Predicted and measured concentrations of pharmaceuticals in hospital effluents. Examination of the strengths and weaknesses of the two approaches through the analysis of a case study

Science of the Total Environment

Volumn 565, Issue , 2016, Pages 82-94

  Verlicchi, Paola ^a   Zambello, Elena ^a  

^a UNIVERSITY OF FERRARA   (Italy)

Author keywords

Hospital effluents; Measured concentrations; Pharmaceuticals; Predicted concentrations; Sensitivity analysis; Uncertainty analysis

Indexed keywords

CHEMICAL ANALYSIS; DRUG PRODUCTS; EFFLUENTS; HOSPITALS; SENSITIVITY ANALYSIS;

ANNUAL CONSUMPTION; CHEMICAL CHARACTERIZATION; DIRECT MEASUREMENT; HOSPITAL EFFLUENT; HYDROCHLOROTHIAZIDE; SAMPLING CAMPAIGNS; SEASONAL VARIABILITY; THERAPEUTIC CLASS;

UNCERTAINTY ANALYSIS;

ATENOLOL; ATORVASTATIN; DRUG; HYDROCHLOROTHIAZIDE;

CHEMICAL COMPOSITION; CONCENTRATION (COMPOSITION); DRUG; EFFLUENT; SEASONAL VARIATION; SENSITIVITY ANALYSIS; UNCERTAINTY ANALYSIS;

ARTICLE; CASE STUDY; FLOW RATE; HOSPITAL WASTE; PREDICTION; PRIORITY JOURNAL; SAMPLING; SEASONAL VARIATION; SENSITIVITY ANALYSIS; UNCERTAINTY; WASTE WATER; ANALYSIS; CHEMISTRY; ENVIRONMENTAL MONITORING; HOSPITAL; ITALY; PROCEDURES; SEWAGE; STATISTICS AND NUMERICAL DATA; WATER POLLUTANT;

ENVIRONMENTAL MONITORING; HOSPITALS; ITALY; PHARMACEUTICAL PREPARATIONS; WASTE DISPOSAL, FLUID; WASTE WATER; WATER POLLUTANTS, CHEMICAL;

EID: 84964863689     PISSN: 00489697     EISSN: 18791026     Source Type: Journal    
DOI: 10.1016/j.scitotenv.2016.04.165     Document Type: Article

References (57)

