AOX-emissions from hospitals into municipal waste water

Removal of Iodine-Containing X-ray Contrast Media from Environment: The Challenge of a Total Mineralization

Iodinated X-ray contrast media (ICM) as emerging micropollutants have attracted considerable attention in recent years due to their high detected concentration in water systems. It results in environmental issues partly due to the formation of toxic by-products during the disinfection process in water treatment. Consequently, various approaches have been investigated by researchers in order to achieve ICM total mineralization. This review discusses the different methods that have been used to degrade them, with special attention to the mineralization yield and to the nature of formed by-products. The problem of pollution by ICM is discussed in the first part dedicated to the presence of ICM in the environment and its consequences. In the second part, the processes for ICM treatment including biological treatment, advanced oxidation/reductive processes, and coupled processes are reviewed in detail. The main results and mechanisms involved in each approach are described, and by-products identified during the different treatments are listed. Moreover, based on their efficiency and their cost-effectiveness, the prospects and process developments of ICM treatment are discussed.

Management of pharmaceutical micropollutants discharged in urban waters: 30 years of systematic review looking at opportunities for developing countries

Pharmaceutical micropollutants' contamination of urban waters has been studied globally for decades, but the concentration of innovations in management initiatives is still in developed economies. The gap between the locus of innovations in pharmaceuticals and the relative stagnation in less developed economies to manage waste originating in this activity seems fruitful for investigations on innovation in integrated micropollutant management strategies. These tensions allow for advances in current knowledge for environmental management and, particularly, finding solutions for the contamination by pharmaceutical micropollutants of urban water bodies in developing countries. We aim to list the main strategies for managing pharmaceutical micropollutants discussed to point out opportunities for developing countries to advance in this direction. Methodologically, we conducted a systematic literature review from 1990 to 2020, covering 3027 documents on "pharmaceutical micropollutants management." The framework formed by the macro-approach to integrated management operationalized by the dimensional micro-approaches: technical, organizational, community, and governmental allowed us to understand that (1) the management of pharmaceutical micropollutants tends to occur through a technical approach centered on the removal of aquatic matrices, green chemistry, and urine diversion; (2) management with an organizational approach has enabled removing drugs from water bodies by drug take-back program, collaborative projects, drug use reduction, and better organizational practices; (3) the community approach have helped minimize this type of pollution by reducing the consumption of medicines and the proper destination for medicines that are no longer in use. Finally, the government management approach emerges as a source of legal, economic, and informational instruments to reduce pollution by pharmaceutical micropollutants. Furthermore, these management approaches allowed us to identify 15 opportunities for possible adjustments for developing societies. These opportunities can be promising for practices and research and, in the medium term, contribute to minimizing pollution by pharmaceutical micropollutants in urban waters.

Current Trends in the Application of Nanomaterials for the Removal of Pollutants from Industrial Wastewater Treatment-A Review

In the recent decades, development of new and innovative technology resulted in a very high amount of effluents. Industrial wastewaters originating from various industries contribute as a major source of water pollution. The pollutants in the wastewater include organic and inorganic pollutants, heavy metals, and non-disintegrating materials. This pollutant poses a severe threat to the environment. Therefore, novel and innovative methods and technologies need to adapt for their removal. Recent years saw nanomaterials as a potential candidate for pollutants removal. Nowadays, a range of cost-effective nanomaterials are available with unique properties. In this context, nano-absorbents are excellent materials. Heavy metal contamination is widespread in underground and surface waters. Recently, various studies focused on the removal of heavy metals. The presented review article here focused on removal of contaminants originated from industrial wastewater utilizing nanomaterials.

SARS-CoV-2 in hospital wastewater during outbreak of COVID-19: A review on detection, survival and disinfection technologies

Currently, the apparition of new SARS-CoV, known as SARS-CoV-2, affected more than 34 million people and causing high death rates worldwide. Recently, several studies reported SARS-CoV-2 ribonucleic acid (RNA) in hospital wastewater. SARS-CoV-2 can be transmitted between humans via respiratory droplets, close contact and fomites. Fecal-oral transmission is considered also as a potential route of transmission since several scientists confirmed the presence of SARS-CoV-2 RNA in feces of infected patients, therefore its transmission via feces in aquatic environment, particularly hospital wastewater. Hospitals are one of the important classes of polluting sectors around the world. It was identified that hospital wastewater contains hazardous elements and a wide variety of microbial pathogens and viruses. Therefore, this may potentially pose a significant risk of public health and environment infection. This study reported an introduction about the Physical-chemical and microbiological characterization of hospital wastewater, which can be a route to identify potential technology to reduce the impact of hospital contaminants before evacuation. The presence of SARS-CoV-2 in aqueous environment was reviewed. The knowledge of the detection and survival of SARS-CoV-2 in wastewater and hospital wastewater were described to understand the different routes of SARS-CoV-2 transmission, which is also useful to avoid the outbreak of CoV-19. In addition, disinfection technologies used commonly for deactivation of SARS-CoV-2 were highlighted. It was revealed that, chlorine-containing disinfectants are the most commonly used disinfectants in this field of research. Meanwhile, other efficient technologies must be developed and improved to avoid another wave of the pandemic of COVID-19 infections.

