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Hospital wastewater contains heavy metals that threaten environmental and human health through bioaccumulation and biomagnification. Each heavy metal contributes a different impact on human health and the environment. Monitoring the heavy metals in wastewater is essential to prevent those severe impacts. However, it is still rare for a study to assess heavy metals obtained from the discharge of hospital wastewater in Indonesia. Therefore, this study investigated 14 parameters of heavy metals in hospital wastewater. We tested wastewater quality from September 2021 to February 2022, with SNI 6989-59-2008 sampling methods with 14 parameters. Results show that over 14 parameters are still below the threshold value and other previous studies. It might be because the biological treatment used in the hospital wastewater treatment plant (HWWTP) reduces these micropollutants efficiently. The fluidized bed biofilm reactor (FBBR) system is an aerobic process with microorganisms attached to the bio-green. This technique is to form suspensions of solid particles in sparse media with gas streams for chemical or physical processes. The sewage discharge reveals the occurrence of heavy metals in hospital wastewater, even though it does not reveal a high concentration due to the effectiveness of the FBBR system in HWWTP.

Chlorinated disinfectants are widely used in hospitals, COVID-19 quarantine facilities, households, institutes, and public areas to combat the spread of the novel coronavirus as they are effective against viruses on various surfaces. Medical facilities have enhanced their routine disinfection of indoors, premises, and in-house sewage. Besides questioning the efficiency of these compounds in combating coronavirus, the impacts of these excessive disinfection efforts have not been discussed anywhere. The impacts of chlorine-based disinfectants on both environment and human health are reviewed in this paper. Chlorine in molecular and in compound forms is known to pose many health hazards. Hypochlorite addition to soil can increase chlorine/chloride concentration, which can be fatal to plant species if exposed. When chlorine compounds reach the sewer/drainage system and are exposed to aqueous media such as wastewater, many disinfection by-products (DBPs) can be formed depending on the concentrations of natural organic matter, inorganics, and anthropogenic pollutants present. Chlorination of hospital wastewater can also produce toxic drug-derived disinfection by-products. Many DBPs are carcinogenic to humans, and some of them are cytotoxic, genotoxic, and mutagenic. DBPs can be harmful to the flora and fauna of the receiving water body and may have adverse effects on microorganisms and plankton present in these ecosystems. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-021-18316-2.

Discharged hospital wastewater contains various pathogenic microorganisms, antibiotic groups, toxic organic compounds, radioactive elements, and ionic pollutants. These contaminants harm the environment and human health causing the spread of disease. Thus, effective treatment of hospital wastewater is an urgent task for sustainable development. Membranes, with controllable porous and nonporous structures, have been rapidly developed for molecular separations. In particular, membrane bioreactor (MBR) technology demonstrated high removal efficiency toward organic compounds and low waste sludge production. To further enhance the separation efficiency and achieve material recovery from hospital waste streams, novel concepts of MBRs and their applications are rapidly evolved through hybridizing novel membranes (non hydrophilic ultrafiltration/microfiltration) into the MBR units (hybrid MBRs) or the MBR as a pretreatment step and integrating other membrane processes as subsequent secondary purification step (integrated MBR-membrane systems). However, there is a lack of reviews on the latest advancement in MBR technologies for hospital wastewater treatment, and analysis on its major challenges and future trends. This review started with an overview of main pollutants in common hospital waste-water, followed by an understanding on the key performance indicators/criteria in MBR membranes (i.e., solute selectivity) and processes (e.g., fouling). Then, an in-depth analysis was provided into the recent development of hybrid MBR and integrated MBR-membrane system concepts, and applications correlated with wastewater sources, with a particular focus on hospital wastewaters. It is anticipated that this review will shed light on the knowledge gaps in the field, highlighting the potential contribution of hybrid MBRs and integrated MBR-membrane systems toward global epidemic prevention.

EnvironmentAsia, 16, 2, 118-126

Hospitals are regarded as ecological niches of antibiotic-resistant bacteria (ARB). ARB can spread outside the hospital environment via hospital wastewater (HWW). Therefore, HWW is often disinfected in local stations to minimize that risk. Chlorine-based treatment is the most popular method of HWW disinfection around the world, however, recent research has suggested that it can contribute to the spread of antimicrobial resistance (AMR). The aim of this study is to determine the impact of HWW disinfection on the clonal similarity of Enterobacteriaceae species and their ability to produce extended-spectrum beta-lactamases (ESBLs). The study was conducted in a hospital with a local chlorine-based disinfection station. Samples of wastewater before disinfection and samples of disinfected wastewater, collected in four research seasons, were analyzed. Bacteria potentially belonging to the Enterobacteriaceae family were isolated from HWW. The Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) method was used to generate DNA fingerprints of all bacterial isolates. The isolates were phenotypically tested for the production of ESBLs. Antibiotic resistance genes (blaSHV, blaTEM, and blaOXA, blaCTX-M-1-group, blaCTX-M-2-group, blaCTX-9-group and blaCTX-M-8/25-group) were detected by PCR in strains with confirmed phenotypic ability to produce ESBLs. The ESBL+ isolates were identified by the sequencing of 16S rDNA. In the present study, the same bacterial clones were isolated from HWW before and after disinfection and HWW was sampled in different seasons. Genetic and phenotypic variations were observed in bacterial clones. ESBL+ strains were isolated significantly more often from disinfected than from non-disinfected HWW. The blaOXA gene was significantly more prevalent in isolates from disinfected than non-disinfected HWW. Enterobacter hormaechei and Klebsiella pneumoniae were the dominant species in ESBL+ strains isolated from both sampling sites. The results of this study indicate that chlorine-based disinfection promotes the survival of ESBL-producing bacteria and/or the transmission of genetic determinants of antimicrobial resistance. As a result, chlorination increases the proportion of ESBL-producing Enterobacteriaceae in disinfected wastewater. Consequently, chlorine-based disinfection practices may pose a risk to the environment and public health by accelerating the spread of antimicrobial resistance.

Antimicrobial resistance (AMR) is becoming a global concern. Recently, research has emerged to evaluate the human and environmental health implications of wastewater from medical facilities and to identify acceptable wastewater treatment methods. In this study, a disinfection wastewater treatment system using an ozone-based continuous flow system was installed in a general hospital located in Japan. The effectiveness of antimicrobial-resistant bacteria (ARB) and antimicrobials in mitigating the environmental impact of hospital wastewater was evaluated. Metagenomic analysis was conducted to characterize the microorganisms in the wastewater before and after treatment. The results demonstrated that ozone treatment enables effective inactivation of general gut bacteria, including Bacteroides, Prevotella, Escherichia coli, Klebsiella, DNA molecules, and ARGs, as well as antimicrobials. Azithromycin and doxycycline removal rates were >99% immediately after treatment, and levofloxacin and vancomycin removal rates remained between 90% and 97% for approximately one month. Clarithromycin was more readily removed than the other antimicrobials (81–91%), and no clear removal trend was observed for ampicillin. Our findings provide a better understanding of the environmental management of hospital wastewater and enhance the effectiveness of disinfection wastewater treatment systems at medical facilities for mitigating the discharge of pollutants into aquatic environments.

