CHAPTER ONE
INTRODUCTION
1.1 General Background
Hospital wastewaters contain antibiotics, X-ray contrast agents, heavy metals, disinfectants, pharmaceuticals and substances with genotoxic and cytotoxic activity and enteric pathogens. As muchas 50 to 90 percent of an administered drug may be excreted by the body in a biologically active form, these drugs are known to be resistant to most biological wastewater treatment plants such as antibiotics, particularly some sulfonamides and fluoroquinolones were found at relatively high concentrations in hospital wastewater and were not completely removed by wastewater treatment. (Patil and Kant, 2000).
Wastewater is defined as any water, whose quality has been adversely being abused by anthropogenic influence. (Kant 2001). This includes liquid waste discharged from domestic homes, industries, hospitals, agricultural and commercial sectors. Many of the pollutants detected in wastewaters are categorized as non-regulated (emerging pollutants). Wastewater is also the leftovers, used water in a liquid form that has no economic value or demand and which must be disposed or thrown ways. (Altın and Değirmenci,2003).
Hospital wastewater also contains several organic substances that are resistant to biological degradation with low biodegradability ratios Biochemical Oxygen Demand (BOD) to Chemical Oxygen Demand (COD) of0.3, which show a resistance toward conventionalactivated sludge biological treatment process.(Escher,2001). Heavy metals such as Cadmium, Chromium, Copper, Lead, Mercury, Nickel, Selenium, Silver and Zinc are toxic to wastewater treatment systems.They are toxic tohumans and other organisms and may end up in surface waterwhere they may influence the aquatic ecosystem and interfere with the food chain. Some pharmaceuticals such as anti-tumor agents are carcinogenic, mutagenic, as much teratogenic and fetotoxic. (Escher et al.2011).
Studies have shown that the release of wastewater from the teaching hospital was associated with an increase in the prevalence of antibiotic resistance. (Aziz, et al. 2001). Antimicrobial resistant gram negative bacterial species were identified in final hospital effluents, residues of pharmaceutically active compoundshave also been found as contaminants in sewage, surface and ground-and drinking water samples. (Altin, et al. 2003).
The general wastewater treatment methods depend on biological processes, principally bacteria feeding onorganic material in the wastewater and most wastewatertreatment plants are designed to remove biodegradable organic material, but not designed to remove low concentrations of synthetic pollutants. (Beyene and Redaie, 2011).
Severalconventional wastewater management practices are noteffective in the complete removal of antibiotics. Most hospitals which use activated sludge and oxidation ditch, bacteria exceeded standard numbers; pathogenic bacteriaand parasites were found in two-thirds of the hospitalsand heavy metals, namely lead, chromium and cadmiumin the hospital effluent were in an acceptable range.(Al-Lami,1986).
Furthermore, water is essential for maintaining an adequate food supply and a productive environment for the human population, animals, plants and microbes worldwide. Population and economics grow, accompanied by increased water use, will not only severely reduce water availability per person but also create stress biodiversity in the entire global ecosystem. Approximately, 20% of the world’s population lacks safe drinking water and nearly half the world population lacks adequate sanitation. This problem is acute in many developing countries, which discharge an estimated 95% of their untreated urban sewage directly to surface waters. Surface water bodies are affected because they received water from wastewater (point source), irrigated drainage and runoff (non-point source). Impacts depend on the extent that wastewater has been in contact with soil, on that type of water body, and their use, as well as the hydraulic retention time and the part played within the ecosystems. One of the main environmental problems putting by the hospital effluents is their discharge, in the same way as the urban classic effluents, towards the urban sewer network without preliminary treatment.
