Genotoxicity evaluation of hospital wastewaters

Hospital wastewater (HWW) treatment in low- and middle-income countries: A systematic review of microbial treatment efficacy

BACKGROUND

Proper treatment of hospital wastewater (HWW) is crucial to minimize the long-term effects on human health and aquatic ecosystems. However, the majority of HWW generated in low and middle-income countries (LMICs), is discharged without adequate treatment. This systematic review aims to fill the knowledge gap in LMICs by examining the efficacy of HWW treatment and the types of technologies used.

METHODS

Studies included in the review offered valuable insights into the current state of HWW management in LMICs. Between 2000 and 2022, only 36 research studies focused on hospital-based wastewater treatment within LMICs. Data were extracted on wastewater treatment technologies in hospitals or healthcare settings in LMICs. Data on sampling techniques, effectiveness, microorganisms and risk of bias of included studies were recorded.

RESULTS

A total of 36 articles met the eligibility criteria: mentioned about 1) hospitals 2) wastewater treatment 3) LMICs and 4) treatment efficacy. Twenty-two studies were conducted in Asia (22/36), 17 were conducted in countries with high Human Development Index. Constructed wetland, and activated sludge process were the most common technologies used in LMICs. A few studies utilized membrane bioreactors and ozone/UV treatment. Fourteen studies reported the concentration reduction to assess the microbial efficacy of the treatment process, 29/36 studies did not meet the national standards for effluent discharge. Reporting on sampling methods, wastewater treatment processes and efficacy of HWW treatment were at high risk of bias. Extreme heterogeneity in study methods and outcomes reporting precluded meta-analysis.

CONCLUSIONS

The existing evidence indicates inadequate microbial treatment in low- and middle-income country hospitals, with this systematic review emphasizing the need for improvement in healthcare waste management. It underscores the importance of long-term studies using innovative treatment methods to better understand waste removal in LMIC hospitals and calls for further research to develop context-specific healthcare waste treatment approaches in these regions.

Cerium based UiO-66 MOF as a multipollutant adsorbent for universal water purification

Herein, we demonstrate the use of cerium (Ce)-UiO-66 metal organic framework (MOF) for the removal of a variety of potentially toxic pollutants. The Ce-UiO-66 MOF, with similar framework topologies to Zr-UiO-66, has not been explored for its adsorptive properties in water remediation. The replacement of Zr metal center with Ce yields a MOF that can be synthesized in shorter durations with lesser energy consumptions and with excellent multipollutant adsorption properties. Further, the Ce-UiO-66 MOF was also studied for its adsorption abilities in the binary component system. Interestingly, the adsorbent showed higher adsorption capacities in the presence of other pollutants. Removal studies for other potentially toxic anionic and cationic dyes showed that the Ce-UiO-66 MOF has a wide range of contaminant removal abilities. Investigations of individual adsorption capacities revealed that the Ce-UiO-66 MOF has a maximum adsorption capacity of 793.7 mg/g for congo red (CR), 110 mg/g for methylene blue (MB), 66.1 mg/g for fluoride (F^-), 30 mg/g for Cr⁶⁺ and 485.4 mg/g for the pharmaceutical waste diclofenac sodium (DCF). To imply the practical applications of the Ce-UiO-66 MOF we have also demonstrated an adaptable filter that could separate all the potentially toxic pollutants.

A comprehensive review on magnetic carbon nanotubes and carbon nanotube-based buckypaper for removal of heavy metals and dyes

Industrial effluents contain several organic and inorganic contaminants. Among others, dyes and heavy metals introduce a serious threat to drinking waterbodies. These pollutants can be noxious or carcinogenic in nature, and harmful to humans and different aquatic species. Therefore, it is of high importance to remove heavy metals and dyes to reduce their environmental toxicity. This has led to an extensive research for the development of novel materials and techniques for the removal of heavy metals and dyes. One route to the removal of these pollutants is the utilization of magnetic carbon nanotubes (CNT) as adsorbents. Magnetic carbon nanotubes hold remarkable properties such as surface-volume ratio, higher surface area, convenient separation methods, etc. The suitable characteristics of magnetic carbon nanotubes have led them to an extensive search for their utilization in water purification. Along with magnetic carbon nanotubes, the buckypaper (BP) membranes are also favorable due to their unique strength, high porosity, and adsorption capability. However, BP membranes are mostly used for salt removal from the aqueous phase and limited literature shows their applications for removal of heavy metals and dyes. This study focuses on the existence of heavy metal ions and dyes in the aquatic environment, and methods for their removal. Various fabrication approaches for the development of magnetic-CNTs and CNT-based BP membranes are also discussed. With the remarkable separation performance and ultra-high-water flux, magnetic-CNTs, and CNT-based BP membranes have a great potential to be the leading technologies for water treatment in future.

