12/4/2011

WATER AND
WASTEWATER TREATMENT
IN HOSPITAL
Mohd Razman Salim
Institute of Environmental and Water Resource
Management, Faculty of Civil Engineering,
Universiti Teknologi Malaysia,
Presented at

2nd International Seminar on Environmental Health

Water and Green Hospital

December 3 4, 2011
Singgasana Hotel, Surabaya

EPA information:
http://www.epa.gov/esd/chemistry/pharma/

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Status of Hospital Wastewater

Intensive consumers of water
HIGHER wastewater flow (400
1200 L/bed/d)
Effluents pathogens (patients
with enteric disease), heavy
metals, PPCPs, toxic chemicals and
radioactive elements.
Difficult to remove even after
treatment cause pollution
(biological imbalance putting
negative effects on environment)

Status of Hospital Wastewater

Hospitals are too dangerous for
the biodiversity as their
wastewater can contaminate
the food chain.
Two kinds of wastewater
hazardous and non-hazardous
wastewater.
Mostly non hazardous and can
be treated as domestic
wastewater.

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Status of Hospital Wastewater

Direct discharge into urban
sewerage systems without
pretreatment risk to environment.
Cause pollution acute infection
and latent characteristics that are
harmful.
Releasing into sewer or river
outbreaks of waterborne infectious
diseases, serious threat to people's
health.

Table 1- Comparison of the average concentrations in pollutants of hospital effluents

(H.E.) and urban classic effluents (U.C.E) [Emmanuel et al., 2001]

Pollutants

Units

Concentrations Concentrations
in U.C.E
in H.E.

Suspended Solid
Matters
BOD5
TOC
COD

mg/L

300

225

mg/L
mg/L
mg/L

220
160
500

603
211
855

Total Phosphorous

mg/L

8.80

Chlorides

mg/L

50

188

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Excerpt from
Newspaper

Expired Drugs Where Do They Go?

500 patients surveyed:
54% disposed of
medications in the trash
35.4% flushed drugs down
the toilet or sink
7.2% did not dispose of
medications

Used All
Prior to
Expiration

Returned to
Pharmacy

Did Not
Dispose

Flushed

Trashed

2% used all medication prior

to expiration
1.4% returned medications
to the pharmacy
Kuspis and Krenzelok. 1996. What happens to expired
medications? A survey of community medication
disposal. Vet Hum Toxicol. 38(1):48-9

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PPCPs in Wastewater
Sources:
Pharmaceutical industries
Hospitals, medical facilities
Households
medicines
Personal care products
Farm animals

Pharmaceuticals and Personal Care Products

Rapid degradation in the environment
Low bioaccumulation in biota
No biomagnification through food
chains
Not acutely toxic
BUT
Have biological effects
even at low doses
Are pseudo-persistent
contaminants

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How Contamination Affect

Aquatic Ecosystem
Chemicals in the aquatic environment can
result in continuous, multigeneration exposure.
Fish Feminization (estrogen exposure?)
e.g.: Boulder Creek, CO: female white suckers outnumber
males by > 5 to 1; 50% of males have female sex tissue
(David Norris, Univ. of Colorado at Boulder)

Antidepressants affect to growth of fish and

frog?
e.g.: Low levels of anti-depressants (Prozac, Zoloft, Paxil and
Celexa) development problems in fish, and metamorphosis
delays in frogs (Marsha Black, Univ. of Georgia)

How Can Wastewater Be Reduced?

Segregate toilets and kitchen
wastewater from laboratory and
operation theatre wastewater.
About 90% wastewater reduction
lesser quantity to be treated
(smaller volume of pollutants).
Wastewater treatment
technologies such as physical,
chemical and biological can be
easily applied.

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Other Approaches:
Control what gets in environment:
Source control (medical disposal
practices)
Design more environmentally friendly
drugs
Minimize over use or misuse of
drugs/chemicals
Point of use treatment of drugs
Add advance waste and water treatment
technologies and source control at point
of entry into environment.

Treatment System Options

Study the LCA of the WWT Systems
Economically viable, eco-friendly and
sustainable
(most of the times is ignored).
Develop guidelines for LCA of WWT
systems.
Pros and cons of the systems e.g:
Energy usage, Residual pollution,
Environmental degradation, cause of
global warming etc..

