Elimination of pharmaceutical residues in biologically pre-treated hospital wastewater using advanced UV irradiation technology: a comparative assessment

Ecological impact of pharmaceutical pollutants and options of river health improvements - A risk analysis-based approach

Pharmaceuticals are one of the emerging pollutants (EPs) in river waters across the world. Due to their toxic effects on aquatic organisms, they have drawn the global attention of the scientific community concerned with river ecosystems. This paper reviews the existing occurrence data for various pharmaceutical pollutants (PPs) reported in river waters in some part of the world and their ecological impacts. Using algae, macroinvertebrates (MI), and fish as biotic indicator groups in water to reflect river health conditions, an attempt has been made to assess the ecological risk due to the presence of PPs in the water environment. After ascertaining the predicted no-effect concentration (PNEC) of PPs for selected groups of aquatic organisms, the risk quotient (RQ) is estimated based on their measured environmental concentration (MEC). When MEC > PNEC and RQ > 1 for any of the biotic indicator, ecologically it is 'high risk' condition. The determination of PNEC uses a minimum assessment factor (AF) of 10 due to uncertainty in data over the no observed effect level (NOEL) or lowest observed effect level (LOEL). Accordingly, MEC 10 times higher than PNEC, (RQ = 10) represents a threshold risk concentration (RCT) beyond which adverse effects may start showing observable manifestations. In the present study, a new classification system of 'high risk' conditions for RQ = 1-10 has been proposed, starting from 'moderately high' to 'severely high'. For RQ > 10, the ecological condition of the river is considered 'impaired'. For river health assessment, in the present study, the whole range of physico-chemical characteristics of river water quality has been divided into three groups based on their ease of measurement and frequency of monitoring. Dissolved oxygen related parameters (DORPs), nutrients (NTs), and EPs. PPs represent EPs in this study. A framework for calculating separate indicator group score (IGS) and the overall river health index (RHI) has been developed to predict indicator group condition (IGC) and river health condition (RHC), respectively. Color-coded hexagonal pictorial forms representing IGC and RHC provide a direct visible perception of the existing aquatic environment and a scientific basis for prioritization of corrective measures in terms of treatment technology selection for river health improvements. The analyses indicate that many rivers across the world are under 'high risk' conditions due to PPs having MEC > PNEC and RQ > 1. Up to RCT, (where RQ = 10), the 'high risk' condition varies from 'moderately high' to 'severely high'. In many instances, RQ is found much more higher than 10, indicating that the ecological condition of river may be considered as 'impaired'. Algae is the most frequently affected group of biotic indicators, followed by MI and fish. A review of treatment methods for selection of appropriate technology to reduce the pollution load, especially PPs from the wastewater streams has been summarized. It appears that constructed wetlands (CWs) are at present the most suitable nature-based solutions, particularly for the developing economies of the world, to reduce the concentrations of PPs within limits to minimize the ecological impacts of pharmaceutical compounds on biotic indicators and restore the river health condition. Some suggestive design guidelines for the CWs have also been presented to initiate the process.

A thorough analysis of the occurrence, removal and environmental risks of organic micropollutants in a full-scale hybrid membrane bioreactor fed by hospital wastewater

The Urban Wastewater Treatment Directive recent draft issued last October 2022 pays attention to contaminants of emerging concern including organic micropollutants (OMPs) and requires the removal of some of them at large urban wastewater treatment plants (WWTPs) calling for their upgrading. Many investigations to date have reported the occurrence of a vast group of OMPs in the influent and many technologies have been tested for their removal at a lab- or pilot-scale. Moreover, it is well-known that hospital wastewater (HWW) contains specific OMPs at high concentration and therefore its management and treatment deserves attention. In this study, a 1-year investigation was carried out at a full-scale membrane bioreactor (MBR) treating mainly HWW. To promote the removal of OMPs, powdered activated carbon (PAC) was added to the bioreactor at 0.1 g/L and 0.2 g/L which resulted in the MBR operating as a hybrid MBR. Its performance was tested for 232 target and 90 non-target OMPs, analyzed by UHPLC-QTOF-MS using a direct injection method. A new methodology was defined to select the key compounds in order to evaluate the performance of the treatments. It was based on their frequency, occurrence, persistence to removal, bioaccumulation and toxicity. Finally, an environmental risk assessment of the OMP residues was conducted by means of the risk quotient approach. The results indicate that PAC addition increased the removal of most of the key OMPs (e.g., sulfamethoxazole, diclofenac, lidocaine) and OMP classes (e.g., antibiotics, psychiatric drugs and stimulants) with the highest loads in the WWTP influent. The hybrid MBR also reduced the risk in the receiving water as the PAC dosage increased mainly for spiramycin, lorazepam, oleandomycin. Finally, uncertainties and issues related to the investigation being carried out at full-scale under real conditions are discussed.

Hospital sustainability indicators and reduction of socio-environmental impacts: a scoping review

OBJECTIVE

To synthesize knowledge about hospital sustainability indicators and evidence of reduced socio-environmental impact.

METHOD

Literature scoping review using Pubmed, Science Direct, Scielo and Lilacs databases. Studies in a time frame of 10 years, addressing hospital sustainability indicators and evidence of reduced socio-environmental impact published in any language were included.

RESULTS

A total of 28 articles were included, most were applied research, published in 2012, in English. Studies showed ways to save water and energy, as well as ways to monitor and mitigate the impact of activities related to effluents, waste and emissions. All studies had nursing work directly or indirectly involved in hospital sustainability.

CONCLUSION

The possibilities of generating less impact on the environment and increasing the economy/efficiency of a hospital are countless. The particularities of each hospital must be taken into account and workers, especially nurses, should be involved.

Antineoplastic drugs in urban wastewater: Occurrence, nanofiltration treatment and toxicity screening

Antineoplastic drugs are pharmaceuticals that have been raising concerns among the scientific community due to: (i) their increasing prescription in the fight against the disease of the twentieth century (cancer); (ii) their recalcitrance to conventional wastewater treatments; (iii) their poor environmental biodegradability; and (iv) their potential risk to any eukaryotic organism. This emerges the urgency in finding solutions to mitigate the entrance and accumulation of these hazardous chemicals in the environment. Advanced oxidation processes (AOPs) have been taken into consideration to improve the degradation of antineoplastic drugs in wastewater treatment plants (WWTPs), but the formation of by-products that are more toxic or exhibit a different toxicity profile than the parent drug is frequently reported. This work evaluates the performance of a nanofiltration pilot unit, equipped with a Desal 5DK membrane, in the treatment of real WWTP effluents contaminated (without spiking) with eleven pharmaceuticals, five of which were never studied before. Average removals of 68 ± 23% were achieved for the eleven compounds, with decreasing risks from feed to permeate for aquatic organisms from receiving waterbodies (with the exception of cyclophosphamide, for which a high risk was estimated in the permeate). Aditionally, no significative impact on the growth and germination of three different seeds (Lepidium sativum, Sinapis alba, and Sorghum saccharatum) were determined for permeate matrix in comparison to the control.

Fate and removal of iodinated X-ray contrast media in membrane bioreactor: Microbial dynamics and effects of different operational parameters

Iodinated X-ray contrast media (ICM) are mainly used in medical sector, and their presence in environmental waters is a cause of concern as they are capable of forming highly toxic iodinated disinfection byproducts. In the present study, the removal mechanisms of the three ICM- iohexol, iopromide, and iopamidol were elucidated in a lab-scale aerobic membrane bioreactor (MBR). At steady-state operation (solids retention time (SRT)- 70 days, organic loading rate (OLR)- 0.80 KgCOD/m³-day, nitrogen loading rate (NLR)- 0.08 KgNH₄-N/m³-day, hydraulic retention time (HRT)- 12 h), the average removal of iohexol and iopromide was found to be 34.9 and 45.2 %, respectively, whereas iopamidol proved to be highly recalcitrant in aerobic conditions of the MBR (removal <10 % in all phases of the MBR operation). Further, through batch kinetic studies and mass balance analysis, it was observed that ICM were primarily biotransformed in the MBR system and biosorption (K_d < 10 L/Kg) was negligible. The biodegradation rate coefficient values (K_biol) of the ICM were found to be <0.65 L/g-d which indicate that biotransformation rate of ICM was slow. Increased OLR (1.60 KgCOD/m³-day) and reduced SRT (20 days) were found to negatively affect the removal of the ICM. Further, the removal of ICM was found to depend on its initial concentration, and the increment in the ammonium loading (0.16 KgNH₄-N/m³-day) did not favor its removal. The dosing of ICM altered the microbial dynamics of the mixed liquor and reduced the microbial diversity and richness. Bdellovibrio, Zoogloea, and bacteria belonging to TM7-3 class, Cryomorphaceae and Hyphomonadaceae families may contribute in ICM biotransformation.

