Evaluation of the efficiency of the liquid waste treatment system in thai nguyen tuberculosis and lung disease hospital

THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY LO THI NGUYEN EVALUATION OF THE EFFICIENCY OF THE LIQUID WASTE TREATMENT SYSTEM IN THAI NGUYEN TUBERCULOSIS AND LUNG DISE

THAI NGUYEN UNIVERSITY UNIVERSITY OF AGRICULTURE AND FORESTRY

LO THI NGUYEN

EVALUATION OF THE EFFICIENCY OF THE LIQUID WASTE

TREATMENT SYSTEM IN THAI NGUYEN TUBERCULOSIS AND LUNG

DISEASE HOSPITAL

BACHELOR THESIS

Study Mode : Full-time

Major : Environmental Science And Management

Faculty : Advanced Education Program Office

Batch : 2014 - 2018

Thai Nguyen, 25 September 2018

Thai Nguyen University of Agriculture and Forestry

Degree Program Bachelor of Environmental Science and Management

Thesis title

Evaluation of the efficiency of the liquid waste treatment system in Thai Nguyen Tuberculosis and Lung Disease Hospital

Supervisors Assoc Prof Tran Van Dien

Supervisor’s signature (s)

Abstract:

This research has opened a new direction in the selection and application of hospital waste treatment technology to suit Vietnam's conditions at low cost IET is a technology for treating waste water by means of biological drip refining improved natural gas level Drip filter is a biological filter with non-submerged contact material Wastewater is divided into small membranes that flow through biological buffer and

by microorganisms that decompose aerobically on the membrane where the toxic

substances in waste water are removed Waste water after treatment will be removed from the sludge in the installation tank; Then disinfected with sodium hypochlorite (electrochemical method) Sodium hypochlorite disinfectant is prepared from saline Based on the test results of the authorities, the quality of wastewater after treatment via IET system has reached National Technical Regulation on Medical Wastewater 28:

2010 / MONRE

The highlight of IET technology is the use of bioremediation in natural gas-filled turrets, so users do not have to pump as much air as other technologies before They often cause noise, and can spread pathogens to the environment System equipment and materials are manufactured in the country, so maintenance or replacement of details as needed should be made in a convenient way; Low investment and operating costs due to not having air blowers and circulating mud pumps as other technologies; Natural gas self-suction system from the bottom of the tower, so even if the power outage system is not affected; The water filter in the tower is small so it can be placed

on the tank so it does not take up much space for the system Due to the modular technology, it is easy to expand the capacity when needed The wastewater after treatment with the drip filter will also be removed from the sludge in the Lamell sedimentation tank Sludge is treated in anaerobic digestion tank The process of sterilization is finished

Keywords: Waster treatment, Wastewater, Drip filter, Bio-aerobic,

Biological Oxygen Demand

Page numbers: 64 pages

Date of submission September 25 , 2018

ACKNOWLEDGEMENT

After 4 months went to internship and time to finish the graduation thesis, althought I got many trouble, difficult and obstacles, but with the support and encouragement from my family, teachers and friends it hepl me to overcome all the complete to finish this thesis

First of all, I would like to thank my parents for being a strong supporter of mine throughout the course and thank for give me opportunity to study

Thanks for the help of Associate Professor Tran Van Dien has led the way, guided me in the direction of research, comments the thesis to make it more scientific and more professional Also thank the good feelings that he has for me

Really special thanks go to Ph.D Ngo Thu Tien, Deputy Director of Hospital helped and facilitated me throughout the course of the research

Thanks also to Teachers of Advanced Education Program who have devotedly taught me the knowledge and support me during the long learning

