Desalination and Water Treatment 263 (2022) 145–151

July
www.deswater.com
doi: 10.5004/dwt.2022.28219

Investigations on pharmaceuticals and radioactive elements in wastewater

from hospitals in Kuwait

A. Mydlarczyk, A. Al-Haddad*, H. Abdullah, A. Aba, A. Esmaeel, R. Al-Yaseen

Kuwait Institute for Scientific Research, Kuwait City, Kuwait, Tel. +965 97877302; email: ahadad@kisr.edu.kw (A. Al-Haddad)

Received 28 February 2022; Accepted 27 April 2022

abstract
A research studies were performed to characterize the wastewater generated from four hospi-
tals located in Kuwait. In general, the wastewater generated from hospitals is discharged directly
without any pre-treatment to public sewage treatment plants supervised by Ministry of Public
Works (MPW). In this study, wastewater samples were collected on weekly basis from four hos-
pitals (Al-Sabah, Al-Razi, Maternity and Chest diseases). Field wastewater measurements were
carried out onsite for all sites including temperature, pH, electrical conductivity and oxidation–
reduction potential. The collected samples were analyzed for determination of chemical parame-
ters (total suspended solids and total dissolved solids), organic parameters including total organic
carbon, chemical oxygen demand, biochemical oxygen demand and five dominate pharmaceutical
compounds (four antibiotics sulfamethoxazole, metronidazole, ranitidine and trimethoprim plus
paracetamol) and concentrations of radioactive elements in the wastewater (I-131, K-40, Tc-99m).
The laboratory results indicated that all wastewaters from hospitals contained high levels of Tc-99m
(0.14–14.151 Bq/L), I-131 (13.56–27.1 Bq/L), and low levels of K-40 (0.45–0.86 Bq/L). In addition,
the pharmaceutics’ concentration results revealed a high concentration of paracetamol (580 μg/L),
where the maximum was detected in wastewater from Al-Razi hospital. The study recommends
construction of onsite wastewater pre-treatment units.
Keywords: Radioactive isotopes; Hospital wastewater; On-site wastewater pre-treatment; Pharmaceu-
tical compounds

1. Introduction disinfectants, pharmaceuticals and MRI contrast agents.

El-Morhit et al. [6] investigated wastewater from hospitals
Wastewater from healthcare institutions usually contains
in Morocco and found that mean value for chemical oxy-
disinfectants, antibiotics, pharmaceuticals and magnetic
gen demand (COD) was 828.4 mg/L, which did not exceed
resonance imaging (MRI) contrast agents. Residues of phar-
the maximum limit for domestic wastewater. Novo and
maceuticals are present in all wastewater treatment plants’
Manaia [7] studied factors influencing antibiotic resistance
effluents. The conventional activated sludge systems are usu-
in municipal wastewater treatment plants and confirmed
ally not efficient for pharmaceuticals removal [1]. Inefficient
that longer hydraulic retention time corresponded to higher
removal of pharmaceuticals from wastewater treatment
bacterial removal rates but still such rates were not efficient
plants was also confirmed by other researchers [2–4].
enough.
Pauwels and Verstraete [5] discussed many aspects of chem-
In Kuwait, there is lack of information regarding char-
icals present in wastewater belong to groups like antibiotics,
acterization of wastewater from hospitals. Kuwait Institute

* Corresponding author.

Presented at the 14th Gulf Water Conference: Water in the GCC… Towards Economic Efficiency and Financial Sustainability, 13–15 February 2022,
Riyadh, Saudi Arabia
1944-3994/1944-3986 © 2022 Desalination Publications. All rights reserved.
146 A. Mydlarczyk et al. / Desalination and Water Treatment 263 (2022) 145–151