Sulfite enhanced transformation of iopamidol by UV photolysis in the presence of oxygen: Role of oxysulfur radicals

UV/sulfite process in the absence of oxygen was previously applied as an advanced reduction process for the removal of many halogenated organics and inorganics in water and wastewater. Here, it was found that UV/sulfite process in the presence of oxygen could act as an advanced oxidation process. Specifically, the oxysulfur radicals (including sulfate radical (SO₄^·-) and sulfite/peroxomonosulfate radicals (SO₃^·-/SO₅^·-)) played important roles on the degradation of iopamidol (IPM) as a typical iodinated contrast media (ICM). Furthermore, the contribution of SO₄^·- on IPM removal gradually increased as pH increased from 5 to 7 and that of SO₃^·-/SO₅^·- decreased. Besides, all water quality parameters (i.e., chloride (Cl^-), iodide (I^-) and natural organic matter (NOM)) investigated here exhibited inhibitory effect on IPM removal. Three inorganic iodine species (i.e., I^-, reactive iodine species and iodate (IO₃^-)) were detected in UV/sulfite process in the presence of oxygen, while only I^- was detected in that without oxygen. During UV/sulfite/ethanol, UV photolysis and UV/peroxydisulfate (PDS)/tert-butyl alcohol (TBA) processes, thirteen transformation products including eleven deiodinated products of IPM were identified by ultra HPLC quadrupole time of flight-mass spectrometry (UPLC-Q-TOF-MS). Besides, these products generated by direct UV photolysis, SO₄^·- and SO₃^·-/SO₅^·- were further distinguished. The acute toxicity assay of Vibrio fischeri indicated that transformation products by UV/sulfite under aerobic conditions were less toxic than that by direct UV photolysis.

Transformation of X-ray contrast media by conventional and advanced oxidation processes during water treatment: Efficiency, oxidation intermediates, and formation of iodinated byproducts

X-ray contrast media (ICM), as the most widely used intravascular pharmaceuticals, have been frequently detected in various environmental compartments. ICM have attracted increasingly scientific interest owing to their role as an iodine contributor, resulting in the high risk of forming toxic iodinated byproducts (I-BPs) during water treatment. In this review, we present the state-of-the-art findings relating to the removal efficiency as well as oxidation intermediates of ICM by conventional and advanced oxidation processes. Moreover, formation of specific small-molecular I-BPs (e.g., iodoacetic acid and iodoform) during these processes is also summarized. Conventional oxidants and disinfectants including chlorine (HOCl) and chloramine (NH₂Cl) have low reactivities towards ICM with HOCl being more reactive. Iodinated/deiodinated intermediates are generated from reactions of HOCl/NH₂Cl with ICM, and they can be further transformed into small-molecular I-BPs. Types of disinfectants and ICM as well as solution conditions (e.g., presence of bromide (Br^-) and natural organic matters (NOM)) display significant impact on formation of I-BPs during chlor(am)ination of ICM. Uncatalyzed advanced oxidation process (AOPs) involving ozone (O₃) and ferrate (Fe(VI)) exhibit slow to mild reactivities towards ICM, usually leading to their incomplete removal under typical water treatment conditions. In contrast, UV photolysis and catalyzed AOPs including hydroxyl radical (HO^•) and/or sulfate radical (SO₄^.-) based AOPs (e.g., UV/hydrogen peroxide, UV/persulfate, UV/peroxymonosulfate (PMS), and CuO/PMS) and reactive chlorine species (RCS) involved AOPs (e.g., UV/HOCl and UV/NH₂Cl) can effectively eliminate ICM under various conditions. Components of water matrix (e.g., chloride (Cl^-), Br^-, bicarbonate (HCO₃^-), and NOM) have great impact on oxidation efficiency of ICM by catalyzed AOPs. Generally, similar intermediates are formed from ICM oxidation by UV photolysis and AOPs, mainly resulting from a series reactions of the side chain and/or C-I groups (e.g. cleavage, dealkylation, oxidation, and rearrange). Further oxidation or disinfection of these intermediates leads to formation of small-molecular I-BPs. Pre-oxidation of ICM-containing waters by AOPs tends to increase formation of I-BPs during post-disinfection process, while this trend also depends on the oxidation processes applied and solution conditions. This review summarizes the latest research findings relating to ICM transformation and (by)products formation during disinfection and AOPs in water treatment, which has great implications for the practical applications of these technologies.

Two-year survey of specific hospital wastewater treatment and its impact on pharmaceutical discharges

It is well known that pharmaceuticals are not completely removed by conventional activated sludge wastewater treatment plants. Hospital effluents are of major concern, as they present high concentrations of pharmaceutically active compounds. Despite this, these specific effluents are usually co-treated with domestic wastewaters. Separate treatment has been recommended. However, there is a lack of information concerning the efficiency of separate hospital wastewater treatment by activated sludge, especially on the removal of pharmaceuticals. In this context, this article presents the results of a 2-year monitoring of conventional parameters, surfactants, gadolinium, and 13 pharmaceuticals on the specific study site SIPIBEL. This site allows the characterization of urban and hospital wastewaters and their separate treatment using the same process. Flow proportional sampling, solid-phase extraction, and liquid chromatography coupled with tandem mass spectrometry were used in order to obtain accurate data and limits of quantification consistent with ultra-trace detection. Thanks to these consolidated data, an in-depth characterization of urban and hospital wastewaters was realized, as well as a comparison of treatment efficiency between both effluents. Higher concentrations of organic carbon, AOX, phosphates, gadolinium, paracetamol, ketoprofen, and antibiotics were observed in hospital wastewaters compared to urban wastewaters. Globally higher removals were observed in the hospital wastewater treatment plant, and some parameters were shown to be of high importance regarding removal efficiencies: hydraulic retention time, redox conditions, and ambient temperature. Eleven pharmaceuticals were still quantified at relevant concentrations in hospital and urban wastewaters after treatment (e.g., up to 1 μg/L for sulfamethoxazole). However, as the urban flow was about 37 times higher than the hospital flow, the hospital contribution appeared relatively low compared to domestic discharges. Thanks to the SIPIBEL site, data obtained from this 2-year program are useful to evaluate the relevance of separate hospital wastewater treatment.

