Proceedings of the Pakistan Academy of Sciences 51 (4): 317–329 (2014) Pakistan Academy of Sciences

Copyright © Pakistan Academy of Sciences

ISSN: 0377 - 2969 (print), 2306 - 1448 (online)
Research Article

Characterization of Hospital Wastewater, Risk Waste Generation

and Management Practices in Lahore
Muhammad Imran Meo1, Sajjad Haydar2, Obaidullah Nadeem3,
Ghulam Hussain2 and Haroon Rashid2
1
Environment Protection Department, Punjab, Lahore, Pakistan
2
Institute of Environmental Engineering & Research (IEER),
University of Engineering & Technology (UET), Lahore, Pakistan
3
Department of City & Regional Planning, UET, Lahore, Pakistan

Abstract: Hospitals generate both, liquid and solid waste. High public health risks are involved in managing
these wastes. Objectives of this study were: (i) to determine the characteristics of hospital wastewater; (ii)
analysis of current risk waste management practices and compliance level with hospital waste management
rules-2005 (HWMR-2005); and (iii) analyse the risk waste generation rates. Three main hospitals of
Lahore, i.e., Services Hospital, General Hospital and Gulab Devi Chest Hospital, were selected for this
study. Wastewater characteristics were determined by taking samples from each hospital. Results were
compared with National Environmental Quality Standards (NEQS). Survey of hospitals was conducted,
using a questionnaire, to determine the compliance status with HWMR-2005. Risk waste generation data
for the year 2012 was collected and analysed. Wastewater analysis revealed that BOD, COD and Cadmium
concentrations were more than the permissible limits prescribed in NEQS. Compliance with HWMR-2005
was found better. Mean risk waste generation rates in Services Hospital, General Hospital, and Gulab Devi
&KHVW+RVSLWDOZHUHDQGNJEHGGD\1RVLJQL¿FDQWYDULDWLRQVZHUHREVHUYHGLQULVNZDVWH
generation rates on daily, weekly, monthly and seasonal basis.

Keywords: Hospital, wastewater, risk waste, generation rates, Lahore

1. INTRODUCTION occupied bed per day [4, 5-7]. This huge volume of
Disinfectants, pharmaceuticals, radionuclides and hazardous wastewater needs special attention.
solvents are widely used in hospitals for medical Outside Pakistan, many studies have been
purposes and research. After application, these reach conducted on hospital wastewater in different
the municipal sewer network [1]. If left untreated, countries such as France, India, Nigeria, Ethiopia,
these could lead to outbreak of communicable Iran, Morocco, Indonesia and Korea. These studies
diseases, water contamination, and radioactive showed that BOD values varied from 242 mg/L to
pollution [2]. Study conducted on bacteriological 632 mg/L and COD values varied from 616 mg/L
and physiochemical qualities of hospital to 1388.75 mg/L. Heavy metals such as Cadmium,
wastewater revealed that there was contamination Chromium, Copper, Lead, Mercury, Nickel and
of the receiving environment (water, soil and air) Zinc were also found in hospital wastewater [1-17,
due to the discharge of hospital wastewater. It could 36]. However, there is no known study on hospital
also be hazardous to human health [3]. Hospitals wastewater in Pakistan and little data exist on its
JHQHUDWHVLJQL¿FDQWYROXPHVRIZDVWHZDWHURQGDLO\ characteristics.
basis [4]. Average wastewater production from In addition to wastewater, hospital also generate
hospitals is estimated to be 362 to 745 litters per risk waste like infectious waste, pathological
————————————————
Received, July 2014; Accepted, October 2014
*Corresponding author: Obaidullah Nadeem; Email: [email protected]
318 Muhammad Imran Meo et al