Techno-economic evaluation of UV light technologies in water remediation

Disinfection commonly follows conventional treatments in wastewater treatment and remediation plants aiming at reducing the presence of pathogens. However, the presence of the so called "micropollutants" has emerged as a serious concern, therefore developing tertiary treatments that are not only able to remove pathogens but also to degrade micropollutants is worth investigating. Nowadays, UV-C photo-degradation processes are widely used for disinfection due to their simplicity and easy operation; additionally, they have shown potential for the removal of contaminants of emerging concern. Conventional mercury lamps are being replaced by light-emitting diodes (LEDs) that avoid the use of toxic mercury and can be switched on and off with no effect on the lamp lifetime. This work aims to comparatively evaluate the performance of several photo-degradation technologies for the removal of two targeted micropollutants, the pharmaceutical dexamethasone (DXMT) and the herbicide S-metolachlor (MTLC), using UV irradiation doses typical of disinfection processes. To this end, the technical performance of UV-A/UV-C photolysis, UV-A/UV-C photocatalysis, UV-C/H₂O₂ and UV-C/NaOCl has been compared. The influence of operating conditions such as the initial concentration of the pollutants (3 mg L^-1 - 30 mg L^-1, concentrations found in membrane or adsorption remediation steps), pH (3-10), and water matrix (WWTP secondary effluent, and ultrapure water) on the degradation efficiency has been studied. The economic evaluation in terms of electricity and chemicals consumption and the carbon footprint has been evaluated. UV-C photolysis and UV-C photocatalysis appear as the most suitable technologies for the degradation of DXMT and MTLC, respectively, in terms of kinetics (1.53·10^-1 min^-1 for DXMT and 1.96·10^-2 min^-1 for MTLC), economic evaluation (1 € m^-3 for DXMT and 32 € m^-3 for MTLC) and environmental indicators (0.5 g-CO₂ for DXMT and 223.1 g-CO₂ for MTLC).

Inclusion of Environmental Spillovers in Applied Economic Evaluations of Healthcare Products

OBJECTIVES

Climate change and environmental factors have an impact on human health and the ecosystem. The healthcare sector is responsible for substantial environmental pollution. Most healthcare systems rely on economic evaluation to select efficient alternatives. Nevertheless, environmental spillovers of healthcare treatments are rarely considered whether it is from a cost or a health perspective. The objective of this article is to identify economic evaluations of healthcare products and guidelines that have included any environmental dimensions.

METHODS

Electronic searches of 3 literature databases (PubMed, Scopus, and EMBASE) and official health agencies guidelines were conducted. Documents were considered eligible if they assessed the environmental spillovers within the economic evaluation of a healthcare product or provided any recommendations on the inclusion of environmental spillovers in the health technology assessment process.

RESULTS

From the 3878 records identified, 62 documents were deemed eligible and 18 were published in 2021 and 2022. The environmental spillovers considered were carbon dioxide (CO₂) emissions, water or energy consumption, and waste disposal. The environmental spillovers were mainly assessed using the lifecycle assessment (LCA) approach while the economic analysis was mostly limited to costs. Only 9 documents, including the guidelines of 2 health agencies presented theoretical and practical ways to include environmental spillovers into the decision-making process.

CONCLUSIONS

There is a clear lack of methods on whether environmental spillovers should be included in health economic evaluation and how this should be done. If healthcare systems want to reduce their environment footprint, the development of methodology which integrates environmental dimensions in health technology assessment will be key.

Life Cycle Assessment of UV-C based treatment systems for the removal of compounds of emerging concern from urban wastewater

In the last decades particular attention is being paid to the efficient and effective removal of compounds of emerging concern (CECs) present in wastewater before their eventual reuse or disposal. Several technologies have been developed for the degradation of CECs in aqueous matrix, in this regard advanced oxidation processes (AOPs) represent a nascent technological solution developed on a laboratory scale with applications on a prototype scale. The experimental evidences have shown that AOPs processes can oxidize numerous organic compounds in a much faster and more efficient way than that of the most common disinfection processes. The most common AOPs processes are those that involve the use of H₂O₂/UV, O₃/UV, H₂O₂/O₃, H₂O₂/O₃/UV, Fenton and photo-Fenton. The aim of this work is to illustrate the results of a comparative LCA study of a laboratory scale UV-C photoreactor for the tertiary treatment of urban wastewater of three treatment systems (UV-C, UV-C + H₂O₂ e UV-C + TiO₂). In particular, the specific objective is to evaluate, from an environmental point of view, an innovative advanced oxidation system based on nanostructures TiO₂ immobilized on a stainless steel mesh. Compared to the UV-C photolysis reference system, the addition of hydrogen peroxide reduces the total environmental impact of the system by almost 75 %, while the use of the stainless-steel mesh coated by the nanostructures titanium dioxide reduces the UV-C environmental impact by 30 %. These results are due to the lower energy consumption of these last treatments compared to photolysis alone. The main impacts of the three systems are related to the electric power consumption of the centrifugal pump (63-64 %) and of the UV-C lamp (32-33 %). The LCA applied to these systems has shown that TiO₂ assisted photocatalysis is not yet advantageous from an environmental point of view and that, therefore, the efficiency of the system needs to be improved.

Hospital wastewater treatment and the role of membrane filtration - removal of micropollutants and pathogens: A review

Dissemination of multiresistant bacteria and high concentrations of micropollutants by hospitals and other medical facilities can be significantly reduced by a wide variety of on-site treatment approaches. Membrane filtration technologies, ranging from microfiltration to reverse osmosis, have been adapted in many studies and offer multiple purposes in advanced wastewater treatment configurations. While the direct rejection of pharmaceutical compounds and pathogens can only be achieved with nanofiltration and reverse osmosis processes, porous membranes are known for their pathogen removal capabilities and can be used in combination with other advanced treatment approaches, such as oxidation and adsorption processes. This review was conducted to systematically assess studies with membrane filtration technologies that are used as either stand-alone or hybrid systems for the treatment of hospital wastewater. In this review, four different databases were screened with a pre-set of search strings to thoroughly investigate the application of membrane filtration technology in hospital wastewater treatment. Hybrid systems that combine multiple treatment technologies seem to be the most promising way of consistently removing micropollutants and pathogens from hospital wastewater, but additional economic assessments are needed for an extensive evaluation.

Membranes for the life sciences and their future roles in medicine

Since the global outbreak of COVID-19, membrane technology for clinical treatments, including extracorporeal membrane oxygenation (ECMO) and protective masks and clothing, has attracted intense research attention for its irreplaceable abilities. Membrane research and applications are now playing an increasingly important role in various fields of life science. In addition to intrinsic properties such as size sieving, dissolution and diffusion, membranes are often endowed with additional functions as cell scaffolds, catalysts or sensors to satisfy the specific requirements of different clinical applications. In this review, we will introduce and discuss state-of-the-art membranes and their respective functions in four typical areas of life science: artificial organs, tissue engineering, in vitro blood diagnosis and medical support. Emphasis will be given to the description of certain specific functions required of membranes in each field to provide guidance for the selection and fabrication of the membrane material. The advantages and disadvantages of these membranes have been compared to indicate further development directions for different clinical applications. Finally, we propose challenges and outlooks for future development.

A critical review on diverse technologies for advanced wastewater treatment during SARS-CoV-2 pandemic: What do we know?

Advanced wastewater treatment technologies are effective methods and currently attract growing attention, especially in arid and semi-arid areas, for reusing water, reducing water pollution, and explicitly declining, inactivating, or removing SARS-CoV-2. Overall, removing organic matter and micropollutants prior to wastewater reuse is critical, considering that water reclamation can help provide a crop irrigation system and domestic purified water. Advanced wastewater treatment processes are highly recommended for contaminants such as monovalent ions from an abiotic source and SARS-CoV-2 from an abiotic source. This work introduces the fundamental knowledge of various methods in advanced water treatment, including membranes, filtration, Ultraviolet (UV) irradiation, ozonation, chlorination, advanced oxidation processes, activated carbon (AC), and algae. Following that, an analysis of each process for organic matter removal and mitigation or prevention of SARS-CoV-2 contamination is discussed. Next, a comprehensive overview of recent advances and breakthroughs is provided for each technology. Finally, the advantages and disadvantages of each method are discussed.

