Document Type : Review Paper
Authors
1 Environmental Research Center, Razi University, Kermanshah,Iran.
2 Department of Civil Engineering, Faculty of Engineering, Razi University, Kermanshah, Iran
Abstract
Healthcare facilities are vital establishments to improve the public health, but with poor waste and wastewater management, may turn into a potential health risk. The fecal-oral
transmission potential of SARS-CoV-2 and the role of the wastewater as a potential source
of infection, more than ever highlights the importance of proper wastewater management
during the COVID-19 pandemic. This systematic review represents a picture of the current
state of hospital wastewater (HWW) management in Iran; an upper-middle income country
with a paucity of proper data concerning HWW management and further provides suggestions for hospital wastewater management during COVID-19 pandemic in the country. We reviewed 31 papers that published from 2005-2020 evaluated 163 hospitals from 82 cities and 17 provinces. HWW generation in Iran varies from 354 to 1892 liter per bed per day (839±363 L/bed/d). BOD, COD and TSS in the raw HWW were in the range of 119-1270, 205-1611 and 58-464 mg/L, respectively. Total coliforms and/or total fecal coliforms were in the range of 105-108 (MPN/100 mL). 44.2 % of hospitals had an active WWTP at the time of the study from which, only 15.3 % complied with discharge standards. More than 55 % of the hospitals in Iran use no disinfection, and less than 7 % comply with the discharge requirements. HWW management in Iran is very poor and there has been no improvement in HWW management within the last decade. To best respond to this pandemic, responsible authorities should address wastewater management in hospitals.
Keywords
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Almasi A., Shokoohizadeh M.J., Pirsaheb M., Khamutian R., Mohajeri
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municipal and hospital wastewater treatment plants in west of Iran,
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Âmouei A., Ghanbari N., Kazemitabar M., Study of wastewater
treatment system in the educational hospitals of Babol University of
medical sciences (2009), Journal of Mazandaran University of
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Arora S., Nag A., Sethi J., Rajvanshi J., Saxena S., Shrivastava SK.,
Gupta A. B., Sewage surveillance for the presence of SARS-CoV-2
genome as a useful wastewater based epidemiology (WBE) tracking
tool in India, Water Science and Technology 82 (2020) 2823–36.
Azizi N., Amini, J., Karimyan K., Ghaffari H., Sharafi K., Sharafi H.,
Arfaeinia, H., Ghaffari, H.R., Management of collection, treatment and
disposal of hospital wastewater-case study: Hamadan and
Kermanshah provinces hospitals (2014), International Journal of
Pharmacy and Technology 8 (2016) 12924-12933.
Binavapour M., Sabzevari A., Farzadkia M., Omidi S., Kulivand A.,
Zafaripour H., Mohammad Taheri A., Investigation of irrigation reuse
potential of wastewater treatment effluent from Hamedan Atieh-
Sazan general hospital, Journal of Water and Wastewater 18 (2007)
83-87 (In Persian).
Carraro E., Bonetta Si., Bertino C., Lorenzi E., Bonetta Sa., Gilli G.,
Hospital effluents management: chemical, physical, microbiological
risks and legislation in different countries, Journal of Environmental
Management 168 (2016) 185-199.
Chaudhry RM., Nelson KL., Drewes JE., Mechanisms of pathogenic
virus removal in a full-scale membrane bioreactor, Environmental
Science and Technology 49 (2015) 2815–22.
Craun GF., Calderon RL., Workshop summary: estimating waterborne
disease risks in the United States, Journal of Water and Health 4
(2006) 241–54.
