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

Origin, types, and contribution of emerging pollutants to environmental degradation and their remediation by physical and chemical techniques

The growing presence of emerging pollutants (EPs) in aquatic environments, as well as their harmful impacts on the biosphere and humans, has become a global concern. Recent developments and advancements in pharmaceuticals, agricultural practices, industrial activities, and human personal care substances have paved the way for drastic changes in EP concentrations and impacts on the ecosystem. As a result, it is critical to mitigate EP's harmful effects before they jeopardize the ecological equilibrium of the overall ecosystem and the sustainable existence of life on Earth. This review comprehensively documented the types, origins, and remediation strategies of EPs, and underscored the significance of this study in the current context. We briefly stated the major classification of EPs based on their organic and inorganic nature. Furthermore, this review systematically evaluates the occurrence of EPs due to the fast-changing ecological scenarios and their impact on human health. Recent studies have critically discussed the emerging physical and chemical processes for EP removal, highlighting the limitations of conventional remediation technologies. We reviewed and presented the challenges associated with EP remediation and degradation using several methods, including physical and chemical methods, with the application of recent technologies. The EP types and various methods discussed in this review help the researchers understand the nature of present-day EPs and utilize an efficient method of choice for EP removal and management in the future for sustainable life and development activities on the planet.

Antibiotic residue contamination in the aquatic environment, sources and associated potential health risks

Antibiotic residues are widely recognized as major pollutants in the aquatic environment on a global scale. As a significant class of pharmaceutically active compounds (PhACs), antibiotics are extensively consumed worldwide. The primary sources of these residues include hospitals, municipal sewage, household disposal, and manures from animal husbandry. These residues are frequently detected in surface and drinking waters, sewage effluents, soils, sediments, and various plant species in countries such as China, Japan, South Korea, Europe, the USA, Canada, and India. Antibiotics are used medicinally in both humans and animals, with a substantial portion excreted into the environment as metabolites in feces and urine. With the advancement of sensitive and quantitative analytical techniques, antibiotics are consistently reported in environmental matrices at concentrations ranging from nanograms per liter (ng/L) to milligrams per liter (mg/L). Agricultural soils, in particular, serve as a significant reservoir for antibiotic residues due to their strong particle adsorption capacities. Plants grown in soils irrigated with PhAC-contaminated water can uptake and accumulate these pharmaceuticals in various tissues, such as roots, leaves, and fruits, raising serious concerns regarding their consumption by humans and animals. There is an increasing need for research to understand the potential human health risks associated with the accumulation of antibiotics in the food chain. The present reviews aims to shed light on the rising environmental pharmaceutical contamination concerns, their sources in the environment, and the potential health risks as well as remediation effort. To discuss the main knowledge gaps and the future research that should be prioritized to achieve the risk assessment. We examined and summarized the available data and information on the antibiotic resistance associated with antibiotic residues in the environment. As studies have indicated that vegetables can absorb, transport, and accumulate antibiotics in edible parts when irrigated with wastewater that is either inadequately treated or untreated. These residues and their metabolites can enter the food chain, with their persistence, bioaccumulation, and toxicity contributing to drug resistance and adverse health effects in living organisms.

Comprehensive analysis of a widely pharmaceutical, furosemide, and its degradation products in aquatic systems: Occurrence, fate, and ecotoxicity

Many pharmaceutical compounds end up in the environment due to incomplete removal by wastewater treatment plants (WWTPs). Some compounds are sometimes present in significant concentrations and therefore represent a risk to the aquatic environment. Furosemide is one of the most widely used drugs in the world. Considered as an essential drug by the World Health Organization, this powerful loop diuretic is used extensively to treat hypertension, heart and kidney failure and many other purposes. However, this important consumption also results in a significant release of furosemide in wastewater and in the receiving environment where concentrations of a few hundred ng/L to several thousand have been found in the literature, making furosemide a compound of great concern. Also, during its transport in wastewater systems and WWTPs, furosemide can be degraded by various processes resulting in the production of more than 74 by-products. Furosemide may therefore present a significant risk to ecosystem health due not only to its direct cytotoxic, genotoxic and hepatotoxic effects in animals, but also indirectly through its transformation products, which are poorly characterized. Many articles classify furosemide as a priority pollutant according to its occurrence in the environment, its persistence, its elimination by WWTPs, its toxicity and ecotoxicity. Here, we present a state-of-the-art review of this emerging pollutant of interest, tracking it, from its consumption to its fate in the aquatic environment. Discussion points include the occurrence of furosemide in various matrices, the efficiency of many processes for the degradation of furosemide, the subsequent production of degradation products following these treatments, as well as their toxicity.

Global insight into the occurrence, treatment technologies and ecological risk of emerging contaminants in sanitary sewers: Effects of the SARS-CoV-2 coronavirus pandemic

The SARS-CoV-2 pandemic caused changes in the consumption of prescribed/non-prescribed drugs and the population's habits, influencing the detection and concentration of emerging contaminants (ECs) in sanitary sewage and harming environmental and health risks. Therefore, the present work sought to discuss current literature data on the effects of the "COVID-19 pandemic factor" on the quality of raw sewage produced over a five-year period (2018-2019: pre-pandemic; 2020-2022: during the pandemic) and biological, physical, chemical and hybrid treatment technologies, influencing factors in the removal of ECs and potential ecological risks (RQs). Seven hundred thirty-one publications correlating sewage and COVID-19 were identified: 184 pre-pandemic and 547 during the pandemic. Eight classes and 37 ECs were detected in sewage between 2018 and 2022, with the "COVID-19 pandemic factor" promoting an increase in estrogens (+31,775 %), antibiotics (+19,544 %), antiepileptics and antipsychotics (+722 %), pesticides (+200 %), analgesics, anti-inflammatories and anticoagulants (+173 %), and stimulant medications (+157 %) in sanitary sewage. Among the treatment systems, aerated reactors integrated into biomembranes removed >90 % of cephalexin, clarithromycin, ibuprofen, estrone, and 17β-estradiol. The absorption, adsorption, and biodegradation mechanisms of planted wetland systems contributed to better cost-benefit in reducing the polluting load of sewage ECs in the COVID-19 pandemic, individually or integrated into the WWTP. The COVID-19 pandemic factor increased the potential ecological risks (RQs) for aquatic organisms by 40 %, with emphasis on clarithromycin and sulfamethoxazole, which changed from negligible risk and low risk to (very) high risk and caffeine with RQ > 2500. Therefore, it is possible to suggest that the COVID-19 pandemic intensified physiological, metabolic, and physical changes to different organisms in aquatic biota by ECs during 2020 and 2022.

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.

Potential of hospital wastewater treatment using locally isolated Chlorella sp. LH2 from cocoon wastewater

Chlorella sp. is able to grow and transform inorganic and organic contaminants in wastewater to create biomass. In the present study, Chlorella sp. LH2 isolated from cocoon wastewater was able to thrive in hospital wastewater, then remove nutrients and eliminate E. coli ATCC 8739. The results indicated that optimal cultivation conditions of Chlorella sp. LH2 in hospital wastewater were pH of 8, light:dark cycle of 16:8 at 30oC. The inhibitory effect of chlorination on algae growth was accompanied with the chlorine concentration. BOD5:COD ratio of 0.77 indicated biodegradability of hospital wastewater. The untreated and treated wastewatee samples were collected to investigated the nutrient removal efficiency after 10 days. Untreated and treated results were192 ± 8.62 mg/l 23.91 ± 2.19 mg/l for BOD5; 245 ± 9.15 mg/l and 47.31 ± 5.71 mg/l for COD. The treated value met the required standards for hospital wastewater treatment. The removal efficiency total nitrogen and total phosphorus were 68.64% and 64.44% after 10 days, respectively. Elimination of E. coli ATCC 8739 after 7 days by Chlorella sp. LH2 was 88.92%. The results of this study suggest the nutrients and pathogens removal potential of Chlorella sp. LH2 in hospital wastewater for further practical applications.

