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Meri-Rastilantie 3 B, FI-00980 Journal of Food, Agriculture & Environment Vol.8 (2): 1199-1202. 2010 www.world-food.net
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Investigation of optimal method for hospital wastewater treatment

1, 2
Akbar Mokhtari Azar , Ali Ghadirpour Jelogir 2*, Golamreza Nabi Bidhendi 2, Naser Mehrdadi 2, Narges
Zaredar 3 and Maryam Khalilzadeh Poshtegal 4
1
Department of the Environmental Health Engineering, School of Public Health, Islamic Azad University, Medical Branch,
Tehran, Iran. 2 Department of the Environmental Engineering, Civil Engineering, University of Tehran, Tehran, Iran.
3
Environmental Science, Department of Environment and Energy, Islamic Azad University, Science and Research Branch, Tehran
Iran. 4 Environmental Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran.
*e-mail: ghadirpoor.ali@gmail.com

Received 17 November 2009, accepted 2 April 2010.

Abstract
Hospital wastewater contains great amount of pathogenic organisms, hazardous chemicals, as well as organic and mineral materials, and one of the
most important source of pollution with water resource is the hospital wastes which contain many pathogenic factors. Thus the necessity of
sanitary collection, treatment and reuse of them is vital because of water shortage in recent decades, in which it requires the wastewater treatment
plant establishing. For construction of such a treatment plant the quality and quantity parameters are needed. The most important quantity
parameter is flow rate, which should be detected for determining of quality parameters. Since, many hospitals are not including wastewater
treatment plant or if they are, the beneficence of their performance isn’t satisfactory. This research tried to investigate the pollution of special and
upper special hospital in the biological oxidation method. The pilot was established in 2008 and after 2 months performance continuously, the
treatment condition was proper and complied with environmental standard range in which the sampling was started in the late August and
September. It is mentionable that at the end of every month three samplings were applied simultaneously and analyzed in order that the accuracy
and veracity of the experiment become clarified. The results showed that all of the parameters were removable in the biological oxidation method.
This procedure is usable for removal of physical, chemical and microbial parameters and heavy metals, and efficiency of biological oxidation
removal method for the main hospital parameters was more than 90%.

Key words: Hospital wastewater, biological oxidation, total coliforms, fecal coliforms, quality, quantity, wastewater discharge, optimal method,
BOD5, COD.

Introduction
Purification of the polluted water is proposed when the relation of
disease incidence was detected. For prevention of pollution of
water, specially in the rivers, the entrance of such wastes was
prohibited. After World War II, by developing the countries or
cities and industries which led to the increase of population, the
need for waste water treatment and establishment of it was clear.
Among the waste treatment methods, the natural treating was
popular. The wastewater is one of the biggest pollution sources
of water. It must be gathered correctly and also should be treated
to back the water cycle system in the nature. If this kind of
wastewater was not well treated and buried, it will be the source of
pollution distribution 14. Hospitals represent an incontestable
release source of many chemical compounds in the aquatic
environment due to laboratory activity or medicine excretion into
wastewater 6. The World Health Organization 17 defines hospital
solid waste as any solid waste that is generated in the diagnosis,
treatment or immunization of human beings or animals, in research
pertaining thereto, or testing of biological, including but not limited
to soiled or blood soaked bandages, culture dishes and other
glassware. It also includes discarded surgical gloves and
instruments, needles, lacents, cultures, stocks and swabs used to
inoculate cultures and removed body organs. Despite problems
arising from these unwanted wastes, a civilised society cannot do
without a healthcare system. This is a basic requirement for human
kind. The waste generated from hospitals is now recognized as a
serious problem that may have detrimental effects either on the
environment or on human beings through direct or indirect contact.
Some of the health impacts originating from exposure to hazardous
hospital wastes include mutagenic, tetragenogenic and
carcinogenic effects, respiratory damage, central nervous
system effects, reproductive system damage and others 2.
Diseases like diarrhoea, leptospirosis, typhoid, cholera, human
immunodeficiency and hepatitis B can be transmitted through the
mismanagement of especially hazardous hospital waste 10.
Environmental nuisance may also arise due to foul odour, flies,
cockroaches, rodents and vermin. Over the years, various waste
management systems and practices have been reported for
appropriate handling and safe disposal of hospital wastes. Some
of these practices include landfills 3, 8, incineration 11, autoclaving13,
and recycling 7. Generally there is no single practice as a solution
to the problems of managing hospital waste, so in most cases, a
number of practices are used in combination. Each practice has its
own weaknesses and strengths. They are reported to have a variety
of endocrine-disrupting properties, including estrogenicity and
serotonergicity 4, 5, 15, 16. More recently, pharmaceutical and
personal care products (PPCPs) were found in municipal effluents,