The emergence and spread of antimicrobial resistance (AMR) has become a persistent problem globally. In this study, an ozone treatment facility was established for an advanced hospital wastewater treatment in a core hospital facility in an urban area in Japan to evaluate the inactivation of antimicrobial-resistant bacteria and antimicrobials. Metagenomic DNA-seq analysis and the isolation of potential extended-spectrum β-lactamase (ESBL)-producing bacteria suggested that ozone exposure for at least 20 min is required for the adequate inactivation of DNA and ESBL-producing bacteria. Escherichia coli and Klebsiella species were markedly susceptible to 20-min ozone exposure, whereas Raoultella ornithinolytica and Pseudomonas putida were isolated even after an 80-min exposure. These ozone-resistant bacteria might play a pivotal role as AMR reservoirs in the environment. Nine antimicrobials (ampicillin, cefdinir, cefpodoxime, ciprofloxacin, levofloxacin, clarithromycin, chlortetracycline, minocycline, and vancomycin) were detected at 373 ng/L to 27 μg/L in the hospital wastewater, and these were removed (96–100% removal) after a 40-min treatment. These results facilitate a comprehensive understanding of the AMR risk posed by hospital wastewater and provides insights for devising strategies to eliminate or mitigate the burden of antimicrobial-resistant bacteria and the flow of antimicrobials into the environment. To the best of our knowledge, this is the first report on the implementation of a batch-type, plant-scale ozone treatment system in a hospital facility to execute and evaluate the inactivation of drug-resistant bacteria and antimicrobials.

The technical feasibility of the continuous flow electrocoagulation process for hospital wastewater treatment was evaluated. The wastewater physicochemical characterization was performed according to the chemical oxygen demand (COD), biochemical oxygen demand (BOD), total suspended solids (TSS), naproxen, phenol and phosphates parameters. An experimental Box-Behnken design and statistical response surface methodology (RSM) were used to evaluate the simple and combined effects of the independent parameters (pH, potential, retention time), and to optimize electrocoagulation process conditions, considering the COD response variable. The removal percentage was: COD (75.5%), BOD (59.2%) phenols (80.7%), phosphates (85.3%), TSS (75.6%) and naproxen (55.7%), under optimal electrocoagulation conditions at pH (7.92), potential (40 V) and retention time (15 min). The electrocoagulation process proved to be an efficient and technically viable alternative for hospital wastewater treatment.

Real-time monitoring of antibiotics in hospital and pharmaceutical wastewater using ultraviolet–visible (UV–Vis) spectroscopy is considered a promising method. Although gas chromatography–mass spectrometry (GC–MS) and other methods can detect antibiotics with quite low limits of detection (LOD), they possess various limitations. UV–Vis spectroscopy combined with chemometric methods is a promising choice for monitoring antibiotics. In this study, two immersed in situ UV–Vis sensors were used to explore the relationship between absorption spectra and antibiotics and study the influence of the optical path length on the LOD. The LODs of sensor 2 using a 10 cm optical path is up to 300 times lower than that of sensor 1 using a 0.5 mm optical path. Moreover, multiple antibiotics in the wastewater were investigated in real-time manner. The absorption spectra of 70 groups of wastewater samples containing different concentrations of tetracycline, ofloxacin, and chloramphenicol were measured. The results indicate that the nine wavelengths selected by interval partial least squares (iPLS) after the second derivative pretreatment have better predictability for ofloxacin and the six wavelengths selected by competitive adaptive reweighted sampling (CARS) after the first derivative. The multi-fold cross-validation results indicate that the model has a good predictive ability.

Wastewater-based epidemiology (WBE) is a beneficial tool for comprehensive health information on communities, especially during the COVID-19 pandemic. In developing countries, including Thailand, the application of WBE is limited. Few SARS-CoV-2 detections and variants have been monitored in wastewater in these countries. This is because of the time-consuming, low recovery of viruses in the concentration techniques and difficulties in finding the proper primers and amplification kits. Therefore, this study aimed to quantify SARS-CoV-2 RNA concentration using a commercial clinical kit. We identified the SARS-CoV-2 variants and estimated the detection costs in the wastewater samples. One hundred and fifty hospital wastewater samples were filtered with commercial ultrafiltration (UF) and then detected for the SARS-CoV-2 concentration using a Sansure Biotech SARS-CoV-2 kit. The recovery of the virus concentration technique in UF was studied using a surrogate (porcine epidemic diarrhea virus). The virus detection in wastewater was quantified by RT-qPCR. In addition, the mutation sites in the partial spike glycoprotein (S) gene of SARS-CoV-2 were verified using short nested RT-PCR. The results showed a high recovery of the commercial UF (80.53%), and 24.6% of hospital wastewater contained SARS-CoV-2. The detection of SARS-CoV-2 in wastewater cost USD 35.43 per sample. The virus variants revealed V70del, H69del, and V144del mutations in the partial S gene of SARS-CoV-2 in B.1.1.7 (SARS-CoV-2 Alpha variant), and T95I and G142D mutations in B.1.617.2 (Delta variant).

The diversity of beta-lactam antibiotic resistance genes, with particular emphasis on carbapenemase genes, during the treatment process at two wastewater treatment plants (WWTPs) with different levels of hospital wastewater inflow was investigated using high-throughput sequencing. An additional aspect of the study was to determine the taxonomic diversity of microorganisms in the studied samples. The obtained results suggest that bacteria of the Fusobacteriaceae family, not associated to date with this phenomenon, may be involved in the spread of antibiotic resistance in the environment. In samples from both wastewater treatment plants, the dominant beta-lactamase genes included blaOXA, blaGES, blaBEL, blaCfxA, and blaTEM. It is worth noting that the blaKPC and blaNDM genes were only found in untreated municipal wastewater with a higher hospital wastewater content. Moreover, an increase in the abundance of the blaIMP gene after the biological treatment stage in the studied treatment plants was found. In wastewater characterized by a higher proportion of hospital wastewater, 94 correlations were observed, while in wastewater with its lower proportion, 41 correlations were noted. Considering the above, the current research indicates that the inflow of hospital wastewater contributes to the spread of antibiotic resistance in the aquatic environment.

Alongside antibiotic resistance, co-selection of antibiotics, biocides, and metal resistance is a growing concern. While hospital wastewater is considered a hotspot for antibiotic-resistant bacteria (ARB) and genes (ARGs), the scenario in India, one of the biggest consumers of antibiotics, remains poorly described. In this study, we used metagenomic sequencing to characterize ARGs and biocide/metal resistance genes (BMRGs) in four wastewater treatment plants (WWTPs) in Jaipur City of India. We observed a significantly lower richness and abundance of ARGs in the influent of a WWTP exclusively receiving hospital wastewater when compared to other three WWTPs involving municipal wastewater treatment. Several tetracycline and macrolide-lincosamide-streptogramin resistance genes were enriched in influents of these three municipal wastewater-related treatment plants, whereas hospital wastewater had a higher abundance of genes conferring resistance to disinfectant-related compounds such as synergize and wex-cide-128, reflecting the patterns of antibiotic/disinfectant use. Of note, in the wastewater system with more chemicals, there was a strong correlation between the numbers of ARGs and BMRGs potentially harbored by common hosts. Our study highlights significant influxes of ARGs from non-hospital sources in Jaipur City, and thus more attention should be paid on the emergence of ARGs in general communities.

