Wastewaters generated from hospitals contain pharmaceuticals residues, pathogens, chemical reagents, radionuclide, and other harmful matter. The wastewater characteristics, quantity, and handling methods have not only variations among countries but also within a country. Some hazardous substances of hospital wastewaters (HWWs) may have a regulatory status and should be treated accordingly while others have characteristics similar to that of domestic sewage.
At a global level, guidelines do exist for the treatment of these HWWs. But literature has shown that legislation has various loopholes in implementation. This chapter outlines the current status of management and handling of HWWs around the major industrial hubs of the worlds in two categories of developed (the United States, United Kingdom, and Europe) and developing (India, China, Iran, and Bangladesh) countries. Various literature and guidelines of these countries have been referred which mainly highlight different treatment scenarios and status of coverage of HWW management guidelines.
BOQU Instrument donated Water Quality Monitoring Analyzers to Hubei Cancer Hospital
Hospitals have an important role in the well-being of mankind and other medical research advancements. Different units/services of hospitals require a large volume of water according to the activities taking place within the hospitals and generate a large amount of wastewater. Quantity as well characteristics of hospital wastewater (HWW) is affected by size (number and type of wards/units), and services provided (kitchen, laundry, and air conditioning), management policies, and awareness of the institution.
A hospital in a developed country generates 400–1200 L wastewater per bed per day whereas for developing countries the value is 200–400 L/capita/day as compared to 100–400 L/capita/day of domestic wastewater generation.In general, the characteristics of wastewater generated from hospitals are similar to the domestic wastewater, but a proportion of the HWW contains toxic/nonbiodegradable/infectious pollutants.
The hospital effluents contain a large variety of substances used for medical, laboratories, research purposes, and also include excreta from patients. These wastes include drugs and their metabolites such as antibiotics, lipid regulators, analgesics, antidepressants, antiepileptics, antineoplastic, antipyretics, antiphlogistic, antirheumatics, estrogens, organic matters, radionuclides, solvents, metals, disinfectants, cytostatic agents, anesthetics and sterilization products, specific detergents for endoscopes and other instruments, radioactive markers, and iodinated contrast media.
Metals present as preservatives in diagnostic agents such as platinum, mercury, rare earth elements (gadolinium, indium, osmium), and iodinated X-ray contrast media. These insoluble/soluble organic/inorganic pollutants have adverse toxic effects on humans as well as aquatic animals even at very low concentrations and termed biologically active substances. These effluents also carry pathogenic microorganisms such as viruses, bacteria, fungi, protozoans, and helminths which induces pressure of rapid adaptation to these fluctuating conditions through genome rearrangement in the innate microorganisms.
This exchange of genes develops a resistance trait in pathogens. In developing countries, hospital effluents are often drained into municipal wastewater systems and discharged into water bodies frequently without any treatment aimed at reducing public health risks. According to the diversity of contaminants, it has been demonstrated that the intrinsic toxicity of the hospital effluents can be 5–15 times greater than an urban effluent as well as the potential inhibition of the activated sludge of wastewater treatment plants
BOQU Insstrument donated Water Quality Monitoring Instrument to Hubei Cancer Hospital
Therefore dealing with HWW and healthcare waste in a way that can minimize potential risks for local populations is one of the greatest challenges faced by healthcare facilities. A growing body of evidence indicates that HWW treatment systems contribute to the spreading of antibiotic-resistant bacteria into the environment. Mobilization and return of the contaminants to the food chain or in drinking water increase the possibility of exposure of organisms to hazardous substances imparting greater risks to the environment in the long run.
Depicts the comparison between the average range of parameters that hospital effluents can bring to the municipal sewage system such as biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), total Kjeldahl nitrogen, total phosphorus (TP), and coliforms.
The facilities discharging waters directly to the municipal sewer systems are called indirect dischargers whereas those that directly discharge to rivers are called direct dischargers. The majority of hospitals are indirect dischargers. These wastes if not handled properly could be dangerous to the ecological balance and public health and may lead to outbreaks of communicable diseases, diarrhea epidemics, water contamination, and radioactive pollution.
Even the urine and feces of patients from specific wards such as oncology contains higher amounts of antibiotics, cytotoxics, their metabolites, and X-ray contrast media, and contributes around 50%–80% of total toxic discharge concentration to the HWWs. Thus appropriate planning and implementation of hazardous liquid waste management by sewer authority can reduce the negative impacts of HWW.
| Water Parameters | HWWa | MWWb | BOQU Instrument |
| BOD5 (mg/L) | 200–300 | 150–400 | BODG-3063 Online BOD Analyzer |
| COD (mg/L) | 120–500 | 50–170 | CODS-3000 UV Online COD Meter |
| TSS (mg/L) | 150–160 | 50–60 | TSG-2087S Online Suspended Solid Meter |
| Total N (mg/L) | 5–80 | 20–70 | TNG-3020 Online Total Nitrogen Analyzer |
| Total P (mg/L) | 0.2–13 | 4–10 | TPG-3030 Online Total Phosphorus Analyzer |
| Chlorides (mg/L) | 65–360 | 30–90 | PFG-3085 Online Chloride Ion Meter |
| Total surfactant (mg/L) | 3–7.2 | 4–8 | / |
| E. coli (MPN/100 mL) | 103−106 | 106−107 | BQST-7000 On-line E.Coli & Coliform Analyzer |
| Fecal coliform (MPN/100 mL) | 103−107 | 106−108 | / |
| Total coliform (MPN/100 mL) | 105−108 | 107−1010 | / |
BOQU Water Quality Monitoring Analyzer in Hubei Cancer Hospital