for Scientific Research conducted two projects. The first from four hospitals in Kuwait. The wastewater generated
one is WT013C [8], which presented parameters for waste- from four hospitals represents a combination of domestic
water from two hospitals namely, Al-Razi and Al-Sabah and industrial water type. The generated wastewater sent
Hospital. The reported results were based on only one sam- to the public sewage network any treatment.
pling from both hospitals which cannot represent actual
fluctuation in concentrations or even considered averages 2. Materials and methods
of parameters. Alajmi [9] studied removal of the pharma-
ceuticals as metronidazole, trimethoprim, sulfamethox- Full chemical and microbiological characteristics of
azole, paracetamol and ranitidine from the wastewater wastewater from studied hospitals were conducted at
coming to Sulaibiya Wastewater Treatment and Reclama­ KISR and external laboratories. The main part of analyses
tion Plant in Kuwait. He has chosen these pharmaceuti­ was carried out at Sulaibiya Research Plant Laboratory,
cals as the most frequently used in Kuwait and stated that which belongs to Wastewater Treatment and Reclamation
their removal was above 97%. In the second project titled Technologies Program. Prior sampling, the following
“A Baseline Screening Survey of Human Pharmaceuticals wastewater parameters were examined: temperature, pH,
in Wastewater Treatment Plants in Kuwait (EM049C)”, electrical conductivity (EC) and oxy-redox potential. The
samples were collected from inflow and effluent of two sampling was carried out on the weekly basis from begin-
wastewater treatment plants. The results indicated that ning of August 2019 until 31 March 2021. Due to spread-
influent concentrations of pharmaceuticals were higher out of Covid-19, the sampling was suspended from March
than in final effluents and it was on the level of micro- 2020 until 18 January 2021. Samples were collected man-
gram per liter. The highest concentration was mainly for ually and all analyses were carried out in accordance to
analgesics and anti-inflammatory drugs Gevao et al. [10] standard methods of APHA [13]. Analyses of radioactive
confirmed that pharmaceuticals are not fully removed in isotopes (I-131, K-40, Tc-99m) presence were carried out by
wastewater treatment plants during the standard biologi- Laboratory of Environmental and Life Sciences Research
cal process. In this study, the obtained field and lab results Center in KISR by application of gamma spectroscopy. 4 L
are compared with KEPA requirements regarding domes- samples were prepared in the geometry of Marinelli Beaker
tic wastewater effluent discharged to sewage network. (3,000 mL). Two gamma spectrometry system, equipped
Prayitno et al. [11] investigated wastewater from three with High Purity Germanium Detectors (Ortic Coaxial
hospitals in Malang City in Indonesia and reported that GMX40-83-LB-C (relative efficiency 40%, FWHM at 1,332
COD ranged between 110, 351 mg/L, and total suspended is 1.95 keV), and Ortic Coaxial GEM50-83-LB-C (relative
solids (TSS) between 43 and 83 mg/L, respectively. These efficiency 50%, FWHM at 1,332 is 1.9 keV)) have been used.
wastewater parameters exceeded the Indonesian quality Both detectors were shielded with low background lead.
standards. Al-Ajlouni et al. [12] evaluated wastewaters dis- The spectrometer was calibrated using a mixed nuclide
charged from twelve hospitals in Jordan. High COD val- standardized solutions QCYB41 (Eckert & Ziegler Nuclide
ues (725–1,356 mg/L) and highly differential values for TSS GmbH).
(45–1,419 mg/L) were obtained. The current study includes The gamma spectrometers used were calibrated using
collection of wastewater from four hospitals (Fig. 1). The standard reference materials. All analyses were carried
aim of this research is to assess the concentration of anti- out in accordance with APHA standards [13]. Presence of
biotics and radioactive elements in wastewater generated pharmaceuticals (four antibiotics such as metronidazole,

Fig. 1. Location map for Al-Sabah, Al-Razi, Chest and Maternity hospitals in Kuwait.
 A. Mydlarczyk et al. / Desalination and Water Treatment 263 (2022) 145–151 147