Skincare Products as Sources of Mutagenic Exposure to Infants: An Imperative Study Using a Battery of Microbial Bioassays

Infant skin is highly absorptive and sensitive to exposure from external agents (microbes, toxicants, heat, cold, etc.). Many specialized infant skincare products are currently commercially available. Although the manufacturers claim that their products are mild enough to suit the infant skin, these products need to be studied for their safety. Using animal models to examine the safety of the ever-increasing number of skincare products is not economically or logistically feasible. To overcome this problem, we suggest using a battery of microbial bioassays as a robust system for monitoring the mutagenic potential of skincare products. We picked popular infant skincare products from the Indian market and assessed them by using a battery of three microbial mutagenicity bioassays. Most of them showed significant and reproducible mutagenic potential. Our study results raise concerns about regular use of infant products and emphasize the need to enforce strict regulations for the manufacturing and safety assessment of infant products.

Starch-Mg/Al layered double hydroxide composites as an efficient solid phase extraction sorbent for non-steroidal anti-inflammatory drugs as environmental pollutants

Using a co-precipitation method, starch-Mg/Al layered double hydroxide (S-Mg/Al LDH) composites were synthesized. Their physicochemical properties were assessed by Fourier-transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy, and thermo-gravimetric analysis. The quantification of six non-steroidal anti-inflammatory drugs (NSAIDs) was conducted using real samples (e.g., hospital waste water, river water, sewage treatment plant water, and tablet formulations) by gas chromatography-mass spectrometry. For the development of this method, the system was optimized in terms of several key variables (e.g., pH, flow rate, and eluent type/volume). The developed method for NSAIDs exhibited good resolution, sensitivity, reproducibility, and specificity even in complex matrices with limits of detection between 4 and 20 pg/mL. Hence, S-Mg/Al LDH composites were proven to be efficient and fast solid phase extraction (SPE) sorbents for NSAIDs. In addition, each LDH-SPE cartridge showed good reusability without a noticeable change in performance (e.g., up to 30 cycles) and target recoveries between 99.5 - 82.9 %. This work should open up new opportunities for a sesnsitive and sustainable quantitative method for the determination of NSAIDs in complex samples.

Snowballing transmission of COVID-19 (SARS-CoV-2) through wastewater: Any sustainable preventive measures to curtail the scourge in low-income countries?

In this communication, we proposed sustainable preventive measures that may be adopted by the low-income countries to forestall the potential outbreak and transmission of COVID-19 (coronavirus disease 2019) through wastewater. Most low-income countries have poor sanitation and wastewater management policies, which create potential risks of COVID 19 spread. Hence, the proposed measures include decentralization of wastewater treatment facilities, community-wide monitoring and testing of SARS-CoV-2 in wastewater samples, improved sanitation, developing point-of-use devices for wastewater decontamination, and more focused policy interventions. Therefore, this paper adds useful insights into the monitoring and management of ongoing COVID-19 outbreak in low-income countries.

Snowballing transmission of COVID-19 (SARS-CoV-2) through wastewater: Any sustainable preventive measures to curtail the scourge in low-income countries?

In this communication, we proposed sustainable preventive measures that may be adopted by the low-income countries to forestall the potential outbreak and transmission of COVID-19 (coronavirus disease 2019) through wastewater. Most low-income countries have poor sanitation and wastewater management policies, which create potential risks of COVID 19 spread. Hence, the proposed measures include decentralization of wastewater treatment facilities, community-wide monitoring and testing of SARS-CoV-2 in wastewater samples, improved sanitation, developing point-of-use devices for wastewater decontamination, and more focused policy interventions. Therefore, this paper adds useful insights into the monitoring and management of ongoing COVID-19 outbreak in low-income countries.

Synthetic organic dyes as contaminants of the aquatic environment and their implications for ecosystems: A review

In recent years interest in the fate of chemical compounds in the aquatic environment has increased. There are many reports of the presence of chemical compounds such as pesticides, steroid hormones or antibiotics in the aquatic environment. At present, little is known about synthetic organic dyes as contaminants of water bodies. These dyes are omnipresent in many application areas from the textile, tannery, cosmetic and food industries to human and veterinary medicine. Their large-scale production and widespread applications have caused synthetic organic dyes to permeate into different compartments of water and soil environment. So far, dyes have been determined in environmental samples such as water, suspended particulate matters, sediment and wild fish. For this reason, they are considered micropollutants of aquatic ecosystems. Due to the toxicological properties and pharmacological activity of some synthetic organic dyes their occurrence in water bodies should be monitored. The hazard potential of synthetic organic dyes should be assessed, especially their influence on aquatic biota, not least because dyes in water ecosystems may pose a threat to animal or human health as higher-order consumers. This review collects scientific data considering application areas, toxicity, sources, environmental occurrence and the fate of synthetic organic dyes and the ecological implications of synthetic organic dyes presence in the total environment. Moreover, analytical methods for dye determination and methods for dye removal from wastewater are described.

