Contribution of Hospital Effluents to the Load of Micropollutants in WWTP Influents

  • Teofana Chonova
  • Jérôme Labanowski
  • Agnès Bouchez
Part of the The Handbook of Environmental Chemistry book series (HEC, volume 60)


Hospital effluents cause growing interest, as they may be an important contamination source of micro- and macropollutants to WWTP influents. These effluents are usually characterised by higher concentrations and greater diversity of pollutants compared to urban wastewater. However, in certain cases, hospital effluents may represent only a small fraction of the total WWTP influent. Several recent studies report that their contribution to WWTP influents is limited and they are only one of the important sources of micropollutants in the environment. Nevertheless, specific micropollutants may exhibit relatively high hospital contribution, which may cause environmental risks. Several other important sources of micropollutants (chronic medication, nursing home, outpatients, cattle, etc.) are released in urban wastewaters. These sources should not be neglected, because they represent an important load that may impact aquatic environments.

Actual loads and characteristics of hospital effluents remain difficult to determine, as they strongly depend on several factors such as the characteristics of the hospital, regional and seasonal variations, variety of molecules and metabolites, load estimation uncertainties and others.

The SIPIBEL observatory enables an unique comparison of hospital and urban untreated and treated effluents, due to parallel processing. Monitoring data obtained over the years demonstrated that despite higher concentrations, the hospital contribution to the total load of contaminants is lower than the urban one, considering both wastewaters and treated effluents. However, specific releases from healthcare facilities deserve attention and require awareness of stakeholders to determine strategies and regulations adapted to protect environmental and human health.


Aquatic pollutants Hospital contribution Hospital wastewater Micropollutants Pharmaceuticals Urban wastewater WWTP 



Hospital contribution


Hospital treated effluent


Hospital wastewater


Iodinated contrast media


Limit of quantification


Nonsteroidal anti-inflammatory drugs


Principal component analysis


Urban contribution


Urban treated effluent


Urban wastewater


Wastewater treatment plant



SIPIBEL observatory ( is a research and observation site which is part of the Rhone Basin Long Term Environmental Research Observatory since 2011. SIPIBEL is operated by GRAIE (Villeurbanne, France) where Vivien Lecomte ensured scientific and technical coordination. Laure Wiest and ISA laboratory (Villeurbanne, France) ensured pharmaceutical and surfactant analyses. François Keck (INRA UMR CARRTEL, Thonon, France) is thanked for his involvement in data analysis, Leslie Mondamert (ENSIP, Poitiers, France) for useful comments and references and Tsvetana Tomova and Katie Warrener for the linguistic correction.