Special thanks for my classmate K46-N02 has joined with me over a long way

TABLE OF CONTENTS

ACKNOWLEDGEMENT iii

LIST OF CONTENTS iv

LIST OF FIGURES vii

LIST OF TABLE viii

LIST OF ABBREVIATIONS ix

PART I INTRODUCTION 1

1.1 Research rationale 1

1.2 Research’s objectives 2

1.3 Research questions and hypotheses 2

1.3.1 Research questions 2

1.3.2 Hypotheses 2

1.4 Limitations 3

1.5 Definitions 3

PART II LITERATURE REVIEW 5

2.1 Overview of hospital wastewater 5

2.1.1 General concept of hospital wastewater 5

2.1.2 The origin of hospital wastewater 5

2.1.2.1 Wastewater from medical examination and treatment 6

2.1.2.2 Wastewater from hospital activities 7

2.1.2.3 Wastewater is runoff water 9

2.1.2.4 Wastewater from other auxiliary works 9

2.1.3 Characteristics of hospital wastewater 9

2.1.4 Impact of hospital wastewater on people and the environment 11

2.1.5 Impact on the environment 12

2.2 Situation of management and treatment of hospital wastewater in Vietnam and in the World 12

2.2.1 In the world 12

2.2.2 In Vietnam 17

PART III RESEARCH METHODS 19

3.1 Time and research scope 19

3.2 Research contents: 19

3.3 Research methodology 19

3.3.1 Collecting primary information 19

3.3.2 Method of collecting secondary information 20

3.3.3 Analytical methods 20

3.3.4 Data processing methods 20

PART IV RESULTS AND DISCUSSIONS 21

4.1 Liquid waste sources 21

4.2 Flow and composition 21

4.3 Waste water treatment system 23

4.3.1 Principles of hospital wastewater treatment system by biological drip filter 23

4.3.2 Operation mode 29

4.3.3 Status of surface water environment 33

4.3.4 Status of groundwater environment 34

4.4 Discussions 35

4.4.1 Treatment measures 35

4.4.2 Treatment of hospital wastewater (domestic wastewater, medical wastewater from departments) 36

4.5 Evaluation of environmental staff, patient and patient's family on waste management and treatment of hospital 41

4.5.1 Evaluation of environmental staff 41

4.5.2 Evaluation of patients and family members 42

PART V CONCLUSIONS 44

REFERENCE 45

APPENDICES 47

LIST OF FIGURES

Figure 2 1 Source of Hospital wastewater 6

Figure 2 2 Waste water treatment methods by ozone 15

Figure 2 3 Diagram for treatment of hospital wastewater in the current situation in Vietnam 18

Figure 4 1 Map of rainwater collection system and hospital waste water 22 Figure 4 2 Biology Lake 23

Figure 4 3 Diagram of the hospital wastewater treatment system 23

Figure 4 4 Diagram of technology for wastewater treatment in Thai Nguyen Tuberculosis and Lung Disease Hospital 24

Figure 4 5 Wastewater treatment system in Thai Nguyen Tuberculosis and Lung Disease Hospital 25

Figure 4 6 Hole - SCR 25

Figure 4 7 Storage Tank 26

Figure 4 8 Slurry tank - settling 27

Figure 4 9 Bio-aerobic treatment tank 27

Figure 4 10 Secondary sedimentation tank 28

Figure 4 11 Disinfection tank 28

Figure 4 12 Sludge decomposition tank 29

Figure 4 13 Diagram of rain drainage, hospital wastewater 36

Figure 4 14 Diagram of the operating principle of the system 38

LIST OF TABLE

Table 2 1 Waste water at hospitals 7 Table 2.2 Characterized components of hospital wastewater 10 Table 4.1 Results of measurement and analysis of hospital wastewater quality 31Table 4.2 Results of measurement and analysis of surface water quality of wastewater 33 Table 4.3 Measurement and analysis results of underground water quality in the project area 34 Table 4 4 Results of the Patients and Family Patients Survey on Management and Treatment of Wastewater at Thai Nguyen Tuberculosis and Lung Disease Hospital 42

LIST OF ABBREVIATIONS

MONRE Ministry of Natural Resources and Environment

UNDP United Nations Development Programme

IET Industrial Engineering Technology

NTROMW National Technical Regulation on Medical Wastewater

NTROSWQ National Technical Regulation on Surface Water Quality

NTROUWQ National Technical Regulation on Underground Water Quality

TSS Total Suspended Solid

SMEWW Standard Methods for the Examination of Water and Wastewater

PART I INTRODUCTION

1.1 Research rationale

Environmental pollution is a top concern for developing countries like Vietnam Especially in the current period of innovation, the rapid development of industries and services, the increasingly urbanization process is the cause of the environmental overload situation

