nhit cao, c kim sot lung kh, ng dng kthut t 02 ln. Rc ph thi c a vo l t bun s cp (nhit 800-1.2000C). Kh thi ra l t s cp c t li ln hai bun th cp cnhit t 1.050-1.1000C. Khng kh cung cp cho qu trnh t t h thngqut ly tm v cc ng ng c van kim sot lung kh.

+ Quy trnh vn hnh l t:

Nhin liu c cp vo bn cha, sau cc van du c m nhi

liu t chy vo thit b t. t thi gian hot ng cho hai thit b t, cc rs phn cp thi gian theo tng bung t. Thi gian thch hp cho bung t cp t khong 60 pht, cho bung t th cp v qut gi khong 6 giy. Khi hthng vn hnh ti cc bung t tng ng s c ng h bo nhit . Qust nhit ti cc bung: khi nhit ti bung t s cp t n nhit 850-1.1000C thit b t s tng ng ngng hot ng; khi nhit h xunn 8000C thit b t tng ng s hot ng tr li.

+ X l kh thi l t:

TTQT&BVMT 60

Dng cht thi rn

Dng kh nngDng kh thi

rc thiloi 1

Khoang lnh Np liu

t rc thi trong bung t s cp

(800-1.2000

C)

t rc thi trong bung t th cp

(1.050-1.1000C)Xyclon mng

t

X l tro x

Mtphnkh nngtunhon

Thi vomi trng

Kh thi

Ghi ch:


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Kh thi l sn phm cui cng ca l t, thnh phn chnh ch yu gCO, bi (thng c ng knh khong t 3 n 100m), SO2, HCl, NOx, HF,kim loi nng (Cu, As, Ni, Pb, Cd, Hg...), Dioxin v Furan...Lng kh thi nyc x l bng phng php Xyclon mng nc vi h thng gm 02 xyclomng nc ni tip. Mi xyclon c chiu cao khong 1,0 - 2,0m, ng kn0,6m, hot ng theo nguyn l cng chiu v ngc chiu (nc vi trong c p lc phun thnh cc tia nh i cng chiu v ngc chiu vi lunkh).

Ti y bi, kh c c hp th v theo dng nc i ra khi lung khvo h thng lng ng, ng thi mt s kh c cng b nc vi hp th chuyn thnh nhng ho cht t c hi hn theo cc phn ng:

SO2 + Ca(OH)2 = CaSO3 + H2O4NO2 + O2+ 2H2O = 4HNO32HNO3 + Ca(OH)2 = Ca(NO3)2 + 2H2OCO2 + Ca(OH)2 = CaCO3 + H2O

Sau khi x l, kh thi l t m bo khng mu, khng mi, khng cha khthi c hi v t TCVN 6560-2005.

Nc thi t h thng xyclon mng nc em theo cc kt ta i vo b

lng pha di, cc cht kt ta c nh k no vt em chn lp ti ni qnh. Phn nc sau cho qua b nc sa vi b sung Ca(OH)2 v sdng quay vng ti s dng.

+ X l tro x:Tro v x pht sinh sau khi t c tp trung v em chn lp ti ni quy

nh ca bnh vin cng vi cc cht kt ta trong khu x l kh thi l t.- Phng php lm tr ha cht thi rn loi 2.

Cht thi loi ny s c lu gi trong cc khoang cha ring c dung tccha


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ti quyt nh s 32/2005/Q-BYT, ngy 31/10/2005 v vic ban hnh tiuchun thit k khoa chun on hnh nh.

Cc thit b chp X-quang, CT-Scanner, MRI phi c xut x r rng (mhiu my, ni sn xut, nm sn xut). Cc thit bi ny c nh k mi nkim tra mt ln, quy trnh kim tra phi da trn vn bn ca Tng cc Tichun-o lng-Cht lng LVN 41:1999.

Trang b y phng tin bo v lao ng cho ngi vn hnh mtrang b cc thit b che chn thch hp nh knh ch che chn tuyn gip. Nhvin iu khin my X-quang phi c trang b liu k c nhn v c khnh k.

4.1.2.5. Cc bin php gim thiu ly lan dch bnh.- Nghim cm a ra khi bnh vin nhng hng ho, vt phm, th

phm, ung c kh nng truyn dch bnh.