Investigating the environmental costs of utilizing graphene-based adsorbents and pulsed power oxidation for the removal of emerging contaminants from urban wastewater

Emerging contaminants continue to pose a threat to environmental quality that warrant mitigation. Novel technologies are being investigated that offer promise in their removal, yet it is important that the environmental costs of these treatments do not overshadow their benefits. With sustainability a key priority in global infrastructure development, insights into the environmental impact of new technologies is necessitated. In the present work, the environmental burden of three novel GBM (graphene-based material) filters (porous graphene, graphene oxide-based foam and hybrid combination) are quantified and compared at a flow rate of 1 m³/d by way of life cycle impact assessment with an alternative solution, an AOP-PPT (advanced oxidation process by pulsed power treatment). Initial results demonstrated negligible differences in overall environmental impact between the three GBM filter formats (7.7-7.9 pt), while significant asymmetry was observed with the AOP-PPT that incurred a total impact score of 67.9 pt. This disparity was attributed to the high energy demand of the AOP-PPT that was a key predictor of environmental cost in an India context due to the high proportion of non-renewable energy sourced. The GBM filters were also considered at a range of breakthrough times and contrasted against the AOP-PPT. Results showed that differences between GBM filters were negligible at all breakthrough periods and that multiple breakthroughs a day would be required before the AOP-PPT became environmentally favourable. Finally, due to the AOP-PPT affording inclusive disinfection, the environmental burden of a GBM filter was compared under different scenarios of incorporated disinfection. The total impact of the AOP-PPT achieving full disinfection was found to be 242.5 pt compared to only 26.8 pt for the GBM filter coupled with UV₂₅₄ (ultraviolet 254 nm) treatment and 13.9 pt when incorporating chlorination/de-chlorination. These findings should support sustainable development goals when combating prevailing emerging contaminants in municipal wastewater.

Biodegradation of pharmaceuticals in photobioreactors - a systematic literature review

This work is a systematic review that reports state-of-the-art in removal of pharmaceuticals from water and wastewater by photosynthetic organisms in photobioreactors. The PRISMA protocol-based review of the most recent literature data from the last 10 years (2011–2021) was reported. Articles were searched by the combination of the following keywords: photobioreactor, pharmaceuticals, drugs, hormones, antibiotics, biodegradation, removal, wastewater treatment. The review focuses on original research papers (not reviews), collected in 3 scientific databases: Scopus, Web of Knowledge, PubMed. The review considered the following factors: type of microorganisms, type of micropollutants removed, degradation efficiency and associated products, types of photosynthetic organisms and photobioreactor types. The conclusion from the systematic review is that the main factors that limit widespread pharmaceuticals removal in photobioreactors are high costs and the problem of low efficiency related with low concentrations of pharmaceuticals. The review indicated a need for further research in this area due to increasing amounts of metabolites in the food chain, such as p-aminophenol and estrone, which can cause harm to people and ichthyofauna. Pharmaceuticals removal can be improved by adapting the type of microorganism used to the type of contamination and implementing photoperiods, which increase the removal efficiency of e.g. sulfamethazine by up to 28%. In the future, it is necessary to search for new solutions in terms of the construction of photobioreactors, as well as for more effective species in terms of pharmaceuticals biodegradation that can survive the competition with other strains during water and wastewater treatment.

The Dark Side of Platinum Based Cytostatic Drugs: From Detection to Removal

The uncontrolled release of pharmaceutical drugs into the environment raised serious concerns in the last decades as they can potentially exert adverse effects on living organisms even at the low concentrations at which they are typically found. Among them, platinum based cytostatic drugs (Pt CDs) are among the most used drugs in cancer treatments which are administered via intravenous infusion and released partially intact or as transformation products. In this review, the studies on environmental occurrence, transformation, potential ecotoxicity, and possible treatment for the removal of platinum cytostatic compounds are revised. The analysis of the literature highlighted the generally low total platinum concentration values (from a few tens of ng L−1 to a few hundred μg L−1) found in hospital effluents. Additionally, several studies highlighted how hospitals are sources of a minor fraction of the total Pt CDs found in the environment due to the slow excretion rate which is longer than the usual treatment durations. Only some data about the impact of the exposure to low levels of Pt CDs on the health of flora and fauna are present in literature. In some cases, adverse effects have been shown to occur in living organisms, even at low concentrations. Further ecotoxicity data are needed to support or exclude their chronic effects on the ecosystem. Finally, fundamental understanding is required on the platinum drugs removal by MBR, AOPs, technologies, and adsorption.

A review on hospital wastewater treatment: A special emphasis on occurrence and removal of pharmaceutically active compounds, resistant microorganisms, and SARS-CoV-2

The hospital wastewater imposes a potent threat to the security of human health concerning its high vulnerability towards the outbreak of several diseases. Furthermore, the outbreak of COVID-19 pandemic demanded a global attention towards monitoring viruses and other infectious pathogens in hospital wastewater and their removal. Apart from that, the presence of various recalcitrant organics, pharmaceutically active compounds (PhACs), etc. imparts a complex pollution load to water resources and ecosystem. In this review, an insight into the occurrence, persistence and removal of drug-resistant microorganisms and infectious viruses as well as other micro-pollutants have been documented. The performance of various pilot/full-scale studies have been evaluated in terms of removal of biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), PhACs, pathogens, etc. It was found that many biological processes, such as membrane bioreactor, activated sludge process, constructed wetlands, etc. provided more than 80% removal of BOD, COD, TSS, etc. However, the removal of several recalcitrant organic pollutants are less responsive to those processes and demands the application of tertiary treatments, such as adsorption, ozone treatment, UV treatment, etc. Antibiotic-resistant microorganisms, viruses were found to be persistent even after the treatment of hospital wastewater, and high dose of chlorination or UV treatment was required to inactivate them. This article circumscribes the various emerging technologies, which have been used to treat PhACs and pathogens. The present review also emphasized the global concern of the presence of SARS-CoV-2 RNA in hospital wastewater and its removal by the existing treatment facilities.

Thermal plasma activation and UV/H2O2 oxidative degradation of pharmaceutical residues

The aquatic environment becomes increasingly contaminated by anthropogenic pollutants such as pharmaceutical residues. Due to poor biodegradation and continuous discharge of persistent compounds in sewage water samples, pharmaceutical residues might end up in surface waters when not removed. To minimize this pollution, onsite wastewater treatment techniques might complement conventional waste water treatment plants (WWTPs). Advanced oxidation processes are useful techniques, since reactive oxygen species (ROS) are used for the degradation of unwanted medicine residues. In this paper we have studied the advanced oxidation in a controlled laboratory setting using thermal plasma and UV/H₂O₂ treatment. Five different matrices, Milli-Q water, tap water, synthetic urine, diluted urine and synthetic sewage water were spiked with 14 pharmaceuticals with a concentration of 5 μg/L. All compounds were reduced or completely decomposed by both 150 W thermal plasma and UV/H₂O₂ treatment. Additionally, also hospital sewage water was tested. First the concentrations of 10 pharmaceutical residues were determined by liquid chromatography mass spectrometry (LC-MS/MS). The pharmaceutical concentration ranged from 0.08 up to 2400 μg/L. With the application of 150 W thermal plasma or UV/H₂O₂, it was found that overall pharmaceutical degradation in hospital sewage water were nearly equivalent to the results obtained in the synthetic sewage water. However, based on the chemical abatement kinetics it was demonstrated that the degree of degradation decreases with increasing matrix complexity. Since reactive oxygen and nitrogen species (RONS) are continuously produced, thermal plasma treatment has the advantage over UV/H₂O₂ treatment.

Removal of pharmaceuticals from wastewater of health care facilities

Health care facilities can represent point sources for pharmaceutical residues in public sewer systems. Compared to general hospitals, more specialized health care facilities might also have a different pattern of medication. Therefore, the on-site treatment of wastewater from such facilities could be an effective strategy to reduce emissions into water bodies and was the aim of this study. Wastewater from three health care facilities (nursing home, clinic with orthopaedic focus, and psychiatric clinic) was treated in lab-scale and semi-industrial trials. Biological treatment was performed via an ultrafiltration membrane bioreactor (UF-MBR), after which adsorption onto granular activated carbon (using rapid-small-scale column tests GAC-RSSCT), ozonation and a UV/H₂O₂ advanced oxidation process (AOP) were tested and compared. The removal of 17 pharmaceutical compounds and drug metabolites from 9 drug classes (e.g. analgesics, antibiotics, anticonvulsants) was evaluated. Most of the measured OMP were detected with concentrations between 1,000 and 30,000 ng L^-1 in the influent of the MBR. The UF-MBR provided an effective mechanical-biological cleaning of the wastewater, with micropollutant removal efficiencies between 0 and > 95%, making further treatment necessary to remove the micropollutants. Each combination of the UF-MBR with one of the three further treatments achieved removal efficiencies above 80% for most of the investigated substances, reducing many to below the quantification limit of 10 ng L^-1. The results show the general suitability of combining the UF-MBR with either GAC-adsorption, ozonation or AOP for eliminating pharmaceutical residues. However, the AOP process has a significantly higher energy demand than the other two processes. Moreover, specific settings and dosages depend on the respective wastewater matrix.