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sciences' hospital wastewater treatment plants, Iran Occupational
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wastewater management in Hospitals of Qom Province, Journal of
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A., Performance evaluation of wastewater treatment facilities in
selected hospitals of North Khorasan in 2012-2013, Journal of North
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presence on viral inactivation in wastewater by the photo-Fenton
process: kinetic modeling and mechanistic interpretation, Applied
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Giannakis S., Rtimi S., Pulgarin C., Light-assisted advanced oxidation
processes for the elimination of chemical and microbiological
pollution of wastewaters in developed and developing countries,
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biological system in removal of organic matter from Razi hospital
wastewater during 2015, Iran, Archives of Hygiene Sciences 6 (2017)
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Akram hospital in Ramshir for irrigation of green space, 2nd National
Conference on Water Consumption Management; Loss Reduction
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biological treatment methods: natural oxidizing lagoons and rotating
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sludge, case study: Tehran Fajr hospital treatment plant, International
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Khan AH., Khan NA., Ahmed S., Dhingra A., Singh CP., Khan SU.,
Mohammadi A.A., Changani F., Yousefi M., alam S., Vambol S.,
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processes followed by different treatment technologies for hospital
wastewater treatment, Journal of Cleaner Production 269 (2020)
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Khan MT., Ali Shah I., Ihsanullah I., Naushad M., Ali Sh., Ali Shah SH.,
Mohammad AW., Hospital wastewater as a source of environmental
contamination: an overview of management practices, environmental
risks, and treatment processes, Journal of Water Process
Engineering 41 (2021) 101990.
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treatment plant of Imam Khomeini hospital, Urmia and upgrading of
operation system, Urmia University of Medical Sciences 16 (2005) 1-
6 (In Persian).
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transmission of SARS-CoV-2 via wastewater, Science of the Total
Environment 749 (2020) 142358.
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wastewater treatment: a special emphasis on occurrence and
removal of pharmaceutically active compounds, resistant microorganisms, and SARS-CoV-2, Journal of Environmental
Chemical Engineering 7 (2021) 104812.
Mahmoudkhani R., Mokhtari Azar A., Khani, M.R., A survey of Tehran
hospitals wastewater, International Conference on Future
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Ahmadian M., Survey wastewater treatment condition and effluent
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systems in hospitals of Iran, Iranian Journal of Environmental Health
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disinfection/removal methods of coronavirus in wastewater and
progress of wastewater-based epidemiology, Journal of
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city hospital wastewater on sewage network and treatment plant of
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SARS at Amoy Gardens., Journal of Environmental Health 68 (2006)
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M., Wastewater characteristics and appropriate method for
wastewater management in the hospitals, Iranian Journal of Public
Health 38 (2009) 34-40.
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M., Wastewater characteristics and appropriate method for
wastewater management in the hospitals, Iranian Journal of Public
Health 38 (2009) 34–40.
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U., Survey the performance of the Shohada of Behshahr the
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wastewater-based epidemiology can overcome representativeness
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Technology 54 (2020) 5311.
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treatment plant, Knowledge and Health in Basic Medical Sciences 4
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pandemic: considerations for the waste and wastewater services
sector, Case Studies in Chemical and Environmental Engineering 1
(2020) 100006.
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Sánchez G., Metropolitan wastewater analysis for COVID-19
epidemiological surveillance, International Journal of Hygiene and
Environmental Health 230 (2020) 113621.
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Medical Sciences 2 (2014) 47-54 (In Persian).
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hospital wastewater in Kermanshah, Iran, Risk Management and
Healthcare Policy 13 (2020) 1035 - 1042.
Alamshah S., Solimani Babarsad M., Rajabzadeh Qotrami E.,
Efficiency evaluation of hospital wastewater treatment system: a case
study of Ayatollah Nabavi hospital in Dezful, Journal on Water
Engineering 5 (2017) 167-17 (In Persian).
Almasi A., Shokoohizadeh M.J., Pirsaheb M., Khamutian R., Mohajeri
P., & Shokoohizadeh L., The frequency of entrotoxigenic E.coli in
municipal and hospital wastewater treatment plants in west of Iran,
International Journal of Pharmacy & Technology 8 (2017) 22765-
22772.
