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In this experiment, we employed Real-time PCR(RT-PCR) and metagenomic Next-Generation Sequencing (mNGS) techniques to detect the presence of Norovirus, Rotavirus Group A, Adenovirus Group F, and Astrovirus in untreated sewage from three major hospitals. A comparison with clinical lab test outcomes revealed Norovirus as having the highest infection rate, followed by Adenovirus Group F and Rotavirus Group A. Despite not testing for Astrovirus in clinical labs, its sewage detection rate was surpassed only by Norovirus, suggesting a potentially high clinical infection rate. Further analysis of these viruses in treated sewage revealed that chlorination failed to eliminate the virus, maintaining viral concentrations in the treated sewage between 10^2 and 10^3 copies/ml. Even though nucleic acid testing methods fail to detect viral actions, the possible danger they present to public safety should not be ignored. During this experiment, viral nucleic acid was extracted directly from the samples without prior concentration. This method, unlike conventional virus detection post-concentration, bypasses concerns such as recovery efficiency, offering a clearer representation of virus concentrations in water samples and facilitating easier operation., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Hospital wastewater is a reservoir for the environmental spread of clinically relevant antimicrobial-resistant bacteria and resistance genes. The aim of this study was to quantify total Escherichia coli, extended-spectrum β-lactamase (ESBL)-producing E. coli, and carbapenemase-producing organisms (CPOs) and perform whole-genome sequencing-based characterization of these bacterial isolates in hospital wastewater samples collected bimonthly in Japan from January to November 2021. Total E. coli counts were 8.1 × 10 3 -8.8 × 10 4 colony-forming units (CFU)/mL. ESBL-producing E. coli were detected in the sampling months of January, March, May, and July, with the ratio of ESBL-producing E. coli to total E. coli being remarkably highest (95 %) in July. In contrast, DHA-1 Ambler class C β-lactamase (AmpC)-producing E. coli was detected in September and November, accounting for 28 % and 3 % of total E. coli counts, respectively. All 140 ESBL-producing E. coli isolates harbored the bla CTX-M genes, with bla CTX-M-14 being the most common genotype (94.3 %), the vast majority of which were associated with the human virulent B2-O25b: H4-ST131-fimH30R/non-Rx. In September, E. coli clade I-O8:H33-ST3910-fimH1074 was primarily associated with bla DHA-1 . Among 26 representative CPO isolates, Aeromonas caviae (34.6 %) and A. hydrophila subsp. hydrophila (30.8 %) were dominant. The most frequently detected carbapenemase gene was bla IMP-1 (57.7 %), followed by bla GES-24 (34.6 %) and bla GES-4 (7.7 %). Estimated bacterial counts of CPOs ranged from 4.0 × 10 -1 to 4.7 × 10 3  CFU/mL over the six sampling months. bla IMP-1 -positive A. hydrophila subsp. hydrophila ST860, which was repeatedly detected over the five sampling months, accounted for the highest total number of this bacterial clone (79 %). Overall, this study provides insights into the overwhelming presence and persistence of E. coli B2-O25b:H4-ST131-H30R/non-Rx with bla CTX-M-14 and Aeromonas spp. with bla IMP-1 in hospital wastewater, and the change in the dynamics of resistance gene prevalence from bla CTX-M -positive E. coli to bla DHA-1 -positive E. coli., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

In recent years, the widespread detection of pharmaceuticals and personal care products (PPCPs) in aquatic environments has become a global concern, and wastewater discharged from hospitals is an important source. This study investigated the occurrence, removal efficiency and risk assessment of 74 commonly used pharmaceutical active compounds (PhACs), including 58 antibiotics, seven psychiatric drugs, four nonsteroidal anti-inflammatory drugs, three β-blockers and two lipid regulators, at wastewater treatment plants (WWTPs) in 11 hospitals. A total of 51 PhACs were detected in the wastewater effluents of 11 hospitals, with concentrations of 0.00089 (alprenolol) ∼ 69 µg/L (acetaminophen) in the influent samples and 0.00057 (alprenolol) ∼ 5.7 µg/L (theophylline) in the effluent samples. Under the same scales, the concentrations of PhACs in the influent of psychiatric hospital WWTP were 1.16 times and 2.28 times greater than those of general hospital and infectious disease hospital, respectively, and the concentrations in small and large hospitals were comparable and were approximately 1.73 times greater than those in medium hospitals, suggesting the influence of the hospital type and scale on the discharge characteristics of PhACs. The removal efficiency of PhACs ranged from negative to 100 %. The removal efficiency of the membrane bioreactor (MBR) was 53.98 %, which was better than that of the biological contact oxidation (BCO). An environmental risk assessment revealed that the PhACs detected in hospital wastewater might pose potential risks to the aquatic environment. In addition, attention should be paid to the management of wastewater discharge in special hospitals and small and medium hospitals. This study provides a basis for the management and control of PhACs in hospitals in China., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