Feasibility study on applying the iron-activated persulfate system as a pre-treatment process for clofibric acid selective degradation in municipal wastewater

Clofibric acid (CFA) was selected as an example of the widespread micropollutants in municipal wastewater to investigate the feasibility of the application of an iron-activated persulfate (Fe-PS) system for selective micropollutants removal prior to biological wastewater treatment. In pure CFA solution, the CFA degradation rate was accelerated with an increase in oxidant dosage and 2.15 mg·L^-1 (0.01 mM) CFA could be completed removed within 30 min with 270 mg·L^-1 (1 mM) potassium persulfate (PS) activated by 56 mg·L^-1 iron powder (Fe). Although both sulfate radicals (SO₄^∙-) and hydroxyl radicals (HO^∙) were generated in the Fe-PS system, SO₄^∙- was identified as the dominant oxidant for CFA degradation. To investigate the interference from model compounds in the municipal wastewater, CFA degradation in different concentrations of ammonia or/and glucose solutions, the synthetic municipal wastewater, and real municipal wastewater systems were investigated. A complete removal of CFA was achieved with ammonia or/and glucose interferences. Less than 3% ammonia was removed due to the formation of aminopropyl radicals. About 15% degradation of dissolved organic carbon (DOC) was mainly attributed to the oxidation of glucose by HO^∙, Indicating the excellent selective oxidation ability of the Fe-PS system targeting at CFA over glucose. Even though the alkalinity significantly hindered the oxidation of CFA in both synthetic and real municipal wastewater system, the removal efficiency of CFA was significantly higher than that of DOC. The decrease of CFA removal efficiency in municipal wastewater system comparing to the other tests was due to the slow degradation of PS in the system and further hindered the SO₄^∙- generation. Therefore, the impacts of other impurities in municipal wastewater on the oxidation activities of Fe-PS system should be further investigated. In general, this study confirmed the feasibility of using the Fe-PS system for selective degrading resistant CFA in municipal wastewater.

Detection and removal of biologically active organic micropollutants from hospital wastewater

The presence of contaminants of emerging concern (CECs), such as antibiotics, antimicrobial disinfectants, nonprescription drugs, personal care products, pharmaceuticals, and steroids, in water resources can impact aquatic and human health. A large portion of the CECs entering regional wastewater treatment plants originate from hospitals. The purposes of this study were to conduct exploratory analytical work to characterize two hospital wastewaters and to evaluate treatment of CECs at hospitals before dilution with domestic wastewater. A 24-h batch reaction with biogenic manganese oxides coated onto coir fiber was used to treat the wastewaters. Organic contaminants in the wastewaters were concentrated by both liquid-liquid extraction (LLE) and solid-phase extraction (SPE). LLE extracts were analyzed by Comprehensive Two-Dimensional Gas Chromatography/Time-of-Flight Mass Spectrometry (GC × GC-TOFMS) while SPE extracts were analyzedby UltraHigh Performance Liquid Chromatography/Time-of-Flight Mass Spectrometry (UHPLC-TOFMS). Fifty-two organic micropollutants were detected (26 by GC × GC-TOFMS, 25 by UHPLC-TOFMS, 1 by both) in the wastewaters, while 29 were removed by >90% and six were degraded by <50% after treatment. Control experiments revealed that sorption to coir fiber and oxidation by manganese oxides were the primary contaminant removal mechanisms. Both the LLE and SPE extracts were used to evaluate potential human toxicity of the hospital wastewaters before and after treatment. Twenty-eight human cell-based bioreceptor assays were used to screen the wastewaters, and secondary tests were run to quantify toxicity equivalents to activated receptors. The wastewaters initially contained organic micropollutants that strongly activated the Androgen Receptor, Estrogen Receptor β, and the Mineralocorticoid Receptor but no bioactive compounds were detected after treatment. Point-of-entry treatment of hospital wastewater should reduce bioactive compounds from entering the environment.

A new decentralized biological treatment process based on activated carbon targeting organic micropollutant removal from hospital wastewaters

Although hospital wastewaters (HWWs) are usually discharged in urban sewage systems, their separate treatment has several benefits, such as the specific treatment of potential toxics as well as avoidance of further dilutions. In this work, an integrated industrial pilot plant (2200 L) corresponding to the technology SeMPAC^® is proposed and validated for such purpose. The process consists of a sequential batch reactor (SBR) connected to an external submerged microfiltration membrane, in which powdered activated carbon (PAC) is directly added into the biological reactor to enhance the removal of the organic micropollutants (OMPs). The combination of different redox conditions in the SBR, as well as the operation at long sludge retention times (SRTs) and high biomass concentrations favored OMP biotransformation in the SBR, being their final removal efficiencies enhanced clearly after PAC addition, especially for the recalcitrant compounds. A periodical renewal of the adsorbent is necessary to overcome its gradual saturation. The main operational conditions were influenced by (i) the recalcitrant OMP carbamazepine, which defines the PAC dosage; (ii) the easily degradable OMP ibuprofen, which can be used to optimize the duration of the aerobic cycle; and (iii) the denitrification efficiency, which defines the correct time length of the anoxic period.

UV/H2O2 process stability and pilot-scale validation for trace organic chemical removal from wastewater treatment plant effluents

This study investigated the removal of 15 trace organic chemicals (TOrCs) occurring at ambient concentrations from municipal wastewater treatment plant effluent by advanced oxidation using UV/H₂O₂ at pilot-scale. Pseudo first-order rate constants (k_obs) for photolytic as well as combined oxidative and photolytic degradation observed at pilot-scale were validated with results from a bench-scale collimated beam device. No significant difference was determined between pilot- and lab-scale performance. During continuous pilot-scale operation at constant UV fluence of 800 mJ/cm² and H₂O₂ dosage of 10 mg/L, the removal of various TOrCs was investigated. The average observed removal for photo-susceptible (k_UV>10^-3 cm²/mJ; like diclofenac, iopromide and sulfamethoxazole), moderately photo-susceptible (10^-4<k_UV<10^-3 cm²/mJ; like climbazole, tramadol, sotalol, citalopram, benzotriazole, venlafaxine and metoprolol), and most photo-resistant (k_UV<10^-4 cm²/mJ; like primidone, carbamazepine and gabapentin) compounds was 90%, 49% and 37% including outliers, respectively. The poorly reactive compound TCEP was not significantly eliminated during pilot-scale experiments. Additionally, based on removal kinetics of photo-resistant TOrCs, continuous pilot-scale operation revealed high variations of OH-radical exposure determined from removal kinetics of photo-resistant TOrCs, primarily due to nitrite concentration fluctuations in the feed water. Furthermore, a correlation between OH-radical exposure and scavenging capacity could be determined and verified by mechanistic modeling using UV fluence, H₂O₂ dosage, and standard water quality parameters (i.e., DOC, NO₃^-, NO₂^- and HCO₃^-) as model input data. This correlation revealed the possibility of OH-radical exposure prediction by water matrix parameters and proved its applicability for pilot-scale operations.

Slurry photocatalytic membrane reactor technology for removal of pharmaceutical compounds from wastewater: Towards cytostatic drug elimination

The potential of photocatalytic membrane reactors (PMR) to degrade cytostatic drugs is presented in this work as an emerging technology for wastewater treatment. Cytostatic drugs are pharmaceutical compounds (PhCs) commonly used in cancer treatment. Such compounds and their metabolites, as well as their degraded by-products have genotoxic and mutagenic effects. A major challenge of cytostatic removal stands in the fact that most drugs are delivered to ambulant patients leading to diluted concentration in the municipal waste. Therefore safe strategies should be developed in order to collect and degrade the micro-pollutants using appropriate treatment technologies. Degradation of cytostatic compounds can be achieved with different conventional processes such as chemical oxidation, photolysis or photocatalysis but the treatment performances obtained are lower than the ones observed with slurry PMRs. Therefore the reasons why slurry PMRs may be considered as the next generation technology will be discussed in this work together with the limitations related to the mechanical abrasion of polymeric and ceramic membranes, catalyst suspension and interferences with the water matrix. Furthermore key recommendations are presented in order to develop a renewable energy powered water treatment based on long lifetime materials.

