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Wastewater Characteristics and Appropriate Method for Wastewater

Management in the Hospitals

Article  in  Iranian journal of public health · July 2012

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Iranian J Publ Health, Vol. 38, No.1, 2009, J Publ Health, Vol. 38, No.1, 2009, pp.34-40
pp.34-40 Original Article

Wastewater Characteristics and Appropriate Method for

Wastewater Management in the Hospitals
AR Mesdaghinia, *K Naddafi, R Nabizadeh, R Saeedi, M Zamanzadeh

Dept. of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Iran
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

(Received 29 Jun 2008; accepted 7 Feb 2009)

Abstract
Background: Hospitals generate relatively large quantities of wastewater that may contain various potentially hazardous
materials; therefore the proper management of hospital wastewater is essential.
Methods: In this cross-sectional study, the quality and quantity of wastewater in the hospitals of Tehran University of
Medical Sciences (TUMS), Tehran, Iran, were studied and the suitable method for wastewater management in the hospitals
was determined.
Results: Monitoring of pH, TSS, BOD5, COD and total coliforms indicated that the quality of wastewater in the hospitals
was similar to domestic wastewater. The wastewater production in the hospitals was determined to be in the range of 398 to
1090 L/d/(occupied bed). The study on wastewater treatment and disposal methods demonstrated that discharge to munici-
pal wastewater collection system is the best alternative for wastewater management in the hospitals, but this approach is not
applicable for all of the hospitals. Baharloo, Cancer Institute, Children, Farabi, Imam Khomeini, Razi, Roozbeh, Shariati
and Valiasr hospitals can be connected to municipal wastewater collection system at present.
Conclusion: It is recommended that these hospitals’ wastewater be discharged to municipal wastewater collection system.
Amir Alam, Bahrami, Mirza Koochak Khan and Sina hospitals will be able to discharge their wastewater into sewerage net-
work at second phase of Tehran sewerage project (in 2010) and Arash Hospital will be able to discharge its wastewater into
sewerage network at third phase of Tehran sewerage project (in 2015). These hospitals have to select onsite separate waste-
water treatment alternative.

Keywords: Hospital, Wastewater, Waterquality, Wastewater treatment, Iran

Introduction infectants also reach the wastewater after as re-

Improvement of the hospital waste management sidual quantities (6, 7). First findings of pharma-
has received increasing attention throughout the ceuticals in the aquatic environment were repor-
world since hospitals generate a considerable ted in the 1970s. Some investigations represented
amount of medical waste each year (1-3). The the existence of drugs in public owned treatment
generation of waste in hospitals has been increasing works effluents (5, 8-10).
due to development in medical services and prod- Hospital wastewater has similar quality to mu-
ucts. Nowadays several thousands of ingredients nicipal wastewater, but may also contain vari-
are used for drugs in even more products (4, 5). ous potentially hazardous components including,
In hospitals, a variety of substances besides phar- mainly, microbiological pathogens, hazardous che-
maceuticals are used for medical purposes as di- mical compounds, disinfectants, pharmaceuticals
agnostics and disinfectants. Besides the active sub- and radioactive isotopes. Indeed hospital waste-
stances, formulation adjutants, pigments and dyes water may have an adverse impact on environ-
are also drug components. Disinfectants, in par- mental and human health; therefore, the proper
ticular, are often complex products or mixtures of management of hospital wastewater is needed
active substances. After application, many drugs (2, 11, 12).
are excreted non-metabolized by the patients and The objective of this research was to study the
enter into wastewater. Diagnostics agents and dis- quality and quantity of wastewater in the hospi-

34 *Corresponding author: Fax: +98 21 66462267,E-mail: knadafi@tums.ac.ir

 AR Mesdaghinia et al: Wastewater Characteristics and…

tals of Tehran University of Medical Sciences obtained from multiplication of water consump-
(TUMS) and to determine the suitable method tion per occupied bed by conversion factor.
for wastewater management in the hospitals. The alternatives of hospital wastewater manage-
ment were compared from the viewpoint of eco-
nomical and health risk aspects, then the best op-
Material and Methods
tion of wastewater management were introduced
In this research, wastewater management in the
for each of the hospitals.
hospitals of TUMS was investigated in 2006.
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

All of the hospitals are located in Tehran, Iran.