SARS-CoV-2, primarily affecting the respiratory system, is also found in fecal samples from COVID-19 patients, demonstrating wastewater as a significant route for viral RNA transmission. During high prevalence periods, healthcare facility wastewater became a potential contamination source. Understanding the role of wastewater in epidemiology is crucial for public health risk assessment. In hospitals, with a specific number of COVID-19 cases, wastewater analysis offers a unique opportunity to link virus presence in wastewater with COVID-19 hospitalizations, a connection that is not possible in urban wastewater treatment plants (WWTPs). Shorter wastewater transit times enable more accurate virus tracking. With documented infection rates and rigorous testing, hospitals are ideal for wastewater monitoring, revealing practicalities and limitations. This review updates global efforts in quantifying SARS-CoV-2 in hospital wastewater, considering hospitalization rates' influence on viral RNA levels and comparing disinfection methods. Insights gleaned from this study contribute to Wastewater-based Epidemiology (WBE) and can be applied to other virus strains, enhancing our understanding of disease transmission dynamics and aiding in public health response strategies., Competing Interests: Declarations. Ethical approval: All authors have read, understood, and have complied as applicable with the statement on “Ethical responsibilities of authors” as found in the Instructions for Authors. Consent for publication: All authors have read and agreed to the publication of the manuscript. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Hospital wastewater is a major hotspot for the spread of antimicrobial resistance (AMR) in aquatic ecosystems. This study aimed to investigate the prevalence of antibiotic resistance genes (ARGs) and their correlation with crAssphage in a hospital wastewater treatment plant (HWWTP) and a receiving canal. Water samples were analyzed for 94 ARGs and crAssphage relative to the 16S rRNA using high-throughput quantitative polymerase chain reaction (HT-qPCR). Subsequently, 7 ARGs and crAssphage were selected and quantified using qPCR. The results showed that the detected genes ranged from 79 to 93 out of 95 genes. The raw wastewater (WW) samples had the highest gene diversity compared to the upstream canal, which had less diversity than downstream samples, as determined by HT-qPCR. The bla GES was the most abundant in WW samples, while qacEΔ1, merA, IS6100, tnpA, and IS26 showed high prevalence throughout the treatment processes. The concentrations of intI1, sul1, bla TEM, bla NDM, bla VIM, tetQ, mcr-1, crAssphage, and 16S rRNA, measured using qPCR, were the highest in WW and significantly reduced in treated water samples. Although some water quality parameters, such as total suspended solids and dissolved oxygen, did not significantly differ before and after treatment, removal efficiency ranged from 0.60 to 3.23 log reduction values (LRV). The highest LRV was observed for the tetQ, whereas the mcr-1 had the lowest LRV. Strong positive correlations among the absolute concentrations of ARGs and crAssphage were observed (Spearman's rho = 0.6-1.0), and biochemical oxygen demand correlated with bla TEM and bla VIM (Spearman's rho = 0.6). These results indicate that crAssphage and water quality could reflect the distribution of other ARGs throughout the HWWTP. Further studies are needed to underscore the importance of monitoring ARGs and genetic markers such as crAssphage in HWWTPs and their receiving waters to enhance our understanding of ARG distribution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Hospital wastewater is a critical source of antimicrobial resistance (AMR), which facilitates the proliferation and spread of clinically significant antimicrobial resistance genes (ARGs) and pathogenic bacteria. This study utilized metagenomic approaches, including advanced binning techniques, such as MetaBAT2, MaxBin2, and CONCOCT, which offer significant improvements in accuracy and completeness over traditional binning methods. These methods were used to comprehensively assess the dynamics and composition of resistomes and mobilomes in untreated wastewater samples taken from two general hospitals and one cancer hospital. This study revealed a diverse bacterial landscape, largely consisting of Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria, with notable variations in microbial composition among hospitals. Analysis of the top 15 genera showed unique microbial pattern distribution in each hospital: Aeromonas was predominant in 1stHWTS (49.39 %), Acidovorax in the CAHWTS at 16.85 %, and Escherichia and Bacteroides in the 2ndHWTS at 11.44 % and 11.33 %, respectively. A total of 114 pathogenic bacteria were identified, with drug-resistant Aeromonas caviae and Escherichia coli being the most prevalent. The study identified 34 types and 1660 subtypes of ARGs, including important last-resort antibiotic resistance genes (LARGs), such as bla NDM , mcr, and tet(X). Using metagenomic binning, this study uncovered distinct patterns of host-resistance associations, particularly with Proteobacteria and Firmicutes. Network analysis highlighted the complex interactions among ARGs, mobile genetic elements (MGEs), and bacterial species, all contributing to the dissemination of AMR. These findings emphasize the intricate nature of AMR in hospital wastewater and the influence of hospital-specific factors on microbial resistance patterns. This study provides support for implementing integrated management strategies, including robust surveillance, advanced wastewater treatment, and strict antibiotic stewardship, to control the dissemination of AMR. Understanding the interplay among bacterial communities, ARGs, and MGEs is important for developing effective public health measures against AMR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Hospital wastewater is known to contain various pathogenic microorganisms and harmful substances. During the hospital wastewater treatment process, the bioaerosols released may encapsulate these pathogens, leading to human infection. This study undertook an investigation to compare the dispersion characteristics and seasonal variations of bioaerosols from hospital and municipal sewage. The results indicated that the airborne bacterial concentration from hospital sewage (119 ± 118 CFU/m 3 ) was higher than municipal sewage (46 ± 19 CFU/m 3 ), with the highest concentration observed in summer. The dominant bacterial genera present in bioaerosols from both sewages were alike, with the proportions varied by sewage types and the structure mainly influenced by seasonal factors. Bacteroides, Escherichia-Shigella and Streptococcus were identified as the most prevalent pathogenic genera in spring, summer and winter bioaerosols, respectively, while Pseudomonas and Acinetobacter were abundant in autumn. Although the non-carcinogenic risk associated with bioaerosols was low (<1), the presence of pathogenic species and their potential synergistic interactions elevated the overall exposure risk. The diffusion modeling results demonstrated that bioaerosol emissions from the surface of hospital sewage can reach up to 10570 CFU/m 3 in summer and can spread more than 300 m downwind. The potential pathogenicity of bioaerosols was also highest in summer, which may pose a health hazard to populations located downwind. Therefore, the management and control of bioaerosols from sewage should be strengthened, especially in summer., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Phages are pivotal in shaping microbial communities and biogeochemical cycles, while our understanding of the diversity, functions potential, and resistance gene carriage of phages in hospital wastewater (HWW) remains limited. We collected influent and effluent samples from the 3 hospital wastewater treatment plants (HWTPs) to assess the diversity and fate of phages, the interactions between phages and hosts, and the presence of resistance genes and auxiliary metabolic genes (AMGs) encoded by phages. Compared to influent, effluent showed reduced phage abundance and altered composition, with decreases in Microviridae and Inoviridae. The gene-sharing network highlights that many phages in HWW are not classified in known viral genera, suggesting HWW as a rich source of new viruses. There was a significant association between phages and microorganisms, with approximately 32.57 % of phages expected to be capable of infecting microbial hosts, characterized primarily by lytic activity. A total of 8 unique antibiotic resistance genes, 13 unique metal resistance genes, and 5 mobile genetic elements were detected in 3 HWTPs phageomes. Phage AMGs have the potential to influence carbon, nitrogen, phosphorus, and sulfur metabolism, impacting biogeochemical cycles. This study reveals the genomic diversity and ecological role of phages in HWTPs, highlighting their environmental and ecosystem impact., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Zhenjun Li reports financial support was provided by National Key R&D Program of China., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The periphery of the hospital water system interfaces at multiple points with patients and staff in clinical areas. This comprises mostly sinks and showers and presents a significant infection control risk. Wastewater drains in particular act as a reservoir of pathogens that can be transmitted to patients. Numerous strategies have been investigated as potential methods to reduce biofilm and bacterial load including regular application of biocidal chemicals. Traditional methods of assessing the efficacy of such products relies on culture-based microbiological techniques, usually targeting a limited range of key pathogens. We assessed the efficacy of a peracetic acid containing drain disinfectant product on seven clinical handwash basin drains, taking daily samples over six weeks (before, during and after use of the drain disinfectant product). We used a rapid, culture-independent estimation of total bacterial viable count (TVC) to assess efficacy. We applied long-read metagenomic sequencing to study the entire drain microbiome, which allowed taxonomic changes to be documented following use of the drain disinfectant product. All samples were found to be heavily contaminated, however the drain disinfectant product reduced the TVC from an estimated mean of 4228 cfu/mL to 2874 cfu/mL. This reduction was sustained in the two weeks following cessation of the product. Long-read metagenomic sequencing showed a microbiome dominated with Gram-negative organisms, with some taxonomic shifts in samples before and after application of the drain disinfectant. The impact on hospital-acquired infections from reducing bioburden in hospital drains by approximately a third, along with any associated changes in bacterial composition, needs evaluation in future studies., (Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Purpose of the Review: Wastewater is a term used to describe water that has undergone degradation in quality owing to anthropogenic activities or natural processes. Wastewater encompasses liquid waste originating from academic institutions, households, agricultural sector, industries, mines and hospitals. Hospital wastewater contains potentially hazardous substances including residues of pharmaceuticals, radioisotopes, detergents and pathogens, with detrimental impacts to the environment and human health. Nevertheless, studies related to hospital waste management are limited in Africa, particularly in Southern Africa. This research offers an overview of aspects surrounding hospital wastewater in Southern Africa, focusing on Zimbabwe. Already published and grey literature was reviewed to compile the paper., Recent Findings: Number of patients, nature of medical services offered and hospital size influences generation of hospital wastewater. Partially and non-treated hospital wastewater is managed together with municipal wastewater. Management of hospital wastewater is impeded by shortage of resources, lack of co-ordination among responsible authorities and ineffective legal framework enforcement, among other challenges. Inappropriate hospital wastewater management results in environmental contamination, causing human ailments. Attainment of sustainable hospital wastewater management requires clearly defined and enforced legislation, collaboration of accountable stakeholders, sufficient resources and enhanced awareness of involved stakeholders. Application of technologies that uphold recycling and reuse of wastewater is essential to reach Sustainable Development Goals, Zimbabwe Vision 2030 and National Development Strategy 1 targets, particularly those dealing with environmental protection while upholding human health., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The electro-peroxone (EP) process encounters two inherent challenges in wastewater treatment: sluggish O 2 /O 3 transfer and substantial ozone waste. To overcome these limitations, we introduced micro-nano bubbles (MNBs) aeration to enhance O 2 /O 3 dissolution and diffusion, ultimately aiming to improve the removal of trace pharmaceutical contaminants from hospital wastewater. In the MNBs aeration system, the ozone transfer coefficient ranging from 0.536 to 0.265 min -1 , significantly surpassing that of conventional aeration (0.220 to 0.090 min -1 ) by approximately 2 to 4.5 times. Consequently, the EP process under MNBs aeration significantly enhanced ozone-resistant ibuprofen (IBU) removal, achieving a removal rate of 98.4 ± 1.5 %, far exceeding the 47.3 ± 4.7 % observed with conventional aeration. This significant improvement was attributed to the heightened production of hydroxyl radicals (•OH), reaching 0.97 × 10 -9 M s, compared to only 0.28 × 10 -9 M s in conventional aeration. The mechanism behind the enhanced •OH production in the MNBs-EP process relied primarily on two factors: improved O 2 /O 3 dissolution due to high internal pressure/large surface and enhanced O 3 /H 2 O 2 activation from high collapse energy. These factors together contributed to the robust oxidation capability of the MNBs-EP system. As a result, over 97 % removal efficiency was achieved for five representative pharmaceutical pollutants (sulfamethoxazole, ribavirin, norfloxacin, tetracycline and ampicillin) in just 1 min. Furthermore, when applied to real hospital wastewater, the MNBs-O 3 -E treatment system reduced all 15 detected trace pharmaceutical compounds to below 10 ng L -1 and achieved 14 types of pollutants with removal rates of over 85 % within 15 min, resulting in an ultrahigh total removal rate of 98.6 %, from an initial total concentration of 2108 ng L -1 to less than 30 ng L -1 . Thus, micro-nano aeration endowed the EP process as a promising advanced oxidation system for rapid and highly-effective removal of trace pharmaceutical contaminants from hospital wastewater., Competing Interests: Declaration of competing interest All the authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

