International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 44 Evaluation of Wastewater Discharge from Hospitals in Amman -JORDAN Kholoud Al-Ajlouni, Saleh Shakhatreh, Nuha AL- Ibraheem , Musa Jawarneh Abstract - Hospital waste management is a crucial environmental and public safety issue. Discharge water is one of the main sources of groundwater and rivers contamination if not treated efficiently Hospitals consume an important volume of water a day, and generate multiple amounts of infectious and hazardous polluted discharge water to the drain .These pollutants should be treated by the WWTP of each hospital before release to the municipal drainage. This study aims at presenting the primary results on characterization of hospital wastewaters in some hospitals in Amman city – Jordan. Twelve major hospitals were selected for this study in Amman ranging from 930 to 32 bed per hospital, none of them have a wastewater treatment plant, WWTP, and the wastewater is rejected untreated to the sewage. This addition of polluted wastewater will increase the load to the WWTPs of the city and reduce the efficiency of treatment processes leading to hazardous pollution in the future. Analysis of the concentration of biochemical oxygen demand, chemical oxygen demand, total suspended solids, sulfate, nitrate, nitrite, ammonia, chlorides, and oils and grease were made during the period (1/6/2010 - 31/12/2010). The study showed an increase in the concentration of pollutants which is higher than the Jordan standards of wastewaters. Index Term-- Hospital effluents, Kalida graph software, Wastewater. I. INTRODUCTION The impact of polluted sewage on surface and ground water is widely regarded as a serious threat to human health and environment in many developing countries of the world [5],[6],[8] [1],[2],[3]. This case applies to Jordan where there is a serious inadequacy of sanitation with resulting pollution from the discharge of untreated sewage into the surface water and groundwater. Ministry of Health in Jordan (MOH) is the main agency responsible for monitoring and managing medical waste sector. MOH has developed and issued regulation no. 1 in the year 2001 that deals with the management of medical waste. The regulation defined the general medical waste as all solid, liquid and gaseous wastes that are generate d at different healthcare institutions, medical laboratories, medical research centers, pharmaceutical industries, veterinary clinics and household health care activities. This definition implies that the waste that is generated by the kitchen and offices of the hospitals and clinics waste is covered under general medical waste category. Kh. S. Al-Ajlouni, Author in Chemical Engineering Department, Al-Huson College University, Al-Balqa Applied University P.O. Box 50 , Al-Huson Jordan, ajlouni@huson.edu.jo S. shakhatreh, Author, Al Balqa' Applied University, Al Huson University College, P.O. Box 50, Al-Huson Jordan , shakhatreh_s@yahoo.com. Nuha AL- Ibraheem , Author, Al Balqa' Applied University, Al Huson University College, P.O. Box 50, Al-Huson Jordan, alrashidnm@hotmail.com Musa Jawarneh, Author, Al Balqa' Applied University, Al Huson University College, P.O. Box 50, Al-Huson Jordan, musa_jawarneh@yahoo.com To differentiate between the general medical waste and the hazardous medical waste, the regulation defined the hazardous medical waste as that part of general medical waste that may pose health risks due to its constituents that may have one or more of the following properties: infectious, pathological, sharps, chemicals, pharmaceutical, cytotoxic or radioactive [4 ], [5 ]. Heavy wastewater released from hospitals may cause many serious environmental problems. These problems vary upon the activity and nature of hospitals, as well as its location and size of the wastewater discharged [6], [7]. Hospitals consume an important volume of water a day. The value generally admitted for hospitals varies from 400 to 1200 liters/day/bed [1]. The amount of wastewater discharged from hospitals is estimated based on per capita production in America to be 1000 liters/person/day [7], [8], [1]. WHO reported that, about 85% of hospital waste is non-hazardous, 10% infective and 5% not infective but hazardous in the United States of America [9]. Hospital effluents are loaded with pathogenic microorganisms, pharmaceutical partially metabolized, radioactive elements and other heavy metals and toxic chemical substances (Cu, Fe, Pb, Cd, Ni, Pt, Hg, Cyanide, phenol and others) [2], [3]. Amman is the capital of Jordan, has the population of 2,315,600 in the year 2009. The total no. of hospitals in Amman is 53 distributed in 4 major sectors and the no. of beds is shown in table (1). The average no. of beds per population is 26 beds per 10,000 inhabitants. These numbers are increasing rapidly through the years due to rapid development in the healthcare services which has put Jordan among countries with advanced