Skip to main content
SpringerLink
Log in

Micro-pollutants in Hospital Effluent: Their Fate, Risk and Treatment Options

  • Chapter
  • First Online:
Book cover Emerging Organic Contaminants and Human Health

Part of the book series: The Handbook of Environmental Chemistry ((HEC,volume 20))

Abstract

This chapter deals with the physicochemical characteristics of hospital effluents, focusing on both macropollutants (conventional contaminants) and micro-pollutants (pharmaceutical compounds, heavy metals and diagnostic agents). It compares their typical concentration ranges measured in hospital effluents and urban wastewaters and then discusses the behaviour of micro-pollutants, mainly pharmaceutical compounds during common treatment processes and upon their release into the environment, attempting to find correlations with their physical properties. It then goes on to provide an overview of the most commonly adopted strategies for managing and treating hospital effluents worldwide, focusing on the ability of the various treatments to remove the wide spectrum of pharmaceuticals contained therein. Some considerations are also made on the tools available for assessing the environmental risks posed by the discharge of hospital effluents, and, finally, guidelines for the best treatment options are proposed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 329.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kolpin DW, Furlong ET, Meyer MT, Thurman EM, Zaugg SD, Barber LB, Buxton HT (2002) Pharmaceuticals, hormones, and other organic wastewater contaminants in U.S. streams, 1999-2000: a national reconnaissance. Environ Sci Technol 36:1202–1211

    CAS  Google Scholar 

  2. Foster AL (2007) Occurrence and fate of endocrine disruptors through the San Marco Wastewater treatment plant. Thesis of Master of Science, Texas State University, USA

    Google Scholar 

  3. Fatta-Kassinos D, Meric S, Nikolaou A (2011) Pharmaceutical residues in environmental waters and wastewater: current status of knowledge and future research. Anal Bioanal Chem 399:251–275

    CAS  Google Scholar 

  4. Khan S, Ongerth J (2005) Occurrence and removal of pharmaceuticals at an Australian sewage treatment plant. Water 32:35–39

    Google Scholar 

  5. Joss A, Andersen H, Ternes T, Richle PR, Siegrist H (2004) Removal of estrogen in municipal wastewater treatment under aerobic and anaerobic conditions: consequences for plant optimization. Environ Sci Technol 38:3047–3055

    CAS  Google Scholar 

  6. Joss A, Keller E, Alder AC, Gobel A, McArdell CS, Ternes T, Siegrist H (2005) Removal of pharmaceuticals and fragrances in biological wastewater treatment. Water Res 39:3139–3152

    CAS  Google Scholar 

  7. Duong H, Pham N, Nguyen H, Hoang T, Pham H, Ca Pham V, Berg M, Giger W, Alder A (2008) Occurrence, fate and antibiotic resistance of fluoroquinolone antibacterials in hospital wastewaters in Hanoi, Vietnam. Chemosphere 72:968–973

    CAS  Google Scholar 

  8. Suarez S, Lema JM, Omil F (2009) Pre-treatment of hospital wastewater by coagulation-flocculation and flotation. Bioresour Technol 100:2138–2146

    CAS  Google Scholar 

  9. Verlicchi P, Galletti A, Petrovic M, Barcelò D (2010) Hospital effluents as a source of emerging pollutants: an overview of micropollutants and sustainable treatment options. J Hydrol 389:416–428

    CAS  Google Scholar 

  10. Sim WJ, Lee JW, Lee ES, Shin SK, Hwang SR, Oh JE (2011) Occurrence and distribution of pharmaceuticals in wastewater from households, livestock farms, hospitals and pharmaceutical manufactures. Chemosphere 82:179–186

    CAS  Google Scholar 

  11. Hawkshead JJ (2008) Hospital wastewater containing pharmaceuticals active compounds and drug-resistant organisms: a source of environmental toxicity and increased antibiotic resistance. J Residual Sci Tech 5:51–60

    CAS  Google Scholar 

  12. Pauwels B, Verstraete W (2006) The treatment of hospital wastewater: an appraisal. J Water Health 4:405–416

    CAS  Google Scholar 

  13. Verlicchi P, Galletti A, Masotti L (2010) Management of hospital wastewaters: the case of the effluent of a large hospital situated in a small town. Water Sci Technol 61:2507–2519

