Field hospital wastewater treatment scenario
DOI:
https://doi.org/10.12775/EQ.2019.022Keywords
environment, pollution, waste management, disposal, pharmaceutical micropollutantsAbstract
In extreme situations with a large number of victims, field hospitals are deployed to provide patients with medical treatment. The large number of patients with different types of medications used generates the problem of hospital waste accumulation, including hospital wastewater (HWW). Wastewater is water having compromised characteristics that adversely affect the environment. Many countries do not have strict regulations regarding the disposal of hospital effluent, which contains pathogens, toxic chemicals and radioisotopes. The disposal of such substances poses a serious threat to public health and the environment. This paper discusses the possibilities of field hospital wastewater management development. Micropollutants, including pharmaceuticals, are found in different ecosystem elements, like soil, surface and ground water, drinking water as well as treated effluent from conventional wastewater treatment plants. Wastewater discharged from different health facilities, with varying concentrations of pharmaceuticals, is often mixed with municipal sewage, thus remains untreated even after passing through conventional treatment plants. Extensive experience in the application of different types of HWW treatment methods allows the development of an optimal treatment scenario for field hospital wastewater problem resolution, including the combination of Microbiological Reactor and Fenton Process technologies. They are applicable in the case of low wastewater flow rate values, specific for field hospital conditions.References
Adamcza K., Lyko S., Nafo S., Evenblij H., Cornelissen A., Igos E., Klepiszewski K., Venditti S., Kovalova L., McArdell C., Helwig K., Pahl O., Barraud O., Casellas M., Dagot C., Maftah C., Ploy M.-C. & Stalder T., 2012, Pharmaceutical residues in the aquatic system – A challenge for the future. Insights and activities of the European cooperation project PILLS. (http://www.pills-project.eu/PILLS_summary_english.pdf).
Al A.M., Verlicchi P. & Voulvoulis N., 2014, A framework for the assessment of the environmental risk posed by pharmaceuticals originating from hospital effluents. Science of the Total Environment 493: 54–64.
Bar-On E., Abargel A., Peleg K. & Kreiss Y., 2013, Coping with the challenges of early disaster response: 24 years of field hospital experience after earthquakes. Disaster Medicine and Public Health Preparedness 7(5): 491-498. (https://doi.org/10.1017/dmp.2013.94).
Batelaan M.V., van den Berg E.A., Koetse E., Wortel N.C., Rimmelzwaan J. & Vellinga S., 2013, Evaluation Report Pharmafilter: full scale demonstration in the Reinier de Graaf Gasthuis (Hospital) Delft. STOWA, Amersfoort.
Beyene H. & Redaie G., 2011, Assessment of waste stabilization ponds for the treatment of hospital wastewater: the case of Hawassa university referral hospital. World Applied Sciences Journal 15(1): 142–150.
Boxall A.B.A., Rudd M.A., Brooks B.W., Caldwell D.J., Choi K., Hickmann S., Innes E., Ostapyk K., Staveley J.P. & Verslycke T., 2012, Pharmaceuticals and personal care products in the environment: what are the big questions? Environmental Health Perspectives 120: 1221–1229.
Brodin T., Fick J., Jonsson M. & Klaminder J., 2013, Dilute concentration of a psychiatric drug alter behavior of fish from natural populations. Science 339: 814–815. (https://doi.org/10.1126/science.1226850).
Carraro E., Bonetta S., Bertino C., Lorenzi E., Bonetta S., & Gilli G., 2016, Hospital effluents management: chemical, physical, microbiological risks and legislation in different countries. Journal of Environmental Management 168: 185–199.
Chartier Y., Emmanuel J., Pieper U., Prüss A., Rushbrook P., Stringer R., Townend W., Wilburn S., Zghondi R. (eds), 2014, Safe Management of wastes from health-care activities, 2 edn. World Health Organization, Geneva, Switzerland, printed in Malta.
