International Journal of Physical Sciences Vol. 7(31), pp.

5213 - 5217, 16 August, 2012

Available online at http://www.academicjournals.org/IJPS
DOI: 10.5897/IJPS12.322
ISSN 1992 - 1950 2012 Academic Journals

Full Length Research Paper

Investigation of hospital wastewater treatment plant

efficiency in north of Iran during 2010-2011
A. Amouei1, H. A. Asgharnia1, A. A. Mohammadi1, H. Fallah1, R. Dehghani2 and M. B.
Miranzadeh2*
1

Department of Environmental Health Engineering, Babol University of Medical Sciences, Iran.

Department of Environmental Health Engineering, Kashan University of Medical Sciences, Iran.

Accepted 20 June, 2012

Hospital wastewater contains pathogenic agents and hazardous compounds; so, it will cause many
risks on environmental and human health of different communities. The aim of this research was to
investigate the efficiency of hospital wastewater treatment plant in north of Iran. This cross-sectional
descriptive research was done on four hospital wastewater treatment plant in north of Iran during 2010
to 2011. A total of 100 grab sample were taken from the influent and effluent of each wastewater
treatment plant. Collected sample were sent to laboratory and analyzes for PH, TSS, BOD, COD and
Total Coliforms (TC) according to standard methods. The mean value of PH, TSS, BOD, COD and TC in
-1
influent wastewater of all studied hospitals was 7.5, 296, 400, 616 mgL and 3.1105 MPN per 100 ml
-1
and in effluent was 7.4, 78, 84, 150 mgL and 831 MPN per 100 ml, respectively. The mean free chlorine
-1
residual in the effluent of these hospitals was reported to be 0.2 mgL . The mean removal of TSS, BOD,
COD and TC in mentioned hospitals wastewater treatment plant was 74.3, 79.6, 76.5 and 99.7%,
respectively. According to the results of this research, the concentration of TSS, BOD, COD and TC in
the effluent of the studied hospitals was more than the Iranian reuse standard which indicates
inefficient removal of pollutants in mentioned hospital wastewater treatment plant. Thus, for effluent
reuse in irrigation more efficient wastewater treatment process is required.
Key words: Hospital wastewater, wastewater treatment, effluent reuse, efficiency.

INTRODUCTION
Although the per capita water use in domestic
applications is about 100 to 200 liter per capita, but this
amount for hospitals is reported in range of 400 to 1200
liter per day per bed (Emmanuel et al., 2001). In
hospitals, also, the water consumed in different units
such as inpatient wards, operating rooms, laboratories,
laundries, kitchens, health services and administrative
units decreases its physical, chemical and biological
quality and is converted to wastewater (Mahvi et al.,
2009).
The amount of produced hospital wastewater is various

*Corresponding author. E-mail: miranmn@yahoo.com. Tel:

00989131612852. Fax: 00983615550111.

in different communities. Wastewater production per

capita in American hospitals has been determined 1000
liter per day per bed (Tchobanoglous et al., 2004). This
amount in our country, on average, is reported 745 liter
per day per bed (Majlesi and Yazdanbakhsh, 2008).
Although the quality of hospital wastewater is similar to
municipal wastewater, but the effluent of hospitals
wastewater may contain non-metabolized pharmaceutical
compounds, antibiotics, disinfectants, anesthetics,
radioactive elements, X-ray contrast agents and other
persistent and dangerous compounds (Boillot, 2008;
Carballa et al., 2004; Jolibois and Guerbet, 2006). In
addition to persistent and hard biodegradable chemicals,
some types of microbial pathogens persistent to
antibiotics also are introduced to the aquatic ecosystems
and other natural receiving bodies of pollution and can

5214

Int. J. Phys. Sci.