An alternative and complementary diagnostic method of surveillance is provided by wastewater-based surveillance (WBS), particularly in low-income nations like Nepal with scant wastewater treatment facilities and clinical testing infrastructure. In this study, a total of 146 water samples collected from two hospitals (n = 63) and three housing wastewaters (n = 83) from the Kathmandu Valley over the period of March 2021-Febraury 2022 were investigated for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using quantitative reverse transcription TaqMan PCR assays targeting the N and E genes. Of the total, 67 % (98/146) samples were positive for SARS-CoV-2 RNA either by using N- or E-gene assay, with concentrations ranging from 3.6 to 9.1 log 10 copies/L. There was a significant difference found between positive ratio (Chi-square test, p < 0.05) and concentration (t-test, p = 0.009) of SARS-CoV-2 RNA detected from hospital wastewater and housing waters. Wastewater data are correlated with COVID-19 active cases, indicating significance in specific areas like the Hospital (APFH) (p < 0.05). According to the application of a bivariate linear regression model (p < 0.05), the concentrations of N gene may be used to predict the COVID-19 cases in the APFH. Remarkably, SARS-CoV-2 RNA was detected prior to, during, and following clinical case surges, implying that wastewater surveillance could serve as an early warning system for public health decisions. The significance of WBS in tracking and managing pandemics is emphasized by this study, especially in resource-constrained settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Pharmaceuticals are progressively employed in both human and veterinary medicine and increasingly recognized as environmental contaminants. This study investigated the occurrence of selected pharmaceuticals in influent and effluent of wastewater treatment plants of 12 hospitals in Hanoi and 3 northern cities of Vietnam during dry and rainy seasons. In addition, environmental risk of pharmaceuticals in both hospital influents and effluents were evaluated based on risk quotients (RQs). Nine selected pharmaceutical compounds including sulfamethoxazole (SMX), naproxen (NPX), diclofenac (DCF), ibuprofen (IBU), acetaminophen (ACT), carbamazepine (CBM), iopromide (IOP), atenolol (ATN), and caffeine (CAF) were frequently detected in most influent and effluent wastewaters of 12 investigated hospitals. Detected compound levels exhibited a wide range, from as low as 1 ng/L for DCF to as high as 61,772 ng/L for ACT. Among these compounds, ACT, CAF, SMX, and IOP were consistently detected at substantial concentrations in both influents and effluents. This investigation also highlighted potential risks posed by SMX, ACT, and CAF residues present in influents and effluents of hospital wastewater treatment plants (WWTPs) to aquatic ecosystem. These finding are expected to provide scientific-based evidence for the development of hospital waste management and environmental management programs in Vietnam., Competing Interests: Declaration of competing interest The authors declare that they have no know competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Hospital wastewater has been identified as a hotspot for the emergence and transmission of multidrug-resistant (MDR) pathogens that present a serious threat to public health. Therefore, we investigated the current status of antibiotic resistance as well as the phenotypic and genotypic basis of biofilm formation in Pseudomonas aeruginosa from hospital wastewater in Dhaka, Bangladesh. The disc diffusion method and the crystal violet assay were performed to characterize antimicrobial resistance and biofilm formation, respectively. Biofilm and integron-associated genes were amplified by the polymerase chain reaction. Isolates exhibited varying degrees of resistance to different antibiotics, in which >80% of isolates showed sensitivity to meropenem, amikacin, and gentamicin. The results indicated that 93.82% of isolates were MDR and 71 out of 76 MDR isolates showed biofilm formation activities. We observed the high prevalence of biofilm-related genes, in which algD + pelF + pslD + (82.7%) was found to be the prevalent biofilm genotypic pattern. Sixteen isolates (19.75%) possessed class 1 integron ( int1 ) genes. However, statistical analysis revealed no significant association between biofilm formation and multidrug resistance ( χ 2 = 0.55). Taken together, hospital wastewater in Dhaka city may act as a reservoir for MDR and biofilm-forming P = 0.55). Taken together, hospital wastewater in Dhaka city may act as a reservoir for MDR and biofilm-forming P. aeruginosa , and therefore, the adequate treatment of wastewater is recommended to reduce the occurrence of outbreaks., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

