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Effects of hospital wastewater on aquatic ecosystem


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Hospitals generate on average 750 liters of wastewater by bed and a day. These effluents are loaded with pathogenic microorganisms, pharmaceutical partially metabolised, radioactive elements and other toxic chemical substances. The dosage of pollutants of hospital origin shows that certain substances, such as anti-tumor agents, antibiotics, 131I and organohalogen compounds (OHC) like AOX, leave mostly wastewater treatment plants (WWTP) without any degradation. By leaving the WWTP, these chemical compounds can provoke the pollution of the natural environment by entailing a biological imbalance. In case the environmental conditions allowing the degradation of these substances are not gathered, they can exercise negative effects on the receiving waters and the living species. This study aims at presenting both the primary results on the biological, physico-chemical and ecotoxicological characterisation of the hospital wastewater before their discharge in the municipal sewage system and their effects on the urban wastewater systems and the environment. The application of the ecotoxicity tests Daphnia magna Strauss on the hospital wastewater samples, in a big city of the southeast of France, indicated a maximal acute toxicity of 116.8 équitox/m3. The high results obtained for the ecotoxicological tests confirm the existence of hazardous substances in hospital wastewater. Considering the volume of wastewater generated by the hospitals and of the extreme diversity of physical, chemical and biological evolutions that these effluents can know it seems important to make their ecotoxicological and sanitary risk assessment.
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Evens EMMANUEL (*)
Université Quisqueya, LAQUE, BP 796, Port-au-Prince, Haïti
ENTPE, L.S.E., Rue Maurice Audin, 69518 VAULX-EN-VELIN
Gérard KECK
École Nationale Vétérinaire de Lyon, BP 83, 69280 MARCY l’ETOILE
INSA de Lyon, LAEPSI, 20 avenue Albert Einstein, 69621 Villeurbanne Cedex
INSA de Lyon, LAEPSI, 20 avenue Albert Einstein, 69621 Villeurbanne Cedex
(*) He is teaching drinking water and wastewater treatments and he is the Director of the Laboratory of Water Quality
and Environment at Quisqueya University in Haiti. Actually, he is doing his Ph’D in management and treatment of
waste at the National Institute of Applied Sciences (INSA) of Lyon (France), in collaboration with the National School
of State Public Works (France), and the National Veterinaire School of Lyon where he works on “Ecotoxicological and
sanitary risk assessment related to hospital wastewater”.
Address of corresponding author (*): École Nationale des Travaux Publics de l’État, Laboratoire des Sciences de
l’Environnement, Rue Maurice Audin, 69518 VAULX-EN-VELIN, France – Tel : + (33) 4 72 04 72 89 – Fax + (33) 4
72 04 77 43. e-mail : ,
Hospitals generate on average 750 liters of wastewater by bed and a day. These effluents are loaded with pathogenic
microorganisms, pharmaceutical partially metabolised, radioactive elements and other toxic chemical substances. The
dosage of pollutants of hospital origin shows that certain substances, such as anti-tumor agents, antibiotics, 131I and
organohalogen compounds (OHC) like AOX, leave mostly wastewater treatment plants (WWTP) without any
degradation. By leaving the WWTP, these chemical compounds can provoke the pollution of the natural environment by
entailing a biological imbalance. In case the environmental conditions allowing the degradation of these substances are
not gathered, they can exercise negative effects on the receiving waters and the living species. This study aims at
presenting both the primary results on the biological, physico-chemical and ecotoxicological characterisation of the
hospital wastewater before their discharge in the municipal sewage system and their effects on the urban wastewater
systems and the environment. The application of the ecotoxicity tests Daphnia magna Strauss on the hospital wastewater
samples, in a big city of the southeast of France, indicated a maximal acute toxicity of 116.8 équitox/m3. The high
results obtained for the ecotoxicological tests confirm the existence of hazardous substances in hospital wastewater.
Considering the volume of wastewater generated by the hospitals and of the extreme diversity of physical, chemical and
biological evolutions that these effluents can know it seems important to make their ecotoxicological and sanitary risk
Keywords: hospital wastewater, WWTP, ecotoxicity, drugs and environment, risk assessment.
Hospitals consume an important volume of water a day. Indeed the consumption of domestic water, is on average 100
liters/person/day (Gadelle, 1995), while the value generally admitted for hospitals varies from 400 to 1200 liters/day/bed
(Deloffre-Bonnamour, 1995 ; CCLIN, 1999). In France, the average needs in water of a university hospital center is
estimated at 750 liters/bed/day (CCLIN, 1999). This important consumption in water of hospitals gives significant
volumes of wastewater loaded with micro-organisms, heavy metals, toxic chemicals, and radioactive elements (CCLIN,
XXVIII Congreso Interamericano de Ingeniería Sanitaria y Ambiental
Cancún, México, 27 al 31 de octubre, 2002
1999 ; Leprat, 1998). As a result the hospitals generate hybrid wastewater, at the same moment domestic, industrial and
effluents of care and medical research (Deloffre-Bonnamour, 1995 ; Jehannin, 1999 ; Emmanuel et al., 2001).