    CAS  Google Scholar 

  14. Schuster A, Hadrick C, Kummerer K (2008) Flows of active pharmaceutical ingredients originating from health care practises on a local, regional, and national level in Germany – is hospital effluent treatment an effective approach for risk reduction? Water Air Soil Pollut Focus 8:457–471

    Google Scholar 

  15. Leprat P (1999) Caractéristiques et impacts des rejets liquides hospitaliers. Tech Hosp 634:56–57

    Google Scholar 

  16. Altin A, Altin S, Degirmenci M (2003) Characteristics and treatability of hospital (medical) wastewaters. Fresenius Environ Bull 12:1098–1108

    CAS  Google Scholar 

  17. Kummerer K, Erbe T, Gartiser S, Brinker L (1998) AOX-emissions from hospital into municipal wastewater. Chemosphere 36:2437–2445

    CAS  Google Scholar 

  18. Wen X, Ding H, Huang X, Liu R (2004) Treatment of hospital wastewater using a submerged membrane bioreactor. Process Biochem 39:1427–1431

    CAS  Google Scholar 

  19. Emmanuel E, Perrodin Y, Keck G, Blanchard JM, Vermande P (2005) Ecotoxicological risk assessment of hospital wastewater: a proposed framework for raw effluents discharging into urban sewer network. J Hazard Mater A117:1–11

    Google Scholar 

  20. Emmanuel E, Pierre MG, Perrodin Y (2009) Groundwater contamination by microbiological and chemical substances released from hospital wastewater: health risk assessment for drinking water consumers. Environ Int 35:718–726

    CAS  Google Scholar 

  21. Hartemann P, Hautemaniere A, Joyeux M (2005) La problématique des effluents hospitaliers. Hygiène 13:369–374

    Google Scholar 

  22. Tsakoma M, Anagnostopoulou E, Gidarakos E (2007) Hospital waste management and toxicity evaluation: a case study. Waste Manag 27:912–920

    Google Scholar 

  23. Boillot C, Bazin C, Tissot-Guerraz F, Droguet J, Perraud M, Cetre JC, Trepo D, Perrodin Y (2008) Daily physicochemical, microbiological and ecotoxicological fluctuations of a hospital effluent according to technical and care activities. Sci Total Environ 403:113–129

    CAS  Google Scholar 

  24. Verlicchi P, Galletti A, Al Aukidy M (2011) Hospital wastewaters: quali-quantitative characterization and strategies for their treatment and disposal. In: Sharma SK, Sanghi R (eds) Water treatment and pollution prevention: advances in research. Springer (in press)

    Google Scholar 

  25. Lopez N, Deblonde T, Hartemann Ph (2010) Les effluents liquid hospitaliers. Hygiène 18:405–410

    Google Scholar 

  26. Gomez MJ, Aguera A, Mezcua M, Hurtado J, Mocholi F, Fernandez-Alba AR (2007) Simultaneous analysis of neutral and acidic pharmaceuticals as well as related compounds by gas chromatography-tandem mass spectrometry in wastewater. Talanta 73:314–320

    CAS  Google Scholar 

  27. Kummerer K, Henninger A (2003) Promoting resistance by the emission of antibiotics from hospital and households into effluent. Clin Microbiol Infect 9:1203–1214

    CAS  Google Scholar 

  28. Schwartz T, Kohnen W, Jansen B, Obst U (2003) Detection of antibiotic-resistant bacteria and their resistance genes in wastewater, surface water, and water biofilms. FEMS Microbiol Ecol 43:325–335

    CAS  Google Scholar 

  29. Adelowo O, Fagade OE, Oke AJ (2008) Prevalence of co-resistance to disinfectants and clinically relevant antibiotics in bacterial isolates from three hospital laboratory wastewaters in South-western Nigeria. World J Microbiol Biotechnol 24:1993–1997

    CAS  Google Scholar 

  30. Chitnis V, Chitnis S, Vaidya K, Ravikant S, Patil S, Chitnis DS (2004) Bacterial population changes in hospital effluent treatment plant in central India. Water Res 38:441–447