transmit acute and dangerous diseases to human

(Escher et al., 2011; Chitnisa, 2004; Pauwels and
Verstraete, 2006). Existence of chlorinated organic
compounds and heavy metals such as Hg and Pb has
been reported in hospitals WTP (wastewater treatment
plant) effluent (Kummerer and Helmer, 2006). In a study,
the concentration of chlorinated organic compounds
AOX, in hospital wastewater, was determined to be
-1
more than 10 mgL . In a research, the number of
coliforms bacteria in raw wastewater entering the hospital
8
WTP was counted 30010 MPN per 100ml, while this
6
number was reported to be 10010 MPN per 100ml in
raw wastewater of municipal wastewater (Emmanuel et
al., 2001).
In communities where there is no epidemic of parasitic
and enteric diseases, the wastewater of hospitals and
other health-care centers could be discharged to
municipal sewerage systems. In such combined systems
as long as more than 95% of wastewater pollutants are
removed and purified by wastewater treatment plant.
Otherwise, hospital wastewater should be treated separately by WTP of each hospital (Ekhaise and Omavoya,
2008; Mahvi et al., 2009). It is necessary to pay adequate
attention to proper management and surveillance to the
generation and treatment processes of hospital wastewater in order to prevent pollution load to environment.
Conventional processes of wastewater treatments, such
as activated sludge with suspended growth, despite of
their widespread use and successes in the municipal
wastewater treatment, are not able to treat hospital
wastewater properly (Lenz et al., 2007; Verlicchi et al.,
2010).
Also, in regard to the investigation on performance of
hospital wastewater treatment plants, several studies
have been done in the country and globally. A research
success rate on this study is based on the optimization
plan of a hospital wastewater treatment system, removal
efficiency of BOD5 and COD which was mentioned to be
89 and 94% respectively (Boillot, 2008; Mesdaghinia et
al., 2009). Given the large number of reception of
patients from different cities of Mazandaran province and
neighboring provinces in hospitals covered by Babol
University of Medical Sciences and various specialty and
subspecialty services in such health-care centers and
increasing changes in quantity and quality of wastewater
generation, on the one hand, and presence of the
ecosystems, valuable and susceptible natural resources
of this province such as river, sea, jungle, agricultural
areas and pasture lands, on the other hand, continuous
assessment and monitoring of hospital wastewater and
the method of treatment, disposal and sludge produced in
such health-care centers is necessary for provision,
maintenance and promotion of community and environmental health (Carballa et al., 2004; Escher et al.,
2011). The aims of this study was to investigate the
efficiency of hospital WTP in health-care centers that is
covered by Babol University of Medical Sciences in north of
Iran.

MATERIALS AND METHODS

This research is a cross-sectional descriptive study which has been
done in four hospitals of Babol University of Medical Sciences
including ShahidBeheshti, ShahidYahyanejad, Children of Amirkola
and Ayatollah Rouhani hospitals during 2010 to 2011. This city is
located in north of Iran (Figure 1).
In order to determine the quality of raw and treated wastewater in
mentioned hospitals a total of 100 composite samples were taken
from the influent and effluent of hospital WTP during 2010 to 2011.
For TC determination, sterile glass bottle and for chemicals
parameters, clean polyethylene container is used. After sampling
and complete mixing of them (composite sampling), samples were
quickly sent to laboratory for chemical and microbial analysis
including pH, BOD5, COD, TSS, chlorine residual and TC parameters. Chlorine residual and pH is measured as on-site
determination. All mentioned parameters were measured according
to the standard methods (Clesceri et al., 2005). Statistical analysis
of this study was done by SPSS software and ANOVA test.
In this research, various methods is used for collection and
disposal of hospital wastewater (disposal in river, absorption well,
discharge into municipal wastewater sewer and use for irrigation
landscape) were studied. Also, the methods of collection and
disposal of the sludge in different treatment processes (thickening
and drying, sludge anaerobic digestion, collection and
transportation of sewage sludge by sludge rake vehicles) were
assessed in these medical centers.

RESULTS
The wastewater treatment system in studied hospitals
were activated sludge with extended aeration. Hospitals
wastewater passes through the bar screen after collection from different medical and non-medical wards and
then enter the pumping station. There is no primary
sedimentation basin in any of these wastewater treatment
systems and the pumping station acts as both
equalization and sedimentation tank.
The characteristics of raw and treated wastewaters in
studied hospitals are presented in Table 1. The mean
value of pH in raw and treated wastewaters was 7.50.6
and 7.40.4 that this difference is not statistically
significant (p>0.05). The mean concentration of TSS,
BOD5 and COD was measured as 296, 400 and 616
-1
-1
mgL in raw wastewater and 78, 84 and 150 mgL in
treated wastewater, respectively, that this differences in
the mentioned parameters of the influent and treated
wastewater is statistically significant (p<0.05). The mean
number of TC has been more than 2400 MPN per 100 ml
in raw wastewater and 831 MPN per 100 ml in treated
wastewater. Also, efficiency removal of TSS, BOD, COD
and TC in studied hospital wastewater treatment plant is
shown in Table 2. As shown in Table 2, the average
removal of TSS, BOD, COD and TC in studied hospital
WTP were 73.1, 78.69, 75.04 and 99.7%, respectively.