The characterisation works realized on the microbiology of the hospital effluents put in evidence in a systematic way the
presence of germs having acquired the characters of resistance in antibiotics (Leprat, 1998). A concentration of bacteria
flora of 3x105/100mL (Leprat, 1998 ; Bernet and Fines, 2000) is deducted for the hospital effluents. These
concentrations are lower than that of the 108/100mL generally present in the municipal sewage system was deducted for
the hospital wastewater (Metcalf and Eddy, 1991). Markers of viral pollution of surface water, such as enterovirus and
other viruses such adenovirus, were identified in the hospital effluents [Mansotte and Jestin, 2000]. Enterovirus appears
in important quantity in wastewater. Their presence, as marker of viral pollution, in the hospital effluents is to correlate
to that of other viruses. Besides, the HIV, causal agent of the AIDS, was isolated from biological liquids and excretions
of infected persons. These liquid effluents, directly rejected in the network drainage of research laboratories and
hospitals, can contribute under certain physico-chemical conditions to the presence of the virus in the urban sewer
networks and in the WWTP (Wastewater Treatment Plant). Indeed, Casson et al. (1997) mention the presence of
infectious particles (IP) of HIV in natural and wastewater. Lue-Hing et al. [1999] found a concentration of PI of HIV by
liter included between 1.4 x 10-2 and 8.6 x 10-1 (lower than 1 IP of HIV by liter of effluent) for the city of Chicago.
Hospital wastewater reveals the presence of molecules chlorinated in high concentrations and in a punctual way the
presence of heavy metals such as mercury and silver. Concentrations in AOX superior to 10 mg/L were proved in the
effluents of the hospitalization services of a university hospital center (Gartiser et al., 1996). The AOX have a bad
biodegradability and a bad behavior of adsorption (Sprehe et al., 1999). The application of Ames and Hamster cell tests
on hospital wastewater indicate that these effluents are potentially mutagenic (Gartiser et al., 1996). The origin of this
mutagenic potential remains to be investigated. The value of the total hospital wastewater showed a high toxicity as
determined using the daphnia and luminescent bacteria tests. (Leprat, 1998; Emmanuel et al., 2001 ; Jehannin, 1999).
The dosage of pollutants of hospital origin shows that certain substances, particularly organohalogens and
pharmaceutical partially metabolised, leave mostly WWTP without any degradation (Richardson and Bowron, 1985;
Gartisser et al., 1996 ; Kümmerer et al., 1997 ; Halling-Sorensen, 1998 ; Sprehe et al., 1999). Indeed, since the 1980s.
Data about the occurrence of pharmaceuticals in natural surface waters and the effluent of sewage treatment plants have
been reported (Richardson and Browron, 1985 ; Kümmerer et al., 1997). Stan et al. (1994) have measured
pharmaceuticals in ground and drinking water. Pharmaceutical drugs given to people and to domestic animals --
including antibiotics, hormones, strong painkillers, tranquilizers, and chemotherapy chemicals given to cancer patients --
are being measured in surface water, in groundwater, and in drinking water at the tap. Large quantities of drugs are
excreted by humans and domestic animals, and are distributed into the environment by flushing toilets and by spreading
manure and sewage sludge onto and into soil (Montague, 1998). Investigations in the United Kingdom as reported by
Waggott (1981), Watts et al. (1983) and Richardson and Browron (1985) revealed that drugs were present in the aquatic
environment at concentrations up to approximately 1 µg/L. On Iona Island (Vancouver/Canada) the two antiphlogistics,
ibuprofen and naproxen have been identified in sewage (Rogers et al., 1986). Hignite and Azarnoff (1977) detected
loads of salicyclic acid up to 28.7 kg/d and of clofibric acid up to 2.7 kg/d in the effluents of the municipal sewage
treatment plant of Kansas City (USA). Earlier investigations of drug residues in WWTP effluents were focused on
clofibric acid, the major metabolite of three lipid regulators (etofibrate, etofyllinclofibrate and clofibrate) (Ternes, 1998 ;
Stumpf et al., 1999). Garrisson et al. (1976) detected clofibric acid in the lower µg/L-range in treated wastewater in the
United States. Waggot (1981) found clofibric acid in the River Lee (Great Britain) at concentration levels below 0.01
µg/L and in Spain clofibric acid was detected in ground water samples (Galceran et al., 1989). In Germany the clofibric
acid has been identified in river and ground water and even in drinking water with concentration levels ranging up to
165 ng/L by Stan et al. (1994), Heberer and Stan (1996).
One of the main environmental problems putting by the hospital effluents is their discharge, in the same way as the
urban classic effluents, towards the urban sewer network without preliminary treatment. The figure 1 illustrates the
environmental problem with the hospital effluents.