This study was cross-sectional in design. Results
Study on wastewater quality Study on wastewater quality
Bahrami, Imam Khomeini, Razi, Shariati, Sina and Fig. 1a shows the average pH value of waste-
Valiasr hospitals were selected for monitoring of water in the investigated hospitals. The average
wastewater quality characteristics. The chemical TSS concentration of wastewater in the studied
and microbial parameters of pH, total suspended hospitals is illustrated in Fig. 1b. The average
solids (TSS), biochemical oxygen demand (BOD5), BOD5 and COD concentrations of wastewater in
chemical oxygen demand (COD) and total coli- the studied hospitals are represented in Fig. 1c.
forms were measured in the collected wastewater The average COD to BOD5 ratio (COD/BOD5)
samples. All of the examinations were perfor- of wastewater in the studied hospitals is illus-
med according to the instructions of “Standard trated in Fig. 1d. The average number of total coli-
Methods for the Examination of Water and Waste- forms of wastewater in the studied hospitals is
water” (13). presented in Fig. 1e.
Study on wastewater quantity, treatment and Study on wastewater quantity
disposal Fig. 2a illustrates the average quantity of water
A questionnaire was provided for determination consumption per occupied bed in the investigated
of wastewater production per occupied bed and hospitals. The conversion factor of water to waste-
used method for wastewater treatment and dis- water was obtained to be in the range of 75-
posal in the hospitals of TUMS. Wastewater treat- 84%. The average quantity of wastewater pro-
ment and disposal and sludge management pro- duction is showed in Fig. 2b.
cedure were investigated in Amir Alam, Cancer Study on wastewater treatment and disposal
Institute, Children, Farabi, Imam Khomeini, Mirza Cancer Institute, Children, Imam Khomeini, Razi,
Koochak Khan, Razi, Roozbeh, Shariati, Sina Shariati, Sina and Valiasr hospitals had the waste-
and Valiasr hospitals. The questionnaire included water treatment plant using activated sludge pro-
several questions about hospital specifications, cess as the secondary treatment. Efficiency of the
quantity of water consumption, wastewater treat- wastewater treatment plants was not appropriate.
ment processes, effluent disposal, sludge process- For example, In Shariati Hospital, efficiency of the
ing and disposal. Wastewater quantity was stud- wastewater treatment plant in removal of BOD5,
ied in Amir Alam, Children, Farabi, Mirza Koo- COD and TSS was obtained 78, 74 and 49%,
chak Khan, Razi, Roozbeh, Shariati and Sina hos- respectively. In all of the treatment works, opera-
pitals. The bills of water in three recent years were tion problems such as raising and bulking of
used to determine the water consumption of the sludge in secondary clarifiers and production of
hospitals. The conversion factor of water to waste- undesirable odors were observed. The most im-
water was estimated with regard to some criteria portant reasons of the low efficiency were im-
such as number of occupied beds, personnel and proper plant operation and maintenance and pro-
wards, green land area to hospital area ratio etc. blems in plant design and construction. In Shariati
The wastewater flowrate per occupied bed was Hospital, the effluent was being discharged to

35
 Iranian J Publ Health, Vol. 38, No.1, 2009, pp.34-40

cesspool and the sludge produced in the waste- ing discharged to cesspool. In Roozbeh Hospital,
water treatment plan was being disposed to the kitchen wastewater was being passed through
Kahrizak Landfill without any processing and sta- grease removal chamber and then discharged to
bilization. Amir Alam Hospital had primary waste- municipal wastewater collection system. The waste-
water treatment plant including septic tank and water produced in the other places such as baths
chlorination basin. Efficiency of the system was and laundry was being discharged to cesspool
very low and was not a suitable system for hos- without any treatment. In Farabi Hospital, the
pital wastewater treatment. In Mirza Koochak raw wastewater was being discharged to muni-
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

Khan Hospital, the untreated wastewater was be- cipal sewerage network.
9 450
8.04
8 400 383
7.45
6.77 6.81 350
7
6.19 6.37

6 300

TSS(mg/L)
243
5 250
pH

193
4 200

3 150 132

2 100 75 72

1 50

0 0
Imam Bahrami Razi Sina Shriati Valiasr Imam Bahrami Razi Sina Shriati Valiasr
Komeimi Komeimi Hospitals
Hospitals

(a) (b)
1800 2.0
COD 1.87
1600 1.9
BOD5
1362

1.8 1.75 1.77

1400 1.73
1227

1.72
1.7
1200 1.62
1.6
COD/BOD5
O2(mg/L)