Meta-analysis addressing the characterization of antibiotic resistome in global hospital wastewater

Hospital wastewater (HWW) is a significant environmental reservoir of antibiotic resistance genes (ARGs). However, currently, no comprehensive understanding exists of the antibiotic resistome in global HWW. In this study, we attempted to address this knowledge gap through an in silico reanalysis of publicly accessible global HWW metagenomic data. We reanalyzed ARGs in 338 HWW samples from 13 countries in Africa, Asia, and Europe. In total, 2420 ARG subtypes belonging to 30 ARG types were detected, dominated by multidrug, beta-lactam, and aminoglycoside resistance genes. ARG composition in Europe differed from that in Asia and Africa. Notably, the ARGs presented co-occurrence with mobile genetic elements (MGEs), metal resistance genes (MRGs), and human bacterial pathogens (HBP), indicating a potential dissemination risk of ARGs in the HWW. Multidrug resistance genes presented co-occurrence with MGEs, MRGs, and HBP, is particularly pronounced. The abundance of contigs that contained ARG, contigs that contained ARG and HBP, contigs that contained ARG and MGE, contigs that contained ARG and MRG were used for health and transmission risk assessment of antibiotic resistome and screened out 40 high risk ARGs in the global HWW. This study first provides a comprehensive characterization and risk of the antibiotic resistome in global HWW.

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.

Top 5 Things Health Professions Students Should Know About Ecology and Waste Management

The environments in which we live affect individual and community risk for disease transmission and illness severity. Communities' and neighborhoods' waste stream management designs and health care organizations' spatial and structural architecture also influence individuals' and communities' pathogenic vulnerabilities and how well health sector industrial hygiene practices support them. This article describes a One Health approach to planetary environmental health and suggests strategies for implementing a One Health or Planetary Health approach in the context of climate change.

Acute inhibition of hospital and medical laboratory wastewater on activated sludge

Sustainable operation is an essential challenge in many municipal wastewater treatment plants. Among many types of wastewater mixed in a sewer, healthcare wastewaters need special attention due to their hazardous substance content, which can be toxic to activated sludge. This study compared the acute inhibitory effects of healthcare wastewaters (HW) and medical laboratory wastewater (MLW) on conventional activated sludge (CAS) and membrane bioreactor (MBR). The sensitivity test showed that nitrifying bacteria (NBs) in MBR sludge have higher resistance to acute toxicity than the CAS. Compared with HW, MLW caused much higher inhibition on both sludges. When the ratio of HW in the tested domestic wastewater was 10%, inhibition of NBs was 39% in AS, while it was 31% in MBR. When the ratio of MLW in the tested domestic wastewater was only 10%, 72% of NBs in AS and 57% of NBs in MBR were already inhibited. The higher resistance of NB in MBR may be explained by the diversity of microorganisms in the MBR operated at high sludge ages. The findings of this study may be used to estimate the acute inhibition effect of HW and MLW discharged directly to the sewage at higher loads.

Characterization of bacterial resistance in treated hospital wastewater

This article seeks to characterize the bacterial profile of pediatric hospital wastewater samples collected at the outlet of a wastewater treatment plant, and to estimate their relative susceptibility to antimicrobial agents. A total of 64 strains were isolated in the wastewater samples, of which 49 were identified as belonging to different families: Enterobacteriaceae (e.g. Escherichia coli, Klebsiella sp., Citrobacter sp.) comprised 57.2% of the identified bacteria, non-Enterobacteriaceae (e.g. Aeromonas sp., Pseudomonas sp.) comprised 30.6%, and Streptococcaceae (e.g. Enterococcus sp.) comprised 12.2%. The tests of the susceptibility of the bacteria to the antimicrobial agents used in the hospital showed that 100% of the bacterial species found discharged in the hospital wastewater treatment system were resistant to one or more of the antimicrobial agents according to the criteria of the U.S. Clinical Laboratory Standards Institute/National Committee for Clinical Laboratory Standards. The antimicrobial agent tests showed that meropenem, norfloxacin, ciprofloxacin, levofloxacin, and cefepime were the most effective antimicrobials against bacteria of the Enterobacteriaceae family. For bacteria of the non-Enterobacteriaceae family, norfloxacin, ciprofloxacin, levofloxacin, and cefepime presented the most effective antimicrobial action, whereas for bacteria of the Streptococcaceae family, ampicillin, vancomycin, and gentamicin were the most effective antimicrobials. Hospital wastewater treatment plants could be considered as places of selection pressure for bacterial resistance because of the presence of antibiotic-resistant bacteria coming from sewers or created at the treatment plant.

Occurrence, fate, and potential risk of pharmaceutical pollutants in agriculture: Challenges and environmentally friendly solutions

In recent years, pharmaceutical active compounds (PhACs) have attained global prevalence. The behavior of PhACs in agricultural soils is complex and depends on several factors, such as the nature of the compounds and their physicochemical characteristics, which affect their fate and potential threats to human health, ecosystems, and the environment. The detection of residual pharmaceutical content is possible in both agricultural soils and environmental matrices. PhACs are commonly found in agricultural soil, with concentrations varying significantly, ranging from as low as 0.048 ng g-1 to as high as 1420.76 mg kg-1. The distribution and persistence of PhACs in agriculture can lead to the leaching of these toxic pollutants into surface water, groundwater, and vegetables/plants, resulting in human health risks and environmental pollution. Biological degradation or bioremediation plays a critical role in environmental protection and efficiently eliminates contamination by hydrolytic and/or photochemical reactions. Membrane bioreactors (MBRs) have been investigated as the most recent approach for the treatment of emerging persistent micropollutants, including PhACs, from wastewater sources. MBR- based technologies have proven to be effective in eliminating pharmaceutical compounds, achieving removal rates of up to 100%. This remarkable outcome is primarily facilitated by the processes of biodegradation and metabolization. In addition, phytoremediation (i.e., constructed wetlands), microalgae-based technologies, and composting can be highly efficient in remediating PhACs in the environment. The exploration of key mechanisms involved in pharmaceutical degradation has revealed a range of approaches, such as phytoextraction, phytostabilization, phytoaccumulation, enhanced rhizosphere biodegradation, and phytovolatilization. The well-known advanced/tertiary removal of sustainable sorption by biochar, activated carbon, chitosan, etc. has high potential and yields excellent quality effluents. Adsorbents developed from agricultural by-products have been recognized to eliminate pharmaceutical compounds and are cost-effective and eco-friendly. However, to reduce the potentially harmful impacts of PhACs, it is necessary to focus on advanced technologies combined with tertiary processes that have low cost, high efficiency, and are energy-saving to remove these emerging pollutants for sustainable development.

Are hospital wastewater treatment plants a source of new resistant bacterial strains?

To understand which type of hospital waste may contain the highest amount of antibiotic resistant microorganisms that could be released into the environment, the bacterial strains entering and leaving a hospital wastewater treatment plant (HWTP) were identified and tested for their antibiotic susceptibility. To achieve this goal, samples were collected from three separate sites, inlet and outlet wastewater positions, and sludge generated in a septic tank. After microbiological characterization according to APHA, AWWA, and WEF protocols, the relative susceptibility of the bacterial strains to various antibiotic agents was assessed according to the Clinical and Laboratory Standards Institute guidelines, to determine whether there were higher numbers of resistant bacterial strains in the inlet wastewater sample than in the outlet wastewater and sludge samples. The results showed more antibiotic resistant bacteria in the sludge than in the inlet wastewater, and that the Enterobacteriaceae family was the predominant species in the collected samples. The most antibiotic-resistant families were found to be Streptococcacea and non-Enterobacteriaceae. Some bacterial strains were resistant to all the tested antibiotics. We conclude that the studied HWTP can be considered a source of resistant bacterial strains. It is suggested that outlet water and sludge generated in HWTPs should be monitored, and that efficient treatment to eliminate all bacteria from the different types of hospital waste released into the environment is adopted.

