A detailed presentation on hospital wastewater management

1. HOSPITAL WASTEWATER
MANAGEMENT
PRESENTED BY : AMIT CHRISTIAN

2. HOSPITALS : HEALTH CARE CENTRES OR POLLUTION
SOURCES?
• hospitals are significant consumers of water
• generates considerable amount of wastewater which
consists of
• pathogens and harmful bacteria, virus
• pharmaceuticals and its metabolites
• radio active elements
• toxic chemicals , heavy metals

3. IMPACT ON ENVIRONMENT
• pathogens can spread disease, adversely affect the biodiversity,
• microbial resistant strains to antibiotics can spread resistance
vertically and horizontally
• persistent, non biodegradable, hydrophilic chemicals pass wwtp
and pollute water bodies
•

4. WATER USE IN HOSPITALS
• average water consumption
750 l/p/d/b
• principal areas of usage:
• sanitary/amenities (taps,
showers, toilets)
• HVAC system
• medical purpose
• cafeteria/dining
places/kitchen
• laundry

5. POLLUTION SOURCES IN HOSPITAL
Administered
drugs to patients
Excretion of patients
containing
pharmaceuticals,
drugs and their
metabolites
Hospital Sewer
Network
Wastewater from care
activities, medical
research
Domestic Wastewater +
Industrial Wastewater

6. POLLUTANTS IN HOSPITAL WASTEWATER
hospital wastewater
microbial
contaminants
and clinical
discharges (e.g.
blood, biological
samples)
heavy
metals
and rare
earth
elements
chemicals ,
pharmaceuticals
and radio active
substances
domestic
wastewater
and
suspended
solids

7. MICROBIAL CONTAMINANTS
• 3 x 105
per 100 ml bacterial flora
• markers of viral pollution adenovirus and enterovirus
• HIV agents
• prions
• multiple antibiotic resistant strain (MARS)
• concentration of MARS 2 to 10 times higher than domestic wastewater
• resistance to antibiotic can be transferred horizontally as well as
vertically
• resistance gene transfer would occur at high cell densities and high
selective pressures (e.g. high concentration of antibiotics)
• may cause ecological imbalance in the environment
• may accumulate in the sewer and in case of epidemic require complete
elimination using chlorination

8. HEAVY METALS AND RARE EARTH ELEMENTS
• Mercury (Hg)
• Persistent, bio accumulative, potent neuro toxin
• Found in health care devices (thermometers, blood pressure
cuffs), laboratory chemicals, measurement devices, fixatives,
cleaning agents
• Can pass wastewater treatment plant and may end up in river
sediments and may bio accumulate in fish and other biological life
in aquatic environment

9. HEAVY METALS AND RARE EARTH ELEMENTS
• Silver(Ag)
• Potentially toxic to aquatic environment
• Mainly used in radiology labs for X-ray film processing
• Concentrated in fix and bleach-fix solutions and wash waters
• Used in dental amalgam and in some chemicals used for chloride
analysis
• Zinc (Zn)
• Originates from Laboratory reagents used for glucose test and
household cleaning products like floor waxes, wax strippers,
stainless steel cleaners
• Gadolinium and Indium : Used for MRI and non-biodegradable
• Platinum : Used in Oncological treatment with cis-platinum and
carbo platinum or other cytostatic agents

10. CHEMICALS, PHARMACEUTICALS AND RADIO
ACTIVE SUBSTANCES
• Hospitals are major contributors of chemicals and pharmaceuticals
in wastewater but not exclusive.
• Major Categories :
• Cytostatic agents
• Anesthetics
• Antibiotics
• Disinfectants
• Iodinated Contrasting Media (ICM)
• Analgesic and anti-inflammatories
• Absorbable Organic substances (AOX)
•

11. CHEMICALS, PHARMACEUTICALS AND RADIO
ACTIVE SUBSTANCES
• Cytostatic agents:
• Mainly used for cancer therapy
• known for their carcinogenic, mutagenic and toxic effects
• Excreted by the patients undergoing chemotherapy
• Highly polar and non volatile . Thus bound to stay in water phase
• Varying biodegradability
• Antibiotics:
• Of total consumption 26% are used in hospitals
• Antibiotics along with their metabolites end up in Wastewater due to
human excretion in urine and faece
• no serious threat to human health for 2L of water consumption per day
and 70 years life span at present concentrations
• Cause antibiotic resistant to bacteria which may imbalance ecological life
in aquatic environment