waste, sharps, pharmaceutical waste, genotoxic management were totally unaware of basic methods
waste, chemical waste, and radioactive waste. of risk waste disposal [27].
Studies have been conducted in different countries Study conducted in ten large public and private
like Iran, South Africa, China, Germany, Korea, hospitals of Rawalpindi and Islamabad shows that
Egypt, UK, Turkey, Bangladesh, India and Congo segregation practices (for risk and non-risk waste)
on the generation and management of risk waste at the point of generation were not followed. Waste
[18-27, 39]. Rules and regulations relating to the segregation issues were due to lack of training of
GH¿QLWLRQ DQG GLVSRVDO RI KRVSLWDO ZDVWH YDU\ medical and other staff including sweepers and
widely in different countries. In European countries ward servants. There were no waste bins. Waste
FODVVL¿FDWLRQ DQG GLVSRVDO RI KRVSLWDO ZDVWH LV was collected without using standard operating
regulated by ordinances [21]. SURFHGXUHV IRU ¿QDO GLVSRVDO DQG WUHDWPHQW 7KH
In Pakistan, Ministry of environment issued study suggests that training of hospital staff can
hospital waste management rules (HWMR) lead to improved hospital risk waste management
in 2005 [11]. According to the rules, waste practices [28].
originating from healthcare facilities like clinic, Another study was conducted in eight teaching
laboratory, dispensary, pharmacy, nursing home, hospitals of Karachi. It revealed that out of eight
health unit, maternity centre, blood bank, autopsy hospitals visited, 2 (25%) were segregating the
centre, mortuary, research institute and veterinary risk waste at source. Only one (12.5%) hospital
institutions is termed as hospital waste. It includes arranged training sessions for its waste handling
both, risk waste and non-risk waste. Non-risk staff regularly. Five (62.5%) hospitals had storage
waste includes paper and cardboard, packaging, area for risk waste but mostly it was not protected
food waste and aerosols and the like. Risk waste from access of scavengers. Five (62.5%) hospitals
is described in the above para. According to World disposed their risk waste by burning in incinerators,
Health Organization, normally, 15 to 20% of waste WZR   GLVSRVHG LW LQ PXQLFLSDO ODQG¿OOV DQG
originating from a healthcare facility is risk waste; one (12.5%) was burning waste in open air without
and it needs special handling and treatment. For DQ\VSHFL¿FWUHDWPHQW1RUHFRUGRIULVNZDVWHZDV
different types of risk waste, HWMR-2005 specify generally maintained. Only two (25%) hospitals
colour coding for its proper segregation at source of had well documented guidelines for risk waste
generation. It suggests to use while colour bags for management and a proper waste management
non-risk waste. While for risk waste yellow colour team. Study concluded that HWMR-2005 should
bag should be used. For sharps, yellow colour, leak be followed and implemented by law enforcement
proof and penetration resistant, container should be agencies [29]. In order to improve risk waste
used [11]. management and develop a management strategy,
In Pakistan, little attention is so far paid to it is important to understand and evaluate current
risk waste management. Study conducted in eight practices [20]. Information about hospital waste
hospitals of Faisalabad city shows that 90% of the management in Pakistan is currently inadequate.
hospital staff was not trained in hospital risk waste Compliance rating of hospitals with HWMR-2005
management. 80% of the hospitals did not ever is non-existent.
received any notice from Pakistan Environmental Different factors affect the hospital risk waste
Protection Agency. There was no segregation of generation rates. Tabasi and Marthandan [30]
risk and non-risk waste in 76.7 % of the hospitals. reviewed 20 research papers that reported relevant
Sanitary workers transport the waste without any associated factors in hospital risk waste production.
personal protective equipment (gloves, boots etc.). Out of 20 studies, 13 studies (65%) reported that
The research indicates that doctors and hospital WKHW\SHRIKHDOWKFDUHHVWDEOLVKPHQWKDVVLJQL¿FDQW
 Characterization and Management of Hospital Wastewater 319

effect on risk waste generation. Other factors (SH) having 1196 beds, General hospital (GH) with
include the number of patients, number of beds 1048 beds and Gulab Devi (GD) chest hospital
and the percentage of bed occupancy. Hospital risk (1500 beds).
waste generation rate were determined in some of
the developing countries like India, Bangladesh, 2.2 Sampling and Analysis of Wastewater
China, Taiwan lie in a range of 0.14 to 0.88 kg/ There were several wards in the selected hospitals.
bed/day [20, 22, 32, 34, 35, 40]. In 2010, study Each ward generated wastewater having different
FRQGXFWHG RQ TXDQWL¿FDWLRQ FODVVL¿FDWLRQ DQG characteristics. All these wastewaters join at the tank
management of hospital waste in Lahore city of disposal station and are homogenized. To take
showed that 785 million ton of risk waste was a representative sample, it was decided to collect
produced and incinerated in Lahore per annum [33]. wastewater from the disposal tank. The parameters
Evaluation of waste generation rates and tested and the testing procedures are mentioned
quantities is essential for the establishment of in Table 1. The heavy metals in the wastewater
a waste management system for hospitals [31]. were analysed by using atomic absorption
The objectives of the present study were to; (1) spectrophotometer (PerkinElmer Analyst 800).
characterize hospital wastewater; (2) evaluate
compliance with HWMR-2005 and (3) evaluate Table 1. Parameters tested and the testing
the risk waste generation rates and its variations. procedures.*
In Pakistan, previous studies on hospital risk waste Parameter Testing Method
generation rates are not rigorous, since these were pH pH paper
based on the data of only one to three weeks [38, Five-day biochemical oxygen demand (BOD) 5210 (B)
39]. However, this study is based on risk waste data Chemical oxygen demand (COD) 5220 (B)

of 52 weeks (one year). Thus all possible variations Total dissolved solids (TDS) 2540 (C)
Chlorides 4500 Cl- (C)
like weekly, monthly and seasonal were accounted
Alkalinity 2320 (B)
for. In addition, no previous work exists on hospital Total nitrogen 4500 Norg (B)
wastewater characteristics which is pre-requisite Ammonia nitrogen 4500 NH3 (B&C)
for the selection of an appropriate treatment Iron 3111 Fe
technology. Manganese 3111 Mn
Cadmium 3111 Cd
Copper 3111 Cu
2. MATERIALS AND METHODS Nickel 3111 Ni
Lead 3111 Pb
2.1 Hospitals Selected for the Study Zinc 3111 Zn
In Lahore, there are 232 hospitals. Out of Chromium 3111 Cr