Hospitals and households as primary emission sources for risk-posing pharmaceuticals in municipal wastewater

A wide range of pharmaceutical residues is known to occur in the environment. While they are released into surface waters mainly through centralized wastewater treatment plants (WWTPs), their primary emission sources are located upstream in the sewer network. Information on emissions from different types of primary emission sources is scarce. However, such information could help direct emission reduction measures more efficiently. In this study, we analysed the concentrations of selected active pharmaceutical ingredients (APIs) in wastewater samples taken from altogether ten sites, covering primary emission sources (hospitals and households), and conventional WWTPs. The concentrations in WWTP effluents were used to identify APIs causing risk in recipient waterbodies. Furthermore, the API loads from households and hospitals were compared to those reaching the WWTP in mixed influents. Our results confirm previously published observations of several pharmaceuticals exceeding their predicted no-effect concentrations in effluent wastewaters. Moreover, the concentrations of most of the analysed APIs are comparatively high in hospital wastewaters, resulting in elevated risk quotients. While the total API loads are relatively low from primary emission sources, owing to the low wastewater volume generated at those sites, per capita emissions were shown to be several times higher at hospital sites than at household sites for APIs such as metronidazole, trimethoprim, and ofloxacin. These findings indicate, that directing emission reduction measures to hospitals could be an effective way to decrease the loads of several risk-posing APIs into the environment, especially where hospital contribution to overall wastewater flow to WWTPs is high.

Textile effluents decolourization potential of metal tolerant Aspergillus species and optimization of biomass concentration and temperature

This research was performed to assess the physicochemical properties of textile effluents collected from different sampling points (industrial park, Hosur, Tamil Nadu, India) and also evaluate the multiple metal tolerance efficiency of pre-isolated Aspergillus flavus. Moreover, their textile effluent decolourization potential was investigated and quantity and temperature required for effective bioremediation was optimized. About 5 textile effluent samples (S0, S1, S2, S3, and S4) were collected from various sampling points and noted that certain physicochemical properties (pH: 9.64 ± 0.38, Turbidity: 18.39 ± 1.4 NTU, Cl^-: 3185.38 ± 15.8 mg L^-1, BOD: 82.52 ± 6.9 mg L^-1, COD: 342.28 ± 8.9 mg L^-1, Ni: 74.21 ± 4.31 mg L^-1, Cr: 48.52 ± 18.34 mg L^-1, Cd: 34.85 ± 1.2 mg L^-1, Zn: 25.52 ± 2.4 mg L^-1, Pb: 11.25 ± 1.5 mg L^-1, Hg: 1.8 ± 0.05 mg L^-1, and As: 7.1 ± 0.41 mg L^-1) were beyond the permissible limits. The A. flavus, showed remarkable metal tolerance to Pb, As, Cr, Ni, Cu, Cd, Hg, and Zn on PDA plates with elevated dosage up to 1000 μg mL^-1. The optimal dosage required for effective decolourization was found as 3 g (48.2%) and compare to dead biomass (42.1%) of A. flavus, the viable biomass showed remarkable decolourization activity on textile effluents in a short duration of treatment process. The optimal temperature for effective decolourization by viable biomass was found at 32 ᵒC. The toxic effects of S4 samples treated at 32 ᵒC on O. sativa as well as brine shrimp larvae were significantly reduced. These findings show that pre-isolated A. flavus viable biomass can be used to decolorize metal-enriched textile effluent. Furthermore, the effectiveness of their metals remediation should be investigated using ex-situ and ex-vivo approaches.

Cascade capture, oxidization and inactivation for removing multi-species pollutants, antimicrobial resistance and pathogenicity from hospital wastewater

As reservoirs of pathogens, antimicrobial resistant microorganisms and a wide variety of pollutants, hospital wastewaters (HWWs) need to be effectively treated before discharge. This study employed the functionalized colloidal microbubble technology as one-step fast HWW treatment. Inorganic coagulant (monomeric Fe(III)-coagulant or polymeric Al(III)-coagulant) and ozone were used as surface-decorator and gaseous core modifier, respectively. The Fe(III)- or Al(III)-modified colloidal gas (or, ozone) microbubbles (Fe(III)-CCGMBs, Fe(III)-CCOMBs, Al(III)-CCGMBs and Al(III)-CCOMBs) were constructed. Within 3 min, CCOMBs decreased COD_Cr and fecal coliform concentration to the levels meeting the national discharge standard for medical organization. Regrowth of bacteria was inhibited and biodegradability of organics was increased after the simultaneous oxidation and cell-inactivation process. The metagenomics analysis further reveals that Al(III)-CCOMBs performed best in capturing the virulence genes, antibiotic resistance genes and their potential hosts. The horizontal transfer of those harmful genes could be effectively hampered thanks to the removal of mobile genetic elements. Interestingly, the virulence factors of adherence, micronutrient uptake/acquisition and phase invasion could facilitate the interface-dominated capture. Featured as cascade processes of capture, oxidation and inactivation in the one-step operation, the robust Al(III)-CCOMB treatment is recommended for the HWW treatment and the protection of downstream aquatic environment.

Selection of indicator contaminants of emerging concern when reusing reclaimed water for irrigation - A proposed methodology

Organic and microbial contaminants of emerging concern (CECs), even though not yet regulated, are of great concern in reclaimed water reuse projects. Due to the large number of CECs and their different characteristics, it is useful to include only a limited number of them in monitoring programs. The selection of the most representative CECs is still a current and open question. This study presents a new methodology for this scope, in particular for the evaluation of the performance of a polishing treatment and the assessment of the risk for the environment and the irrigated crops. As to organic CECs, the methodology is based on four criteria (occurrence, persistence, bioaccumulation and toxicity) expressed in terms of surrogates (respectively, concentrations in the secondary effluent, removal achieved in conventional activated sludge systems, Log K_ow and predicted-no-effect concentration). It consists of: (i) development of a dataset including the CECs found in the secondary effluent, together with the corresponding values of surrogates found in the literature or by in-field investigations; (ii) normalization step with the assignment of a score between 1 (low environmental impact) and 5 (high environmental impact) to the different criteria based on threshold values set according to the literature and experts' judgement; (iii) CEC ranking according to their final score obtained as the sum of the specific scores; and (iv) selection of the representative CECs for the different needs. Regarding microbial CECs, the selection is based on their occurrence and their highest detection frequency in the secondary effluent and in the receiving water, the antibiotic consumption patterns, and recommendations by national and international organisations. The methodology was applied within the ongoing reuse project SERPIC resulting in a list of 30 indicator CECs, including amoxicillin, bisphenol A, ciprofloxacin, diclofenac, erythromycin, ibuprofen, iopromide, perfluorooctane sulfonate (PFOS), sulfamethoxazole, tetracycline, Escherichia coli, faecal coliform, 16S rRNA, sul1, and sul2.

