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姓名	克莉絲汀(Tashana Providence)  查詢紙本館藏	畢業系所	國際永續發展碩士在職專班
論文名稱	聖文森與格林納汀斯醫療廢棄物管理之探討 (Medical Waste Management in St. Vincent and the Grenadines)
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摘要(中)	醫療廢物，包括由醫療機構，科研設施和實驗室產生的廢物。人類健康和環境的負面影響，在管理不當。本論文經由資料收集與分析方法，選擇位於聖文森和格林納丁斯群島(SVG) 的一個一般醫院、四個鄉鎮醫院和衛生中心和八個鄉鎮地區診所，進行問卷調查和訪談，探討SVG當前的醫療廢物管理政策。為進一步收集現有醫療廢棄物管理之作法及廢棄物分類之容器色彩編碼系統相關資料，本研究並採用面對面的採訪方式訪問醫療保健設施主管和被雇用在上述醫院或診所的廢棄物管理負責人。另一方面，本研究進行實地調查以瞭解工作人員和公眾對於當前醫療廢物管理做法之看法和態度。此外，應用多準則分析方法分析這些受訪者認為較有效的醫療廢物處理方法。 調查結果顯示大部分觀察到的醫院或診所對於不同類型的廢棄物之容器，有採用色彩編碼系統進行不同種類廢棄物之區隔與分辨。從這些醫院和診所產出的病理和解剖類廢棄物，被送到掩埋場予以深度掩埋，或埋於混凝土包覆之垃圾坑中。掩埋處理之前，這些具有感染項之廢棄物將先經高壓滅菌處理。其他無感染風險的廢棄物則與都市固體廢棄物一起送到衛生掩埋場掩埋。在一般的醫院，衛生下水道也接納實驗室廢液。 問卷調查受訪者對於醫療廢棄物管理的關注情形，結果顯示有44%的受訪者高度關注，18%有關注，31%稍有關注，6%不關心。高度關注者之35%為護理人員；這是因為他們是第一線的醫務工作者之緣故。這項調查還顯示年輕一代，無關於教育水準，對於MWM有較多關注。另一方面，受過較高教育的受訪者，對於醫療廢物管理於人體健康和環境方面之影響的問題，較有深刻的認識。59%的受訪者高度關注，14%有關注，20%稍有關注，7%不關心。有趣的是，一般民眾之所以對MWM高度關注，是因為他們想要知道當他們進入醫療保健設施時，如果該設施有不當的醫療廢物管理，可能會出現多大的風險。這項研究因此有一個結論，要進一步改進醫療廢棄物管理，不僅需要醫療人員之感知和合作，也需要一般民眾共同督促相關單位於政策之改變及醫療廢棄物之風險管理的多所關注。 調查受訪者對於醫療廢棄物最佳處置方法的看法，認為焚化法較佳者，於一般公眾有30%，於醫療院所之工作人員有42%。應用多準則分析法分析結果顯示，受訪者認為於SVG採用壓力鍋是最佳的方法。 目前在聖文森和格林納丁斯群島掩埋場對於掩埋物之滲出液係設置滲出液池，用於收集掩埋醫療廢棄物的衛生掩埋場的垃圾滲出液。儲存在滲出液池塘裡的廢液之處理方法，係藉於溫暖天氣之蒸發作用，以及緩慢滲透到地面下之方式處理。本研究建議在滲出液池塘增設可促進有機物分解的曝氣機加以改進，由敏感性分析發現投資成本及每年耗能費用為本改進方法之敏感參數。
摘要(英)	Medical Waste (MW) includes all of the waste that is generated by healthcare establishments, research facilities and laboratories. It negatively impacts both human health and the environment, when improperly managed. This thesis analyses the current Medical Waste Management (MWM) policy at a general hospital, four Rural Hospitals and Health Centres and eight Rural District Clinics in St. Vincent and the Grenadines (SVG), using a face-to-face interview. Its objectives are to understand the perception and attitude of staff and the general public towards MWM and employ a questionnaire survey and a self-completed questionnaire survey within its methodology, respectively. It seeks to explore their acceptance of the best treatment and disposal method and conducts a Multi-criteria Analysis (MCA) on the best selected treatment and disposal method for MWM. The face-to-face interview process was administered to the heads of healthcare facilities and to waste managers employed at these facilities. The results show that segregation practices at selected facilities, involve the use colour coded plastic bags system and sharps boxes. Pathological and Anatomical waste are buried in a deep burial pit or at close by cemeteries. And the infectious wastes after autoclaving, accompanied with non-infectious wastes are disposed of along with municipal solid waste at centralised Sanitary Landfills (SL’s). At the general hospital, a sanitary sewer is also used to discard laboratory free-flowing waste. Employees’ levels of concern towards MWM showed that 46% of the female respondents, 42% staff members and 100% doctors and heads of facilities had high concerns about MWM than other participants. The reason is that, most of the respondents are nurses. Doctors and nurses are more likely to be infected by viruses through direct contact with MW. The results also show that the younger generation despite educational levels, are aware of environmental issues and are concern about MWM. Persons with a higher level of education on the other hand, illustrate that they have a greater awareness of the health and environmental issues associated with MWM. The majority of the general public mentioned that their high levels of concern towards MWM are the fact that, they desire to gain knowledge about how to protect them when visiting healthcare facilities and how improper management of MW would affect the environment in which they live. The perception and attitude of the general public play an important role in determining public responses to MW, their demands for political change and increased attention to risk management institutions. In the exploration of the best treatment and disposal method for MW, participants preference of incineration illustrate 30% are from the general public and 42% are employees at healthcare facilities. Although both the general public and employees accepted incineration, the results of the MCA illustrate that Autoclave is the best method for MWM in SVG. Currently at Sanitary Landfills in SVG, Leachate Ponds are used to collect discharged leachate, which is normally allowed to evaporate and or slowly percolate into the ground. A sensitivity analysis was conducted on improving leachate management by installing surface aerators into already existing naturally aerobic ponds. The results show that capital investment and annual energy savings are the most sensitive parameters.