In recent years, hospitals have not only developed in number but also improved

in terms of service quality However, in the process of operating the hospital system is still inadequate, the hospital is always overloaded; However, the funding for investment in upgrading infrastructure is still limited, especially the system of treatment of dangerous and hazardous wastes is not complete and not meet the requirements of the environmental law, especially the system The amount of wastewater generated is increasing, which is proportional to the increase in the number

of patients, causing the pollution to become more complicated Before that situation, the Ministry of Natural Resources and Environment has issued National Technical Regulation on Medical Wastewater 28:2010/MONRE This standard specifies the maximum allowable values of parameters and pollutants in medical wastewater of the facilities healthcare Many public and non-public hospitals nationwide have been equipped with wastewater treatment systems, with different technologies, so different prices and areas of use are also different and especially the quality of the output water

is different

Hospital wastewater is one of the concerns because it can cause serious environmental pollution and harm to human life The top concern for hospital wastewater is the problem of germs and antibiotics and disinfectants Pathogenic germs can survive for a certain time outside of the environment when there is a chance

it will develop on another host and that is the spread of infectious diseases Tuberculosis and Lung Disease Hospital, Thai Nguyen Province was formed to serve the needs of people in the district and surrounding areas In addition to the

concentration have not been properly considered, affecting the health of the community and the living environment

Starting from the above situation, I carried out the research topic: "Evaluation

of the efficiency of the liquid waste treatment system in Thai Nguyen Tuberculosis and Lung Disease Hospital"

1.2 Research’s objectives

- Determining the source of wastewater at the hospital

- Assessing the status of wastewater management and treatment in Thai Nguyen

Tuberculosis and Lung Disease Hospital

- Proposing some solutions to improve efficiency in wastewater management and

treatment to contribute to environmental protection

1.3 Research questions and hypotheses

Alternative Hypothesis (Ha): Liquid waste treatment system at Thai Nguyen Tuberculosis and Lung Diseases Hospital operate effeciently, waste water after treatment are allowed to discharge into the Environment

1.4 Limitations

Collecting and sanitation issues

In fact, the collection of wastewater from the general hospital Tuberculosis and lung disease in Thai Nguyen Province has not been operated properly, there are still places where sewage pipes and waste water drainages have been damaged

Where waste water is collected from all departments, waste rooms still have many waste, plastic bags, dried leaves Medical instruments such as operating rooms, laundry rooms, surgery rooms, and infectious diseases are highly toxic

Management and handling

Wastewater and rainwater in the drainage system of the hospital are not separated They re mixed and then poured into the system, causing difficulties and costs in the treatment of waste water The hospital has no infection control room

Environmental awareness

The advocacy on advocacy and environmental protection in general and the management and treatment of waste water in particular has not been paid due attention and attention Communication is mainly through word of mouth or through loudspeaker On the other hand, most people who have been exposed are outpatients, outpatients, and out-patients

1.5 Definitions

Liquid waste: is all waste that exists as a liquid rather than either a gas or a solid It includes both waste produced as a liquid and waste that has been converted into a liquid for handling

Wastewater: is broken into two categories (gray and black water) Gray water is from showers, baths, whirlpool tubs, washing machines, dishwashers and sinks other than the kitchen sink Black water is from toilets and kitchen sinks

Wastewater treatment: is the process of removing pollutants from waste water such as household, commercial and institutional wastewater It includes physical, chemical, and biological processes to remove pollutants

Drip filter: is a biofilter with non-submerged contact material Wastewater is divided into small membranes that flow through biological buffer and by microorganisms that decompose aerobically on the membrane where the organic matter in the wastewater is removed The liquid waste treatment system by refining bio-modified IET natural gas is the method with modern technology

