Hospital effluent: Investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment

Verlicchi, Paola; Aukidy, M. Al; Galletti, Alessio; Petrović, Mira; Barceló, Damià

doi:10.1016/j.scitotenv.2012.04.055

Cited by 499 publications

(274 citation statements)

References 39 publications

Supporting

Mentioning

209

Contrasting

Unclassified

Order By: Relevance

“…Comparatively to previous findings, Thomas et al (2007) reported higher levels of acetaminophen (329,852 ng L − 1 ) in the effluents of hospitals from Oslo (Norway), while ibuprofen did not exceed 8957 ng L − 1 .On the other hand, lower concentrations of these pharmaceuticals were detected in the effluents of two Italian hospitals, where acetaminophen levels went from 1400 to 5900 ng L − 1 and ibuprofen from 380 to 3200 ng L − 1 (Verlicchi et al, 2012a). Opposite to this trend, Sim et al (2011) never detected acetaminophen or ibuprofen in effluents from four general hospitals in Korea.…”

Section: Occurrence Of Pharmaceuticals In Hospital Effluentscontrasting

confidence: 52%

“…These changes will have impact on pharmaceuticals detected in hospital effluents, since they are closely related with the substances that are being administered in a certain hospital as well as their quantities. Several authors have shown the presence of pharmaceuticals in hospital wastewaters (Gómez et al, 2006;Lin and Tsai, 2009;Sim et al, 2011;Verlicchi et al, 2012a;Weissbrodt et al, 2009). Furthermore, hospital effluents also play an important role in the introduction of pathogens into public wastewaters, especially concerning multi-resistant bacteria, contributing to the spread of antibiotic resistance into the environment (Kümmerer, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Usually hospital effluents are directly discharged into public sewer network, being co-treated with domestic wastewaters in municipal WWTPs. This practice has been questioned by some authors (Pauwels and Verstraete, 2006;Verlicchi et al, 2012a), who suggested the adoption of a more dedicated treatment for hospital effluents before being discharged into public wastewaters and then both urban and hospital wastewaters would be subsequently treated in WWTPs (Pauwels and Verstraete, 2006;Verlicchi et al, 2010a). This approach has benefits like avoiding the dilution of hospital wastewaters with urban wastewaters, which may result in the inhibition of biomass and reduction of removal efficiency in WWTPs, as well as to avoid losses into the environment due to sewer leakage and combined sewer overflows (Kovalova et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, few data is available on the contribution of hospital effluents towards the load of pharmaceuticals in WWTPs (Beier et al, 2011;Langford and Thomas, 2009;Ort et al, 2010;Thomas et al, 2007;Verlicchi et al, 2012a). At the same time, available data regarding the environmental risk posed by hospital effluents to aquatic organisms is still sparse and often limited to predicted (Escher et al, 2011;Souza et al, 2009) rather than measured concentrations (Verlicchi et al, 2012a).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: Identification of ecologically relevant pharmaceuticals

