Jaldhara Technologies

Changing the way the World treats Wastewater and Effluent

HOSPITAL WASTEWATER MANAGEMENT

PRESENTED BY : AMIT CHRISTIAN AREA MANAGER JALDHARA TECHNOLOGIES PVT LTD

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

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

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
Food water use in hospital Laundry Services 5% 9%
Medical Process 14% Misc 9%

HVAC 22%
Sanitary 41%

POLLUTION SOURCES IN HOSPITAL

Wastewater from care activities, medical research Hospital Sewer Network

Administered drugs to patients

Domestic Wastewater + Industrial Wastewater

Excretion of patients containing pharmaceuticals, drugs and their metabolites

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

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

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

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

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)

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 faeces 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

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

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

QUANTITATIVE CHARACTERISTICS OF HOSPITAL WASTEWATER

Macro Pollutants :
Parameter pH BOD (mg/l) COD (mg/l) SS (mg/l) TKN (mg/l) Total P (mg/l) Fat, oil and Grease(mg/l) Total Surfactant HWW 7.7-8.1 300-400 800-1000 400-600 5-80 0.2-13 5-60 3-7.2 Urban Wastewater 75.-8.5 200-300 600-800 150-300 20-70 4-10 50-100 4-8

E.Coli MPN/100 ml
Faecal coliform Total Coliform

10- 10
10-10 10-10

10-10
10-10 10-10

QUANTITATIVE CHARACTERISTICS OF HOSPITAL WASTEWATER

Micro- Pollutants:
Therapeutic Class Analgesic (g/l) Antibiotic Cytostatic - blockers Hormones ICM AOX HWW (Avg. Value) 100 11 24 5.9 0.16 1008 1371 UWW (Avg. Value) 11.9 1.17 2.97 3.21 0.10 6.99 150

Gadolinium Platinum
Mercury

32 13
1.65

0.7 0.155
0.54

DISCHARGE STANDARDS
no specific standards for hospital wastewater Indian Standards :
Parameter pH TSS BOD O&G Limit 6.5-9.0 100 mg/l 30 mg/l 10 mg/l

COD Bio-assay test

250 mg/l 90% survival of fish after 96 hrs in 100% effluent

DISCHARGE STANDARDS
WHO (World Bank) guidelines :
Parameter pH BOD COD TSS Oil and grease Cadmium Limit 6-9 50 mg/l 250 mg/l 20 mg/l 10 mg/l 0.1 mg/l

Chromium Lead
Mercury Chlorine (Total residue) Phenols Fecal Coliforms

0.5 mg/l 0.1 mg/l

0.01 mg/l 0.2 mg/l 0.5 mg/l 400 MPN/ 100 ml

WATER MANAGEMENT AND ABATEMENT OF EMISSIONS

Hospital wastewater a complex matrix Water Use efficiency Source Reduction/ Segregation Recycle/reuse Treatment and disposal

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

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)

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

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

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

DISPOSAL AND TREATMENT OF HOSPITAL WASTEWATER

Option Direct Disposal Advantages No investment, maintenance cost. Disadvantages 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 Not viable option as based on dilution rather than pollutant segregation. Toxic substances may severely harm processes Additional cost of investment and maintenance

Co- treatment in municipal WWTP

No direct discharge to environment 90% reduction in pollutant load

Onsite WWTP

Onsite + Municipal

Double treatment Costly

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)

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 CO , HO Anaerobic Process: Absence of oxygen Certain slow growing micro organisms utilize oxygen bound to inorganic compounds like nitrate and sulfate

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)

SEQUENCING BATCH REACTOR

Suspended growth biological wastewater treatment system Fill and Draw type reactor where all the treatment steps take place in the same reactor. Wastewater is treated in batches rather than continuously Phases of SBR: a) Fill b) Mix c) React d) Settle e) Decant

SBR PHASES

ADVANTAGES OF SBR
Smaller foot print compared to conventional plants Operational stability against shock loading due to equalization Settling occurs under ideal conditions so better removal of suspended solids Can be configured to nitrification-de nitrification without adding additional tanks Compact and stabilized sludge No sludge recirculation and thus can be operated at higher SRTs and MLSS concentrations compared to CAS. Offers automation facility Complete operational and process flexibility due incorporation of VFDs and PLCs for its operation. Energy efficient operation due to automation and VFDs Minimal operator intervention required

ADVANTAGES FOR HOSPITAL WWT

Removal of estrogens is associated with nutrient removal, higher sludge age (SRT) and long hydraulic retention time. Nitrifying bacteria have a key role in the biodegradation of pharmaceuticals in WWTP that are operate at higher SRT Longer SRTs provides more diverse community of micro- organisms with broader physiological properties, enhanced metabolic and cometabolic processes affecting removal of recalcitrant compounds providing more complete mineralization Better process stability towards shock loadings due to equalization of flow and pollutant loadings.

PROCESS LAYOUT FOR SBR SYTEM

TREATED WATER QUALITY

Parameter pH SS Treated Water at the outlet of Reactor Tank 6.5-8 < 30 mg/l Treated water at the outlet of Post treatment 6.5-8 < 2 mg/l

BOD
COD TKN Total P Oil and Grease

<20 mg/l
<100 mg/l < 10 mg/l < 2 mg/l < 10 ppm

< 5 mg/l
< 50 mg/l < 3 mg/l < 0.5 mg/l Nil

APPLICATION OF TREATED WATER

Cooling Water Gardening Irrigation Toilet Flushing

GREWA-R
Single Tank Sequential Biological Reactor (SBR)

Plug-n-Play

Silent Operation

Modularly expand up to 300% of original capacity

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Grewa-R
Pre-engineered and pre-fabricated (in a container);

Decentralized Wastewater Treatment Product

- Plug and Play : Ready to Install with no civil / fabrication work at site - Fully Automatic : No dedicated Operator required - No odour : No Emmissions or Gases

Low Footprint Efficient Treatment Nutrient Reduction Scalable and modular Low Power Consumption

> 40 % savings on space compared to others in range Achieves 4 log reduction in organic and bacteriological contaminants Converts nitrates into nitrogen Can easily meet growth requirements 0.75 - 0.85 KW/m3 as against 1.4 - 1.8 KW/m3 in conventional plants

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