these 47 are public and the rest are private. To *All the testing methods are based on Standard Methods for
the Examination of Water and Wastewater, 20th edition (1998),
study wastewater characteristics and risk waste www.standardmethods.org.
generation, it was necessary to select major
hospitals with plenty of instrumentation, a range of
2.3 Methodology for Analysis of Hospital
medical services and large outrun of patients. For
Waste Management Practices
this study, hospitals having 200 or more beds were
considered as major. Thirteen public hospitals in For analysis of current hospital waste management
Lahore meet this criteria. Out of these, 3 hospitals practices, a survey questionnaire based on HWMR-
were selected randomly making a sample size of  ZDV GHYHORSHG 4XHVWLRQQDLUH ZDV ¿OOHG
23%. Ten percent or more sample is considered to through visits of the selected hospitals. It contained
be a good sample size for small populations [41]. 25 questions about different aspects of hospital
The selected hospitals included: Services hospital waste management.
320 Muhammad Imran Meo et al

2.4 Methodology for Determination of monthly and seasonal variations are shown as error
Generation Rates EDURQWKHUHOHYDQW¿JXUHVLQVHFWLRQ6WDQGDUG
Proper record of risk waste generated, in the selected error of mean could not be calculated for seasonal
hospitals, was maintained on daily basis. For this variation due to difference is sample size.
study risk waste generation data from 1st January to In order to compare the amount of risk waste
31st December 2012 (365 days) were collected from generated from each unit of a hospital, one week risk
the available record of selected hospitals. Statistical waste generation data was taken for two hospitals
analysis was performed on the yearly data including i.e. GH and GD. The week was randomly selected.
mean, minimum, maximum, standard deviation and However, the same week for the two hospitals was
FRHI¿FLHQWRIYDULDWLRQ taken. Mean of the entire week, for each unit, was
6HSDUDWH DQDO\VLV ZDV SHUIRUPHG WR ¿QG RXW then plotted for the sake of comparison.
weekly, monthly and seasonal variations in risk
waste generation. There are 52 weeks in a year, 3. RESULTS AND DISCUSSION
therefore each day approximately occurs 52 times in
3.1 Characteristics of Hospital Wastewater
D\HDU)RUZHHNO\YDULDWLRQGDWDIRUDVSHFL¿FGD\
of the week, for the entire year, was added and mean Hospitals investigated had no wastewater treatment
and standard deviation (SD) was calculated. Mean plant. The results of physico- chemical parameters
of different days were compared by calculating are presented and compared with NEQS in Table 2.
standard error of mean (SEM) and lastly values for Values of pH varied from 6.8 to 7.5. These values
FRQ¿GHQFHLQWHUYDOZHUHIRXQGRXW were within the permissible limits of NEQS. Similar
results were obtained in other studies. Beyene
Similarly, for monthly variations, the mean
and Redaie [7] determined pH value in hospital
of each month was calculated from the daily risk
wastewater to be 7.4. Study on hospital wastewater
waste generation data, along with SD for each
in India showed pH value of 7.36 [2].
month. Mean of different days were compared by
calculating standard error of mean (SEM) and lastly BOD and COD values varied from 112 mg/L to
YDOXHV IRU  FRQ¿GHQFH LQWHUYDO ZHUH IRXQG 750 mg/L and 251 mg/L to 1400 mg/L respectively.
out. For seasonal variations, period from May to These concentrations were more than the permissible
September was taken as summer, from October to limits of NEQS. Highest concentrations of BOD
November as autumn, from December to February and COD were in General hospital and Services
as winter and March to April as spring. Mean of hospital. TDS and Chlorides concentrations were in
each season was calculated from the daily data for a range of 620 mg/L to 1400 mg/L and 70 mg/L to
that season with SD for each season. SD for weekly, 200 mg/L, respectively. These values were within

Table 2. Physicochemical charcterisation of hospital wastewater.

General Services GulabDevi
Parameters NEQs
Hospital Hospital Chest Hospital
pH 6–9 6.8 7.2 7.5
BOD 80 mg/L 120 750 300
COD 150 mg/L 280 1480 680
TDS 3500 mg/L 900 800 1400
Chlorides (Cl-) 1000 mg/L 110 110 70
Alkalinity * 480 600 670
Total Nitrogen * 27.6 45.2 18.6
Ammonia Nitrogen 40 mg/L 16.7 24.2 17.6
* No NEQs for this parameter.
 Characterization and Management of Hospital Wastewater 321

Table 3. Concentrations of heavy metals in hospital wastewater.

