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

Results of the Patients and Family Patients Survey on Management and Treatment of Wastewater at Thai Nguyen Tuberculosis and Lung Disease Hospital .... - Assessing the status of wastewat

THAI NGUYEN UNIVERSITY

UNIVERSITY OF AGRICULTURE AND FORESTRY

Study Mode : Full-time

Thai Nguyen, 25 September 2018

Thai Nguyen University of Agriculture and Forestry

Degree Program Bachelor of Environmental Science and ManagementStudent name LO THI NGUYEN

by microorganisms that decompose aerobically on the membrane where the toxic

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substances in waste water are removed Waste water after treatment will be removedfrom 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 viaIET 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-filledturrets, so users do not have to pump as much air as other technologies before Theyoften cause noise, and can spread pathogens to the environment System equipmentand materials are manufactured in the country, so maintenance or replacement ofdetails as needed should be made in a convenient way; Low investment and operatingcosts 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 poweroutage 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 modulartechnology, it is easy to expand the capacity when needed The wastewater aftertreatment with the drip filter will also be removed from the sludge in the Lamellsedimentation tank Sludge is treated in anaerobic digestion tank The process ofsterilization is finished

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

Biological Oxygen Demand

Page numbers: 64 pages

Date of submission September 25 , 2018

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 andencouragement from my family, teachers and friends it hepl me to overcome all thecomplete to finish this thesis

First of all, I would like to thank my parents for being a strong supporter ofmine 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 scientificand 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 Hospitalhelped and facilitated me throughout the course of the research

Thanks also to Teachers of Advanced Education Program who have devotedlytaught 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

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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

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LIST OF TABLE

Table 2 1 Waste water at hospitals 7

Table 2.2 Characterized components of hospital wastewater 10Table 4.1 Results of measurement and analysis of hospital wastewater quality 31Table 4.2 Results of measurement and analysis of surface water quality of wastewater33

Table 4.3 Measurement and analysis results of underground water quality in the

project area 34Table 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

COD Chemical Oxygen Demand

BOD Biological Oxygen Demand

BOD5 Biochemical Oxygen Demand

MONRE Ministry of Natural Resources and Environment

UNDP United Nations Development Programme

ASBC American Standard Building Code

IET Industrial Engineering Technology

MBR Membrane Bio - Reactor

NTROMW National Technical Regulation on Medical WastewaterNTROSWQ National Technical Regulation on Surface Water QualityNTROUWQ National Technical Regulation on Underground Water Quality

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TSS Total Suspended Solid

AAO Anaerobic - Anoxic - Oxic

MBBR Moving Bed Biofilm Reactor

PAC Poly Aluminium Chloride

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 andservices, the increasingly urbanization process is the cause of the environmentaloverload 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 isstill inadequate, the hospital is always overloaded; However, the funding forinvestment in upgrading infrastructure is still limited, especially the system oftreatment of dangerous and hazardous wastes is not complete and not meet therequirements of the environmental law, especially the system The amount ofwastewater 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 TechnicalRegulation on Medical Wastewater 28:2010/MONRE This standard specifies themaximum allowable values of parameters and pollutants in medical wastewater of thefacilities healthcare Many public and non-public hospitals nationwide have beenequipped with wastewater treatment systems, with different technologies, so differentprices 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 seriousenvironmental pollution and harm to human life The top concern for hospitalwastewater is the problem of germs and antibiotics and disinfectants Pathogenicgerms 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 servethe needs of people in the district and surrounding areas In addition to theachievements, the solid waste of health and waste water with high volume and

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concentration have not been properly considered, affecting the health of thecommunity 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 andtreatment to contribute to environmental protection

1.3 Research questions and hypotheses

Alternative Hypothesis (Ha): Liquid waste treatment system at Thai NguyenTuberculosis and Lung Diseases Hospital operate effeciently, waste water aftertreatment 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 andlung disease in Thai Nguyen Province has not been operated properly, there are stillplaces where sewage pipes and waste water drainages have been damaged

Where waste water is collected from all departments, waste rooms still havemany 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 notseparated They re mixed and then poured into the system, causing difficulties andcosts 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 themanagement and treatment of waste water in particular has not been paid due attentionand attention Communication is mainly through word of mouth or throughloudspeaker 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 asolid It includes both waste produced as a liquid and waste that has been convertedinto a liquid for handling

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

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Wastewater treatment: is the process of removing pollutants from waste watersuch 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 isdivided into small membranes that flow through biological buffer and bymicroorganisms that decompose aerobically on the membrane where the organicmatter in the wastewater is removed The liquid waste treatment system by refiningbio-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, arisingfrom various stages of hospital operations: blood, body fluids, patient laundry Theenvironment is full of pathogenic bacteria such as Staphylococcus, Streptococcus,Vibrio, Cholerae, Coliorm This is the most difficult source of wastewater to controlthe toxicity Bacteria are also the bacteria, the virus that is released from the patientcan 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 ofcourse will generate waste water Due to the characteristics of different parts of wateruse, the waste water discharge capacity is not the same However, this difference is notlarge, so to simplify the wastewater collection process and facilitate the designcalculation process, it is common to view the nature of wastewater generated fromsewage in the hospital is the same