In this study, the wastewater from the Departmental Hospital Center of Atacora in Benin was characterized and then treated with activated carbon/potassium permanganate (AC/KMnO 4 ) composite in a fixed bed column system. The AC/KMnO 4 composites with impregnation ratios range 0.025-0.100 were prepared from peanut shell activated carbon and potassium permanganate. The wastewater characteristics revealed that 75% of Escherichia coli strains identified were extended-spectrum lactamases (ESBL) with CTX-M dominance, while 25% of Staphylococcus aureus strains produced Panton and Valentine leucocidin and 77.80% of Salmonella typhi strains were resistant to Trimethoprim/Sulfamethoxazole. The fixed bed column system results showed removal efficiency of 72.18 ± 4.98% turbidity, 63.12 ± 4.11% COD, 0.70 ± 0.04 log 10 against E. coli and 3.82 ± 0.01 log 10 against S. typhi strains using activated carbon as adsorbent with 0.7 cm bed depth after 3 h of treatment. The composite adsorbent AC/KMnO 4 significantly increased the effectiveness of treatment due to the strong oxidant power of KMnO 4 in the composite material. The results depicted a removal rate of 83.88 ± 5.00%, 89 ± 1.95%, 90 ± 0.65% turbidity, 66.47 ± 1.62%, 69.82 ± 2.00%, 78.20 ± 2.82% COD, 2.0 ± 0.08 log 10 , 5.0 ± 0.07 log 10 against E. coli and 3.82 ± 0.01 log 10 against S. typhi strains using AC/KMnO 4 with 0.025, 0.050 and 0.100 ratios respectively at 0.7 cm bed depth. Finally, AC/KMnO 4 revealed more adsorption potential and antibacterial property than AC, hence, the composite material could be used as a cost-effective adsorbent for efficient removing of multi-resistant bacteria from hospital wastewater., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

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%., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The main objective of this study was to determine the occurrence of polycyclic aromatic hydrocarbons (PAHs) in surface water samples collected from different points along the stream that flows through the Campus of the Federal University of Santa Maria, RS-Brazil. Before reaching the campus, the water in the stream is already contaminated by wastewater discharged from the surrounding, and once inside the Campus, additional wastewater from a Gas Station situated close to the University hospital. A bench scale photodegradation experiment was conducted of the occurring traces of anthracene, phenanthrene and naphthalene, with the aid of a stirred tank reactor and polymer-supported TiO 2 as a catalyst. To prevent loss of the low soluble analytes, it was necessary to add 5% and 10% acetonitrile, as an organic modifier of the synthetic aqueous solutions and real samples, respectively. An experimental design was employed and the best conditions for the photocatalysis of the aqueous solutions and real samples were pH 9 and pH 7, and 35°C and 30°C, respectively. Under optimized conditions, the analytes were completely degraded after 60 min of irradiation. The subproducts of the photocatalysis were identified through gas chromatography/mass spectrometry, and fragmentation routes were proposed. The mean concentrations of PAHs in the polluted surface water and hospital wastewater were relatively high: 3.9 ± 1.7 and 21.5 ± 2.8 µg L -1 , respectively. A preliminary risk assessment revealed that the presence of anthracene requires particular attention. The risk posed by the occurrence of PAHs in the surface water and hospital wastewater samples confirms the need for an efficient treatment system.

Antibiotics, antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and mobile genetic elements (MGEs) have been reported in many environments. However, the investigation of their occurrence and diversity in untreated hospital wastewater is still insufficient. High concentrations of antibiotic residues were found in hospital wastewater using solid-phase extraction and UPLC-MS/MS analysis. The concentrations of six of 14 antibiotics reached μg/L levels in the hospital wastewater, which is higher than reported in other aquatic environments. Results of high-throughput sequencing analysis indicated that sequences affiliated to genera Escherichia and Acinetobacter were the predominant in the cultivable multiple-antibiotic-resistant bacteria (CMARB) recovered from the wastewater of three hospitals in China, with compositions of 34%-74%. Notably, several genera containing clinically pathogenic or opportunistic CMARB (e.g., Escherichia, Acinetobacter, Aeromonas, Myroides, Enterococcus, Proteus, Pseudomonas, and Streptococcus) were detected at high relative abundances in the wastewaters of the three hospitals. High-capacity quantitative PCR showed that 131-139 unique ARGs of the 178 targeted genes were detected in the hospital wastewaters. The high prevalence of five MGEs and 12 ARGs was confirmed with qPCR, and some positive correlations between ARGs and MGEs were identified, such as between intI1 and qnrD, intI2 and sul3, intI3 and tetX, Tn916/Tn1545 and sul2, and ISCR1 and sul3. These results suggest that highly abundant antibiotic-resistant pathogens and highly mobile ARGs already exist in the human body, and that their release from hospitals without effective treatment poses high risks to environments and human health., (Copyright © 2017 Elsevier B.V. All rights reserved.)

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., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Hospital wastewater contains a great variety of pharmaceutical compounds (PhCs), mainly due to excretion by patients. These PhCs, called emerging pollutants, are not fully eliminated in treatment plants, and are consequently detected in various environmental matrices, contributing to bacterial resistance and adverse environmental impacts on water resources. This study explores a consumption-based approach to predict the contribution of PhCs to a Brazilian hospital's wastewater. This approach identifies the consumption of major pharmaceutical classes in the studied hospital. Overall, this approach demonstrates a unique opportunity to screen PhCs used in hospitals and identify priority pollutants in hospital wastewater.

Hollow fiber (HF) and flat sheet (FS) Sponge MBRs were operated at 10-20 LMH flux treating hospital wastewater. Simultaneous nitrification denitrification (SND) occurred considerably with TN removal rate of 0.011-0.020mg TN mgVSS -1 d -1 . Furthermore, there was a remarkable removal of antibiotics in both Sponge MBRs, namely Norfloxacin (93-99% (FS); 62-86% (HF)), Ofloxacin (73-93% (FS); 68-93% (HF)), Ciprofloxacin (76-93% (FS); 54-70% (HF)), Tetracycline (approximately 100% for both FS and HF) and Trimethoprim (60-97% (FS); 47-93% (HF). Whereas there was a quite high removal efficiency of Erythromycin in Sponge MBRs, with 67-78% (FS) and 22-48% (HF). Moreover, a slightly higher removal of antibiotics in FS than in HF achieved, with the removal rate being of 0.67-32.40 and 0.44-30.42µgmgVSS -1 d -1 , respectively. In addition, a significant reduction of membrane fouling of 2-50 times was achieved in HF-Sponge MBR for the flux range., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of the study was to present first preliminary characterization of Turkish hospital wastewaters, their environmental risk, and a method for toxicity assessment. The hospital wastewater samples were collected from two of the largest medical faculty hospitals and a training and research hospital in Istanbul, Turkey. The samples from the selected hospitals were taken as grab samples on March 2014. Overall, 55 substances including pharmaceuticals and their metabolites, pesticides, and corrosion inhibitors were analyzed in all hospital wastewaters. Analysis of toxicity and the antibiotic resistance bacteria were investigated in addition to the chemical analysis in the wastewater of one hospital. Hazard quotients (HQs) and toxic units (TUs) were calculated as basis of the environmental risk assessment. Fourteen pharmaceuticals in hospital wastewater (HWW) were classified as "high risk" with HQ > 10. HQ HWW values higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQ HWW of 9090 was observed to be the most hazardous compound. HQ and TU values of the wastewater treatment plant (WWTP) effluent dropped significantly due to dilution in the sewer. Further elimination by biological degradation or adsorption was observed only in some cases. However, the decreased HQ WWTPeffluent values do not the change environmental load significantly. Therefore, advanced treatment processes should be applied to remove the persistent compounds. In combination with the results on antibiotic resistance, we would prefer on-site treatment of hospital wastewater. Toxicological assessment was performed using cytotoxic and mutagenic screening tests. The results of the Ames assay showed that the native hospital wastewaters had strongly mutagenic activity with a ≤10-fold increase relative to negative controls. The mutagenic potentials of the samples were generally concentration and metabolic activation dependent. Multiple antibiotic resistances were demonstrated with the tested isolates to ciprofloxacin, trimethoprim, and ceftazidime. This study demonstrates that the hospital wastewaters in Istanbul exhibit strong environmental and toxicological risks, as well as high multiple drug resistance to commonly used antibiotics.