In order to assess the toxicological potential and thus forecast the potential effect posed by untreated hospital wastewater discharges according to exposed ecosystem, the ecotoxicological analysis were performed. During the study the real samples of hospital wastewater were used. The ecotoxicological analysis included the following tests: immobilization test according to crustacean Daphnia magna; mortality test according to crustacean Thamnocephalus platyourus and Artemia salina and growth inhibition test relative to ciliates Tetrahymena termophila. Within each test, the value of ecotoxicological indicators EC50 (effect concentration) were estimated. The EC50 value were transformed into the Toxic Unit (TU), basis of which the analyzed hospital wastewater samples were classified. The results proves that hospital wastewater pose a serious threat to exposed aquatic organisms and their insufficient purification as well as uncontrolled discharge into the environment may cause adverse changes in the environment.

Hospital wastewater basically contains organic materials and inorganic materials. Levels of these materials can be determined by testing of Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Total Dissolved Solid (TDS), and Total Suspended Solid (TSS). The hospital wastewater treatment proposed in this research is the electrocoagulation treatment using electrodes Fe-Fe and uses the response surface method for optimizing the response variable. Referring to this resea rch, the result shows that the relationship between the process variables and the TSS is significantly influential. As the contact time (15, 30, and 45 minutes) is longer and the voltage (6, 9, and 12 volts) is higher, the percentage reductions of TSS increase. However, the electrolyte solution (0–1 M) has little influence/significance to a response variable of TSS. The highest percentage of TSS reduction is at the contact time 30 minutes and 12 volts, which declined at contact time 45 minutes. The model recommended is a quadratic form with a low error less than 1.6%. In such a way, the optimum condition is at contact time 36 minutes, voltage 12 volts, and the electrolyte (NaCl) concentration 0.1 M. The reduction percentage is TSS 72.45%.

In the present study, a pilot-scale ozonation system was introduced as post treatment to reduce the pharmaceuticals and toxicity in the effluent of a pilot-scale Moving Bed Biofilm Reactor (MBBR) treating hospital wastewater. The ozonated effluent was polished further by suspended biofilm carriers to remove biodegradable organic matter and toxicity generated from ozonation by-products. A laboratory ozonation system was used to mimic the experiments, which were carried out at the pilot plant so that the removal of pharmaceuticals in the pilot and laboratory experiments could be compared. Delivered ozone dose achieved 90% removal of pharmaceutical was obtained and it was normalised to dissolved organic carbon (DOC). These normalised results show that trimethoprim was eliminated by ozone easier than other pharmaceuticals. Fluorescence was found to be highly correlated to the removal of pharmaceuticals, and fluorescence with a wavelength of 275 nm of excitation and 310 nm of emission had the closest correlation. After polishing MBBR was introduced into the ozonated wastewater, half of its protein-like fluorophore was removed. The toxicity of the hospital wastewater during MBBR treatment was measured by Vibrio fischeri, the inhibition of which decreased from 80% to 50%. By applying ozonation, this inhibition reduced to 20%.

The presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in wastewater produced interest in its use for sentinel surveillance at a community level and as a complementary approach to syndromic surveillance. With this work, we set the foundations for wastewater-based epidemiology (WBE) in Portugal by monitoring the trends of SARS-CoV-2 RNA circulation in the community, on a nationwide perspective during different epidemiological phases of the pandemic. The Charité assays (E_Sarbecco, RdRP, and N_Sarbecco) were applied to monitor, over 32-weeks (April to December 2020), the dynamics of SARS-CoV-2 RNA at the inlet of five wastewater treatment plants (WWTP), which together serve more than two million people in Portugal. Raw wastewater from three Coronavirus disease 2019 (COVID-19) reference hospitals was also analyzed during this period. In total, more than 600 samples were tested. For the first weeks, detection of SARS-CoV-2 RNA was sporadic, with concentrations varying from 103 to 105 genome copies per liter (GC/L). Prevalence of SARS-CoV-2 RNA increased steeply by the end of May into late June, mainly in Lisboa e Vale do Tejo region (LVT), during the reopening phase. After the summer, with the reopening of schools in mid-September and return to partial face-to-face work, a pronounced increase of SARS-CoV-2 RNA in wastewater was detected. In the LVT area, SARS-CoV-2 RNA load agreed with reported trends in hotspots of infection. Synchrony between trends of SARS-CoV-2 RNA in raw wastewater and daily new COVID-19 cases highlights the value of WBE as a surveillance tool, particularly after the phasing out of the epidemiological curve and when hotspots of disease re-emerge in the population which might be difficult to spot based solely on syndromic surveillance and contact tracing. This is the first study crossing several epidemiological stages highlighting the long-term use of WBE for SARS-CoV-2., Graphical abstract Unlabelled Image

Introduction Hospital wastewater contains highly resistant and virulent bacteria that can spread into the environment. This study was conducted to investigate the antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in raw and treated hospital wastewater. Methods During a three-month period, 40 sewage samples were collected from the hospital sewage (Kermanshah, Iran), and S. aureus were identified using culture and biochemical tests. MRSA was detected by resistance to cefoxitin. Antibiotic resistance (AR) was determined using disk diffusion according to the Clinical and Laboratory Standards Institute (CLSI) in 20 MSSA (10 raw and 10 treated sewage) and 40 MRSA isolates (20 raw and 20 treated sewage). The antimicrobial resistance genes (ARGs) were determined by PCR. Results Eleven and eight percent of the isolates were MRSA in raw and treated sewage samples, respectively. Out of 60 isolates, 59 (98%) were multidrug resistant (MDR). The most common ARGs were mecA (raw=100%, treated=100%), aacA-D (raw=100%, treated=85%) and tetK (raw =95%, treated =45%) in MRSA, while the tetM gene was the most abundant gene (raw=50%, treated=80%) in MSSA. None of isolates (n=60) was positive for the vanB gene. MSSR (n=20) had the highest level of resistance against penicillin (100%), clindamycin (raw=90%, treated=90%), azithromycin (raw=80%, treated=90%). All MRSA isolates (n=40,100%) in both raw and treated sewage samples were non-susceptible to penicillin, oxacillin and azithromycin. There was no significant difference in the frequency AR and ARGs between raw and treated sewage samples (p>0.05). Conclusion The results indicated a high frequency of MDR and ARGs in both raw and treated sewage isolates which could be released into the environment through sewage system and pose a serious threat to public health. Hospital wastewater treatment processes should be improved in order to prevent the dissemination of the most resistant strains of S. aureus.

Hospital wastewater represents an important source of pharmaceutical active compounds (PhACs) as contaminants of emerging concern for urban wastewater treatment plants. This work evaluates a fungal biological treatment of a hospital effluent before discharging in the municipal sewer system. This treatment was performed in rotating biological contactors (RBCs) covered with wooden planks in order to promote the attachment of the fungal biomass. These bioreactors, initially inoculated with Trametes versicolor as white rot fungi, have created biofilms of a diversified population of fungal (wood-decaying fungi belonging to Basidiomycota and Ascomycetes) and bacterial (Beta-proteobacteria, Firmicutes, and Acidobacteria) microorganisms. The mixed fungal/bacterial community achieved a stable performance in terms of carbon, nitrogen, and phosphorous reductions for 75 days of continuous operation. Moreover, a remarkable removal of pharmaceutical micropollutants was accomplished especially for antibiotics (98.4 ± 0.7, 83 ± 8% and 76 ± 10 for azithromycin, metronidazole and sulfamethoxazole, respectively). Previous studies have proven a high efficiency of fungi for the removal of microcontaminants as a result of advanced bio-oxidation processes mediated by oxidizing hydroxyl radicals. This study evidences the development of a stable fungal-bacterial mixed culture over wooden-modified RBCs for in-situ removal of pharmaceutical compounds of hospital wastewater under non-sterile conditions and non-strict temperature control, avoiding periodical fungal inoculation due to destabilization and displacement of fungal cultures by indigenous wastewater bacteria.