Effective removal of selected pharmaceuticals from sewerage treatment plant effluent using natural clay (Na-montmorillonite)

The consumption of pharmaceuticals has rapidly increased on a global scale due to the serious increase in Covid-19, influenza and respiratuar sinsityal virus, which is called "triple epidemic" in the world. The use of non-prescription analgesic and anti-inflammatory drugs (AAIDs), especially paracetamol, is higher compared to pre-pandemic. This increased the AAIDs load discharged to the aqueous media through sewerage treatment plant (STP). Therefore, simple and effective treatment options for removing AAIDs from STP effluents are needed. The aim of the study was to remove AAIDs (paracetamol, acetylsalicylic acid, codeine, diclofenac, ibuprofen, indomethacin, ketoprofen, mefenamic acid, naproxen, and phenylbutazone) from STP effluents by nearly pure natural clay Na-montmorillonite. The Na-montmorillonite taken from the Ordu region in the northern part of Turkey. Surface area of the Na-montmorillonite is 99.58 m2/g and CEC is 92.40 meq/100 g. The removal efficiencies of AAIDs using Na-montmorillonite were between 82 ± 5% (ibuprofen) and 94 ± 4% (naproxen). Paracetamol was used as a model compound in kinetic and isotherm model studies. Freundlich isotherm model and the pseudo second order kinetic model were the best-fit using the obtained experimental data. Film diffusion governed its rate mechanism. The paracetamol adsorption capacity was acquired as 244 mg/g at 120 min contact time at pH 6.5 at 25 °C. With this study, it could be shown that montmorillonite can be used effectively to eliminate paracetamol from STP effluent. Natural clay can be used as a simple, inexpensive and effective adsorbent for removing AAIDs from STP effluents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13201-023-01930-5.

Anticancer drugs in wastewater and natural environments: A review on their occurrence, environmental persistence, treatment, and ecological risks

The consumption of anticancer drugs (also known as chemotherapy drugs or antineoplastic drugs) has augmented over the last decades due to increased cancer incidence. Although there is an increasing concern about the presence of pharmaceutical compounds in natural environments and urban/domestic wastewater, anticancer drugs used in chemotherapy and anticancer medication have received less attention. In this review, the occurrence, environmental persistence, and known and potential ecological impacts of anticancer drugs is discussed. This review shows that these compounds are being increasingly detected in effluents of hospitals, influents and effluents of wastewater treatment plants, river surface water and sediments, groundwater, and even drinking water. Anticancer drugs can impact aquatic organisms such as algae, crustaceans, rotifers, and fish and may promote changes in soil and water microbial communities that may alter ecosystem functioning. Our knowledge of technologies for the removal of anticancer drugs is still limited, and these drugs can be dispersed in nature in a diffuse way in an uncontrolled manner. For this reason, an improved understanding of the presence, persistence, and ecological impacts of anticancer drugs in wastewater and natural environments is needed to help design management strategies, protect aquatic microorganisms, and mitigate potential ecological impacts.

Cefotaxime degradation by the coupled binary CdS-PbS: characterization and the photocatalytic process kinetics

Increased water pollution due to discharging industrial/urban/hospital wastewater has been adopted to introduce/develop novel removal techniques/catalyst/adsorbent. The hexagonal (wurtzite) CdS and the cubic PbS nanoparticles (NPs) were synthesized, coupled, and supported onto clinoptilolite NPs (CNP). Then, the sample was characterized by X-ray powder diffraction (XRD), diffuse reflectance spectroscopy (DRS), Fourier transform infrared (FTIR), and a scanning electron microscope equipped with an energy dispersive X-ray analyzer (SEM-EDX) techniques. The average crystallite size for CdS NPs, PbS NPs, CNP, and CdS-PbS/CNP samples was obtained at about 24, 36, 27, and 14 nm using the Scherrer formula value of nanometer, by the W-H formula, 31, 17, 39, and 51, respectively. Only a detectable slope can be observed from the DRS spectra for CdS NPs at 591 nm corresponding to an Eg value of 2.1 eV. PbS NPs have a broad abruption peak that begins from the visible region and extends to the IR region of the light. A boosted photocatalytic activity of the supported binary catalysts towards cefotaxime (CT) was reached. An apparent first kinetic model was reached with a k-value of 0.021 min^-1 corresponding to the t_1/2 value of 33 min. A decreased COD trend for the photodegraded CT solutions was reached, and the chemical oxygen demand (COD) results in the Hinshelwood model showed a k-value of 0.016 min^-1, corresponding to a t_1/2 value of 43 min.

Methods involved in the treatment of four representative pharmaceuticals in hospital wastewater using sonochemical and biological processes

A primary pollution source by pharmaceuticals is hospital wastewater (HWW). Herein, the methods involved in the action of a biological system (BS, aerobic activated sludge) or a sonochemical treatment (US, 375 kHz and 30.8 W), for degrading four relevant pharmaceuticals (azithromycin, ciprofloxacin, paracetamol, and valsartan) in HWW, are shown. Before treatment of HWW, the correct performance of BS was assessed using glucose as a reference substance, monitoring oxygen consumption, and organic carbon removal. Meanwhile, for US, a preliminary test using ciprofloxacin in distilled water was carried out. The determination of risk quotients (RQ) and theoretical analyses about reactive moieties on these target substances are also presented. For both, the degradation of the pharmaceuticals and the calculation of RQ, analyses were performed by LC-MS/MS. The BS action decreased the concentration of paracetamol and valsartan by ∼96 and 86%, respectively. However, a poor action on azithromycin (2% removal) was found, whereas ciprofloxacin concentration increased ∼20%; leading to an RQ value of 1.61 (high risk) for the pharmaceuticals mixture. The analyses using a biodegradation pathway predictor (EAWAG-BDD methodology) revealed that the amide group on paracetamol and alkyl moieties on valsartan could experience aerobic biotransformations. In turn, US action decreased the concentration of the four pharmaceuticals (removals > 60% for azithromycin, ciprofloxacin, and paracetamol), diminishing the environmental risk (RQ: 0.51 for the target pharmaceuticals mixture). Atomic charge analyses (based on the electronegativity equalization method) were performed, showing that the amino-sugar on azithromycin; piperazyl ring, and double bond close to the two carbonyls on ciprofloxacin, acetamide group on paracetamol, and the alkyl moieties bonded to the amide group of valsartan are the most susceptible moieties to attacks by sonogenerated radicals. The LC-MS/MS analytical methodology, RQ calculations, and theoretical analyses allowed for determining the degrading performance of BS and US toward the target pollutants in HWW.•Biological and sonochemical treatments as useful methods for degrading 4 representative pharmaceuticals are presented.•Sonochemical treatment had higher degrading action than the biological one on the target pharmaceuticals.•Methodologies for risk environmental calculation and identification of moieties on the pharmaceuticals susceptible to radical attacks are shown.

Integration of ozonation with water treatment for pharmaceuticals removal from Arroio Diluvio in southern Brazil

Pharmaceutical compounds can reach water bodies through sewage systems. The process of water treatment is insufficient for the removal of these contaminants. The ozonation has great potential to be integrated into the treatment, since it promotes the reduction of pharmaceuticals, reduces the generation of disinfection byproducts and can reduce operational costs. In this work, the integration of the ozonation process with water treatment was studied. The ozone was applied in the pre-oxidation and intermediate ozonation stages, to evaluate the dependence of different variables. Water samples were collected from Arroio Diluvio, a river of the city of Porto Alegre (Brazil). The doses of ozone were maintained between 0.5 and 1.0 mgO₃ L^-1 while the coagulant was between 25 and 150 mg·L^-1. Pre-ozonation resulted in a removal of pharmaceuticals at pH 10.0, time of 15 min and coagulant concentration of 52.5 mgL^-1. The intermediate ozonation provided a removal with pH 10.0 and a time of 5 min of bubbling. Based on the results, it was confirmed that the synergy of the ozonation process with conventional water treatment is an effective, sensitive and fast method for the removal of pharmaceuticals from the aqueous medium.