Ethanol-activated granular aerogel as efficient adsorbent for persistent organic pollutants from real leachate and hospital wastewater

Hydrophobic aerogels were used to remove three types of persistent organic pollutants: pharmaceutical drugs (i.e. doxorubicin [DOX], paclitaxel [TAX]), phthalates (diethyl phthalate [DEP]), and hydrophilic rhodamine dye (RhB) from synthetic and real wastewaters, using Lumira granular aerogel from Cabot activated with EtOH (ET-GAG). The hydrophobic silica aerogel was characterized by X-ray diffraction (XRD), High-Resolution Transmission Electron Microscopy (HRTEM), Brunauer-Emmet-Teller (BET) and attenuated total reflection-Fourier transform infrared spectroscopy. The pollutants were analysed by high-performance liquid chromatography (HPLC)-UV and HPLC-mass spectrometry. The adsorption process was governed by hydrophobic- hydrophobic interactions between the ET-GAG and micropollutants. The adsorption capacity of ET-GAG, examined by batch experiments, for DOX, TAX and DEP were 13.80, 14.28 and 17.54 mg/g respectively. The rate of adsorption to ET-GAG is high in the initial 40 min followed by no change in the rate due to saturation of adsorption sites. ET-GAG was able to completely remove micropollutants from real leachate and hospital wastewater, implying practical applications. Regeneration of the aerogel was studied by solvent extraction. Et-GAG adsorbent demonstrated better removal of toxic chemotherapeutic drugs and phthalates than GAC.

Facile Synthesis of Porous Carbon for the Removal of Diclofenac Sodium from Water

In this work, a series of porous carbon materials (PCs) were obtained at different carbonization temperatures (800, 900, 1000, and 1100 °C) by a simple and fast solvent-free method. Moreover, the feasibility of PCs as reliable and efficient adsorbents to capture diclofenac sodium (DCF) from the water was evaluated. Notably, porous carbon (PC) prepared at 1000 °C (PC-1000) was found to be the best candidate for the adsorption of DCF. Remarkably, adsorption equilibrium was achieved within 3 h, which followed a pseudo-second-order kinetic model with a high correlation coefficient (R ² > 0.994). Furthermore, experimental data obtained from adsorption isotherm indicated that the capture of DCF onto PC-1000 followed the Langmuir adsorption model (R ² > 0.997), wherein its maximum adsorption capacity was calculated to be 392 mg/g. In addition, based on the results obtained from the zeta potential of PC-1000 under different pH and the adsorbed quantity of DCF along with functional groups created on the surface of PC-1000, electrostatic and H-bonding interactions were proposed as the possible adsorption mechanisms. Due to its high stability and excellent reusability, PC-1000 has been testified as a promising candidate for removing DCF from contaminated water.

The effect of silver nanoparticles on the mutagenic and the genotoxic properties of the urban wastewater liquid sludges

Nanoparticles are very effective compounds to transform and detoxicate common environmental contaminants. For this reason, crude urban liquid wastewater sludges were treated by silver nanoparticles (Ag-NPs, 100 nm) for 24 h. Both Ag-NPs' treated and untreated sludges were examined for the evaluation if there are possible mutagenic/anti-mutagenic, cytotoxic, and genotoxic/anti-genotoxic effects by Ames and Allium cepa tests. The results were then subjected to statistical analyses by using SPSS software and p < 0.05 was accepted as a significant value. The data obtained from the Ames test showed that while untreated crude liquid sludge had a significant mutagenic effect, Ag-NP-treated one decreased its mutagenicity. Similar effects were also observed in the chromosome aberration-Allium cepa tests. Significant chromosome aberrations observed were C-metaphase, sticky metaphase, sticky anaphase, anaphase bridge, vagrant chromosome, and multipolar anaphases. Both tests demonstrated that silver nanoparticle treatment decreased the major mutagenicity and genotoxicity detected in the liquid wastewater sludges.

Novel nanofibers mat as an efficient, fast and reusable adsorbent for solid phase extraction of non-steroidal anti-inflammatory drugs in environmental water

Core-shell polyaniline/polyacrylonitrile nanofibers mat (PANI/Pan NFsM) was prepared for extraction of hydrophilic non-steroidal anti-inflammatory drugs (NSAIDs) in environmental water. Superior adsorption and desorption performance of PANI/Pan NFsM was confirmed by both static and dynamic adsorption/desorption experiments. These properties proved PANI/Pan NFsM was a potentially efficient and fast solid phase extraction (SPE) adsorbent for NSAIDs. Under the optimized conditions, only 3 mg of PANI/Pan NFsM could easily extract eight target analytes in 10 mL of water sample without any pre-treatment, and the analytes retained on NFsM could be easily eluted by 500 μL of 1% acetic acid methanol for direct UPLC-MS/MS analysis. In addition, each piece of PANI/Pan NFsM could be reused for at least 20 times without performance decline. Possible adsorption mechanisms were also proposed. Practical feasibility was validated through the actual sample analysis.

Assessment of mutagenicity caused by popular baby foods and baby plastic-ware products: An imperative study using microbial bioassays and migration analysis

Specialized products for infants have become every parent's first choice. Although these products claim to be safe and mild for infant use, yet there is a need to monitor them using different tools for mutagenicity detection to ensure further safety. In this study, a range of popular ready to eat and powdered baby foods, formula milk powders and attractive plasticware for infants were picked from the Indian market and tested for their mutagenicity using two microbial bioassays based on Salmonella typhimurium, viz., Ames bacterial reversion assay and fluctuation assay. Furthermore, chemical migration analysis was done on the most toxic baby food and baby plasticware samples as shown by the bioassays to detect possible leaching of Bisphenol a (BPA), lead and Di-2 ethyl hexyl phthalate (DEHP). It was surprising to find that the products made for the most risk-prone group in the society, i.e., infants have a significant potential to cause mutagenicity.

