Importance of Water Recycling and Zero Discharge System in Hospitals

Introduction:

The healthcare sector in India is growing at a rapid pace and contributing immensely to the growth of the quality of services. The sector is expected to grow several-fold in the next decade.

While this augurs well for the country, there is an imminent need to introduce green concepts and techniques in this sector, which can aid growth in a sustainable manner.

Green Hospitals can have tremendous benefits, both tangible as well as intangible. The most tangible benefits are the reduction in water and energy consumption right from day one of occupancy. The water savings around 20 - 30%.

•       The hospital Industry in India is growing at a rapid pace and focusing immensely on the quality of healthcare services.

•       Introducing green concepts in the healthcare facilities can help address national issues of water efficiency and energy efficiency and in general, conservation of natural resources. 

•       People often avoid to go and stay in hospital as they are not comfortable with the standard of physical environment like air, water and regular equipment of common usage (Stretcher and wheel chair)

•       The goal of the study is to ensure that inpatients and out patients have a positive orientation, rather than a negative impression of healthcare system.

•       As per studies and reports available, most of the hospitals are energy guzzlers as they are wasting energy due to inadequate techniques and processes.

Objectives of the Water Management:

• We need to assess the existing practices of our water use at our Hospital
• We need to assess the existing practices of Recycling of water at our Hospital
• We need to assess the possibilities for decreasing water consumption at our Hospital
• We need to give more awareness about water management

Meaning of Water Conservation: 

Most of the Asian countries are water stressed and in country like India, water table has reduced drastically over the last decade. We need to encourage use of water in self-sustainable manner through reduce, recycle and reuse strategies.

Water conservation day is celebrated on 22nd of March. Water conservation includes all the policies, strategies and activities to sustainably manage the natural resources of Fresh Water, to protect the hydrosphere, and to meet the current and future human demand. Population, household size and growth and affluence all affect how much water is used. Factors such as climate change have increased pressures on natural water resources especially in manufacturing and agricultural irrigation.

Many countries have already implemented policies aimed at water conservation, with much success.

The goals of water conservation efforts include:

• Ensuring the availability of water for future generations where the withdrawal of fresh water from an ecosystem does not exceed its natural replacement rate.

• Energy conservation as water pumping, delivery and waste water treatment facilities consume a significant amount of energy. In some regions of the world over 15% of total electricity is devoted to water management.
• Habitat conservation where minimizing human water use helps to preserve fresh water habitat for local wildlife and migrating waterfowl, but also water quality. The water that leaks from aquagaurd should be collected and could be used for household works.

Meaning of Water Efficiency:

Water efficiency is reducing water wastage by measuring the amount of water required for a particular purpose and the amount of water used or delivered. Water efficiency differs from water conservation in that it focuses on reducing waste, not restricting use. Solutions for water efficiency focus not only on reducing the amount of potable water used, but also on reducing the use of non-potable water where appropriate (i.e. Flushing Toilet, water landscape, etc.). It also emphasises the influence consumers can have in water efficiency by making small behavioural changes to reduce water wastage and by choosing more water efficient products.

Examples of water efficient steps includes fixing leaking taps, taking showers rather than baths, installing displacements devices inside toilet cisterns, males using urinals rather than toilet stalls, and using dishwashers and washing machines with full loads. These are things that fall under the definition of water efficiency, as their purpose is to obtain the desired result or level of service with the least necessary water.

Innovative waste water technologies:

Water efficiency landscaping:

Proper landscaping techniques not only create beautiful landscapes, but also benefit the environment and save water. In addition, attractive, water-efficient, low-maintenance landscapes can increase home values. Water-efficient landscaping offers many economic and environmental benefits. To limit or eliminate the use of potable water or other natural surface or subsurface water resources available on or near the project site for landscape irrigation.

Requirements:

Reduce potable water consumption for irrigation by 50% from a calculated baseline case for the month with the highest evapotranspiration rate.

Reductions must be attributed to any combination of the following items:

• Plant species, density and microclimate factor
• Irrigation efficiency
• Use of captured rainwater
• Use of recycled wastewater
• Use of water treated and conveyed by a public agency specifically for nonpotable uses
• Water efficiency in air conditioning system

Water Use Reduction:

Because hospitals and healthcare facilities use so much water, it is likely they will come under greater pressure to develop procedures and systems that help reduce their consumption. Fortunately, there are several ways this can be accomplished in a cost-effective manner with little impact on building users, which will likely prove to be a cost savings as well. By category, some of the more significant steps medical facilities can take include these:

Heating and cooling: 

One of the most significant steps medical facilities can take to save water is to modify their refrigeration systems so that the water used for cooling is “close looped” and recirculated; many systems use a “once through” water cooling system where the water is drained after use. When incorporated in one U.S. hospital, the recirculation system reduced water consumption by about three million gallons per year and the facility saved more than $20,000 in annual water and sewer costs. Initial cost of this project: $29,000, providing a return on the investment in less than 18 months.

Retrofit toilet flush valves: 

Toilets do not necessarily need to be replaced in order to save water. Low flush valves reducing water consumption to 1.6 gallons per flush can be easily installed to reduce consumption; it is even possible to turn a conventional one-flush toilet into a dual-flush system.  One hospital saved more than five million gallons of water with these valves at a cost of $65,000. Annual savings are estimated at $45,000 with an estimated payback in 18 months.