health care services in the Mediterranean Region. During the last 10 years, the number of the kingdom’s hospitals increased by 32% [4]. According to a report issued by the Jordan Environment Society JES, 32% of the Kingdom’s hospitals were applying some sort of incineration combustion of the medical waste. The remaining hospitals are disposing the medical waste along with the municipal waste stream into landfills. JES report estimated that the average generation rate of the medical waste in the middle region hospitals (Amman, Zarqa, Madaba and Balqa) is about 0.5 kg/bed/day. Amman’s hospitals produce about 2.3 tons /day [10]. The Division of Laboratory and Environment Directorate of Amman reports indicated that all hospitals in Amman city do not have WWTPs. The risk of this hazardous discharged water is the access to the municipal sewage treatment plant of the city, which is primarily designed to treat the sewage of houses, and therefore exceed the capacity of the sewage plant, so the treatment process will be quite inefficient. Most researches focused on solid waste from hospitals and clinics, because of lack previous studies in this field, this research was conducted to identify the pollutants by Amman hospitals into the main sewage system, and their impact on the environment in Jordan. Finally a statically analysis of linear correlations and regressions between some selected variables was conducted. 135704-9090- IJBAS-IJENS @ August IJENS International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 45 -1 II. MATERIAL AND METHODS The hospitals under consideration in this study are listed in table (2), there are 10 private hospitals, one public, and one educational hospitals. Remarks classifies private, public and educational sector. WWTP, stands for wastewater treatment plant, shows which hospitals have such plants. Chemicals used are from (BDH, Merck) of high commercial grade were used in the analysis. Parameters such as pH and electrical conductance, (EC), were measured of the samples. The concentration of Chemical requirement of oxygen (COD), Biochemical requirement of oxygen (BOD), Dissolved Oxygen (DO), Total Suspended solids (TSS), Phosphate, Calcium and magnesium (Ca+2), (Mg+2), chloride the hydrogen atom, because the hydrogen activity is a good representation of the acidity or alkalinity of the water. A change in the pH of water can have a number of consequences. In the environment, many plants animals are harmed, or even killed, as a result of acidification. Since the pH values in the hospitals ranges from 6.665 to 8.55, these levels shows no threat to the aquatic species within the ecosystem. The pH values are acceptable according to Jordan standard values [12 ]. and It is noted that the decrease of the average of pH values from 8 to 7.1 refers to the consumption of dissolved CO2 in water resulted from the bio- oxidative and decomposition processes or it might be due to the consumption of the ionic of the dissolved bicarbonates as a source for the non-organic carbon due to the following equation: HCO3-1 + H2O + h  {CH2O} + OH-1 + O2 Generally, it is noted that the property of water tends to acetic phase which is unlikely difficult to remove heavy metals in the sedimentation basin except a small portion because the removal of heavy metals only occurs in the base circumstances when pH up to 11. Regarding the electrical conductivity and the solid dissolved materials, there is a strong relation between the values of the electrical conductivity and the solid dissolved solid materials which express the salinity of water. The parameters BOD5 and COD are widely used to characterize the organic matter content of wastewater. COD or Chemical Oxygen Demand is the total measurement of all chemicals in the water that can be oxidized. BOD- Biochemical Oxygen Demand is supposed to measure the amount of food (or organic carbons) that bacteria can oxidize. Dissolved oxygen or DO analysis measures the amount of gaseous oxygen (O2) dissolved in an aqueous solution. Oxygen gets into water by diffusion from the surrounding air, by aeration (rapid movement), and as a waste product of photosynthesis. Figure (2) compare the values of COD, BOD5 and DO for the hospitals. The value of DO is very low in comparison to COD and BOD5.Four hospitals, H1, H3, H4 and H5 exceeded the maximum value of BOD5 of Jordan standard (500 mg/L), while the other six fluctuate around 400 mg/L. The average value is 482.1 mg/L which is considered high comparing with European norms, 30 mg/L (Algeria) or 110350 mg/L in Iran, and even 300 mg/L in Bangkok [8]. Hospital, H2, showed a significant pollution, the highest concentration of COD is1356.5 mg/L, but is still beyond the maximum value of COD in Jordan standards. The lowest concentration was at H4 of 725.25 mg/L, as shown in the figure. The average COD value is 997 mg/L is higher than -2 (Cl ), Ammonia (NH3, Sulfate (SO4 ), nitrate (NO3-1), ammonia (NH3), chlorides(Cl-1), calcium (Ca+2), magnesium (Mg+2), ammonium (NH4+), and oils and grease , were also measured according to the standard methods [12]. III. RESULTS AND DISCUSSION Table (3) shows average value for the analysis of wastewater for the characteristics parameters of the 12 hospitals. Discussion of the physical and chemical analysis will be based on the Jordan standards of wastewater. The results were analyzes using Excel to describe the statistical average, linear correlation and regression. Figures were plotted using Kalieda graph software. The pH level is a measurement of the activity of 125 mg/L of European norms, 250-800 mg/L of Iran, and 430 mg/L in Bangkok. The biodegradability of organic substances is a measure of the speed and completeness of their degradations by microorganisms and therefore the (BOD5/COD) ratio could be used to analyze the degree of degradation, A (BOD5/COD) ratio 0.5-0.6 could be considered as threshold value in Romania (patent). From the Jordan standards this ratio is 0.25 which makes a good result. In some references the ratio of (COD/BOD5) is taken for the same purpose and it is the basis of selection of proper biological treatment processes. The average ratio of (COD/BOD5) = 2.17 of the 12 hospitals, this ratio is lower or equal to 2.5 [13]. Nevertheless, three hospitals had COD/BOD5 > 2.5, H2, H7 and H10. Dissolved oxygen DO analysis measures the amount of gaseous oxygen (O2) dissolved in an aqueous solution. Oxygen gets into water by diffusion from the surrounding air, by aeration (rapid movement), and as a waste product of photosynthesis. TSS is another parameter used in defining the wastewater. "Dissolved solids" refer to any minerals, salts, metals, cations or anions dissolved in water. Total dissolved solids (TDS) comprise inorganic salts (principally calcium, magnesium, potassium, sodium, bicarbonates, chlorides and sulfates) and some small amounts of organic matter that are dissolved in water. The suspended or colloidal particles, commonly referred to as total suspended solids (TSS), are all the extremely small suspended solids in water which will not settle out by gravity. The highest value for TSS was at H2 Hospital as 1419 mg/L which is almost 3 times greater than the Jordan standards, and the lowest is 44.5 mg/L at H5. The average value of all hospitals is 402.3 mg/L greater than 300 mg/L in Romania, and 383 mg/L in Iran. TDS or Total Dissolved Solids is a measure of the total ions in solution. EC is actually a measure of the ionic activity of a solution in term of its capacity to transmit current. In dilute solution, TDS and EC are reasonably comparable. The relationship between conductivity and TDS is not directly linear, however, since the conductive mobility of ionic species is + variable. Univalent cations such as Na are more mobile +2 than multivalent ions such as Ca +3 and Al . Similarly, - univalent anions such as Cl are more mobile than -2 multivalent ions such as SO 4 -2 and CO . The EC can be 3 calculated as: EC (dS/m) = TDS (mg/L) *.64 [14] The value recommended by FAO and EPA should not exceed 135704-9090- IJBAS-IJENS @ August IJENS International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 1.26 , in our case H2,H3,H4, H6, H8 and H11 do. The increment of electrical conductivity is due to concentration of large amount of heavy dissolved solid materials thrown by Hospitals as well as the chemical interactions between the acetic compounds formed from the bio- oxidative and decomposition processes with the acetic compounds exist in the suspended materials like CaCO3 which will change into dissolved Ca (HCO3)2. According to the table (3), it is obvious that all hospitals had exceeded the maximum limit for the concentrations of phosphate with 3mg/L. The main source for phosphate in sewages of Hospitals comes from sodium tri- phosphate (STPP) which is the activate Builder phosphorous that cleaning liquid used frequently, and the most substance used is STPP (Na5P3O10) that melt directly in washing water according to the equation [16]. Na5P3O10 + 2H2O  2 Na2HPO4 + NaH2PO4 NaH2PO4  Na+ + H2PO4 The source for Nitrate NO3-1 is (NO2-1) which resulted of ammonia because of the activity of aerobic bacteria in sewage water which is rich in nitrogen compounds according to the equation: Nitrosomonas NH3 + Oxygen NO2-1 + energy -1 NO2 + Oxygen Nitrobacter NO3-1 + energy The dissolved nitrogen materials in wastewater of hospitals that reached the main net sewage have the highest concentration of ammonia NH3 (table1) in all hospitals, that Nitrogen dioxide into nitrite then to nitrate according to the above equation. It is evident that there was no treatment, or lack of units for treating the dissolved nitrogen materials. Such materials will reach land and dams which with help of highest concentrations of phosphate will cause the phenomenon of Eutrophication in water areas that harm the aquatic environment and agriculture [15], [16]. Also it is