Comparative investigation of X-ray contrast medium degradation by UV/chlorine and UV/H2O2

The degradation of iopamidol and diatrizoate sodium (DTZ) by UV/chlorine was carried out according to efficiency, mechanism, and oxidation products, and compared to that by UV/H₂O₂. The pseudo-first order rate (k') of iopamidol and DTZ was accelerated by UV/chlorine compared to that by UV and chlorine alone. k' of iopamidol and DTZ by UV/chlorine increased with increasing chlorine dosage. Both of iopamidol and DTZ could not be effectively removed by UV/H₂O₂ compared to that by UV/chlorine. Secondary radicals (Cl₂^- and ClO) rather than primary radicals (HO and Cl) were demonstrated to be mainly responsible for the enhanced removal of iopamidol and DTZ by UV/chlorine. The oxidation products of iopamidol and DTZ resulting from UV/chlorine and UV/H₂O₂ process were identified, and differences existed in the two systems. IO₃^- (the desired sink of I^-) was the major inorganic product in the UV/chlorine process whereas I^- was the predominant inorganic product in the UV/H₂O₂ process. The formation of chlorine-containing products during the degradation of iopamidol and DTZ by UV/chlorine was also observed. H-abstraction, additions, de-iodination were shared during the degradation of iopamidol by UV/chlorine and UV/H₂O₂. Neutral pH condition was preferred for the removal of iopamidol and DTZ by UV/chlorine. UV/chlorine could also be applied in real waters for the removal of iopamidol and DTZ.

Treatment of hospital laundry wastewater by UV/H2O2 process

Hospitals consume a large volume of water to carry out their activities and, hence, generate a large volume of effluent that is commonly discharged into the local sewage system without any treatment. Among the various sectors of healthcare facilities, the laundry is responsible for the majority of water consumption and generates a highly complex effluent. Although several advanced oxidation processes (AOPs) are currently under investigation on the degradation of a variety of contaminants, few of them are based on real wastewater samples. In this paper, the UV/H₂O₂ AOP was evaluated on the treatment of a hospital laundry wastewater, after the application of a physicochemical pretreatment composed of coagulation-flocculation and anthracite filtration. For the UV/H₂O₂ process, a photoreactor equipped with a low-pressure UV-C lamp was used and the effects of initial pH and [H₂O₂]/chemical oxygen demand (COD) ratio on COD removal were investigated through a randomized factorial block design that considered the batches of effluent as blocks. The results indicated that the initial pH had no significant effect on the COD removal, and the process was favored by the increase in [H₂O₂]/COD ratio. Color and turbidity were satisfactorily reduced after the application of the physicochemical pretreatment, and COD was completely removed by the UV/H₂O₂ process under suitable conditions. The results of this study show that the UV/H₂O₂ AOP is a promising candidate for hospital laundry wastewater treatment and should be explored to enable wastewater reuse in the washing process.

AOX contamination status and genotoxicity of AOX-bearing pharmaceutical wastewater

Adsorbable organic halogens (AOX) are a general indicator for the total amount of compounds containing organically bonded halogens. AOX concentrations and components were investigated along the wastewater treatment process in four large-scale pharmaceutical factories of China, and genotoxicity based on the SOS/umu test was also evaluated. The results showed that AOX concentrations in wastewater of four factories ranged from 4.6 to 619.4mg/L, which were high but greatly different owing to differences in the raw materials and products. The wastewater treatment process removed 50.0%-89.9% of AOX, leaving 1.3-302.5mg/L AOX in the effluents. Genotoxicity levels ranged between 2.1 and 68.0μg 4-NQO/L in the raw wastewater and decreased to 1.2-41.2μg 4-NQO/L in the effluents of the wastewater treatment plants (WWTPs). One of the main products of factory I, ciprofloxacin, was identified as the predominant contributor to its genotoxicity. However, for the other three factories, no significant relationship was observed between genotoxicity and detected AOX compounds.

Oxidation of AOX and organic compounds in pharmaceutical wastewater in RSM-optimized-Fenton system

Adsorbable organic halogens (AOX) and total organic carbon (TOC) removal efficiencies in pharmaceutical wastewater treated by Fenton process under response surface methodology (RSM) optimized conditions were studied. High regression coefficient value R(2) (R(2) = 0.9680, 0.9040 for AOX and TOC removal efficiency, respectively) and low value coefficient of variation (2.21%, 2.04% for AOX and TOC, respectively) of the quadratic model indicated that the model was accurate in predicting the experimental results. The desirability function was used to optimize AOX and TOC removal efficiencies simultaneously. The optimal pH, Fe(2+) concentration, molar ratio of H2O2/Fe(2+) and reaction time were found to be 3.3, 19.05 mM, 20.16 and 2.2 h, respectively, and 91.78% AOX and 75.01% TOC were removed under these conditions, which was validated. Furthermore, gas chromatography-mass spectrometer (GC-MS) results revealed that 28 out of 33 kinds of organic compounds, including 11 kinds of AOX were completely removed by the Fenton process while one new AOX compound, 4,5,6,7-tetrachlorophthalide, was produced which was the result of the carbonyl of 4,5,6,7-tetrachloro-1,3-isobenzofurandione being attacked in the Fenton reaction. These results indicated that analysis of organics was important since new AOX compounds could be produced in Fenton process despite the value of AOX decreasing.

Dynamics of active pharmaceutical ingredients loads in a Swiss university hospital wastewaters and prediction of the related environmental risk for the aquatic ecosystems