    CAS  Google Scholar 

  31. Prado T, Silva DM, Guilayn WC, Rose TL, Gaspar AMC, Miagostovich MP (2011) Quantification and molecular characterization of enteric viruses detected in effluents from two hospital wastewater treatment plants. Water Res 45:1287–1297

    CAS  Google Scholar 

  32. Kummerer K (2001) Drugs in the environment: emission of drugs, diagnostic aids and disinfectants into wastewater by hospital in relation to other sources - a review. Chemosphere 45:957–969

    CAS  Google Scholar 

  33. Kummerer K, Helmers E, Hubner P, Mascart G, Milandri M, Reinthaler F, Zwakenberg M (1999) European hospitals as a source for platinum in the environment in comparison with other sources. Sci Total Environ 225:155–165

    CAS  Google Scholar 

  34. Lenz K, Mahnik SN, Weissenbacher N, Mader RM, Krenn P, Hann S, Koellensperger G, Uhl M, Knasmuller S, Ferk F, Bursch W, Fuerhacker M (2007) Monitoring, removal and risk assessment of cytostatic drugs in hospital wastewater. Water Sci Technol 56:141–149

    CAS  Google Scholar 

  35. Kummerer K, Helmers E (2000) Hospital effluents as a source of gadolinium in the aquatic environment. Environ Sci Technol 34:573–577

    Google Scholar 

  36. Verlicchi P, Galletti A, Masotti L (2008) Caratterizzazione e trattabilità di reflui ospedalieri: in-dagine sperimentale (con sistemi MBR) presso un ospedale dell’area ferrarese, Proc. Sidisa Conference Florence, Italy

    Google Scholar 

  37. Barceló D (2003) Emerging pollutants in water analysis. Trac-Trend Anal Chem 22:xiv–xvi

    Google Scholar 

  38. Jjemba PK (2006) Excretion and ecotoxicity of pharmaceuticals and personal care products in the environment. Ecotox Environ Safe 63:113–130

    CAS  Google Scholar 

  39. Halling-Sorensen B, Nors Nielsen S, Lanzky PF, Ingerslev F, Holten Lutzhoft HC, Jorgensen SE (1998) Occurrence, fate and effects of pharmaceutical substances in the environment- a review. Chemosphere 36:357–393

    CAS  Google Scholar 

  40. Lienert J, Burki T, Escher BI (2007) Reducing micropollutants with source control: substance flow analysis of 212 pharmaceuticals in faeces and urine. Water Sci Technol 55:87–96

    Google Scholar 

  41. Heberer T (2002) Occurrence, fate, and removal of pharmaceutical residues in the aquatic environment: a review of recent research data. Toxicol Lett 131:5–17

    CAS  Google Scholar 

  42. Verlicchi P, Al Aukidy M, Galletti A, Petrovic M, Barcelò D (2011) Hospital effluent: investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment (in press)

    Google Scholar 

  43. Lin AYC, Yu TH, Lin CF (2008) Pharmaceutical contamination in residential, industrial, and agricultural waste streams: risk to aqueous environments in Taiwan. Chemosphere 74:131–141

    CAS  Google Scholar 

  44. Galletti A, Verlicchi P, Al Aukidy M, Petrovic M, Barcelò D (2011) Hospital as a source of emerging contaminants (pharmaceuticals): results of an investigation on its final effluent chemical characteristics. Proc. CEST 2011, Rhodes A578–A587

    Google Scholar 

  45. Tauxe-Wuersch A, De Alencastro LP, Grandjean D, Tarradellas J (2006) Trace determination of tamoxifen and 5-fluorouracil in hospital and urban wastewaters. Int J Environ Anal Chem 86:473–485

    CAS  Google Scholar 

  46. Gomez MJ, Petrovic M, Fernandez-Alba AR, Barcelò D (2006) Determination of pharmaceuticals of various therapeutic classes by solid-phase extraction and liquid chromatography-tandem mass spectrometry analysis in hospital effluent wastewaters. J Chromatogr A 1114:224–233