Microbial Mutagenicity Assay: Ames Test

The Microbial mutagenicity Ames test is a bacterial bioassay accomplished in vitro to evaluate the mutagenicity of various environmental carcinogens and toxins. While Ames test is used to identify the revert mutations which are present in strains, it can also be used to detect the mutagenicity of environmental samples such as drugs, dyes, reagents, cosmetics, waste water, pesticides and other substances which are easily solubilized in a liquid suspension. We present the protocol for conducting Ames test in the laboratory.

Identification and risk assessment of human and veterinary antibiotics in the wastewater treatment plants and the adjacent sea in Tunisia

In the following study, we came up with and validated a prompt, sensitive and precise method for the simultaneous determination of 56 antimicrobial drugs (tetracyclines, sulfonamides, β-lactams, macrolides and quinolones) using the ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). This method was implemented with success to determine antibiotics in samples collected from four wastewater treatment plants and five coasts in Tunisia. Results showed the presence of high concentrations of antibiotics that ranged from 0.1 to 646 ng mL^-1, which can induce many negative impacts on health and the environment. For this reason, we have opted to evaluate toxicity of wastewater samples using a battery of biotests. In fact, genotoxicity was assessed using three tests: Vitotox, comet and micronucleus assays. The input and output of wastewater treatment plants induced a strongly genotoxic effect on the Salmonella typhimurium TA104 prokaryotic Vitotox assay. This result was confirmed using the comet and the micronucleus assays performed on the human liver hepatocellular carcinoma cells. The genotoxic power of the tested wastewater treatment plants' samples could be attributed to the presence of the higher quantities of antibiotics that are detected in these samples and to the antibiotic and organic compound cocktails.

Paracetamol and salicylic acid removal from contaminated water by microalgae

The biomass growth, pharmaceutical removal and light conversion efficiency of Chlorella sorokiniana under the presence of paracetamol (PC) and salicylic acid (SaC) were assessed and compared at two different concentrations of these pharmaceuticals (I: 25 mg l^-1, II: 250 mg l^-1). Microalgae were resistant to these concentrations and, moreover, their growth was significantly stimulated (p ≤ 0.05) under these drugs (biomass concentration increased above 33% PCI, 35% SaCI, 13% PCII and 45% SaCII, as compared with the respective positive controls). At the steady state of the semicontinuous culture, C. sorokiniana showed removal efficiencies above 41% and 69% for PCI and PCII, respectively; and above 93% and 98% for SaCI and SaCII, respectively. Under an irradiance of 370 μE m^-2 s^-1, higher quantum yields were reached by microalgae under the presence of drugs, either at dose I or II, than by the respective positive controls. These results point to C. sorokiniana as a robust strain for the bioremediation of paracetamol and salicylic acid concentrated wastewaters.

Consumption-based approach for pharmaceutical compounds in a large hospital

Hospital wastewater contains a great variety of pharmaceutical compounds (PhCs), mainly due to excretion by patients. These PhCs, called emerging pollutants, are not fully eliminated in treatment plants, and are consequently detected in various environmental matrices, contributing to bacterial resistance and adverse environmental impacts on water resources. This study explores a consumption-based approach to predict the contribution of PhCs to a Brazilian hospital's wastewater. This approach identifies the consumption of major pharmaceutical classes in the studied hospital. Overall, this approach demonstrates a unique opportunity to screen PhCs used in hospitals and identify priority pollutants in hospital wastewater.

Characterization and toxicity of hospital wastewaters in Turkey

The aim of the study was to present first preliminary characterization of Turkish hospital wastewaters, their environmental risk, and a method for toxicity assessment. The hospital wastewater samples were collected from two of the largest medical faculty hospitals and a training and research hospital in Istanbul, Turkey. The samples from the selected hospitals were taken as grab samples on March 2014. Overall, 55 substances including pharmaceuticals and their metabolites, pesticides, and corrosion inhibitors were analyzed in all hospital wastewaters. Analysis of toxicity and the antibiotic resistance bacteria were investigated in addition to the chemical analysis in the wastewater of one hospital. Hazard quotients (HQs) and toxic units (TUs) were calculated as basis of the environmental risk assessment. Fourteen pharmaceuticals in hospital wastewater (HWW) were classified as "high risk" with HQ > 10. HQ_HWW values higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQ_HWW of 9090 was observed to be the most hazardous compound. HQ and TU values of the wastewater treatment plant (WWTP) effluent dropped significantly due to dilution in the sewer. Further elimination by biological degradation or adsorption was observed only in some cases. However, the decreased HQ_WWTPeffluent values do not the change environmental load significantly. Therefore, advanced treatment processes should be applied to remove the persistent compounds. In combination with the results on antibiotic resistance, we would prefer on-site treatment of hospital wastewater. Toxicological assessment was performed using cytotoxic and mutagenic screening tests. The results of the Ames assay showed that the native hospital wastewaters had strongly mutagenic activity with a ≤10-fold increase relative to negative controls. The mutagenic potentials of the samples were generally concentration and metabolic activation dependent. Multiple antibiotic resistances were demonstrated with the tested isolates to ciprofloxacin, trimethoprim, and ceftazidime. This study demonstrates that the hospital wastewaters in Istanbul exhibit strong environmental and toxicological risks, as well as high multiple drug resistance to commonly used antibiotics.