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Effluents from Hospital Activities (PPCPs,

pathogens etc.
Domestic
and Hospital
Wastewaters

Hospital Sewerage
System
Urban
Wastewater

Urban Sewerage
System

Surface Water

Wastewater
Treatment
Plant

Groundwater

Option for Hospital WWT

Option 1
Merits
Direct
No investment,
Discharged maintenance cost and
process control

Demerits
Potential risk of
contaminations
surface water
drinking water
human body. If
epidemic, raw sewage
should be disinfected
causing environmental
damages

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Option for Hospital WWT

Option 2

Merits

Demerits

Sewer and co- Direct discharge to

treatment
the environment is
with municipal eliminated
WWTP

Dilution by
stormwater
overflow hinders
the biological
degradation in the
WWTP

Option for Hospital WWT

Option 3
On-Site
WWTP

Merits
Reduction of
loading by
approximately
90%

Demerits
Requires stringent
monitoring and
process control by
the operators and
also the local
authorities

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Option for Hospital WWT

Option 4
On-Site and
subsequent
municipal
WWTP

Merits
Demerits
Dual treatment
Expensive and
processes allowing complex
for optimum
safety

Municipal STP Connection

Area without epidemics of enteric disease sewer
discharge is acceptable but need to meet
requirements below:
Efficient STP connection available (with 95%
bacterial removal)
Proper sludge treatment
(anaerobic digestion)
Effective waste management
system eliminating pollutants
in discharged sewage
Separate treatment of
excreta of hospital patients

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Aerobic Processes
Type

Treatment Process

Application

Suspended
Growth

Activated-Sludge Process
(es)
Aerated Lagoons
Aerobic Digester
Membrane Bioreactor (MBR)

Carbonaceous BOD
Removal, Nitrification
Stabilization,
Carbonaceous BOD
Removal

Fixed Film
(Attached Growth)

Trickling Filters
Rotating Biological Contactor
(RBC)
Biotowers
Aerobic Filter Bed

Carbonaceous BOD
Removal, Nitrification

Hybrid (Combined) Aerobic Filter Bed/ Activated

Sludge
Attached and
Suspended
Growth Processes

Carbonaceous BOD
Removal, Nitrification

Wastewater Treatment

Process steps
Influent

Receiving water

3) Biological Process:
1) Preliminary 2) Primary
4) Secondary
Conversion to
Treatment
sedimentation
sedimentation settleable solids

5) Sludge solids to
further treatment
and disposal

5) Sludge solids to
further treatment
and disposal

Activated Sludge
Process

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Anoxic processes
Type

Treatment Process Application

Suspended SuspendedGrowth
Growth
Denitrification
Fixed Film
(Attached
Growth)

Denitrification

Attached-Growth Denitrification
Denitrification

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Anaerobic Processes
Type

Treatment Process

Application

Suspended Anaerobic Contact

Carbonaceous BOD
Growth
Processes
Removal, Stabilization,
Anaerobic digestion Solids Destruction,
Pathogen Removal
Attached
Growth

Anaerobic Filter and Carbonaceous BOD

Fluidized Bed
Removal, Waste
Stabilization Denitrification

Sludge
Blanket

Upflow Anaerobic
Sludge Blanket
(UASB)

Hybrid
UASB/Attached
(Combined) Growth

Carbonaceous BOD
Removal, (High-Strength
Waste)
Carbonaceous BOD
Removal

Aerobic, Anoxic and Anaerobic

Processes
Type
Treatment Process
Suspended Single- or Multistage
Growth
Processes,
Various Fabricated
Processes
Hybrid
Single- or multistage
(Combined) processes with packing
for attached growth

Application
Carbonaceous BOD
Removal, Nitrification,
Denitrification and
Phosphorus Removal
Carbonaceous BOD
Removal, Nitrification,
Denitrification and
Phosphorus Removal

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SBR and MBR

FILL
REACT
IDLE

influent
air
SBR
DRAIN

SETTLE

MBR
effluent

Conventional Vs MBR

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Process Basics
discharge
DN

SCT

SS
conventional technology
membrane technology
effluent
SS
Deni

UF not
Sec. Clarif.

Nitri

Assessment of MBR Technology

Advantages
High effluent quality
No sludge settling problems
Reduced volume requirements

Disadvantages
Membrane fouling
Increased operational costs

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Constructed Wetlands
Constructed wetlands (CW), are
now widely used as an accepted
method of treating wastewater
(Gopal, 1999; Kivaisi, 2001;
Vymazak, 2007; Rousseau et al,
2008) and are cheaper than
traditional wastewater
treatment plants.
CW is appealing to developing
nations in the tropics due to the
high rate of plant growth (Kivaisi,
2001).

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Sumiani Yusoff, Universiti Malaya

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