Figure 1-The environmental problem with hospital wastewater
This study aims at presenting both data on the biological, physico-chemical and ecotoxicological characterisation of the
hospital wastewater before their discharge in the municipal sewage system and their effects as well as those of the
pharmaceuticals and disinfectants on the urban wastewater systems and on the environment. In addition, this review on
hospital wastewater allows identifying some environmental stressors released by hospital activities. This knowledge is
important for risk assessment as well as risk management related to hospital effluents.
The effluents of the service of infectious and tropical diseases of a hospital of the Southeast of France were collected for
the determination of the various physico-chemical, microbiological and ecotoxicological parameters. Water sampling
took place from february 22 to march 22 of 2001, and from march 1 to march 22 of 2002 (rainy season) on the effluents
of this service of 144 beds. Samples are taken in a deep well of 4 m about of the hospital ’s sewage system. The
European and French standards were applied in the determination of the different parameters with the exception of the
COD (only for samples of 2001) where the protocol HACH was used. To evaluate the toxicity of industrial effluents,
French water agencies have developed a specific unit called “équitox/m3” (which is equal to: 1/EC x 100 or 1/IC x 100).
This unit has been use in this study for the ecotoxicity tests. Table 1 supplies the parameter standards.
Administered drugs to the patients
Excretion of the patients with
pharmaceutical residues (drugs and
their metabolites)
urban sewer network
Wastewater treatment plant
Surface Water
Purification water plant
Drinking water
Wastewater from care activities and medical
research (blood, urine, feces, gastric liquid,
…, solvents, acids, bases, miscellaneous
reagents, radio elements, disinfectants,
cleaners , …)
Hospital sewer
TABLE 1 : Selected parameters and their protocol of execution
SSM NF EN 872 mg/L
BOD NF EN 1899-1, 05/98 mg/L
pH NF T90-008 -----------------------------------
Conductivity NF EN 27888, IS0 7888 mS/cm
COD HACH & NF T 90-101 mg/L
TOC EN 1484 mg/L
Chlorides ISO 10 304 mg/L
AOX ISO 9562 mg/L
Fecal coli. (E. coli) NF T 90-433 N/100mL
Microtox NF EN ISO 11348-3 Equitox/m3
Daphnia magna Strauuss NF EN ISO 6341 Equitox/m3
Table 2 shows the different values obtained for the selected parameters.
TABLE 2 – Concentration of the selected parameters
Conductivity mS/cm 1 0,524 1,669
PH ------------ 7,85 6,26 8,52
Chlorides mg/L 8,2 7,9 8,5
SSM mg/L 225 155,16 297,6
AOX mg/L 0,67 0,38 1,24
BOD5 mg/L 603 251 1 559
COD mg/L 1 223 604 2 590
TOC mg/L 211 160 350
BOD5/COD -------------- 0,43 0,31 0,60
Microtox Equitox/m3 30,35 24,07 40,51
Daphnia magna Strauss Equitox/m3 46,26 9,8 116,7
A concentration of bacteria flora of 2,4x103/100mL lower than that of the 108/100mL generally present in the municipal
sewage system was deducted for the hospital wastewater. These effluents present an important concentration in AOX
(1,24 mg/L), in chlorides (359,45 mg/L) and have an average report BOD5 / COD of 0,43. The average concentrations
obtained for the hospital effluents have been compared with the medium values of the municipal wastewater. The table 3
illustrates the load in pollutants, which the hospitable effluents can bring to the municipal sewage system and their
possible impact on treatment mechanisms of the WWTP.
TABLE 3: Comparison of the average concentrations in pollutants of hospital effluents (H.E.) and urban
classic effluents (C.U.E)
Suspended Solid Matters mg/L 300 225
BOD5 mg/L 220 603
TOC mg/L 160 211
COD mg/L 500 855
Total Phosphorous mg/L 8 8.80
Chlorides mg/L 50 188
This high toxicity, of 116.8 équitox/m3 indicated by the application of the ecotoxicity tests Daphnia magna Strauss on
hospital wastewater samples, is due probably to the presence of organohalogen compounds resulting from the use of the
hypochlorite of sodium and some iodized substances, in considerable quantities, in the disinfection of hospital effluents
(Emmanuel et al., 2002). Made before the implemented of the processes of settling of solid substances and filtration of
the floating, this disinfection leads to an increase of the concentration of organohalogen compounds (OHC) resulting
from reactions of oxide-reduction between the organic matter and the disinfectants. OHC are mostly lipophilic,
persistent, and toxic (Carey et al., 1998). Emmanuel et al. (2002), at pH 8, are used chlorides as indicators of hospital
wastewater toxicity on daphnia. A coefficient of correlation r=0,978 was found between the concentration in chlorides
and the results of the test of ecotoxicity on Daphnia. The equation of the model is Y= -24,147 + 0,369X or equitox/m3
[Daphnia] = -24,147 + 0,369 [Cl-] mg/L. Figure 2 shows the graph of the linear regression between Daphnia and
Figure 5 – Graph of the linear regression between Daphnia and chlorides
Having crossed the maximal threshold of efficiency of unitary process, the flow and the polluting load of the hospital
effluents have already provoked in the municipal WWTP the effects of saturation which allow releasing pollutants in the
natural environment (Figure 2). In theory, the flow of the liquid effluents (expressed in m3/s) and their superficial charge
or polluting charge by unit surface (expressed in m3/ m2/s) are among the main parameters which enter in the design of
almost all the reactors constituting the units of treatment of WWTP. They participate largely in the definition of the
maximal threshold of efficiency of the WWTP. For unitary systems in operation, as the reactors of WWTP, any increase
of the hydraulic load and/or the organic and inorganic loads of wastewater can entail the demonstration of a
phenomenon of excess load in the mechanisms of cleanup.