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., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aims: To evaluate the diversity of Pseudomonads and antibiotic resistance profiles of Pseudomonas aeruginosa in a hospital wastewater treatment plant (HWTP) located in Rio de Janeiro city, Brazil. Due its intrinsic multidrug resistance and its ability to colonize several environments, we selected Ps. aeruginosa isolates as indicator of antimicrobial resistance frequency., Methods and Results: Twenty-seven Ps. aeruginosa strains isolated from five stages of HWTP identified by rrs 16S rDNA sequencing were submitted against 12 antimicrobials through disc diffusion method. Among these isolates, 62·9% showed aztreonam resistance, followed by ticarcillin/clavulanic acid (33·3%) and cefepime (22·2%). Of these isolates, 22·2% were classified as multidrug-resistant (MDR ≥ 3 classes). Five 16S rRNA gene libraries of Pseudomonas genus were constructed, one for each stages of the plant, yielding 93 sequences clustered in 41 Operational Taxonomic Units (OTUs). Each treatment step showed unique OTU's composition, suggesting changes in Pseudomonas spp. communities during the process. Several Pseudomonas species involved in biodegradation and bioremediation of xenobiotics were detected suggesting a positive impact in the wastewater treatment., Conclusions: Our strategy using metagenomics associated with the isolation of Ps. aeruginosa strains as bio-indicator allowed us to assess their antimicrobial susceptibility, the viability and diversity of Pseudomonas species in the hospital wastewater., Significance and Impact of the Study: The presence of MDR bacteria from treated effluents alerts for the need to improve these systems to avoid the spreading of resistance genes in aquatic ecosystems. This has special relevance in Brazil, where a significant portion of the population has no access to treated water., (© 2015 The Society for Applied Microbiology.)

Hospital effluents contribute to the occurrence of emerging contaminants in the environment due to their high load of pharmaceutical active compounds (PhACs) and some endocrine disruptor compounds (EDCs). Nowadays, hospital wastewaters are co-treated with urban wastewater; however, the dilution factor and the inefficiency of wastewater treatment plants in the removal of PhACs and EDCs make inappropriate the co-treatment of both effluents. In this paper, a new alternative to pre-treat hospital wastewater concerning the removal of PhACs and EDCs is presented. The treatment was carried out in a batch fluidized bed bioreactor under sterile and non-sterile conditions with Trametes versicolor pellets. Results on non-sterile experiments pointed out that 46 out of the 51 detected PhACs and EDCs were partially to completely removed. The total initial PhAC amount into the bioreactor was 8185 μg in sterile treatment and 8426 μg in non-sterile treatment, and the overall load elimination was 83.2% and 53.3% in their respective treatments. In addition, the Microtox test showed reduction of wastewater toxicity after the treatment. Hence, the good efficiency of the fungal treatment regarding removal of the wide diversity of PhACs and EDCs detected in hospital effluents is demonstrated., (Copyright © 2014. Published by Elsevier B.V.)

To understand which type of hospital waste may contain the highest amount of antibiotic resistant microorganisms that could be released into the environment, the bacterial strains entering and leaving a hospital wastewater treatment plant (HWTP) were identified and tested for their antibiotic susceptibility. To achieve this goal, samples were collected from three separate sites, inlet and outlet wastewater positions, and sludge generated in a septic tank. After microbiological characterization according to APHA, AWWA, and WEF protocols, the relative susceptibility of the bacterial strains to various antibiotic agents was assessed according to the Clinical and Laboratory Standards Institute guidelines, to determine whether there were higher numbers of resistant bacterial strains in the inlet wastewater sample than in the outlet wastewater and sludge samples. The results showed more antibiotic resistant bacteria in the sludge than in the inlet wastewater, and that the Enterobacteriaceae family was the predominant species in the collected samples. The most antibiotic-resistant families were found to be Streptococcacea and non-Enterobacteriaceae. Some bacterial strains were resistant to all the tested antibiotics. We conclude that the studied HWTP can be considered a source of resistant bacterial strains. It is suggested that outlet water and sludge generated in HWTPs should be monitored, and that efficient treatment to eliminate all bacteria from the different types of hospital waste released into the environment is adopted. [ABSTRACT FROM AUTHOR]

Background: The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) attracted extensive attention. Information on CRKP from hospital wastewater (HWW) is limited. The aims of this study were to investigate the genomic characteristics and to evaluate the survivability characteristics of 11 CRKP from HWW in a Chinese teaching hospital in Fujian province. Results: A total of 11 CRKP from HWW were recovered in this study. All CRKP from HWW were resistant to most antibiotics. Comparative genetic analysis demonstrated that all CRKP isolates were clustered into the three distinct phylogenetic clades and clade 2 and clade 3 were mixtures of samples collected from both HWW and clinical settings. Varieties of resistance genes, virulence genes and plasmid replicon types were detected in CRKP from HWW. In vitro transfer of blaKPC-2 was successful for 3 blaKPC-2-positive CRKP from HWW with high conjugation frequency. Our study demonstrated that the genetic environments of blaKPC−2 shared core structure with ISKpn27-blaKPC−2-ISKpn6. Group analysis showed that CRKP from HWW had a lower survivability in serum compared to clinical CRKP (p < 005); and CRKP from HWW had no significant difference in survivability in HWW compared to clinical CRKP (p > 005). Conclusions: We analyzed the genomic and survivability characteristics of CRKP from HWW in a Chinese teaching hospital. These genomes represent a significant addition of genomic data from the genus and could serve as a valuable resource for future genomic studies about CRKP from HWW. [ABSTRACT FROM AUTHOR]