  1. 1.
    Le Corre KS, Ort C, Kateley D, Allen B, Escher BI, Keller J (2012) Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater. Environ Int 45:99–111CrossRefGoogle Scholar
  2. 2.
    Carraro E, Bonetta S, Bertino C, Lorenzi E, Bonetta S, Gilli G (2016) Hospital effluents management: chemical, physical, microbiological risks and legislation in different countries. J Environ Manag 168:185–199CrossRefGoogle Scholar
  3. 3.
    Verlicchi P, Al Aukidy M, Galletti A, Petrovic M, Barceló D (2012) Hospital effluent: investigation of the concentrations and distribution of pharmaceuticals and environmental risk assessment. Sci Total Environ 430:109–118CrossRefGoogle Scholar
  4. 4.
    Chonova T, Keck F, Labanowski J, Montuelle B, Rimet F, Bouchez A (2016) Separate treatment of hospital and urban wastewaters: a real scale comparison of effluents and their effect on microbial communities. Sci Total Environ 542:965–975CrossRefGoogle Scholar
  5. 5.
    Verlicchi P, Galletti A, Petrovic M, Barceló D (2010) Hospital effluents as a source of emerging pollutants: an overview of micropollutants and sustainable treatment options. J Hydrol 389:416–428CrossRefGoogle Scholar
  6. 6.
    Verlicchi P, Al Aukidy M, Zambello E (2015) What have we learned from worldwide experiences on the management and treatment of hospital effluent? – an overview and a discussion on perspectives. Sci Total Environ 514:467–491CrossRefGoogle Scholar
  7. 7.
    Kümmerer K (2009) The presence of pharmaceuticals in the environment due to human use – present knowledge and future challenges. J Environ Manag 90:2354–2366CrossRefGoogle Scholar
  8. 8.
    Ort C, Lawrence MG, Reungoat J, Eaglesham G, Carter S, Keller J (2010) Determining the fraction of pharmaceutical residues in wastewater originating from a hospital. Water Res 44:605–615CrossRefGoogle Scholar
  9. 9.
    Langford KH, Thomas KV (2009) Determination of pharmaceutical compounds in hospital effluents and their contribution to wastewater treatment works. Environ Int 35:766–770CrossRefGoogle Scholar
  10. 10.
    Herrmann M, Olsson O, Fiehn R, Herrel M, Kümmerer K (2015) The significance of different health institutions and their respective contributions of active pharmaceutical ingredients to wastewater. Environ Int 85:61–76CrossRefGoogle Scholar
  11. 11.
    Kümmerer K, Henninger A (2003) Promoting resistance by the emission of antibiotics from hospitals and households into effluent. Clin Microbiol Infect 9:1203–1214CrossRefGoogle Scholar
  12. 12.
    Weissbrodt D, Ort C, Pazhepurackel V (2009) Mass flows of X-ray contrast media and cytostatics in hospital wastewater. Environ Sci Technol 43:4810–4817CrossRefGoogle Scholar
  13. 13.
    Wirth K, Schröder H, Meyer E, Nink K, Hofman S, Steib-Bauert M, Kümmerer R, Rueß S, Daschner F, Kern W (2004) Antibiotic use in Germany and Europe. Dtsch Med Wochenschr 129:1987–1992CrossRefGoogle Scholar
  14. 14.
    House of Lords (UK) (1998) House of Lords Select Committee on Science and Technology. Seventh Report. The Stationery Office, LondonGoogle Scholar
  15. 15.
    Wise R (2002) Antimicrobial resistance: priorities for action. J Antimicrob Chemother 49:585–586CrossRefGoogle Scholar
  16. 16.
    Thomas KV, Dye C, Schlabach M, Langford KH (2007) Source to sink tracking of selected human pharmaceuticals from two Oslo city hospitals and a wastewater treatment works. J Environ Monit 9:1410–1418CrossRefGoogle Scholar
  17. 17.
    Beier S, Cramer C, Köster S, Mauer C, Palmowski L, Schröder 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 63:66–71CrossRefGoogle Scholar
  18. 18.
    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 45:75–92CrossRefGoogle Scholar
  19. 19.
    Daouk S, Chèvre N, Vernaz N, Widmer C, Daali Y, Fleury-Souverain S (2016) Dynamics of active pharmaceutical ingredients loads in a Swiss university hospital wastewaters and prediction of the related environmental risk for the aquatic ecosystems. Sci Total Environ 547:244–253CrossRefGoogle Scholar
  20. 20.
    Santos LHMLM, Gros M, Rodriguez-Mozaz S, Delerue-Matos C, Pena A, Barceló D, Montenegro MCBSM (2013) Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals. Sci Total Environ 461–462:302–316CrossRefGoogle Scholar
  21. 21.
    Azuma T, Arima N, Tsukada A, HiramiS MR, Moriwake R, Ishiuchi H, Inoyama T, Teranishi Y, Yamaoka M, Mino Y, Hayashi T, Fujita Y, Masada M (2016) Detection of pharmaceuticals and phytochemicals together with their metabolites in hospital effluents in Japan, and their contribution to sewage treatment plant influents. Sci Total Environ 548–549:189–197CrossRefGoogle Scholar
  22. 22.
    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 56:141–149CrossRefGoogle Scholar