Combined use of VUV and UVC photoreactors for the treatment of hospital laundry wastewaters: Reduction of load parameters, detoxification and life cycle assessment of different configurations

The present research investigated the treatment of hospital laundry wastewaters by the combined use of photochemical VUV and UVC reactors. Seven different configurations were tested and the performances of each of them were evaluated based on the removal of the load parameters, detoxification and life cycle assessment (LCA). The characterization of studied wastewaters included analysis of the following parameters: COD, BOD₅, TKN, total P, pH, turbidity and conductivity. Acute ecotoxicity was evaluated using Daphnia magna. Ultraviolet-Visible (UV-Vis) spectroscopy was performed to determine the organic fraction and chromatography coupled to the mass spectrometer (GC-MS) was used for the qualitative characterization of priority pollutants. Characterization parameters showed the presence of drugs like lidocaine and dipyrone and a high organic load with a poor biodegradability. Wastewaters presented an extreme acute toxicity against D. magna (EC₅₀ 6.7%). The ozonation process (mainly generated by the VUV reactor) obtained the best results concerning the ratio between the consumed energy and the removed COD and the UVC process presented the lowest environmental impacts for the characterization and normalization parameters of the LCA. Normalization revealed that the highest environmental burdens were associated with human toxicity, ecotoxicity and eutrophication of surface waters as well as to the use of non-renewable resources. VUV/UVC/O₃ process presented the best results considering detoxification (EC₅₀ 100%).

Light-Assisted Advanced Oxidation Processes for the Elimination of Chemical and Microbiological Pollution of Wastewaters in Developed and Developing Countries

In this work, the issue of hospital and urban wastewater treatment is studied in two different contexts, in Switzerland and in developing countries (Ivory Coast and Colombia). For this purpose, the treatment of municipal wastewater effluents is studied, simulating the developed countries’ context, while cheap and sustainable solutions are proposed for the developing countries, to form a barrier between effluents and receiving water bodies. In order to propose proper methods for each case, the characteristics of the matrices and the targets are described here in detail. In both contexts, the use of Advanced Oxidation Processes (AOPs) is implemented, focusing on UV-based and solar-supported ones, in the respective target areas. A list of emerging contaminants and bacteria are firstly studied to provide operational and engineering details on their removal by AOPs. Fundamental mechanistic insights are also provided on the degradation of the effluent wastewater organic matter. The use of viruses and yeasts as potential model pathogens is also accounted for, treated by the photo-Fenton process. In addition, two pharmaceutically active compound (PhAC) models of hospital and/or industrial origin are studied in wastewater and urine, treated by all accounted AOPs, as a proposed method to effectively control concentrated point-source pollution from hospital wastewaters. Their elimination was modeled and the degradation pathway was elucidated by the use of state-of-the-art analytical techniques. In conclusion, the use of light-supported AOPs was proven to be effective in degrading the respective target and further insights were provided by each application, which could facilitate their divulgation and potential application in the field.

Occurrence and behaviour of pharmaceutical compounds in a Portuguese wastewater treatment plant: Removal efficiency through conventional treatment processes

Wastewater treatments can eliminate or remove a substantial amount of pharmaceutical active compounds (PhACs), but there may still be significant concentrations of them in effluents discharged into surface water bodies. Beirolas wastewater treatment plant (WWTP) is located in the Lisbon area and makes its effluent discharges into Tagus estuary (Portugal). The main objective of this study is to quantify a group of 32 PhACs in the different treatments used in this WWTP. Twelve sampling campaigns of wastewater belonging to the different treatments were made in 2013-2014 in order to study their removal efficiency. The wastewaters were analysed by solid phase extraction (SPE) and ultra-performance liquid chromatography coupled with tandem mass detection (UPLC-MS/MS). The anti-diabetics were the most frequently found in wastewater influent (WWI) and wastewater effluent (WWE) (208 and 1.7 μg/L, respectively), followed by analgesics/antipyretics (135 μg/L and < LOQ, respectively), psychostimulants (113 and 0.49 μg/L, respectively), non-steroidal anti-inflammatory drugs (33 and 2.6 μg/L, respectively), antibiotics (5.2 and 1.8 μg/L, respectively), antilipidemics (1.6 and 0.24 μg/L, respectively), anticonvulsants (1.5 and 0.63 μg/L, respectively) and beta blockers (1.3 and 0.51 μg/L, respectively). A snapshot of the ability of each treatment step to remove these target PhACs is provided, and it was found that global efficiency is strongly dependent on the efficiency of secondary treatment. Seasonal occurrence and removal efficiency was also monitored, and they did not show a significant seasonal trend.

Biological and photochemical degradation of cytostatic drugs under laboratory conditions

Cytostatic drugs, used in chemotherapy, have emerged as new environmental contaminants due to their recurrent presence in surface waters and genotoxic effects. Yet, their degradability and environmental fate is largely unknown. The aim of this study was to determine the degradation kinetics of 16 cytostatic drugs, prioritized according to their usage and occurrence in hospital and wastewater treatment plants (WWTP) effluents, through the following laboratory scale processes: hydrolysis, aerobic biodegradation, UV-C photolysis, UV-C/H₂O₂ and simulated solar radiation. Some drugs were unstable in milli-Q water (vincristine, vinblastine, daunorubicin, doxorubicin and irinotecan); others were photodegraded under UV-C light (melphalan and etoposide) but some others were found to be recalcitrant to biodegradation and/or UV-C, making necessary the use of advanced oxidation processes (AOPs) such as UV-C/H₂O₂ for complete elimination (cytarabine, ifosfamide and cyclophosphamide). Finally, radiation in a solar box was used to simulate the fate of cytostatic drugs in surface waters under natural radiation and complete removal was not observed for any drug. The degradation process was monitored using liquid chromatography coupled to high resolution mass spectrometry and pseudo-first order kinetic degradation constants were calculated. This study provides new data on the degradability of cytostatic compounds in water, thus contributing to the existing knowledge on their fate and risk in the environment.

Low cost UVA-LED as a radiation source for the photo-Fenton process: a new approach for micropollutant removal from urban wastewater

A UVA-LED driven photo-Fenton process is shown as a feasible technology for micropollutant removal. The photoreactor design, which strongly depends on the energy efficiency and LED wavelength, needs to be carried out using parameters such as Electrical-Energy-per-Order (E_EO).

Evaluation of a membrane bioreactor system as post-treatment in waste water treatment for better removal of micropollutants

Organic micropollutants (OMPs) such as pharmaceuticals are persistent pollutants that are only partially degraded in waste water treatment plants (WWTPs). In this study, a membrane bioreactor (MBR) system was used as a polishing step on a full-scale WWTP, and its ability to remove micropollutants was examined together with the development and stability of the microbial community. Two stages of operation were studied during a period of 9 months, one with (S1) and one without (S2) the addition of exogenous OMPs. Ibuprofen and naproxen had the highest degradation rates with values of 248 μg/g_VSS·h and 71 μg/g_VSS·h, whereas diclofenac was a more persistent OMP (7.28 μg/g_VSS·h). Mineralization of ¹⁴C-labeled OMPs in batch kinetic experiments indicates that higher removal rates (∼0.8 ng/mg_TSS·h) with a short lag phase can be obtained when artificial addition of organic micropollutants was performed. Similar microbial populations dominated S1 and S2, despite the independent operations. Hydrogenophaga, Nitrospira, p55-a5, the actinobacterial Tetrasphaera, Propionicimonas, Fodinicola, and Candidatus Microthrix were the most abundant groups in the polishing MBR. Finally, potential microbial candidates for ibuprofen and naproxen degradation are proposed.