PART II LITERATURE REVIEW

2.1 Overview of hospital wastewater

2.1.1 General concept of hospital wastewater

Hospital wastewater is wastewater discharged from medical facilities, arising from various stages of hospital operations: blood, body fluids, patient laundry The environment is full of pathogenic bacteria such as Staphylococcus, Streptococcus, Vibrio, Cholerae, Coliorm This is the most difficult source of wastewater to control the toxicity Bacteria are also the bacteria, the virus that is released from the patient can lead to spread Antimicrobial discharges from the hospital will prevent the activity

of microorganisms in the wild, as well as the sewage treatment system

2.1.2 The origin of hospital wastewater

During the operation of the hospital most of the sewage is used to water and of course will generate waste water Due to the characteristics of different parts of water use, the waste water discharge capacity is not the same However, this difference is not large, so to simplify the wastewater collection process and facilitate the design calculation process, it is common to view the nature of wastewater generated from sewage in the hospital is the same

(Source: Ministry of Health, 2009)

Figure 2 1 Source of Hospital wastewater

Generally, hospital wastewater comes from the following sources:

- Activities of patients, relatives of patients, staff of hospital

- Preparation of drugs

- Sterilization, cleaning of medical instruments

- Samples, patient wounds

- Wastewater from operating rooms, laboratories, toilets

- Wastewater is rainwater that spills over the entire hospital premises

2.1.2.1 Wastewater from medical examination and treatment

Hospital wastewater Administrati

ve Region

Protected

Drug injection stations

Laboratory Surgical

area

Emergency room

Wastewater from medical examination and treatment: The wastewater has high organic pollution and contains the most pathogenic bacteria in wastewater from the hospital This waste comes from a variety of processes in the operation of the hospital (laboratory, surgical, pediatric, medical instruments, test tubes, chemical vials) Each medical examination and treatment area has different medical examination and treatment services, the characteristics of wastewater arising are different:

- Surgical wastewater containing blood, swabs, body fluids, disinfectants

- Wastewater treatment area contains many types of germs, waste water can also

be contaminated from the X-ray area and film washing

- Wastewater treatment area: contains many halogenated organic compounds

- Waste water for blood transfusion, serology, obstetrics: contains serum and

clinical specimens, heavy metals (Hg), oxidants Wastewater from research areas: contains oxidation (H2O2), heavy metals from analysis

In general, wastewater include pathogenic germs possibly radioactive substances These are toxic wastes, which cause a big deal of environmental pollution and have a negatives impact on public health

2.1.2.2 Wastewater from hospital activities

Waste water is discharged after use for living needs in the hospital of staff, patients, family patients such as waste water in the canteen, toilet, bathroom, from work areas The amount of waste water depends on the number of hospital staff, the number of beds and the number of patients visiting patients, the number of patients

Domestic wastewater accounts for nearly 80% of the water supplied for daily life Domestic wastewater often contains different impurities These ingredients include: 52% organic matter, 48% inorganic matter, in addition to many pathogenic microorganism, most microorganism in the wastewater are viruses, cholera, typhoid

Table 2 1 Waste water at hospitals

No Scale of hospital

(Patient beds)

Water consumption (l/people/day)

Quantity of waste water (m 3 /day)

6 The hospital combines

research and training

(Source: Ministry of Health, 2010)

2.1.2.3 Wastewater is runoff water

Amount of wastewater is generated by rainwater falling on the hospital premises, which is collected in the drainage system The quality of this wastewater depends on the cleanliness of the atmosphere and the washout area of the hospital If the area of the hospital premises such as yards, unclean roads, long-term accumulation

of garbage, muddy roads, this type of wastewater will be most contaminated first rainy season In contrast, the sanitation of yards, roads, the amount of rainwater flowing through that area will have low levels of pollution

2.1.2.4 Wastewater from other auxiliary works

Wastewater from other auxiliary facilities such as backup generators, car wash and garage (Nguyen Xuan Nghiem, 2009)

