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

Dynamics of antimicrobial resistance and susceptibility profile in full-scale hospital wastewater treatment plants

Drug resistance has become a matter of great concern, with many bacteria now resist multiple antibiotics. This study depicts the occurrence of antibiotic-resistant bacteria (ARB) and resistance patterns in five full-scale hospital wastewater treatment plants (WWTPs). Samples of raw influent wastewater, as well as pre- and post-disinfected effluents, were monitored for targeted ARB and resistance genes in September 2022 and February 2023. Shifts in resistance profiles of Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii antimicrobial-resistant indicators in the treated effluent compared to that in the raw wastewater were also worked out. Ceftazidime (6.78 × 105 CFU/mL) and cefotaxime (6.14 × 105 CFU/mL) resistant species showed the highest concentrations followed by ciprofloxacin (6.29 × 104 CFU/mL), and gentamicin (4.88 × 104 CFU/mL), in raw influent respectively. WWTP-D employing a combination of biological treatment and coagulation/clarification for wastewater decontamination showed promising results for reducing ARB emissions from wastewater. Relationships between treated effluent quality parameters and ARB loadings showed that high BOD5 and nitrate levels were possibly contributing to the persistence and/or selection of ARBs in WWTPs. Furthermore, antimicrobial susceptibility tests of targeted species revealed dynamic shifts in resistance profiles through treatment processes, highlighting the potential for ARB and ARGs in hospital wastewater to persist or amplify during treatment.

Environmental and Human Health Problems Associated with Hospital Wastewater Management in Zimbabwe

PURPOSE OF THE REVIEW

Wastewater is a term used to describe water that has undergone degradation in quality owing to anthropogenic activities or natural processes. Wastewater encompasses liquid waste originating from academic institutions, households, agricultural sector, industries, mines and hospitals. Hospital wastewater contains potentially hazardous substances including residues of pharmaceuticals, radioisotopes, detergents and pathogens, with detrimental impacts to the environment and human health. Nevertheless, studies related to hospital waste management are limited in Africa, particularly in Southern Africa. This research offers an overview of aspects surrounding hospital wastewater in Southern Africa, focusing on Zimbabwe. Already published and grey literature was reviewed to compile the paper.

RECENT FINDINGS

Number of patients, nature of medical services offered and hospital size influences generation of hospital wastewater. Partially and non-treated hospital wastewater is managed together with municipal wastewater. Management of hospital wastewater is impeded by shortage of resources, lack of co-ordination among responsible authorities and ineffective legal framework enforcement, among other challenges. Inappropriate hospital wastewater management results in environmental contamination, causing human ailments. Attainment of sustainable hospital wastewater management requires clearly defined and enforced legislation, collaboration of accountable stakeholders, sufficient resources and enhanced awareness of involved stakeholders. Application of technologies that uphold recycling and reuse of wastewater is essential to reach Sustainable Development Goals, Zimbabwe Vision 2030 and National Development Strategy 1 targets, particularly those dealing with environmental protection while upholding human health.

Small-scale wastewater-based epidemiology (WBE) for infectious diseases and antibiotic resistance: A scoping review

Wastewater analysis can serve as a source of public health information. In recent years, wastewater-based epidemiology (WBE) has emerged and proven useful for the detection of infectious diseases. However, insights from the wastewater treatment plant do not allow for the small-scale differentiation within the sewer system that is needed to analyze the target population under study in more detail. Small-scale WBE offers several advantages, but there has been no systematic overview of its application. The aim of this scoping review is to provide a comprehensive overview of the current state of knowledge on small-scale WBE for infectious diseases, including methodological considerations for its application. A systematic database search was conducted, considering only peer-reviewed articles. Data analyses included quantitative summary and qualitative narrative synthesis. Of 2130 articles, we included 278, most of which were published since 2020. The studies analyzed wastewater at the building level (n = 203), especially healthcare (n = 110) and educational facilities (n = 80), and at the neighborhood scale (n = 86). The main analytical parameters were viruses (n = 178), notably SARS-CoV-2 (n = 161), and antibiotic resistance (ABR) biomarkers (n = 99), often analyzed by polymerase chain reaction (PCR), with DNA sequencing techniques being less common. In terms of sampling techniques, active sampling dominated. The frequent lack of detailed information on the specification of selection criteria and the characterization of the small-scale sampling sites was identified as a concern. In conclusion, based on the large number of studies, we identified several methodological considerations and overarching strategic aspects for small-scale WBE. An enabling environment for small-scale WBE requires inter- and transdisciplinary knowledge sharing across countries. Promoting the adoption of small-scale WBE will benefit from a common international conceptualization of the approach, including standardized and internationally accepted terminology. In particular, the development of good WBE practices for different aspects of small-scale WBE is warranted. This includes the establishment of guidelines for a comprehensive characterization of the local sewer system and its sub-sewersheds, and transparent reporting to ensure comparability of small-scale WBE results.