China, 1998, National Standard of the People’s Republic of China. Integrated wastewater discharge standard GB 8978–88. Date of Approval: Oct. 4, 1996. Date of Enforcement: Jan 1, 1998.
Chonova T., Keck F., Labanowski J., Montuelle B., Rimet F. & Bouchez A., 2016, Separate treatment of hospital and urban wastewaters: a real scale comparison of effluents and their effect on microbial communities. Science of the Total Environment 542: 965–975.
Cizmas L., Sharma V.K., Gray C.M. & McDonald T.J., 2015, Pharmaceuticals and personal care products in waters: occurrence, toxicity, and risk. Environmental Chemistry Letters 13: 381. (https://doi.org/10.1007/s10311- 015-0524-4).
Clean Water Act, 1972, Federal Water Pollution Control Act, 33 U.S.C. 1251 et seq. (https://www.epa.gov/sites/production/files/2017-08/documents/federal-water-pollution-control-act-508full.pdf).
Daouk S., Chèvre N., Vernaz N., Wildmer C., Daali Y. & Fleury-Souverain S., 2016, Dynamics of active pharmaceutical ingredients loads in a Swiss university hospital wastewaters and prediction of the related environmental risk for the aquatic ecosystems. Science of the Total Environment 547: 244–253. (https://doi.org/10.1016/j.scitotenv.2015.12.117).
Duong H.A., Pham N.H., Nguyen H.T., Hoang T.T., Pham H.V., Pham V.C., Berg M., Giger W. & Alder A.C., 2008, Occurrence, fate and antibiotic resistance of fluoroquinolone anti-bacterial in hospital wastewaters in Hanoi, Vietnam. Chemosphere 72: 968–973.
El-Ogri F., Ouazzani N., Boraâm F. & Mandi L., 2016, A survey of wastewaters generated by a hospital in Marrakech city and their characterization. Desalination and Water Treatment 57: 17061–17074. (https://doi.org/10.1080/19443994.2016.1138328).
EPA, 2016, Preliminary 2016 effluent guidelines program plan. EPA.821-R-16-001, Washington DC, USA.
EU, 1991, European Union. Council Directive 91/271/EEC of 21 May 1991 concerning urban waste-water treatment. (https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31991L0271:EN:HTML).
EU, 1998, European Union. Commission Directive 98/15/EC of 27 February 1998 amending Council Directive 91/271/EEC with respect to certain requirements established in Annex I thereof (Text with EEA relevance). Official Journal of the European Communities 7.3.98: I.67/29-30. (https://publications.europa.eu/en/publication-detail/-/publication/ff7ec087-8cc3-4619-bffc-b08ea4883d2c).
EU, 2008, European Union. Directive 2008/98/EC of the European Parliament and of the Council of 19 November 2008 on waste and repealing certain Directives (Text with EEA relevance). Official Journal of the European Union 22.11.2008: L 312/3. (https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A32008L0098).
Federal Ministry for the Environment, Nature Conservation and Nuclear Safety, 2004, Promulgation of the New Version of the Ordinance on Requirements for the Discharge of Waste Water into Waters (Waste Water Ordinance – AbwV) of 17 June 2004. BMU, Bonn, Germany. (https://www.bmu.de/fileadmin/bmuimport/files/pdfs/allgemein/application/pdf/wastewater_ordinance.pdf).
Fekadu S., Merid Y., Beyene H., Teshome W. & Gebre-Selassie S., 2015, Assessment of antibiotic and disinfectant-resistant bacteria in hospital wastewater, South Ethiopia: a cross-sectional study. Journal of Infection in Developing Countries 9(2): 149–156.
Galus M., Jeyaranjaan J., Smith E., Li H., Metcalfe C. & Wilson J.Y., 2013a, Chronic effects of exposure to a pharmaceutical mixture and municipal wastewater in zebrafish. Aquatic Toxicolology 132–133: 212–222.