- Nghim cm tuyt i cc bnh nhn sinh hot bn ngoi bnh vin, bit i vi cc bnh nhn iu tr cc khoa ly nhim.

- Thc hin thng xuyn cng tc ty u, dit khun, v sinh mi trn01 ln/tun.

- Nghim cm khng cho bnh nhn ra khi bnh vin, tip xc vi ngngoi khi ang trong qu trnh iu tr ni.

- Nghim cm tuyt i a ngi v phng tin vo ni c kh nng llan dch bnh; trong trng hp c bit cn trang b y cc dng c phh theo ng quy nh ca B Y t.

4.1.3. Cc gii php khc.- Trng cy xanh trong khun vin bnh vin v xung quanh hng ro

to cnh quan, chng bi, n, cc loi kh v lm trong sch mi trng. Chcc loi cy cao, l to, nhiu tng nh: Cy g h u, keo tai tng, bch nkhong cch cc cy t 5 - 10 m.

- Xy dng cc bin php bo v ngi lao ng trong khu x l nc thtrnh kh nng b nh hng ti sc khe do tip xc vi khng kh c mang vsinh vt, bi. nh k khm sc kho, c bit l cc bnh nhim khun h hd ng tai mi hng, d ng ngoi da.

4.2. Cc bin php phng nga, ng ph vi s c mi trng.

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- Xy dng b cha nc, trang b cc thit b cha chy y phnchy, cha chy theo ng quy nh v theo tiu chun phng chng chyTCVN 3254-89.

- Lp t h thng bo chy t ng ti cc ni quan trng v c kh nnxy ra chy n cao.

- Xy dng ni quy an ton s dng in, s dng bnh oxy ph bin ti cv tr lm vic.

- i vi cc cp in c t trn cao c automat t ct khi xy rchp in, cu dao in c thit k ph hp v c t trong hp quy nh

- Hun luyn cho cn b cng nhn vin cc phng thc v bin php x

l trong trng hp c s c xy ra, theo ng nguyn tc an ton lao ng.- m bo an ton lao ng, bnh vin trang b y cc phng tin b

h lao ng v yu cu cn b cng nhn vin thc hin nghim tc trong cnvic.

- phng trnh s c do st: Bnh vin lp t h thng chng st nhng v tr cao tng v cc thit b bng kim loi c cao theo Quy nh76/VT ngy 2/3/1983 ca B Vt t. Lp t h thng li chng st cho ccng trnh khng phi kim loi c cao >15m gm cc ct thu li b tr quanmi.

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CHNG VCAM KT THC HIN BIN PHP BO V MI TRNG

Bnh vin 71 Trung ng l n v ch u t d n u t xy dng,

ci to, m rng, nng cp Bnh vin 71 Trung ng quy m 500 ging iu tr ni tr , cam kt phi hp cng cc c quan chc nng thc hinnghim tc cc gii php bo v mi trng nu chng 4 ca bo ccng nh cc quy nh chung v bo v mi trng c lin quan n qu trntrin khai, thc hin d n.

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CHNG VI

CC CNG TRNH X L MI TRNG

CHNG TRNH QUN L V GIM ST MI TRNG

6.1. Danh mc cc cng trnh x l nhim mi trngTrn c s cc gii php x l mi trng nu chng 4 Bnh vin 7

Trung ng s u t, xy dng cc thit b, hng mc cng trnh nhm x hiu qu cc cht nhim sau:

Bng 17: Danh mc cc cng trnh x l nhim mi trng TT Danh mc cng trnh x l mi trng S lngI H thng x l cht thi rn1 Khoang lnh cha CTR c php thiu hu 01 khoang2 Khoang BTCT cha CTR khng c php tiu

hu01 khoang

3 H thng thu gom rc thi y t 01 h thngTi nilonThng nha

4 Xe y thu gom rc thi sinh hot 02 ciII H thng x l nc thi5 Mng li thot nc ma 01 h thng6 B t hoi 3 ngn 10 b7 B thu gom nc thi tp trung 01 b8 B thu gom v lc rc 01 b9 B x l theo nguyn l modun hp khi 01 h thng

B x l ym kh B x l hiu kh B lng B kh trng

10 B x l bn 01 b11 H sinh hc 01 h

12 H thng thu gom x l nc thi cc phnglabo xt nghim 01 h thngIII H thng x l kh 13 Phng x l kh bng tia t ngoi 01 phng14 H thng phun nc ng giao thng ni b 01 h thng