Hospital effluents +
Urban effluents
Releasing of pollutants
Y = - 24.147 + 0.369
r = 0.978
0 100 200 300 400
X : c h l o r i d e s
Y : Daphnia
Level of cleanup of WWTP Maximal threshold of efficiency
0 Threshold Level of hospital
Figure 2– Effects of hospital effluents on WWTP
The hospital effluents have generally a very weak microbiological load resulting from the regular use of disinfectants.
These bactericides can have a negative influence on the biological processes of the WWTP. Even by considering that
these effluents are diluted after their discharge towards the municipal WWTP, it remains evident that it is not necessary
to neglect the possibility that certain substances present in the WWTP effluents can generate by cumulative effect a
biological imbalance in aquatic ecosystem. To protect the natural environment against the phenomenon of excess load in
the processes of the WWTP, it seems important to consider upstream treatments of hospital wastewater before their
discharge in the municipal sewage system (Emmanuel, 2001).
Indeed, the contact of hospital pollutants with the elements of the aquatic ecosystems puts in evidence a danger which is
bound to the existence of hazardous substances, i.e., which have the potentiality to exercise negative effects on the
environment and the living species (Rivière, 1998). In case the environmental conditions allowing the degradation of
these substances are not gathered, hospital pollutants risk to be present for a long time in the natural environment and
can represent a risk in short, middle and long term for the living species of the ecosystems.
The risk is the probability of appearance of toxic effects after the exposure of the living organisms to hazardous objects.
The existence of a possible exposure of biological, chemical and radioactive substances released by hospital effluents
conducts to take into account, the eventuality of a radioactive chemical and microbiological risk for the abiotic system
and the living species which populate them. Rivière (1998) distinguishes the hazardous products of the others by their
capacity to provoke toxic short-term effects (mortality) or in the long-term (appearance of cancers, reproduction
problems, etc.). The high results obtained for the ecotoxicological tests confirm the existence of hazardous substances in
hospital wastewater. Considering the volume of wastewater generated by the hospitals and of the extreme diversity of
physical, chemical and biological evolutions that these effluents can know it seems important to make their
ecotoxicological and sanitary risk assessment.
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... Wastewater generated from hospitals usually contain pathogens, human tissues and fluids, pharmaceuticals, substances with genotoxic properties, chemical substances, heavy metals, and radio-active wastes, which may endanger public health, and contribute to oxygen demand and nutrient loading of the water bodies and in the process promote toxic algal blooms and leading to a destabilized aquatic ecosystem, if discharged without treatments into water bodies [5]. One of the chief environmental problems putting by the hospital sewages is their discharge, in the same way as the urban typical effluents, towards the urban sewer network without initial treatment [6]. ...
... The rain is naturally slightly acidic due to the carbon dioxide dissolved in it [17]. The pH mean value particularly of discharging point was almost similar that of hospital wastewater in France as reported by [6] who suggested to be due to the presence of pollution, or may be related to the degradation of organic materials that produced dissolved carbon dioxide which leads to forming HCO 3 with low temperature and increasing hydrogen ion as concluded by a recent study [18]. In addition, the present data were similar to those reported by [19] and [20].However, these mean pH values were within Iraqi, WHO and American standards. ...
... The COD results from site-2 were significantly (P≥0.001) higher than those of other sites being discharge point, in addition to high organic matter in this site, which coincided with undetectable oxygen throughout several months during the study period. These results are similar to those found by [14], but in a work of Greater Zab river and lower than those reported by [42] on Iran hospital wastewater, and also lower than those of [6] France hospital wastewater. However, the mean value of COD is higher than that of permissible limit of Iraqi river standards. ...
... The discharge of these effluents in the urban sewer networks or into the natural environment can generate risks for human health. These effluents represent also a significant contribution to the general contamination of the environment [6][7][8][9]. Chemical residues are toxic environmental pollutants and are the most highly bio-concentrated trace metals [8]. ...
... Risks presented by hospital fluids to the ecosystem and the steps for assessing these risks. Source: adapted from Evens et al. [9] HOSPITAL WASTEWATERS MANAGEMENT SITUATION Difficulties related to the management of hospital wastewaters Currently, around the world, very few policies are concerned with the management of hospitals wastewaters [21]. Even noting for the infrastructures which are put in place for the treatment of these effluents before their discharge into the environment [22]. ...