Data Paper; International audience; The Bellecombe pilot site - SIPIBEL - was created in 2010 in order to study the characterisation, treatability and impacts of hospital effluents in an urban wastewater treatment plant. This pilot site is composed of: i) the Alpes Leman hospital (CHAL), opened in February 2012, ii) the Bellecombe wastewater treatment plant, with two separate treatment lines allowing to fully separate the hospital wastewater and the urban wastewater, and iii) the Arve River as the receiving water body and a tributary of the Rhone River and the Geneva aquifer. The database includes in total 48 439 values measured on 961 samples (raw and treated hospital and urban wastewater, activated sludge in aeration tanks, dried sludge after dewatering, river and groundwater, and a few additional campaigns in aerobic and anaerobic sewers) with 44 455 physico-chemistry values (including 15 pharmaceuticals and 14 related transformation products, biocides compounds, metals, organic micropollutants), 2 193 bioassay values (ecotoxicity), 1 679 microbiology values (including microorganisms and antibioresistance indicators) and 112 hydrobiology values.

Introduction: In recent years, there has been an increase in hospital and/or community-acquired infections caused by antibiotic-resistant microorganisms. To prevent or to reduce these infections, reliable, effective disinfection methods are needed to be used in disinfecting the hospital wastewater. In this study, the sensitivity of multidrug resistant strains of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus bacteria, which are often encountered as hospital infection agents to ozone gas and/or negative ions, is investigated, and the use of these disinfection methods in our hospital’s waste water systems is evaluated. Materials and Methods: Our study included multidrug resistant clinical isolates identified by our hospital infection control committee as agents of hospital-acquired infection. Bacterial suspensions were prepared from the isolates at a concentration of 1.5 x 108 cfu/mL and serial dilutions were then made to 1.5 x 102 cfu/mL. Two different ozone generators with an ozone generating capacity at concentrations of 10.5 mg/h and 6.6 mg/h and a negative ionizer with a negative ion output of 3.3 million/cm3 were used. For a total of seven different bacterial concentrations, ozone and/or negative ion application was performed at different application times, and the changes observed in the number of bacteria were recorded. The effectiveness of the ozone on the agar plate surface and in the aqueous medium were examined, and finally, the disinfection efficiency on the waste water treatment system was evaluated by applying ozone to the water samples taken from the entrance and exit points of the hospital wastewater treatment system. Results: It was determined that all bacterial species studied were highly susceptible to ozone gas, and their growth was inhibited in a short exposure time. However, it was observed that high concentrations of ozone gas and/or continuous ozone application might be required, especially at high bacterial concentrations. It was also found that the activity of ozone in the aqueous environment was much higher. It was observed that the negative ions were ineffective at high bacterial concentrations and therefore the use of this method in the disinfection of wastewater systems with high pathogen load was not beneficial. Conclusion: It is concluded that the use of ozone gas in the disinfection of hospital wastewater systems is effective and reliable.

Hospital wastewater contains high concentrations of pharmaceuticals, which pose risks to receiving waters. In this study, a pilot plant consisting of six moving bed biofilm reactors (MBBRs) in series (with the intention to integrate Biological Oxygen Demand (BOD) removal, nitrification and denitrification as well as prepolishing Chemical Oxygen Demand (COD) for ozonation) was built to integrate pharmaceutical removal and intermittent feeding of the latter reactors aimed for micropollutant removal. Based on the experimental resultss, nitrifying MBBRs achieved higher removal as compared to denitrifying MBBRs except for azithromycin, clarithromycin, diatrizoic acid, propranolol and trimethoprim. In the batch experiments, nitrifying MBBRs showed the ability to remove most of the analysed pharmaceuticals, with degradation rate constants ranging from 5.0 × 10−3 h−1 to 2.6 h−1. In general, the highest degradation rate constants were observed in the nitrifying MBBRs while the latter MBBRs showed lower degradation rate constant. However, when the degradation rate constants were normalised to the respective biomass, the intermittently fed reactors presented the highest specific activity. Out of the 22 compounds studied, 17 compounds were removed with more than 20%.

In Indonesia, Hospital wastewater treatment generally use biological process followed by chlorination process. Chlorination process has a negative impact on the aquatic environment that is cause death of other microorganisms by the residual chlorine. On the other hand, ozone is more effective than chlorine in killing microorganisms and other pollutants in hospital wastewater. The objective of research is to determine the effect of contact time and dose of ozone to reduction of pollutants (BOD, COD, free Ammonia and Phenol) in hospital wastewater. The experiment was carried out using an ozone reactor containing 'packing', an ozone generator as an ozone gas supplier. The experimental material is a hospital wastewater containing BOD, COD, Phenol and Ammonia free. The experimental variables used were: Contact time (1, 2, and 3 min), Dose of ozone (10, 15, and 20 mg/ L). Experiments were done by flowing hospital waste water at the top of the reactor ozone at certain rate and simultaneously flowed ozone gas from an ozone generator in the bottom of the ozone reactor so that it contacts the fluid in counter-current to the surface of the packing material (packing) in an ozone reactor. By adjusting the flowrate of the wastewater and the height of the packing, it can be determined the amount of contact time and ozone dose. Furthermore, by measuring the amount of pollutant concentration on the influent and effluent of the ozone reactor, it can be obtained the amount of removal in the pollutant concentration of the hospital wastewater.The results showed that contact time and ozone dose influence the decrease of pollutant concentration in hospital wastewater where contact time at 3 minutes and ozone dose 20 mg/L and ozonation time 15 minutes can reduce of pollutants concentration as BOD (97%), COD (98%), Ammonia free (97%), and Phenol (96%).

Micropollutants such as pharmaceutical active compounds, present at high concentration in hospital wastewater (HWW), pose both environmental and human health challenges. Fungal reactors can effectively remove such contaminants and produce non-toxic effluents, but their ability to operate for a long period of time is yet to be demonstrated in real hospital wastewater. Several process variables need to be studied beforehand. Here, variables: pellet size, aeration and carbon-to-nitrogen ratio are studied in continuous operations with real HWW. Moreover, a novel strategy for inoculum production that could reduce economical and operational costs is proposed and tested. Optimum pellet size was found to be 2 mm and an aeration of 0.8 L min−1 was needed to maintain fungal viability. The carbon-to-nitrogen ratio of 7.5 was selected and the pellet production time was reduced from 6 to 3 days. The novel low-cost inoculum preparation produced pellets with the same characteristics as the traditionally prepared ones. © 2018 Elsevier Ltd, This work has been funded by the Spanish Ministry of Economy and Competitiveness (project CTM 2013–48545-C2-1-R ) and partly supported by the Generalitat de Catalunya (Consolidated Research Group 2014-SGR-0476 ). The Department of Chemical, Biological and Environmental Engineering of Universitat Autònoma de Barcelona (UAB) is member of the Xarxa de Referència en Biotecnologia de la Generalitat de Catalunya. J.A. Mir-Tutusaus acknowledges the predoctoral grant from UAB . Appendix A