2.1.3 Characteristics of hospital wastewater

Domestic wastewater is characterized by many biodegradable organic substances (represented by BOD5) parameters), large amount of suspended solids Compared with the total hospital wastewater, wastewater accounts for 80% Noteworthy of the hospital wastewater is the wastewater from the laboratory and laboratory wastewater The characteristics of this wastewater is rich in microorganisms, especially pathogenic microorganisms such as yellow staphylococcus aureus (82.5%), blue late colloid (14.62%), E coli (51 , 61%), Enterobacter (19.36%) These are all bacteria that can not be released into the environment In addition, the waste water contains many toxic chemicals, antibiotics, halogen compounds used in laboratories, treatment of cancer patients, radioactive elements used in treatment and X-Optical All of these hazardous wastes are discharged into the hospital's wastewater system Therefore, hospital wastewater without effective treatment measures will increase the risk of disease outbreak, seriously affect the environment and public health

Through hospitals surveyed, the composition of wastewater is usually at the following level

Table 2.2 Characterized components of hospital wastewater

Parameters Unit Approximate

value

Typical values

NTR 7382-

2004 (level I)

NTROMW 28:2010/MONRE (colum B)

eutrophication of the source of the waste stream, affecting live organisms in the aquatic environment; Suspended solids cause turbidity of the water, causing deposits

to clog sewers and pipes, conduits Hospital wastewater is very dangerous because they are the source of germs and bacteria, especially infectious diseases such as typhoid fever, dysentery, which affect public health

In addition, hospital wastewater also contains some heavy metals with low content such as manganese, copper, mercury, chromium The results of analysis of heavy metals in hospital wastewater often show the function The quantity of these metals is smaller than the permitted standard National Technical Regulation on Industrial Wastewater 24: 2009/MONRE

2.1.4 Impact of hospital wastewater on people and the environment

Hospital wastewater is very dangerous and they are severely contaminated by organic matter and microorganisms, which is the source of bacteria and germs, especially infectious diseases such as cholera, dysentery, typhoid severely affected human health Particularly if the drugs used to treat cancer or their metabolites are not processed, but discharged directly into the environment, they are likely to be teratogenic and cause cancer to the person who comes in contact with them In addition, untreated hospital wastewater flows directly into the environment not only bringing germs into the ditches and rivers through residential areas, but also permeating the groundwater Not only that, the hospital waste water stinks bad smell that affects the quality of life near the hospital

When the hospital wastewater is discharged into the environment without treatment or unsatisfactory treatment, harmful substances and microorganisms harmful

in waste water will enter the environment and follow the food chain The human body causes dangerous diseases Also when people use polluted water due to hospital wastewater can also suffer from skin disease, if exposed for long will be at risk of serious illness

2.1.5 Impact on the environment

Impact on the air environment

The waste, such as blood, fluid, urine, is high in organic matter, quickly decomposed if not properly treated, not only causes disease but also smells bad, polluting the surrounding air

The process of decomposing waste produces pollutants such as H2S, CH4, volatile halogen compounds which cause global problems, greenhouse gases, and the perforation of the ozone layer

Impacts on soil environment

Heavy metals such as manganese, copper, mercury, chrome, etc are discharged directly into the environment through drainage systems and rivers High concentrations of heavy metals will cause degradation and soil pollution

2.2 Situation of management and treatment of hospital wastewater in Vietnam and in the World

2.2.1 In the world

In the world, environmental pollution caused by hospital wastewater is a matter

of concern for many organizations and countries There are now a number of treatment technologies available in medical facilities around the world Some countries in the

world such as Japan, China, Greece hospital wastewater after incineration are processed on the spot

While some countries like Switzerland hospital wastewater are directed to the city's sewage treatment plants In-hospital waste water treatment has the advantage of avoiding dilution due to mixing with municipal waste water and avoiding waste water leakage due to conduction

In Germany: Waste water treatment technology is considered effective, especially hospital wastewater treatment by MBR technology MBR technology can handle 95% of the contaminants in wastewater

In China: According to a survey by the Chinese Environmental Management Agency in 2010, China has more than 50% of the 8515 health facilities with 133309 beds polluting the environment due to hospital wastewater Waste water is estimated at 823400m3 Depending on the condition of each region, the number of health facilities has different treatment systems District hospitals in the eastern part of the country have 90% of facilities having sewage treatment systems While medical facilities in the West have wastewater treatment systems only 10-30%