    CAS  Google Scholar 

  47. Nagarnaik P, Batt A, Boulanger B (2011) Source characterization of nervous active pharmaceutical ingredients in healthcare facility wastewaters. J Environ Manage 92:872–877

    CAS  Google Scholar 

  48. Heberer T, Feldman D (2005) Contribution of effluents from hospital and private households to the total loads of diclofenac and carbamazepine in municipal sewage effluents – modeling versus measurements. J Hazard Mater 122:211–218

    CAS  Google Scholar 

  49. Escher BI, Baumgartner R, Koller M, Treyer K, Lienert J, McArdell CS (2011) Environmental toxicology and risk assessment of pharmaceuticals from hospital wastewater. Water Res 45:75–92

    CAS  Google Scholar 

  50. EMEA (2003) Note for guidance on environmental risk assessment of medicinal products for human use. DRAFT. CPMP/SWP/4447/00 draft corr. The European Agency for the Evaluation of Medical Products

    Google Scholar 

  51. EMEA (2006) Guideline on the environmental risk assessment of medicinal products for human use CHMP/SWP/4447/00. The European Agency for the Evaluation of Medicinal Products, London

    Google Scholar 

  52. DDD data web site URL: http://www.whocc.no/atc_ddd_index/. Accessed 2 Nov 2011

  53. Kummerer K (2009) Antibiotics in the aquatic environment – a review – Part I. Chemosphere 75:417–439

    Google Scholar 

  54. Epi: suite program available at the website (accessed 28 Oct 2011) http://www.epa.gov/oppt/exposure/pubs/episuite.htm

  55. Suarez S, Carballa M, Omil F, Lema JM (2008) How are pharmaceutical and personal care products (PPCPs) removed from urban wastewaters? Rev Environ Sci Biotechnol 7:125–138

    CAS  Google Scholar 

  56. Ternes TA, Joss A (2006) Human Pharmaceuticals, Hormones and Fragrances. The challenge of micropollutants in urban water management. IWA Publishing, London

    Google Scholar 

  57. Joss A, Zabczynsk S, Gobel A, Hoffmann B, Loffler D, McArdell CS, Ternes TA, Thomsen A, Siegrist H (2006) Biological degradation of pharmaceuticals in municipal wastewater treatment: proposing a classification scheme. Water Res 40:1686–1696

    CAS  Google Scholar 

  58. Radjenovic J, Petrovic M, Barceló D (2009) Fate and distribution of pharmaceuticals in wastewater and sewage sludge of the conventional activated sludge (CAS) and advanced membrane bioreactor (MBR) treatment. Water Res 43:831–841

    CAS  Google Scholar 

  59. Clara M, Kreuzinger N, Strenn B, Gans O, Kroiss H (2005) The solids retention time—a suitable design parameter to evaluate the capacity of wastewater treatment plants to remove micropollutants. Water Res 39:97–106

    CAS  Google Scholar 

  60. USEPA (2009) Nutrient Control Design Manual, State of Technology Review report, EPA/600/R-09/012, U.S. Environmental Protection Agency, Washington, D.C.

    Google Scholar 

  61. Kummerer K (2009) The presence of pharmaceuticals in the environment due to human use – present knowledge and future challenges. J Environ Manage 90:2354–2366

    Google Scholar 

  62. Golet EM, Alder AC, Giger W (2002) Environmental exposure and risk assessment of fluoroquinolone antibacterial agents in wastewater and river water of the Glatt Valley Watershed, Switzerland. Environ Sci Technol 36:3645–3651

    CAS  Google Scholar 

  63. Gu C, Karthikeyan KG (2005) Sorption of the antimicrobial ciprofloxacin to aluminum and iron hydrous oxides. Environ Sci Technol 39:9166–9173

    CAS  Google Scholar 

  64. Christian T, Schneider RJ, Färber HA, Skutlarek D, Meyer MT, Goldbach HE (2003) Determination of antibiotic residues in manure, soil, and surface waters. Acta Hydrochim Hydrobiol 31:36–44

    CAS  Google Scholar 

  65. Gu C, Karthikeyan KG (2008) Sorption of the antibiotic tetracycline to humic-mineral complexes. J Environ Qual 37:704–711