The wastewater contamination of a Swiss university hospital by active pharmaceutical ingredient (API) residues was evaluated with a three months monitoring campaign at the outlet of the main building. Flow-proportional samples were collected with an automatic refrigerated sampler and analyzed for 15 API, including antibiotics, analgesics, antiepileptic and anti-inflammatory drugs, by using a validated LC-MS/MS method. The metals Gd and Pt were also analyzed using ICP-MS. Measured concentrations were compared to the predicted ones calculated after the drug average consumption data obtained from the hospital pharmacy. The hospital contribution to the total urban load was calculated according to the consumption data obtained from city pharmacies. Lastly, the environmental hazard and risk quotients (RQ) related to the hospital fraction and the total urban consumption were calculated. Median concentrations of the 15 selected compounds were ranging from 0.04 to 675 μg/L, with a mean detection frequency of 84%. The ratio between predicted and measured environmental concentrations (PEC/MEC) has shown a good accuracy for 5 out of 15 compounds, revealing over- and under-estimations of the PEC model. Mean daily loads were ranging between 0.01 and 14.2g/d, with the exception of paracetamol (109.7 g/d). The hospital contribution to the total urban loads varied from 2.1 to 100% according to the compound. While taking into account dilution and removal efficiencies in wastewater treatment plant, only the hospital fraction of the antibiotics ciprofloxacin and sulfamethoxazole showed, respectively, a high (RQ>1) and moderate (RQ>0.1) risk for the aquatic ecosystems. Nevertheless, when considering the total urban consumption, 7 compounds showed potential deleterious effects on aquatic organisms (RQ>1): gabapentin, sulfamethoxazole, ciprofloxacin, piperacillin, ibuprofen, diclofenac and mefenamic acid. In order to reduce inputs of API residues originating from hospitals various solutions can be envisioned. With results of the present study, hospital managers can start handling this important issue.

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.

Reductive and oxidative degradation of iopamidol, iodinated X-ray contrast media, by Fe(III)-oxalate under UV and visible light treatment

Iopamidol, widely employed as iodinated X-ray contrast media (ICM), is readily degraded in a Fe(III)-oxalate photochemical system under UV (350 nm) and visible light (450 nm) irradiation. The degradation is nicely modeled by pseudo first order kinetics. The rates of hydroxyl radical (OH) production for Fe(III)-oxalate/H2O2/UV (350 nm) and Fe(III)-oxalate/H2O2/visible (450 nm) systems were 1.19 ± 0.12 and 0.30 ± 0.01 μM/min, respectively. The steady-state concentration of hydroxyl radical (OH) for the Fe(III)-oxalate/H2O2/UV (350 nm) conditions was 10.88 ± 1.13 × 10(-14) M and 2.7 ± 0.1 × 10(-14) M for the Fe(III)-oxalate/H2O2/visible (450 nm). The rate of superoxide anion radical (O2(-)) production under Fe(III)-oxalate/H2O2/UV (350 nm) was 0.19 ± 0.02 μM/min with a steady-state concentration of 5.43 ± 0.473 × 10(-10) M. Detailed product studies using liquid chromatography coupled to Q-TOF/MS demonstrate both reduction (multiple dehalogenations) and oxidation (aromatic ring and side chains) contribute to the degradation pathways. The reduction processes appear to be initiated by the carbon dioxide anion radical (CO2(-)) while oxidation processes are consistent with OH initiated reaction pathways. Unlike most advanced oxidation processes the Fe(III)-oxalate/H2O2/photochemical system can initiate to both reductive and oxidative degradation processes. The observed reductive dehalogenation is an attractive remediation strategy for halogenated organic compounds as the process can dramatically reduce the formation of the problematic disinfection by-products often associated with oxidative treatment processes.

Ecotoxicological risk assessment linked to the discharge by hospitals of bio-accumulative pharmaceuticals into aquatic media: The case of mitotane

The release of hospital wastewater into the urban sewer networks contributes to the general contamination of aquatic media by pharmaceutical residues. These residues include bio-accumulative pharmaceuticals that lead to increased risk for ecosystems because they can concentrate in organisms and food chains, and therefore reach toxic levels. In order to assess the ecotoxicological risks linked to this particular category of residues, we have developed a specific method, by combining a theoretical calculation of pollutant concentrations in organisms to estimate Body Residue (BR), and ecotoxicity biomarkers in fish cell lines, enabling the calculation of a Critical Body Residue (CBR). This method finally results in the calculation of a specific risk quotient (Qb=BR/CBR), characterizing the risk linked to this type of pollutant. This method was applied to mitotane, a bio-accumulative pharmaceutical typically found in hospital wastewater, in the framework of an exposure scenario corresponding to the discharge of all the hospital wastewaters into the Rhone River which flows through the city of Lyon, France. This approach leads to risk quotients (Qb and Qbg) much higher than those found with the classical approach, i.e. Q=PEC/PNEC (Predictive Environmental Concentration/Predictive Non Effect Concentration)=0.0006. This difference in the appreciation of risk is important when using cytotoxicity as the criterion for measuring the toxicity of mitotane (Qb=0.056) and it is even greater when the criterion used is genotoxicity (Qbg=6.8). This study must be now consolidated by taking the biomagnification of the pharmaceuticals into consideration.

Characterisation of the ecotoxicity of hospital effluents: a review

The multiple activities that take place in hospitals (surgery, drug treatments, radiology, cleaning of premises and linen, chemical and biological analysis laboratories, etc.), are a major source of pollutant emissions into the environment (disinfectants, detergents, drug residues, etc.). Most of these pollutants can be found in hospital effluents (HWW), then in urban sewer networks and WWTP (weakly adapted for their treatment) and finally in aquatic environments. In view to evaluating the impact of these pollutants on aquatic ecosystems, it is necessary to characterise their ecotoxicity. Several reviews have focused on the quantitative and qualitative characterisation of pollutants present in HWW. However, none have focused specifically on the characterisation of their experimental ecotoxicity. We have evaluated this according to two complementary approaches: (i) a "substance" approach based on the identification of the experimental data in the literature for different substances found in hospital effluents, and on the calculation of their PNEC (Predicted Non Effect Concentration), (ii) a "matrix" approach for which we have synthesised ecotoxicity data obtained from the hospital effluents directly. This work first highlights the diversity of the substances present within hospital effluents, and the very high ecotoxicity of some of them (minimum PNEC observed close to 0,01 pg/L). We also observed that the consumption of drugs in hospitals was a predominant factor chosen by authors to prioritise the compounds to be sought. Other criteria such as biodegradability, excretion rate and the bioaccumulability of pollutants are considered, though more rarely. Studies of the ecotoxicity of the particulate phase of effluents must also be taken into account. It is also necessary to monitor the effluents of each of the specialised departments of the hospital studied. These steps is necessary to define realistic environmental management policies for hospitals (replacement of toxic products by less pollutant ones, etc.).