General Services Gulab Devi
Heavy metals NEQS
Hospital Hospital Chest Hospital
Cadmium (mg/L) 0.1 0.032 0.045 0.676
Chromium (mg/L) 1.0 0.042 0.107 0.088
Lead (mg/L) 0.5 0.012 0.104 0.229
Nickel (mg/L) 1.0 0.593 0.631 0.634
Zinc (mg/L) 5.0 0.077 0.174 0.150
Copper (mg/L) 1.0 BDL* BDL* BDL*
Manganese (mg/L) 1.5 0.027 0.057 0.027
Iron (mg/L) 8.0 0.339 0.447 0.445

*BDL=Below Detection Limit

the permissible limits of NEQS. Alkalinity was in DQRWL¿HGZDVWHPDQDJHPHQWWHDPGXWLHVRIWHDP

a range of 480 mg/L to 670 mg/L as CaCO3. Total PXVW EH GH¿QHG DQG KRVSLWDO DGPLQLVWUDWLRQ PXVW
nitrogen and ammonia nitrogen were in a range make waste management plans. It was observed
of 18.6 mg/L to 45.2 mg/L and 16.7 mg/L to 24.2 WKDWZDVWHPDQDJHPHQWWHDPVZHUHQRWL¿HGXQGHU
mg/L respectively. These values were within the UXOH XU     :DVWH PDQDJHPHQW RI¿FHU ZDV
permissible limits of NEQS. nominated u/r 4(4). Duties and responsibilities of
ZDVWHPDQDJHPHQWWHDPZHUHQRWL¿HGXU   
The results of heavy metal concentrations in
5. Meetings of waste management team u/r 6 were
hospital wastewater samples are presented and
conducted twice a month.
compared with NEQS in Table 3. It can be seen
that concentration of all heavy metals were within 3.2.2 Segregation of Waste
permissible range except Cadmium in Gulab
HWMR-2005 prescribe that risk waste should
Devi hospital. Possible reasons of high Cadmuim
be segregated, on site, inside the hospital. After
contents are old and discarded nickel-cadmium
segregation, it should be weighed and packed
batteries, pigments, coatings and plating, used in
in color coded bags as described in Section 1. It
the hospitals. High concentration of cadmium may
was observed that risk waste was separated from
cause kidneys, lungs, and bones effects.
non-risk waste at source u/r 16(1). Syringe needle
3.2 Analysis of Hospital Waste Management cutting u/r 16(2) was practiced. Plastic bags,
Practices infusion bags, drip bags were being cut down u/r
16(2). Broken syringes and needles were placed
7KH¿QGLQJVRIWKHTXHVWLRQQDLUH¿OOHGGXULQJ¿HOG
in yellow boxes u/r 16(4). Sharp containers were
visits, are discussed below.
yellow in color u/r 16(4). Sharp containers were
3.2.1 Waste Management Team marked “Danger! Contaminated Sharps” u/r 16(4).
The sharp container was closed and sealed when 03
HWMR-2005 specify that each hospital must have quarters u/r 16(4). Non risk waste containers were
Table 4. Results of statistical analysis of risk waste generation data for year 2012.
Total Average
Average Minimum Maximum Standard &RHI¿FLHQW
Hospital Name Annual (kg/bed/
(kg/day) (kg/day) (kg/day) Deviation of variation
(kg/day) day)
Services Hospital 234 127 326 40 17 73,118 0.22
General Hospital 204 115 324 46 22 63,863 0.20
Gulab Devi Hospital 28 12 64 11 39 8,906 0.02
322 Muhammad Imran Meo et al