been shown that the concentrations of Sulphate exceeded the allowed limits [2] [12], and the concentration of chloride in the dispatched materials were between 42.5 to 225m/l, which comes from detergents and sterilizers that hospitals use extensively. It is also noted that the difference in the concentration of the additive chloride added cause a difference in the portions of the concentration of chloride. The table indicates a high percentage of oils and grease reached the main treatment plant, which will cause many technical problems. The decrease in the values refers to the effect of liquid wasted thrown in the sewage network which will go to the wastewater treatment station will cause the decomposition and bio oxidative processes which cause many acid components like acetic acid, Carboxylic acids, and mineral acids. Linear correlation and regression between some selected variables among the concentration of the seventeen substances are shown in table (4). 46 limits permitted by the Jordanian environmental legislations. These chemicals and toxic materials will certainly pollute the underground and surface water when reaching the main treatment plant of the city since it is designed for treating residential sewages. The authors recommend that Jordanian government imposes environmental legislations in which each hospital should have an effective wastewater treatment unit, thus protecting the Jordanian aquatic ecosystem. V. ACKNOWLEDGMENT The authors would like to thank engineer Quatibah M. Rasheed for his assistance and help. REFERENCES [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] Emmanuel. E. et. al., Effects of Hospital Wastewater on Aquatic Ecosystem, 18th Congreso Interamericano de Ingeniería Sanitariay Ambiental Cancún, México, 2002. Jolibois B and . Guerbet M. Hospital Wastewater Genotoxicity , British Occupational Hygiene Society Published by Oxford University Press, (2005). Riyanto Haribowo, (2011), Evaluation of wastewater treatment plant in Mataram General Hospital, Indonesia , Journal of Applied Sciences Research. M. Abu- Qudais and Abu Qdais H. A. Energy Content of Municipal Solid Waste in Jordan and Its Potential Utilization. Energy Conversion and Management, 41(2000) pp 983-991. Hashemite Kingdom of Jordan, MOH, Annual statistics 2009, pp 68-90. Arnold Greenberg, Standard methods for Examination of Water and Wastewater, 16th ed., American Public Health Association, Washington D.C., 1985. Ibeh I., Omoruyi M., Seasonal Dynamics in the Physiochemical parameters of Hospital Effluent from a University Teaching Hospital based in Southern Nigeria, Global Journal of Environmental Research volume 5, 2011. Mahvi A. et. el, Survey Wastewater Treatment Condition and Effluent Quality of Kerman Province Hospitals, World Applied Sciences Journal 7, 2009. WHO, Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies. Essential drugs and other Medicines Department. World Health Organization, Geneva, Switzerland, 1999. Jordan Environment Society, JES, Report on Medical Waste Management in the Middle Region, 1999. American Public Health Assoc. Washington D.C. (1985), Standard methods for the examination of water and waste water, 16th ed. Jordan Standards and Metrology Organization JISM, Jordan Standards of wastewater, 2006. Salem Z. et. al., (2007), Evaluation of Hospital Wastewaters Pollution and Treatment Recommendations, Proceedings of the 10th International Conference on Environmental Science and Technology Greece. Sirba D. et, al., (2008), Assessment of Management of Wastewater quality from a healthcare unit: a case study, Annals of DAAM and Proceedings. Ali Lateef Humaid, Industrial Pollution, AL-Mussel University, (1978). Hammer M. J, Water and Wastewater Technology, 6th Edition, (2008). VI. CONCLUSION Most biological and physiochemical analysis showed that all hospitals had exceeded the maximum allowable 135704-9090- IJBAS-IJENS @ August IJENS International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 47 Table I Hospitals in Jordan, 2009 [5]. Table II Name of hospitals and their capacity [5]. 135704-9090- IJBAS-IJENS @ August IJENS International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 48 Table III Analysis of wastewater samples from the 12 hospitals (Average values). Table IV Relation between selected variables 135704-9090- IJBAS-IJENS @ August IJENS International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 49 Fig. 1. pH values for all hospitals. Fig. 2. BOD5, COD, and DO values for all hospitals. Red: BOD5, blue: COD, and green: DO. Fig. 3. EC, TDS, and TSS values for all hospitals. Red: EC, blue: TDS, and green: TSS. 135704-9090- IJBAS-IJENS @ August IJENS International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:04 50 Fig. 4. NO3-1, N-NH3, and NH3+1 values for all hospitals. Red: NO3-1, blue: N-NH3, and green: NH3+1. Fig. 5. PO4-3, and SO4-2 values for all hospitals. Red: PO4-3, and blue: SO4-2 135704-9090- IJBAS-IJENS @ August IJENS