A priori assessment of ecotoxicological risks linked to building a hospital

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

Formation of toxic iodinated disinfection by-products from compounds used in medical imaging

Iodinated X-ray contrast media (ICM) were investigated as a source of iodine in the formation of iodo-trihalomethane (iodo-THM) and iodo-acid disinfection byproducts (DBPs), both of which are highly genotoxic and/or cytotoxic in mammalian cells. ICM are widely used at medical centers to enable imaging of soft tissues (e.g., organs, veins, blood vessels) and are designed to be inert substances, with 95% eliminated in urine and feces unmetabolized within 24 h. ICM are not well removed in wastewater treatment plants, such that they have been found at elevated concentrations in rivers and streams (up to 100 μg/L). Naturally occurring iodide in source waters is believed to be a primary source of iodine in the formation of iodo-DBPs, but a previous 23-city iodo-DBP occurrence study also revealed appreciable levels of iodo-DBPs in some drinking waters that had very low or no detectable iodide in their source waters. When 10 of the original 23 cities' source waters were resampled, four ICM were found--iopamidol, iopromide, iohexol, and diatrizoate--with iopamidol most frequently detected, in 6 of the 10 plants sampled, with concentrations up to 2700 ng/L. Subsequent controlled laboratory reactions of iopamidol with aqueous chlorine and monochloramine in the absence of natural organic matter (NOM) produced only trace levels of iodo-DBPs; however, when reacted in real source waters (containing NOM), chlorine and monochloramine produced significant levels of iodo-THMs and iodo-acids, up to 212 nM for dichloroiodomethane and 3.0 nM for iodoacetic acid, respectively, for chlorination. The pH behavior was different for chlorine and monochloramine, such that iodo-DBP concentrations maximized at higher pH (8.5) for chlorine, but at lower pH (6.5) for monochloramine. Extracts from chloraminated source waters with and without iopamidol, as well as from chlorinated source waters with iopamidol, were the most cytotoxic samples in mammalian cells. Source waters with iopamidol but no disinfectant added were the least cytotoxic. While extracts from chlorinated and chloraminated source waters were genotoxic, the addition of iopamidol enhanced their genotoxicity. Therefore, while ICM are not toxic in themselves, their presence in source waters may be a source of concern because of the formation of highly toxic iodo-DBPs in chlorinated and chloraminated drinking water.

Degradation mechanisms and kinetic studies for the treatment of X-ray contrast media compounds by advanced oxidation/reduction processes

The presence of iodinated X-ray contrast media compounds (ICM) in surface and ground waters has been reported. This is likely due to their biological inertness and incomplete removal in wastewater treatment processes. The present study reports partial degradation mechanisms based on elucidating the structures of major reaction by-products using gamma-irradiation and LC-MS. Studies conducted at concentrations higher than observed in natural waters is necessary to elucidate the reaction by-product structures and to develop destruction mechanisms. To support these mechanistic studies, the bimolecular rate constants for the reaction of OH and e(-)(aq) with one ionic ICM (diatrizoate), four non-ionic ICM (iohexol, iopromide, iopamidol, and iomeprol), and the several analogues of diatrizoate were determined. The absolute bimolecular reaction rate constants for diatrizoate, iohexol, iopromide, iopamidol, and iomeprol with OH were (9.58 +/- 0.23)x10(8), (3.20 +/- 0.13)x10(9), (3.34 +/- 0.14)x10(9), (3.42 +/- 0.28)x10(9), and (2.03 +/- 0.13) x 10(9) M(-1) s(-1), and with e(-)(aq) were (2.13 +/- 0.03)x10(10), (3.35 +/- 0.03)x10(10), (3.25 +/- 0.05)x10(10), (3.37 +/- 0.05)x10(10), and (3.47 +/- 0.02) x 10(10) M(-1) s(-1), respectively. Transient spectra for the intermediates formed by the reaction of OH were also measured over the time period of 1-100 micros to better understand the stability of the radicals and for evaluation of reaction rate constants. Degradation efficiencies for the OH and e(-)(aq) reactions with the five ICM were determined using steady-state gamma-radiolysis. Collectively, these data will form the basis of kinetic models for application of advanced oxidation/reduction processes for treating water containing these compounds.

Daily physicochemical, microbiological and ecotoxicological fluctuations of a hospital effluent according to technical and care activities

The problem of hospital effluents falls into the framework of hazardous substances due to the specific substances used and discharged for the most part into urban drainage networks without prior treatment. This in-depth study has led to greater understanding of the effluents discharged by hospitals. The experimental program implemented consisted in carrying out parallel sampling of the effluents of one hospital: a 24 h-average sample and 5 periodic samples corresponding to fractions of times and hospital activities. The samples were characterized by physicochemical, microbiological and ecotoxicological analyses. The results highlight that the effluents contained very little bacterial flora and a moderate organic pollution. However, a numerous of specific pollutants were detected: AOX, glutaraldehyde, free chlorine, detergents, Freon 113 as well as alcohols, acetone, formaldehyde, acetaldehyde, ammonium, phenols and several metals. The battery of bioassays showed that the effluents had a high level of ecotoxicity partly linked to particles in suspension and, that pollution fluctuated greatly during the day in connection with hospital activities. Finally, the PNEC values compared to the concentrations of pollutants dosed in the effluents highlighted that their toxicity was mainly due to several major pollutants, in particular free chlorine. Some hypotheses require additional experiments to be carried out. They concern: reactions of fermentations likely to occur in the drainage network and to form secondary toxic compounds, retention of chlorine by particles and physicochemical characterization of suspended solids.