Although the per capita water use in domestic applications is about 100 to 200 liter per capita, but this amount for hospitals is reported in range of 400 to 1200 liter per day per bed (Emmanuel et al., 2001). In hospitals, water consumed in different units such as inpatient wards, operating rooms, laboratories, laundries, kitchens, health services and administrative units decreases its physical, chemical and biological quality and is converted to wastewater (Mahvi, et al., 2009). The amount of produced hospital wastewater is variousin different communities. Wastewater production per capita in American hospitals has been determined 1000 liter per day per bed (Tchobanoglous et al., 2004). Although the quality of hospital wastewater is similar to municipal wastewater, but the effluent of hospitals wastewater may contain non-metabolized pharmaceutical compounds, antibiotics, disinfectants, anesthetics, radioactive elements, X-ray contrast agents and other persistent and dangerous compounds (Boillot, 2008; Carballa et al., 2004; Jolibois and Guerbet, 2006). In addition to persistent and hard biodegradable chemicals, some types of microbial pathogens persistent to antibiotics also are introduced to the aquatic ecosystems and other natural receiving bodies of pollution and cantransmit acute and dangerous diseases to human (Escher et al., 2011; Chitnisa, 2004; Pauwels and Verstraete, 2006). Existence of chlorinated organic compounds and heavy metals such as Hg and Pb has been reported in hospitals WTP (wastewater treatment plant) effluent (Kummerer and Helmer, 2006). In a study, the concentration of chlorinated organic compounds “AOX”, in hospital wastewater, was determined to be more than 10 mgL-1. In a research, the number of coliforms bacteria in raw wastewater entering the hospital WTP was counted 300×108 MPN per 100ml, while this number was reported to be 100×106 MPN per 100ml in raw wastewater of municipal wastewater (Emmanuel et al., 2001).
Also, in regard to the investigation on performance of hospital wastewater treatment plants, several studies have been done in the country and globally. A research success rate on this study is based on the optimization plan of a hospital wastewater treatment system, removal efficiency of BOD5 and COD which was mentioned to be 89 and 94% respectively (Boillot, 2008; Mesdaghinia et al., 2009). Given the large number of reception of patients from different cities of Mazandaran province and neighboring provinces in hospitals covered by Babol University of Medical Sciences and various specialty and subspecialty services in such health-care centers and increasing changes in quantity and quality of wastewater generation, on the one hand, and presence of the ecosystems, valuable and susceptible natural resources of this province such as river, sea, jungle, agricultural areas and pasture lands, on the other hand, continuous assessment and monitoring of hospital wastewater and the method of treatment, disposal and sludge produced in such health-care centers is necessary for provision, maintenance and promotion of community and environmental health (Carballa et al., 2004; Escher et al., 2011).
A proportion of the generated wastewater from health-care facilities will pose a higher risk than domestic wastewater. Depending on the service level and task of the health-care facility, the wastewater might contain chemicals, pharmaceuticals and contagious biological agents, and might even contain radioisotopes. Sewers of health-care facilities are often not watertight, and a significant part of the wastewater in many places may leak into the ground water. Often, hospitals are not connected to efficient; working sewage-treatment plants and sometimes municipal sewerage networks may not even exist. In many developing countries, the major part of health-care wastewater is discharged in surface watercourses or percolates into underlying groundwater aquifers with no or only partial treatment. (Mara 1996).
1.2 Aims and Objectives
1.2.1 Aims
The aim of this study was to survey the physiochemical and biological parameter of University of Uyo Teaching Hospital Wastewater, how the waste water in the hospital is been manage in order to reduce the health damage of the neighborhood.
1.2.2 Objectives
The objectives of the present study are:

To evaluate the quantity of wastewater generated in the University of Uyo Teaching Hospital.

To determine the quality of wastewater generated in the University of Uyo Teaching Hospital.

To investigate the current status of wastewater management practices in the selected hospital.

To proffer feasible solution to the problems of wastewater generated.
1.3 Scope of the Study
This research was conducted with a focus on the survey of physiochemical and the biological parameters of the University of Uyo Teaching Hospital wastewater, management and effects that the hospital wastewater can cause to the neighborhood.