The significance of different health institutions and their respective contributions of active pharmaceutical ingredients to wastewater

Active pharmaceutical ingredients (APIs) have been frequently found in the environment. It is, however, still not quite clear who is mainly responsible for API emissions. Hospitals have been considered to be the main contributing point sources for wastewater (WW) discharge of APIs. However, recent studies have shown that the contribution of hospitals to the input of APIs into the aquatic environment is quite low. Due to demographic change and the increase of psychiatric diseases, health institutions (HIs) such as psychiatric hospitals and nursing homes are likely to be important sources as well, but no data is available in this respect. This study aims to assess the impact of HIs and to provide a methodology to measure their respective contributions. Drawing on pharmaceutical consumption data for the years 2010, 2011, and 2012, this study identified API usage patterns for a psychiatric hospital (146 beds), a nursing home (286 inhabitants), and a general hospital (741 beds), the latter of which comprises three separate locations. All the HIs are located in two sub-regions of a county district with about 400,000 citizens in southwestern Germany. A selection of neurological drugs was quantified in the sewer of these facilities to evaluate the correlation between consumption and emission. The API contribution of HIs was assessed by comparing the specific consumption in the facilities with the consumption in households, expressed as the emission potential (IEP). The study shows that the usage patterns of APIs in the psychiatric hospital and the nursing home were different from the general hospital. Neurological drugs such as anticonvulsants, psycholeptics, and psychoanaleptics were mainly consumed in the psychiatric hospital and the nursing home (74% and 65%, respectively). Predicted and average measured concentrations in the effluent of the investigated HIs differed mostly by less than one order of magnitude. Therefore, the consumption-based approach is a useful method to assess usage patterns of APIs in HIs and to predict their respective contributions to WW. The national contribution of HIs on total WW discharge of APIs compared to households was very low. Only the results for the sedative clomethiazole in general hospitals as well as the antidepressant moclobemide and the antipsychotic quetiapine for the nursing homes were found to deserve some attention. The regional comparison showed that in sub-regions with a comparably higher density of HIs, the allocated facilities could be seen as point sources emitting particular APIs. However, in general, the bulk of the consumed pharmaceuticals to WW discharge has to be attributed to households.

Mutagenic and genotoxic effects of Guelma's urban wastewater, Algeria

Assessment of water pollution and its effect upon river biotic communities and human health is indispensable to develop control and management strategies. In this study, the mutagenicity and genotoxicity of urban wastewater of the city of Guelma in Algeria were examined between April 2012 and April 2013. For this, two biological tests, namely Amesand chromosomal aberrations (CA) test in Allium cepa root tips were employed on the samples collected from five different sampling stages (S1-S5). In Ames test, two strains of Salmonella typhimurium TA98 and TA100 with or without metabolic activation (S9-mix) were used. All water samples were found to be mutagenic to S. typhimurium TA98 with or without S9-mix. A significant decrease in mitotic index (MI) was observed with a decrease in the percentage of cells in the prophase and an increase in the telophase. Main aberrations observed were anaphase bridges, disturbed anaphase-telophase cells, vagrants and stickiness in anaphase-telophase cells. All treatments of wastewater in April 2012, at S5 in July 2012, at S1 and S5 in November 2012, at S5 in February 2013, and at S1 in April 2013 induced CA when compared to the negative control. Some physicochemical parameters and heavy metals (Cd, Pb, and Cu) were also recorded in the samples examined.

Ecotoxicological and genotoxic assessment of hospital laundry wastewaters

The aim of the present study was to assess the ecotoxicity and genotoxicity of hospital laundry wastewaters generated from a regional hospital located in Rio Pardo Valley in the state of Rio Grande do Sul, Brazil. Physicochemical, microbiological, ecotoxicological, and genotoxic analyses were performed, and the results indicate that some parameters were not in accordance with the limit concentrations established by Brazilian and international guidelines for urban wastewaters. Daphnia magna (EC50 2.01%) and Danio rerio (LC50 29.25%) acute toxicity was detected, and sublethal effects were identified in Lactuca sativa (IC25 12.50%) and Allium cepa (IC25 51.25%). Cytotoxicity was observed at the five wastewater concentrations used yielding statistically significant differences (p < 0.05) in the meristematic cells of A. cepa compared with the negative control. The results obtained here warn about the necessity to develop treatment methods that can mitigate the environmental impacts caused by the ecotoxicity and genotoxicity of hospital laundry wastewaters.