1. Al Aukidy M., Verlicchi P., Voulvoulis N. A framework for the assessment of the environmental risk posed by pharmaceuticals originating from hospital effluents. Sci. Total Environ. 2014, 493:54-64.
2. Beier S., Cramer C., Koster S., Mauer C., Palmowski L., Schroder H.F., et al. Full scale membrane bioreactor treatment of hospital wastewater as forerunner for hot-spot wastewater treatment solutions in high density urban areas. Water Sci. Technol. 2011, 63:66-71.
3. Besse J.P., Kausch-Barreto C., Garric J. Exposure assessment of pharmaceuticals and their metabolites in the aquatic environment: application to the French situation and preliminary prioritization. Human and Ecological Risk Assessment: An International Journal 2008, 14:665-695.
4. Boillot C., Bazin C., Tissot-Guerraz F., Droguet J., Perraud M., Cetre J.C., et al. Daily physicochemical, microbiological and ecotoxicological fluctuations of a hospital effluent according to technical and care activities. Sci. Total Environ. 2008, 403:113-129.
5. Carlsson C., Johansson A.K., Alvan G., et al. Are pharmaceuticals potent environmental pollutants? Part I: environmental risk assessments of selected active pharmaceutical ingredients. Sci. Total Environ. 2006, 364:67-87.
6. Coutu S., Rossi L., Barry D.A., Rudaz S., Vernaz N. Temporal variability of antibiotics fluxes in wastewater and contribution from hospitals. PLoS ONE 2013, 8(1). Open Access.
7. Daouk S., Chèvre N., Vernaz N., Bonnabry P., Dayer P., Daali Y., Fleury-Souverain S. Prioritization methodology for the monitoring of active pharmaceutical ingredients in hospital effluents. J. Environ. Manag. 2015, 160:324-332.
8. Daouk S., Chèvre N., Vernaz N., Widmer C., Daali Y., Fleury-Souverain S. Dynamics of active pharmaceutical ingredients loads in a Swiss university hospital wastewaters and prediction of the related environmental risk for the aquatic ecosystems. Sci. Total Environ. 2016, 547:244-253.
9. Daughton C.G., Ruhoy I.S. Environmental footprint of pharmaceuticals: the significance of factors beyond direct excretion to sewers. Environ. Toxicol. Chem. 2009, 28(12):2495-2521.
10. Daughton C.G. The Matthew Effect and widely prescribed pharmaceuticals lacking environmental monitoring: Case study of an exposure-assessment vulnerability. Sci. Total Environ. 2014, 466-467:315-325.
11. De Luigi A. Impatto di un ospedale sull'ambiente e indagine sperimentale sull'efficacia della disinfezione di un suo effluente - Dissertation for the degree of M.Sc. in Civil Enginering, University of Ferrara, Italy (in Italian).
12. de Souza S.M.L., de Vasconcelos E.C., Dziedzic M., de Oliveira C.M.R. Environmental risk assessment of antibiotics: an intensive care unit analysis. Chemosphere 2009, 77:962-967.
13. Diwan V., Stålsby Lundborg C., Tamhankar A.J. Seasonal and temporal variation in release of antibiotics in hospital wastewater: estimation using continuous and grab sampling. PLoS ONE 2013, 8(7).
14. Emmanuel E., Perrodin Y., Keck G., Blanchard J.-, Vermande P. Ecotoxicological risk assessment of hospital wastewater: a proposed framework for raw effluents discharging into urban sewer network. J. Hazard. Mater. 2005, 117:1-11.
15. Escher B.I., Baumgartner R., Koller M., Treyer K., Lienert J., McArdell C.S. Environmental toxicology and risk assessment of pharmaceuticals from hospital wastewater. Water Res. 2011, 45:75-92.
16. Frédéric O., Yves P. Pharmaceuticals in hospital wastewater: their ecotoxicity and contribution to the environmental hazard of the effluent. Chemosphere 2014, 115:31-39.
17. Galletti A. Pharmaceutical Compounds in Waters. Investigations on Hospital Effluents as a Source of Environmental Contamination and on Their Treatability 2011, PhD Dissertation in Science of Engineering, University of Ferrara, Italy.
18. Gautam A.K., Kumar S., Sabumon P.C. Preliminary study of physico-chemical treatment options for hospital wastewater. J. Environ. Manag. 2007, 83:298-306.
19. Heberer T., Feldmann D. Contribution of effluents from hospitals and private households to the total loads of diclofenac and carbamazepine in municipal sewage effluents-modeling versus measurements. J. Hazard. Mater. 2005, 122:211-218.