    CAS  Google Scholar 

  66. Carballa M, Omil F, Lema JM (2005) Removal of cosmetic ingredients and pharmaceuticals in sewage primary treatment. Water Res 39:4790–4796

    CAS  Google Scholar 

  67. Bendz D, Paxéus NA, Ginn TR, Loge FJ (2005) Occurrence and fate of pharmaceutically active in the environment, a case study: Hoje River in Sweden. J Hazard Mater 122:195–204

    CAS  Google Scholar 

  68. Vieno N, Tuhkanen T, Kronberg L (2007) Elimination of pharmaceuticals in sewage treatment plants in Finland. Water Res 41:1001–1012

    CAS  Google Scholar 

  69. Jalonen HG (1988) Simultaneous determination of tamoxifen citrate and its E-isomer impurity in bulk drug and tablets by high-performance liquid-chromatography. J Pharm Sci 77:810–813

    CAS  Google Scholar 

  70. Andreozzi R, Raffaele M, Nicklas P (2003) Pharmaceuticals in STP effluents and their solar photodegradation in aquatic environment. Chemosphere 50:1319–1330

    CAS  Google Scholar 

  71. Werner JJ, Arnold WA, McNeill K (2006) Water hardness as a photochemical parameter: tetracycline photolysis as a function of calcium concentration, magnesium concentration, and pH. Environ Sci Technol 40:7236–7241

    CAS  Google Scholar 

  72. Kallenborn R, Fick J, Lindberg R, Moe M, Nielsen KM, Tysklind M, Vasskog T (2008) Pharmaceutical residues in Northern European environments: consequences and perspectives. In: Kümmerer K (ed) Pharmaceuticals in the environment. Sources, fate, effects and risk, 3rd edn. Springer, Berlin, pp 61–74

    Google Scholar 

  73. Turiel E, Bordin G, Rodríguez AR (2005) Study of the evolution and degradation products of ciprofloxacin and oxolinic acid in river water samples by HPLC–UV/MS/MS–MS. J Environ Monit 7:189–195

    CAS  Google Scholar 

  74. Hu L, Flanders PM, Miller PL, Strathmann TJ (2008) Oxidation of sulfamethoxazole and related antimicrobial agents by TiO2 photocatalysis. Water Res 41:2612–2626

    Google Scholar 

  75. Sukul P, Lamshöft M, Zühlke S, Spiteller M (2008) Photolysis of (14)C-sulfadiazine in water and manure. Chemosphere 71:717–725

    CAS  Google Scholar 

  76. Verlicchi P, Galletti A, Al Aukidy M (2011) Best practices in the management of hospital effluents. Proc. VI EWRA International Symposium Water Engineering and Management in a Changing Environment, Catania, Italy

    Google Scholar 

  77. Kreuzinger N, Clara M, Droiss H (2004) Relevance of the Sludge Retention Time (SRT) as de-sign criteria for wastewater treatment plants for the removal of endocrine disruptors and pharmaceuticals from wastewater. Water Sci Technol 50:149–156

    CAS  Google Scholar 

  78. Kimura K, Hara H, Watanabe Y (2007) Elimination of selected acidic pharmaceuticals from municipal wastewaters by activated sludge systems and membrane bioreactors. Environ Sci Technol 41:3708–3714

    CAS  Google Scholar 

  79. Oppenheimer J, Wert EC, Yoon Y (2007) Role of membranes and activated carbon in the removal of endocrine disruptors and pharmaceuticals. Desalination 202:156–181

    Google Scholar 

  80. Radjenovic J, Petrovic M, Barceló D (2007) Analysis of pharmaceuticals in wastewater and removal using a membrane bioreactor. Anal Bioanal Chem 387:1365–1377

    CAS  Google Scholar 

  81. Ottoson J, Hansen A, Bjorlenius B, Norder H, Stenstrom TA (2006) Removal of viruses, parasitic protozoa and microbial indicators in conventional and membrane processes in a wastewater pilot plant. Water Res 40:1449–1457

