An Efficiency and Environmental Impact of Hospital Wastewater Treatment Systems in Balikpapan, Indonesia

Abstract

This study evaluated the performance and environmental implications of hospital wastewater treatment systems in Balikpapan, Indonesia, a rapidly urbanizing city with expanding healthcare infrastructure. Wastewater samples from three representative hospitals (Type A: large referral; Type B: regional; Type C: private mid-scale) were analyzed for physicochemical parameters, heavy metals, pharmaceuticals, and microbial contaminants following APHA (2023) and USEPA Method 3050B protocols. Influent samples exhibited high organic loads (BOD₅: 210–450 mg/L; COD: 420–780 mg/L), far exceeding national discharge limits. Overall removal efficiencies ranged from 70–86%, with only Hospital A’s integrated aerobic–anaerobic–chlorination system achieving regulatory compliance. Persistent pollutants, including heavy metals (Hg, Pb, Cd) remained detectable in effluents, with incomplete removal (<50%) and ecological Risk Quotients (RQ) exceeding 1. Microbial analysis revealed high concentrations of total coliforms (10⁴–10⁶ CFU/mL) and E. coli (10³–10⁴ CFU/mL), indicating incomplete disinfection. Comparative assessment underscored that operational management, maintenance frequency, and operator training were equally crucial as system design in determining treatment efficiency. The findings emphasize the urgent need to incorporate tertiary treatment technologies and enhance regulatory enforcement to mitigate pollutant release, protect aquatic ecosystems, and safeguard public health in tropical developing cities.