Hospital effluents as a source of emerging pollutants: An overview of micropollutants and sustainable treatment options

Verlicchi, Paola; Galletti, Alessio; Petrović, Mira; Barceló, Damià

doi:10.1016/j.jhydrol.2010.06.005

Cited by 699 publications

(391 citation statements)

References 114 publications

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“…Analgesics/anti-inflammatories, antibiotics and X-ray contrast agent are amongst the therapeutic groups most widely detected in hospital effluents, as was previously reported by Verlicchi et al (2010b).…”

Section: Occurrence Of Pharmaceuticals In Hospital Effluentssupporting

confidence: 54%

“…Glibenclamide has been described as the oral antidiabetic most often used in hospitals (Verlicchi et al, 2010b) and its presence has been reported in their effluents at concentrations from 50 to 110 ng L −1 (Verlicchi et al, 2012a). Nevertheless, in this study only metformin was detected in hospital effluents, rising levels up to 4040 ng L −1 in maternity hospital, which might be justified with the higher consumption rate of metformin among Portuguese population comparatively to glibenclamide (INFARMED, 2012).…”

Section: Occurrence Of Pharmaceuticals In Hospital Effluentsmentioning

confidence: 55%

“…Several studies pointed out that Wastewater Treatment Plants (WWTPs) are not able to completely remove pharmaceuticals (Behera et al, 2011;Gracia-Lor et al, 2012;Jelic et al, 2011;Kosma et al, 2010;Zorita et al, 2009). Besides urban wastewaters, hospital wastewaters have also stood up as an important environmental exposure pathway of pharmaceuticals (Verlicchi et al, 2010b).…”

Section: Introductionmentioning

confidence: 99%

“…Due to their specific nature, it is expected that hospital effluents present a mixture of compounds, including not only pharmaceuticals and their metabolites, but also diagnostic agents, disinfectants, among others, resulting from diagnostic, laboratory and research activities and principally from medicine excretion from patients (Verlicchi et al, 2010b). Consumption, use and application of pharmaceuticals in a hospital may vary over the year and from country to country (Schuster et al, 2008), due to the predominance of diseases and to the hospital activity, as well as to the local list of pharmaceuticals suggested for the treatment of different diseases.…”

Section: Introductionmentioning

confidence: 99%

“…), number and types of wards and units, institution management policies, cultural and geographical factors, among others (Verlicchi et al, 2010b). Usually hospital effluents are directly discharged into public sewer network, being co-treated with domestic wastewaters in municipal WWTPs.…”

Section: Introductionmentioning

confidence: 99%

See 4 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

524

216

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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.

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Section: Occurrence Of Pharmaceuticals In Hospital Effluentssupporting

confidence: 54%

Section: Occurrence Of Pharmaceuticals In Hospital Effluentsmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

524

216

View full text Add to dashboard Cite

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Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Balch¹,

Schoen²,

Patel

2017

AMA Journal of Ethics

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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?

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Liquid Chromatography/Mass Spectrometry in Environmental Analysis

Mattarozzi

Careri

2015

Encyclopedia of Analytical Chemistry

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Liquid chromatography/mass spectrometry (LC‐MS) technique enables analysis of emergent polar compounds without the need for derivatization reaction, while the introduction of high‐resolution mass analyzers in hybrid configurations makes possible to elucidate chemical structure, also without reference standards. Over the past 10 years, besides target analysis, the coupling of LC to high‐resolution mass spectrometry (HRMS) has allowed screening of compounds expected to be in the environment, as well as nontarget screening of unknown compounds, such as transformation products (TPs) formed in the environment or during technical wastewater and sewage purification treatments. Nowadays, analytical chemists are trying to achieve real nontarget analysis of numerous unknowns in environmental samples for a comprehensive view of the true overall contamination present in samples, but it still remains a very challenging issue. The development of new software tools to extract relevant data, spectra libraries, and databases will be of great help to solve this issue, enhancing the success rate. This article represents the second edition of a previous manuscript by Careri,2000 which was updated to take into account the huge progress in MS instrumentation and related methodologies and also advances in environmental analytical chemistry. In this overview, among the environmental applications of LC‐MS, current and innovative approaches for the analysis of selected classes of emerging pollutants, such as novel brominated flame retardants, nanomaterials, hormones and other endocrine disruptors, and pharmaceutical and personal care products in environmental samples are discussed.

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Hospital effluents as a source of emerging pollutants: An overview of micropollutants and sustainable treatment options

Cited by 699 publications

References 114 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

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Liquid Chromatography/Mass Spectrometry in Environmental Analysis

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