1000
1.5
768

800
687

661

1.4
533
515

600
435

1.3
371

313

299

400
1.2
228

200
1.1

0 1.0
Imam Bahrami Razi Sina Shriati Valiasr Imam Bahrami Razi Sina Shriati Valiasr
Komeimi Hospitals Komeimi Hospitals

(c) (d)
1.E+10

1.E+09
3.84E+08
Total coliform (MPN/100mL)

7.67E+07 8.53E+07
1.E+08
4.18E+07
2.23E+07 2.77E+07

1.E+07

1.E+06

1.E+05

1.E+04
Imam Bahrami Razi Sina Shriati Valiasr
Komeimi
Hospitals
(e)
Fig. 1: Quality characteristics of wastewater in the investigated hospitals; (a) pH, (b) TSS, (c) COD and BOD5, (d)
COD/BOD5 ratio and (e) Total coliforms

36
 AR Mesdaghinia et al: Wastewater Characteristics and…

1800 1400

1600

Wastewater production (L/d/occupied bed)

1473 1200
Water consumption (L/d/occupied bed)

1090
1400
1000
1200 815
994 800
1000 696 679 693
848 848 856 645 642
813
768 600
800 `
398
600 531 400
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

400
200
200
0
0 Amir Razi Roozbeh Sina Shariati Farabi Children Mirza
Amir Razi Roozbeh Sina Shariati Farabi Children Mirza Alam Koochak
Alam Koochak Hospitals Khan
Hospitals Khan
(b)
(a)
Fig. 2: Water consumption (a) and wastewater production (b) per occupied bed in the investigated hospitals

Discussion Moersidik (17) studied the wastewater quality of a

Study on wastewater quality hospital in Indonesia. In the hospital, the TSS
The acidic or basic wastewater damages the waste- concentration was determined to be in the range
water collection and treatment facilities and pre- of 36-269 mg/L. Also the TSS concentration of
vents the biological treatment processes (14). Ac- a hospital wastewater in Thailand was 103 mg/L
cording to Fig. 1a, the minimum and maximum (16). Wangsaatmaja (18) obtained the TSS con-
pH values were observed in the wastewater of centration of a hospital wastewater in Bangkok
Imam Khomeini Hospital and Valiasr Hospital, to be 90 mg/L.
so the average pH value of wastewater in these The parameters of BOD5 and COD are widely
hospitals was obtained to be 6.2 and 8, respec- used to characterize the organic matter content
tively. The mentioned range (6.2-8) is suitable of wastewater (15). According to Fig. 1c, the
from the viewpoint of wastewater treatment proc- minimum and maximum concentrations of BOD5
esses and comparable to pH of domestic waste- and COD were obtained in Valiasr Hospital and
water (15). The equivalent results were obtained in Bahrami Hospital, so the average concentrations of
the other studies. Clean Technology Consultant BOD5 and COD in Valiasr Hospital were deter-
(16) determined the wastewater pH value of a mined to be 228 and 435 mg/L, respectively and
hospital in Thailand to be 7.2. In Indonesia, the the average concentrations of BOD5 and COD
range of pH in the hospital wastewater was in Bahrami Hospital were obtained 768 and 1362
obtained 5.9-12.5 (17). mg/L, respectively. The average BOD5 and COD
One of the common parameters used in defining concentrations of domestic wastewater with re-
a wastewater is TSS. According to Fig. 1b, the gard to its pollution strength are in the ranges of
minimum and maximum TSS concentrations were 110-350 and 250-800 mg/L, respectively (15).
obtained in the wastewater of Valiasr Hospital In the most of the hospitals, the BOD5 and COD
and Bahrami Hospital, so the average TSS con- concentrations of wastewater are almost equal to
centration of wastewater in these hospitals was ob- the domestic wastewater values. Clean Technol-
tained 72 and 383 mg/L, respectively. The aver- ogy Consultant (16) determined the BOD5 and
age TSS concentration of domestic wastewater is COD concentrations of a hospital wastewater to
in the range of 120-400 mg/L that is compara- be 113 and 232 mg/L, respectively. In Bangkok,
ble to the results obtained in the investigation (15). the BOD5 and COD concentrations of a hospital

