Abstract
Wastewater refers to any water whose quality has been compromised by human activities. It includes liquid waste discharged from domestic homes, agricultural commercial sectors, pharmaceutical sectors, and hospitals. Hospital wastewater (HWW) can contain hazardous substances, such as pharmaceutical residues, chemical hazardous substances, pathogens, and radioisotopes. Due to these substances, hospital wastewater can represent a chemical, biological, and physical risk for public and environmental health. Nevertheless, very frequently there are no legal requirements for hospital effluent treatment prior to its discharge into the municipal collector or directly onto surface water after pretreatment.
In this chapter a brief introduction about the role of hospital wastewater on the environmental contamination was reported. Subsequently the main principles on the hospital wastewater reported in different legislation around the world have been addressed. Moreover the main content reported in the WHO guidelines, EPA guidelines, and guidelines about radionuclide releases to the environment from hospitals was described. A case study of excellence on hospital wastewater management was also illustrated. The chapter ends with some brief final remarks.
Keywords
- Hospital wastewater
- Management
- Regulation
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References
Fekadu S, Merid Y, Beyene H, Teshome W, Gebre-Selassie S (2015) Assessment of antibiotic- and disinfectant-resistant bacteria in hospital wastewater, South Ethiopia: a cross-sectional study. J Infect Dev Ctries 9(2):149–156
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 542:965–975
Santos LH, Gros M, Rodriguez-Mozaz S, Delerue-Matos C, Pena A, Barceló D, Montenegro MC (2013) Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals. Sci Total Environ 461–462:302–316
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 430:109–118
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
Maheshwari M, Yaser NH, Naz S, Fatima M, Ahmad I (2016) Emergence of ciprofloxacin-resistant extended-spectrum β-lactamase-producing enteric bacteria in hospital wastewater and clinical sources. J Glob Antimicrob Resist 5:22–25
Varela AR, André S, Nunes OC, Manaia CM (2014) Insights into the relationship between antimicrobial residues and bacterial populations in a hospital-urban wastewater treatment plant system. Water Res 54:327–336
Ministry of Environment and Forest, Government of India, New Deli (1986) The Environment (Protection) Act. N° 29 of 1986
Ministry of Environment & Forests (1998) Bio-medical waste (management & handling) rules, 1998 S.O.630(E), [20/7/1998]
EU (1991) European Union. Council Directive 91/271/EEC of 21 May 1991 concerning urban waste-water treatment
EU (1998) European Union. Commission Directive 98/15/EC of 27 February 1998 amending Council Directive 91/271/EEC with respect to certain requirements established in Annex I thereof (Text with EEA relevance)
EU (2008) European Union. Directive 2008/98/EC of the European Parliament and of the Council of 19 November 2008 on waste and repealing certain Directives (Text with EEA relevance)
Decreto 57/2005, de 30 de junio, por el que se revisan los Anexos de la Ley 10/1993, de 26 de octubre, sobre Vertidos Líquidos Industriales al Sistema Integral de Saneamiento
Decreto n 26042-S-MINAE (1997) Reglamento de Vertido y Aguas Residuales. La Gaeta n. 117, Jueves 19 de junio de 1997
Federal Ministry for the Environment, Nature Conservation and Nuclear Safety, Germany (2004) Promulgation of the New Version of the Ordinance on Requirements for the Discharge of Waste Water into Waters (Waste Water Ordinance – AbwV) of 17 June 2004
Carraro E, Bonetta S, Bertino C, Lorenzi E, Bonetta S, Gilli G Hospital effluents management: chemical, physical, microbiological risks and legislation in different countries. J Environ Manag 168:185–199
D.P.R. 19 Ottobre 2011 n. 227. Regolamento per la semplificazione di adempimenti amministrativi in materia ambientale gravanti sulle imprese, a norma dell'articolo 49, comma 4-quater, del decreto-legge 31 maggio 2010, n. 78, convertito, con modificazioni, dalla legge 30 luglio 2010, n. 122. Pubblicato nella Gazz. Uff. 3 febbraio 2012, n. 28
Decreto Legislativo (D. Lgs.) 3 aprile 2006, n. 152. Norme in materia ambientale. Gazzetta Ufficiale n. 88. Suppl. Ord. n. 96 del 14 aprile 2006
National Standard of the People’s Republic of China (1998) Integrated wastewater discharge standard GB 8978–88. Date of Approval: Oct. 4, 1996. Date of Enforcement: Jan 1, 1998
The Socialist Republic of Vietnam (2014) Law of environmental protection. No. 55/2014/QH13
The Socialist Republic of Vietnam (2010) National Technical Regulation on Health Care Wastewater. QCVN 28:2010/BTNMT
WHO (1999) In: Prüss A, Giroult E, Rushbrook P (eds) Safe management of wastes from health-care activities
WHO (2014) In: Chartier Y et al. (eds) Safe Management of wastes from health-care activities, 2 edn
Clean Water Act (1972) Federal Water Pollution Control Act, 33 U.S.C. 1251 et seq
EPA (2016) Preliminary 2016 effluent guidelines program plan. EPA.821-R-16-001, Washington DC, USA
Mattsson S, Bernhardsson C (2013) Release of patients after radionuclide therapy: radionuclide releases to the environment from hospitals and patients. In: Mattsson S, Hoeschen C (eds) Radiation protection in nuclear medicine. Springer, Heidelberg, Berlin
IAEA (2009) Release of patients after radionuclide therapy. International Atomic Energy Agency, Safety Reports Series No. 63, Vienna
ICRP (2004) International Commission on Radiological Protection. Release of patients after therapy with unsealed radionuclides. Ann ICRP 34(2):1–79
ICRP (2013) Release of patients after therapy with unsealed radionuclides. Ann ICRP 42(4):341
SIPIBEL (2014) Effluents hospitaliers et stations d’épuration urbaines: caractérisation, risques et traitabilité. Site Pilote de Bellecombe. Presentation et premiers resultants (www.graie.org/Sipibel/publications/sipibel-presentation-effluentsmedicaments. pdf, also: http://www.graie.org/Sipibel/publications.html)
SIPIBEL-RILACT (2015) Mise en evidence de solutions pour limiter les rejets pollutants d’un etablissement de soins: Etude au Centre Hospitalier Alpes Léman (http://www.graie.org/Sipibel/rilact.html)
NoPILLS (2015) NoPILLS report. Interreg IV NEW project partnership 2012–2015. http://www.no-pills.eu/
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Carraro, E., Bonetta, S., Bonetta, S. (2017). Hospital Wastewater: Existing Regulations and Current Trends in Management. In: Verlicchi, P. (eds) Hospital Wastewaters. The Handbook of Environmental Chemistry, vol 60. Springer, Cham. https://doi.org/10.1007/698_2017_10
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DOI: https://doi.org/10.1007/698_2017_10
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