Background: Hospitals with their high antimicrobial selection pressure represent the presumably most important reservoir of multidrug-resistant human pathogens. Antibiotics administered in the course of treatment are excreted and discharged into the wastewater system. Not only in patients, but also in the sewers, antimicrobial substances exert selection pressure on existing bacteria and promote the emergence and dissemination of multidrug-resistant clones. In previous studies, two main clusters were identified in all sections of the hospital wastewater network that was investigated, one K. pneumoniae ST147 cluster encoding NDM- and OXA-48 carbapenemases and one VIM-encoding P. aeruginosa ST823 cluster. In the current study, we investigated if NDM- and OXA-48-encoding K. pneumoniae and VIM-encoding P. aeruginosa isolates recovered between 2014 and 2021 from oncological patients belonged to those same clusters. Methods: The 32 isolates were re-cultured, whole-genome sequenced, phenotypically tested for their antimicrobial susceptibility, and analyzed for clonality and resistance genes in silico. Results: Among these strains, 25 belonged to the two clusters that had been predominant in the wastewater, while two others belonged to a sequence-type less prominently detected in the drains of the patient rooms. Conclusion: Patients constantly exposed to antibiotics can, in interaction with their persistently antibiotic-exposed sanitary facilities, form a niche that might be supportive for the emergence, the development, the dissemination, and the maintenance of certain nosocomial pathogen populations in the hospital, due to antibiotic-induced selection pressure. Technical and infection control solutions might help preventing transmission of microorganisms from the wastewater system to the patient and vice versa, particularly concerning the shower and toilet drainage. However, a major driving force might also be antibiotic induced selection pressure and parallel antimicrobial stewardship efforts could be essential. [ABSTRACT FROM AUTHOR]

Antibiotic resistance (AR) remains one of the greatest threats to global health, and Aeromonas species have the potential to spread AR in the aquatic environment. The spread of resistance to antibiotics important to human health, such as third-generation cephalosporins (3GCs) and carbapenems, is of great concern. We isolated and identified 15 cefotaxime (3GC)- and 51 carbapenem-resistant Aeromonas spp. from untreated hospital and treated municipal wastewater in January 2020. The most common species were Aeromonas caviae (58%), A. hydrophila (17%), A. media (11%), and A. veronii (11%). Almost all isolates exhibited a multidrug-resistant phenotype and harboured a diverse plasmidome, with the plasmid replicons ColE, IncU, and IncR being the most frequently detected. The most prevalent carbapenemase gene was the plasmid-associated blaKPC-2 and, for the first time, the blaVIM-2, blaOXA-48, and blaIMP-13 genes were identified in Aeromonas spp. Among the 3GC-resistant isolates, the blaGES-5 and blaMOX genes were the most prevalent. Of the 10 isolates examined, three were capable of transferring carbapenem resistance to susceptible recipient E. coli. Our results suggest that conventionally treated municipal and untreated hospital wastewater is a reservoir for 3GC- and carbapenem-resistant, potentially harmful Aeromonas spp. that can be introduced into aquatic systems and pose a threat to both the environment and public health. [ABSTRACT FROM AUTHOR]

This study investigates the feasibility of applying electro-Fenton (EF) and sono-electro-Fenton (SEF) processes for the removal of chemical oxygen demand (COD) from the hospital wastewater generated by the Al-Diwaniyah hospital located in Iraq. The effect of various operational parameters on COD removal was studied based on the response surface methodology (RSM). The optimal conditions for maximum removal of COD using EF were found to be a current density of 19.293 mA/cm2, an H 2 O 2 /COD ratio of 1.4, and a time duration of 46.67 min, in which 96.27% COD removal was obtained at a specific energy consumption rate of 7.325 kWh/kg COD. In the EF process, results showed that the H 2 O 2 /COD ratio has the most effect on COD removal, with a 61.76% contribution, followed by the current density, which contributed 22.78%. The suitability of the model equation was confirmed by its high R2 value (98.90%). For the SEF system, the best operating conditions were found to be a current density of 10 mA/cm2, an H 2 O 2 /COD ratio of 0.2, and a time duration of 46.67 min, in which 88.31% COD removal was obtained at a specific energy consumption of 2.082kWh/kg COD. Adopting the SEF process showed that the specific energy, H 2 O 2 , and iron consumptions are lowered by 1/3.5, 1/7, and 1/2, respectively, compared to those observed at the optimum conditions for maximizing EF alone. Results revealed a significant improvement in the EF system when combined with the ultrasonic (US) technique, wherein a considerable amount of COD removal with a final value of COD less than 100 ppm was observed at a lower cost in terms of energy consumption and the chemicals used, thus confirming the role of SEF for treating hospital wastewater using a more efficient and cost-effective approach. [ABSTRACT FROM AUTHOR]

In this work, high removal of contaminants in hospital wastewater has been achieved using an integration of electrocoagulation (EC) with ultrafiltration (UF) and reverse osmosis (RO). In EC system, Al electrodes were arranged in a monopolar-parallel and bipolar configuration. There are two parameters studied in the EC system, i.e., the configuration of electrodes (2A-2C-2B and 4A-2C-2B) and current densities. The EC-UF system with a configuration of 4A-2 C-2B and a current density of 88.5 A.m−2 resulted in high removal of TSS, TDS, BOD, and COD by 95.12 %, 97.53 %, 95.18 %, and 97.88 %, respectively. The effluent quality of the EC-UF was improved by substituting UF with RO membrane. The TSS, TDS, BOD, and COD removal were enhanced to 97.64 %, 99.85 %, 97.88 %, and 98.38 %, respectively. The permeate flux decline in UF membrane system was 47.83 % during 60 min of filtration time due to cake layer fouling on the membrane surface, while in the RO membrane system was 29.49 %. Since the EC-UF and EC-RO showed high efficiency in contaminants removal, these configurations could be used as clean technology to produce clean water for water reuse purposes. At a wastewater capacity of 5 m3.day−1, the operating cost for the EC-UF system was 3.92 US$.m−3, while the EC-RO system was 4.02 US$.m−3. The increase of wastewater capacity to 50 m3.day−1 reduced the operating cost to 0.89 US$.m−3 for the EC-UF system and 0.93 US$.m−3 for the EC-RO system. [ABSTRACT FROM AUTHOR]

This study investigated coliform removal from hospital wastewater in a membrane bioreactor (MBR) and disinfection using either chlorine or ozone. A laboratory-scale MBR equipped with a hollow-fiber membrane module was operated with hydraulic retention times varied at 3 and 6 hours. The disinfection of MBR effluent was carried out using either chlorine or ozone with concentrations varied between 1 and 10 mg/l and contact time varied between 1 and 30 min. During 150 days of MBR operation, organic removal efficiencies averaged 96.5% and 97.7% for BOD and 73.6% and 84.1% during its operation at an HRT of 3 and 6 hours respectively. Simultaneously, 6.7 and 6.4 log reduction of total coliforms and 6.2 and 6.1 log reduction of E. coli were achieved under these respective HRT conditions. The use of chlorine for disinfection of MBR effluent could eliminate total coliforms and E. coli completely at >6 and 3 mg/L at 30 min contact time, whereas only >3 and 1 mg/L was required for ozone at the same contact time. There was a significant improvement of disinfection efficacy of solid-free MBR effluent compared to that of activated sludge effluent. [ABSTRACT FROM AUTHOR]