H thng cyclon mng t 01 h thng15 Kho ho cht dit khun, kh trng 01 kho16 Bm phun dit khun 05 ciIV H thng khc17 H thng cy xanh 01 h thng18 H thng chng chy 01 h thng19 H thng chng st 01 h thng

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6.2. Chng trnh qun l v gim st mi trng

Chng trnh qun l mi trng m bo cho cc bin php bo v mtrng xut trong bo co TM c thc thi, cc bin php qun l mtrng, t chc qun l, thc hin cc bin php phng trnh, cng tc quantrc, ng cu khi c tai bin mi trng phi m bo cc nguyn tc sau:

6.2.1. Qun l mi trng

Khi d n i vo hot ng, Ch d n s thc hin nghim chng trnqun l mi trng, bao gm:

- Xy dng k hoch qun l mi trng khu vc.

- ra chng trnh quan trc mi trng.

- Xy dng quy trnh p ng khn cp v tai bin mi trng.

- C k hoch qun l, trin khai cc cng tc bo v mi trng tng cho cc giai on: chun b mt bng thi cng cng trnh v vn hnh cng trnh

- Qun l cht thi rn, nc thi v kh c hi sinh ra

6.2.2. Chng trnh gim st, quan trc mi trng

Chng trnh gim st, quan trc mi trng c tin hnh mt cch lintc trong sut qa trnh hot ng ca d n v xc nh c cc ni dung sau

- i tng, ch tiu quan trc mi trng.

- Thi gian v tn sut gim st.

- D tr kinh ph cho quan trc mi trng.

a. Gim st cht lng mi trng khng kh

Ch tiu gim stTn sutgim st a im gim st

Vi kh hu04ln/nm

Gm 6 v tr :01 im trc phng khm bnh.01 im ti khu hnh chnh bnhvin.01 im ti trung tm bnh vin.02 im ti khu dn c gn bnh

vin

Nng biTing n NH3H2SSO2 NO2COCO2

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u ng khi ca l t cht thi rnCH4THC- Tiu chun p dng:

+ TCVN 5937; 5938 - 2005 Cht lng khng kh - Tiu chun cht lngkhng kh xung quanh.

+ Tiu chun ca B Y t v v sinh mi trng ban hnh km theo Quynh s 3733/Q - BYT ngy 10/10/2002 ca B Y t.

+ TCVN 6560-1999: Cht lng khng kh i vi l t rc thi y t.

b. Gim st ting n:

- Cc im gim st:

02 im trong khun vin Bnh vin.

04 im khu dn c ngoi tng ro bnh vin.

- Tiu chun p dng: TCVN 5949 - 1998 - Ting n khu vc cng cng v khu dn c - Mc n ti a cho php.

- Tn sut gim st: 04 ln/nm.

c. Kim sot an ton bc x:

- Tn sut gim st: 04 ln/nm.

- V tr gim st ti khu vc khoa chun on hnh nh

d. Gim st cht lng mi trng nc

Ch tiu gim stTn sutgim st

a im gim st

PH

04 ln/nm

Gm 03 v tr:

+ Nc thi sau h thng x l+ 03 im nc ging nh dn+ 03 im nc mt khu vc

NO3-SO42-Tng NTng PCht rn l lngBOD5COD

Coliorm

- Tiu chun p dng:

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+ TCVN 5942 - 1995: Gi tr gii hn cho php ca cc thng s v nng cc cht nhim trong nc mt.

+ TCVN 5944 - 1995: Gi tr gii hn cho php ca cc thng s v nng cc cht nhim trong nc ngm.

+ TCVN 6772: 2000 - Cht lng nc - Nc thi sinh hot - Gii hnnhim cho php.

6.2.3. Quan trc v sinh mi trng lao ng

iu kin v sinh mi trng lao ng s c quan trc ti cc v tr ckh nng chu nh hng ca cc yu t bt li i vi sc khe con ng Nhit , m, ting n, chiu sng v sut liu lng phng x, hi

c. Cc v tr gim st l cc khoa, phng, khu iu tr, bung chp X-quang.Hng nm, bnh vin s lp k hoch gim st cht lng mi trng v

cc c quan chuyn mn ly mu, phn tch, o c, nh gi cc thng scn thit. Cc s liu s c lu gi lm c s theo di hin trng mtrng bnh vin.