DISCUSSION
One of the important parameters for evaluation of the
quality of wastewater is pH value or acidic or alkaline

Amouei et al.

5215

Figure 1. Location of investigated area.

status. Increase or decrease of this parameter in a

wastewater will cause the corrosion and damage of WTP
and sewers. This index also plays a significant role in
biologic processes of wastewater treatment (Chitnisa,
2004). In this research the maximum pH of raw
wastewater in hospitals of Yahyanejad and children of
Amirkola were 8.5 and 7.9 and mean value were 7.7 and
7.4, respectively. The mean pH value of raw wastewater
of all studied hospitals was 7.5. In a study on Turkey
hospitals, the mean pH of raw wastewater hospitals was
A7.3 (Altin et al., 2003). In another study on hospitals
wastewater, somewhere in the globe, the mean pH value
in health-care centers wastewater was about 7.2.
According to the standards of IREPA, the acceptable
level of PH to discharge of effluent to receiving water is
6.5 to 8.5 (IR EPA, 2003), considering our study findings
it is clear that pH of studied hospital wastewater were
compatible with this standards.
As shown in Table 1, the maximum and minimum of
TSS in raw wastewater were measured in Shahidbeheshti
-1
(523 mgL ) and Children of Amirkola hospital wastewater
-1
(72 mgL ), respectively, and mean concentration of TSS
in raw wastewater in all studied hospitals wastewater
-1
were 296 mgL . The mean TSS of domestic wastewater
-1
is in the range of 120 to 400 mgL (Tchobanoglous et al.,
2004), that is close to the obtained results of our study.
Results of a study in Turkey shows that mean TSS

concentration in raw wastewater in some hospitals of

-1
Turkey was 101 mgL (Altin et al., 2003).
Based on our study findings, the mean removal of TSS
by WTP of ShahidBeheshti, Yahyanejad and Children
hospital of Amirkola, were 69.6, 72.8 and 80.6%,
respectively and mean overall removal in studied hospital
WTP were 74.3%. Another study in Iran shows that mean
removal of TSS by treatment system of Khalije Fars
hospital of Hormozgan province, was between 66 to
87.9% (Majlesi and Yazdanbakhsh, 2008; Sarafraz et al.,
2006).
The mean concentration of BOD and COD in domestic
wastewater, in terms of wastewater strength, are reported
-1
in the range of 110 to 350 and 250 to 800 mgL
(Tchobanoglous et al., 2004). In Thailand, the mean
concentration of BOD and COD in raw wastewater of
-1
Thailand hospitals was 113 and 232 mgL , respectively.
The mean concentration of BOD and COD of raw
wastewater of 70 hospitals of Iran has been reported 348
-1
and 527 mgL
as respectively (Majlesi and
Yazdanbakhsh, 2008) that is close to the results of the
present study. The mean removal of BOD and COD in
WTP of ShahidBeheshti, Yahyanejad and Children of
Amirkola hospital were 76.1, 70.5, 78.8 and 77, 83.8 and
82.1%, respectively and the mean overall removal of
BOD and COD in all studied hospitals WTP were 79.6
and 76.5%, respectively. Findings of another study show

5216

Int. J. Phys. Sci.

Table 1. The characteristics of raw and treated wastewater in studied hospitals WTP.