... Hospital wastewater may include wastewaters from medical tests, blood, urine, feces, gastric fluids, and other body liquids, disinfectants, solvents, acids, bases, reagents, metals, blackwater which includes non-metabolized pharmaceuticals, micro-organisms, and any other medical waste discarded by the hospital (Emmanuel et al., 2002;Jones et al., 2005;Carraro et al., 2016;Pandey and Dwivedi, 2016). Prior studies show that there are some deficiencies in existing primary treatment plants which are not able to treat HWW unto an optimum standard and it treats wastewater by leaving major contaminants such as pharmaceuticals (Nemathaga et al., 2008;Prayitno et al., 2013;Frederic and Yves, 2014;Tilley et al., 2014;Chanpika et al., 2015;Todt, 2015;Wiest et al., 2018). ...
... Moreover, direct discharge of HWW without any treatment is common practice in the developing world including some hospitals in Sri Lanka (Haniffa, 2004;Kumarathilaka et al., 2015). If HWW is left untreated, it may lead to outbreaks of communicable diseases as well as other severe environmental pollution which contributes to increased oxygen demand and nutrient, pharmaceutical loading of water bodies which may result in the promotion of growth of toxic algal blooms, tropical unbalance, destabilized aquatic ecosystem, increasing Viral and Bacterial concentrations which may have acute toxicity (Emmanuel et al., 2002;Aththanyaka et al., 2014) and bioaccumulation of pharmaceuticals in ecosystems (Jean et al., 2012;Zenker et al., 2014;Carraro et al., 2016;Paulus et al., 2019). ...
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Direct discharge of untreated hospital wastewater (HWW) can create severe environmental impacts. Hence, the study focuses on assessing the performance of an existing treatment plant, while determining the most suitable filter material from five different alluvial clays to remove total suspended solids (TSS) and total dissolved solids (TSS) in HWW and investigate a hospital that does not have a treatment plant to elaborate the requirement of a treatment plant. Wastewaters from Provincial General Hospital (PGH, n=5) and Base Hospital (BHTB, n=4) were collected weekly over three weeks (total n=27) where physical (n=4), chemical (n=12) and biological (n=1) parameters were measured. The clays were treated with HWW, and the adsorption of TSS and TDS to clay was determined. The water quality after the trickling filter in PGH shows a clear drop for BOD5, TSS, and pH. Maximum values for BOD5, COD, TSS, and PO4 3-of the waters were 108, 290, 904, and 16.39 mg/L, respectively, and are much higher than the National Environmental Act (CEA) standards. In BHTB, all discharged water outlets are open to the environment, and the BOD5, PO4 3-and NO3-of discharged water varies within 8-98, 3.77-8.16, and 0.80-14.60 mg/L and are higher than CEA standards. The treatment plant at PGH is unsatisfactory to meet the increasing capacity requirements, thus needs improvements, and a treatment plant is required for BHTB. The highest removal of TSS was achieved using illite clay within two weeks, and the removal percentage is 96% while it was showing removal of Benzidine dihydrochloride (C12H12N2.2HCl), Neodymium titanium oxide (Nd2Ti2O7), Bismuth selenide (Bi2Se3) and Iron fluoride (FeF3) which are found to be in HWW.
... Only conventional parameters such as BOD, COD, pH, temperature and TSS have been legislated for the disposal of wastewater in public sewers. For industries or hospitals, a few specific micropollutants such as anionic detergents, adsorbable organic halogens (AOX), nitrates, total nitrogen, sulphates, total and free chlorine, disinfectants, tensio-actives, cyanides, organophosphates, heavy metals and biological parameters (E. coli and faecal coli, etc.) are also to be quantified (Carraro et al., 2016;Emmanuel et al., 2002). However, the probable emerging contaminants, such as pharmaceutical residues, and chemical residues such as hypochlorite and glutaraldehyde which are used in huge quantities in hospitals, antibiotic resistant strains, and radioactive elements in hospital effluents, are not being regulated. ...
... In cases where the environmental conditions are not suitable for degradation of these pollutants it represents a short-to long-term risk to the organisms living there because of their high bio-accumulation potential and bio-magnification. Because of its complex composition, hospital effluent poses a physical, chemical, as well as biological, risk to organisms in the aquatic ecosystem (Emmanuel et al., 2002). Many compounds, such as pharmaceutical residues and phenolic compounds, are known to cause acute or chronic toxicity, changed behaviour, reduced reproduction potential and stunted growth in the lower organisms. ...
... Sampling was conducted from industrial sites releasing organic industrial wastewater. Hospital discharges were recognized as hybrid wastewater carrying domestic, industrial, and medical effluents (Emmanuel et al., 2002). From each drain, 3 samples were picked up in sterilized bottles and mixed to form a single heterogeneous mixture and chemical properties were observed (Table 1). ...