Galus M., Kirischian N., Higgins S., Purdy J., Chow J., Rangaranjan S., Li H., Metcalfe C. & Wilson J.Y., 2013b, Chronic, low concentration exposure to pharmaceuticals impacts multiple organ systems in zebrafish. Aquatic Toxicology 132–133: 200–211.
Göbel A., McArdell C.S., Joss A., Siegrist H. & Giger W., 2007, Fate of sulfonamides, macrolides, and trimethoprim in different wastewater treatment technologies. Science of the Total Environment 372: 361–371. (https://doi.org/10.1016/j.scitotenv.2006.07.039).
Gracepavithra K., Ponnusamy S.K., Sundarrajan P., Saravanan A. & Naushad M., 2017, Sources and impacts of pharmaceutical components in wastewater and its treatment process: A review. Korean Journal of Chemical Engineering 34(11): 2787-2805. (https://doi.org/10.1007/s11814-017-0255-2).
Grundfos BioBooster A/S, 2015, Private-Public Innovation Project Background and Project objectives. RPCIG Langaa, Denmark. (https://www.herlevhospital.dk/nythospitalherlev/nyheder-og-presse/nyheder/Documents/10988_Biobooster_Herlev_LOW_opslag.pdf).
Halpern P., Rosen B., Carasso S., Sorkine P., Wolf Y., Benedek P. & Martinovich G., 2003, Intensive care in a field hospital in an urban disaster area: lessons from the August 1999 earthquake in Turkey. Critical Care Medicine 31(5): 1410-1414. (https://doi.org/10.1097/01.CCM.0000059439.07851.BD).
Hancock F., 1999, Catalytic strategies for industrial water re-use. Catalysis Today 53: 3–9. (https://doi.org/10.1016/S0920-5861(99)00098-X).
Hermann M., Olsson O., Fiehn R., Herrel R., Herrel M. & Kümmerer K., 2015, The significance of different health institutions and their respective contributions of active pharmaceutical ingredients to wastewater. Environment International 85: 61–76.
ICRP, 2004, Release of patients after therapy with unsealed radionucleides ICRP Publication 94. Ann. ICRP 34(2): v-vi, 1-79.
Italy, 2011, D.P.R. 19 Ottobre 2011 n. 227. Regolamento per la semplificazione di adempimenti amministrativi in materia ambientale gravanti sulle imprese, a norma dell’articolo 49, comma 4-quater, del decreto-legge 31 maggio 2010, n. 78, convertito, con modificazioni, dalla legge 30 luglio 2010, n. 122. Pubblicato nella Gazz. Uff. 3 febbraio 2012, n. 28.
Jones-Lepp T.L. & Stevens R., 2007, Pharmaceuticals and personal care products in biosolids/sewage sludge: The interface between analytical chemistry and regulation. Analytical and Bioanalytical Chemistry 387(4): 1173–1183.
Jones-Lepp T.L., Alvarez D.A., Englert B. & Batt A., 2009, Pharmaceuticals and hormones in the environment, [in:] R.A. Meyers (ed.), Encyclopedia of Analytical Chemistry: Applications, Theory, and Instrumentation. John Wiley & Sons Incorporated, New York, NY. 75(1): 1-59.
Jones-Lepp T.L., Sanchez C., Alvarez D.A., Wilson D.C. & Taniguchu-Fu R.L., 2012, Point sources of emerging contaminants along the Colorado River Basin: Source water for the arid Southwestern United States. Science of the Total Environment 430: 237–245.
Jones-Lepp T.L., Sanchez C.A., Moy T. & Kazemi R., 2010, Method development and application to determine potential plant uptake of antibiotics and other drugs in irrigated crop production systems. Journal of Agricultural and Food Chemistry 58(22): 11568–11573.
Kosma C.I., Lambropoulou D.A. & Albanis T.A., 2010, Occurrence and removal of PPCPs in municipal and hospital wastewaters in Greece. Journal of Hazardous Materials 179: 804–817. (https://doi.org/10.1016/j.jhazmat.2010.03.075).