Copyright of Annali di Igiene, Medicina Preventiva e di Comunità is the property of Societa Editrice Universo s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Resistant bacteria may leave the hospital environment through wastewater. The opportunistic pathogen Pseudomonas aeruginosa, due to its intrinsic resistance to many antibiotics and its ability to easily acquire antibiotic resistance determinants, poses a significant threat to public health. The aim of this study was to evaluate the antibiotic resistance profiles of cultivated P. aeruginosa in untreated hospital effluents in the Czech Republic. Fifty-nine P. aeruginosa strains isolated from six hospital wastewaters were tested for antimicrobial susceptibility through the disc diffusion method against seven antimicrobial agents. Resistance was found in all antibiotics tested. The highest resistance values were observed for ciprofloxacin (30.5%), gentamicin (28.8%), and meropenem (27.2%). The P. aeruginosa isolates also exhibited resistance to ceftazidime (11.5%), amikacin (11.5%), piperacillin-tazobactam (11.5%), and aztreonam (8.5%). Seventeen strains of P. aeruginosa (28.8%) were classified as multidrug-resistant (MDR). The results of this study revealed that antibiotic-resistant strains are commonly present in hospital wastewater and are resistant to clinically relevant antipseudomonal drugs. In the absence of an appropriate treatment process for hospital wastewater, resistant bacteria are released directly into public sewer networks, where they can serve as potential vectors for the spread of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Copyright of SDU Journal of Engineering Sciences & Design / Mühendislik Bilimleri ve Tasarım Dergisi is the property of Journal of Engineering Sciences & Design and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Controlling antibiotic resistance genes (ARGs) is a worldwide intervention to ensure global health. Hospital wastewater is the main pollution source of antibiotic-resistant bacteria and ARGs in the environment. Expanding our knowledge on the bacterial composition of hospital wastewater could help us to control infections in hospitals and decrease pathogen release into the environment. In this study, a high-throughput sequencing-based metagenomic approach was applied to investigate the community composition of bacteria and ARGs in untreated wastewater from three different types of hospitals [the general hospital, traditional Chinese medicine (TCM) hospital, and stomatology hospital]. In total, 130 phyla and 2,554 genera were identified from the microbiota of the wastewaters, with significantly different bacterial community compositions among the three hospitals. Total ARG analysis using the Antibiotic Resistance Genes Database (ARDB) and Comprehensive Antibiotic Resistance Database (CARD) revealed that the microbiota in the wastewaters from the three hospitals harbored different types and percentage of ARGs, and their composition was specific to the hospital type based on the correlation analysis between species and ARG abundance, some ARGs contributed to different bacterial genera with various relationships in different hospitals. In summary, our findings demonstrated a widespread occurrence of ARGs and ARG-harboring microbiota in untreated wastewaters of different hospitals, suggesting that protection measures should be applied to prevent human infections. Concurrently, hospital wastewater should be treated more specifically for the removal of pathogens before its discharge into the urban sewage system. [ABSTRACT FROM AUTHOR]

There are a number of wastewater studies, however research work of hospital wastewater is still lacking. This is owing to low volume of wastewater as compared to municipal wastewater. Nevertheless, hospital wastewater is very distinct in nature as compared to wastewater of other origins particularly owing to various hospital related activities. Hence this study evaluated treatment performance of hospital wastewater using Submerged Membrane bioreactor (SMBR) and Extended aeration process. The investigation parameters for both treatment process was kept same for comparison of treatment efficiency of both processes. Additionally, Tubesettler was employed to enhance treatment efficiency. The treatment efficiency of both processes was low. However, encoupled with Tubesettler satisfactory results were obtained. The BOD 5 /COD ratio for SMBR effluent varied between 0.22 and 0.92 while for extended aeration process ratio ranged between 0.29 and 0.92. The increase in nitrate concentration in SMBR and EA indicated nitrification. But since the system was well aerated and no anoxic or anaerobic condition prevailed denitrification was not observed. The results of this study suggested that using hospital wastewater as seeding and as influent provided lesser efficiency as compared to synthetic wastewater as influent. Also 85% COD reduction and 91% BOD 5 removal in EA indicated better performance as compared to SMBR with 72% COD reduction and 78% BOD 5 removal. However, for nitrification SMBR (295%) performed better than EA (140%) Future studies are required to establish conventional parameters with pharmaceutical removal, variation of control parameters on treatment efficiency and effect on microbial activities. [ABSTRACT FROM AUTHOR]

Purpose: This investigation aims to study the various approaches currently used to reduce the load on computer servers in order to better manage data on hospital wastewater treatment and solid waste generation. Design/methodology/approach: This manuscript investigates the taxonomies of deduplication procedures based on literature and other data sources, thereby presenting its classification and its challenges in detection. Findings: Based on the literature survey of deduplication techniques, the method of deduplication dispensed on cloud gadget devices has been found to be a promising research challenge. The gaps discussed include a reduction in storage space, bandwidth, type of disks used, and expenditure on energy usage and heat emissions when implementing these strategies. The art work on a scalable, robust, green and allocated approach to deduplication for a cloud gadget will remain of interest in destiny. Research limitations/implications: Considerable attention is focused on the deduplication due to efficient, extensive storage system. Practical implications: This research paper will be useful to identify deduplication techniques which are nowadays used in different hospital wastewater data collection systems and put significant proposals for further improvements in deduplication. Originality/value: This manuscript portrays a broader assessment of the available literature for data duplication along with the classification of different methods for the data storage used in the different level of storage of hospital wastewater data collection. [ABSTRACT FROM AUTHOR]

Wastewater (WW) carry considerable amount of chemicals that could have mutagenic or cytotoxic effect from hospital discharges to aquatic environment. Our objective was to determinate the possible mutagenic and toxic effects of hospital originated WWs and effectiveness of the wastewater treatment plants (WTP) functions. In the study the mutagenic and cytotoxic potential of three hospitals and influent/effluent of a treatment plant WW collected in Istanbul and was examined using AMES, XTT, and lactate dehydrogenase (LDH) assays. Mutagenic effects were detected at both hospital discharges and advanced biological wastewater plant. We observed no cytotoxic effect in fibroblasts for LDH and XTT assays whereas high cytotoxicity for all samples was found in hepatocytes by XTT assay. According to the results even if advanced technology is used for treatment of WW, mutagenic and cytotoxic effects still remain, and the present technologies need to be further improved. [ABSTRACT FROM AUTHOR]

Hospitals' effluents contain a considerable amount of chemicals. Considering the significant volume of wastewater discharged by hospitals, the presence of these chemicals represents a real threat to the environment and human health. Thus, the aim of this study was to evaluate the in vivo and in vitro genotoxicities of three wastewater effluents collected from Tunisian hospitals. The liver of Swiss albino male mice, previously treated with different doses of the hospital wastewaters, was used as a model to detect DNA fragmentation. Our results showed all the hospital effluents caused significant qualitative and quantitative hazards in hepatic DNA. The wastewater collected from Sfax hospital exhibited the highest genotoxic effect, which may be explained by the presence in this effluent of some toxic micropolluants. There was a significant increase in genotoxicity, proportionally to the concentration of effluent. However, the vitotox assay did not show any significant genotoxicity on Salmonella typhimurium TA104 in the presence or absence of microsomal fraction S9. The ratio gentox/cytox was lower than the threshold 1.5. This study assessed the toxicological risk issued from Tunisian hospital wastewaters, which is potentially very harmful, and it has been pointed out that wastewater treatment requires special attention. [ABSTRACT FROM AUTHOR]