Hospital name
Rouhani
Beheshti
Yahyanejad
Amirkola
Mean
P-value
Effluent standard

pH
Influent
Effluent
7.60.7
7.40.4
7.60.7
7.40.4
7.70.8
7.50.4
7.40.5
7.40.4
7.50.6
7.40.4
P>0.05
6.5-8.5

TSS (mgL-1)
Influent
Effluent
375148
11439
375148
11439
261124
7138
253181
4930
296151
7836
P<0.05
40

BOD5 (mgL-1)
Influent
Effluent
498176
11945
498196
11945
358153
7633
345191
5616.5
400173
8431.5
P<0.05
30

COD (mgL-1)
Influent
Effluent
787255
23281
787255
23281
540213
12447
520289
9325
616252
15051
P<0.05
60

TC (MPN/100 ml)
Influent
Effluent
4.2105
1109854
4.2105
1109854
3.8105
826432
1.3105
557241
3.1105
831509
P<0.05
1000

Chlorine residual
(mgL-1)
0.2
0.2
0.1
0.2
0.17
-

Table 2. Efficiency removal of TSS, BOD, COD and TC in studied hospital wastewater treatment plant.

Hospital name

Efficiency
COD (%)
70.52
59.10
87.54

Rouhani

Mean
Minimum
Maximum

TSS (%)
69.6
58.1
79.8

BOD5 (%)
76.1
63.40
86.40

Beheshti

Mean
Minimum
Maximum

69.6
57.6
78.7

76.1
64.4
86.90

70.52
59.75
79.72

99.73
99.29
99.99

Yahyanejad

Mean
Minimum
Maximum

72.8
63.4
81.50

78.77
67.70
86.22

77.03
65.81
86.54

99.78
99.41
99.97

Mean
Minimum
Maximum
Average mean

80.63
72.42
88.32
73.16

83.77
77.53
89.81
78.69

82.11
76.60
92.21
75.04

99.57
99.12
99.90
99.7

Amirkola

that the mean removal of BOD and COD in 70

hospitals of Iran was 67.5 and 64.3%, respectively
that is compatible with our study findings (Majlesi
and Yazdanbakhsh, 2008). Findings of a study in

the wastewater treatment plant of the city of

Thessaloniki (northern Greece) shows that
removal of persistent organic pollutants (POPs)
during the conventional activated sludge

TC (%)
99.73
99.37
99.90

treatment process were between 65 to 91%

through-out the whole treatment process
(Katsoyiannis and Samara, 2004).
Coliforms bacteria are one of the significant

Amouei et al.

indicators for microbial quality assessment of wastewater.

According to IREPA standards for effluent reuse, the
permissible limit of total coliforms bacteria in hospital
wastewater effluent is 1000 MPN per 100ml of effluent
(IR EPA, 2003). In the present study, the maximum
number of coliforms bacteria is observed in
ShahidBeheshti hospital (1963 MPN per 100 ml) and its
minimum is in Children hospital of Amirkola (316 MPN
per 100 ml). The overall mean number of coliforms
bacteria in effluent of all the studied hospitals was
831509 MPN per 100 ml. The mean rate of total
coliforms bacteria removal by WTP in ShahidBeheshti,
Yahyanejad and Children of Amirkola hospitals were
99.7, 99.8, 99.6%, respectively and overall mean removal
were 99.7%. The rate of fecal coliforms removal has
been reported between 90.63 to 99.57% in hospitals of
Sari and 99.96% in Hamadan (west of Iran) hospital
(Mahvi et al., 2009).
According to the results of this study, all of the studied
hospitals were equipped with wastewater treatment and
disposal systems, but the efficiency of treatment and
removal of the pollutants is different among them. In our
study despite the chlorination systems in all WTP, the
mean chlorine residual in effluent were less than the
-1
standard level of 1 mgL . The mean concentrations of
TSS, BOD and COD in wastewater effluent of the studied
hospitals WTP were more than reuse standard of the
IREPA. This indicates inefficient removal of mentioned
parameters from the hospital wastewater by WTP in such
hospitals. For TC bacteria, the mean value in effluent of
all WTP was in acceptable levels for reuse (IR EPA,
2003).

Conclusion
Findings of this study show that although, regarding to
the mean TC bacteria, effluent of all hospital wastewater
treatment plant is suitable for reuse but for efficient
removal of TSS, BOD5 and COD, further treatment is
necessary and also, rehabilitation of chlorination system
is recommended.