關鍵字(中)	★ 醫療廢棄物管理 ★ 多準則分析法	關鍵字(英)	★ Medical Waste Management ★ Multi-criteria Analysis
論文目次	Table of Contents Abstract i Chinese Abstract iii Acknowledgements v Table of Contents vi List of Tables viii List of Figures ix List of Acronyms x Chapter 1: Introduction 1 1.1 Overview of Medical Waste Management (MWM) 1 1.2 Study Background 4 1.3. Study Motivation 11 1.4. Goal and Objectives 13 1.5. Research Difficulties 14 Chapter 2: Literature Review 15 2.1. Medical Waste (MW) 15 2.1.1. Classification of MW 16 2.1.2. Sources of MW 19 2.1.3. Hazards caused by MW 21 2.1.3.1. Hazards caused by the classifications of MW 21 2.1.3.2. Hazards to the general public and the environment 23 2.1.4. MW generation and composition 24 2.1.5. MW treatment and disposal methods 25 2.2. Medical Waste Management (MWM) 30 2.2.1. Challenges facing MWM 32 2.3. Multi-criteria Analysis (MCA) 33 2.4. Perception and attitude towards MWM 37 2.4.1 Staff perception and attitude towards MWM 37 2.4.2 General public’s perception and attitude towards MWM 39 Chapter 3: Study Methodology 42 3.1 Research Objective and Framework 42 3.1.1. Problem Survey 42 3.2. MWM Policy 43 3.2.1. Face-to-face Interview 43 3.2.1.1. Prepare and conduct the interview 47 3.2.1.2. Conclude the interview 48 3.2.1.3. Revise and analysis the information 49 3.3. Multi-criteria Analysis (MCA) for MWM 50 3.3.1. Questionnaire and Self-completed Questionnaire surveys 50 3.4. Survey Development 52 3.4.1. Selection of Sample Size 53 3.4.2. Questionnaire Design 53 3.5. Surveys Implementation 54 3.6. Surveys Analysis 55 3.7. Application of Multi-criteria Analysis (MCA) for MWM 57 3.7.1. Introducing the MCA technique 57 3.7.2. Steps in employing the MCA for MWM 58 Chapter 4: Results and Discussion 65 4.1. Characteristics of selected facilities 65 4.2. MWM policy at selected facilities 66 4.2.1. Environmental health practices 68 4.2.2. Estimated amounts of MW generated 69 4.3. Obstacles encountered in MWM 70 4.4. Perception and attitude of staff towards MWM 71 4.4.1. Descriptive demographic statistics and level of concern towards MWM 71 4.4.2. Perception of MW constituents 73 4.4.3. Staff perception and attitude towards current MWM policy 74 4.4.4. Attitude towards training and improving MWM 78 4.5. General public’s perception and attitude towards MWM 78 4.5.1.Descriptive demographic statistics and level of concern towards MWM 78 4.5.2. Perception and attitude towards MWM 80 4.6 Acceptance of the best treatment and disposal method for MWM 82 4.7. Presentation of MCA results 83 4.8. Discussion 84 4.8.1. Comparing treatment and disposal methods 101 4.8.2. Disposal of MW at SL’s in SVG 103 4.8.3. Leachate composition at SL’s 107 4.8.3.1 Estimating leachate constituents vs. landfill age in SVG 109 4.8.3.2 Introducing the sensitivity analysis on leachate management 110 4.8.3.3 Sensitivity analysis on leachate management at SL’s in SVG 112 Chapter 5: Conclusion and Recommendations 115 5.1. Conclusion 115 5.2. Recommendations 118 References 120 Appendixes 128 Appendix 1 129 Appendix 2 139 Appendix 3 143 Appendix 4 146
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指導教授	廖萬李(Wan-li Liao)	審核日期	2013-6-10
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