Direct electrochemical determination of environmentally harmful pharmaceutical ciprofloxacin in 3D printed flow-through cell

Rising amounts of antibiotic residues in wastewater cause serious problems including increased bacterial resistance. Wastewater treatment plants (WWTPs) do not, in the case of new, modern pharmaceuticals, ensure their complete removal. Ciprofloxacin (CIP) is one of many micropollutants that partially pass through WWTPs, implying that its monitoring is essential for the assessment of the water quality. In real sewage systems, the determination of CIP needs to be performed under flowing conditions, which calls for the deployment of inexpensive, robust, and easily integrable approaches such as electrochemical techniques. However, to the best of our knowledge, there is no report on the electrochemical determination of CIP in a flowing matrix. To bridge this gap, we perform here cyclic and square-wave voltammetric sensing study of CIP employing boron-doped diamond screen printed electrodes in a custom-made 3D printed flow-through cell to mimic conditions in real sewage systems. An irreversible two-step oxidation of CIP is demonstrated, with the first step providing clear Faradaic response as analytically relevant signal. This response was found to scale with the sample flow rate according to the prediction given by Levich equation. Our work provides an in-depth inspection of the electrochemical response of CIP under controlled-convection conditions, which is an essential prerequisite for monitoring this antibiotic in real flowing sewage systems.

The boosted photocatalytic effects of a zeolite supported CdS towards an antibiotic model pollutant: a brief kinetics study

In recent decades, increased world population and industrial activities explosively polluted our environment, especially the aquatic resources. This requires introducing/developing novel methods to decrease the pollution extent of such resources. Here, the hexagonal (wurtzite) CdS nanoparticles (NPs) were synthesized and supported onto ball-mill prepared clinoptilolite NPs (CNP). Samples were briefly characterized by X-ray powder diffraction (XRD), Fourier transform infrared (FTIR), scanning electron microscope equipped with an energy dispersive X-ray analyzer (SEM-EDX), and diffuse reflectance spectroscopy (DRS) techniques. The average crystallite size for CdS NPs and CdS-CNP samples was estimated to be about 9.0 nm and 12.3 nm (from the Scherrer formula) and about 19.7 and 17.5 nm (from the Williamson-Hall model), respectively. From the DRS spectra, the absorption wavelengths of 595 and 546 nm correspond to band gap energies of 2.08, and 2.27 eV was obtained for CdS NPs and CdS-CNP samples. The samples were then used in the photodegradation of cefotaxime (CT), and the results showed a boosted photocatalytic activity for CdS-CNP rather than CdS NPs. The photodegradation process obeyed the pseudo-first-order kinetic model, and the CdS and CdS-CNP catalysts obtained the k-values of 0.013 min^-1 and 0.023 min^-1. When the photodegraded CT solutions were used in COD experiments, the k-values changed to 0.011 min^-1 and 0.029 min^-1, respectively. The zeolite support is an eco-friendly natural zeolite with abundant deposits in Iran that yields a cost-effective method.

Antibiotic-resistant bacteria in hospital wastewater treatment plant effluent and the possible consequences of its reuse in agricultural irrigation

Wastewater from hospitals should be monitored precisely and treated properly before discharge and reuse to avoid epidemic and pandemic complications, as it contains hazardous pollutants for the ecosystem. Antibiotic residues in treated hospital wastewater effluents constitute a major environmental concern since they resist various wastewater treatment processes. The emergence and spread of multi-drug-resistant bacteria, that cause public health problems, are therefore always a major concern. The aims and objectives of this study were mainly to characterize the chemical and microbial properties of the hospital effluent of wastewater treatment plant (WWTP) before discharge to the environment. Special attention was paid to the presence of multiple resistant bacteria and the effects of hospital effluent reuse in irrigation on zucchini as an economically important plant. The risk of cell-free DNA carrying antibiotic resistance genes contained in the hospital effluent as a long-lasting hazard had been discussed. In this study, 21 bacterial strains were isolated from the effluent of a hospital WWTP. Isolated bacteria were evaluated for multi-drug resistance ability against 5 antibiotics (Tetracycline, Ampicillin, Amoxicillin, Chloramphenicol, and Erythromycin) at a concentration of 25 ppm. Out of them, three isolates (AH-03, AH-07, and AH-13) were selected because they recorded the highest growth in presence of tested antibiotics. Selected isolates were identified using 16S rRNA gene sequence homology as Staphylococcus haemolyticus (AH-03), Enterococcus faecalis (AH-07), and Escherichia coli (AH-13). Their susceptibility to ascending concentrations of tested antibiotics indicated that they were all susceptible at a concentration above 50 ppm. Results of the greenhouse experiment regarding the effect of hospital WWTP effluent reuse on zucchini plant fresh weights compared to that irrigated with fresh water indicated that the former recorded a limited increase in total fresh weights (6.2 g and 5.3 g/plant, respectively). Our results demonstrated the low impact of the reuse of Hospital WWTP effluent in agriculture irrigation compared to its greater risk in transferring multiple antibiotic bacteria and antibiotic resistance genes to soil bacteria through natural transformation.

Boosted photocatalytic effect of binary AgI/Ag2WO4 nanocatalyst: characterization and kinetics study towards ceftriaxone photodegradation

In modern chemistry, great interest has been paid to introducing outstanding photocatalysts for degrading organic pollutants. Herein, a highly efficient binary AgI/Ag₂WO₄ photocatalyst was prepared from AgI and Ag₂WO₄ nanoparticles (NPs) and characterized by scanning electron microscope (SEM), X-ray diffraction (XRD), UV-Vis diffuse reflectance spectroscopy (DRS), electrochemical impedance spectroscopy (EIS), and Fourier transform infrared (FT-IR) techniques. In the Scherrer model, the average crystallite sizes of 34.9, 42.0, and 24.1 nm were estimated for the AgI, Ag₂WO₄, and the binary catalyst, while the values were 91, 13, and 85 nm by the Williamson-Hall model. FTIR confirmed the presence of W-O-W, O-W-O, Ag-I, and O-Ag-O bonds in the coupled material. DRS results showed absorption edge wavelengths of 451, 462, and 495 nm (corresponding to the band gap values of 2.75, 2.68, and 2.51 eV) for Ag₂WO₄, AgI, and AgI/Ag₂WO₄ catalyst, respectively. Synergistic photocatalytic activity of the coupled system was achieved towards ceftriaxone (CTX) in an aqueous solution (about 33% 10 ppm CTX solution was degraded without any optimization in the initial conditions of catal dose 0.3 g/L (Ag₂WO₄:AgI with mole ratio 1:2 and 30 min abrasion time), and irrad. time 45 min, C_CTX). This boosted effect depended on the AgI:Ag₂WO₄ mole ratio and grinding time for the mechanical preparation of the binary catalyst (optimums: mole ratio of 4:1 and time 30 min). The photodegradation kinetics obeyed the Hinshelwood model with the apparent first-order rate constant (k) of 0.013 min^-1 (t_1/2 = 53.30 min). Performing the COD on the photodegraded CTX solutions got a Hinshelwood plot with a slope of 0.019 min^-1 (t_1/2 = 36.5 min).

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.

Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

The effect of ultrafiltration process on the fate of antibiotic-related microcontaminants, pathogenic microbes, and toxicity in urban wastewater

Ultrafiltration (UF) was assessed at chemical, microbiological, genetical and toxicological level and in terms of removing specific antibiotic-related microcontaminants from urban wastewater. The UF capacity to remove various antibiotics (clarithromycin, erythromycin, ampicillin, ofloxacin, sulfamethoxazole, trimethoprim, and tetracycline; [A₀] = 100 μg L^-1) was optimised with respect to the feed recirculation rate (25-50%) and feed/transmembrane pressure (1.5-3/1.5-2.4 bar, respectively). Here, we tested the UF capacity to reduce the cultivable bacteria (faecal coliforms, total heterotrophs, Enterococci, Pseudomonas aeruginosa), enteric opportunistic pathogens, including antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs) load. Moreover, the toxicity towards Daphnia magna and three plant species was investigated. Upon optimisation of UF, the removal of antibiotics ranged from 19% for trimethoprim to 95% for clarithromycin. The concentration of cultivable faecal coliforms in the permeate was significantly reduced compared to the feed (P < 0.001), whereas all the bacterial species decreased by more than 3 logs. A similar pattern of reduction was observed for the ARGs (P < 0.001) and enteric opportunistic pathogens (~3-4 logs reduction). A nearly complete removal of the antibiotics was obtained by UF followed by granular activated carbon adsorption (contact time: 90 min), demonstrating the positive contribution of such combination to the abatement of chemical microcontaminants.