20. Helwig K., Hunter C., MacLachlan J., McNaughtan M., Roberts J., et al. Micropollutant point sources in the built environment: identification and monitoring of priority pharmaceutical substances in hospital effluents. J. Environ. Anal. Toxicol. 2013, 3:177. 10.4172/2161-0525.1000177.
21. Herrmann M., Olsson O., Fiehn R., Herrel M., Kümmerer K. The significance of different health institutions and their respective contributions of active pharmaceutical ingredients to wastewater. Environ. Int. 2015, 85:61-76.
22. Jean J., Perrodin Y., Pivot C., Trepo D., Perraud M., Droguet J., Tissot-Guerraz F., Locher F. Identification and prioritization of bioaccumulable pharmaceutical substances discharged in hospital effluents. J. Environ. Manag. 2012, 103:113-121.
23. Jjemba P.K. Excretion and ecotoxicity of pharmaceutical and personal care products in the environment. Ecotoxicol. Environ. Saf. 2006, 63:113-130.
24. Kern D.I., Schwaickhardt R.O., Mohr G., Lobo E.A., Kist L.T., Machado T.L. Toxicity and genotoxicity of hospital laundry wastewaters treated with photocatalytic ozonation. Sci. Total Environ. 2013, 443:566-572.
25. Kovalova L., Siegrist H., Singer H., Wittmer A., McArdell C.S. Hospital wastewater treatment by membrane bioreactor: performance and efficiency for organic micropollutant elimination. Environ. Sci. Technol. 2012, 46:1536-1545.
26. Kummerer K., Henninger A. Promoting resistance by the emission of antibiotics from hospitals and households into effluent. Clin. Microbiol. Infect. 2003, 9:1203-1214.
27. Lai F.Y., Ort C., Gartner C., Carter S., Prichard J., Kirkbride P., Bruno R., Hall W., Eaglesham G., Mueller J.F. Refining the estimation of illicit drug consumptions from wastewater analysis: co-analysis of prescription pharmaceuticals and uncertainty assessment. Water Res. 2011, 45(15):4437-4448.
28. Langford K.H., Thomas K.V. Determination of pharmaceutical compounds in hospital effluents and their contribution to wastewater treatment works. Environ. Int. 2009, 35:766-770.
29. Le Corre K.S., Ort C., Kateley D., Allen B., Escher B.I., Keller J. Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater. Environ. Int. 2012, 45:99-111.
30. Lienert J., Bürki T., Escher B.I. Reducing micropollutants with source control: substance flow analysis of 212 pharmaceuticals in faeces and urine. Water Sci. Technol. 2007, 56(5):87-96.
31. Lienert J., Güdel K., Escher B.I. Screening method for ecotoxicological hazard assessment of 42 pharmaceuticals considering human metabolism and excretory routes. Environ. Sci. Technol. 2007, 41(12):4471-4478.
32. Mankes R.F., Silver C.D. Quantitative study of controlled substance bedside wasting, disposal and evaluation of potential ecologic effects. Sci. Total Environ. 2013, 444:298-310.
33. McArdell C.S., Kovalova L., Siegrist H. Input and elimination of pharmaceuticals and disinfectants from hospital wastewater Final Report (July).
34. Mendoza A., Aceña J., Pérez S., de Alda M López, Barceló D., Gil A., Valcárcel Y. Pharmaceuticals and iodinated contrast media in a hospital wastewater: a case study to analyse their presence and characterise their environmental risk and hazard. Environ. Res. 2015, 140:225-241.
35. Metcalf, Eddy Wastewater engineering. Treatment, disposal, reuse 1991, McGrawHill, Singapore. third ed.
36. Monteiro S.C., Boxall A.B.A. Occurrence and fate of human pharmaceuticals in the environment. Rev. Environ. Contam. Toxicol. 2010, 202:53-154.
37. Mullot J.U., Karolak S., Fontova A., Levi Y. Modeling of hospital wastewater pollution by pharmaceuticals: first results of mediflux study carried out in three French hospitals. Water Sci. Technol. 2010, 62(12):2912-2919.
38. Ort C., Hollender J., Schaerer M., Siegriest H. Model-based evaluation of reduction strategies for micropollutants from wastewater treatment plants in complex river network. Environ. Sci. Technol. 2009, 43:3214-3220.