    CAS  Google Scholar 

  82. Zhang K, Farahbakhsh K (2007) Removal of native coliphages and coliform bacteria from municipal wastewater by various wastewater treatment processes: implications to water reuse. Water Res 41:2816–2824

    CAS  Google Scholar 

  83. Batt AL, Kim S, Aga DS (2007) Comparison of the occurrence of antibiotics in four-full scale wastewater treatment plants with varying designs and operations. Chemosphere 68:428–435

    CAS  Google Scholar 

  84. Ikehata K, Naghashkar NJ, El-Din MG (2006) Degradation of aqueous pharmaceuticals by ozonation and advanced oxidation processes: a review. Ozone-Sci Eng 28:353–414

    CAS  Google Scholar 

  85. Bolong N, Ismail AF, Salim MR, Matsuura T (2009) A review of the effects of emerging contaminants in wastewaters and options for their removal. Desalination 239:229–246

    CAS  Google Scholar 

  86. Snyder SA, Adham S, Redding AM, Cannon FS, DeCarolis J, Oppenheimer J, Wert EC, Yoon Y (2006) Role of membranes and activated carbon in the removal of endocrine disruptors and pharmaceuticals. Desalination 202:156–181

    Google Scholar 

  87. Watkinson AJ, Murby EJ, Costanzo SD (2007) Removal of antibiotics in conventional and advanced wastewater treatment: implications for environmental discharge and wastewater recycling. Water Res 41:4164–4174

    CAS  Google Scholar 

  88. Emmanuel E, Keck G, Blanchard J, Vermande P, Perrodin Y (2004) Toxicological effects of disinfections using sodium hypochlorite on aquatic organisms and its contribution to AOX formation in hospital wastewater. Environ Int 30:891–900

    CAS  Google Scholar 

  89. Galletti A, Al Aukidy M, Verlicchi P, Petrovic M, Barcelò D (2010) Pharmaceuticals removal in a H-SSF treating a secondary domestic wastewater – an experimental investigation. Proc. IWA Conference Wetland Systems for Water Pollution Control, Venice, 382–384

    Google Scholar 

  90. Matamoros V, Garcia J, Bajona JM (2008) Organic micropollutant removal in a full-scale surface flow constructed wetland fed with secondary effluent. Water Res 42:653–660

    CAS  Google Scholar 

  91. Bartels P, von Tumpling W (2008) The environmental fate of the antiviral drug oseltamivir carboxylate in different waters. Sci Total Environ 405:215–225

    CAS  Google Scholar 

  92. Beier S, Cramer C, Koster S, Mauer C, Palmowski L, Schroeder HF, Pinnekamp J (2011) Full scale membrane bioreactor treatment of hospital wastewater as forerunner for hot-spot wastewater treatment solutions in high density urban areas. Water Sci Technol 63:66–71

    CAS  Google Scholar 

  93. Beier S, Koster S, Veltmann K, Schroder HFr, Pinnekamp J (2010) Treatment of hospital wastewater effluent by nanofiltration and reverse osmosis. Water Sci Technol 61:1691–1698

    CAS  Google Scholar 

  94. Liu Q, Zhou Y, Chen L, Zheng X (2010) Application of MBR for hospital wastewater treatment in China. Desalination 250:605–608

    CAS  Google Scholar 

  95. Bound JP, Voulvoulis N (2006) Predicted and measured concentrations for selected pharmaceuticals in UK rivers: implications for risk assessment. Water Res 40:2585–2592

    Google Scholar 

  96. Furhacker M (2008) The Water Framework Directive – can we reach the target? Water Sci Technol 57:9–17

    CAS  Google Scholar 

  97. Council Directive 93/39/EEC 14 June 1993 amending Directives 65/65/EEC, 75/318/EEC and 75/319/EEC in respect of medicinal products

    Google Scholar 

  98. EMEA (2001) Discussion paper on environmental risk assessment on non-genetically modified organisms (non-GMO) containing medicinal products for human use. CPMP/SWP/4447/00 draft corr. The European Agency for the Evaluation of Medical Products