Environmental impacts of mass drug administration programs: exposures, risks, and mitigation of antimicrobial resistance

Mass drug administration (MDA) of antimicrobials has shown promise in the reduction and potential elimination of a variety of neglected tropical diseases (NTDs). However, with antimicrobial resistance (AMR) becoming a global crisis, the risks posed by widespread antimicrobial use need to be evaluated. As the role of the environment in AMR emergence and dissemination has become increasingly recognized, it is likewise crucial to establish the role of MDA in environmental AMR pollution, along with the potential impacts of such pollution. This review presents the current state of knowledge on the antimicrobial compounds, resistant organisms, and antimicrobial resistance genes in MDA trials, routes of these determinants into the environment, and their persistence and ecological impacts, particularly in low and middle-income countries where these trials are most common. From the few studies directly evaluating AMR outcomes in azithromycin MDA trials, it is becoming apparent that MDA efforts can increase carriage and excretion of resistant pathogens in a lasting way. However, research on these outcomes for other antimicrobials used in MDA trials is sorely needed. Furthermore, while paths of AMR determinants from human waste to the environment and their persistence thereafter are supported by the literature, quantitative information on the scope and likelihood of this is largely absent. We recommend some mitigative approaches that would be valuable to consider in future MDA efforts. This review stands to be a valuable resource for researchers and policymakers seeking to evaluate the impacts of MDA.

Inactivation of Bacteria and Residual Antimicrobials in Hospital Wastewater by Ozone Treatment

The emergence and spread of antimicrobial resistance (AMR) has become a persistent problem globally. In this study, an ozone treatment facility was established for an advanced hospital wastewater treatment in a core hospital facility in an urban area in Japan to evaluate the inactivation of antimicrobial-resistant bacteria and antimicrobials. Metagenomic DNA-seq analysis and the isolation of potential extended-spectrum β-lactamase (ESBL)-producing bacteria suggested that ozone exposure for at least 20 min is required for the adequate inactivation of DNA and ESBL-producing bacteria. Escherichia coli and Klebsiella species were markedly susceptible to 20-min ozone exposure, whereas Raoultella ornithinolytica and Pseudomonas putida were isolated even after an 80-min exposure. These ozone-resistant bacteria might play a pivotal role as AMR reservoirs in the environment. Nine antimicrobials (ampicillin, cefdinir, cefpodoxime, ciprofloxacin, levofloxacin, clarithromycin, chlortetracycline, minocycline, and vancomycin) were detected at 373 ng/L to 27 μg/L in the hospital wastewater, and these were removed (96–100% removal) after a 40-min treatment. These results facilitate a comprehensive understanding of the AMR risk posed by hospital wastewater and provides insights for devising strategies to eliminate or mitigate the burden of antimicrobial-resistant bacteria and the flow of antimicrobials into the environment. To the best of our knowledge, this is the first report on the implementation of a batch-type, plant-scale ozone treatment system in a hospital facility to execute and evaluate the inactivation of drug-resistant bacteria and antimicrobials.

Estimating antibiotics use in major cities in China through wastewater-based epidemiology

Antibiotics have been widely used for disease treatment and may pose adverse effects on human health due to increasing presence of antibiotic-resistant genes in environment. Therefore, it is important to understand antibiotic use in a specific region or country. China is a major producer of antibiotic and has a large number of consumers. In this work, wastewater samples were collected from 76 wastewater treatment plants in 31 major cities covering all of the geographic regions of China. Concentrations of eight metabolites of sulfonamide, quinolone and macrolide antibiotics were determined. The consumption levels of corresponding antibiotics were estimated based on wastewater-based epidemiology (WBE) approach. Desmethyl ofloxacin, desethylene norfloxacin, desmethyl azithromycin and N⁴-acetyl sulfamethoxazole were detected in all or the overwhelming majority of wastewater samples. The estimated ∑8Antibiotics consumption levels ranged from 275.1 ± 139.4 mg/1000 inh/d (Nanchang) to 3860.9 ± 1332.3 mg/1000 inh/d (Harbin) with a mean level of 1170.0 ± 452.1 mg/1000 inh/d. Quinolones accounted for the highest proportion (74.3%, national average contribution) in the total consumption level, with norfloxacin being the dominant one (38.4%), followed by ofloxacin (29.1%) and ciprofloxacin (6.8%). The ∑8Antibiotics consumption level in northern China (1517.0 ± 1022.8 mg/1000 inh/d) was statistically higher than the level in southern China (1060.7 ± 989.1 mg/1000 inh/d) (t-test, p < 0.05). In contrast, no significant difference was found between eastern (1256.2 ± 1105.1 mg/1000 inh/d) and western China (988.3 ± 474.5 mg/1000 inh/d) (t-test, p > 0.05). The overview of antibiotics consumption derived from this work can serve as a baseline to assess the implementation of related plans/policies in China.

Monitoring COVID-19 through SARS-CoV-2 quantification in wastewater: progress, challenges and prospects

Wastewater-Based Epidemiology (WBE) is widely used to monitor the progression of the current SARS-CoV-2 pandemic at local levels. In this review, we address the different approaches to the steps needed for this surveillance: sampling wastewaters (WWs), concentrating the virus from the samples and quantifying them by qPCR, focusing on the main limitations of the methodologies used. Factors that can influence SARS-CoV-2 monitoring in WWs include: (i) physical parameters as temperature that can hamper the detection in warm seasons and tropical regions, (ii) sampling methodologies and timetables, being composite samples and Moore swabs the less variable and more sensitive approaches, (iii) virus concentration methodologies that need to be feasible and practicable in simpler laboratories and (iv) detection methodologies that should tend to use faster and cost-effective procedures. The efficiency of WW treatments and the use of WWs for SARS-CoV-2 variants detection are also addressed. Furthermore, we discuss the need for the development of common standardized protocols, although these must be versatile enough to comprise variations among target communities. WBE screening of risk populations will allow for the prediction of future outbreaks, thus alerting authorities to implement early action measurements.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.

Ferrate (VI), Fenton Reaction and Its Modification: An Effective Method of Removing SARS-CoV-2 RNA from Hospital Wastewater

The outbreak of the coronavirus disease 2019 (COVID-19) raises questions about the effective inactivation of its causative agent, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in medical wastewater by disinfectants. For this reason, our study of wastewater from a selected hospital evaluated several different advanced oxidation methods (Fenton reaction and Fenton-like reaction and ferrate (VI)) capable of effectively removing SARS-CoV-2 RNA. The obtained results of all investigated oxidation processes, such as ferrates, Fenton reaction and its modifications achieved above 90% efficiency in degradation of SARS-CoV-2 RNA in model water. The efficiency of degradation of real SARS-CoV-2 from hospital wastewater declines in following order ferrate (VI) > Fenton reaction > Fenton-like reaction. Similarly, the decrease of chemical oxygen demand compared to effluent was observed. Therefore, all of these methods can be used as a replacement of chlorination at the wastewater effluent, which appeared to be insufficient in SARS-CoV-2 removal (60%), whereas using of ferrates showed efficiency of up to 99%.