Occurrence, fate and assessment of polar metamizole (dipyrone) residues in hospital and municipal wastewater

The occurrence and fate of residues from the therapeutic use of the non-steroidal anti-inflammatory drug metamizole have been studied in investigations of sewage effluents from a military hospital, municipal sewers and a sewage treatment plant (STP) in Berlin, Germany. The loads of the metabolites aminoantipyrin (AA), 4-acetylaminoantipyrin (AAA) and 4-formyl-aminoantipyrin (FAA), rapidly formed after the application of metamizole, were predicted from pharmacokinetic data and based on the evaluation of extensive data sets of on the administration in hospitals and private households. In parallel, the actual concentrations were measured within three field trials. For the military hospital, the estimated average annual discharges of AA/AAA and FAA were 10.5 and 3.2 kg, respectively. For the STP, annual loads of 333 and 133 kg were determined for AA/AAA and FAA, respectively. During sewage treatment, an average decrease of 26% of the loads was measured for AA/AAA whereas no changes were observed for FAA. Generally, the prediction of the loads resulted in an overestimation of the residue levels compared to those measured in the respective sewers. Thus, modeling of predicted loads or concentrations alone will not be sufficient for a realistic assessment. Concerns for human or other mammals' health are not expected from the occurrence of metamizole residues in the aquatic system measured at concentrations up to 7 microg l(-1) in STP effluents. However, a rest of uncertainty remains as it was not possible to derive a no observed effect level for the induction of rare but potentially fatal toxicological side effects reported for metamizole.

Formation of oxidation by-products of the iodinated X-ray contrast medium iomeprol during ozonation

The present work describes the investigation of the formation of oxidation by-products of the iodinated X-ray contrast medium (ICM) iomeprol during ozonation in water treatment. Bench-scale investigations revealed that ICM can be partly oxidized during ozonation processes, whereas the ionic diatrizoic acid showed the lowest reactivity. Iomeprol, as a representative of ICM, was not fully mineralized during ozonation. Thus, unknown oxidation by-products were formed. Aqueous solutions of iomeprol were treated by ozonation in order to assess the formation of oxidation by-products. The by-products were characterized by different liquid chromatography methods including detection of single-stage mass spectra, product ion mass spectra, and induced in-source fragmentation for analysis of iodine containing oxidation by-products. Aldehyde and carbonyl containing compounds were proposed to be among the stable by-products. A derivatization step confirms that the aldehyde and carbonyl moieties are major functional groups in oxidation by-products of iomeprol. Furthermore, oxidation by-products of iomeprol were detected at the outlet of an ozone reactor at a full-scale waterworks. However, the toxicological relevance of the by-products is a major future research tasks.

Preliminary study of physico-chemical treatment options for hospital wastewater

Hospital effluents are loaded with pathogenic microorganisms, partially metabolized pharmaceutical substances, radioactive elements, and other toxic substances. Such effluents if not treated properly can damage the natural environment and create a biological imbalance. This paper points out the areas of concern for hospital wastewater disposal and reports the findings of a limited physico-chemical study of treatment options for hospital effluents conducted at Christian Medical College and Hospital, Vellore, Tamil Nadu. The effluent collected was checked for conventional parameters and subjected to coagulation experiments. The raw and settled effluents were coagulated with FeCl(3), filtered and disinfected. Physico-chemical treatment seems to be an attractive option for the cost-effective disposal of hospital effluents. The results of this study call for further detailed study in this area.

Fate and occurrence of X-ray contrast media in the environment

Interest in the presence of pharmaceuticals in the environment has recently increased. Despite continuous research efforts there is still a large gap in our knowledge of their fate and effects on the ecosystem. This review covers current information on the occurrence of iodinated X-ray contrast media (ICM) in the environment and developments in the analysis of these highly polar organic micropollutants in aqueous environmental samples. Findings from monitoring surveys conducted on wastewater-treatment plants (WWTP), surface waters, and drinking waters are compiled, and strategies for removal of the compounds in WWTP and waterworks using advanced treatment are reported. Characteristics and advantages of different compound-specific or element-specific mass spectrometric techniques used to monitor ICM in the environment are compared, and applications in elucidation of the structures of biotransformation products, generated in laboratory-scale experiments that simulate sewage treatment or river water/sediment systems, are described.

Attenuation of wastewater-derived contaminants in an effluent-dominated river

Although wastewater-derived chemical contaminants undergo transformation through a variety of mechanisms, the relative importance of processes such as biotransformation and photolysis is poorly understood under conditions representative of large rivers. To assess attenuation rates under conditions encountered in such systems, samples from the Trinity River were analyzed for a suite of wastewater-derived contaminants during a period when wastewater effluent accounted for nearly the entire flow of the river over a travel time of approximately 2 weeks. While the concentration of total adsorbable organic iodide, a surrogate for recalcitrant X-ray phase contrast media in wastewater, was approximately constant throughout the river, concentrations of ethylenediamine tetraacetate, gemfibrozil, ibuprofen, metoprolol, and naproxen all decreased between 60% and 90% as the water flowed downstream. Comparison of attenuation rates estimated in the river with rates measured in laboratory-scale microcosms suggests that biotransformation was more important than photolysis for most of the compounds. Further evidence for biotransformation in the river was provided by measurements of the enantiomeric fraction of metoprolol, which showed a gradual decrease as the water moved downstream. Results of this study indicate that natural attenuation can result in significant decreases in concentrations of wastewater-derived contaminants in large rivers.

Monitoring of iodinated X-ray contrast media in surface water

A monitoring programme was carried out in order to determine iodinated X-ray contrast media (ICM) in the River Danube and to investigate the raw water quality for drinking water production at Langenau waterworks. The study revealed that the maximum concentrations of ICM (over 500 ng l(-1) for diatrizoic acid and iopamidol) were found in 2h-composite samples taken from the downstream of the Ulm/Neu-Ulm metropolitan area. By means of a concentration profile over one month the highest ICM concentrations were observed on weekdays. The extended data evaluation with principal component analysis shows that the upstream and downstream samples had different pattern of variations in ICM concentration and also demonstrates a clear change in ICM composition by the discharge of municipal wastewater. In addition to load profiles of ICM, time-dependent plots of principal component 1 exhibited peaks, indicating a short-term discharge of ICM between the two sampling sites. In conclusion, a point source for ICM contamination between the sampling sites in Ulm upstream and Leipheim downstream seems to be the reasonable explanation for peak ICM concentrations. Due to the observed high variations of ICM concentrations in river, the evaluation of natural waters by means of a single analysis is not representative.

