World Applied Sciences Journal 7 (12): 1521-1525, 2009

ISSN 1818-4952
© IDOSI Publications, 2009

Survey Wastewater Treatment Condition and Effluent Quality

of Kerman Province Hospitals
1
A. Mahvi, 2A. Rajabizadeh, 3A. Fatehizadeh, 3N. Yousefi
3
H. Hosseini and 3M. Ahmadian

1
School of Public Health and Center for Environmental Research, Tehran University of Medical Sciences
and National Institute of Health Research, Ministry Of Health, Tehran Iran
2
Manager of Environmental Health Engineering Faculty of Health,
Kerman University of Medical Sciences, Kerman Iran
3
M.Sc. of Environmental Health Engineering, Kerman University of Medical Sciences, Kerman Iran

Abstract: Hospital wastewaters are loaded with pathogenic microorganisms, laboratory and pharmaceutical
residuals, pharmaceutical partially metabolized, radioactive elements and other toxic chemical substances, So
in order to wastewater treatment and disposal condition have special importance. Aim of this study is survey
Kerman province (southwest Iran) hospitals wastewater treatment condition and effluent quality. This
cross-sectional study has performed at 2005-2007. In this study, first Kerman province divided in 7 clusters and
from between these clusters, selected 7 hospitals by random digit table and exist condition of Kerman province
hospitals wastewater plant assessment in order to Chemical Oxygen Demand(COD), Biochemical Oxygen
Demand (BOD5), Dissolved Oxygen (DO), Total Suspended Solid (TSS), pH, Nitrate and Nitrite, Chloride,
Phosphate and Sulfate. In addition to, different sections of wastewater treatment plant have been visited.
The results of this study showed that surveyed parameters in effluent of total hospitals have decreased than
influent, but amount of this parameter is higher of standard limit. As measured72.24% of BOD5 and 65.52% of
COD were higher of standard limit. The amount of measured for pH, Chloride, Sulfate and Nitrite were in range
of standard limit. The hospital wastewater treatment plants, in this study, don’t have sufficient efficiency and
revise of type of treatment process and operating is necessary.

Key words: Hospital % Wastewater treatment % Kerman province % Effluent

INTRODUCTION metabolites, radioactive elements and other chemicals.

Wastewater refers to water used by human due to
lose its quality and unusable, which include waste liquid
of domestic resources, industrial, agricultural and
commercial [1, 2]. In hospitals water consumed by various
parts such as hospitalization, surgery rooms, laboratories,
administrative units, laundry, health services, kitchen and
etc, physical chemical and biological quality decreased
and converted to wastewater [3]. Per capita production of
wastewater per bed per day in America was1000 liters [4].
The most important contaminants of hospital
wastewater are different microorganisms, organic materials
and mineral contaminants. Hospital wastewater is
hazardous due to high amount of pathogenic
microorganisms, laboratory and drug residuals, drug
Analysis of hospital contaminants has shown disposal
of special materials such as antitumor substances,
halogenated organic materials and antibiotic that its been
caused to greater risk for potential human health and the
environment than urban wastewater [3, 5-8]. These
compounds will be affected on natural environment and
caused biological imbalances if this material discharged
from waste water treatment plants. This material can not
destroyed in environmental conditions and have negative
effects on the received waters and different organisms
[5, 6].
In the countries that enteric diseases and parasites
are not outbreak, hospital wastewater could discharge to
urban sewer system without pretreatment, if the following
conditions could be achieved:

Corresponding Author: M. Ahmadian Kerman, Haft Baghe Alavi Highway, University of Medical Sciences School of Public Health
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 World Appl. Sci. J., 7 (12): 1521-1525, 2009
C Urban wastewater will transfer to wastewater
treatment plant that bacterial removal efficiency is at
least 95 percent.
C Remaining sludge of wastewater treatment is
digested in anaerobic digester; this sludge should
not have more than one warm egg per liter of
digested sludge.
C Waste management system in these plants should
have high standard.
C Excretion of patients that curing by Cytotoxic drugs,
separately collected and sufficiently treated [5, 6].
In normal conditions, the usual secondary biological
treatment of wastewater, properly applied, complemented
by anaerobic digestion of sludge, can be considered as
well sufficiently. But during of incidence of epidemic and
season sensitive conditions (summer and autumn),
effluents of wastewater treatment systems must be
disinfected by chlorine dioxide or other disinfectants [9].
Unfortunately, hospital wastewater treatment plants
have not appropriate performance to following reasons:
C Inappropriate operation of hospital wastewater
treatment plant due to operator unfamiliarity with
wastewater treatment principals.
C Negligence in management of wastewater treatment
plant from authorities [3].
Kerman province is located at south-eastern part of
Iran with longitude 54°, 21´- 59°, 34´ and latitude of 26°,
29´-31°, 58´ [10]. Kerman characterized by warm and arid
climate and considerable temperature diversity between
days and night times. Hospitals water in this province
through the urban water distribution network was
supplied. The aim of this study was to evaluate the
conditions and quality of wastewater treatment effluent of
hospitals in Kerman province.
MATERIALS AND METHODS
This cross-sectional study was performed from
2005-2007. The first in this study Kerman province divided
to 7 clusters and among of these clusters in order to
random numbers Table, 7 hospitals were selected and
efficiency of their existing system were investigated. For
evaluation the current condition of these hospitals was
conducted field visits and the circumstance of these
sections and wastewater treatment system was studied.
According to the Standard methods for water and
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wastewater examination, sampling points selected and
samples was transferred to laboratory in 2 hours [11].
COD, BOD5, DO, TSS, pH, nitrate and nitrite, phosphate,
chloride and sulfate parameters as the parameters of
operation index of wastewater treatment plant and
effluents disposal were studied.
RESULTS AND DISCUSSION
Table 1 showed that characteristic of hospitals that
studied. All of hospital wastewater treatment systems
were Activated sludge. Blood and laundry wastewater
disposed directly to wastewater collection system.
Collected hospital wastewater was discharging into
pumping station. Kitchen wastewater collected in the
reservoir separately and removing fat then transferred to
pumping station. In all of hospitals, fat removal units not
service timely and collected fat not disposal timely that
caused of inappropriate performance this unit.
In this treatment system dose not exist primary
sedimentation tank and suspended solid only have the
sediment opportunity in pumping station. After aeration,
the effluent of aeration tank discharge into secondary
sedimentation. Effluent of secondary sedimentation was
disinfected by Liquid chlorination which generally has
operational problems, imbalance of chlorine dose
injection and failure of injection pump diaphragm. Then
chlorination, final effluent disposed into seepage well.
Table 2 showed that average values of measured
parameters in wastewater treatment plant in Kerman
Province Hospitals at 2005-2007.
Generally measured 72.41% samples BOD5 values of
hospitals wastewater treatment plants effluent were higher
than WHO standards. The average BOD5 of samples
73mg/L, the lowest BOD 11mg/L (June 2006 in Kerman
Afzalipour Doctor Hospital) and highest BOD5 412mg/L
(June 2005 in Rafsanjan Ali Ebn Abi Taleb Hospital) were
measured. Also measured 65.52% of the sample COD
values were higher than WHO standards. The average
COD of samples 162mg/L, the lowest COD value 28mg/L
(June 2006 in Kerman Afzalipour Doctor Hospital) and
highest COD (June 2005 in Rafsanjan Ali Ebn Abi Taleb
Hospital) equal to1150mg/L were measured. The
average TSS and pH were measured 59.27 mg/L and 7.5
respectively. PH value of the samples were in range of
WHO standards [12].
Khorsandi et al. (2003) showed that the average
value of COD, BOD5 and TSS in the effluent equal to 374,
60.5 and 50 mg/L respectively [13].
 World Appl. Sci. J., 7 (12): 1521-1525, 2009

Table 1: Characteristic of the studied hospitals in Kerman province at 2005-2007

Characteristics
--------------------------------------------------------------------------------------------------------------------------------------------------
Hospital No of sections Infectious section No of bed + personal
Taemin Ejtemai, Zarand 7 Available 283
Pastour, Bam 7 Available 704
Ali Ebne Abitaleb, Rafsanjan 13 Available 803
12 Farvardin, Kahnooj 6 Unavailable 290
Afzalipoor Doctor, Kerman 17 Available 1073
Gharazi Doctor, Sirjan 8 Available 390
Ghaem, Bardsir 8 Available 255

Table 2: The average values of measured parameters in wastewater treatment plant in Kerman province hospitals at 2005-2007
Parameters as (mg/L)
------------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital pH BOD5 COD TSS NO3- NO2- PO43- CL- SO42-
Taemin Ejtemai, Zarand 7.56 58 91 13.4 13.54 3.34 8.04 223.6 269.1
Pastour, Bam 7.5 85 115 85 4 0.36 26 444 99.5
Ali Ebne Abitaleb, Rafsanjan 7.5 412 813 98 0.1 - - 312 73.4
12 Farvardin, Kahnooj 8.15 86.25 356.63 78 - - 51.5 887.5 -
Afzalipoor Doctor, Kerman 7.7 39.33 107.17 59 16.1 0.29 1.65 253.57 130.8
Gharazi Doctor, Sirjan 7.39 45.18 76.55 12.7 12.32 2.75 6.1 213.97 168.16
Ghaem, Bardsir 7.5 250 369 35 14.5 2 4.7 266 118
WHO standards 5-9 30 60 100 10 10 6 600 400