Monitoring hospital wastewaters for their probable genotoxicity and mutagenicity

Cancer is a leading cause of death worldwide. Excluding the genetic factors, environmental factors, mainly the pollutants, have been implicated in the causation of the majority of cancers. Wastewater originated from health-care sectors such as hospitals may carry vast amounts of carcinogenic and genotoxic chemicals to surface waters or any other source of drinking water, if discharged untreated. Humans get exposed to such contaminants through a variety of ways including drinking water. The aim of the present study was, thus, to monitor the genotoxic and mutagenic potential of wastewaters from three big hospitals located in Jaipur (Rajasthan), India. One of them was operating an effluent treatment plant (ETP) for treatment of its wastewater and therefore both the untreated and treated effluents from this hospital were studied for their genotoxicity. Two short-term bacterial bioassays namely the Salmonella fluctuation assay and the SOS chromotest were used for the purpose. Results of fluctuation assay revealed the highly genotoxic nature of all untreated effluent samples with mutagenicity ratios (MR) up to 23.13 ± 0.18 and 42.25 ± 0.35 as measured with Salmonella typhimurium strains TA98 and TA100, respectively. As determined with the chromotest, all untreated effluents produced significant induction factors (IF) ranging from 3.29 ± 1.11 to 13.35 ± 3.58 at higher concentrations. In contrast, treated effluent samples were found to be slightly genotoxic in fluctuation test only with an MR = 3.75 ± 0.35 for TA100 at 10 % concentration. Overall, the results indicated that proper treatment of hospital wastewaters may render the effluents safe for disposal contrary to the untreated ones, possessing high genotoxic potential.

Ecotoxicological and genotoxic evaluation of Buenos Aires city (Argentina) hospital wastewater

Hospital wastewater (HWW) constitutes a potential risk to the ecosystems and human health due to the presence of toxic and genotoxic chemical compounds. In the present work we investigated toxicity and genotoxicity of wastewaters from the public hospital of Buenos Aires (Argentina). The effluent from the sewage treatment plant (STP) serving around 10 million inhabitants was also evaluated. The study was carried out between April and September 2012. Toxicity and genotoxicity assessment was performed using the green algae Pseudokirchneriella subcapitata and the Allium cepa test, respectively. Toxicity assay showed that 55% of the samples were toxic to the algae (%I of growth between 23.9 and 54.8). The A. cepa test showed that 40% of the samples were genotoxic. The analysis of chromosome aberrations (CA) and micronucleus (MN) showed no significant differences between days and significant differences between months. The sample from the STP was not genotoxic to A. cepa but toxic to the algae (%I = 41%), showing that sewage treatment was not totally effective. This study highlights the need for environmental control programs and the establishment of advanced and effective effluent treatment plants in the hospitals, which are merely dumping the wastewaters in the municipal sewerage system.

A comparative study of the sensitivities of Salmonella typhimurium strains TA 98, TA 100 and TA 102 to hospital waste waters

Hospitals are a release source of many chemical compounds in their wastewaters. In the present study Salmonella typhimurium strains TA 98, TA 100 and TA 102 were analyzed for their sensitivity to hospital waste waters. The results of the study showed that hospital waste waters consists of mutagens causing frame shift mutations and base pair substitutions and amongst the three strains used in this study, TA 102 was most effective which along with TA 98 can be used for quick assessment of genotoxicity of hospital waste waters prior to its discharge. Genotoxic potential of hospital waste waters from five major hospitals located in Jaipur and Delhi was studied. Such waste waters should be treated prior to their discharge. The results of this study call for further detailed study in this area of research.

Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals

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 pharmaceuticals 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 pharmaceutical load. Results indicate that pharmaceuticals are widespread pollutants in both hospital and urban wastewaters. 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. Furthermore, 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 organisms, showing that especial attention should be paid to antibiotics such as ciprofloxacin, ofloxacin, sulfamethoxazole, azithromycin and clarithromycin, since their hazard quotients in WWTP effluent revealed that they could pose an ecotoxicological risk to algae.

Health care industries: potential generators of genotoxic waste

Health care waste includes all the waste generated by health care establishments, research facilities, and laboratories. This constitutes a variety of chemical substances, such as pharmaceuticals, radionuclides, solvents, and disinfectants. Recently, scientists and environmentalists have discovered that wastewater produced by hospitals possesses toxic properties due to various toxic chemicals and pharmaceuticals capable of causing environmental impacts and even lethal effects to organisms in aquatic ecosystems. Many of these compounds resist normal wastewater treatment and end up in surface waters. Besides aquatic organisms, humans can be exposed through drinking water produced from contaminated surface water. Indeed, some of the substances found in wastewaters are genotoxic and are suspected to be potential contributors to certain cancers. The aim of this study was to evaluate the genotoxic and cytotoxic potential of wastewaters from two hospitals and three clinical diagnostic centers located in Jaipur (Rajasthan State), India using the prokaryotic Salmonella mutagenicity assay (Ames assay) and the eukaryotic Saccharomyces cerevisiae respiration inhibition assay. In the Ames assay, untreated wastewaters from both of the health care sectors resulted in significantly increased numbers of revertant colonies up to 1,000-4,050 as measured by the Salmonella typhimurium TA98 and TA100 strains (with and without metabolic activation) after exposure to undiluted samples, which indicated the highly genotoxic nature of these wastewaters. Furthermore, both hospital and diagnostic samples were found to be highly cytotoxic. Effective concentrations at which 20 % (EC20) and 50 % (EC50) inhibition of the respiration rate of the cells occurred ranged between ~0.00 and 0.52 % and between 0.005 and 41.30 % (calculated with the help of the MS excel software XLSTAT 2012.1.01; Addinsoft), respectively, as determined by the S. cerevisiae assay. The results indicated that hospital wastewaters contain genotoxic and cytotoxic components. In addition, diagnostic centers also represent small but significant sources of genotoxic and cytotoxic wastes.