lined with white waste bags u/r 16(8). generation rates were high in SH (234 kg/day; 0.22
kg/bed/day) and GH (204 kg/day; 0.20 Kg/bed/
3.2.3 On-Site Collection and Transportation of day) as compared to GD (28 kg/day; 0.02 kg/bed/
Waste day). Risk waste generation in GD is much less
Directions of on-site collection and transportation than other hospitals. The major reason is that type
of waste were followed as per HWMR-2005. Waste of healthcare facilities provided in GD hospital are
was collected once daily u/r 17(3) a. All waste bags different from other two hospitals. It is discussed
were labelled indicating point of production and in more detail in section 3.5.
contents u/r 17(3) b. The transportation of waste The range in which risk waste generation per
was properly documented u/r 18(5) g. Risk waste day varied in SH, GH and GD were 127 to 326,
was transported by trollies to the central storage 115 to 325 and 12 to 64 kg/day, respectively. The
facility. Before transferring the waste was again respective standard deviation for the yearly data,
weighed and proper record of waste generation was for the above hospitals, was 40, 46 and 11, whereas
maintained. There was violation of rule 17(2) in all WKH FRHI¿FLHQW RI YDULDWLRQ ZHUH   DQG 
the studied hospitals as sanitary staff and sweeper This shows that variations/scatter in the risk waste
did not wear personal protective equipment (gloves, generation in GD is more than the other two.
boots, and clothes).
An important parameter, for reporting and
3.2.4 Waste Storage designing systems for risk waste management, is
ULVNZDVWHJHQHUDWHGSHUEHGSHUGD\7KHVH¿JXUHV
HWMR-2005 direct to store risk waste in a separate for SH, GH and GD hospital were evaluated to
room inside hospital for temporary storage, at EHDQGUHVSHFWLYHO\7KH¿JXUHIRU
suitable temperature. It was observed that the above GD does not lie in the reported range for other
facility u/r 19(1) was provided in all the studied developing countries (0.14 to 0.88 kg/bed/day).
hospitals. These storage facilities were away from The reason are discussed in detail at the end of this
the public approach. Proper cooling was provided in section.
the storage rooms to maintain temperature between
30C to 80C. 3.4 Variations in Risk Waste Generation
In addition to daily variation of risk waste
3.2.5 Treatment/Disposal of Risk Waste
discussed in section 3.3, seasonal, monthly and
It was told by the concerned persons in the weekly variation are also important to study.
hospitals that risk waste is sent to the incinerator As these are taken into account while designing
installed in the Children hospital Lahore. Before waste management system. The results for weekly
transportation, it is again weighed and proper variation are presented in Fig. 1, which shows
record was maintained by both the authorities average value for each day of the week and standard
operating incinerator and the hospital. There was deviation as error bar. It can be seen that there is
a small scale incinerator available in the Services QR VLJQL¿FDQW YDULDWLRQ EHWZHHQ GLIIHUHQW GD\V RI
hospital Lahore. It is based on old technology the week for all the hospitals. Table 5 shows the
and thus causes air pollution. Concerned staff at FRQ¿GHQFH LQWHUYDO IRU  FRQ¿GHQFH OHYHO IRU
incineration plant told that it is utilized only in case all the hospitals, for weekly variation. The margins
of emergency such as shutdown of the incinerator of error shows the standard error of the mean. It can
at Children hospital. be seen that margin of error for GH and SH are very
close to each other. This may be due to the similar
3.3 Generation Rates of Risk Waste nature of treatment facilities provided. For 95%
Statistical analysis of the risk waste data is presented RIWKHWLPHWKHULVNZDVWHRQDVSHFL¿FGD\RIWKH
in Table 4. It shows that average daily risk waste week lied in a range of 190 to 218, 25 to 32 and 220
 Characterization and Management of Hospital Wastewater 323

Average risk waste (kg/day)

Fig. 1. Average week days risk waste generation rates.

Average risk waste (kg/day)

Fig. 2. Average monthly risk waste generation rates.

324 Muhammad Imran Meo et al

Table 5. 6WDQGDUGHUURUDQGFRQ¿GHQFHLQWHUYDOVIRUZHHNO\YDULDWLRQ
&RQ¿GHQFHLQWHUYDO
&RQ¿GHQFH &RQ¿GHQFH Margin of
Hospital Name Upper bound Lower bound
level FRHI¿FLHQW error
(kg/day) (kg/day)

General Hospital 14 218 190

Gulab Devi Hospital 95% 1.96 3 32 25
Services Hospital 13 247 220

Table 6. 6WDQGDUGHUURUDQGFRQ¿GHQFHLQWHUYDOVIRUPRQWKO\YDULDWLRQ
&RQ¿GHQFHLQWHUYDO
&RQ¿GHQFH &RQ¿GHQFH Margin of
Hospital Name Upper bound Lower bound
level FRHI¿FLHQW error
(kg/day) (kg/day)
General Hospital 19 223 185
Gulab Devi Hospital 95% 1.96 5 33 24
Services Hospital 18 251 216