Analytical tools employed to determine pharmaceutical compounds in wastewaters after application of advanced oxidation processes

Today, the presence of contaminants in the environment is a topic of interest for society in general and for the scientific community in particular. A very large amount of different chemical substances reaches the environment after passing through wastewater treatment plants without being eliminated. This is due to the inefficiency of conventional removal processes and the lack of government regulations. The list of compounds entering treatment plants is gradually becoming longer and more varied because most of these compounds come from pharmaceuticals, hormones or personal care products, which are increasingly used by modern society. As a result of this increase in compound variety, to address these emerging pollutants, the development of new and more efficient removal technologies is needed. Different advanced oxidation processes (AOPs), especially photochemical AOPs, have been proposed as supplements to traditional treatments for the elimination of pollutants, showing significant advantages over the use of conventional methods alone. This work aims to review the analytical methodologies employed for the analysis of pharmaceutical compounds from wastewater in studies in which advanced oxidation processes are applied. Due to the low concentrations of these substances in wastewater, mass spectrometry detectors are usually chosen to meet the low detection limits and identification power required. Specifically, time-of-flight detectors are required to analyse the by-products.

Experimental and in silico assessment of fate and effects of the antipsychotic drug quetiapine and its bio- and phototransformation products in aquatic environments

The antipsychotic drug quetiapine (QUT) has been frequently detected in sewage treatment plants. However, information on the fate of QUT in aquatic environments and its behavior during UV treatment is limited. In this study, QUT is shown not to be readily biodegradable in the Closed Bottle Test and the Manometric Respirometry Test according to OECD guidelines. The main biotransformation product (BTP) formed in the tests, a carboxylic acid derivative, was identified by means of high-resolution mass spectrometry. This BTP is presumably a human metabolite and showed higher detection rates than QUT in a river sampling campaign conducted in northern Germany. UV elimination kinetics of QUT at different initial concentrations (226.5, 45.3, 11.3, and 2.3 μmol L^-1) were faster at lower initial concentrations. All seven phototransformation products (PTPs) could be still identified at initial concentration of 11.3 μmol L^-1. The photolytic mixture generated after 128 min of photolysis of QUT was not better biodegradable than QUT. Initial UV treatment of QUT led to the formation of several additional BTPs. Four of them were identified. The bacterial cytotoxicity and genotoxicity before and after phototransformation of QUT in a modified luminescent bacteria test (LBT) and the umu-test (ISO/FDIS 13829) showed cytotoxic effects in the LBT for QUT. Furthermore, PTPs had similar cytotoxic effects on luminescent bacteria. The umu-test did not reveal any genotoxic activity for QUT or PTPs. In conclusion, the release of QUT into sewage treatment plants and aquatic environments could result in the formation of a main BTP. Additional UV treatment of QUT would lead to the formation of additional BTPs. Moreover, treatment did not result in lower toxicity to tested organisms. In conclusion, UV treatment of QUT should be considered critically as a potential treatment for QUT in aquatic systems.

UV/H2O2degradation of the antidepressants venlafaxine and O-desmethylvenlafaxine: Elucidation of their transformation pathway and environmental fate

The aim of the present work is to investigate the removal and transformation of the antidepressants venlafaxine (VFX) and its main metabolite O-desmethylvenlafaxine (DVFX) upon advanced oxidation with UV/H2O2 under lab conditions. High-resolution mass spectrometry (HRMS) analyses were carried out by means of ultra-high pressure liquid chromatography (UHPLC)-linear ion trap high resolution Orbitrap instrument (LTQ-Orbitrap-MS) in order to elucidate the different transformation products (TPs) generated. The depletion of both VFX and DVFX was very significant, with the 99.9% of both compounds eliminated after 5 and 30 min of reaction, respectively. Eleven TPs for VFX and six for DVFX were detected and their molecular structures elucidated by means of MS(2) and MS(3) scans, and the corresponding degradation pathways were proposed. The combined ecotoxicity at different treatment times was evaluated by means of bioluminescence inhibition assays with the marine bacteria Vibrio fischeri. Results showed an increase in the ecotoxicity during the UV/H2O2 experiment, especially at those reaction times where the total abundance of TPs was higher.

Human metabolites and transformation products of cyclophosphamide and ifosfamide: analysis, occurrence and formation during abiotic treatments

This study describes a gas chromatography-mass spectrometry analytical method for the analysis of cytostatic cyclophosphamide (CP), ifosfamide (IF) and their selected metabolites/transformation products (TPs): carboxy-cyclophosphamide (carboxy-CP), keto-cyclophosphamide (keto-CP) and 3-dechloroethyl-ifosfamide/N-dechloroethyl-cyclophosphamide (N-decl-CP) in wastewater (WW). Keto-cyclophosphamide, CP and IF were extracted with Oasis HLB and N-decl-CP and carboxy-CP with Isolute ENV+ cartridges. Analyte derivatization was performed by silylation (metabolites/TPs) and acetylation (CP and IF). The recoveries and LOQs of the developed method were 58, 87 and 103 % and 77.7, 43.7 and 6.7 ng L(-1) for carboxy-CP, keto-CP and N-decl-CP, respectively. After validation, the analytical method was applied to hospital WW and influent and effluent samples of a receiving WW treatment plant. In hospital WW, levels up to 2690, 47.0, 13,200, 2100 and 178 ng L(-1) were detected for CP, IF, carboxy-CP, N-decl-CP and keto-CP, respectively, while in influent and effluent samples concentrations were below LOQs. The formation of TPs during abiotic treatments was also studied. Liquid chromatography-high-resolution mass spectrometry was used to identify CP and IF TPs in ultrapure water, treated with UV and UV/H2O2. UV treatment produced four CP TPs and four IF TPs, while UV/H2O2 resulted in five CPs and four IF TPs. Besides already known TPs, three novel TPs (CP-TP138a, imino-ifosfamide and IF-TP138) have been tentatively identified. In hospital WW treated by UV/O3/H2O2, none of the target metabolites/TPs resulted above LOQs.

Occurrence and removal of organic micropollutants: An overview of the watch list of EU Decision 2015/495

Although there are no legal discharge limits for micropollutants into the environment, some regulations have been published in the last few years. Recently, a watch list of substances for European Union-wide monitoring was reported in the Decision 2015/495/EU of 20 March 2015. Besides the substances previously recommended to be included by the Directive 39/2013/EU, namely two pharmaceuticals (diclofenac and the synthetic hormone 17-alpha-ethinylestradiol (EE2)) and a natural hormone (17-beta-estradiol (E2)), the first watch list of 10 substances/groups of substances also refers three macrolide antibiotics (azithromycin, clarithromycin and erythromycin), other natural hormone (estrone (E1)), some pesticides (methiocarb, oxadiazon, imidacloprid, thiacloprid, thiamethoxam, clothianidin, acetamiprid and triallate), a UV filter (2-ethylhexyl-4-methoxycinnamate) and an antioxidant (2,6-di-tert-butyl-4-methylphenol) commonly used as food additive. Since little is known about the removal of most of the substances included in the Decision 2015/495/EU, particularly regarding realistic concentrations in aqueous environmental samples, this review aims to: (i) overview the European policy in the water field; (ii) briefly describe the most commonly used conventional and advanced treatment processes to remove micropollutants; (iii) summarize the relevant data published in the last decade, regarding occurrence and removal in aqueous matrices of the 10 substances/groups of substances that were recently included in the first watch list for European Union monitoring (Decision 2015/495/EU); and (iv) highlight the lack of reports concerning some substances of the watch list, the study of un-spiked aquatic matrices and the assessment of transformation by-products.

Removal of Endocrine Disruptors from Urban Wastewater by Advanced Oxidation Processes (AOPs): A Review

Over the last years the growing presence of endocrine disrupting compounds in the environment has been regarded as a serious sanitary issue. The more and more frequent detection of these compounds in the effluents of wastewater treatment plants poses the risk associated to their persistence into the aquatic systems as well as to their adverse effects on both public health and environment.

As conventional systems do not allow their efficient removal, great attention has been raised towards their possible treatment by Advanced Oxidation Processes (AOPs). They rely on the action of hydroxyl radicals, which are highly reactive species, able to oxidize recalcitrant and non-biodegradable pollutants.

AOPs can either provide contaminant partial degradation or their complete removal. As their effectiveness has been proved for a wide spectrum of both organic and inorganic pollutants, they are considered a suitable option for the treatment of contaminated aqueous media, especially when combined with conventional biological processes.

This paper aims at reviewing main AOPs for the removal of endocrine disruptors, in order to highlight the most important features of different technologies, thus providing their comparative assessment. To this end, a brief overview of the most frequently detected endocrine disruptor compounds was also discussed, in order to clarify their fate into the environment as well as the contamination pathways of greatest concern for human health.