Hospitals and wastewater treatment plants (WWTPs) are high-risk point sources of antibiotic-resistance genes (ARGs) and antibiotic-resistant bacteria. This study investigates the occurrence of clinically relevant ARGs (sul1, tet(B), blaCTX-M, blaNDM-1, qnrS) and a class one integron (intI1) gene in urban rivers, hospitals, and municipal wastewater in the Kathmandu Valley, Nepal. Twenty-five water samples were collected from three rivers, six hospitals, and a wastewater treatment plant to determine the concentrations of ARGs and intI1 using quantitative polymerase chain reactions. From the results, all tested ARGs were detected in the river water, also, concentrations of ARGs in WWTP and hospital effluents varied from 6.2 to 12.5 log10 copies/L, highlighting the role of a WWTP and hospitals in the dissemination of ARGs. Except for blaNDM-1, significant positive correlations were found between intI1 and other individual ARGs (r = 0.71–0.96, p &lt, 0.05), indicating the probable implications of intI1 in the transfer of ARGs. Furthermore, this study supports the statement that the blaNDM-1 gene is most likely to be spread in the environment through untreated hospital wastewater. Due to the interaction of surface water and groundwater, future research should focus on ARGs and factors associated with the increase/decrease in their concentration levels in drinking water sources of the Kathmandu Valley.

Real hospital wastewater was effectively treated by a promising technology based on degradation reaction catalyzed by Fe0 under microwave irradiation in this work. Fe0 powders were synthesized and characterized by different techniques, resulting in a single-phase sample with spherical particles. Optimum experimental conditions were determined by a central composite rotatable design combined with a response surface methodology, resulting in 96.8% of chemical oxygen demand reduction and 100% organic carbon removal, after applying MW power of 780 W and Fe0 dosage of 0.36 g L−1 for 60 min. Amongst the several organic compounds identified in the wastewater sample, diclofenac and ibuprofen were present in higher concentrations; therefore, they were set as target pollutants. Both compounds were completely degraded in 35 min of reaction time. Their plausible degradation pathways were investigated and proposed. Overall, the method developed in this work effectively removed high concentrations of pharmaceuticals in hospital wastewater En este trabajo, las aguas residuales hospitalarias reales fueron tratadas eficazmente mediante una tecnología prometedora basada en la reacción de degradación catalizada por Fe0 bajo irradiación de microondas. Los polvos de Fe0 se sintetizaron y caracterizaron mediante diferentes técnicas, dando como resultado una muestra monofásica con partículas esféricas. Las condiciones experimentales óptimas se determinaron mediante un diseño central compuesto giratorio combinado con una metodología de superficie de respuesta, lo que resultó en una reducción del 96,8% de la demanda química de oxígeno y una eliminación del 100% de carbono orgánico, después de aplicar una potencia de MW de 780 W y una dosis de Fe0 de 0,36 g L − 1. durante 60 min. Entre los varios compuestos orgánicos identificados en la muestra de aguas residuales, el diclofenaco y el ibuprofeno estaban presentes en concentraciones más altas; por lo tanto, se establecieron como contaminantes objetivo. Ambos compuestos se degradaron completamente en 35 min de tiempo de reacción. Se investigaron y propusieron sus posibles vías de degradación. En general, el método desarrollado en este trabajo eliminó de manera efectiva las altas concentraciones de productos farmacéuticos en las aguas residuales de los hospitales.

Background & Aims of the Study: The most important compounds in hospital wastewater are antibiotics, disinfectants, anesthetics, radioactive elements, static cytotoxic agents, other chemicals and hazardous materials that caused to be different domestic sewage. The purpose of this study was the evaluation of performance of extended aeration biological system in pollutants removal from Razi Hospital wastewater treatment plant (WTP), Ahvaz city of Iran. Materials and Methods: The hospital wastewater disposal and treatment in Razi hospital have been studied in this cross-sectional research. Total of 12 samples from effluents of wastewater treatment plants were collected and tested for pH, Biological Oxygen Demand (BOD5), Chemical Oxygen Demand (COD), Total Suspended Solid (TSS) and Total Coliform (TC). EPA standard method was used for conducted trials. Finally, the relationship between results at different months and stations was done, using SPSS18 and descriptive statistics. Results: Results shown that parameters average in effluent was pH=7.46، BOD= 48.58 mg/l, COD=99.25 mg/l, TSS=54 mg/l, NH3=5.65mg/l, Turbidity=29.57 NTU. Also total coliform and fecal coliform of effluent were 46.19 MPN/100 ml and 36.65 MPN/100 ml, respectively. According to results, the percentage of BOD, COD, TSS and TC removal in WTP were 85.21, 82.46, 86 and 90.15. Conclusion: Based on these findings, Razi hospital effluent wastewater treatment plant was mitted at Iran environmental standards for discharge to recipient wasters. Based on the result of our study, Extended Aeration Biological System is a comparatively suitable process for BOD, COD, TSS and TC removal from hospital wastewater.

The chapter deals with the occurrence of a selection of anticancer drugs in different water environments: hospital wastewater, wastewater treatment plant influents and effluents, surface water, sea water, and drinking water. Unfortunately, no data are available for groundwater up to now. The chapter presents and discusses measured environmental concentrations of anticancer drugs collected in 56 peer-reviewed papers referring to investigations carried out in 18 countries all over the world. It focuses on the variability of observed concentrations in the different environments, and it highlights the importance of planning efficient sampling strategies in order to obtain representative water samples.

Indiscriminate use of antibiotics has resulted in a catastrophic increase in the levels of antibiotic resistance in India. Hospitals treat critical bacterial infections and thus can serve as reservoirs of multidrug resistant (MDR) bacteria. Hence, this study was conducted to gauge the prevalence patterns of MDR bacteria in hospital wastewater. Water samples collected from 11 hospitals and 4 environmental sources belonging to 5 most-densely populated districts of West Bengal, India were grown on MacConkey and Eosin Methylene Blue agar. A total of 84 (hospital-associated = 70, environmental water sources = 14) isolates were characterized. The predominant species found in water from hospital-associated areas (HAA) were Acinetobacter baumannii (22.9%), Escherichia coli (28.6 %), and Klebsiella pneumoniae (25.7%). Greater than 75% of the HAA isolates were found to be mcr-1 gene negative and colistinresistant. Meropenem non-susceptibility was also high among the HAA isolates at 58.6%, with the presence of the carbapenemase gene and blaNDM in 67.1% of the non-susceptible isolates. Among the three predominant species, significantly higher numbers of E. coli isolates were found to be non-susceptible to meropenem ((80%), p-value = 0.00432) and amikacin (AK (90%), p-value = 0.00037). This study provides evidence for the presence of high numbers of colistin-resistant and carbapenem-hydrolyzing Proteobacteriain hospital wastewater.