Mobility of pharmaceuticals carbamazepine, diclofenac, ibuprofen, and propyphenazone in miscible-displacement experiments

Many pharmaceuticals pass the unsaturated zone before reaching an aquifer. Therefore, laboratory sand column transport experiments were conducted to study the transport behavior of carbamazepine, diclofenac, ibuprofen, and propyphenazone under unsaturated conditions. The test water was artificial sewage effluent to simulate the infiltration of reused wastewater. The test water was spiked with the pharmaceutically active compounds and the tracer LiCl. Afterwards it was passed through laboratory sand columns, one experiment for each pharmaceutical. The physical and chemical parameters were recorded and general ions measured. Pharmaceuticals were measured using solid phase extraction, derivatization, and detection with GC-MS. The column experiments indicate a significant elimination of ibuprofen (54%), propyphenazone (55%), and diclofenac (35%), whereas carbamazepine was not eliminated. Retardation factors varied between 1.84 for carbamazepine, 2.51 for propyphenazone, 3.00 for ibuprofen, and 4.80 for diclofenac. These results show that mobility and elimination of diclofenac, ibuprofen, and propyphenazone is about in the same range as for experiments under saturated conditions whereas carbamazepine had a significantly lower sorption and elimination under unsaturated conditions.

Adsorbable organic halogens (AOXs) in solid residues from hazardous and clinical waste incineration

Trace concentrations of a variety of chemicals remain in solid residues following combustion even in properly designed and operated incinerators. In the present study, the adsorbable organic halogen (AOX) levels of the solid residues, i.e., bottom ash, fly ash, and filter cake, were investigated during a 82-day of continuous operation of a Hazardous and Clinical Waste Incinerator. The distribution of halogens in the waste input prior to the incineration was also determined. The AOX levels measured in bottom ash, fly ash and filter cake were in the range of 0.014-1.879, 0.012-0.263, and 0.004-0.062 mg-Cl(-)/kg, respectively. The AOX levels are significantly low in the fly ash and filter cake due to the post-combustion process in the incinerator. At the end of the 82 days, the total AOX output in the bottom ash, fly ash, and filter cake were 571, 3.71, and 6.26 g, respectively. The partitioning of the total AOX in solid residues was 98.28, 0.64, and 1.08% for the bottom ash, fly ash and filter cake, respectively. This shows that the bottom ash is more contaminated with AOX than the other two residues.

Biodegradability of the X-ray contrast compound diatrizoic acid, identification of aerobic degradation products and effects against sewage sludge micro-organisms

Pharmaceuticals and contrast media have been detected in hospital effluents, sewage treatment plants, surface water, and ground water. Only little is known about their elimination during sewage treatment and effects of possible biotransformation products against bacteria. The modified Zahn-Wellens test (ZWT, OECD 302 B) and a test simulating biological sewage treatment (modified OECD 303 A test) were used to assess the biodegradability of the widely used ionic iodinated contrast agent diatrizoic acid (diatrizoate). Effects against sewage sludge bacteria were studied in the two test systems by monitoring the biomarkers quinones, polyamines, phospholipids and adenosine triphosphate. Diatrizoate was biotransformed into 2,4,6-triiodo-3,5-diamino-benzoic acid in the ZWT. 2,4,6-Triiodo-3,5-diamino-benzoic acid was stable under the test conditions of the ZWT. Diatrizoate was not eliminated in the OECD 303 A simulation test. It was not adsorbed by the sewage sludge. No effects of the test compound or its aerobic transformation products against the bacteria present in the sewage sludge were detected using phospholipids, quinones, polyamines, and adenosine triphosphate as biomarkers.

Analysis of iodinated X-ray contrast agents in water samples by ion chromatography and inductively-coupled plasma mass spectrometry

In this paper, an analytical method for the determination of six iodinated X-ray contrast agents (amidotrizoic acid, iohexol, iomeprol, iopamidol, iopromide, and ioxitalamic acid), iodide, and iodate in water samples is presented. The method is based on a separation of the analytes by ion chromatography (IC) and a subsequent detection by inductively-coupled plasma mass spectrometry (ICP-MS). The method was optimised with respect to separation conditions (column type and eluent composition) and extensively validated. Without pre-concentration of the samples, limits of detection below 0.2 microg/l could be achieved whereby reproducibility was below 6% for all compounds under investigation.

Ecotoxicological risk assessment of hospital wastewater: a proposed framework for raw effluents discharging into urban sewer network

In hospitals a large variety of substances are in use for medical purposes such as diagnostics and research. After application, diagnostic agents, disinfectants and excreted non-metabolized pharmaceuticals by patients, reach the wastewater. This form of elimination may generate risks for aquatic organisms. The aim of this study was to present: (i) the steps of an ecological risk assessment and management framework related to hospital effluents evacuating into wastewater treatment plant (WWTP) without preliminary treatment; and (ii) the results of its application on wastewater from an infectious and tropical diseases department of a hospital of a large city in southeastern France. The characterization of effects has been made under two assumptions, which were related to: (a) the effects of hospital wastewater on biological treatment process of WWTP, particularly on the community of organisms in charge of the biological decomposition of the organic matter; (b) the effects on aquatic organisms. COD and BOD5 have been measured for studying global organic pollution. Assessment of halogenated organic compounds was made using halogenated organic compounds absorbable on activated carbon (AOX) concentrations. Heavy metals (arsenic, cadmium, chrome, copper, mercury, nickel, lead and zinc) were measured. Low most probable number (MPP) for faecal coliforms has been considered as an indirect detection of antibiotics and disinfectants presence. For toxicity assessment, bioluminescence assay using Vibrio fischeri photobacteria, 72-h EC50 algae growth Pseudokirchneriella subcapitata and 24-h EC50 on Daphnia magna were used. The scenario allows to a semi-quantitative risk characterization. It needs to be improved on some aspects, particularly those linked to: long term toxicity assessment on target organisms (bioaccumulation of pollutants, genotoxicity, etc.); ecotoxicological interactions between pharmaceuticals, disinfectants used both in diagnostics and in cleaning of surfaces, and detergents used in cleaning of surfaces; the interactions into the sewage network, between the hospital effluents and the aquatic ecosystem.

