Hospital waste water of Karachi

Wastewater is defined as any water, whose quality has been adversely being abused by anthropogenic influence. This includes liquid waste discharged from domestic homes, industries, hospitals, agricultural and commercial sectors.

Hospital waste water of KarachiMany of the pollutants detected in wastewaters are categorized as non-regulated “emerging pollutants”. The contact of this kind of wastewater with the surrounding environment results in adverse effects on the biological balance of aquatic ecosystems, causing imbalance at different trophic levels possibly related to the action of toxic and genotoxic agents and indirectly by eutrophication.

Disinfectants, pharmaceuticals; radionuclides and solvents are widely used in hospitals for medical purposes and research. After application, these reach the municipal sewer network. If left untreated, these could lead to outbreak of communicable diseases, water contamination, and radioactive pollution in various countries in the world facing different issues.

In recent time hospital effluent has been gained a significant attention in various countries in the world facing different issues. It is well established that hospitals may consume extensive amount of water in a day, ranging between 400 to 1200 L day-1 and consequently, generate equally significant volume of wastewater load.

Hospital wastewaters (HWW) are generated in different sectors of a hospital including patient wards, surgery units, laboratories, clinical wards, ICU, laundries and possess a quite variable composition depending on the activities involvedIn this context, HWW (Hospital Waste Water) consist a numerous persistent chemical compounds and complex mixtures of organic matter including pharmaceuticals, radionuclides, detergents, antibiotics, antiseptics, surfactants, solvents, medical drugs, heavy metals, radioactive substances and microorganisms.

After usage, some of these compounds and nonmetabolized drugs excreted by patients are detected in HWW and then, enter the municipal sewer network without preliminary treatment. For this reason, this composition leads to extensive levels of toxicity, genotoxicity and organic load and subsequently, causes an adverse impact on the natural ecosystem and inherent hazard to human health.

One of the major environmental concerns due to hospital effluent is their discharge into urban sewerage systems without adequate treatment. HWW could be negatively affected to the ecological balance and public health. If left untreated, pathological, radiaoactive, pharmaceutical, chemical and infectious components of HWW lead to outbreaks of communicable diseases, diarrhea epidemics, cholera, skin diseases, enteric illness, water contamination and radioactive pollution.

On the other hand, HWW sludge from on-site treatment plants are to be carefully managed with the precautions as municipal waste sludge. Such sludge must not be utilized as manure without proper pretreatment for food crops.

There are 796 hospitals in the urban areas of Pakistan. In 1993, a survey indicates that there are 153 hospitals with 12,014 beds and about 832 clinics and dispensaries with 500 beds, treated 0.6 million indoor patients and generated total waste of about 13,140 tonnes, at the rate of 36 tonnes/day at Karachi city

Issues related to water

While major international forums have advocated for safe drinking water, and many developing countries are striving to provide safe drinking water, the quality of drinking water in urban cities, secondary cities and in rural towns of Sindh in the Indus basin is unsafe to drink. Figures of access to safe water in Pakistan and in Sindh are variable.

According to the Water Aid’s Pakistan Country Strategy 2010-2015, around 50 per cent of the population has adequate access to drinking water and a mere 15pc to sanitation. In December 2015, the federal minister for science and technology said that 82pc of Pakistanis consume dirty water.

A recent report in Dawn said that 40pc of water samples collected from different parts of Karachi were not properly chlorinated. Because of this has serious implications for the health of the people not in Karachi but a whole Sindh. Like (8)Diarrhoeal diseases and other infections often occur due to consumption of contaminated water.

Contamination can occur at the source, between source and storage points or in storage tanks &Environmental degradation costs Pakistan Rs365 billion per year, and these costs fall disproportionately upon the poor. About a third of this cost is the result of expenditure incurred on death and diseases due to inadequate water supply, sanitation and hygiene.

According to a World Wide Fund for Nature (WWF) report titled, “Pakistan’s Waters at Risk“, 20pc to 40pc of the hospital beds in Pakistan are occupied by patients suffering from water-related diseases, such as typhoid, cholera, dysentery and hepatitis, which are responsible for one third of all deaths.Unfortunately, proper and authoritative data on drinking water quality for Sindh is not readily available.

Whatever little data is available shows that the drinking water quality in all cities and towns of Sindh is unsafe and does not meet the WHO’s drinking water guidelines. In 2013, the Pakistan Council of Research in Water Resources (PCRWR) collected and analysed 28 samples of water, collected from different localities of Karachi.

Of them, only two were fit for consumption, and the rest 26 samples had bacterial contamination & a local study collected 52 domestic water samples in Karachi and analysed them for presence of bacterial contamination.