37
 Iranian J Publ Health, Vol. 38, No.1, 2009, pp.34-40

wastewater were 300 and 430 mg/L, respec- In hospitals of the United States, quantity of waste-
tively (18). According to Fig. 1d, the COD/BOD5 water production per personnel and per bed has
ratio was in the range of 1.6-1.9, however in the been estimated 40 and 1000 L/d, respectively (15).
domestic wastewater, the ratio is around 2.3. Clean Technology Consultant (16) determined the
Therefore, the organic matters in the hospital wastewater production of a hospital in Thailand
wastewater had higher biodegradability in com- to be 904 L/d/bed. In Bangkok, the quantity of
parison with domestic wastewater. The high bio- hospital wastewater was 1182 L/d/bed (18).
degradability of organic matters is very desirable Study on wastewater treatment and disposal
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

from the viewpoint of wastewater treatment and Cheremisinoff and Shah (21) stated the assess-
promotes the efficiency of wastewater treatment ment of the risk of hospital wastewater is based
plants (15). upon dilution. In developed countries, most hos-
The principal area of concern is wastewater with a pitals are connected to relatively large municipal
high content of enteric pathogens, including bac- wastewater collection systems and hospital waste-
teria, viruses, protozoa and helminths, which are water represents only a small fraction of the vol-
easily transmitted through water. Wastewater of ume of sewage. Therefore, the risk of hospital
hospitals treating patients with enteric diseases is wastewater is at least because of the most dilu-
a particular problem during outbreaks of diar- tion. Smaller systems may be more hazardous
rhoeal disease. Therefore the microbial quality owing to smaller volumes of wastewater and he-
of hospital wastewater is very critical (19, 20). nce, less dilution of contaminants. A major con-
In this research, total coliforms were selected as cern in the disposal of hospital wastewater is that
indicator organisms. According to Fig. 1e, the mini- hospitals have their own sewage treatment fa-
mum and maximum numbers of total coliforms cilities. Furthermore, smaller systems are less ef-
were obtained in the wastewater of Razi Hospital ficient and may permit the discharge of infec-
and Bahrami Hospital, so the average number of tious agents into groundwater and other environ-
total coliforms in these hospitals wastewater was ments which may be a hazard for both hospital
obtained to be 2.2×107 and 3.8×108 MPN/100mL, personnel and the nearby community.
respectively. The average number of total coli- The study on wastewater quality indicated that the
forms in domestic wastewater is in the range of wastewater quality in the hospitals of TUMS
106-1010 MPN/100mL that is comparable to the was similar to domestic wastewater quality; there-
results obtained in the investigation. fore according to directions of Iranian Water &
Study on wastewater quantity Wastewater Company, wastewater management
Water consumption in a hospital is depend on in the hospitals has not limitation for onsite se-
several parameters including type of supplied me- parate wastewater treatment or discharge to mu-
dical services, number of beds, personnel and nicipal sewerage network. Environmental risk as-
wards, social, cultural and economical condition sessment and economical evaluation of waste-
of society etc (16). According to Fig. 2a, b, the water treatment and disposal methods (data not
minimum and maximum quantities of water con- shown) demonstrated that discharge to munici-
sumption and wastewater production per occu- pal wastewater collection system is the best al-
pied bed were observed in Roozbeh Hospital and ternative for wastewater management in the hos-
Razi Hospital, so the average quantity of water pitals, but this method is not applicable for all
consumption and wastewater production in Rooz- of the hospitals. Baharloo, Cancer Institute, Chil-
beh Hospital was obtained to be 531 and 398 L/ dren, Farabi, Imam Khomeini, Razi, Roozbeh,
d/(occupied bed), respectively and the average Shariati and Valiasr hospitals can be connected
quantity of water consumption and wastewater to municipal wastewater collection system at pre-
production in Razi Hospital was obtained to be sent. It is suggested that these hospitals are con-
1473 and 1090 L/d/ (occupied bed), respectively. nected to municipal wastewater collection sys-

38
 AR Mesdaghinia et al: Wastewater Characteristics and…

tem. Amir Alam, Bahrami, Mirza Koochak Khan 5. Kümmerer K (2001). Drugs in the environ-
and Sina hospitals will be able to discharge their ment: emission of drugs, diagnostic aids
wastewater into municipal wastewater collection and disinfectants into wastewater by hos-
system at second phase of Tehran sewerage pro- pitals in relation to other sources, a
ject (in 2010) and Arash Hospital will be able to review. Chemosphere, 45: 957-69.
discharge its wastewater into municipal waste- 6. Kümmerer K, Erbe T, Gartiser S, Brinker L
water collection system at third phase of Tehran (1998). AOX-Emission from hospital into
sewerage project (in 2015). These hospitals have municipal wastewater. Chemosphere, 36
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

to select onsite separate wastewater treatment (11): 2437-45.