Evaluation of mutagenicity of wastewater in the vicinity of pesticide industry

Pesticide industrial wastewater samples were taken from the Chinhat industrial area nearby Lucknow city, India. GC-MS analysis revealed the presence of pesticides lindane, α-endosulfan, β-endosulfan, chlorpyriphos, monocrotophos, dimethoate and malathion. A pesticide mixture and wastewater extracts were studied to determine the mutagenicity by Ames Salmonella test, survival of DNA repair defective E. coli K-12 mutants and bacteriophage λ systems. Wastewater samples were concentrated with XAD-resins as an adsorbent and liquid-liquid extraction procedure. The XAD concentrated sample exhibited maximum mutagenic activity in comparison to liquid-liquid extracted sample. TA98 strain was the most responsive strain for both test samples with (+S9) and without (-S9) metabolic activation, while other strains exhibited weak response. A significant decline of DNA repair defective E. coli K-12 mutants, bacteriophage λ was observed with test samples in the survival. The intracellular damage was highest when treated with XAD concentrated sample as compared to liquid-liquid extract after 6h treatment.

Toxicity and genotoxicity of hospital laundry wastewaters treated with photocatalytic ozonation

The aim of the present study was to assess the efficiency of advanced oxidative processes based on photocatalytic ozonation (O(3), UV, UV/O(3), UV/O(3)/Fe(2+) 50 mg L(-1) and 150 mg L(-1)) in the treatment of hospital laundry wastewaters. The analysis of the investigated wastewater revealed high chemical oxygen demand (COD - 3343.8 mg L(-1)), biochemical oxygen demand (BOD(5) - 1906.4 mg L(-1)), total Kjeldahl nitrogen (TKN - 79.8 mg L(-1)) and Daphnia magna toxicity (EC50=1.73). Genotoxic effects were also detected for Allium cepa. Reductions of some parameters occurred after photocatalytic ozonation. The UV/O(3)/Fe(2+) 150 mg L(-1) method was more efficient in reducing COD (59.1%), BOD(5) (50.3%) and TKN (86.8%). There was significant reduction (p<0.05) in D. magna toxicity, O(3) (EC50=47.3%), UV (EC50=50.6%) and UV/O(3)/Fe(2+) 150 mg L(-1) (EC50=45.4%) processes. Normalization of the mitotic index and reduction of micronucleated cells were observed in A. cepa after the treatments. Results demonstrate that these methods were efficient in the degradation of hospital laundry wastewaters, representing a thriving alternative for the removal of pollutants that cause toxicity and genotoxicity.

A priori assessment of ecotoxicological risks linked to building a hospital

Hospital wastewaters contain a large number of chemical pollutants such as disinfectants, detergents, and drug residues. A part of these pollutants is not eliminated by traditional urban waste water treatment plants, leading to a major risk for the aquatic ecosystems receiving these effluents. After having formulated a specific methodology in order to assessment ecotoxicological risk for such a situation, we applied it to the project to build a new hospital shared by several towns in the French Alps. This methodology is based on the ecotoxicological characterisation of the hospital wastewater using a battery of three chronic bioassays (Pseudokirchneriella subcapitata, Heterocypris incongruens and Brachionus calyciflorus) and of genotoxicity tests (Ames fluctuation assay on Salmonella typhimurium, and a Fpg-modified comet assay on the trout liver cell line RTL-W1). The formulated methodology highlights a moderate risk of the hospital wastewater for the organisms of the water column of the river concerned. Nevertheless, this discharge contributes significantly to the global ecotoxicological risk when taking into account all the releases of the watershed into the river. This leads to recommending the implementation of a specific treatment system in the urban WWTP, or upstream to it, in view to protecting the aquatic organisms.

Consumption-based approach for assessing the contribution of hospitals towards the load of pharmaceutical residues in municipal wastewater