This work evaluates the occurrence of pharmaceuticals, with special emphasis on their metabolites, in raw hospital wastewater (HWW) using wide-scope screening based on liquid chromatography coupled to high resolution mass spectrometry. The applied strategy uses an extended purpose-built database, containing >1000 pharmaceuticals and 250 metabolites. Raw HWW samples from a hospital located in south Brazil were collected over six months, with a monthly sampling frequency. Accurate-mass full-spectrum data provided by quadrupole-time of flight MS allowed the identification of 43 pharmaceuticals and up to 31 metabolites in the samples under study. Additionally, other four metabolites not included in the initial database could be identified using a complementary strategy based on the common fragmentation pathway between the parent compound and its metabolites. Nine metabolites derived from four pharmaceuticals were identified in the raw HWW samples, whereas their parent compounds were not found in these samples. The results of this work illustrate the importance of including not only parent pharmaceuticals but also their main metabolites in screening analysis. Besides, the inclusion of in silico QSAR predictions allowed assessing the environmental fate and effect of pharmaceuticals and metabolites in terms of biodegradability, as possible Persistent, Bioaccumulative and Toxic (PBT) compounds, and their potential hazard to the aquatic environment.

Background:Hospital wastewater is among hazardous wastewater due to its composition of pathogens and toxic chemicals. Discharge of untreated hospital wastewater to environment is hazardous for human and environment. Aims of this study were to identify Operational and Maintenance problems of Extended Aeration Activated sludge process in Golestan Hospital wastewater treatment plant (WTP), Ahwaz, Iran, and to find their solutions. Materials and Methods:Sampling period was 6 months of 2015. BOD5, COD, and TSS parameters analysed in the hospital WTP effluent. In addition, VLR, Qr/Q, MLSS, F/M, SVI, HRT, and θc parameters measured in aeration tank, then operational and maintenance parameters calculated. Results:Results shown that average of operation & maintenance parameters were: F/M = 0.35, HRT = 6 hour, Qr/Q = 64.28 %, VLR = 1.1 Kg BOD/m3.d, MLSS = 2819.36 mg/l, SVI = 144.89 ml/g, θc = 10.93 days. Conclusion:Results of operational and maintenance parameters shown that biological process behavior of the hospital WTP was Extended Aeration Activated Sludge in past years, but converted to conventional activated sludge process due to increase in hospital beds of clinical and out patients departments , which increased water consumption lead to increase wastewater flow rate. High flow rate lead to increase hydraulic load and diluting organic matter load, so hydraulic retention time and sludge age decreased.

Hospital wastewater is commonly polluted with high loads of pharmaceutically active compounds, which pass through wastewater treatment plants (WWTPs) and end up in water bodies, posing ecological and health risks. White-rot fungal treatments can cope with the elimination of a wide variety of micropollutants while remaining ecologically and economically attractive. Unfortunately, bacterial contamination has impeded so far a successful implementation of fungal treatment for real applications., This work has been funded by the Spanish Ministry of Economy and Competitiveness (project CTM 2013–48545-C2) and partly supported by the Generalitat de Catalunya (Consolidated Research Groups 2017-SGR-14, 2017SGR-1404, 2017-SGR-1124 and 2017-SGR-1762) and the European Union through the European Regional Development Fund (ERDF). The Department of Chemical Engineering of UAB is member of the Xarxa de Referència en Biotecnologia de la Generalitat de Catalunya. S. Rodriguez-Mozaz acknowledges the Ramon y Cajal program (RYC-2014-16707). J. A. Mir-Tutusaus and E. Parladé acknowledge the predoctoral grants from UAB.

Study of antibiotic resistance was done among the metal tolerant E. coli isolates from hospital wastewater at Lucknow city. Metal tolerance was determined in terms of visible growth on metal amended plates at their varying concentrations. MICs were also determined among all metal tolerant E. coli isolates. All the isolates showed their MIC in between 100-2000 µg/ml while maximum isolates demonstrated their MICs at 400, 800 and 1600 µg/ml against all the metal tested. 23.07% of the isolates showed their MIC at 2000 µg/ml against Ni(3+). Multiple antibiotic resistances were recorded among all the metal resistant E.coli isolates. A high level of resistance was observed against Methicillin (86.53%) followed by penicillin (73.07%), Cephradin (57.69%), Rifampicin (34.61%), Erythromycin (26.92%), Nalidixic acids (25%), Chloramphenicol (3.84%) and least to Gentamycine (1.92%). Streptomycin was recorded most effective against E.coli isolates among the entire antibiotic tested. Antimicrobial resistance observed among the bacteria from the aquatic system contaminated with hospital wastes may be threatful for the environment and public health both.

This study investigates the degradation of the β-blockers in hospital wastewater by direct ozonation and Fe2+/ozonation with a focus on measurements at different initial pHs and Fe2+ concentrations, and the determination of kinetic constants. The results showed that these 'emerging contaminants' were completely degraded, when the removal rate of organic matter reached 30.6% and 49.1% for ozonation and Fe2+/ozonation, respectively. Likewise, the aromaticity removal rates were 63.4% and 77.9% for ozonation and Fe2+/ozonation, respectively. The experimental design showed that pH was the variable which had the greatest effect on the Fe2+/ozonation. The kinetic constants of atenolol, metoprolol and propranolol degradation by direct ozonation complied with pseudo-first-order conditions, while Fe2+/ozonation was suited to a biphasic degradation model. The kobs tended to rise when the pH increases; propranolol showed high kobs, which can be attributed to the naphthalene group (an electron-rich moiety). The identification of degradation products was carried out in aqueous solution using HPLC-MS2, followed by a suggestion of degradation pathways by means of ozonation. The degradation products proved to be dependent on the initial pH, and followed pathways that are based on direct ozonolysis and free radicals.

Hospital wastewaters are a main source of pharmaceutical active compounds, which are usually highly recalcitrant and can accumulate in surface and groundwater bodies. Fungal treatments can remove these contaminants prior to discharge, but real wastewater poses a problem to fungal survival due to bacterial competition. This study successfully treated real non-spiked, non-sterile wastewater in a continuous fungal fluidized bed bioreactor coupled to a coagulation-flocculation pretreatment for 56 days. A control bioreactor without the fungus was also operated and the results were compared. A denaturing gradient gel electrophoresis (DGGE) and sequencing approach was used to study the microbial community arisen in both reactors and as a result some bacterial degraders are proposed. The fungal operation successfully removed analgesics and anti-inflammatories, and even the most recalcitrant pharmaceutical families such as antibiotics and psychiatric drugs., This work has been funded by the Spanish Ministry of Economy and Competitiveness (project CTM2013-48545-C2) and partly supported by the European Union through the European Regional Development Fund (ERDF) and the Generalitat de Catalunya (Consolidated Research Groups 2014-SGR-599, 2014-SGR-476 and 2014-SGR-291). The Department of Chemical, Biological and Environmental Engineering of UAB is member of the Xarxa de Referència en Biotecnologia de la Generalitat de Catalunya. J. A. Mir-Tutusaus and E. Parladé acknowledge the predoctoral grants from UAB. S. Rodriguez-Mozaz acknowledges the Ramon y Cajal program (RYC-2014-16707) and M. Llorca acknowledges the Juan de la Cierva – Incorporación research fellowship (JdC-2014-21736).

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.