Ngoi ra, bnh vin c chng trnh kim tra sc khe nh k cho cn bcng nhn vin. y l mt cng vic rt quan trng nhm pht hin kp th bnh ngh nghip iu tr hoc bi dng, phc hi sc khe

TTQT&BVMT 68


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CHNG VIID TON KINH PH CHO CC CNG TRNH MI TRNG- Cn c lp d ton:+ D ton xy dng cng trnh.+ n gi XDCB ban hnh km theo quyt nh s 2992/2006/Q-UBND

ngy 19/10/2006 ca UBND tnh Thanh Ha+ n gi XDCB ban hnh km theo quyt nh s 2993/2006/Q-UBND

ngy 19/10/2006 ca UBND tnh Thanh Ha+ nh mc d ton xy dng c bn ban hnh km theo quyt nh s

24/2005/Q-BXD ngy 29/07/2005 ca B trng B xy dng+ nh mc chi ph t vn u t theo Q s 10/2005/Q-BXD ngy

15/04/2005 ca B xy dng+ Thng bo gi Qu II nm 2007 ca lin S Xy dng - S TC tnh Thanh

Ha+ Thng bo gi thit b x l mi trng ca trung tm cng ngh x l

mi trng - B t lnh ha hc v cc n v khc.+ V cc vn bn hin hnh khc.- Gi tr d ton:c tnh l 7.166.000.000 vn, bao gm co hng mc

sau:+ Xy dng h thng x l cht thi rn: 249.000.000 vn+ Xy dng h thng x l nc thi: 6.125.000.000 vn+ H thng x l kh: 702.000.000 vn+ H thng x l khc: 90.000.000 vn

Bng 23: D ton ti chnh xy dng cc cng trnh x l mi trng ()TT

Danh mc cng trnh x l mitrng

Slng

D trkinh ph Thnh tin

I H thng x l cht thi rn 249.000.0001 Khoang lnh cha CTR c phpthiu hy

01khoang 50.000.000 50.000.000

2 B cha cht thi rn khng c php tiu hu 01 B 75.000.000 75.000.000

3 H thng thu gom rc thi y t 01 HT50.000.000 50.000.000Ti nilonThng nha

4 Xe y thu gom rc thi sinh hot 02 ci 2.000.000 4.000.000

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5 Ci tin nng cp l t ln 45kg/h 70.000.000II H thng x l nc thi 6.125.000.0006 Mng li thot nc ma 01 HT1.500.000.000 1.500.000.0007 B t hoi 3 ngn 10 b200.000.000 2.000.000.0008 B thu gom nc thi tp trung 01 b300.000.000 300.000.0009 B thu gom v lc rc 01 b200.000.000 200.000.00010 B x l theo nguyn l modunhp khi 01 HT 1.500.000.000 1.500.000.000

B x l ym kh B x l hiu kh B lng B kh trng

11 B x l bn 01 b 50.000.000 50.000.00012 H sinh hc 01 h 500.000.000 500.000.00013 H thng thu gom v x l ncthi labo xt nghim 01 HT 75.000.000 75.000.000

III H thng x l kh 702.000.000

14 Phng x l kh bng tia t ngoi 01 phng 500.000.000 500.000.000

15 H thng phun nc ng giaothng ni b 01 HT 150.000.000 150.000.000

16 H thng Cyclon mng t 01 HT30.000.000 30.000.00017 Kho ha cht dit khun, khtrng 01 Kho 20.000.000 20.000.000

18 Bm phun dit khun 05 ci 400.000 2.000.000IV H thng khc 90.000.00019 H thng cy xanh 01 HT 50.000.000 50.000.00020 H thng chng chy 01 HT 15.000.000 15.000.00021 H thng chng st 01 HT 10.000.000 10.000.000

22 Ph gim st mi trng15.000.000 15.000.000

Tng cng 7.166.000.000(Bng ch: By t, mt trm su mi su triu ng)

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CHNG VIIITHAM VN KIN CNG NG

Trong qu trnh thc hin lp bo co TM, ch u t l Bnh vin 7

Trung ng cng nhm chuyn gia ca c quan t vn tin hnh t chc thamvn kin cng ng x Qung Tm, huyn Qung Xng, tnh Thanh Ho.

Nhng ni dung chnh m Ban qun l d n cp xin kin tha

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