Monitoring SARS-CoV-2 RNA in wastewater from a shared septic system and sub-sewershed sites to expand COVID-19 disease surveillance

Wastewater-based epidemiology has expanded as a tool for collecting COVID-19 surveillance data, but there is limited information on the feasibility of this form of surveillance within decentralized wastewater systems (e.g., septic systems). This study assessed SARS-CoV-2 RNA concentrations in wastewater samples from a septic system servicing a mobile home park (66 households) and from two pumping stations serving a similarly sized (71 households) and a larger (1,000 households) neighborhood within a nearby sewershed over 35 weeks in 2020. Also, raw wastewater from a hospital in the same sewershed was sampled. The mobile home park samples had the highest detection frequency (39/39 days) and mean concentration of SARS-CoV-2 RNA (2.7 × 107 gene copies/person/day for the N1) among the four sampling sites. N1 gene and N2 gene copies were highly correlated across mobile home park samples (Pearson's r = 0.93, p < 0.0001). In the larger neighborhood, new COVID-19 cases were reported every week during the sampling period; however, we detected SARS-CoV-2 RNA in 12% of the corresponding wastewater samples. The results of this study suggest that sampling from decentralized wastewater infrastructure can be used for continuous monitoring of SARS-CoV-2 infections.

Unveiling the potential of machine learning in cost-effective degradation of pharmaceutically active compounds: A stirred photo-reactor study

In this study, neural networks and support vector regression (SVR) were employed to predict the degradation over three pharmaceutically active compounds (PhACs): Ibuprofen (IBP), diclofenac (DCF), and caffeine (CAF) within a stirred reactor featuring a flotation cell with two non-concentric ultraviolet lamps. A total of 438 datapoints were collected from published works and distributed into 70% training and 30% test datasets while cross-validation was utilized to assess the training reliability. The models incorporated 15 input variables concerning reaction kinetics, molecular properties, hydrodynamic information, presence of radiation, and catalytic properties. It was observed that the Support Vector Regression (SVR) presented a poor performance as the ε hyperparameter ignored large error over low concentration levels. Meanwhile, the Artificial Neural Networks (ANN) model was able to provide rough estimations on the expected degradation of the pollutants without requiring information regarding reaction rate constants. The multi-objective optimization analysis suggested a leading role due to ozone kinetic for a rapid degradation of the contaminants and most of the results required intensification with hydrogen peroxide and Fenton process. Although both models were affected by accuracy limitations, this work provided a lightweight model to evaluate different Advanced Oxidation Processes (AOPs) by providing general information regarding the process operational conditions as well as know molecular and catalytic properties.

Remediation of groundwater polluted with lindane production wastes by conductive-diamond electrochemical oxidation

This work studies the remediation of groundwater saturated with dense non-aqueous phase liquid (DNAPL) from lindane production wastes by electrochemical oxidation. DNAPL-saturated groundwater contains up to 26 chlorinated organic compounds (COCs), including different isomers of hexachlorocyclohexane (HCH). To do this, polluted groundwater was electrolysed using boron-doped diamond (BDD) and stainless steel (SS) as anode and cathode, respectively, and the influence of the current density on COCs removal was evaluated in the range from 5 to 50 mA cm-2. Results show that current densities higher than 25 mA cm-2 lead to the complete removal and mineralisation of all COCs identified in groundwater. The higher the current density, the higher the COCs removal rate. At lower current densities (5 mA cm-2), chlorobenzenes were completely removed, and degradations above 90 % were reached for COCs with more than five chlorine atoms in their molecules. The use of BDD anodes promotes the electrochemical generation of powerful reactive species, such as persulfate, hypochlorite or hydroxyl radicals, that contribute to the degradation and mineralisation of COCs. The applied current density also influences the generation of these species. Finally, no acute toxicity towards Vibrio fischeri was observed for the treated groundwater after the electrochemical oxidation performed at 5 and 10 mA cm-2. These findings demonstrate that electrochemical oxidation with BDD anodes at moderate current densities is a promising alternative for the remediation of actual groundwater contaminated with DNAPLs.