to 247 kg/day for GH, GD and SH, respectively. to design waste management system. More storage
is required during the season when more risk waste
The monthly variation of risk waste is shown
is generated.
in Fig. 2. It can be seen that risk waste generation
is maximum in the month of August and June for
3.5 Type of Healthcare Facility and Risk Waste
GH and SH, respectively; probably it may be due
to Dengue fever. While it is minimum during the The risk waste generation from each unit of GH and
month of October and March for GH and SH, GD are shown in Fig. 4 and 5. It is evident from a
UHVSHFWLYHO\ 7KLV ¿QGLQJ LV KHOSIXO ZKLOH ¿QGLQJ comparison of risk waste generated in a unit, within
storage capacity for risk waste. More storage is WKHVDPHKRVSLWDOWKDWW\SHRIXQLWKDVDVLJQL¿FDQW
required in the month of August and June. It can impact on the amount of risk waste generation. For
EH REVHUYHG WKDW IRU *' WKHUH LV QR VLJQL¿FDQW example, in the case of GH (Fig. 4), Homio Dialysis
monthly variations; it may due to the fact that GD unit generates the maximum amount of risk waste
is only for tuberculosis patients. No other patients (48 kg/day) and is followed by Surgical Operation
DUHHQWHUWDLQHGKHUH7DEOHVKRZVWKHFRQ¿GHQFH Theatre (17 kg/day) and Medical Emergency (17
LQWHUYDO IRU  FRQ¿GHQFH OHYHO IRU DOO WKH kg/day). It can also be observed that minimum risk
hospitals, for monthly variation. Again the margin waste is generated from eye wards (< 1 kg/day)
of error for GH and SH are very close; the reason while no risk waste is generated from Angiography
being the same as stated for weekly data. For 95% unit.
of the time, the risk waste in a month lied in a range
From Fig. 5, it is evident that in GD maximum
of 185 to 223, 24 to 33 and 216 to 251 kg/day for
amount of risk waste is generated in Micro Lab
GH, GD and SH, respectively.
(4.7 kg/day), which is followed by Cardiac OT (4.5
The seasonal variation is shown in Fig. 3. This kg/day). Earlier studies conducted on this hospital
¿JXUH VKRZV PHDQ ULVN ZDVWH JHQHUDWHG GXULQJ did not collect the risk waste generation data from
each season and standard deviation as error bars. all the wards/ units. e.g. the data for GD did not
,W FDQ EH FRQFOXGHG IURP WKLV ¿JXUH WKDW WKHUH LV
include Micro Lab and Cardiac OT which produces
QR VLJQL¿FDQW VHDVRQDO YDULDWLRQ LQ *+ DQG *'
highest risk waste in this hospital [38].
However, in the case of SH slight seasonal variation
has been observed. More risk waste is generated It is also evident from Fig. 4 and 5 that the type
during autumn and summHU7KLV¿QGLQJPD\KHOS RIKHDOWKFDUHIDFLOLW\KDVDVLJQL¿FDQWLPSDFWRQWKH
 Characterization and Management of Hospital Wastewater 325

Average risk waste (kg/day)

Fig. 3. Average seasonal risk waste generation rates.

amount of risk waste. GD is solely for chest while LV ¿QDOO\ GLVSRVHG LQ  ULYHU 5DYL DQG DJULFXOWXUHO
GH deals with all types of patients. This can also ¿HOGV7KLVVLWXDWLRQFDOOVIRULPPHGLDWHDWWHQWLRQ
be seen from Table 4 that mean (yearly mean) daily Compliance level of HWMR-2005 in the selected
risk waste from GD is 28 kg/day while the same for hospitals was better. Risk waste was disposed
*+LVNJGD\7KLV¿QGLQJLVHQGRUVHGE\RWKHU through incineration. Average daily risk waste
studies in Lahore [39]. generation rates in the hospitals varied from 28 to
234 kg/day (yearly mean). When related to number
4. CONCLUSIONS AND RECOMMENDATIONS of beds, it varied from 0.02 to 0.2 kg/bed/day. The
Following conclusions can be drawn from the unit producing maximum amount of risk waste is
current study with a few recommendations: Homio-dialysis. Thus, it can safely be concluded
WKDW WKH W\SH RI KHDOWKFDUH IDFLOLWLHV VLJQL¿FDQWO\
Wastewater treatment is not on the priority list of
affect the amount of risk waste generation. There
the management of selected hospitals. Since none
ZDV QR VLJQL¿FDQW YDULDWLRQV LQ PHDQ ZHHNO\ DQG
of the hospitals have wastewater treatment plant.
monthly risk waste generation. However, season
BOD and COD of hospital wastewater are above
may affect the generation.
the limits prescribed in NEQS, while rests of the
parameters tested were within the limits. Except
5. ACKNOWLEDGEMENTS
Cadmium, all heavy metals analysed were within
the permisible limit of NEQS. Cadmium was high This publication is based on post-graduate research study
conducted at the IEER. The authors acknowledge the
in the wastewater of Gulab Devi Chest hospital due
assistance provided by the medical staff of all the studied
to its specialzied nature. The high amounts of BOD, hospitals. Funding by UET and assistance of laboratory
COD and Cadmium may harm the aquatic life and staff of IEER in lab testing are also acknowledged.
even human health, since the wastewater in Lahore
326 Muhammad Imran Meo et al

Average generation rates (kg/d)

Fig. 4. Average risk waste of different wards/units of General Hospital (weekly average).
 Characterization and Management of Hospital Wastewater 327

Average generation rates (kg/d)

Fig. 5. Average risk waste of different wards/units of Gulab Devi Chest Hospital
(weekly average).
328 Muhammad Imran Meo et al