ACKNOWLEDGEMENT
We acknowledge the Department of Research and
Technology of Babol University of Medical Sciences for
their financial support towards this project.
REFERENCES
Altin A, Altin S, Degirmenci M (2003). Characteristics and treatability of
hospital (medical) waste waters. Fresenius Environ. Bull. 12(9):10981108.

5217

Boillot C (2008). Daily physicochemical, microbiological and

ecotoxicological fluctuation of a hospital effluent according to
technical and care activities. Sci. Total Environ. 403:113-129.
Carballa M, Omil F, Lema JM, Llompart M, Garca-Jares C, Rodrguez I,
Gmez M, Ternes T (2004). Behavior of pHarmaceuticals, cosmotics
and hormones in sewage treatment plant. Water Res. 38:2918-2926.
Chitnisa V (2004). Bacterial population changes in hospital effluent
treatment Plant in central India. Water Res. 38:441-447.
Clesceri LS, Greenberg AE, Eaton AD (2005). Standard method for
examination of water and wastewater. APHA, WPCF, AWWA, 21th
ed., Washington DC.
Ekhaise F, Omavoya B (2008). Influence of Hospital Wastewater
Discharged From University of Benin Teaching Hospital (UBTH),
Benin City on its Receiving Environment. American-Euroasian. J.
Agric. Environ. Sci. 4(4):484-488.
Emmanuel E, Perrodin Y, Keck G, Blanchard JM (2005).
Ecotoxicological risk assessment of hospital wastewater: a proposed
framework for raw effluents discharging into urban sewer network. J.
Hazard. Mater. A117:1-11.
Escher BI, Baugmartner R, Koller M, Treyer K, Lienert J, McArdell CS
(2011). Environmental toxicity and risk assessment of
pharmaceuticals from hospital wastewater. Water Res. 45:75-92.
Iranian Environment protection Agency (IR EPA) (2003). Environmental
regulations and standards of effluent reuse in Iran. Islamic republic of
Iran. pp. 234-239.
Jolibois B, Guerbet M (2006). Hospital wastewater genotoxicity. Ann.
Occup. Hyg. 50(2):189-196.
Katsoyiannis A, Samara C (2004). Persistent organic pollutants (POPs)
in the sewage treatment plant of Thessaloniki, northern Greece:
occurrence and removal. Water Res. 38(11):2685-2698.
Kummerer K, Helmers E (2006). Hospital effluents as a source for
platinum in the environment. Sci. Total Environ. 193:179-184.
Lenz C, Koellensperger G, Hann S, Weissenbacher N, Mahnik SN,
Fuerhacker M (2007). Fate of cancerostatic platinium compounds in
biological wastewater treatment of hospital effluents. ChemospHere
69:1756-1774.
Mahvi A, Rajabizadeh A, Yousefi N, Hosseini H, Ahmadian M (2009).
Survey of wastewater treatment condition and effluent quality of
Kerman Province hospitals. World Appl. Sci. J. 7(12):1521-1525.
Majlesi NM, Yazdanbakhsh A (2008). Study On Wastewater Treatment
Systems In Hospitals of
Iran. Iran. J. Environ. Health Sci. Eng.
5(3):211-215.
Mesdaghinia A, Naddafi K, Nabizadeh R, Saeedi R, Zamanzadeh M
(2009). Wastewater characteristics and appropriate method for
wastewater management in the hospitals. Iran. J. Public Health
38(1):34-40.
Pauwels B, Verstraete W (2006). The treatment of hospital wastewater.
J. Water Health. IWA publishing, 4(4):405-416.
Sarafraz Sh, Khani MR, Yaghmaeian K (2006). Quality and quantity
survey of hospital wastewaters in Hormozgan province. Iran. J.
Environ. Health Sci. Eng. 4(1):43-50.
Tchobanoglous G, Burton, F, Stensel H (2004). Wastewater engineering:
Treatment and Reuse, 4th ed. Metcalf & Eddy Inc . Mc Graw- Hill.
New York, pp. 30-69.
Verlicchi P, Galletti A, Petrovic M, Barcelo D (2010). Hospital effluents
as a sources of emerging pollutant: An overview of micro pollutants
and sustainable treatment options. J. Hydrol. 389:416- 428.