Journal of Food, Agriculture & Environment, Vol.8 (2), April 2010 1199
where they represent a major source of contamination to the aquatic
environment 1, 6 . The hospital effluents are discharged, usually, in
the urban sewer system where they mix with other effluents and
finally reach the sewage treatment plant. The important
contaminants of concern in wastewater treatment include
suspended solid, biodegradable organics, pathogens, nutrients,
priority pollutants, refractory organics, heavy metals and dissolved
inorganic. Secondary treatment standards for wastewater are
concerned with the removal of biodegradable organics,
suspended solid and pathogens. Many of the more stringent
standards that have been developed recently deal with the removal
of nutrients and priority pollutants. When wastewater is to be
reused, standards include requirements for the removal of
refractory organics, heavy metals and in some cases dissolved
inorganic solids. The wastewater of remedial centers is like city
waste with some decomposable organic and mineral (liquid,
colloidal) materials, toxic metals, detergents, microbial pathogens,
toxic chemicals, pharmaceutical matters and radioactive isotopes.
Waste is classified as general, medical and sharps. General waste
is defined as hospital waste that does not pose any immediate
danger to humans or the environment. Examples of general waste
include packaging materials such as cardboard, office paper,
leftover food, cans etc. Pathological waste contains tissues,
organs, placentas and other body parts. Infectious waste is defined
as waste that contains pathogens in sufficient quantity that when
exposed to it can result in diseases. Examples of this waste include
culture plates, drainage bags, surgical and theatre wastes,
contaminated plastic items etc. Sharps are defined as anything
that could cause a cut or puncture leading to wound. Items like
needles, syringes, scalpels, knives, broken glass, and etc. form
part of sharp wastes. All of these definitions are consistent with
those reported in the literature 7, 9, 10. However, neither of the
hospitals had a clear definition of medical waste. Medical waste is
only known to include infectious, pathological and chemical waste.
From the literature, the terms hospital and medical wastes have
often been used interchangeably 7, 9. Lee et al. 7 used the term
medical waste to deal with all types of wastes produced by
healthcare facilities rather than the term hospital waste. One of
the environmental problems caused by hospital waste water is
forwarding this kind of waste water without any pretreatment to
city waste water network. In hospitals, widespread kinds of
compound materials like drugs and special materials are used.
These materials are for medicine, diagnostic and antiseptic.
Moreover; these active compounds, formulized materials and some
pigments for drug is used as medicine. Antiseptics are complex
and active compounds. After using these materials, there would
be many excretions from patients, which are not metabolized and
injected to city waste water system. After using antiseptics, they
would be found their way out to flowing water.
Materials and Methods
The method of the article was librarian studies, field and laboratory
studies. Two hospitals were selected for sampling and analyzing,
in which one of them was public and the other one was private
hospital. The results were evaluated and showed that the physical,
chemical and microbial parameters were below environmental
standard range, according to the environmental organization in
Iran.
For a sample in the pilot experiment, and also for proposing the
1200
optimum method of hospital wastewater treatment, the samplings
were taken from effluent and influent of special kidney hospital.
It is mentionable that as the effluent and influent of treatment
plant were above the environmental standard range, the samples
were suitable for the pilot study.
Therefore, 15 m3 of influent wastewater were taken in 5 times
interval and disposed to the pilot that the capacity of pilot was 80
litres. It is mentionable that, the basic performance of pilot was
biological oxidation method. Fig. 1 shows the schematic picture
of the study pilot.
r r
lit 50 litr lit
15 15
Primary
Primary settling
settling
Aeration
Aeration Secondary settling
Secondary settling
Figure 1. The pilot of hospital wastewater treatment by biological
oxidation method.
For achieving the proper qualitative standard of hospital
wastewater, the biological oxidation method was applied that it
includes two sage of aerobic and anaerobic phase. First the
wastewater pumped from storage reservoir and by the venturimeter
which was in the way of wastewater was conducted to the primary
settling tank. After that the wastewater entered to the aeration
tank in which the biological oxidation was performed while aeration
was applied.
After that aeration tanks were off that leads the tanks to get
anaerobic zone. This process repeated continuously in 3 hr
intervals. The Air on and Air off process for nitrification were
performed properly which shows significant removal of
phosphorus and nitrogen. By means of third pump the wastewater
was conducted from aeration tank to the secondary settling tank
in which the solid wastes were settled and purified wastewater
outflowed above the reservoir.
Biological oxidation was applied for increasing of biological
decomposition (oxidation without chemical materials). Period of
pilot study was 2 months that all the experiments were done in the
effluent to stabilize the system. It is worthwhile doing that the
tests and experiments repeated continuously during the months
to get the accuracy of the pilot. For statistical analyses of
experiment data, the Excel software and descriptive statistics were
applied. Pilot conditions in 5 months of experiment were:
temperature 15to 25°C, pH 6.5 to 7.5, dissolved oxygen 4 to 5 mg/
litre. The period of this research was 10 months. The measurement
methods of qualitative parameters are mentioned in Table 1.
Results and Discussion
The study was conducted from early July 2008 to the end of
August continuously. After two months in August 2008, three
samples were simultaneously applied and 14 mentioned
parameters were analyzed. This procedure was repeated in
September and October 2008, and the results of analyses are
shown in Tables 2 to 4.
The accuracy of the analyses was achieved after three periodic
experiments which showed proper results, thus in order to prove
Journal of Food, Agriculture & Environment, Vol.8 (2), April 2010
Table 1. Measurement methods of qualitative parameters of hospital wastewater.
Measurement Measurement
Row Parameter Row Parameter
method method
1 BOD5 5210 8 NO2 4500
2 COD 5220 9 NO3 4500
3 TSS 25420 10 pH 4500_H+
4 ABS 5540 11 O&D 5520
5 Ni 3500 12 PO4 4500
6 E.coli MPN 13 Ag 3500
7 Tot. coliforms MPN 14 Hg 3500