Kümmerer K. & Helmers E., 2000, Hospital effluents as a source of Gadolinium in the aquatic environment. Environment Science & Technology 34: 573–577.
Kümmerer K., 2009a, Antibiotics in the aquatic environment – A review – Part I. Chemosphere 75(4): 417–434.
Kümmerer K., 2009b, Antibiotics in the aquatic environment – A review – Part II. Chemosphere 75(4): 435–441.
Kümmerer K., 2010, Pharmaceuticals in the environment. Annual Review of Environment and Resources 35(1): 57–75.
Lenz K., Mahnik S.N., Weissenbacher N., Mader R.M., Krenn P., Hann S., Koellensperger G., Uhl M., Knasmüller S., Ferk F., Bursch W. & Fuerhacker M., 2007, Monitoring, removal and risk assessment of cytostatic drugs in hospital wastewater. Water Science & Technology 56: 141–149. (https://doi.org/10.2166/wst.2007.828).
Lien L.T.Q., Hoa N.Q., Chuc N.T.K., Thoa N.T.M., Phuc H.D., Diwan V., Dat N.T., Tamhankar A.J. & Lundborg C.S., 2016, Antibiotics in wastewater of a rural and an urban hospital before and after wastewater treatment, and the relationship with antibiotic use-a one year study from Vietnam. International Journal of Environmental Research and Public Health 13: 1–13. (https://doi.org/10.3390/ijerph13060588).
Liu Q., Zhou Y., Chen L. & Zheng X., 2010, Application of MBR for hospital wastewater treatment in China. Desalination 250(2): 605–608.
Maheshwari M., Yaser N.H., Naz S., Fatima M. & Ahmad I., 2016, Emergence of ciprofloxacin resistant extended-spectrum β-lactamase-producing enteric bacteria in hospital wastewater and clinical sources. Journal of Global Antimicrobial Resistance 5: 22–25.
Mahvi A., Rajabizadeh A., Fatehizadeh A., Yousefi N., Hosseini H. & Ahmadian M., 2009, Survey wastewater treatment condition and effluent quality of Kerman Province hospitals. World Applied Sciences Journal 7(12): 1521–1525.
Martins A.F., Vasconcelos T.G., Henriques D.M., Frank C., König A. & Kümmerer K., 2008, Concentration of ciprofloxacin in Brazilian hospital effluent and preliminary risk assessment: A case study. CLEAN – Soil, Air, Water 36: 264–269. (https://doi.org/10.1002/clen.200700171).
Ministry of Environment and Forests, Department of Environment, Forest and Wildlife, 1986, The Environment (Protection) Act. No 29 of 1986. Government of India, New Delhi.
Naor M., Heyman S.N., Bader T. & Merin O., 2017, Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades. American Journal of Disaster Medicine 12(4): 243-256. (https://doi.org/10.5055/ajdm.2017.0277).
Parolini M., Pedriali A. & Binelli A., 2013, Application of a biomarker response index for ranking the toxicity of five pharmaceuticals and personal care products (PPCP) to the bivalve Dreissena polymorpha. Archives of Environmental Contamination and Toxicology 64: 439–447.
Prabhasankar V.P., Joshua D.I., Balakrishna K., Siddiqui I.F., Taniyasu S., Yamashita N., Kannan K., Akiba M., Praveenkumarreddy Y. & Guruge K.S., 2016, Removal rates of antibiotics in four sewage treatment plants in South India. Environmental Science and Pollution Research Int. 23(9): 8679-8685. (https://doi.org/10.1007/s11356- 015-5968-3).
Prado T., Silva D.M., Guilayn W.C., Rose T.L., Gaspar A.M.C. Miagostovich M.P., 2011, Quantification and molecular characterization of enteric viruses detected in effluents from two hospital wastewater treatment plants. Water Research 45: 1287–1297. (https://doi.org/10.1016/j.watres.2010.10.012).