    Google Scholar 

  99. Lienert J, Gudel K, Escher BI (2007) Screening method for ecotoxicological hazard assessment of 42 pharmaceuticals considering human metabolism and excretory routes. Environ Sci Technol 41:4471–4478

    CAS  Google Scholar 

  100. Brown VM (1968) The calculation of the acute toxicity of mixture of poisons to rainbow trout. Water Res 2:723–733

    CAS  Google Scholar 

  101. Altenburger R, Nendza M, Schuurmann G (2003) Mixture toxicity and its modeling by quantitative structure-activity relationships. Environ Toxicol Chem 22:1900–1915

    CAS  Google Scholar 

  102. Altenburger R, Walter H, Grote M (2004) What contributes to the combined effect of a complex mixture? Environ Sci Technol 38:6353–6362

    CAS  Google Scholar 

  103. Hernando MD, Mezcua M, Fernandez-Alba AR, Barceló D (2006) Environmental risk assessment of pharmaceutical residues in wastewater effluents, surface waters and sediments. Talanta 69:334–342

    CAS  Google Scholar 

  104. de Souza SML, de Vasconcelos EC, Dziedzic M (2009) Environmental risk assessment of antibiotics: an intensive care unit analysis. Chemosphere 77:962–967

    Google Scholar 

  105. Zhao JL, Ying GG, Liu YS, Chen F, Yang JF, Wang L, Yang XB, Stauber JL, Warne MSt J (2010) Occurrence and screening level risk assessment of human pharmaceutical in the Pearl River system, South China. Environ Toxicol Chem 29:1377–1384

    CAS  Google Scholar 

  106. Tauxe-Wuersch A, De Alencastro LF, Grandjean D, Tarradellas J (2005) Occurrence of several acidic drugs in sewage treatment plants in Switzerland and risk assessment. Water Res 39:1761–1772

    CAS  Google Scholar 

  107. EC (2003) Technical guidance on risk assessment, TGD Part II. Technical Report, Institute for health and consumer protection, European Chemicals Bureau, European Commission (EC)

    Google Scholar 

  108. Sanderson H, Johnson DJ, Wilson CJ, Brain RA, Solomon KR (2003) Probabilistic hazard assessment of environmentally occurring pharmaceuticals toxicity to fish, Daphnia and algae by ECOSAR screening. Toxicol Lett 144:383–395

    CAS  Google Scholar 

  109. Stuer-Lauridsen F, Birkved M, Hansen LP, Holten Lutzhoft H-C, Halling-Sùrensen B (2000) Environmental risk assessment of human pharmaceuticals in Denmark after normal therapeutic use. Chemosphere 40:783–793

    CAS  Google Scholar 

  110. Boillot C (2008) Évaluation des risques écotoxicologiques liés aux rejets d’effluents hospitaliers dans les milieux aquatiques. Contribution à l’amélioration de la phase « caractérisation des effets ». PhD Thesis. Institut National des Sciences Appliquées de Lyon, France, N° d’ordre ISAL 0021

    Google Scholar 

  111. Ferrari B, Paxeus N, Lo Giudice R, Pollio A, Garric J (2003) Ecotoxicological impact of pharmaceuticals found in treated wastewaters: study of carbamazepine, clofibric acid, and diclofenac. Ecotox Environ Safe 55:359–370

    CAS  Google Scholar 

  112. Escher BI, Baumgartner R, Lienert J, Fenner K (2009) In: Boxall ABA (ed) Reaction and processes, Part P – transformation products of synthetic chemicals in the environment, vol 2. Springer, Berlin, pp 205–244. doi: 210.1007/1978-1003-1540-88273-88272

  113. Santos JL, Aparicio I, Alonso E (2007) Occurrence and risk assessment of pharmaceutically active compounds in wastewater treatment plants. A case study: Seville city (Spain). Environ Int 33:596–601

    CAS  Google Scholar 

  114. Santos LHMLM, Araujo AN, Fachini A, Pena A, Delerue-Matos C, Montenegro MCBSM (2010) Ecotoxicological aspects related to the presence of pharmaceuticals in the aquatic environment. J Hazard Mater 175:45–95