Toxicological effects of disinfections using sodium hypochlorite on aquatic organisms and its contribution to AOX formation in hospital wastewater

Sodium hypochlorite (NaOCl) is often used for disinfecting hospital wastewater in order to prevent the spread of pathogenic microorganisms, causal agents of nosocomial infectious diseases. Chlorine disinfectants in wastewater react with organic matters, giving rise to organic chlorine compounds such as AOX (halogenated organic compounds adsorbable on activated carbon), which are toxic for aquatic organisms and are persistent environmental contaminants. The aim of this study was to evaluate the toxicity on aquatic organisms of hospital wastewater from services using NaOCl in pre-chlorination. Wastewater samples from the infectious and tropical diseases department of a hospital of a large city in southeast of France were collected. Three samples per day were collected in the connecting well department at 9 a.m., 1 p.m. and 5 p.m. during 8 days from 13 March to 22 March 2001, and a mixture was made at 6 p.m. with the three samples in order to obtain a representative sample for the day. The toxicity test comprised the 24-h EC50 on Daphnia magna and a bioluminescence assay using Vibrio fischeri photobacteria. Fecal coliforms and physicochemical analyses such as total organic carbon (TOC), chloride, AOX, total suspended solids (TSS) and chemical oxygen demand (COD) were carried out. Wastewater samples highlighted considerable acute toxicity on D. magna and V. fischeri photobacteria. However, low most probable numbers (MPN), ranging from <3 to 2400 for 100 ml, were detected for fecal coliforms. Statistical analysis, with a confidence interval of 95%, gave a strong linear regression assessed with r=0.98 between AOX concentrations and EC50 (TU) on daphnia. The identification of an ideal concentration of NaOCl in disinfecting hospital wastewater, i.e. its non-observed effect concentration (NOEC) on algae and D. magna, seems to be a research issue that could facilitate the control of AOX toxicity effects on aquatic organisms. Therefore, it would be necessary to monitor the biocide properties of NaOCl on fecal coliforms at various doses and its toxicity effects on aquatic organisms.

Fate of pharmaceuticals--photodegradation by simulated solar UV-light

The fate of pharmaceuticals in surface waters under solar irradiation was investigated. Photodegradation of pharmaceuticals caused by sun irradiation may be of major significance in the natural elimination process. Based on a data compilation from the literature, the lipid lowering agent metabolite clofibric acid, the iodinated X-ray contrast media iomeprol, which contribute to the adsorbable organic halogen compounds, and the antiepileptic drug carbamazepine were selected. The irradiation experiments were carried out in batch experiments with simulated UV-sunlight. The photodegradation of the pharmaceuticals showed a pseudo-first-order kinetics. The objective of this investigation was to demonstrate that the extent of photoinduced degradation of pharmaceuticals can vary significantly for the different pharmaceuticals and it strongly depends on the water constituents present in solution. The influences of different initial pharmaceutical concentrations, the presence of other pharmaceuticals like carbamazepine or clofibric acid and the presence of natural organic matter on the photochemical degradation rate of pharmaceuticals in aqueous solutions were investigated. Analyses of the pharmaceuticals and their photodegradation products were carried out by high performance liquid chromatography with diode-array and fluorescence detection.

Detection of hospital wastewater genotoxicity with the SOS chromotest and Ames fluctuation test

The genotoxic potential of Rouen University Hospital wastewater was evaluated by the SOS chromotest (on Escherichia coli PQ37) and Ames fluctuation test on Salmonella typhimurium strains TA 98 and TA 100 without metabolic activation. The samples were taken during the hospital maximal activity period (8:00 a.m. to 6:00 p.m.) over three one-week periods of the year. The simultaneous use of SOS chromotest and Ames fluctuation test allows us to carry out a preliminary screening of the hospital wastewater and to gain some insight by which mechanism the genotoxic compounds act. Out of a total of 18 daytime unconcentrated samples tested, 10 (55%) are positive in at least one assay. The two tests have different sensitivity. Indeed, nine genotoxic samples (50%) are detected by the Ames test, and four (22%) by the SOS chromotest. Distribution and intensity of the genotoxic response are different at the three periods. In order to explain this phenomenon, the influence of the rain levels is discussed. This work showed that the hospital wastewater samples tested were overall genotoxic, the response intensity being inflected by the pluviometry. Efforts are now under way to try to identify one or several genotoxic compounds in order to take precautionary measures to limit their release in hospital wastewaters.

Drugs in the environment: emission of drugs, diagnostic aids and disinfectants into wastewater by hospitals in relation to other sources--a review

After administration, pharmaceuticals are excreted by the patients into wastewater. Unused medications are sometimes disposed of in drains. The drugs enter the aquatic environment and eventually reach drinking water if they are not biodegraded or eliminated during sewage treatment. Additionally, antibiotics and disinfectants are supposed to disturb the wastewater treatment process and the microbial ecology in surface waters. Furthermore, resistant bacteria may be selected in the aeration tanks of STPs by the antibiotic substances present. Recently, pharmaceuticals have been detected in surface water, ground water and drinking water. However, only little is known about the significance of emissions from households and hospitals. A brief summary of input by different sources, occurrence, and elimination of different pharmaceutical groups such as antibiotics, anti-tumour drugs, anaesthetics and contrast media as well as AOX resulting from hospital effluent input into sewage water and surface water will be presented.