Rogers H.R., 1996, Sources, behaviour and fate of organic contaminants during sewage treatment and in sewage sludges. Science of the Total Environment 185: 3–26. (https://doi.org/10.1016/0048-9697(96)05039-5).
Santos L.H., Gros M., Rodriguez-Mozaz S., Delerue-Matos C., Pena A., Barceló D. & Montenegro M.C., 2013, Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals. Science of the Total Environment 461–462: 302–316.
Shrestha R.R., Haberl R. & Laber J., 2001a, Constructed wetland technology transfer to Nepal. Water Science & Technology 43: 345–350.
Shrestha R.R., Haberl R., Laber J., Manandhar R. & Mader J., 2001b, Application of constructed wetlands for wastewater treatment in Nepal. Water Science & Technology 44: 381–386.
Sim W.J., Kim H.Y., Choi S.D., Kwon J.H. & Oh J.E., 2013, Evaluation of pharmaceuticals and personal care products with emphasis on anthelmintics in human sanitary waste, sewage, hospital wastewater, livestock wastewater and receiving water. Journal of Hazardous Materials 248–249: 219–227.
Sokolov D., Sobyna V., Vambol S. & Vambol V., 2018, Substantiation of the choice of the cutter material and method of its hardening, working under the action of friction and cyclic loading. Archives of Materials Science and Engineering 94(2): 49–54. (https://doi.org/10.5604/01.3001.0012.8658).
Tambosi J.L., de Sena R.F., Gebhardt W., Moreira R.F.P.M., José H.J. & Schröder H.F., 2009, Physicochemical and advanced oxidation processes - A comparison of elimination results of antibiotic compounds following an MBR treatment. Ozone: Science & Engineering 31: 428–435. (https://doi.org/10.1080/01919510903324420).
The Socialist Republic of Vietnam, 2014, Law on environmental protection. No. 55/2014/QH13. Official Gazette Issue nos. 11-12/July 2014: 5-63. Vietnam Law and Legal Forum, Hanoi. (https://www.informea.org/sites/default/files/legislation/vie167836.pdf).
Vambol S., Vambol V., Kondratenko O., Koloskov V. & Suchikova Y., 2018, Substantiation of expedience of application of high-temperature utilization of used tires for liquefied methane production. Journal of Achievements in Materials and Manufacturing Engineering 87(2): 77–84. (https://doi.org/10.5604/01.3001.0012.2830).
Vambol S., Vambol V., Sundararajan M. & Ansari I., 2019, The nature and detection of unauthorized waste dump sites using remote sensing. Ecological Questions 30(3): 1–17. (https://doi.org/10.12775/EQ.2019.018).
Verlicchi P. & Zambello E., 2016, Predicted and measured concentrations of pharmaceuticals in hospital effluents. Examination of the strengths and weaknesses of the two approaches through the analysis of a case study. Science of the Total Environment 565: 82–94.
Verlicchi P., Al Aukidy M., Galletti A., Petrovic M. & Barceló D., 2012a, Hospital effluent: investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment. Science of the Total Environment 430: 109–118.
Verlicchi P., Aukidy M. & Zambello E., 2012b, Occurrence of pharmaceutical compounds in urban wastewater: Removal, mass load and environmental risk after a secondary treatment - A review. Science of the Total Environment 429: 123–155. (https://doi.org/10.1016/j.scitotenv.2012.04.028).
Verlicchi P., Galletti A. & Masotti L., 2010a, Management of hospital wastewaters: The case of the effluent of a large hospital situated in a small town. Water Science & Technology 61: 2507–2519. (https://doi.org/10.2166/wst.2010.138).
Verlicchi P., Galletti A., Petrovic M. & Barceló D., 2010b, Hospital effluents as a source of emerging pollutants: an overview of micropollutants and sustainable treatment options. Journal of Hydrology 389: 416–428.
Yu J., Li Q. & Yan S., 2013, Design and running for a hospital wastewater treatment project. Advanced Materials Research 777: 356–359.
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