12. CHEMICALS, PHARMACEUTICALS AND RADIO
ACTIVE SUBSTANCES
• Iodinated Contrasted Media (ICM) :
• Used for X-ray imaging of soft tissues
• For one treatment about 100g is used
• About 30g of it represents Absorbable Organic Iodinated Media (AOI)
• Biologically inert and stable towards metabolism thus easily pass from
body and end up in wastewater
• Hydrophilic in nature thus persist in water phase for longer time
• Poor sorption and bio accumulation properties
• Fate and impact on environment unknown
• Risk of ending up in groundwater

13. CHEMICALS, PHARMACEUTICALS AND RADIO
ACTIVE SUBSTANCES
• Adsorbable Organic Halogen Compounds (AOX):
• Derived as byproducts of disinfectants application
• ICM are significant source of AOX and radiology department
contributes maximum to AOX concentrations
• Persistent in environment
• Accumulate in food chain
• Poor bio degradability

14. QUANTITATIVE CHARACTERISTICS OF HOSPITAL WASTEWATER
• Macro Pollutants :
Parameter HWW Urban Wastewater
pH 7.7-8.1 75.-8.5
BOD₅ (mg/l) 300-400 200-300
COD (mg/l) 800-1000 600-800
SS (mg/l) 400-600 150-300
TKN (mg/l) 5-80 20-70
Total – P (mg/l) 0.2-13 4-10
Fat, oil and Grease(mg/l) 5-60 50-100
Total Surfactant 3-7.2 4-8
E.Coli MPN/100 ml 10 - 10⁶ᶟ 10⁶-10⁷
Faecal coliform 10 -10⁷ᶟ 10⁶-10⁸
Total Coliform 10⁵-10⁸ 10⁷-10⁹

15. QUANTITATIVE CHARACTERISTICS OF HOSPITAL
WASTEWATER
• Micro- Pollutants:
Therapeutic Class HWW (Avg. Value) UWW (Avg. Value)
Analgesic (µg/l) 100 11.9
Antibiotic 11 1.17
Cytostatic 24 2.97
Β- blockers 5.9 3.21
Hormones 0.16 0.10
ICM 1008 6.99
AOX 1371 150
Gadolinium 32 0.7
Platinum 13 0.155
Mercury 1.65 0.54

16. DISCHARGE STANDARDS
• no specific standards for hospital wastewater
• Indian Standards :
Parameter Limit
pH 6.5-9.0
TSS 100 mg/l
BOD 30 mg/l
O & G 10 mg/l
COD 250 mg/l
Bio-assay test 90% survival of fish after 96
hrs in 100% effluent

17. DISCHARGE STANDARDS
• WHO (World Bank) guidelines :
Parameter Limit
pH 6-9
BOD₅ 50 mg/l
COD 250 mg/l
TSS 20 mg/l
Oil and grease 10 mg/l
Cadmium 0.1 mg/l
Chromium 0.5 mg/l
Lead 0.1 mg/l
Mercury 0.01 mg/l
Chlorine (Total residue) 0.2 mg/l
Phenols 0.5 mg/l
Fecal Coliforms 400 MPN/ 100 ml

18. WATER MANAGEMENT AND ABATEMENT OF
EMISSIONS
• Hospital wastewater a
complex matrix
• Water Use efficiency
• Source Reduction/
Segregation
• Recycle/reuse
• Treatment and disposal

19. WATER MANAGEMENT AND ABATEMENT OF
EMISSIONS
• Water Use Efficiency :
• Main areas to be considered:
• Water Leakages :
• Sanitary / Amenities
• HVAC system
• Medical Processes
• Cafeteria /dining places/kitchens
• Laundry