The relationship between water quality and the microbial virulome and resistome in urban streams in Brazil

Urban streams that receive untreated domestic and hospital waste can transmit infectious diseases and spread drug residues, including antimicrobials, which can then increase the selection of antimicrobial-resistant bacteria. Here, water samples were collected from three different urban streams in the state of São Paulo, Brazil, to relate their range of Water Quality Indices (WQIs) to the diversity and composition of aquatic microbial taxa, virulence genes (virulome), and antimicrobial resistance determinants (resistome), all assessed using untargeted metagenome sequencing. There was a predominance of phyla Proteobacteria, Actinobacteria, and Bacteroidetes in all samples, and Pseudomonas was the most abundant detected genus. Virulence genes associated with motility, adherence, and secretion systems were highly abundant and mainly associated with Pseudomonas aeruginosa. Furthermore, some opportunistic pathogenic genera had negative correlations with WQI. Many clinically relevant antimicrobial resistance genes (ARGs) and efflux pump-encoding genes that confer resistance to critically important antimicrobials were detected. The highest relative abundances of ARGs were β-lactams and macrolide-lincosamide-streptogramin. No statistically supported relationship was detected between the abundance of virulome/resistome and collection type/WQI. On the other hand, total solids were a weak predictor of gene abundance patterns. These results provide insights into various microbial outcomes given urban stream quality and point to its ecological complexity. In addition, this study suggests potential consequences for human health as mediated by aquatic microbial communities responding to typical urban outputs.

Prevalence of antibiotics, antibiotic resistance genes, and their associations in municipal wastewater treatment plants along the Yangtze River basin, China

The overuse and misuse of antibiotics have resulted in the pollution of antibiotics and antibiotic resistance genes (ARGs) in municipal wastewater treatment plants (WWTPs), posing threats to ecological security and human health. Thus, a comprehensive investigation was conducted to assess the occurrence, removal efficiency, and ecological risk of antibiotics, along with the diversity, abundance, and co-occurrence of ARGs, and their correlations in 13 WWTPs along the Yangtze River Basin. Among 35 target antibiotics, 23 antibiotics within 6 categories were detected in all the samples. Amoxicillin (AMO), ofloxacin (OFL), and pefloxacin (PEF) were predominant in influents, while AMO exhibited dominance with the highest concentration of 1409 ng/L in effluents. Although antibiotic removal performance varied among different WWTPs, a significant decrease in each antibiotic category and overall antibiotics was observed in effluents compared with that in influents (p < 0.05). Remarkably, ecological risk assessment revealed high risks associated with AMO and ciprofloxacin (CIP) and medium risks linked to several antibiotics, notably including OFL, roxithromycin (ROX), clarithromycin (CLA), and tetracycline (TC). Furthermore, 96 ARG subtypes within 12 resistance types were detected in this study, and the total absolute abundance and diversity of ARGs were significantly decreased from influents to effluents (p < 0.05). Enrichment of 38 ARGs (e.g., blaNDM, ermA, vatA, mexA, and dfrA25) in effluents indicated potential health risks. Various mobile genetic elements (MGEs), exhibited significant correlations with a majority of ARGs in both influents and effluents, such as intⅠ1, tnpA1, tnpA5, and tp614, underscoring the important role of MGEs in contributing to the ARG dissemination. Many antibiotics displayed lower correlations with corresponding ARGs, but exhibited higher correlations with other ARGs, suggesting complex selective pressures influencing ARG propagation. Overall, the incomplete elimination of antibiotics and ARGs in WWTPs is likely to pose adverse impacts on aquatic ecosystems in the Yangtze River Basin.

Monitoring viruses and beta-lactam resistance genes through wastewater surveillance during a COVID-19 surge in Suwon, South Korea

