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 h to 2.6 h. 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%.

Previous studies have demonstrated that aerobic moving bed biofilm reactors (MBBRs) remove pharmaceuticals better than activated sludge. Thus we used a MBBR system to polish the effluent of an activated sludge wastewater treatment plant. To overcome that effluent contains insufficient organic matter to sustain enough biomass, the biofilm was intermittently fed with raw wastewater. The capacity of pharmaceutical degradation was investigated by spiking pharmaceuticals. Actual removal during treatment was assessed by sampling the inlets and outlets of reactors. The removal of the majority of pharmaceuticals was enhanced through the intermittent feeding of the MBBR. First-order rate constants for pharmaceutical removal, normalised to biomass, were significantly higher compared to other studies on activated sludge and suspended biofilms, especially for diclofenac, metoprolol and atenolol. Due to the intermittently feeding, degradation of diclofenac occurred with a half-life of only 2.1h and was thus much faster than any hitherto described wastewater bioreactor treatment.

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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 degradation of organic micropollutants in wastewater treatment is suspected to depend on co-degradation i.e. be dependent on concentrations of substrate. This complicates predicting and modelling their fate. The effect of humic acid, as a model for complex organic substrate, was investigated in relation to the biodegradation of pharmaceuticals by suspended biofilm carriers adapted to polishing effluent water from a tertiary sewage treatment plant. Twelve out of 22 investigated pharmaceuticals were significantly biodegradable. The biodegradation rate constants of ten of those compounds were increasing with increased humic acid concentrations. At the highest humic acid concentration (30mgC/L), the biodegradation rate constants were four times higher than the biodegradation rate constants without added humic acid. This shows that the presence of complex substrate stimulates degradation via a co-metabolism-like mechanism and competitive inhibition does not occur. Increases of rate constant per mgC/L are tentatively calculated.