6. REFERENCES HIÀXHQW GLVFKDUJHV RQ WKH SK\VLFRFKHPLFDO ZDWHU

quality of a receiving stream at Ile-Ife, Southwestern
1. Emmanuel, E., Y. Perrodin, G. Keck, J.M. Blanchard
Nigeria. Journal of Sustainable Development 5(11):
& P. Vermande. Ecotoxicological risk assessment
82-92 (2012).
of hospital wastewater: a proposed framework for
13. Mahvi, A., A. Rajabizadeh, A. Fatehizadeh & N.
UDZHIÀXHQWVGLVFKDUJLQJLQWRXUEDQVHZHUQHWZRUN
<RXVH¿ 6XUYH\ ZDVWHZDWHU WUHDWPHQW FRQGLWLRQ
Journal of Hazardous Materials 117: 1-11 (2005).
DQGHIÀXHQWTXDOLW\RI.HUPDQ3URYLQFHKRVSLWDOV
2. Gautam, A.K., S. Kumar. & P.C. Sabumon.
World Applied Sciences Journal 7(12): 1521-1525
Preliminary study of physicochemical treatment
(2009).
options for hospital wastewater. Journal of
14. Amouei, A.A., H.A. Asgharnia, J. Goodarzi & A.
Environmental Management 83: 298-306 (2007).
Salehi. Characteristic of wastewater in the hospitals
3. (NKDLVH )2  %3 2PDYZR\D ,QÀXHQFH RI
of Babol Medical University (Iran). Journal of
hospital wastewater discharged from university of
Babol University of Medical Science 12(2): 77-82
Benin teaching hospital (UBTH), Benin City on its
(2010).
receiving environment. African Journal of Applied
15. Amouei, A., H.A. Asgharnia, A.A. Mohammadi,
Zoology & Environmental Biology 10: 56-60 (2008).
H. Fallah, R. Dehghan & M.B. Miranzadeh.
4. Amouei, A., H. Asgharnia & M. Amouei. Quantity
Investigation of hospital wastewater treatment
and quality of wastewater in the hospitals of
SODQWHI¿FLHQF\LQQRUWKRI,UDQGXULQJ
Babol medical university (Iran) and effects on
International Journal of Physical Sciences 7(31):
the environmental health. Proceedings of the 12th
5213-5217 (2012).
International Conference on Environmental Science
16. Tahiri, E.M., L. Benaabidate, C. Nejjari & K.F.
and Technology 8(10): 39-44 (2011).
Benbrahim. Assessment of physicochemical and
5. Sarafraz, S., M.R. Khani & K. Yaghmaeian.
biological parameters of Al Ghassani hospital
Quality and quantity survey of hospital wastewaters
wastewaters Fez – Morocco. Journal of Materials
in Hormozgan province. Iranian Journal of
and Environmental Science 3(1): 115-120 (2012).
Environmental Health Sciences and Engineering
17. Sim, W.J., J.W. Lee, E.S. Lee, S.K. Shin, S.R.
4(1): 43-50 (2007).
Hwang, & J.E. Oh. Occurrence and distribution of
6. Nasr, M.M. & A.R. Yazdanbakhsh. Study on
pharmaceuticals in wastewater from households,
wastewater treatment systems in hospitals of Iran.
livestock farms, hospitals and pharmaceutical
Iranian Journal of Environmental Health Science &
manufactures. Chemosphere 82: 179-186 (2011).
Engineering 5(3): 211-215 (2008).
18. Karamouz, M., B. Zahraie, R. Kerachian, N.
7. Beyene, H., & G. Redaie. Assessment of waste
Jaafarzadeh, & N. Mahjouri. Developing a master
stabilization ponds for the treatment of hospital
plan for hospital solid waste management: A case
wastewater: the case of Hawassa university referral
study. Waste Management 27: 626-638 (2007).
hospital. World Applied Sciences Journal 15(1):
19. Nemathaga, F., S. Maringa & L. Chimuka.
142-150 (2011).
Hospital solid waste management practices in
8. Boillot, C., C. Bazin, F.T. Guerraz, J. Drogue,
Limpopo Province, South Africa: A case study of
M. Perraud, J.C. Cetre, & D.Y. Trepo. Daily
two hospitals. Waste Management 28: 1236-1245
physicochemical, microbiological and ecotoxi-
(2008).
FRORJLFDOÀXFWXDWLRQVRIDKRVSLWDOHIÀXHQWDFFRUGLQJ
20. Yong, Z., X. Gang, W. Guanxin, Z. Tao, & J. Dawei.
to technical and care activities. Science of the Total
Medical waste management in China: A case study
Environment 403: 113-129 (2008).
of Nanjing. Waste Management 29: 1376-1382
9. Emmanuel, E., M.G. Pierre & Y. Perrodin.
(2009).
Groundwater contamination by microbiological
21. Muhlich, M., M. Scherrer, & F.D. Daschner.
and chemical substances released from hospital
Comparison of infectious waste management in
wastewater: health risk assessment for drinking
European hospitals. Journal of Hospital Infection
water consumers. Environment International 35:
55: 260-268 (2003).
718–726 (2009).
22. Jang, Y.C., C. Lee, O.S. Yoon, & H. Kim.
10. Ibeh, I.N. & M.I. Omoruyi. Seasonal dynamics in
Medical waste management in Korea. Journal of
WKH SK\VLRFKHPLFDO SDUDPHWHUV RI KRVSLWDO HIÀXHQW
(QYLURQPHQWDO0DQDJHPHQW 80: 107-115 (2006).
from a university teaching hospital based in Southern
23. Abd El-Salam, M.M. Hospital waste management
Nigeria. -RXUQDORI$VLDQ6FLHQWL¿F5HVHDUFK 1(1):
in El-Beheira Governorate, Egypt. Journal of
7-17 (2011).
Environmental Management 91: 618-629 (2010).
11. GoP/DoE. +RVSLWDO:DVWH0DQDJHPHQW5XOHV
24. Blenkharn, J.I. Standards of clinical waste
S.R.O.1013 (1)/2005, Government of Pakistan/
management in UK hospitals. Journal of Hospital
Ministry of Environment, Islamabad (2005).
Infection 62: 300-303 (2006).
12. Ojo, O.A. & I.F. Adeniyi. The impacts of hospital
 Characterization and Management of Hospital Wastewater 329