In Japan, hospitals and clinics have a sewage treatment system There are two designs using Aerotank and ASBC (improved aerotank) But Japan is adopting a plan

to use activated sludge and MBR filters Using this option clearly shows better operating costs, less occupancy and higher efficiency

Wastewater treatment at hospitals is subject to specific requirements by the WHO, with processes including: primary treatment, biological treatment, sterilization and high-tech processing Sludge after treatment contains many bacteria and parasite eggs should be treated anaerobic or dried and then burn with medical waste

According to World Environment Organization classification, the hospital wastewater has a solid total solids index of 1200mg/l, in which the suspended solids is 350mg/l, the total organic carbon content is 290mg/l, total phosphorus (measured in P) was 15mg/l and total nitrogen was 85mg/l (Hoang Thi Lien, 2009)

Hospital wastewater treatment methods in the world

In the world, there are many advanced methods that have been widely applied

in USA, Japan and Russia including AAO technology, MBBR microbial technology and MBR One of the most advanced wastewater treatment methods being applied in the world today is OZONE method treatment

(Source: Duong Thi Phuong Thao,2013)

Figure 2 2 Waste water treatment methods by ozone

Waste water

Collector

Air tanks Air blower

High-level oxidation (PEROZONE)

Clarifier

Mud tank Disinfection tank

Sources Chlorine

Principles of operation

Collecting ponds: It is the task of treatment to concentrate wastewater before

pumping it through the air conditioning tank

Air tanks: Regulate the flow to reduce size and create stable working

conditions for subsequent treatment works, avoiding overload

High-level oxidation (PEROZONE): The technology uses ozone gas (O3) combined with H2O2 catalysts to convert the cutting of complex organic substances into simple organic substances, enabling the aerobic biological treatment tank to operate higher efficiency

Bio-aerobic biofilter: In the aerobic tank, the bacteria will stay in the

suspended form, sticky by the action of bubbles and they will receive oxygen, convert the suspended substance into food In aerobic environments, microorganisms will consume organic matter to grow and grow, increasing biomass and reducing the level

of pollutants in wastewater to the lowest level After passing this device COD, BOD decreased 80-95% This tank works much better than Aerotank and less muddy than Aerotank The processing efficiency is also much higher Wastewater will carry an amount of suspended sediment through the settling tank

Sedimentation tank: The wastewater from the bio-reservoir carrying

suspended sediment is distributed to the spillway of the horizontal settling tank Sedimentation ponds are designed so that the water flows in static state, the principle

of horizontal settling in 2-3 hour is sufficient for the formation of dregs with greater density than the upward velocity of the effluent and settling to the bottom of the settling tank The effluent from the settling tank has a COD reduction of 75-80% The surface water from the tank settles down to the disinfection tank

Disinfection tank: Only about 103-106 bacteria in 1ml of water after being

treated by biological methods, most of the bacteria remaining are not pathogenic bacteria, but also exclude some Bacteria have the potential to cause disease Use of

chlorine combined with the structure of the tank reacts with the internal enzyme of the cell, destroying the metabolism leading to the microorganism is destroyed

Waste water after the treatment system standards discharge

2.2.2 In Vietnam

Hospital wastewater includes domestic wastewater, rain water, medical water and other auxiliary works Hospital wastewater is mostly treated in septic tanks and then discharged into the common sewer

In Vietnam, most of the hospitals have been built for a long time, the new hospital was built later not to take into account the toxic level of hazardous waste of hospitals, so the solid waste treatment system and substances The hospital discharge has either not been available or has not been used, or has been successfully delivered Cause of limited budget, low environmental awareness, slow emission regulations or not seriously implemented

(Source: Hoang Trong Vu,2009)

Figure 2 3 Diagram for treatment of hospital wastewater in the current situation

Discharged into water sources

Waste water from the

faculties

Sedimentation and anaerobic digestion

Chemical disinfection

Discharged into sewer lines for centralized treatment