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The alarming upsurge in the co-existence of heavy metal and antibiotic resistance may have a devastating impact on humans, animals, and the environment. Four metal-resistant bacteria were isolated from hospital effluents and industrial drain. Heavy metal resistance and antimicrobial resistance were examined in the isolates followed by identification through 16S rRNA gene sequencing. Delftia tsuruhatensis strain FK-01 and Carnobacterium inhibens strain FK-02 tolerated arsenic with maximal tolerated concentration (MTC) of 30 mM and 10 mM, respectively. Staphylococcus hominis strain FK-04 tolerated copper up to 4 mM and lead-resistant Raoultella ornithinolytica strain FK-05 exhibited tolerance to 1 mM lead. The growth kinetics of bacteria were monitored in the presence of metals and the following antibiotics, tetracycline, chloramphenicol, and kanamycin. The presence of arsenate significantly enhanced tetracycline resistance in C. inhibens. Heavy metal–induced antibiotic resistance was also observed in S. hominis and R. ornithinolytica, against chloramphenicol and tetracycline respectively. D. tsuruhatensis showed resistance to kanamycin but when grown in the presence of arsenic and kanamycin, bacteria lost resistance to the antibiotic. Therefore, it is suggested that the novel arsenate-resistant strain Delftia tsuruhatensis FK-01 has a unique ability to inhibit antimicrobial resistance that can be harnessed in bioremediation.
... 2. Type G facility stores demolition waste mixed with certain industrial wastes. 3. Type H facility stores non-polluted soil from works and sorted demolition wastes and technically separable plaster certain industrial wastes (Emmanuel et al., 2002). ...
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Waste has a long history of association with humans and other organisms. It is inevitable and has different sources right from crop residues (agriculture), food production and its movement through food chain, industries and their processes. Waste has different environmental implications like leachate and can contaminate groundwater. Emissions from waste burning cause air pollution, and its dumping in soil cause soil pollution. There are different methods and technologies being used in the world to minimize waste. All the technologies being used are reviewed and presented in it with their pros and cons of all the technologies. This chapter will include all these technologies and associated environmental concerns.
... 3 Water plays a pivotal role in infection transmission to humans. 4 According to a study by Emmanuel et al., 5 hospitals generate 750 liters of wastewater per bed daily on average. The discharged water is laden with microorganisms, partly metabolized pharmaceuticals, radioactive elements, and other hazardous chemicals. ...
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Dissemination of antibiotic resistance via aquatic systems is considered an important environmental health concern. The present study aimed to assess the levels of multidrug-resistant bacteria in the raw wastewater of two hospitals in Port Harcourt metropolis using standard microbiological techniques. Among 64 bacterial isolates, seven bacterial groups were identified, including Klebsiella pneumoniae, Escherichia coli, Enterobacter, Staphylococcus aureus, Citrobacter, Shigella, and Bacillus. The bacterial counts were within the ranges of 7.8 x 10 4-4.8 x 10 6 CFU/ml and 6.9 x 10 4-1.09 x 10 5 CFU/ml in hospitals A and B respectively. The obtained results indicated high resistance to quinolones/fluoroquinolones (83.3-90%) and penicillins (50-70%). In addition, 86.9% of the isolates showed multidrug resistance. The multiple antibiotic resistance (MAR) index was within the range of 0.1-0.8 in the Gram positive bacteria and 0.1-0.6 in the Gram negative bacteria. The findings confirmed the presence of bacteria with high MAR indices in the untreated hospital wastewater.
... The radioactive effluent was discharged into the nearby Crocodile River after it has complied with discharge criteria as set by the National Nuclear Regulator and the Department of Water Affairs and Forestry. Emmanuel (2002) carried out a study on wastewater samples discharged from a hospital in a city, Southeast of France which was aimed at presenting the primary results of the biological, physiochemical and ecotoxicological properties of the wastewater before its discharge into the municipal sewage system. It's effects on the urban wastewater systems and the environment was also studied. ...
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This work measures the radiological content of liquid effluent discharged from a Nigerian Hospital that has a Department of Nuclear Medicine where diagnostic and therapeutic activities were carried out using medical radioisotopes. The main focus is to examine the management of radioactive biological waste from patients after undergoing radio-iodine therapy. This study was carried out for a period of 5 days. Samples of liquid effluent at the point of final discharge from the Hospital into the Municipal sewer system were collected on daily basis, within the hour after radioactive urine waste was discharged into the hospital sewer system. A G.M Tube detector was used in measuring the mean dose rates directly from the liquid effluent samples. The dose rates measured from the liquid effluent samples range from 0.13 to 0.20µSv/hr which was within similar range as the mean dose rate (0.20µSv/hr) from natural background radiation measured prior to the study at locations upstream of the hospital. Corresponding activity concentrations of Iodine-131 were evaluated using empirical correlations. The values of activity concentration ranged from 0.0028 to 0.0043 Bq/L. This showed that the activity concentration of Iodine-131 contained in the liquid effluent discharged was very low when compared with the threshold of 0.1 Bq/L. This is adduced to very high dilution (99.91%) of Iodine-131 within the hospital sewer before being discharged into the Municipal sewer system. Radiation hazard indices were also evaluated to determine the radiological burden of the effluent discharge on the surrounding. Annual Effective Dose Equivalent and Excess Life Cancer Risk values of 15.94 - 24.53 µSv/yr and 0.14 x 10-3 - 0.20 x 10-3 were within the acceptable standard Thresholds of 70 µSv/yr and 0.29 x 10-3 respectively. The low values of radiological properties measured for Iodine-131 in the liquid effluent discharged from the Nigerian Hospital are within acceptable clearance level for safe final discharge.