trimethoprim, sulfamethoxazole and ranitidine plus parac- of ORP were observed for Al-Razi hospital. Moreover, the
etamol) was determined by external laboratory (Biofocus in mean value was also the highest.
Germany).
3.4. Radioactivity in wastewater of all studied hospitals
3. Results and discussion The efficiency calibration curve of the Marneli Beake
3.1. Analysis of wastewater pH from studied hospitals counting geometry used (3,000 mL) is shown in Fig. 5.
The collected gamma spectra were analyzed by Canberra
The results of seasonal pH changes for wastewater from Genie-2000 gamma acquisition and analyses software.
all the discussed hospitals are presented in Fig. 2. All sta- Fig. 6 shows a gamma spectrum generated by the Genie-2000
tistical values for Al-Sabah hospital wastewater were the software using the HPGe detector.
highest among all studied hospitals. The activity concentration was calculated using the cal-
ibration parameters and the created radionuclide library
that including the radiopharmaceuticals nuclide.
3.2. Analysis of wastewater EC from studied hospitals
It should be noted that the concentration of the radio-
The changes of electrical conductivity for wastewater nuclides was decay corrected, as most of the radiophar-
from all hospitals is shown in Fig. 3. All presented values maceuticals are short-lived radioisotopes. The obtained
are smaller than maximum required by KEPA (2,000 µS/cm) results were compared with maximum limits established
for wastewater discharged to sewage network in Kuwait. by Environment Public Authority in Kuwait for materials
discharged to environment (2017).
99m
Tc radio-pharmaceutical, which is extensively used
3.3. Analysis of wastewater oxy-redox potential
for diagnosis has been found as a common radionuclide
for studied hospitals
used in the four discharging points; while 131I was found
The results of oxidation–reduction potential (ORP) are only in Al-Razi and Al-Sabah hospitals. The natural radio-
presented in Fig. 4. The minimum and maximum values nuclide 40K was found in all samples within the natural

10
9
8
7
6
pH

5
4
3
2
1
0
Al-Sabah Al-Razi Maternity Chest Diseases
Hospital Name
Min Max Avg. Min Limit Max Limit

Fig. 2. pH variation for hospital wastewater in Kuwait.

2500
Electrical Conductivity (μS/cm)

2000

1500

1000

500

0
Al-Sabah Al-Razi Maternity Chest Diseases
Hospital Name
Min Max Avg. EPA Limit

Fig. 3. Electrical conductivity variation for hospital wastewater in Kuwait.

148 A. Mydlarczyk et al. / Desalination and Water Treatment 263 (2022) 145–151

-300
Oxy - r e d o x P o t e nt ia l ( mV ) -250
-200
-150
-100
-50
0
50
Al-Sabah Al-Razi Maternity Chest Diseases
Hospital Name
Min Max Avg.

Fig. 4. Oxidation–reduction potential (ORP) variation for hospital wastewater in Kuwait.

Fig. 5. Detector efficiency curve of the Marinelli Beaker counting geometry.

background level. According to the activity concentration The highest value for all five studied pharmaceuticals
observed in all healthcare centers, the 131I varied from 0.03 was found in wastewater from Al-Razi hospital and it was
to 27.1 Bq/L with an average of 5.48 Bq/L. Fig. 7 showed that equal 580 µg per liter. The lowest values of antibiotic con-
131
I was detected only on the discharge point of Al-Sabah centration in studied wastewater were found for metro-
healthcare center in frequent dates. The highest activ- nidazole and trimethoprim, which were below 0.01 µg/L.
ity value belongs to the sample collected in 19 Sep 2019,
which reached 27 Bq/L (Fig. 7). 4. Conclusion
On the other hand, 99mTc activity concentration varied
from 0.14 to 14,151 Bq/L with an average value 717 Bq/L. Five pharmaceuticals including metronidazole, tri-
The highest concentration was found in the sample of 25 methoprim, sulfamethoxazole, paracetamol and ranit-
January 2021 from Chest Diseases hospital (Fig. 8). The idine were analyzed and it was found that the maximum
daily discharge of 99mTc from all hospitals exceeded daily concentration among them appeared for paracetamol,
maximum limit set by EPA in Kuwait for this radioac- which was equal 130 μg/L for the sample from Chest dis-
tive isotope. The concentration of natural radionuclide 40K eases hospital when for Al-Sabah and Al-Razi, the concen-
presented in Fig. 9, which was in the natural background tration reached 370 and 580 μg/L. Other antibiotics were
level, however the variation found was due to the amount frequently present in wastewater from all studied hospi-
of suspended particles in the sample. tals. Several researches indicated that advanced oxidation
methods through using ozone and hydrogen peroxide
gases were suggested to treat the wastewater antibiotics
3.5. Pharmaceutical compounds in wastewater generated
generated from the hospitals [14]. Therefore, the obtained
by hospitals in Kuwait
low concentrations of pharmaceutical compounds might
The obtained mean concentrations of the five most be treated through advanced oxidation techniques and not
common pharmaceuticals in wastewater generated from through the biological treatment (resistant to antibiotics)
the four hospitals in Kuwait are presented in Table 1. in municipal wastewater treatment plants.
 A. Mydlarczyk et al. / Desalination and Water Treatment 263 (2022) 145–151 149