Âmouei A., Ghanbari N., Kazemitabar M., Study of wastewater
treatment system in the educational hospitals of Babol University of
medical sciences (2009), Journal of Mazandaran University of
Medical Sciences 20 (2010) 78-86 (In Persian).
Arora S., Nag A., Sethi J., Rajvanshi J., Saxena S., Shrivastava SK.,
Gupta A. B., Sewage surveillance for the presence of SARS-CoV-2
genome as a useful wastewater based epidemiology (WBE) tracking
tool in India, Water Science and Technology 82 (2020) 2823–36.
Azizi N., Amini, J., Karimyan K., Ghaffari H., Sharafi K., Sharafi H.,
Arfaeinia, H., Ghaffari, H.R., Management of collection, treatment and
disposal of hospital wastewater-case study: Hamadan and
Kermanshah provinces hospitals (2014), International Journal of
Pharmacy and Technology 8 (2016) 12924-12933.
Binavapour M., Sabzevari A., Farzadkia M., Omidi S., Kulivand A.,
Zafaripour H., Mohammad Taheri A., Investigation of irrigation reuse
potential of wastewater treatment effluent from Hamedan Atieh-
Sazan general hospital, Journal of Water and Wastewater 18 (2007)
83-87 (In Persian).
Carraro E., Bonetta Si., Bertino C., Lorenzi E., Bonetta Sa., Gilli G.,
Hospital effluents management: chemical, physical, microbiological
risks and legislation in different countries, Journal of Environmental
Management 168 (2016) 185-199.
Chaudhry RM., Nelson KL., Drewes JE., Mechanisms of pathogenic
virus removal in a full-scale membrane bioreactor, Environmental
Science and Technology 49 (2015) 2815–22.
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disease risks in the United States, Journal of Water and Health 4
(2006) 241–54.
Dehghan Kang Zeiton A., Gholami M., Farzadkia M., Javadi Z.,
Moabedi I., Performance evaluation of Iran University of medical
sciences' hospital wastewater treatment plants, Iran Occupational
Health 6 (2010) 47-54 (In Persian).
Escher B.I., Baumgartner R., Koller M., Treyer K., Lienert J., McArdell
CS., Environmental toxicology and risk assessment of
pharmaceuticals from hospital wastewater, Water Research 45
(2011) 75–92.
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wastewater management in Hospitals of Qom Province, Journal of
Hospital 14 (2015) 127-135 (In Persian).
Ghafouri Safa S., Mirzaali A., Ghorbanpour R., Kamali H., Gholizadeh
A., Performance evaluation of wastewater treatment facilities in
selected hospitals of North Khorasan in 2012-2013, Journal of North
Khorasan University of Medical Sciences 6 (2014) 371-379 (In
Persian).
Ghanadzadeh M., Rezaei Ashtiani A. A., Rajaei M., Faraz A., Disposal
and filtration of wastewater in hospitals of Markazi Province in 2009,
Journal of Arak Univesity of Medical Sciences 13 (2010) 100-108 (In
Persian).
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evaluation of hospital wastewaters discharged to Zarjub river in
Rasht, 12th National Congress On Environmental Health, Tehran
(2009) (In Persian).
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C.,Effect of Fe(II)/Fe(III) species, pH, irradiance and bacterial
presence on viral inactivation in wastewater by the photo-Fenton
process: kinetic modeling and mechanistic interpretation, Applied
Catalysis B: Environmental 204 (2017a) 156–66.
Giannakis S., Rtimi S., Pulgarin C., Light-assisted advanced oxidation
processes for the elimination of chemical and microbiological
pollution of wastewaters in developed and developing countries,
Molecules 22 (2017b) 1–21.
Gonçalves J., Koritnik T., Mioč V., Trkov M., Bolješič M., Berginc N.,
Prosenc K., Kotar T., Paragi M., Detection of SARS-CoV-2 RNA in
hospital wastewater from a low COVID-19 disease prevalence area,
Science of The Total Environment 755 (2021) 143226.