25. Altin, S., A. Altin & B. Elevli. V.O. Determination of (2010).

hospital waste composition and disposal methods: A 34. Cheng, Y.W., F.C. Sung, Y. Yang, Y.H. Lo, Y.T.
case study. Polish Journal of Environmental Studies Chung & K.C. Li. Medical waste production at
12(2): 251-255 (2003). hospitals and associated factors. Waste Management
26. Patwary, M.A., W.T.O. Hare & M.H. Sarker. 29: 440-444 (2009).
Assessment of occupational and environmental 35. Patwary, M.A., W.T.O. Hare, G. Street, K.M.
safety associated with medical waste disposal in Elahi, S.H. Hossain & M.H. Sarker. Quantitative
developing countries: A qualitative approach. Safety assessment of medical waste generation in the
Science 49: 1200-1207 (2011). capital city of Bangladesh. Waste Management 29:
27. Anwar, O., N. Malik & M. Asim. Evaluation of 2392-2397 (2009).
hospital waste management in public and private 36. Sanida, G., A. Karagiannidis, F. Mavidou.
sector hospitals of Faisalabad city. Pakistan D. Vartzopoulos, N. Moussiopoulos & S.
Academic Journal of Interdisciplinary Studies 2(2): Chatzopoulos. Assessing generated quantities
161-166 (2013). of infectious medical wastes: A case study for a
28. Verma, L.K., S. Mani, N. Sinha, & S. Rana. health region administration in Central Macedonia,
Biomedical waste management in nursing homes Greece. Waste Management 30: 532-538 (2010).
and smaller hospitals in Delhi. Waste Management 37. Benmalek, Y., T. Benayad, L. Madour, H. Hacene
28: 2723-2734 (2008). & M.L. Fardeau. Study on Cadmium Resistant-
29. Kumar, R., E.A. Khan, J. Ahmad, Z. Khan, M. Bacteria Isolated from Hospital Wastewaters.
Magan, Nosheen. & M.I. Mughal. Health care waste Advances in Bioscience and Biotechnology 5:718-
management (HCWM) in Pakistan: current situation 726 (2014).
and training options. Journal of Ayub Medical 38. Sobia, M., A.B. Syeda & N.C. Muhammad.
College Abbottabad 22(4): 101-106 (2010). Characterization of hospital waste in Lahore,
30. Rasheed, S, S. Iqbal, & L. Baig. Hospital waste Pakistan. Chinese Medical Journal 127 (9): 1732-
management in the teaching hospitals of Karachi. 1736 (2014).
Journal of Pakistan Medical Association 55: 192- 39. Seema, I., A. Shoaib & S.S. Malik. Healthcare Waste:
195 ((2005). Evaluation of its generation rate and management
31. Tabasi, R. & G. Marthandan. Clinical waste practices in tertiary care hospitals of Lahore. Annals
management: A review on important factors in 9(4): 274-281 (2013).
clinical waste generation rate. International Journal 40. Josué, I.M. et al. Effects of untreated hospital
of Science and Technology 3(3): 194-200 (2013). HIÀXHQWV RQ WKH DFFXPXODWLRQ RI WR[LF PHWDOV
32. Hamoda, H.M., H.N. El-Tomi & Q.Y Bahman. in sediments of receiving system under tropical
Variations in hospital waste quantities and conditions: Case of South India and Democratic
generation rates. Journal of Environmental Science Republic of Congo. Chemosphere 93:1070–1076
and Health 40(A): 467-476 (2005). (2013).
33. .KDQ05 05LD]4XDQWL¿FDWLRQFODVVL¿FDWLRQ 41. Neuman, W.L. 6RFLDO 5HVHDUFK 0HWKRGV
and management of hospital waste in Lahore city. Qualitative and Quantitative Approaches, 3rd ed.
3DNLVWDQ-RXUQDORI0HGLFDO5HVHDUFK 49(3): 74-79 Allyn & Bacon, England (1996).