Santos

Gros²,

Rodríguez-Mozaz³

et al. 2013

Science of The Total Environment

507

204

View full text Add to dashboard Cite

The impact of effluent wastewaters from four different hospitals: a university (1456 beds), a general (350 beds), a pediatric (110 beds) and a maternity hospital (96 beds), which are conveyed to the same wastewater treatment plant (WWTP), was evaluated in the receiving urban wastewaters. The occurrence of 78 pharma-ceuticals belonging to several therapeutic classes was assessed in hospital effluents and WWTP wastewaters (influent and effluent) as well as the contribution of each hospital in WWTP influent in terms of pharmaceu-tical load. Results indicate that pharmaceuticals are widespread pollutants in both hospital and urban waste-waters. The contribution of hospitals to the input of pharmaceuticals in urban wastewaters widely varies, according to their dimension. The estimated total mass loadings were 306 g d − 1 for the university hospital, 155 g d − 1 for the general one, 14 g d −1 for the pediatric hospital and 1.5 g d − 1 for the maternity hospital, showing that the biggest hospitals have a greater contribution to the total mass load of pharmaceuticals. Fur-thermore, analysis of individual contributions of each therapeutic group showed that NSAIDs, analgesics and antibiotics are among the groups with the highest inputs. Removal efficiency can go from over 90% for pharmaceuticals like acetaminophen and ibuprofen to not removal for β-blockers and salbutamol. Total mass load of pharmaceuticals into receiving surface waters was estimated between 5 and 14 g/d/1000 inhabitants. Finally, the environmental risk posed by pharmaceuticals detected in hospital and WWTP effluents was assessed by means of hazard quotients toward different trophic levels (algae, daphnids and fish). Several pharmaceuticals present in the different matrices were identified as potentially hazardous to aquatic organ-isms, showing that especial attention should be paid to antibiotics such as ciprofloxacin, ofloxacin, sulfameth-oxazole, azithromycin and clarithromycin, since their hazard quotients in WWTP effluent revealed that they could pose an ecotoxicological risk to algae.

show abstract

Section: Occurrence Of Pharmaceuticals In Hospital Effluentscontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: Identification of ecologically relevant pharmaceuticals

Santos

Gros²,

Rodríguez-Mozaz³

et al. 2013

Science of The Total Environment

507

204

View full text Add to dashboard Cite

show abstract

“…PNEC values of the PPCPs were estimated based on toxicity data reported in the literature (Hernando et al, 2006;Verlicchi et al, 2012), as summarized in the Supporting information (Table S4). Risks were subsequently classified into three levels: RQ 0.01-0.1, low risk; RQ 0.1-1, medium risk; and RQ N 1, high risk (Hernando et al, 2006).…”

Section: Environmental Risksmentioning

confidence: 99%

Occurrence and ecological potential of pharmaceuticals and personal care products in groundwater and reservoirs in the vicinity of municipal landfills in China

Peng

Wang

et al. 2014

Science of The Total Environment

239

View full text Add to dashboard Cite

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Balch¹,

Schoen²,

Patel

2017

AMA Journal of Ethics

View full text Add to dashboard Cite

Pharmaceuticals are beginning to receive attention as a source of pollution in aquatic environments. Yet the impact of physician prescription patterns on water resources is not often discussed in clinical decision making. Here, we comment on a case in which empiric antibiotic treatment might benefit a patient while simultaneously being detrimental to the aquatic environment. We first highlight the potential harm caused by this prescription from its production to its disposal. We then suggest that Van Rensselaer Potter's original conceptualization of bioethics can be used to balance clinicians' obligations to protect individual, public, and environmental health. CaseDr. Turner, a hospitalist, is called to assess Mr. Johnson, an elderly patient with a history of urinary tract infections (UTIs), who presented to the ER with altered mental status. Urine cultures are pending but previous cultures have grown Escherichia coli (E. coli) with an extended-spectrum beta-lactamase (ESBL) gene. Although Mr. Johnson improves with intravenous fluids, Dr. Turner plans to treat Mr. Johnson with ciprofloxacin, a broadspectrum fluoroquinolone-class antibiotic, to cover the E. coli that he has grown in the past. Dr. Turner recently read that this drug can persist, unaltered, in the hospital's wastewater collection system and in the municipal wastewater water treatment plant (WWTP). While much will be filtered, a quantifiable amount will end up in Mr. Johnson's local watershed. How should Dr. Turner, other physicians, and their institutions weigh the benefits that individual patients derive from pharmaceutical treatment with the contamination risk this treatment poses to freshwater resources used by entire communities and ecosystems?

show abstract

Hospital effluent: Investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment

Cited by 499 publications

References 39 publications

Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: Identification of ecologically relevant pharmaceuticals

Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: Identification of ecologically relevant pharmaceuticals

Occurrence and ecological potential of pharmaceuticals and personal care products in groundwater and reservoirs in the vicinity of municipal landfills in China

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Contact Info

Product

Resources

About