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Surgical

Canteen

Laboratory

Emergencyroom

Patient room

(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

Wastewater from medical examination and treatment: The wastewater has highorganic pollution and contains the most pathogenic bacteria in wastewater from thehospital This waste comes from a variety of processes in the operation of the hospital(laboratory, surgical, pediatric, medical instruments, test tubes, chemical vials) Eachmedical examination and treatment area has different medical examination andtreatment 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 andclinical 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 anegatives 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, fromwork areas The amount of waste water depends on the number of hospital staff, thenumber of beds and the number of patients visiting patients, the number of patients

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

Table 2 1 Waste water at hospitals

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No Scale of hospital Water consumption Quantity of waste

(Patient beds) (l/people/day) water (m

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 hospitalpremises, which is collected in the drainage system The quality of this wastewaterdepends on the cleanliness of the atmosphere and the washout area of the hospital Ifthe 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 rainyseason In contrast, the sanitation of yards, roads, the amount of rainwater flowingthrough 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 washand garage (Nguyen Xuan Nghiem, 2009)

2.1.3 Characteristics of hospital wastewater

Domestic wastewater is characterized by many biodegradable organicsubstances (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 andlaboratory wastewater The characteristics of this wastewater is rich inmicroorganisms, especially pathogenic microorganisms such as yellow staphylococcusaureus (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, thewaste water contains many toxic chemicals, antibiotics, halogen compounds used inlaboratories, treatment of cancer patients, radioactive elements used in treatment andX-Optical All of these hazardous wastes are discharged into the hospital's wastewatersystem Therefore, hospital wastewater without effective treatment measures willincrease the risk of disease outbreak, seriously affect the environment and publichealth

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

Table 2.2 Characterized components of hospital wastewater

NTR

NTROMW Approximate Typical 7382-

value values 2004

(colum B) (level I)

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

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

In addition, hospital wastewater also contains some heavy metals with lowcontent such as manganese, copper, mercury, chromium The results of analysis ofheavy metals in hospital wastewater often show the function The quantity of thesemetals is smaller than the permitted standard National Technical Regulation onIndustrial 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 byorganic matter and microorganisms, which is the source of bacteria and germs,especially infectious diseases such as cholera, dysentery, typhoid severely affectedhuman health Particularly if the drugs used to treat cancer or their metabolites are notprocessed, but discharged directly into the environment, they are likely to beteratogenic and cause cancer to the person who comes in contact with them Inaddition, untreated hospital wastewater flows directly into the environment not onlybringing germs into the ditches and rivers through residential areas, but alsopermeating the groundwater Not only that, the hospital waste water stinks bad smellthat affects the quality of life near the hospital

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When the hospital wastewater is discharged into the environment withouttreatment or unsatisfactory treatment, harmful substances and microorganisms harmful

in waste water will enter the environment and follow the food chain The human bodycauses dangerous diseases Also when people use polluted water due to hospitalwastewater can also suffer from skin disease, if exposed for long will be at risk ofserious 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, quicklydecomposed 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 theperforation of the ozone layer

Impacts on soil environment

Heavy metals such as manganese, copper, mercury, chrome, etc are dischargeddirectly into the environment through drainage systems and rivers Highconcentrations 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 treatmenttechnologies available in medical facilities around the world Some countries in the

world such as Japan, China, Greece hospital wastewater after incineration areprocessed on the spot.

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

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

In China: According to a survey by the Chinese Environmental ManagementAgency in 2010, China has more than 50% of the 8515 health facilities with 133309beds polluting the environment due to hospital wastewater Waste water is estimated at823400m3 Depending on the condition of each region, the number of health facilitieshas different treatment systems District hospitals in the eastern part of the countryhave 90% of facilities having sewage treatment systems While medical facilities in theWest have wastewater treatment systems only 10-30%

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

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

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

According to World Environment Organization classification, the hospitalwastewater has a solid total solids index of 1200mg/l, in which the suspended solids is350mg/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)

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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 technologyand MBR One of the most advanced wastewater treatment methods being applied inthe world today is OZONE method treatment

(Source: Duong Thi Phuong Thao,2013)

Figure 2 2 Waste water treatment methods by ozone

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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 substancesinto simple organic substances, enabling the aerobic biological treatment tank tooperate 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, convertthe suspended substance into food In aerobic environments, microorganisms willconsume 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, BODdecreased 80-95% This tank works much better than Aerotank and less muddy thanAerotank The processing efficiency is also much higher Wastewater will carry anamount 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 greaterdensity than the upward velocity of the effluent and settling to the bottom of thesettling tank The effluent from the settling tank has a COD reduction of 75-80% Thesurface 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 pathogenicbacteria, 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 thecell, 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 waterand other auxiliary works Hospital wastewater is mostly treated in septic tanks andthen discharged into the common sewer

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

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Infectious waste water

department

Sterilized by physical methods

Biological treatment

Chemical disinfection

Discharged into water sources

Waste water from the

faculties

Sedimentation andanaerobic digestion

Chemical disinfection

Discharged into sewer lines

for centralized treatment

(Source: Hoang Trong Vu,2009)

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

situation in Vietnam

PART III RESEARCH METHODS

3.1 Time and research scope

- Time: The research was conducted from 3/3/2018 to 6/7/2018

- Research scope: Management of medical solid wastes of Thai Nguyen

Tuberculosis and Lung disease hospital

3.3.1 Collecting primary information

Field survey: Sources of wastewater in the hospital were observedphotographed for assessment of current wastewater status The waste water collectionand treatment systemsand the sewage discharge into the hospital environment werealso recored and

Interviewing by questionnaires: An interview with key staff in charge ofhospital environment on information of hospital waste management and treatmentstatus was also conducted by the questionaires

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