The present article deals with the calibration and validation of a biological model of SMBR for hospital wastewater treatment using respirometry. In a first part, the stoichiometric and kinetic parameters are estimated and validated using the experimental oxygen uptake rate (OUR) profiles from the sodium acetate degradation process, according two kinetic theories: one considering that microorganisms use the carbon reserve and easily biodegradable substrates simultaneously for growth; and the other that microorganisms use the carbon reserve only when easily biodegradable substrate is depleted. In this study, the first theory proved to be the most adequate to predict the experimental OUR profile. In the second part, the hospital wastewater degradation process simulated using the theory determined as the more suitable. The stoichiometric parameters obtained for acetate were used for the hospital wastewater COD fractionation process, considering simultaneous growth and substrate storage. These COD fractions and the stoichiometric parameters obtained for acetate were employed for the simulation process of hospital wastewater degradation, where only kinetic parameters were calibrated. Good correspondence was obtained between experimental data and the model outputs. The values obtained for kinetic parameters were different from those obtained for sodium acetate, evidencing the influence of the substrate nature. Through the calibration of stoichiometric and kinetic parameters using the proposed procedure, the activated sludge models proved their capacity and usefulness for the simulation of a hospital wastewater degradation process. [ABSTRACT FROM AUTHOR]

The efficiency of rotating biodisks and natural oxidizing lagoon procedures is investigated at a Tunisian semi-industrial pilot plant, El Menzeh I, where the wastewater is mainly provided by three different neighbouring hospital clinics. Throughout 2011, 102 wastewater samples were collected from the two mentioned wastewater treatment procedures. Results showed that the Sapovirus (SaV) frequency was approximately 29.4% using the real-time reverse transcription polymerase chain reaction (RT-PCR) technique, and about 16.6% using the conventional RT-PCR. Also, the SaV genogroups and genotypes were identified and genotyping revealed that all of the four Tunisian SaV strains obtained belonged to the two genogroups GIV.1 and GGI.3. In addition, two new genotypes, D and C, were detected. A moderate decrease in the SaV frequencies was observed at the exit of the two treatment processes and the SaV removal rate was around 90% in the natural oxidizing lagoons and 94% in the rotating biodisks procedure showing the temperate sensitivity of these viruses to the implemented biological wastewater. Therefore, an urgent disinfection process should be implemented downstream of the two biological treatment procedures for safe release of treated effluent in the different natural environments. Abbreviations: NoV: Noroviruses; SaV: Sapoviruses; EC: Electrical Conductivity; COD: Chemical Oxygen Demand; BOD5: Biological Oxygen Demand; SS: Suspended Solids; NH4-N: Ammonium Nitrogen; P-PO4: Ortho-Phosphate; AlCl3: aluminum chloride [ABSTRACT FROM AUTHOR]

• Viruses were persistent in the influent and effluent of hospital wastewater systems. • Only 0.14% of the total viral populations carried ARGs in hospital wastewater. • More than half of phages that host antibiotic-resistant bacteria were lytic. Antimicrobial resistance poses a serious threat to human health and is responsible for the death of millions of people annually. Hospital wastewater is an important hotspot for antibiotic-resistance genes (ARGs) and antibiotic-resistant bacteria (ARB). However, little is known about the relationship between phages and ARGs in hospital wastewater systems (HWS). In the present study, the viral diversity of 12 HWSs using data from public metagenomic databases was investigated. Viruses were widely found in both the influent and effluent of each HWS. A total of 45 unique ARGs were carried by 85 viral contigs, which accounted for only 0.14% of the total viral populations, implying that ARGs were not commonly present in phages. Three efflux pump genes were identified as shared between phages and bacterial genomes. However, the predominant types of ARGs in HWS such as aminoglycoside- and beta-lactam-resistance genes were rarely found in phages. Based on CRISPR spacer and tRNA matches, interactions between 171 viral contigs and 60 antibiotic-resistant genomes were predicted, including interactions involving phages and vancomycin-resistant Enterococcus_B faecium or beta-lactam-resistant Klebsiella pneumoniae. More than half (56.1%) of these viral contigs indicated lytic and none of them carried ARGs. As the vOTUs in this study had few ARGs and were primarily lytic, HWS may be a valuable source for phage discovery. Future studies will be able to experimentally validate these sequence-based results to confirm the suitability of HWS phages for pathogen control measures in wastewater. [Display omitted] [ABSTRACT FROM AUTHOR]

Investigation of domestic and hospital effluents in a sewage system of an elementary watershed showed that antibiotics belonging to eight classes were present with concentrations ranging from < LOQ to 50 μg L − 1 . The compounds most often detected in the effluents were the fluoroquinolones (79–100%), the sulfonamides (86–100%) and the macrolides (79–86%). Vancomycin, strictly reserved for hospital use in France, was detected exclusively in the hospital effluent, supporting its pertinent use as a marker of hospital discharge. Beta-lactams, which are among the most frequently consumed compounds, were rarely detected in the effluents, due to their rapid hydrolysis. Out of 23 antibiotics used in veterinary and human medicine, fourteen were quantified in both the wastewater treatment plant (WWTP) input and output: erythromycin, amoxicillin, tetracycline, trimethoprim, ormethoprim, sulfamethoxazole, vancomycin and seven quinolones (flumequine, enrofloxacin, enoxacin, ofloxacin, lomefloxacin, norfloxacin and ciprofloxacin). Antibiotic concentrations in the hospital effluent (from 0.04 to 17.9 μg L − 1 ) were ten times higher than those measured in the domestic effluent (from 0.03 to 1.75 μg L − 1 ), contributing to 90% of the antibiotic inputs to the WWTP. Some molecules such as sulfamethoxazole, erythromycin and trimethoprim displayed higher concentrations after wastewater treatment due to deconjugation of their metabolites, which restores the parent molecules. For other compounds, the antibiotic elimination showed discrepancies depending on their physicochemical properties. For fluoroquinolones, the apparent removal processes were mainly based on adsorption mechanisms, followed by settling, leading to sludge contamination (from 13 to 18,800 μg kg − 1 dry weight). [ABSTRACT FROM AUTHOR]

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 theHWWsample, whereas the abundance of Proteobacteria in theHWWsample 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. [ABSTRACT FROM AUTHOR]

In this study, the ozonation of raw hospital wastewater was conducted in the batch reactor and the efficiency of this pretreatment was evaluated based on both chemical oxygen demand (COD)-in H2O2 and absorbance-non-H2O2. Process variables as initial pH, reaction time, ozone concentration and H2O2 were investigated as major factors. Response surface methodology (RSM) was applied to evaluate the major factors influencing organic matter and color removal rates, and the interactions between these factors, and optimized the operating parameters as well. Quadratic models were developed with 60% absorbance and 46% COD as the responses, and the model predictions were confirmed to be appropriate to the experimental data with a deviation less than 3.5%. [ABSTRACT FROM AUTHOR]