Table 2. Physical, chemical and microbial parameters of treated hospital wastewater by the pilot in August 2008.
Environmental standard (ppm)
Row Test Unit Test 1 Test 2 Test 3 Disposal to the Disposal to the Agriculture
surface water wells consumption
1 --- pH --- 7.22 7.19 7.21 6.5-8.5 5-9 6-8.5
2 TSS Total dissolved solids mg/litre 4 5 4 40 instantly 60 --- 100
3 NO3 Nitrate mg/litre 0.3 0.5 0.4 50 10 ---
4 NO2 Nitrite mg/litre 0.09 0.12 0.11 10 10 ---
5 PO4 Phosphate mg/litre 0.08 0.10 0.09 6 6 ---
6 ABS Detergents mg/litre 0.065 0.063 0.069 1.5 0.5 0.5
7 COD Chemical oxygen demand mg/litre 7 10 9 60 instantly 100 60 instantly 100 200
8 BOD Biological oxygen demand mg/litre 5.5 6.3 5.8 30 instantly 50 30 instantly 50 100
9 O&G Oil and grease mg/litre 7 8 7 10 10 10
10 T.C. Total coliform MPN/100 ml 74 79 75 1000 1000 1000
11 E.coli Fecal coliform MPN/100 ml 26 21 22 400 400 400
12 Ag Silver mg/litre 0.021 0.024 0.025 1 0.1 0.1
13 Hg Mercury mg/litre 0.001 0.001 0.001 negligible negligible negligible
14 Ni Nickel mg/litre 0.034 0.031 0.035 2 2 2

Table 3. Physical, chemical and microbial parameters of treated hospital wastewater by the pilot in September 2008.
Environmental standard (ppm)
Row Test Unit Test 1 Test 2 Test 3 Disposal to the Disposal to the Agriculture
surface water wells consumption
1 --- pH --- 7.13 7.16 7.15 6.5-8.5 5-9 6 - 8.5
2 TSS Total dissolved solids mg/litre 6 5 5 40 instantly 60 --- 100
3 NO3 Nitrate mg/litre 0.3 0.2 0.2 50 10 ---
4 NO2 Nitrite mg/litre 0.14 0.10 0.11 10 10 ---
5 PO4 Phosphate mg/litre 0.11 0.08 0.09 6 6 ---
6 ABS Detergents mg/litre 0.058 0.055 0.061 1.5 0.5 0.5
7 COD Chemical oxygen demand mg/litre 9 8 11 60 instantly 100 60 instantly 100 200
8 BOD Biological oxygen demand mg/litre 6.7 6.1 7.2 30 instantly 50 30 instantly 50 100
9 O&G Oil and grease mg/litre 9 10 12 10 10 10
10 T.C. Total coliforms MPN/100 ml 81 78 76 1000 1000 1000
11 E.coli Fecal coliforms MPN/100 ml 25 21 23 400 400 400
12 Ag Silver mg/litre 0.026 0.028 0.031 1 0.1 0.1
13 Hg Mercury mg/litre 0.002 0.001 0.001 negligible negligible negligible
14 Ni Nickel mg/litre 0.037 0.032 0.035 2 2 2