Ecotoxicity and genotoxicity of cyclophosphamide, ifosfamide, their metabolites/transformation products and their mixtures

Cyclophosphamide (CP) and ifosfamide (IF) are commonly used cytostatic drugs that repress cell division by interaction with DNA. The present study investigates the ecotoxicity and genotoxicity of CP, IF, their human metabolites/transformation products (TPs) carboxy-cyclophosphamide (CPCOOH), keto-cyclophosphamide (ketoCP) and N-dechloroethyl-cyclophosphamide (NdCP) as individual compounds and as mixture. The two parent compounds (CP and IF), at concentrations up to 320 mg L(-1), were non-toxic towards the alga Pseudokirchneriella subcapitata and cyanobacterium Synecococcus leopoliensis. Further ecotoxicity studies of metabolites/TPs and a mixture of parent compounds and metabolites/TPs performed in cyanobacteria S. leopoliensis, showed that only CPCOOH (EC50 = 17.1 mg L(-1)) was toxic. The measured toxicity (EC50 = 11.5 mg L(-1)) of the mixture was lower from the toxicity predicted by concentration addition model (EC50 = 21.1 mg L(-1)) indicating potentiating effects of the CPCOOH toxicity. The SOS/umuC assay with Salmonella typhimurium revealed genotoxic activity of CP, CPCOOH and the mixture in the presence of S9 metabolic activation. Only CPCOOH was genotoxic also in the absence of metabolic activation indicating that this compound is a direct acting genotoxin. This finding is of particular importance as in the environment such compounds can directly affect DNA of non-target organisms and also explains toxicity of CPCOOH against cyanobacteria S. leopoliensis. The degradation study with UV irradiation of samples containing CP and IF showed efficient degradation of both compounds and remained non-toxic towards S. leopoliensis, suggesting that no stable TPs with adverse effects were formed. To our knowledge, this is the first study describing the ecotoxicity and genotoxicity of the commonly used cytostatics CP and IF, their known metabolites/TPs and their mixture. The results indicate the importance of toxicological evaluation and monitoring of drug metabolites as they may be for certain aquatic species more hazardous than parent compounds.

Advanced oxidation of the antibiotic sulfapyridine by UV/H₂O₂: Characterization of its transformation products and ecotoxicological implications

The aim of the present work is to investigate, under lab-scale conditions, the removal and transformation of the antibiotic sulfapyridine (SPY) upon advanced oxidation with UV/H2O2. High resolution mass spectrometry (HRMS) analyses by means of an ultra-high pressure liquid chromatography (UHPLC)-linear ion trap high resolution Orbitrap instrument (LTQ-Orbitrap-MS) were carried out in order to elucidate the different transformation products (TPs) generated. The abatement (>99%) of the antibiotic was only achieved after 180 min, highlighting its resilience to elimination and its potential persistence in the environment A total of 10 TPs for SPY were detected and their molecular structures elucidated by means of MS(2) and MS(3) scans. Finally, the combined ecotoxicity at different treatment times was evaluated by means of bioluminescence inhibition assays with the marine bacteria Vibrio fischeri.

Degradation of the anticancer drug erlotinib during water chlorination: Non-targeted approach for the identification of transformation products

Erlotinib is a highly potent tyrosine kinase inhibitor used in the treatment of the most common type of lung cancer. Due to its recent introduction, very scarce information is available on its occurrence, environmental fate and toxicological effects on aquatic organisms. During chlorination processes normally carried out in wastewater treatment plants and in the pretreatment of hospital effluents, chlorinated transformation products can be formed with an enhanced toxicity relative to the parent compound. Thus, the reactivity of the cytostatic drug erlotinib in free chlorine-containing water was investigated for the first time in the present work. A non-targeted screening approach based on the use of differential profiling tools was applied in order to reveal its potential transformation products. Structural elucidation of the detected transformation products was performed by ultra-performance liquid chromatography coupled to high-resolution hybrid quadrupole-Orbitrap tandem mass spectrometry. The proposed approach allowed detecting a total of nineteen transformation products, being eighteen of them described for the first time in this work, which demonstrates its potential in environmental analysis. Among them, six compounds presented chlorine atoms in their structures, which may be of major concern. Other transformation products involved hydroxylation and oxidation reactions. Time-course profiles of erlotinib and its transformation products were followed in real wastewater samples under conditions that simulate wastewater disinfection. Although the structures of these transformation products could not be positively confirmed due to lack of standards, their chemical formulas and product ions can be added to databases, which will allow their screening in future monitoring studies.

Transformation of tamoxifen and its major metabolites during water chlorination: Identification and in silico toxicity assessment of their disinfection byproducts

The selective estrogen receptor modulator tamoxifen is the most commonly used drug for the treatment and prevention of breast cancer. Tamoxifen is considered as a pro-drug since it is known to exert its pharmacological effect through its major active metabolites, 4-hydroxy-tamoxifen and 4-hydroxy-N-desmethyl-tamoxifen, which are mainly excreted in the urine in the days following administration. In the present work, the reactivity of tamoxifen and its major active metabolites in free chlorine-containing water was investigated for the first time. Under the studied chlorination conditions, tamoxifen was fairly stable whereas its metabolites were quickly degraded. A total of thirteen chlorinated byproducts were tentatively identified by ultra-high performance liquid chromatography coupled to high-resolution hybrid quadrupole-Orbitrap tandem mass spectrometry. Time-course profiles of the identified byproducts were followed in real wastewater samples under conditions that simulate wastewater disinfection. A preliminary assessment of their acute aquatic toxicity at two trophic levels by means of quantitative structure-activity relationship models showed that the identified byproducts were up to 110-fold more toxic than the parent compounds.

Global risk of pharmaceutical contamination from highly populated developing countries

Global pharmaceutical industry has relocated from the west to Asian countries to ensure competitive advantage. This industrial relocation has posed serious threats to the environment. The present study was carried out to assess the possible pharmaceutical contamination in the environment of emerging pharmaceutical manufacturing countries (Bangladesh, China, India and Pakistan). Although these countries have made tremendous progress in the pharmaceutical sector but most of their industrial units discharge wastewater into domestic sewage network without any treatment. The application of untreated wastewater (industrial and domestic) and biosolids (sewage sludge and manure) in agriculture causes the contamination of surface water, soil, groundwater, and the entire food web with pharmaceutical compounds (PCs), their metabolites and transformed products (TPs), and multidrug resistant microbes. This pharmaceutical contamination in Asian countries poses global risks via product export and international traveling. Several prospective research hypotheses including the development of new analytical methods to monitor these PCs/TPs and their metabolites, highly resistant microbial strains, and mixture toxicity as a consequence of pharmaceutical contamination in these emerging pharmaceutical exporters have also been proposed based on the available literature.

Biodegradation of pharmaceuticals in hospital wastewater by staged Moving Bed Biofilm Reactors (MBBR)

Hospital wastewater represents a significant input of pharmaceuticals into municipal wastewater. As Moving Bed Biofilm Reactors (MBBRs) appear to remove organic micro-pollutants, hospital wastewater was treated with a pilot plant consisting of three MBBRs in series. The removal of pharmaceuticals was studied in two experiments: 1) A batch experiment where pharmaceuticals were spiked to each reactor and 2) a continuous flow experiment at native concentrations. DOC removal, nitrification as well as removal of pharmaceuticals (including X-ray contrast media, β-blockers, analgesics and antibiotics) occurred mainly in the first reactor. In the batch experiment most of the compounds followed a single first-order kinetics degradation function, giving degradation rate constants ranged from 5.77 × 10(-3) to 4.07 h(-1), from -5.53 × 10(-3) to 9.24 × 10(-1) h(-1) and from 1.83 × 10(-3) to 2.42 × 10(-1) h(-1) for first, second and third reactor respectively. Generally, the highest removal rate constants were found in the first reactor while the lowest were found in the third one. This order was inverted for most compounds, when the removal rate constants were normalized to biomass, indicating that the last tank had the most effective biofilms. In the batch experiment, 21 out of 26 compounds were assessed to be degraded with more than 20% within the MBBR train. In the continuous flow experiment the measured removal rates were lower than those estimated from the batch experiments.