Hashemzadeh B., Geravandi S., Mohammadi M. J., Yari A. R.,
Charkhloo E., Omidi Khaniabadi Y., Takdastan A., Vosoughi M.,
Fazlzadeh M., Khoshgoftar M., Performance of extended aeration
biological system in removal of organic matter from Razi hospital
wastewater during 2015, Iran, Archives of Hygiene Sciences 6 (2017)
244-249.
Heydari M., Asrari E., Feasibility of reusing the wastewater of Rasoul
Akram hospital in Ramshir for irrigation of green space, 2nd National
Conference on Water Consumption Management; Loss Reduction
and Reuse, Tehran (2019) (In Persian).
Ibrahim C., Mehri I., Hammami S., Mejri S., Hassen A., Pothier P.,
Removal of human astroviruses from hospital wastewater by two
biological treatment methods: natural oxidizing lagoons and rotating
biodisks, Desalination and Water Treatment 89 (2017) 287–96.
ISC., ISC COVID-19 Visualizer Geo-Spatial_Temporal Visualization &
Analysis of 2019-nCov Data & Research V1 (ISC. 2021).
https://maps.isc.ac/covid19/#/world
Karimi A., Rahimi Rashtabadi Z., Investigation of sewage treatment
conditions in Guilan province hospitals, Human & Environment 18
(2020) 1-11 (In Persian).
Kebriaei R., Zarei Mahmoudabadi H., Mirhoseyni S.A., Soltaninejad S.,
Feasibility of reusing the effluent of hospitals and medical centers for
irrigation of green space (case study: Mahshahr Petrochemical
hospital), Second National Conference on Water Crisis (climate
change, water and environment), Shahr-e-Kord (2014) (In Persian).
Khalesidoost M., Sasani H., Noori M., Evaluation the performance of
hospital wastewater treatment with integrated fixed film activated
sludge, case study: Tehran Fajr hospital treatment plant, International
Conference on Water and Wastewater with Focus on Privatization
and Benchmarking, Tehran (2011).
Khan AH., Khan NA., Ahmed S., Dhingra A., Singh CP., Khan SU.,
Mohammadi A.A., Changani F., Yousefi M., alam S., Vambol S.,
Vambol V., Khursheed A., Ali I., Application of advanced oxidation
processes followed by different treatment technologies for hospital
wastewater treatment, Journal of Cleaner Production 269 (2020)
122411.
Khan MT., Ali Shah I., Ihsanullah I., Naushad M., Ali Sh., Ali Shah SH.,
Mohammad AW., Hospital wastewater as a source of environmental
contamination: an overview of management practices, environmental
risks, and treatment processes, Journal of Water Process
Engineering 41 (2021) 101990.
Khorsandi H., Navidjouy N., Evaluation the efficiency of wastewater
treatment plant of Imam Khomeini hospital, Urmia and upgrading of
operation system, Urmia University of Medical Sciences 16 (2005) 1-
6 (In Persian).
Liu D., Thompson J.R., Carducci A., Bi X., Potential secondary
transmission of SARS-CoV-2 via wastewater, Science of the Total
Environment 749 (2020) 142358.
Majumder A., Gupta AK., Ghosal PS., Varma M., A review on hospital
wastewater treatment: a special emphasis on occurrence and
removal of pharmaceutically active compounds, resistant microorganisms, and SARS-CoV-2, Journal of Environmental
Chemical Engineering 7 (2021) 104812.
Mahmoudkhani R., Mokhtari Azar A., Khani, M.R., A survey of Tehran
hospitals wastewater, International Conference on Future
Environment and Energy (IPCBEE), Singapore (2012) 28-22.
Mahvi A., Rajabizadeh A., Fatehizadeh A., Yousefi N., Hosseini H.,
Ahmadian M., Survey wastewater treatment condition and effluent
quality of Kerman province hospitals, World applied sciences journal
7 (2009) 1521-1525.