Acinetobacter spp. and Stenotrophomonas maltophilia are bacteria commonly associated with infections at the clinical settings. Reports of infections caused by environmental isolates are rare. Therefore, this study focused on determination of the antibiotic resistance patterns, antibiotic resistance genes, efflux pumps and virulence signatures of Acinetobacter spp. and S. maltophilia recovered from river water, plant rhizosphere and river sediment samples. The isolates were identified and confirmed using biochemical tests and PCR. The antimicrobial resistance profiles of the isolates were determined using Kirby Bauer disk diffusion assay and presence of antibiotic resistance and virulence genes were detected using PCR. S. maltophilia was more frequent in plant rhizosphere and sediment samples than the water samples. Acinetobacter spp. were mostly resistant to trimethoprim-sulfamethoxazole (96% of isolates), followed by polymyxin b (86%), cefixime (54%), colistin (42%), ampicillin (35%) and meropenem (19%). The S. maltophilia isolates displayed total resistance (100%) to trimethoprim- sulfamethoxazole, meropenem, imipenem, ampicillin and cefixime, while 80% of the isolates were resistant to ceftazidime. Acinetobacter spp. contained different antibiotic resistance genes such as sul1 (24% of isolates), sul2 (29%), blaOXA 23/51 (21%) and blaTEM (29%), while S. maltophilia harbored sul1 (8%) and blaTEM (20%). Additionally, efflux pump genes were present in all S. maltophilia isolates. The presence of multidrug resistant Acinetobacter spp. and Stenotrophomonas maltophilia in surface water raises concerns for community-acquired infections as this water is directly been used by the community for various purposes. Therefore, there is the need to institute measures aimed at reducing the risks of these infections and the resulting burden this may have on the health care system within the study area.
“Adsorbable organic halogens (AOX)” is a comprehensive index defined as the sum of all halogenated organic compounds which can be adsorbed onto the activated carbon and detected by microcoulometry. AOX have received increasing attention because of their widespread distribution, potential toxicity and bioaccumulation. It is urgent to control AOX pollution due to their hazard to eco-environment and human health. However, a significant gap still exists in our knowledge of the source, pollution extent and character of AOX. This review describes the contamination status of AOX and identifies their key sources, pollution-intensive sectors as well as emission hotspots. Considering the generation of AOX during high salinity wastewater treatments and the accumulation of AOX in sludges, the wastewater treatment plants (WWTPs), which have been neglected previously, are identified as potential sources of AOX. Besides, the performance and innovative improvements of AOX removal technologies are critically evaluated. Different scenarios are proposed to enhance removal efficiency and avoid byproduct generation during AOX treatment processes.
An episode of groundwater pollution detected in the Municipality of 'Les Franqueses del Valles' (Catalonia, Spain) at the beginning of 1987 is described. To ascertain the scope of the problem and take correct decisions about groundwater uses, a screening of the organic pollutants in samples collected in fifteen wells was carried out. Acidic and basic plus neutral compounds were analyzed by combined gas chromatography-mass spectrometry. More than 30 compounds were identified. In the acidic fractions, fatty acids were the most important pollutants whereas in basic plus neutral fractions phtalates, morpholine derivatives, isocyanomethylbenzene, 2-methylquinazoline and carbonetrithioic dimethyl ester were the most relevant ones. Factor analysis was applied to tentatively establish the sources of pollution. Eleven parameters including eight organic compounds, two general parameters of water quality and cyanide were considered. From this study isocyanomethylbenzene, cyanide and the total organic matter content can be related to wastes stored in uncontrolled conditions from a factory located in the zone.
Results obtained from the use of high-performance liquid chromatography and field desorption mass spectrometry for the separation and identification of non—volatile organics isolated from river and drinking waters are presented. Complex mixtures of non-volatile organics with a wide diversity of structural types have been shown to be present in these water samples. Among the non-volatile organics identified are poly chlorinated terphenyls, non-ionic and cationic surfactants, pharmaceuticals, pesticides and epoxy resin components. The majority of the identified compounds are anthropogenic in origin and many of them are biologically active. Only a small proportion of the non-volatiles present have been identified and the others await further application of the techniques used here and the development of new techniques.