  23. 23.
    Verlicchi P, Zambello E (2016) Predicted and measured concentrations of pharmaceuticals in hospital effluents. Examination of the strengths and weaknesses of the two approaches through the analysis of a case study. Sci Total Environ 565:82–94CrossRefGoogle Scholar
  24. 24.
    Vieno N, Tuhkanen T, Kronberg L (2005) Seasonal variation in the occurrence of pharmaceuticals in effluents from a sewage treatment plant and in the recipient water. Environ Sci Technol 39:8220–8226CrossRefGoogle Scholar
  25. 25.
    Heberer T, Feldmann D (2005) Contribution of effluents from hospitals and private households to the total loads of diclofenac and carbamazepine in municipal sewage effluents – modeling versus measurements. J Hazard Mater 122:211–218CrossRefGoogle Scholar
  26. 26.
    Coutu S, Rossi L, Barry D, Rudaz S, Vernaz N (2013) Temporal variability of antibiotics fluxes in wastewater and contribution from hospitals. PLoS ONE 8:e53592CrossRefGoogle Scholar
  27. 27.
    Goullé JP, Saussereau E, Mahieu L, Cellier D, Spiroux J, Guerbet M (2012) Importance of anthropogenic metals in hospital and urban wastewater: its significance for the environment. Bull Environ Contam Toxicol 89:1220–1224CrossRefGoogle Scholar
  28. 28.
    Verlicchi P, Al Aukidy M, Jelic A, Petrović M, Barceló D (2014) Comparison of measured and predicted concentrations of selected pharmaceuticals in wastewater and surface water: a case study of a catchment area in the Po valley (Italy). Sci Total Environ 470–471:844–854CrossRefGoogle Scholar
  29. 29.
    Perrodin Y, Bazin C, Orias F, Wigh A, Bastide T, Berlioz-Barbier A, Vulliet E, Wiest L (2016) A posteriori assessment of ecotoxicological risks linked to building a hospital. Chemosphere 144:440–445CrossRefGoogle Scholar
  30. 30.
    Sipibel Report 2011–2015 (2016) Effluents hospitaliers et stations d'épuration urbaines: caractérisation, risques et traitabilité – Synthèse des résultats de quatre années de suivi, d’études et de recherche sur le site pilote de Bellecombe. Accessed 20 Sept 2016
  31. 31.
    Wiest L, Chonova T, Bergé A, Baudot R, Bessueille-Barbier F, Ayouni-Derouiche L, Vulliet E. Two year survey of specific hospital wastewater treatment at the SIPIBEL site (France): impact on pharmaceutical discharges (submitted)Google Scholar
  32. 32.
    Dray S, Dufour AB, Chessel D (2007) The ade4 package – II: two-table and K-table methods. R News 7:47–52Google Scholar
  33. 33.
    Bartelt-Hunt SL, Snow DD, Damon T, Shockley J, Hoagland K (2009) The occurrence of illicit and therapeutic pharmaceuticals in wastewater effluent and surface waters in Nebraska. Environ Pollut 157:786–791CrossRefGoogle Scholar
  34. 34.
    Clara M, Strenn B, Gans O, Martinez E, Kreuzinger N, Kroiss H (2005) Removal of selected pharmaceuticals, fragrances and endocrine disrupting compounds in a membrane bioreactor and conventional wastewater treatment plants. Water Res 39:4797–4807CrossRefGoogle Scholar
  35. 35.
    Carballa M, Omil F, Lema JM (2003) Removal of pharmaceuticals and personal care products (PPCPS) from municipal wastewaters by physico-chemical processes. Electron J Environ Agric Food Chem 2:309–313Google Scholar
  36. 36.
    Vieno N, Tuhkanen T, Kronberg L (2007) Elimination of pharmaceuticals in sewage treatment plants in Finland. Water Res 41:1001–1012CrossRefGoogle Scholar
  37. 37.
    Kosma CI, Lambropoulou DA, Albanis TA (2010) Occurrence and removal of PPCPs in municipal and hospital wastewaters in Greece. J Hazard Mater 179:804–817CrossRefGoogle Scholar
  38. 38.
    Leprat P (1999) Caractéristiques et impacts des rejets liquides hospitaliers. Tech Hosp 634:56–57Google Scholar
  39. 39.
    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 117:1–11CrossRefGoogle Scholar
  40. 40.
    Mullot JU (2009) Modeling pharmaceuticals loads in hospital sewage. University of Paris-Sud, Châtenay-Malabry, 306 ppGoogle Scholar
  41. 41.
    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 82:179–186CrossRefGoogle Scholar
  42. 42.
    Wise R, Hart T, Cars O (1998) Antimicrobial resistance is a major threat to public health. BMJ 317:609–610CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Teofana Chonova
    • 1
    • 2
  • Jérôme Labanowski
    • 3
  • Agnès Bouchez
    • 1
  1. 1.UMR CARRTEL, INRA, USMBThonon-les-BainsFrance
  2. 2.Earth and Environment Sciences, Department F.-A. Forel for Environmental and Aquatic Sciences, Environmental Biogeochemistry and EcotoxicologyUniversity of GenevaGenevaSwitzerland
  3. 3.ENSIP, UMR CNRS 7285, Inst Chim Milieux & Mat PoitiersUniversité de PoitiersPoitiersFrance

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