Hospitals are considered as major sources of pharmaceutical residues discharged to municipal wastewater, but recent experimental studies showed that the contribution of hospitals to the loads of selected, quantifiable pharmaceuticals in sewage treatment plant (STP) influents was limited. However such conclusions are made based on the experimental analysis of pharmaceuticals in hospital wastewater which is hindered by a number of factors such as access to suitable sampling sites, difficulties in obtaining representative samples and availability of analytical methods. Therefore, this study explores a refined and extended consumption-based approach to predict the contribution of six selected Australian hospitals to the loads of 589 pharmaceuticals in municipal wastewater. In addition, the possibility that hospital-specific substances are present at levels that may pose a risk for human health was evaluated. For 63 to 84% of the pharmaceuticals investigated, the selected hospitals are not a major point source with individual contributions likely to be less than 15% which is in line with previous experimental studies. In contrast, between 10 and 20% of the pharmaceuticals consumed in the selected hospitals are exclusively used in these hospitals. For these hospital-specific substances, 57 distinct pharmaceuticals may cause concerns for human health as concentrations predicted in hospital effluents are less than 100-fold lower than effect thresholds. However, when concentrations were predicted in the influent of the corresponding STP, only 12 compounds (including the antineoplastic vincristine, the antibiotics tazobactam and piperacillin) remain in concentration close to effect thresholds, but further decrease is expected after removal in STP, dilution in the receiving stream and drinking water treatment. The results of this study suggest that risks of human exposure to the pharmaceuticals exclusively administered in the investigated hospitals are limited and decentralised wastewater treatment at these sites would not have a substantial impact on pharmaceutical loads entering STPs, and finally the environment. Overall, our approach demonstrates a unique opportunity to screen for pharmaceuticals used in hospitals and identifying priority pollutants in hospital wastewater explicitly accounting for site-specific conditions. Being based on consumption and loads discharged by hospitals into municipal wastewater, it is not limited by 1) the big effort to obtain representative samples from sewers, 2) the availability of sensitive chemical analysis or 3) a pre-selection of consumption data (e.g. consumption volume).

Evaluation of the mutagenicity of sesquiterpenic compounds and their influence on the susceptibility towards antibiotics of two clinically relevant bacterial strains

Sesquiterpenic compounds are natural chemicals present in organisms from different Phylae or Divisions, which have proved to be important bioactive products, namely in potentiating the action of antibiotics. In the first step, the mutagenicity of nine sesquiterpenic compounds (hydrocarbons and alcohols) was screened in a Salmonella typhimurium his(-)-reversion test with strains TA98 and TA100, in the presence or absence of in vitro metabolic activation. Under the test conditions, none of the compounds showed mutagenicity up to a concentration of 222μg/plate. trans-Farnesol, nerolidol, and α-bisabolol displayed cytotoxicity when tested at concentrations ranging from 14 to 222μg/plate. Then, the combined effect of antibiotic-sesquiterpenic compounds was evaluated on two clinically relevant pathogens, Escherichia coli and Staphylococcus aureus, with well-defined resistance-sensitive profiles. The agar-disc diffusion assay revealed that all the combinations of antibiotic-sesquiterpenic compounds increased the antibacterial activity of the antibiotics tested against S. aureus. For E. coli, an antagonistic effect was observed for various combinations on the growth of this bacterium.

A statistical evaluation of the potential genotoxic activity in the surface waters of the Golden Horn Estuary

The potential genotoxic activity in the surface waters of the Golden Horn Estuary was statistically evaluated utilizing a combination of appropriate parametric and non-parametric tests. The genotoxic activities that were associated with the water samples were determined by the SOS chromotest microplate assay. This assay utilizes β-galactosidase activity, alkaline phosphatase activity, and four different solvent controls, to generate reliable results when corrected induction factors (CIF) are used as quantitative measurements of genotoxic activity. The CIF values were obtained from a total of 384 different genotoxic experiments that were grouped into subsets according to the respective seasons and the selected sampling locations. A total of 160 subsets were statistically compared to assess any possible differences between the pairs of groups, with 95% confidence limits. The findings of this study clearly indicate that some seasonal variations exist in the CIF values at several sampling sites. However, no potentially hazardous impact to the aquatic environment was found in the estuarine system.

Sampling for pharmaceuticals and personal care products (PPCPs) and illicit drugs in wastewater systems: are your conclusions valid? A critical review

The analysis of 87 peer-reviewed journal articles reveals that sampling for pharmaceuticals and personal care products (PPCPs) and illicit drugs in sewers and sewage treatment plant influents is mostly carried out according to existing tradition or standard laboratory protocols. Less than 5% of all studies explicitly consider internationally acknowledged guidelines or methods for the experimental design of monitoring campaigns. In the absence of a proper analysis of the system under investigation, the importance of short-term pollutant variations was typically not addressed. Therefore, due to relatively long sampling intervals, potentially inadequate sampling modes, or insufficient documentation, it remains unclear for the majority of reviewed studies whether observed variations can be attributed to "real" variations or if they simply reflect sampling artifacts. Based on results from previous and current work, the present paper demonstrates that sampling errors can lead to overinterpretation of measured data and ultimately, wrong conclusions. Depending on catchment size, sewer type, sampling setup, substance of interest, and accuracy of analytical method, avoidable sampling artifacts can range from "not significant" to "100% or more" for different compounds even within the same study. However, in most situations sampling errors can be reduced greatly, and sampling biases can be eliminated completely, by choosing an appropriate sampling mode and frequency. This is crucial, because proper sampling will help to maximize the value of measured data for the experimental assessment of the fate of PPCPs as well as for the formulation and validation of mathematical models. The trend from reporting presence or absence of a compound in "clean" water samples toward the quantification of PPCPs in raw wastewater requires not only sophisticated analytical methods but also adapted sampling methods. With increasing accuracy of chemical analyses, inappropriate sampling increasingly represents the major source of inaccuracy. A condensed step-by-step Sampling Guide is proposed as a starting point for future studies.