Bioremediation of 27 Micropollutants by Symbiotic Microorganisms of Wetland Macrophytes

Background: Micropollutants in bodies of water represent many challenges. We addressed these challenges by the application of constructed wetlands, which represent advanced treatment technology for the removal of micropollutants from water. However, which mechanisms specifically contribute to the removal efficiency often remains unclear. Methods: Here, we focus on the removal of 27 micropollutants by bioremediation. For this, macrophytes Phragmites australis, Iris pseudacorus and Lythrum salicaria were taken from established wetlands, and a special experimental set-up was designed. In order to better understand the impact of the rhizosphere microbiome, we determined the microbial composition using 16S rRNA gene sequencing and investigated the role of identified genera in the micropollutant removal of micropollutants. Moreover, we studied the colonization of macrophyte roots by arbuscular mycorrhizal fungi, which are known for their symbiotic relationship with plants. This symbiosis could result in increased removal of present micropollutants. Results: We found Iris pseudacorus to be the most successful bioremediative system, as it removed 22 compounds, including persistent ones, with more than 80% efficiency. The most abundant genera that contributed to the removal of micropollutants were Pseudomonas, Flavobacterium, Variovorax, Methylotenera, Reyranella, Amaricoccus and Hydrogenophaga. Iris pseudacorus exhibited the highest colonization rate (56%). Conclusions: Our experiments demonstrate the positive impact of rhizosphere microorganisms on the removal of micropollutants.

An Initial Approach to the Presence of Pharmaceuticals in Wastewater from Hospitals in Colombia and Their Environmental Risk

Hospital wastewater (HWW) from three different cities in Colombia was characterized. Wastewater quality indicators and 38 relevant pharmaceuticals were examined. The HWW had pH from 6.82 to 8.06, chemical oxygen demand was between 235.5 and 1203 mg L−1, and conductivity ranged from 276.5 to 717.5 µS cm−1. Additionally, most of the target pharmaceuticals (20 of 38) had 100% occurrence frequency in the samples due to their high and continuous consumption in the hospitals. Indeed, acetaminophen, diclofenac, azithromycin, ciprofloxacin, sulfamethoxazole, losartan, metoprolol, and omeprazole were present in all samples at concentrations from one up to some hundreds of μg L−1. Once pharmaceuticals are discharged into local sewage systems or rivers, because of the high dilution of HWW, the individual environmental hazards are low (i.e., risk quotients, RQ < 0.1 were determined). The action of conventional treatments on HWW also decreased the individual environmental risks of pharmaceuticals (RQ values < 0.1). However, the mixture of pharmaceuticals in the HWW had potential environmental risks (as RQ > 0.1 were found), remarking the need for efficient processes to eliminate pharmaceuticals from HWW. This work provides an initial view on the characterization of diverse Colombian HWW, which could be useful for the understanding of the current situation of pollution by pharmaceuticals in Latin America.

Advanced bio-oxidation of fungal mixed cultures immobilized on rotating biological contactors for the removal of pharmaceutical micropollutants in a real hospital wastewater

Hospital wastewater represents an important source of pharmaceutical active compounds (PhACs) as contaminants of emerging concern for urban wastewater treatment plants. This work evaluates a fungal biological treatment of a hospital effluent before discharging in the municipal sewer system. This treatment was performed in rotating biological contactors (RBCs) covered with wooden planks in order to promote the attachment of the fungal biomass. These bioreactors, initially inoculated with Trametes versicolor as white rot fungi, have created biofilms of a diversified population of fungal (wood-decaying fungi belonging to Basidiomycota and Ascomycetes) and bacterial (Beta-proteobacteria, Firmicutes, and Acidobacteria) microorganisms. The mixed fungal/bacterial community achieved a stable performance in terms of carbon, nitrogen, and phosphorous reductions for 75 days of continuous operation. Moreover, a remarkable removal of pharmaceutical micropollutants was accomplished especially for antibiotics (98.4 ± 0.7, 83 ± 8% and 76 ± 10 for azithromycin, metronidazole and sulfamethoxazole, respectively). Previous studies have proven a high efficiency of fungi for the removal of microcontaminants as a result of advanced bio-oxidation processes mediated by oxidizing hydroxyl radicals. This study evidences the development of a stable fungal-bacterial mixed culture over wooden-modified RBCs for in-situ removal of pharmaceutical compounds of hospital wastewater under non-sterile conditions and non-strict temperature control, avoiding periodical fungal inoculation due to destabilization and displacement of fungal cultures by indigenous wastewater bacteria.

Abundance, fate, and effects of pharmaceuticals and personal care products in aquatic environments

Pharmaceuticals and personal care products (PPCPs) are found in wastewater, and thus, the environment. In this study, current knowledge about the occurrence and fate of PPCPs in aquatic systems-including wastewater treatment plants (WWTPs) and natural waters around the world-is critically reviewed to inform the state of the science and highlight existing knowledge gaps. Excretion by humans is the primary route of PPCPs entry into municipal wastewater systems, but significant contributions also occur through emissions from hospitals, PPCPs manufacturers, and agriculture. Abundance of PPCPs in raw wastewater is influenced by several factors, including the population density and demography served by WWTPs, presence of hospitals and drugs manufacturers in the sewershed, disease burden of the population served, local regulations, and climatic conditions. Based on the data obtained from WWTPs, analgesics, antibiotics, and stimulants (e.g., caffeine) are the most abundant PPCPs in raw wastewater. In conventional WWTPs, most removal of PPCPs occurs during secondary treatment, and overall removal exceeds 90% for treatable PPCPs. Regardless, the total PPCP mass discharged with effluent by an average WWTP into receiving waters (7.35-20,160 g/day) is still considerable, because potential adverse effects of some PPCPs (such as ibuprofen) on aquatic organisms occur within measured concentrations found in surface waters.

Inactivation of Antibiotic-Resistant Bacteria in Wastewater by Ozone-Based Advanced Water Treatment Processes

The inactivating effect of ozone (O₃)-based advanced oxidation processes (AOPs) (O₃/H₂O₂, O₃/UV, and O₃/UV/H₂O₂ systems) on antimicrobial-resistant bacteria (AMRB) and antimicrobial-susceptible bacteria (AMSB) in sewage treatment plant (STP) wastewater was investigated. The AMRB were grouped into six classes: carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E), multidrug-resistant Acinetobacter (MDRA), multidrug-resistant Pseudomonas aeruginosa (MDRP), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE); these classes constituted the World Health Organization (WHO) global priority list of AMRB. The results indicate that O₃-based advanced wastewater treatment inactivated all AMRB and AMSB (>99.9%) after 10 min of treatment, and significant differences (p < 0.5) were not observed in the disinfection of AMRB and AMSB by each treatment. Altered taxonomic diversity of micro-organisms based on 16S rRNA gene sequencing via O₃/UV and O₃/UV/H₂O₂ treatment showed that advanced wastewater treatments not only inactivated AMRB but also removed antimicrobial resistance genes (AMRGs) in the wastewater. Consequently, this study recommends the use of advanced wastewater treatments for treating the STP effluent, reducing environmental pollution, and alleviating the potential hazard to human health caused by AMRB, AMSB, and infectious diseases. Overall, this study provides a new method for assessing environmental risks associated with the spread of AMRB and AMSB in aquatic environments, while keeping the water environment safe and maintaining human health.

Effects of pharmaceuticals on the nitrogen cycle in water and soil: a review

The effects of pharmaceuticals on the nitrogen cycle in water and soil have recently become an increasingly important issue for environmental research. However, a few studies have investigated the direct effects of pharmaceuticals on the nitrogen cycle in water and soil. Pharmaceuticals can contribute to inhibition and stimulation of nitrogen cycle processes in the environment. Some pharmaceuticals have no observable effect on the nitrogen cycle in water and soil while others appeared to inhibit or stimulate for it. This review reports on the most recent evidence of effects of pharmaceuticals on the nitrogen cycle processes by examination of the potential impact of pharmaceuticals on nitrogen fixation, nitrification, ammonification, denitrification, and anammox. Research studies have identified pharmaceuticals that can either inhibit or stimulate nitrification, ammonification, denitrification, and anammox. Among these, amoxicillin, chlortetracycline, ciprofloxacin, clarithromycin, enrofloxacin, erythromycin, narasin, norfloxacin, and sulfamethazine had the most significant effects on nitrogen cycle processes. This review also clearly demonstrates that some nitrogen transformation processes such as nitrification show much higher sensitivity to the presence of pharmaceuticals than other nitrogen transformations or flows such as mineralization or ammonia volatilization. We conclude by suggesting that future studies take a more comprehensive approach to report on pharmaceuticals' impact on the nitrogen cycle process.