The results showed that 50 out of 52 samples had bacteriological contamination. In Karachi, more than 20,000 children die annually, with the majority of deaths caused by drinking contaminated water.(9)

Health Facilities:

118869 hospital beds in Pakistan In 2015 the number of hospitals was 1167, dispensaries 5695, BHUs sub health centres 5464, maternity and child health centres 733, rural health centres 675, TB centres 339, total beds 118869 and population per bed was 1613.Keeping 2000 as the base year we measure the progress in the number of health facilities.

From 2000 to 2015, there has been a 33% increase in the number hospitals, a 23% increase in the number of dispensaries, a 6% increase in the number of BHUs sub health centres, a 27% increase in the number of rural health centres and a 24% increase in the number of TB centres.

While we see an increase in the number of most health facilities, the number of maternity and child health centres have observed a 14% decrease. A 27% increase has been seen in the number of total beds and the population per bed has increased by 11 %( 10).

Recommendation For Hospital waste waster

The Waste Water which are generated from Hospitals contains various toxic/Harmful substances which are hazardous in nature and causes great damage to the ecosystem around the hospital and environment in general.

Hospital Sewage Effluent Water is similar to integrated wastewater which contain much more complex chemical & if partially treated or untreated (Without technological treatment) wastewater discharge, it causes serious Pollution for natural resources & Living beings.

Need for Treatment of Hospital waste water:

 There are two main reason for treatment of Hospital Waste-Water Viz.  i) Prevention of pollution in the form of biological, chemical and Pharmaceutical waste pollution to the ecosystem surrounding the Hospitals  ii) protecting the public health by safeguarding ground and Surface water supplies and preventing the spread of waterborne diseases from biological and Chemical waste.

Technological solutions for hospital Waste-water treatment and disposal:

Various technological options are now available for treatment and safe disposal of Hospital Waste-Water management.  Some of the Technologies like FAB/MBBR, MBR, SBR, UV Radiation, electric Coagulation etc. Older technology Waste-water treatment plants were built on a large-scale requiring huge processing areas and high upfront capital investment costs which may require government intervention to setup such plants.

Since, environmental protection cannot wait government initiative and strict regulations have already been passed by Central Pollution Control board (CPCB) a more compact, low costs Water Treatment Plant installation in every Hospitals is becoming mandatory requirement.  Fluidized aerobic bioreactor (FAB)/ Moving Bed Bio Reactor (MBBR) is one of the low costs and space saving technologies for Hospital Waste-Water treatment,

While other Technologies requires huge upfront investment, FAB/MBBR can be installed and operated at minimal space by individual hospitals at minimal costs and still meet the latest Pollution Control board norms.  One of the great advantage of FAB/MBBR technology is that it can be operated without sludge recirculation and media back washing and can be built as a mobile unit which can be even transported or built on rooftops.

Hospital Waste Water treatment by employing FAB/MBBR technology:
FAB/ MBBR technology is a unique water treatment technology along with suspended particles and attached growth process promotes highly specialized biomass with the help of floating plastic cylindrical carrier which are kept in moving bed bio-reactor (MBBR) tank to provide a place for bacterial growth.

The Term MBBR was coined from the presence of moving plastic media and it acts as a bed /home for bacteria based on low capital costs, space saving, easy operations, high COD (Chemical Oxygen Demand) and BOD (Biological oxygen Demand) removal efficiency, less amount of sludge generation, self-regulation of biomass, single pass treatment, extremely compact design than others.

Water in its abundance is blessing and its scarcity a curse. Mother earth possess 71 percentage of water in her womb but still her children are afraid of to drink it . The famous saying water,water everywhere but no drop to drink is true in today’s world. As most of water is contaminated and hazardous to drink.

There are quite a large reasons such as Hospital solid waste in water is a potential health hazard to the health care workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases.

The procedures that applied on hospital solid waste that wastes should be separated the place where the first emerge, transported separately and specially stored in a temporarily, separate storage. While carrying them from temporary warehouse to the last destruction areas, separate carriers and trained personnel should be used.

In the last destruction areas, they should be burned in incinerators or buried in specific ways. With such a project in a university hospital with 600 beds , Beside, at national, regional and local level, some planning should be made for the health care waste management. The wastes should be reduced by identifying and monitoring the sources of waste.
The wastes should be able to use again.

Some measures need to be determined to reduce the cost and re-use the wastes. With planning, authorities, health care workers and the society are motivated and other activities that need, could be define. However few other possible measurements should be taken through modern technology and methods mentioned above

Asadullah Khan

Future Environmentalist..

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