method. In these hospitals, establishment of waste- 7. Kümmerer K, Helmers E (2000). Hospitals
water treatment plant or upgrading of existing effluents as a source of gadolinium in the
wastewater treatment plant and improvement of aquatic environment. Environ Sci Technol,
operation and maintenance practices by employ- 34: 573-77.
ment of experienced operators is needed for ob- 8. Erlandsson B, Matsson S (1978). Medically
servance of effluent discharge standards. used radionuclides in sewage sludge. Water,
Air and soil Pollution, 9(2): 199-206.
9. Kümmerer K, Steger-Hartmann T, Meyer M
Acknowledgements
(1997). Biodegradability of the anti-tu-
This research has been supported by TUMS
mour agent ifosfamide and its occurrence
grant No. 132/3810. The authors are most grate-
in hospital effluents and communal sew-
ful to the laboratory staff of the Department of
age. Water Res, 31(11): 2705-10.
Environmental Health Engineering, School of Pub-
10. Ayscough NJ, Fawell J, Franklin G, Young
lic Health, TUMS, Iran, for their collaboration in
W (2000). Review of Human Pharma-
this research.
ceuticals in the Environment. UK Envi-
ronmental Agency. Bristol.
References 11. Casson LW, Ritter MD, Cossentino LM,
1. Craig PJ (1986). Organometallic Com- Gupta P (1997). Survival and recovery
pounds in the Environment, Principles of seeded HIV in water and wastewater.
and Reactions. Longman. UK. Water Environ Res, 69(2): 285-93.
2. Halling-Sorencen B, Nielsen N, Lanzky PF, 12. Jolibois B, Guerbet M (2006). Hospital waste-
Ingerslev F, Holten-Lutzhoft C, Jorgensen water genotoxicity. Ann Occup Hyg, 50(2):
SE (1998). Occurrence, fate and effects 189-96.
of pharmaceutical substances in the en- 13. APAH, AWWA, WEF (1998). Standard
vironment- a review. Chemosphere, 36: Methods for the Examination of Water
357-93. and Wastewater. 20th ed. United Book
3. Kümmerer K, Helmers E, Hubner P, Mascart Press. Baltimore.
G, Milandri M, Reinthaler F, Zwakenburg 14. Hammer MJ, Hammer MJ Jr (2001). Water
M (1999). European hospitals as a source and Wastewater Technology. Prentice-
of platinum in the environment: emis- Hall. New Jersey.
sion with effluent-concentrations, amounts 15. Metcalf & Eddy Inc (2003). Wastewater
and comparison with other sources. Sci Engineering: Treatment and Reuse. 4th
Total Environ, 225: 155-65. Ed. McGraw-Hill. New York.
4. Richardson ML, Bowron JM (1985). The 16. Clean Technology Consultant (1994). Design
fate of pharmaceutical chemicals in the criteria of wastewater treatment plant. Ra-
aquatic environment. J Pharm Pharmacol, tchawithi hospital. Bangkok. Thailand.
37: 1-12.

39
 Iranian J Publ Health, Vol. 38, No.1, 2009, pp.34-40

17. Moersidik SS (1993). Technology alterna- Care Activities. World Health Organiza-
tives for hospital waste management. Se- tion. Geneva. Switzerland.
minar Limbah Rumah Sakit. Jakarta. 14 20. Tsai CT, Lai JS, Lin ST (1998). Quantifica-
September 1993. Universitas Indonesia. tion of pathogenic micro-organisms in the
Indonesia. sludge from treated hospital wastewater.
18. Wangsaatmaja S (1997). Environmental ac- J Appl Microbiol, 85: 171-76.
tion plan for a hospital. Asian Institute 21. Cheremisinoff PN, Shah MK (1990). Hos-
of Technology. School of Environment. pital waste management. Pollution Eng,
Downloaded from http://journals.tums.ac.ir/ on Friday, July 20, 2012

Bangkok. Thailand. 22(4): 60-66.

19. Prüss A, Giroult E, Rushbrook P (1999).
Safe Management of Wastes from Health-

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