Biodegradation of pharmaceuticals in hospital wastewater by a hybrid biofilm and activated sludge system (Hybas)

Hospital wastewater contributes a significant input of pharmaceuticals into municipal wastewater. The combination of suspended activated sludge and biofilm processes, as stand-alone or as hybrid process (hybrid biofilm and activated sludge system (Hybas™)) has been suggested as a possible solution for hospital wastewater treatment. To investigate the potential of such a hybrid system for the removal of pharmaceuticals in hospital wastewater a pilot plant consisting of a series of one activated sludge reactor, two Hybas™ reactors and one moving bed biofilm reactor (MBBR) has been established and adapted during 10 months of continuous operation. After this adaption phase batch and continuous experiments were performed for the determination of degradation of pharmaceuticals. Removal of organic matter and nitrification mainly occurred in the first reactor. Most pharmaceuticals were removed significantly. The removal of pharmaceuticals (including X-ray contrast media, β-blockers, analgesics and antibiotics) was fitted to a single first-order kinetics degradation function, giving degradation rate constants from 0 to 1.49 h(-1), from 0 to 7.78 × 10(-1)h(-1), from 0 to 7.86 × 10(-1)h(-1) and from 0 to 1.07 × 10(-1)h(-1) for first, second, third and fourth reactors respectively. Generally, the highest removal rate constants were found in the first and third reactors while the lowest were found in the second one. When the removal rate constants were normalized to biomass amount, the last reactor (biofilm only) appeared to have the most effective biomass in respect to removing pharmaceuticals. In the batch experiment, out of 26 compounds, 16 were assessed to degrade more than 20% of the respective pharmaceutical within the Hybas™ train. In the continuous flow experiments, the measured removals were similar to those estimated from the batch experiments, but the concentrations of a few pharmaceuticals appeared to increase during the first treatment step. Such increase could be attributed to de-conjugation or formation from other metabolites.

Occurrence of cyclophosphamide and ifosfamide in aqueous environment and their removal by biological and abiotic wastewater treatment processes

Cytostatic drug residues in the aqueous environment are of concern due to their possible adverse effects on non-target organisms. Here we report the occurrence and removal efficiency of cyclophosphamide (CP) and ifosfamide (IF) by biological and abiotic treatments including advanced oxidation processes (AOPs). Cyclophosphamide was detected in hospital wastewaters (14-22,000 ng L(-1)), wastewater treatment plant influents (19-27 ng L(-1)) and effluent (17 ng L(-1)), whereas IF was detected only in hospital wastewaters (48-6800 ng L(-1)). The highest removal efficiency during biological treatment (attached growth biomass in a flow through bioreactor) was 59 ± 15% and 35 ± 9.3% for CP and IF, respectively. Also reported are the removal efficiencies of both compounds from wastewater using hydrodynamic cavitation (HC), ozonation (O3) and/or UV, either individually or in combination with hydrogen peroxide (H2O2). Hydrodynamic cavitation did not remove CP and IF to any significant degree. The highest removal efficiencies: 99 ± 0.71% for CP and 94 ± 2.4% for IF, were achieved using UV/O3/H2O2 at 5 g L(-1) for 120 min. When combined with biological treatment, removal efficiencies were >99% for both compounds. This is the first report of combined biological and AOP treatment of CP and IF from wastewater with a removal efficiency >99%.

What have we learned from worldwide experiences on the management and treatment of hospital effluent? - an overview and a discussion on perspectives

This study overviews lessons learned from experimental investigations on dedicated treatment systems of hospital effluent carried out worldwide in the last twenty years. It includes 48 peer reviewed papers from 1995 to 2015 assessing the efficacy of different treatment levels (preliminary, primary, secondary and polishing) of hospital wastewater in removing a wide spectrum of pharmaceutical compounds as well as conventional contaminants. Moreover, it highlights the rationale and the reasons for each study: reducing the discharge of micropollutants in surface water, improving existing wastewater treatment technologies and reducing the risk of spread of pathogens causing endemic diseases and finally, it offers a critical analysis of the conclusions and suggestions of each study. The most investigated technologies are membrane bioreactors equipped with ultrafiltration membranes in the secondary step, ozonation followed by activated carbon filtration (in powder and in granules) in the polishing step. Interesting research projects deal with photo-Fenton processes acting as primary treatments to enhance biodegradation before biological treatment, and as a polishing step, thus further reducing micro-contaminant occurrence. Investment and operational costs are also presented and discussed for the different treatment technologies tested worldwide, in particular membrane bioreactors and various advanced oxidation processes. This study also discusses the need for further research to evaluate toxicity resulting from advanced oxidation processes as well as the need to develop an accurate feasibility study that encompasses technical, ecotoxicological and economic aspects to identify the best available treatment in the different situations from a global view point.

Degradation of the cytostatic etoposide in chlorinated water by liquid chromatography coupled to quadrupole-Orbitrap mass spectrometry: identification and quantification of by-products in real water samples

Once discharged into the sewage system, many pharmaceuticals may undergo degradation reactions in the presence of chemical disinfectants, generating by-products that may possess enhanced toxicity relative to the parent compounds. For this reason, the stability of the widely used cytostatic etoposide in chlorinated water has been investigated for the first time in the present work. Taking advantage of the high-resolution/accurate-mass capabilities of the hybrid quadrupole-Orbitrap mass spectrometer Q Exactive, two new oxidation by-products of etoposide were reliably identified. The time course of etoposide and its by-products was followed at different pH values, free chlorine concentrations and water matrices. Finally, the occurrence of etoposide and its major identified by-product (3'-O-desmethyl etoposide) was investigated in real water samples by on-line solid-phase extraction-liquid chromatography-tandem mass spectrometry using a 4000QTRAP hybrid quadrupole-linear ion trap mass spectrometer. The etoposide by-product was found in various river and wastewater samples at levels between 14 and 33 ng L(-1), whereas etoposide was not detected in any sample.

Aquatic toxicity of the macrolide antibiotic clarithromycin and its metabolites

The human macrolide antibiotic clarithromycin is widespread in surface waters. Our study shows that its major metabolite 14-hydroxy(R)-clarithromycin is found in surface waters in comparable amounts. This metabolite is known to be pharmacologically active. Additionally, clarithromycin is partly metabolised to N-desmethyl-clarithromycin, which has no antimicrobial activity. For clarithromycin, some ecotoxicological studies on aquatic organisms have been published. However, many of them are not conform with the scientific principles as given in the "Technical guidance for deriving environmental quality standards" (TGD-EQS), because numerous studies were poorly documented and the methods did not contain analytical measurements confirming that the exposure concentrations were in the range of ± 20% of the nominal concentrations. Ecotoxicological effects of clarithromycin and its two metabolites on the zebrafish Danio rerio (embryo test), the microcrustacean Daphnia magna, the aquatic monocotyledonous macrophyte Lemna minor, the freshwater green alga Desmodesmus subspicatus (Chlorophyta) and the cyanobacterium Anabaena flosaquae were investigated in compliance with the TGD-EQS. Environmental risk assessment was performed using ErC10 values of Anabaena, the species most sensitive to clarithromycin and 14-hydroxy(R)-clarithromycin in our testing. Based oncomparable toxicity and similar concentrations of clarithromycin and its active metabolite 14-hydroxy(R)-clarithromycin in surface waters, an additional multiplication factor of 2 to the assessment factor of 10 on the ErC10 of clarithromycin should be used. Consequently, a freshwater quality standard of 0.130 μg L(-1) is proposed for clarithromycin as the "lead substance". Taking this additional multiplication factor of 2 into account, single monitoring of clarithromycin may be sufficient, in order to reduce the number of substances listed for routine monitoring programs.

Photolytic degradation of sulfamethoxazole and trimethoprim using UV-A, UV-C and vacuum-UV (VUV)

The photolytic degradation of the non-degradable pharmaceuticals sulfamethoxazole (SMX) and trimethoprim (TMP) in an aqueous solution was investigated using three kinds of low-pressure mercury lamp UV-A (352 nm), UV-C (254 nm), and vacuum-UV (VUV, 185 nm and 254 nm). The degradation rates were highly dependent on the target compounds as well as the UV sources. No degradation of the target compounds was observed using UV-A treatment, because there was no overlap between the UV-A emission spectrum and absorption spectrum of the target compounds. On the other hand, UVC and VUV revealed higher reactivity. The results also indicated that SMX had a greater potential to react photochemically than TMP. Among the UV sources, VUV was the most effective process for the degradation of target compounds. Furthermore, the addition of oxidants such as hydrogen peroxide (H2O2) and sodium persulfate (Na2S2O8) to the reaction system improved the overall degradation rate significantly.The experimental results for the VUV-irradiated samples with the addition of methanol as a hydroxyl radical scavenger revealed that hydroxyl radicals contribute significantly to the elimination of the target compound. Overall, the degradation rate of the target compounds was in the order: VUV = UV-C > UV-A for sulfamethoxazole and VUV/H2O2 > VUV/ Na2S2O8 > VUV >UV-C >UV-A for trimethoprim.