20. WATER MANAGEMENT AND ABATEMENT OF
EMISSIONS
• Do ward wise water audit and identify major users
• Continuous staff training, education, campaigns
• Water Management committee
• Assess water and energy demands for equipment when they are
purchased
• Sanitary/Amenities:
• Reduce wastage through regular maintenance of taps, shower heads and
replacement with efficient ones (e.g. aerated taps)
• Use toilets with efficient flush models
• HVAC systems:
• Reduce waste in cooling towers, use close loop system rather than open
loop
• Efficient pumps and chillers
• Recycling of wastewater for cooling , toilets and irrigation (30% of usage)

21. WATER MANAGEMENT AND ABATEMENT OF
EMISSIONS
• Medical equipment and Processes:
• Efficient management of steam sterilizers
• Cold water is used to bring down the temperature of hot water . Instead
use heat exchanger to reduce the temperature of hot water
• X-ray machines: Constant flow of water is used to cool the machine and
develop films
• Shift to digital processing
• Use of stop valve to control the flow of machine when not in use

22. WATER MANAGEMENT AND ABATEMENT OF
EMISSIONS
• Source Reduction and Segregation:
• Mercury :
• Conduct a mercury assessment survey
• Collect mercury containing wastes for hazardous waste disposal
• Substitute mercury containing chemicals and reagents
• Replace mercury containing measuring instrument with digital ones
• Waste containing mercury from dental surgery collected separately
• Silver:
• Install silver recovery unit
• Employ digital processing
• Substitute low silver film

23. WATER MANAGEMENT AND ABATEMENT OF
EMISSIONS
• Iodinated Contrast Media (ICM):
• Separate collection of urine for the patients undergoing X-ray
imaging
• Treat it as hazardous waste in incinerator
• Avoid residual quantities while preparation and separate collection
for the residuals

24. DISPOSAL AND TREATMENT OF HOSPITAL
WASTEWATER
Option Advantages Disadvantages
Direct Disposal No investment,
maintenance
cost.
A Major danger of pollution spread
in the environment due to harmful
bacteria and virus. Serious threat to
aquatic life and contamination of
aquatic bodies. In case of epidemic
complete chlorination of wastewater
required which can further harm
environment
Co- treatment in municipal
WWTP
No direct
discharge to
environment
Not viable option as based on
dilution rather than pollutant
segregation. Toxic substances may
severely harm processes
Onsite WWTP 90% reduction in
pollutant load
Additional cost of investment and
maintenance
Onsite + Municipal Double treatment Costly

25. TREATMENT TECHNOLOGIES
• Much of the hospital wastewater has similar characteristics as domestic
wastewater
• Biological Wastewater Treatment Technologies most sustainable and cost
effective option.
• Chemical treatments add up harmful byproducts.
• Available Technologies :
• Conventional Activated Sludge (CAS)
• Sequencing Batch Reactor (SBR)
• Membrane Bio reactor(MBR)
• Moving Bed bio reactor (MBBR)
• Constructed Wet lands
• Submerged Aerated Fix Film Reactor(SAFF)

26. BIOLOGICAL WASTEWATER TREATMENT
• Principle:
• Biochemical oxidation processes
• Under controlled conditions Micro-organism utilize organic matter for the
production of energy for cellular respiration and new biomass production
• Types of processes on the basis of kinetics : a) aerobic , b) anaerobic
• Aerobic Process:
• Presence of oxygen
• Aerobic micro organisms
• Production of new cells and CO₂ , H₂O
• Anaerobic Process:
• Absence of oxygen
• Certain slow growing micro organisms utilize oxygen bound to inorganic
compounds like nitrate and sulfate
•

27. BIOLOGICAL WASTEWATER TREATMENT
• Two Types of Processes : a) Suspended Growth , 2) Attached Growth
• Suspended growth:
• Micro organisms responsible for degradation are maintained in liquid suspension
• Influent is allowed to come in contact with the suspension
• Utilization of organic matter by micro-organisms for cellular respiration and new
cell growth
• Conventional Activated Sludge System (CAS), Sequencing batch reactor (SBR),
Oxidation ditch ponds, Contact Stabilization
• Attached Growth:
• Micro- organisms responsible for degradation are allowed to grow on fixed , inert
plastic media
• Influent is allowed to flow past the fixed film
• Micro organisms utilize it as food source and for cell growth
• Percolating filter, Moving Bed Bio Reactor (MBBR), Fluidized Media Reactor
(FMR) , Rotating Biological Contactor (RBC)

