Pharmaceutical pollution is a growing problem; Not only can pharmaceutical residues harm ecosystems and the environment, but their presence in groundwater, drinking water, soil and more could contribute to the growing threat of antibiotic resistance around the world.
A new report from Health Care Without Harm Europe has examined how hospital wastewater contributes to the amount of pharmaceuticals in the environment and explores the different methods used by European hospitals to reduce the amount of pharmaceutical residues in their waste.
A pilot wastewater treatment plant based on biological processes
Saint-Pierre Ottignies Clinic (CSPO), Belgium
In 2019, CSPO partnered with engineering company John Cockerill Balteau to test pilot wastewater treatment technology designed to treat macro-pollution, pharmaceutical pollution, pathogenic microorganisms and antibiotic-resistant bacteria. in the hospital wastewater.
John Cockerill Balteau’s MEDIX technology is based on biological processes that help eliminate micropollutants in water; using the enzymatic capacities of microorganisms, a wide range of pharmaceutical residues can be biologically degraded and eliminated.
Once broken down, the microorganisms are separated from the treated water by membrane filtration, generating sludge waste that must be incinerated off-site.
The process has been found to remove over 95% of pharmaceutical residues in wastewater.
Peracetic acid to neutralize bacteria resistant to antibiotics
Aarhus University Hospital, Denmark
Aarhus University Hospital began studying how peracetic acid could reduce the level of antibiotic-resistant bacteria in its untreated wastewater in 2019.
The hospital’s research focused on bacteria resistant to ciprofloxacin, as ciprofloxacin is one of the most commonly used antibiotics in hospitals and primary care and is therefore likely to be found at high levels. in hospital wastewater.
The hospital aimed to bring the level of ciprofloxacin-resistant bacteria in its wastewater to the same level as in domestic wastewater after treatment with peracetic acid.
To assess the neutralizing effect of peracetic acid on bacteria resistant to ciprofloxacin, it was injected directly into untreated hospital wastewater. Tests have shown that peracetic acid at different concentrations can achieve a reduction rate of between 98% and 99.9% of bacteria resistant to ciprofloxacin after ten minutes.
Urine pockets to keep iodinated contrast media out of the water cycle
MERK’MAL project, Germany
Iodinated contrast media (ICM), contrast agents used for medical x-ray imaging, are typically excreted in sewage systems via human urine within 24 hours of consumption. Since ICM cannot be completely removed by treatment plants, substances enter the water cycle and accumulate over time.
Although MCIs are not considered toxicologically harmful, health risks cannot be completely excluded. For example, drinking water containing ICM could be of concern; chlorination of water containing a high concentration of the iopamidol contrast agent can lead to the formation of toxic by-products.
The MERK’MAL project was started by the IWW Water Center in 2017 to determine if urine bags would be a cost-effective way to reduce ICM in water.
The project focused on an area around two hospitals and two radiology practices: St Marien-Hospital Mülheim an der Ruhr, Evangelisches Krankenhaus Mülheim, Radiologische Gemeinschaftspraxis Mülheim and Medizinisches Versorgungszentrum Mülheim an der Ruhr.
The researchers behind the project observed a significant reduction in ICM concentrations in the effluents of the local wastewater treatment plant. It was estimated that the use of urine bags could prevent the release of 270 kg of ICM into the water of the surrounding city each year.
Thermal plasma to degrade pharmaceutical residues
Radboud University Medical Center (Radboudumc), The Netherlands
MEDUWA-Vecht (e) is a collaboration between 27 Dutch and German companies, universities, hospitals and governmental and non-governmental organizations to develop solutions to reduce or prevent contamination of water, soil and food by drugs and multidrug-resistant microorganisms.
Radboudumc joined the project in 2014 and partnered with Dutch company VitalFluid to determine whether plasma water activation could effectively degrade pharmaceutical residues from hospital wastewater before it enters the system. sewers.
Plasma water activation is an advanced oxidation process that increases reactive oxygen and nitrogen species that dissolve in water and break down contaminants. Radboudumc researchers studied the efficiency of thermal plasma in breaking down 14 pharmaceutical compounds commonly found in the Vechte River, compared to a more conventional treatment technique.
In the study, all of the pharmaceutical compounds in the water were reduced or completely degraded by both the 150W thermal plasma and UV / H2O2 treatment.
A test bed of good practices to reduce pharmaceutical pollution
Caithness General Hospital (CGH), United Kingdom
The One Health Breakthrough Partnership (OHBP) was a collaboration between the NHS Highland, Scottish Water, the Scottish Environment Protection Agency, HIE, the James Hutton Institute and the Environmental Research Institute at the University of the Highlands and Islands, aimed at a product non-toxic environment in the Scottish Highlands. One of the main goals of the collaboration was the impact of pharmaceuticals on the aquatic environment.
OHBP partners conducted research at CGH, a rural hospital, evaluating the effectiveness of the local wastewater treatment plant in removing eight pharmaceutical residues: diclofenac, ibuprofen, paracetamol, clarithromycin, trimethoprim, carbamazepine, fluoxetine and 17- alpha-ethinylestradiol.
All compounds, except 17-Alpha-ethinylestradiol, were detected in the wastewater of the hospital and the local treatment plant. The plant has been shown to have a varying ability to remove pharmaceutical contaminants from water before it is released.
In response to the findings, the NHS Highland developed an action plan to reduce pharmaceutical pollution, including: a drug waste ‘amnesty’ program to prevent unused drugs from being dumped into drug supply systems. water, raising awareness through educational tools and public messages, substituting damaging drugs for less toxic ones and testing an innovative wastewater treatment filter to remove pharmaceutical contaminants.
After being used as a test bed for the project to remove pharmaceuticals from the environment, CGH became the first hospital in the world to achieve the Alliance of Water Stewardship Standard.