Waterless urinals: 

Instead of installing water-reducing urinals, some medical facilities have installed no-flush urinal systems, which use no water at all. One small Northern California clinic calculated that by removing 14 conventional urinals, which use on average three gallons of water per flush, and replacing them with waterless systems, the savings totaled more than 280,000 gallons of water annually. Based on water charges at that time, the hospital estimated they were saving more than $2,100 annually.

Laundry systems: 

Some hospitals are installing rinse water reuse systems. Installed in one hospital, the system saved nearly two million gallons of water annually. According to at least one manufacturer of these systems, the average reuse water usage in healthcare-related facilities is about 25 percent.

Zero Liquid Discharge Stages:

Stage 1: Preliminary Treatment

• Effluent screening process.
• Oil removal process.
• Effluent mixing process.
• pH correction process.

Stage 2: Primary Treatment

• Electrochemical Coagulation & Flocculation process.
• Primary sludge settling, treatment process.
• TSS, color & associated BOD/COD removal process.
• Hardness & heavy metals removal process.

Stage 3: Secondary Treatment

• Biological treatment process.
• Secondary sludge settling process.
• Sludge treatment Process.
• BOD & COD removal process.

Stage 4: Tertiary Treatment

• Depth filtration / Polishing process.
• Polishing of TSS, SDI, Color, Turbidity, Virus etc.

Stage 5: Recycle Treatment

• Salts / Total dissolved solids / TDS removal process.
• Salts / Total dissolved solids / TDS final polishing process.

Stage 6: Salt Crystallization:

• Salts / Total dissolved solids / TDS concentration Process.
• Salt crystallization process.

Ensuring Adequate Quality & Quantity of Water:

Hospitals need to ensure that the water supply is adequate as per the requirement of the hospital. For the health facilities having beds less than 100, the water requirement is around 350 litres per bed per day and for hospitals having more than 100 beds the requirement escalates to around 400 litres per bed per day.

Hospitals should calculate the requirements of the facility and should ensure that they have enough provisions for storage of water as per calculated requirement.

Hospitals should take appropriate measures for ensuring the quality of water supplied by the hospital. 

The basic measures that can be undertaken by the hospital are:

• Regular cleaning of water tanks and reservoirs.
• Regular maintenance of RO plants and water dispensing machines.
• Regular water testing for any growth of micro-organisms.
• Chlorination of water.
• The records for water testing and cleaning of tanks and dispensing system should be retained by the hospitals.

Maintenance of Water Supply System:

Hospitals need to ensure that they undertake regular maintenance of water supply system as per the periodic maintenance plan of the hospital.

Inspection for Water Wastage:

Hospitals need to periodically check for any leaking taps, pipes, overflowing tanks, dysfunctional cisterns etc. It should be ensured that designated staff is responsible for carrying out these activities in the health facility. Immediate corrective actions need to be undertaken by the health facility for any fault noticed during the inspection for water wastage.

Rain Water Harvesting:

• Rainwater harvesting is the technique of collection and storage of rainwater at the surface or in subsurface aquifers, before it is lost as surface runoff.
• Ground water augmentation through diversion of rainfall to sub-surface reservoirs by various artificial recharge techniques can be adopted by the hospital
• Hospitals can also adopt a twin strategy of simple artificial recharge techniques in rural areas like Percolation Tanks, Check Dams, Recharge Shafts, Dug Well Recharge and Sub-surface Dykes and adopting Roof top rainwater harvesting in urban areas.

Roof Top Harvesting:

What is Rooftop Rain Water Harvesting?

Rooftop rain water harvesting is the technique through which rain water is captured from the roof catchments and stored in reservoirs. Harvested rain water can be stored in sub-surface ground water reservoirs by adopting artificial recharge techniques to meet household needs through storage in tanks. The main objective of rooftop rain water harvesting is to make water available for future use. Capturing and storing rain water for use is particularly important in dryland, hilly, urban and coastal areas.

Need for Rooftop Rain Water Harvesting:

• To meet the ever increasing demand for water
• To reduce the runoff which chokes storm drains
• To avoid flooding of roads
• To augment ground water storage and control decline of water levels
• To reduce soil erosion
• To supplement domestic water requirement during summer, drought etc.

Safety Consideration for Storage in Ground Water Reservoir:

• For rooftop rain water harvesting through existing tube wells and hand pumps, filter or desilting pit should be provided so that the wells are not silted
• Such tube wells if pumped intermittently increase the efficiency of recharge
• If the ground water reservoir is recharged through shaft, dug well etc., inverted filter may be provided.

 Storage in Tanks:

• A storage tank should not be located close to a source of contamination, such as a septic tank etc.
• A storage tank should be located on a lower level than the roof to ensure that it fills completely
• A rainwater system should include installation of an overflow pipe which empties into a non-flooding area. Excess water may also be used for recharging the aquifer through dug well or abandoned hand pump or tube well etc.
• A speed breaker plate should be provided below inlet pipe in the filter so as not to disturb the filtering material
• Storage tanks should be accessible for cleaning
• The inlet into the storage tank should be screened in such a way that it can be cleaned regularly
• Water may be disinfected regularly before using for drinking purpose by chlorination or boiling etc.

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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