Fig. 1: Variation of BOD and COD wastewater measured in Kerman province hospitals

Majlesinasr (2008) showed that measured BOD5, COD
and TSS in the effluent were113, 188 and 99 mg/L
respectively [14]. Mesdaghinia et al. (2009) showed that
Efficiency of the wastewater treatment plants was not
appropriate [15]. Results of this study were confirmed by
mentioned studies.
Sarafraz (2006) showed that measured BOD5, COD
and TSS in the effluent were 12.53, 51.7 and 19.68 mg/L,
respectively, when the wastewater treatment plant was
worked properly [16]. Fig.1 Showed variation of BOD5 and
COD value of wastewater measured in Kerman province
hospitals.
Average values of nitrate, nitrite and phosphate were
measured, 12.26, 2.28 and 9.64mg/L respectively. Lowest
nitrate 0.1mg/L (in Rafsanjan Ali Ebn Abi Taleb Hospital
in June 2005) and highest nitrate 38.8mg/L (in May 2006 in

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 World Appl. Sci. J., 7 (12): 1521-1525, 2009
Kerman Afzalipour Doctor hospital) were measured. In
general measured 56.25% of nitrite samples were higher
than of WHO standards. Lowest nitrite 0.04mg/L
(in May 2006 in the Kerman Afzalipour Doctor Hospital)
and highest of nitrite 4.6mg/L (in September 2005in the
Sirjan Gharazi Doctor Hospital) were measured. Generally,
100% of samples have amount of nitrite less than of WHO
standards [12].
Lowest value of phosphate 0.54 mg/L (in October
2005 in Kerman Afzalipour Doctor Hospital) and highest
value of phosphate 51.5mg/L (in June 2005 in the
Rafsanjan Ali Ebn Abi Taleb Hospital) were measured. In
general measured 29.41% of the samples phosphate were
higher than the recommended WHO standards [12].
Average values of chloride and sulfate of measured
samples of hospitals wastewater treatment plants effluent
were 267.53 and 185.34 mg/L respectively that these
values were less than the WHO standards. TDS value was
measured 1166.89 mg/L. Amount of detergent in 90% of
collected samples from the wastewater treatment plant
effluents was less than permission limit for disposal to the
seepage wells [12]. In this study; DO parameter has been
regarded as indicates the performance of aeration
systems. The average DO value in the samples was
2.3mg/L.
CONCLUSION
The average COD and BOD5 values of studied
hospital wastewater treatment plant were higher than
WHO standards [12]. This indicated that lack suitable
performance in this unit to reduce these indicator
parameters. The main reason for this can be attributed to
inappropriate organic loading to system, cross sectional
discharge of wastewater to system and creating organic
shock due to raw wastewater and negative affect on floc
formation microorganisms into aeration tank, improper
performance of secondary sedimentation, microorganisms
death because of drugs and antibiotics in raw wastewater,
improper return of sludge into aeration tank, thermal
shock to the system of laundry.
Presence of nitrate higher than WHO standard
indicated weak denitrification in hospital wastewater
treatment plants, which can be referred to hydraulic shock
to wastewater treatment plant, improper return of sludge
into aeration tank from the secondary sedimentation tank,
improper (F/M) ratio.
Regarding to results of this study, problems related
to improper performance of hospital wastewater treatment
studied in Kerman province can be due to the following
factors:
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C Mismatch of flow rate of wastewater treatment plant
design to wastewater production.
C Influent wastewater to wastewater treatment plant
was discontinuous.
C Type and pattern of surface air mixer layout.
C Improper operation of returned sludge flow line.
C Some of the wastewater treatment plant are old.
C Improper performance of chlorination unit.
C Improper performance of screening units.
C Lack measurement of SVI and operation of
wastewater treatment plant regardless to SVI.
C Operators unfamiliarity to wastewater treatment
principles.
C Inappropriate wastewater treatment plant in terms of
safety and aesthetic aspects.
ACKNOWLEDGEMENT
The authors would like to thank environmental health
units’ authorities of Kerman province hospitals.
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