Majlesi Nasr M., Yazdanbakhsh A.R., Study on wastewater treatment
systems in hospitals of Iran, Iranian Journal of Environmental Health
Science and Engineering 5 (2008) 211–215.
Mandal P., Gupta AK., Dubey BK., A review on presence, survival,
disinfection/removal methods of coronavirus in wastewater and
progress of wastewater-based epidemiology, Journal of
Environmental Chemical Engineering 8 (2020) 104317.
Mazlomi S., Mahvi A. H., Mamghani negad M., Kamalzadeh M., Daryaei
G. A., Khodayari M., Quantitative and qualitative assessment of Arak
city hospital wastewater on sewage network and treatment plant of
Arak city, (from point of organic pollutants and heavy metals), Journal
of Environmental Health Engineering 1 (2014) 84-92 (In Persian).
McKinney K.R., Gong Y.Y., Lewis T.G., Environmental transmission of
SARS at Amoy Gardens., Journal of Environmental Health 68 (2006)
26–52.
Mesdaghinia A.R., Naddafi K., Nabizadeh R., Saeedi R., Zamanzadeh
M., Wastewater characteristics and appropriate method for
wastewater management in the hospitals, Iranian Journal of Public
Health 38 (2009) 34-40.
Mesdaghinia A.R., Naddafi K., Nabizadeh R., Saeedi R., Zamanzadeh
M., Wastewater characteristics and appropriate method for
wastewater management in the hospitals, Iranian Journal of Public
Health 38 (2009) 34–40.
Mollaie Tavani S., Dehghanifard E., Hajibagher Tehrani S., Ebrahimi
U., Survey the performance of the Shohada of Behshahr the
wastewater treatment plant hospital in 2015-2016, Journal of
Environmental Health Engineering 4 (2017) 161-173 (In Persian).
Murakami M., Hata A., Honda R., Watanabe T., Letter to the editor:
wastewater-based epidemiology can overcome representativeness
and stigma issues related to COVID-19, Environmental Science and
Technology 54 (2020) 5311.
Nazemi, S., Abbasi, A., Noorian, J., Sohrabi, M.B., Khosravi, A.,
Investigating the efficacy of Imam Hossein hospital wastewater
treatment plant, Knowledge and Health in Basic Medical Sciences 4
(2009) 36-40 (In Persian).
Nghiem L.D., Morgan B., Donner E., Short MD.,The COVID-19
pandemic: considerations for the waste and wastewater services
sector, Case Studies in Chemical and Environmental Engineering 1
(2020) 100006.
Randazzo W., Cuevas-Ferrando E., Sanjuán R., Domingo-Calap P.,
Sánchez G., Metropolitan wastewater analysis for COVID-19
epidemiological surveillance, International Journal of Hygiene and
Environmental Health 230 (2020) 113621.
Sadat Taghavi S., takdastan A., mohammadi M.J., montazeri zadeh S.,
Evaluation of wastewater treatment plant specialty and subspecialty
hospital Mehr Ahvaz, Iran, Journal of Torbat Heydariyeh University of
Medical Sciences 2 (2014) 47-54 (In Persian).
Sarafraz Sh., Khani M. R., Yaghmaeian K., Quality and quantity survey
of hospital wastewaters in Hormozgan province, Iranian Journal of
Environmental Health Science and Engineering 4 (2007) 43.
SCI.,Iran statistical yearbook 1395 2. Environment, 2016.
SCI.,Iran statistical yearbook 1397 2. Environment, 2018.
Shahryari T., Barikbin B., Sharifzadeh G., Dorri H., Evaluation of Vali
Asr (aj) hospital effluent for irrigation of the green, Journal of Birjand
University of Medical Sciences 19 (2012) 59-69 (In Persian).
Simmons F.J., Kuo D.H.W., Xagoraraki I., Removal of human enteric
viruses by a full-scale membrane bioreactor during municipal
wastewater processing, Water Research 45 (2011) 2739–50.
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