In China, the number of hospitals has increased to 19,712 in 2008, with the production of hospital wastewater reaching 1.29 × 10 6 m 3 /d. Membrane bioreactor (MBR) technology presents a more efficient system at removing pathological microorganism compared with existing wastewater treatment systems. In the past 8 yr, over 50 MBR plants have been successfully built for hospital wastewater treatments, with the capacity ranging from 20 to 2000 m 3 /d. MBR can effectively save disinfectant consumption (chlorine addition can decrease to 1.0 mg/L), shorten the reaction time (approximately 1.5 min, 2.5–5% of conventional wastewater treatment process), and attain a good effect of inactivation of microorganism. Higher disinfection efficacy is achieved in MBR effluents at lower dose of disinfectant with less disinfection by-products (DBPs). Moreover, when capacity of MBR plants increases from 20 to 1000 m 3 /d, their operating cost decreases sharply.

This study was carried out to evaluate the occurrence of the fluoroquinolone antimicrobial agent ciprofloxacin (CIP) in the effluent of the Hospital of the Federal University of Santa Maria (HUSM). Measured environmental concentrations (MECs) of CIP in the hospital wastewater, both before (P1) and after (P2) cesspit/filter system treatment (CFTS), were determined by means of solid phase extraction and reversed-phase liquid chromatography with fluorescence detection (LC-FLD) and reversed-phase liquid chromatography with mass spectrometric detection (LC-MS/MS). The MECs (n = 7 daily composed samples) were 19 to 155 μg L–1 (average: 54 ± 21 μg L–1) and 32 to 99 μg L–1 (average: 65 ± 45 μg L–1) in P1 and P2, respectively. No relevant removal was observed from P1 to P2. In a worst case scenario, the final effluent was regarded as MECs of surface water. These MECs were generally 5 to 20,000-fold higher than what was previously known. If the present data is drawn on to form a model of the situation in developing countries, the picture provides a first rough indication that the environmental risk associated with the use and emission of pharmaceuticals into the environment in developing countries might be higher than in developed countries. This study was carried out to evaluate the occurrence of the fluoroquinolone antimicrobial agent ciprofloxacin (CIP) in the effluent of the Hospital of the Federal University of Santa Maria (HUSM). Measured environmental concentrations (MECs) of CIP in the hospital wastewater, both before (P1) and after (P2) cesspit/filter system treatment (CFTS), were determined by means of solid phase extraction and reversed-phase liquid chromatography with fluorescence detection (LC-FLD) and reversed-phase liquid chromatography with mass spectrometric detection (LC-MS/MS). The MECs (n = 7 daily composed samples) were 19 to 155 μg L–1 (average: 54 ± 21 μg L–1) and 32 to 99 μg L–1 (average: 65 ± 45 μg L–1) in P1 and P2, respectively. No relevant removal was observed from P1 to P2. In a worst case scenario, the final effluent was regarded as MECs of surface water. These MECs were generally 5 to 20,000-fold higher than what was previously known. If the present data is drawn on to form a model of the situation in developing countries, the picture provides a first rough indication that the environmental risk associated with the use and emission of pharmaceuticals into the environment in developing countries might be higher than in developed countries.

In this work voltammetric and electrolysis experiments have been carried out on a conductive boron doped diamond (BDD) electrode in a solution containing amoxicillin in its pharmaceutical formulation. The physical characterization of the BDD surface by scanning electron microscopy (SEM) reveals a polycrystalline structure with grain sizes ranging between 0.3 and 0.6 µm. With Raman spectroscopy BDD surface is composed of diamond type carbon (Csp3) and graphitic type carbon (Csp2). The XPS survey of the BDD surface has revealed the presence of C 1s and O 1s. The deconvolution of the C1s spectrum showed that the BDD surface chemical bonds were composed by C C and C H. The ferri/ferrocyanide redox couple showed a quasi reversible behavior on BDD and BDD showed a quasi metallic properties with a good electrical contact between the diamond coating and the silicone substrate. The electrochemical characterization of the BDD electrode in sulfuric acid electrolyte showed a wide potential window of 2.74 V. The oxidation of amoxicillin showed an irreversible anodic wave on the voltammogram in the domain of water stability indicating a direct oxidation of amoxicillin at BDD surface. The treatment of amoxicillin in the synthetic wastewaters under various constant current densities 20 50 100 135 mA cm 2 on BDD showed that amoxicillin is highly reduced under 100 mA cm 2 reaching 92 of the chemical Oxygen demand (COD) removal after 5 h of electrolysis. Investigation performed in perchloric acid as supporting electrolyte led to 87 of COD removal after 5 h of electrolysis. Mineralization of amoxicillin occurs on BDD and the COD removal was higher in sulfuric acid than in perchloric acid owing to the involvement of the in situ formed persulfate and perchlorate to the degradation process mainly in the bulk of the solution. The instantaneous current efficiency (ICE) presents an exponential decay indicating that the process was limited by diffusion. The specific energy consumed after 5 h of the amoxicillin electrolysis was 0.096 kWh COD 1 and 0.035 kWh COD 1 in sulfuric acid and in perchloric acid respectively. Keywords Boron doped diamond Amoxicillin Electrolysis Anodic oxidation Hospital wastewater

Hospital wastewater (HWW) can contain hazardous substances, such as pharmaceutical residues, chemical hazardous substances, pathogens and radioisotopes. Due to these substances, hospital wastewater can represent a chemical, biological and physical risk for public and environmental health. In particular, several studies demonstrate that the main effects of these substances can't be neutralised by wastewater treatment plants (WWTPs). These substances can be found in a wide range of concentrations due to the size of a hospital, the bed density, number of inpatients and outpatients, the number and the type of wards, the number and types of services, the country and the season. Some hazardous substances produced in hospital facilities have a regulatory status and are treated like waste and are disposed of accordingly (i.e., dental amalgam and medications). Legislation is quite homogeneous for these substances in all industrial countries. Problems that have emerged in the last decade concern substances and microorganisms that don't have a regulatory status, such as antibiotic residues, drugs and specific pathogens. At a global level, guidelines exist for treatment methods for these effluents, but legislation in all major industrial countries don't contain limitations on these parameters. Therefore, a monitoring system is necessary for these effluents as well as for substances and pathogens, as these elements can represent a risk to the environment and public health.

International audience; Hospital wastewater (HWW) contain a large number of chemical pollutants such as disinfectants, surfactants, and pharmaceutical residues. A part of these pollutants is not eliminated by traditional urban wastewater treatment plants (WWTP), leading to a risk for the aquatic ecosystems receiving these effluents. In order to assess this risk, we formulated a specific methodology based on the ecotoxicological characterisation of the hospital wastewater using a battery of three chronic bioassays (Pseudokirchneriella subcapitata, Heterocypris incongruens and Brachionus calyciflorus). We used it for the posteriori risk assessment of a hospital recently built in south-east France, and we studied the evolution of this risk during two years. We also used it to assess the decrease of the ecotoxicological risk after treatment of the effluent in a specific line of the local WWTP. Lastly, we compared these results with the risk assessment made before the building of the hospital in the context of a priori risk assessment. The results obtained showed an important evolution of the risk overtime, according to the hospital activities and the river flows, and a real decrease of the risk after treatment in the dedicated line. They also showed that the a priori assessment of ecotoxicological risks, made previously, was overstated, mainly because of the application of the precautionary principle.