Fig. 6. Gamma spectrum generated by the Genie 2000 Software using the HPGe detector.

100

Al-Razi Al-Sabah Chest Maternity

I C o n c e n tra tio n (Bq l-1)

10

1
131

BDL

0.1
09-Feb-21

16-Feb-21

09-Mar-21

16-Mar-21

23-Mar-21

30-Mar-21
20-Jan-20

25-Jan-21
11-Sep-19

16-Oct-19

20-Dec-19

Fig. 7. 131I activity concentration in wastewater from all studied hospitals in Kuwait.

5. Recommendation • The suggested onsite treatment unit should consist of the

following stages: preliminary treatment, extended aera-
• Yearly wastewater monitoring program should be estab-
tion, membrane bioreactor, and adsorption by activated
lished for all hospitals. The wastewater sampling cam-
granulated carbon, ozone oxidation for permeate disin-
paign should cover full analysis of physical, chemical,
fection by UV and excess sludge utilization.
organics, microbial, radioactive isotopes, toxicity, human
hormones and pharmaceutical compounds. In addition,
onsite field measurements should be conducted prior to
Acknowledgment
sampling. Automatic online sampling equipment should
be implemented to obtain fully representative samples. The authors would like to extend their appreciation to
• Onsite treatment units should be constructed within the Kuwait Foundation for the Advancement of Science
each hospital premises to treat and if possible reuse of (KFAS) for its generous financial support. The overall sup-
generated wastewater. The capacity of treatment units port from the management of the Kuwait Institute for
should be designed based on the volume of wastewater Scientific Research (KISR) is also gratefully acknowledged.
generated by each hospital daily. Special thanks are extended to the staff of Technical Division
150 A. Mydlarczyk et al. / Desalination and Water Treatment 263 (2022) 145–151

100000
Al-Razi Al-Sabah Chest Maternity

10000
Tc Conce ntra tion (Bq l-1)

1000

100

10

1
99m

0.1

BDL
0.01
09-Feb-21

16-Feb-21
16-Oct-19

09-Mar-21

16-Mar-21

23-Mar-21

30-Mar-21
20-Jan-20

25-Jan-21
11-Sep-19

20-Dec-19

Fig. 8. 99mTc activity concentration in wastewater from all studied hospitals in Kuwait.

10
Al-Razi Al-Sabah Chest Maternity
K Conce ntra tion (Bq l-1)

BDL
40

0.1
09-Feb-21

16-Feb-21

09-Mar-21

16-Mar-21

23-Mar-21

30-Mar-21
16-Oct-19

20-Jan-20

25-Jan-21
11-Sep-19

20-Dec-19

Fig. 9. 40K activity concentration in wastewater from all studied hospitals in Kuwait.

Table 1
Mean concentrations of pharmaceutics in wastewater from four hospitals in Kuwait

S. No. Name of pharmaceuticals Names of hospitals

Al-Sabah Al-Razi Maternity Chest
1 Metronidazole (μg/L) 10.12 0.403 45.8 0.159
2 Paracetamol (μg/L) 141.6 179.2 66.55 49.04
3 Ranitidine (μg/L) 0.26 0.05 0.07 0.10
4 Sulfamethoxazole (μg/L) 0.42 0.71 0.06 0.03
5 Trimethoprim (μg/L) 0.08 0.11 0.02 0.01
 A. Mydlarczyk et al. / Desalination and Water Treatment 263 (2022) 145–151 151

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