39. Ort C., Lawrence M.G., Reungoat J., Eaglesham G., Carter S., Keller J. Determining the fraction of pharmaceutical residues in wastewater originating from a hospital. Water Res. 2010, 44(2):605-615.
40. Ort C., Lawrence M.G., Reungoat J., Mueller J.F. Sampling for PPCPs in wastewater systems: comparison of different sampling modes and optimization strategies. Environ. Sci. Technol. 2010, 44:6289-6296.
41. Ort C., Lawrence M.G., Rieckermann J., Joss A. Sampling of pharmaceuticals and personal care products (PPCPs) and illicit drugs in wastewater systems: are your conclusions valid? A critical review. Environ. Sci. Technol. 2010, 44:6024-6035.
42. Pauwels B, Verstraete W. The treatment of hospital wastewater: an appraisal. J. Water Health 2006;4:405-16.
43. Perrodin Y., Orias F., Boillot C., De Hugo A Brackers, Jean J., Panouilleres M., Emmanuel E. Ecotoxicological risk assessment of hospital wastewater and management recommendations. Rev Sci Eau 2015, 28(1):59-64.
44. PILLS Report- Pharmaceutical residues in the aquatic system: - a challenge for the future. Final Report of the European Cooperation Project PILLS 2012 (available at the address: (last access on March 30th 2016). http://www.pills-project.eu.
45. Santos L.H.M.L.M., Gros M., Rodriguez-Mozaz S., Delerue-Matos C., Pena A., et al. Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals. Sci. Total Environ. 2013, 461-462:302-316.
46. Schuster A., Hädrich C., Kummerer K. Flows of active pharmaceutical ingredients originating from health care practices on a local, regional, and nationwide level in Germany-is hospital effluent treatment an effective approach for risk reduction?. Water Air Soil Pollut Focus 2008, 8(5-6):457-471.
47. Stalder T., Barraud O., Jové T., Casellas M., Gaschet M., Dagot C. Ploy M-. quantitative and qualitative impact of hospital effluent on dissemination of the integron pool. ISME J 2014, 8(4):768-777.
48. Thomas K.V., Dye C., Schlabach M., Langford K.H. Source to sink tracking of selected human pharmaceuticals from two Oslo city hospitals and a wastewater treatment works. J. Environ. Monit. 2007, 9:1410-1418.
49. Verlicchi P., Al Aukidy M., Galletti A., Petrovic M., Barceló D. Hospital effluent: investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment. Sci. Total Environ. 2012, 430:109-118.
50. Verlicchi P., Al Aukidy M., Jelic A., Petrović M., Barceló D. Comparison of measured and predicted concentrations of selected pharmaceuticals in wastewater and surface water: A case study of a catchment area in the Po valley (Italy). Sci. Total Environ. 2014, 470-471:844-854.
51. Verlicchi P., Al Aukidy M., Zambello E. What have we learned from worldwide experiences on the management and treatment of hospital effluent? - an overview and a discussion on perspectives. Sci. Total Environ. 2015, 514:467-491.
52. Verlicchi P., Galletti A., Al Aukidy M. Hospital wastewaters: quali-quantitative characterization and strategies for their treatment and disposal. Wastewater Reuse and Management 2013, 225-251. Springer Science + Business Media, Germany. S.K. Sharma, R. Sanghi (Eds.).
53. Verlicchi P., Galletti A., Masotti L. Caratterizzazione e trattabilità di reflui ospedalieri: indagine sperimentale (con sistemi MBR) presso un ospedale dell'area ferrarese. Proc. International Conference SIDISA 2008, Florence (in Italian).
54. Verlicchi P., Galletti A., Petrovic M., Barcelò D. Hospital effluents as a source of emerging pollutants: an overview of micropollutants and sustainable treatment options. J. Hydrol. 2010, 389(3-4):416-428.
55. Wangsaatmaja S. Environmental Action Plan for a Hospital 1997, (MS Thesis in Engineering), Asian Institute of Technology, Bangkok, Thailand.
56. Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., Mcardell C.S. Mass flows of X-ray contrast media and cytostatics in hospital wastewater. Environ. Sci. Technol. 2009, 43(13):4810-4817.
57. Yuan S., Jiang X., Xia X., Zhang H., Zheng S. Detection, occurrence and fate of 22 psychiatric pharmaceuticals in psychiatric hospital and municipal wastewater treatment plants in Beijing, China. Chemosphere 2013, 90(10):2520-2525.