Table 4. Physical, chemical and microbial parameters of treated hospital wastewater by the pilot in October 2008.
Environmental standard (ppm)
Row Test Unit Test 1 Test 2 Test 3 Disposal to the Disposal to the Agriculture
surface water wells consumption
1 --- pH --- 7.19 7.17 7.20 6.5-8.5 5-9 6-8.5
2 TSS Total dissolved solids mg/litre 7 5 6 40 instantly 60 --- 100
3 NO3 Nitrate mg/litre 0.3 0.4 0.3 50 10 ---
4 NO2 Nitrite mg/litre 0.12 0.15 0.11 10 10 ---
5 PO4 Phosphate mg/litre 0.10 0.13 0.09 6 6 ---
6 ABS Detergents mg/litre 0.062 0.059 0.058 1.5 0.5 0.5
7 COD Chemical oxygen demand mg/litre 10 9 9 60 instantly 100 60 instantly 100 200
8 BOD Biological oxygen demand mg/litre 6.8 6.5 6.6 30 instantly 50 30 instantly 50 100
9 O&G Oil and grease mg/litre 10 8 11 10 10 10
10 T.C. Total coliforms MPN/100 ml 71 72 69 1000 1000 1000
11 E.coli Fecal coliforms MPN/100 ml 19 27 24 400 400 400
12 Ag Silver mg/litre 0.027 0.023 0.028 1 0.1 0.1
13 Hg Mercury mg/litre 0.001 0.002 0.001 negligible negligible negligible
14 Ni Nickel mg/litre 0.039 0.033 0.036 2 2 2

Journal of Food, Agriculture & Environment, Vol.8 (2), April 2010 1201
Table 5. Mean, variance, standard deviation and accuracy of research pilot in October 2008.
October 2008 pH TSS Nitrate Nitrite Phosphate Detergent BOD
Test 1 7.19 7 0.3 0.12 0.1 0.062 6.8
Test 2 7.17 5 0.4 0.15 0.13 0.059 6.5
Test 3 7.2 6 0.3 0.11 0.09 0.058 6.6
Mean 7.18 6 0.33 0.126 0.106 0.0596 6.63
Variance 0.000233 1 0.0033 0.000433 0.000433 0.0000043 0.023
Standard deviation 0.015 1 0.057 0.02 0.02 0.002 0.151
-95% 7.169 4.8 0.26 0.104 0.084 0.0574 6.46
95% 7.203 7.1 0.39 0.149 0.129 0.0619 6.80

October 2008 COD O&G T.C. E. coli Silver Mercury Nickel

Test 1 10 10 71 19 0.027 0.001 0.039
Test 2 9 8 72 27 0.023 0.002 0.033
Test 3 9 11 69 24 0.028 0.001 0.036
Mean 9.3 9.6 70.6 23.3 0.026 0.0013 0.036
Variance 0.33 2.33 2.33 16.3 0.000007 3.33E-07 0.000009
Standard deviation 0.57 1.52 1.52 4.04 0.0026 0.00057 0.003
-95% 8.6 7.9 68.9 18.7 0.0230 0.0006 0.0326
95% 9.9 11.3 72.3 27.9 0.0289 0.0019 0.0393

the accuracy of 95%. Mean, variance and standard deviation were
calculated for each of three periods and also for 14 parameters
involved during the experiments (Table 5).
According to the results of 14 parameters which were analyzed
in each of three months it is clear that all of the parameters in the
pilot effluent are in concordance with the environmental standards
and can be disposable to the surface water, wells and are also
usable for agricultural consumption. Therefore, it can be optimal
method for the hospital wastewater treatment.
Removal efficiency in biological treatment by the biological
oxidation method is achievable upper than 90% for the main
parameters of hospital wastewater. The method of biological
oxidation for the hospital wastewater is beneficial and can be
applied for all the hospital wastewater treatment that includes
similar pollution. By utilization of this method, removal of all the
important parameters in hospital wastewater, such as BOD, COD,
detergent and microbial parameters achieved high efficiency.
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