An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19

https://doi.org/10.1016/j.jenvman.2022.114609Get rights and content

Highlights

  • High-income countries generate around 466 m3/day of HWW and 2–4 kg of BMW/bed/day.

  • Low-income countries generate around 95 m3/day of HWW and 4–6 kg of BMW/bed/day.

  • Conventional and advanced biological processes may remove around 50–70% of ECs.

  • Pre-treatment followed by Fenton, AC adsorption, nanofiltration show >90% EC removal.

  • Autoclave, microwave and incineration are the mostly practised for disposing BMW.

Abstract

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%–70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

Keywords

Advanced oxidation processes
Biodegradation
Biomedical waste management
Emerging contaminants
Hospital wastewater treatment
Legislations

Abbreviations

AOP
Advanced oxidation process
ASP
Activated sludge process
ARGs
Antibiotic-resistance genes
ARB
Antibiotic-resistance bacteria
BAT
Best available techniques
BEP
Best environmental practises
BWMHR
Biomedical waste management and handling rules
BMW
Biomedical waste
BOD
Biochemical oxygen demand
CBMW
Common biomedical waste management
COD
Chemical oxygen demand
CPF
Carcinogenic potency factor
CWs
Constructed wetlands
CWA
Clean water act
CWAO
Catalytic wet air oxidation
DWEL
Drinking water equivalent limit
ECs
Emerging contaminants
EU
European Union
FBR
Fluidized bed reactors
GNI
Gross national income
HAdV
Human adenoviruses
HRT
Hydraulic retention time
HQ
Hazard quotient
HWW
Hospital wastewater
ICRP
International commission on radiological protection
ISWA
International Solid Waste Association
Kow
Octanol-water partition coefficient
MBBR
Moving bed biofilm reactor
MBR
Membrane bioreactor
MERS-CoV
Middle east respiratory syndrome coronavirus
MWW
Municipal wastewater
NF
Nanofiltration
NSAIDs
Non-steroidal anti-inflammatory drugs
ORMs
Ozone-reactive moieties
PAC
Powder activated carbon
PhACs
Pharmaceutically active compounds
pKa
Acid dissociation constant
PNEC
Predicted no-effect concentration
POPs
Persistent organic pollutants
PPE
Personal protective equipment
RQ
Risk quotient
RO
Reverse osmosis
SARS-CoV
Severe acute respiratory syndrome coronavirus
SRT
Sludge retention time
TOC
Total organic carbon
TFs
Trickling filters
US EPA
United States environmental protection agency
UV
Ultraviolet
WHO
World health organisation
WWTP
Wastewater treatment plant

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