    CAS  Google Scholar 

  115. Chitnis V, Chitnis D, Patil S, Kant R (2000) Hospital effluent as a source of multiple drug-resistant bacteria. Curr Sci India 79:989–991

    Google Scholar 

  116. Kummerer K (2004) Resistance in the environment. J Antimicrob Chemother 54:311–320

    CAS  Google Scholar 

  117. Jolibois B, Guerbet M (2005) Evaluation of industrial, hospital and domestic wastewater genotoxicity with the Salmonella fluctuation test and the SOS chromotest. Mutat Res 565(2):151–162

    CAS  Google Scholar 

  118. Ferk F, Misik M, Grummt T, Majer B, Fuerhacker M, Buchmann C, Vital M, Uhl M, Lenz K, Grillitsch B, Parzefall W, Nersesyan A, Knasmuller S (2009) Genotoxic effects of wastewater from an oncological ward. Mutat Res 672:69–75

    CAS  Google Scholar 

  119. Hirsch R, Ternes TA, Haberer K, Kratz KL (1999) Occurrence of antibiotics in the aquatic environment. Sci Total Environ 225:109–118

    CAS  Google Scholar 

  120. Al-Almad A, Daschner FD, Kummerer K (1999) Biodegradability of cefotiam, ciprofloxacin, meropenem, penicillin G and sulfamethoxazole and inhibition of wastewater bacteria. Arch Environ Contam Toxicol 37:158–163

    Google Scholar 

  121. Clara M, Strenn B, Kreuzinger N (2004) Carbamazepine as a possible anthropogenic marker in the aquatic environment: investigations on the behaviour of carbamazepine in wastewater treatment and during groundwater infiltration. Water Res 38:947–954

    CAS  Google Scholar 

  122. Blaise C, Gagné F, Eulaffroy P, Férard J-F (2007) Ecotoxicology of selected pharmaceuticals of urban origin discharged to the Saint-Lauwence river (Québec, Canada): a review. Braz J Aquat Sci Technol 10:29–51

    Google Scholar 

  123. Berto J, Rochenbach GC, Barreiros MAA, Correa AXR, Silva SP, Radetski CM (2009) Physico-chemical microbiological and ecotoxicological evaluation of a septic tank/Fenton reaction combination for the treatment of hospital wastewaters. Ecotox Environ Safe 72:1076–1081

    CAS  Google Scholar 

  124. Hollender J, Zimmermann SG, Koepke S, Krauss M, McArdell CS, Ort C, Singer H, von Gunten U, Siegrist H (2009) Elimination of organic micropollutants in a municipal wastewater treatment plant Upgraded with a full-scale Post ozonation followed by sand filtration. Environ Sci Technol 43:7862–7869

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Engineering, University of Ferrara, Via Saragat 1, 44122, Ferrara, Italy

    Paola Verlicchi & Alessio Galletti

  2. Catalan Institute for Water Research (ICRA), c/Emili Grahit 101, 17003, Girona, Spain

    Mira Petrovic & Damià Barceló

  3. Catalan Institution for Research and Advanced Studies (ICREA), Passeig Lluis Companys 23, 80010, Barcelona, Spain

    Mira Petrovic

  4. Department of Environmental Chemistry, IDAEA-CSIC, c/Jordi Girona 18-26, 08034, Barcelona, Spain

    Damià Barceló

  5. King Saud University, 2454, Riyadh, 11451, Saudi Arabia

    Damià Barceló

Authors
  1. Paola Verlicchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessio Galletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mira Petrovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Damià Barceló
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paola Verlicchi .

Editor information

Editors and Affiliations

  1. Jordi Girona 18 -26, Barcelona, 08034, Spain

    Damià Barceló

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg 2011

About this chapter

Cite this chapter

Verlicchi, P., Galletti, A., Petrovic, M., Barceló, D. (2012). Micro-pollutants in Hospital Effluent: Their Fate, Risk and Treatment Options. In: Barceló, D. (eds) Emerging Organic Contaminants and Human Health. The Handbook of Environmental Chemistry(), vol 20. Springer, Berlin, Heidelberg. https://doi.org/10.1007/698_2011_134

Download citation

Publish with us

Policies and ethics

Search

Navigation