SWOT-SOR Analysis of Activated Carbon-Based Technologies and O3/UV Process as Polishing Treatments for Hospital Effluent

The management and treatment of hospital wastewater are issues of great concern worldwide. Both in the case of a dedicated treatment or co-treatment with urban wastewater, hospital effluent is generally subjected to pre-treatments followed by a biological step. A polishing treatment is suggested to promote (and guarantee) the removal of micropollutants still present and to reduce the total pollutant load released. Activated carbon-based technologies and advanced oxidation processes have been widely investigated from technical and economic viewpoints and applied in many cases. In this study, the potential exploitation of these technologies for the polishing treatment of hospital effluent is investigated by combining a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis with a Strategic Orientation (SOR) analysis. This approach allows a coherent strategy to be extracted from the SWOT-SOR data, increasing the chances of success of each technology. It emerges that both technologies present relevant and sometimes similar strengths and can present opportunities. At the same time, activated carbon-based technologies are more likely to contain the main identified threats than O3/UV technology. The study also finds that, for both technologies, further research and development could improve their potential applications in the treatment of hospital wastewater.

Anaerobic membrane bioreactors (AnMBRs) for municipal wastewater treatment- potential benefits, constraints, and future perspectives: An updated review

The application of Anaerobic Membrane Bioreactors (AnMBRs) for municipal wastewater treatment has been made sufficiently sustainable for practical implementations. The potential benefits are significant as AnMBRs effectively remove a broad range of contaminants from wastewater for water reuse, degrade organics in wastewater to yield methane-rich biogas for resultant energy production, and concentrate nutrients for subsequent recovery for fertilizer production. However, there still exist some concerns requiring vigilant considerations to make AnMBRs economically and technically viable. This review paper briefly describes process fundamentals and the basic AnMBR configurations and highlights six major factors which obstruct the way to AnMBRs installations affecting their performance for municipal wastewater treatment: (i) organic strength, (ii) membrane fouling, (iii) salinity build-up, (iv) inhibitory substances, (v) temperature, and (vi) membrane stability. This review also covers the energy utilization and energy potential in AnMBRs aiming energy neutrality or positivity of the systems which entails the requirement to further determine the economics of AnMBRs. The implications and related discussions have also been made on future perspectives of the concurrent challenges being faced in AnMBRs operation.

Emergency Management of Medical Wastewater in Hospitals Specializing in Infectious Diseases: A Case Study of Huoshenshan Hospital, Wuhan, China

Medical wastewater originating from hospitals specializing in infectious diseases pose a major risk to human and environmental health during pandemics. However, there have been few systematic studies on the management of this type of wastewater management. The function of the Huoshenshan Hospital as a designated emergency field hospital for the treatment of COVID-19 has provided lessons for the management measures of medical wastewater, mainly including: (1) Modern information technology, management schemes, and related standard systems provided the legislative foundation for emergency management of medical wastewater. (2) The three-tier prevention and control medical wastewater management system ensured the discharged wastewater met water quality standards, especially for the leak-proof sealed collection system of the first tier, and the biological and chemical treatment technology of the second tier. (3) The establishment of an effective three-tier medical wastewater quality monitoring accountability system. This system was particularly relevant for ensuring continuous data monitoring and dynamic analysis of characteristic indicators. (4) Information disclosure by government and public supervision promoted successful implementation of medical wastewater management and control measures. Public questionnaires (n = 212) further confirmed the effectiveness of information disclosure. The results of this study can act as methodological reference for the emergency management of wastewater in designated infectious disease hospitals under similar situations.

Recent advances in structural modifications of photo-catalysts for organic pollutants degradation - A comprehensive review

Over the last few years, industrial and anthropogenic activities have increased the presence of organic pollutants such as dyes, herbicides, pesticides, analgesics, and antibiotics in the water that adversely affect human health and the environment worldwide. Photocatalytic treatment is considered a promising, economical, effective, and sustainable process that utilizes light energy to degrade the pollutants in water. However, certain drawbacks like rapid recombination and low migration capability of photogenerated electrons and holes have restricted the use of photo-catalysts in industries. Hence, despite the abundance of lab-scale research, the technology is still not much commercialized in the mainstream. Several structural modifications in the photo-catalysts have been adopted to enhance the pollutant degradation performance to overcome the same. In this context, the present review article outlines the different advanced heterostructures synthesized to date for improved degradation of three major organic pollutants: antibiotics, dyes, and pesticides. Moreover, the article also emphasizes the degradation kinetics of photo-catalysts and the publication trend in the past decade along with the roadblocks preventing the transfer of technology from the laboratory to industry and new age photo-catalysts for the profitable implications in industrial sectors.

Simultaneous Determination of Seven Antibiotics and Five of Their Metabolites in Municipal Wastewater and Evaluation of Their Stability under Laboratory Conditions

The selection and spread of antibiotic resistance poses risks to public health by reducing the therapeutic potential of antibiotics against human pathogens. Wastewater-based epidemiology (WBE) is potentially the most reliable approach to estimate antibiotics use. Previous WBE studies used parent antibiotics as biomarkers, which may lead to overestimation since parent antibiotics may be directly disposed of. Using metabolites as biomarkers can avoid this drawback. This study developed a simultaneous solid-phase extraction coupled with ultra-high-performance liquid chromatography tandem mass spectrometry method for analyzing 12 antibiotics and human metabolites in wastewater to help assess health risk. Optimum conditions were achieved using a PEP cartridge at pH 3.0. The extraction efficiencies were 73.3~95.4% in influent and 72.0~102.7% in effluent for most of the target analytes. Method detection limit ranged from 0.1 to 1.5 ng/L for influent wastewater and 0.03 to 0.7 ng/L for effluent wastewater. A stability experiment showed that sulfonamide parents and their metabolites were stable at 4 °C, −20 °C and −80 °C, while macrolides metabolites were more stable than their corresponding parents at 4 °C and −20 °C. Finally, the method was applied to measure these analytes in wastewater samples collected from three Beijing WWTPs and to derive apparent removal rates. All metabolites were detected in wastewater samples with concentrations ranging from 1.2 to 772.2 ng/L in influent, from <MDL to 235.6 ng/L in effluent. The apparent removal rates of five metabolites were above 72.6%. These results set a solid foundation for applying WBE to evaluate antibiotics use and its public health effects.

Hospital Wastewater-Source of Specific Micropollutants, Antibiotic-Resistant Microorganisms, Viruses, and Their Elimination

Municipal wastewaters can generally provide real-time information on drug consumption, the incidence of specific diseases, or establish exposure to certain agents and determine some lifestyle consequences. From this point of view, wastewater-based epidemiology represents a modern diagnostic tool for describing the health status of a certain part of the population in a specific region. Hospital wastewater is a complex mixture of pharmaceuticals, illegal drugs, and their metabolites as well as different susceptible and antibiotic-resistant microorganisms, including viruses. Many studies pointed out that wastewater from healthcare facilities (including hospital wastewater), significantly contributes to higher loads of micropollutants, including bacteria and viruses, in municipal wastewater. In addition, such a mixture can increase the selective pressure on bacteria, thus contributing to the development and dissemination of antimicrobial resistance. Because many pharmaceuticals, drugs, and microorganisms can pass through wastewater treatment plants without any significant change in their structure and toxicity and enter surface waters, treatment technologies need to be improved. This short review summarizes the recent knowledge from studies on micropollutants, pathogens, antibiotic-resistant bacteria, and viruses (including SARS-CoV-2) in wastewater from healthcare facilities. It also proposes several possibilities for improving the wastewater treatment process in terms of efficiency as well as economy.