Cephalosporins type antibiotics are widely used to treat infectious diseases. Their determination is not only important in blood/serum of patients under treatment but also in diverse matrices like wastewaters, milk etc. as contaminant. Keeping in view the need, a new high performance liquid chromatographic method for the determination of three cephalosporins (cefradine, cefuroxime and cefotaxime) has been developed. Separation was performed on an ODS column with binary solvent elution of aqueous formic acid (0.05%) and methanol in the ratio of 45: 55 (v/v) at a flow rate of 1 mL min-1 and UV detection at 260 nm. Under optimised conditions, all three cephalosporins were baseline separated within 5 min. Linear responses for cefradine 5–20 μg mL-1, cefuroxime 0.5-15 μg mL-1 and cefotaxime 1.0-20 μg mL-1 were established. LOD of 0.05-0.25 μg mL-1 after preconcentration was achieved. The method was applied to serum samples of patients under treatment with these antibiotics and to screen the selected cephalosporins from hospital wastewater and milk samples. Moreover, method was applied to study stability of aqueous solutions and acid/base induced degradation of all three drugs.

The community of whole microbes and antibiotic resistance bacteria (ARB) in hospital wastewater treatment plants (WWTP) receiving domestic wastewater (DWW) and hospital wastewater (HWW) was investigated. Samples from an influent of a secondary clarifier, at each treatment train, were characterized for the whole microbial community and ARB on the antibiotic resistance database, based on high-throughput pyrosequencing. The pyrosequencing analysis revealed that the abundance of Bacteroidetes in the DWW sample was higher (~1.6 times) than in the HWW sample, whereas the abundance of Proteobacteria in the HWW sample was greater than in the DWW sample. At the top twenty of the genus level, distinct genera were observed—Saprospiraceae in the DWW and Zoogloea in the HWW. Apart from the top twenty genera, minor genera showed various antibiotic resistance types based on the antibiotic resistance gene database.

Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001).

This study investigated the degradation of atenolol, metoprolol and propranolol beta-blockers by ferrate (K2FeO4) in hospital wastewater and in aqueous solution. In the case of hospital wastewater, the effect of the independent variables pH and [Fe(VI)] was evaluated by means of response surface methodology. The results showed that Fe(VI) plays an important role in the oxidation-coagulation process, and the treatment of the hospital wastewater led to degradations above 90% for all the three β-blockers, and to reductions of aromaticity that were close to 60%. In addition, only 17% of the organic load was removed. In aqueous solution, the degradation of the β-blockers atenolol, metoprolol and propranolol was 71.7%, 24.7% and 96.5%, respectively, when a ratio of 1:10 [β-blocker]:[Fe(VI)] was used. No mineralization was achieved, which suggests that there was a conversion of the β-blockers to degradation products identified by liquid chromatography/mass spectrometry tandem. Degradation pathways were proposed, which took account of the role of Fe(VI). Furthermore, the ready biodegradability of the post-process samples was evaluated by using the closed bottle test, and showed an increase in biodegradability. The use of the ferrate advanced oxidation technology seems to be a useful means of ensuring the remediation of hospital and similar wastewater. This study investigated the degradation of atenolol, metoprolol and propranolol beta-blockers by ferrate (K2FeO4) in hospital wastewater and in aqueous solution. In the case of hospital wastewater, the effect of the independent variables pH and [Fe(VI)] was evaluated by means of response surface methodology. The results showed that Fe(VI) plays an important role in the oxidation–coagulation process, and the treatment of the hospital wastewater led to degradations above 90% for all the three β-blockers, and to reductions of aromaticity that were close to 60%. In addition, only 17% of the organic load was removed. In aqueous solution, the degradation of the β-blockers atenolol, metoprolol and propranolol was 71.7%, 24.7% and 96.5%, respectively, when a ratio of 1:10 [β-blocker]:[Fe(VI)] was used. No mineralization was achieved, which suggests that there was a conversion of the β-blockers to degradation products identified by liquid chromatography/mass spectrometry tandem. Degradation pathways were proposed, which took account of the role of Fe(VI). Furthermore, the ready biodegradability of the post-process samples was evaluated by using the closed bottle test, and showed an increase in biodegradability. The use of the ferrate advanced oxidation technology seems to be a useful means of ensuring the remediation of hospital and similar wastewater.

Many sewage waste treatment systems are aiming for complete pathogen removal which necessitates search for novel approaches that does not harm the environment. One such novel approach is exploring the possibilities of bacteriophages for pathogen removal. Hospital wastewater was collected from different locations of Tamil Nadu and used for the study. The total heterotroph and total coliform population ranged from 1.6 × 105 to 8.3 × 106 per mL and from 1.2 × 103 to 1.6 × 103/ 100 mL of sample respectively. Higher frequency of antibiotic resistant E. coli, Pseudomonas sp. Streptococcus sp and Bacillus spp were observed in all the places, which clearly indicated the extent of pollution. All the samples had specific phages against E. coli and none of the samples had phages against MTCC culture. E. coli specific phage was isolated and the population of phage required for effective killing of E. coli has been standardized as 3 × 104 pfu / mL of lysate. The inoculation resulted in 100% removal of pathogen from sewage water within 14 hours of incubation.

Determining optimal ozone doses for organic micropollutant elimination during wastewater ozonation is challenged by the presence of a large number of structurally diverse micropollutants for varying wastewater matrice compositions. A chemical kinetics approach based on ozone and hydroxyl radical (·OH) rate constant and measurements of ozone and ·OH exposures is proposed to predict the micropollutant elimination efficiency. To further test and validate the chemical kinetics approach, the elimination efficiency of 25 micropollutants present in a hospital wastewater effluent from a pilot-scale membrane bioreactor (MBR) were determined at pH 7.0 and 8.5 in bench-scale experiments with ozone alone and ozone combined with H2O2 as a function of DOC-normalized specific ozone doses (gO3/gDOC). Furthermore, ozone and ·OH exposures, ·OH yields, and ·OH consumption rates were determined. Consistent eliminations as a function of gO3/gDOC were observed for micropollutants with similar ozone and ·OH rate constants. They could be classified into five groups having characteristic elimination patterns. By increasing the pH from 7.0 to 8.5, the elimination levels increased for the amine-containing micropollutants due to the increased apparent second-order ozone rate constants while decreased for most micropollutants due to the diminished ozone or ·OH exposures. Increased ·OH quenching by effluent organic matter and carbonate with increasing pH was responsible for the lower ·OH exposures. Upon H2O2 addition, the elimination levels of the micropollutants slightly increased at pH 7 (80% for gO3/gDOC = 0.5).

The Danish hospitals are currently being centralised into regional super hospitals each servicing an entire regions replacing many local hospitals. This centralisation cause increased load of antibiotic resistant bacteria (ARB) at few WWTPs. In this study, ARB levels in sewage was determined to specify disinfection required to eliminate hospitals as point source for ARB. New super hospitals have separate pipe for wastewater to WWTP that makes it ideal for disinfection reaction tanks.Pilot experiments were conducted on hospital wastewaters using continuous dosing of peracetic acid (PAA) and different contact time. PAA concentration profiles and ARB elimination indicated a possibility to mitigate hospitals as point source of ARB. A typical dosage of 50 mg PAA/L and contact time of minimum 20 min reduced ARBs by 99.9%. The method appears ideal to minimizing the risk to sewage and WWTP workers posed by high loads of ARBs from centralized hospitals.