28. MBBR/IFAS PROCESS
• A combination of suspended growth
as well as fixed film based technology
• Utilize specialized carriers in
suspension for biomass retention
• MBBR :
• Once through process
• No sludge is recycled back
• Separate reactors for BOD,COD ,
nitrification removal
• IFAS :
• Sludge is recycled back to aeration
basin
• Additional biomass in suspended
phase as well
• A truly hybrid system

29. ADVANTAGES OF MBBR/IFAS PROCESS
• A combination of suspended growth as well as fixed film based technology
• Utilize specialized carriers in suspension for biomass retention
• Offers advantages of both technologies which includes :
• Growth of specialized biomass for the desired treatment goals
• Continuous flow and thus eliminating need of backwashing unlike other fixed
film processes
• Same flexibility and flow sheet simplicity as suspended growth based systems
• Additional biomass in the reactor without increasing solids loading to clarifiers
• Flexibility in separation technologies thus achieving better SS removal
• Reduced sludge production (0.3 g VSS/gCOD compared to 0.4-0.6 for CAS)
• High rate treatment and thus offers space saving due to smaller foot print
• Improved process stability and faster recovery from shock loads
• Better settling properties of sludge reducing handling costs
•

30. Biofilm Tech GmbH
• About Us:
• A specialized company providing innovative solutions for the
treatment of wastewater and polluted air
• A team with more than 40 years of experience in research and
development of fixed film based technologies for industrial and
difficult to treat wastewater and polluted air
• What We do :
• Problem analysis for the treatment of high strength industrial and
municipal wastewater treatment
• Define treatment goals and conceptual process design
• Development of optimal process and parameters
• Manufacturing of high performance tailor made bio carriers for the
application
• Process Start up and trouble shooting

31. LEVAPOR CARRIERS
• First synthesized Bio
Carrier
• Porous, Flexible, Durable
PU foam impregnated
with surface active
pigments with high
surface area
• Due to variability of foam
and pigment type and
their ratios, tailor made
carriers can be produced
with varying properties

32. Unique Properties
PROPERTIES
• High Adsorbing Surface
• High Porosity
• Fast wetting and water
binding
• High surface Area
• Higher fluidization ability
ATTRIBUTES
• Adsorption of inhibitory
substances and fast colonization
• Protection of biomass against
shear, anoxic zone formation
• Homogenization of media and
maintenance of bio activity
• Lower Degree of Filling (12-
15%)
• Less Power consumption

33. Advantages of Levapor based
MBBR/IFAS
• Reversible adsorption of inhibitory substances and
slowly bio degradable pollutants
• Short process start up and higher performance
compared to suspended mass based systems (100 to
300%)
• Colonization of carrier by more active bio mass and
simultaneous nitrification-de nitrification
• Higher process stability and lower sludge yield
• Lower degree of filling (12 to 15% compared to 40-65%
for plastic based media)
• Remarkable lower power consumption compared to
conventional MBBRs

34. ADVANTAGES FOR HOSPITAL WWT
• Adsorption of disinfection by products (AOX) on activated carbon
which stabilizes the process and their subsequent biodegradation
• Removal of pharmaceutical micro pollutants possible due to
adsorption and higher SRTs compared to conventional systems
• Development of specialized biomass providing more diverse
community of micro- organisms with broader physiological
properties, enhanced metabolic and co-metabolic processes
affecting removal of recalcitrant compounds providing more
complete mineralization
• Better process stability towards shock loadings due to adsorption
and internal porosity

35. TREATED WATER QUALITY
Parameter Treated Water at the
outlet of Reactor Tank
Treated water at the
outlet of Post treatment
pH 6.5-8 6.5-8
SS < 30 mg/l < 2 mg/l
BOD <20 mg/l < 5 mg/l
COD <100 mg/l < 50 mg/l
TKN < 10 mg/l < 3 mg/l
Total P < 2 mg/l < 0.5 mg/l
Oil and Grease < 10 ppm Nil

36. APPLICATION OF TREATED WATER
• Cooling Water
• Gardening
• Irrigation
• Toilet Flushing

37. THANK YOU