Composite five to seven-day sample s of chlorinated and unchlorinated primary-treated municipal wastewater were collected at the Iona Island treatment plant during a 62-day exposure of juvenile chinook salmon (Oncorhynchus tshawytscha). No differences between chlorinated and unchlorinated samp les were detectable and only 9 chlorinated extractables we re identified. Mass spectrometric analysis of sewage and sludge extracts identified 100 base/neutral components and 60 acidic substances. Some major constituent s we re quantified. Fatty acids, petroleum hydrocarbons, aromatic acids and chemical disinfectants we re predominant. Toxic compounds present included chlorophenols, polynuclear aromatic hydrocarbons (PAH’s) and nonylphenols plus nonylphenolethoxylates. Tetrachlorophenol (TCP) and pentachlorophenol (PCP) reached maximum levels of 7.8 and 13.2 μg · L−l respectively. The PAH’s we re heavily concentrated in sludge samples. Nonylphenol was present in wastewater and sludge but the corresponding ethoxylates occurred only in wastewater. PCB’s were detectable only in sludge. Some novel identifications included two substituted monochiorophenol disinfectants and two generic drugs.
Es wurden 45 Krankenhausabwasserproben aus verschiedenen Bereichen (Gesamtabwasser, Pflegebereich und Laboratorien) auf chemische Parameter und mit biologischen Testverfahren (Daphnientest, Leuchtbakterientest, Ames-Test und Hamsterzelltest) untersucht. Parallel hierzu wurde der Verbrauch wichtiger abwasserrelevanter Produktgruppen bilanziert. Der Wasserverbrauch der Krankenhäuser streut in einem weiten Bereich und beeinflußt maßgeblich die Abwasserbeschaffenheit. Die Werte der chemischen Parameter lagen überwiegend in einem mit kommunalem Abwasser vergleichbaren Bereich. Die AOX Konzentrationen waren mit rd. 0.41 mg/L (Gesamtabwasser) bzw. 0.95 mg/L (Pflegebereich) deutlich erhöht. Die Bilanzierung ergab, daß jodhaltige Röntgenkontrastmittel einen großen Anteil an der AOX-Fracht von Krankenhausabwasser haben. Die Daphnien- und die Leuchtbakterientoxizität der Gesamtabwasser- und der Laborabwasserproben waren teilweise sehr hoch. Fünf von 23 Proben aus dem Klinischen Bereich und sieben von neun Laborabwasser proben erwiesen sich im Ames-Test bzw. Hamsterzelltest als eindeutig mutagen. Die Herkunft der Mutagenität konnte nicht eindeutig geklärt werden.
A portion of administered pharmaceuticals are excreted unmetabolised by patients and can be found in hospital effluent and municipal sewage. Some pharmaceuticals such as anti-tumour agents are carcinogenic, mutagenic, teratogenic and fetotoxic. Little is known about their environmental impact. Therefore, the biodegradability of the widely used anti-tumour agent ifosfamide (IF) was assessed with the modified Zahn-Wellens test (OECD 302 B) and a test simulating biological sewage treatment. The biodegradation was monitored by DOC and . The concentration of IF in hospital effluent, communal sewage and the effluent from a communal sewage treatment plant (STP) was analysed as well as calculated by the amounts of water and IF used in hospitals. The expected concentration of IF in German surface waters was calculated. IF was not biodegradable in the Zahn-Wellens test and the STP simulation test. It was not adsorbed by the sewage sludge. The concentrations measured in the hospital effluents, the STP influent and the STP effluent were of the same order of magnitude as the calculated ones, indicating that no adsorption, biodegradation or other elimination of IF took place to any noticeable extent.
The occurrence of 32 drug residues belonging to different medicinal classes like antiphlogistics, lipid regulators, psychiatric drugs, antiepileptic drugs, betablockers and β2-sympathomimetics as well as five metabolites has been investigated in German municipal sewage treatment plant (STP) discharges, river and stream waters. Due to the incomplete removal of drug residues during passage through a STP, above 80% of the selected drugs were detectable in at least one municipal STP effluent with concentration levels up to 6.3 μg l−1 (carbamazepine) and thus resulting in the contamination of the receiving waters. 20 different drugs and 4 corresponding metabolites were measured in river and stream waters. Mainly acidic drugs like the lipid regulators bezafibrate, gemfibrozil, the antiphlogistics diclofenac, ibuprofen, indometacine, naproxen, phenazone and the metabolites clofibric acid, fenofibric acid and salicylic acid as well as neutral or weak basic drugs like the betablockers metoprolol, propranolol and the antiepileptic drug carbamazepine were found to be ubiquitously present in the riversand streams, mostly in the ng l−1-range. However, maximum concentrations were determined up to 3.1 μg l−1 and median values as high as 0.35 μg l−1 (both bezafibrate). The drugs detected in the environment were predominantly applied in human medicine. It can therefore be assumed that the load of municipal STP effluents in the surface water highly influences the contamination. Due to their wide-spread presence in the aquatic environment many of these drugs have to be classified as relevant environmental chemicals.
Chlorophenoxyisobutyrate (CPIB) and salicylic acid, the metabolites of clofibrate and aspirin, were quantitated by gas chromatography-mass spectrometry in the effluent of a sewage disposal plant in Kansas City, Missouri. The average daily output of CPIB was 2.1 (0.76–2.92) kg and salicylic acid 8.64 (0.55–28.69) kg over a 10 month period. Approximately one-half of the clofibrate consumed in this area is discharged into the Missouri River.