Center for Experimental Economics in Education, Shaanxi Normal University, Xi'an, China.
Freeman Spogli Institute of International Studies, Stanford University, Stanford, California, United States of America.
PLoS One. 2018 Jul 20;13(7):e0200889. doi: 10.1371/journal.pone.0200889. eCollection 2018.
The purpose of this paper is to describe current practices of medical waste management, including its generation, investments, collection, storage, segregation, and disposal, and to explore the level of support from upper tiers of the government and health care system for medical waste management in rural China.
The authors draw on a dataset comprised of 209 randomly selected rural township health centers (THCs) in 21 counties in three provinces of China: Anhui, Shaanxi and Sichuan. Surveys were administered to health center administrators in sample THCs in June 2015.
The results show that the generation rate of medical waste was about 0.18 kg/bed, 0.15 kg/patient, or 0.13 kg/person per day on average. Such per capita levels are significant given China's large rural population. Although investments of medical waste facilities and personnel in THCs have improved, results show that compliance with national regulations is low. For example, less than half of hazardous medical waste was packed in sealed containers or containers labeled with bio-hazard markings. None of the THCs segregated correctly according to the categories required by formal Chinese regulations. Many THCs reported improper disposal methods of medical waste. Our results also indicate low levels of staff training and low rates of centralized disposal in rural THCs.
Medical waste is a serious environmental issue that is rising on the agenda of policymakers. While a large share of THCs has invested in medical waste facilities and personnel, it appears that actual compliance remains low. Using evidence of low rates of training and centralized disposal, we surmise that a lack of support from upper tiers of management is one contributing factor. Given these findings, we recommend that China's policymakers should enhance support from upper tiers and improve monitoring as well as incentives in order to improve medical waste management.
本文旨在描述当前中国农村地区的医疗废物管理实践，包括其产生、投资、收集、储存、分类和处置，并探讨政府和医疗体系对医疗废物管理的支持程度。
作者利用了一组由中国三省 21 个县的 209 个随机选择的乡镇卫生院（THC）组成的数据集。2015 年 6 月，对样本 THC 的卫生中心管理人员进行了调查。
结果表明，医疗废物的产生率约为 0.18 公斤/床、0.15 公斤/病人或 0.13 公斤/人/天，考虑到中国庞大的农村人口，这一水平相当可观。尽管 THC 对医疗废物设施和人员的投资有所增加，但结果表明合规性较低。例如，不到一半的危险医疗废物装在密封容器或贴有生物危害标记的容器中。没有一家 THC 按照中国正式法规要求的类别进行正确分类。许多 THC 报告了医疗废物的不当处理方法。我们的结果还表明，农村 THC 的员工培训水平低，集中处理率低。
医疗废物是一个日益受到政策制定者关注的严重环境问题。虽然很大一部分 THC 已经对医疗废物设施和人员进行了投资，但实际合规性似乎仍然较低。根据培训和集中处理率低的证据，我们推测管理层高层的支持不足是一个促成因素。鉴于这些发现，我们建议中国的政策制定者应该加强上级的支持，并改善监测以及激励措施，以改善医疗废物管理。
