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Hospital wastewater is of great environmental concern because it contains a variety of hazardous microbial and chemical substances. This study aims to investigate the efficiency of a moving bed biofilm reactor (MBBR) with a light expanded clay aggregate (LECA) carrier for treating hospital wastewater. This pilot study used a Plexiglas reactor that had a volume of 100 L, a continuous up-flow hydraulic regime, and a LECA carrier to test removal of chemical oxygen demand (COD) from wastewater in a public hospital. To assess MBBR efficiency, the study used retention times of 8, 12, and 24 hours, filling percentages of 30% and 50%, and mixed liquor suspended solids (MLSSs) of 1000, 3000, and 5000 mg/L. The results indicated that using a single LECA carrier in an MBBR system was not sufficient to remove organic materials from hospital wastewater, because the carrier could not be completely suspended. After some modifications, consisting mainly of returning activated sludge, the system was 83% efficient at removing COD using a LECA carrier at a retention time of 24 hours, with 50% filling, and 5000 mg/L of MLSS.