The present study reports data on a long-term campaign for monitoring SARS-CoV-2, norovirus, hepatitis A virus, and beta-lactam resistance genes in wastewater samples from a wastewater treatment plant during COVID-19 surge in Suwon, South Korea. Real-time digital PCR (RT-dPCR) assays indicated 100 % occurrence of all but hepatitis A virus and blaNDM gene in influent wastewater samples. CDC-N1 assay detected SARS-CoV-2 in all influent samples with an average log-transformed concentration of 5.1 ± 0.39 and the highest level at 6.02 gene copies/L. All samples were also positive for norovirus throughout the study with a mean concentration 5.67 ± 0.65 log10 gene copies/L. On the contrary, all treated wastewater (effluent) tested negative for both viruses' genetic materials. Furthermore, plasmid-mediated AmpC β-lactamases (PABLs) genes blaDHA, blaACC, and blaFOX, extended-spectrum β-lactamases (ESBLs) genes blaTEM and blaCTX, and Klebsiella pneumoniae carbapenemase (blaKPC) gene were measured at average concentrations of 7.05 ± 0.26, 5.60 ± 0.35, 7.82 ± 0.43, 8.38 ± 0.20, 7.64 ± 0.29, and 7.62 ± 0.41 log10 gene copies/L wastewater, respectively. Beta-lactam resistance genes showed strong correlations (r), the highest being 0.86 for blaKPC - blaFOX, followed by 0.82 for blaTEM - blaCTX and 0.79 for blaTEM - blaDHA. SARS-CoV-2 RNA occurrence in the wastewater was strongly associated (r = 0.796) with COVID-19 cases in the catchment during the initial study period of six months. A positive association of the SARS-CoV-2 RNA with the prevalence of COVID-19 cases showed a promising role of community-scale monitoring of pathogens to provide considerable early signals of infection dynamics. High concentrations of beta-lactam resistance genes in wastewater indicated a high concern for one of the biggest global health threats in South Korea and the need to find control measures. Moreover, antibiotic-resistance genes in treated wastewater flowing through water bodies and agricultural environments indicate further dissemination of antibiotic resistance traits and increasing microbial antibiotic resistance.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Callistemon viminalis leaf extract phytochemicals modified silver-ruthenium bimetallic zinc oxide nanocomposite biosynthesis: application on nanocoating photocatalytic Escherichia coli disinfection

Antibiotics are of great interest due to antibiotic-resistant problems around the globe due to bacterial resistance to conventional antibiotics. In this study, a novel green biosynthesis of silver-ruthenium bimetallic zinc oxide nanocomposite using Callistemon viminalis leaf extract as a reducing agent using zinc nitrate hexahydrate, silver nitrate, and ruthenium(iii) chloride as capping agents was reported. The results demonstrated that the surface morphology of the prepared bimetallic nanocomposite by scanning electron microscopy was hexagonal in shape for zinc nanoparticle, rectangular in shape for silver nanoparticle, and tetragonal in shape for ruthenium nanoparticle, having an average surface size 25, 35, and 55 nm, respectively. Fourier transform infrared analysis confirmed the presence of compounds containing alkene, halo-, sulfoxide, phenol, nitro-, phenyl-ester, carboxylic acid, amines, and alcohols which act as functional groups attached to the surface of nanocomposites. Results from X-ray diffraction analysis found 81.12% crystallinity and hexagonal structure of zinc nanoparticles, rectangular structure of silver nanoparticles, and tetragonal structure of ruthenium nanoparticles, which are also similar to the results from transmission electron microscopy analysis. The average size distribution by dynamic light scattering of silver-ruthenium bimetallic zinc oxide nanocomposite was 255 nm, which confirms the biosynthesis of non-uniform size. Photo-disinfection activity of a silver-ruthenium bimetallic zinc oxide nanocomposite against Escherichia coli bacteria isolated from hospital wastewater under dark and ultraviolet-A irradiation conditions was observed. The antibacterial activity was calculated at 2.42704239, ensuring the silver-ruthenium bimetallic zinc oxide nanomaterials have photo-disinfection properties. The results from this study revealed that the developed novel antibacterial nanocomposite of silver-ruthenium bimetallic zinc oxide is useful in nanocoating photocatalytic Escherichia coli disinfection and can be applied to disinfect surfaces.

Occurrence and fate of pharmaceutical pollutants in wastewater: Insights on ecotoxicity, health risk, and state-of-the-art removal

Pharmaceutical active compound (PhAC) residues are considered an emerging micropollutant that enters the aquatic environment and causes harmful ecotoxicity. The significant sources of PhACs in the environment include the pharmaceutical industry, hospital streams, and agricultural wastes (animal husbandry). Recent investigations demonstrated that wastewater treatment plants (WWTPs) are an important source of PhACs discharging ecosystems. Several commonly reported that PhACs are detected in a range level from ng L-1 to μg L-1 concentration in WWTP effluents. These compounds can have acute and chronic adverse impacts on natural wildlife, including flora and fauna. The approaches for PhAC removals in WWTPs include bioremediation, adsorption (e.g., biochar, chitosan, and graphene), and advanced oxidation processes (AOPs). Overall, adsorption and AOPs can effectively remove PhACs from wastewater aided by oxidizing radicals. Heterogeneous photocatalysis has also proved to be a sustainable solution. Bioremediation approaches such as membrane bioreactors (MBRs), constructed wetlands (CWs), and microalgal-based systems were applied to minimize pharmaceutical pollution. Noteworthy, applying MBRs has illustrated high removal efficiencies of up to 99%, promising prospective future. However, WWTPs should be combined with advanced solutions, e.g., AOPs/photodegradation, microalgae-bacteria consortia, etc., to treat and minimize their accumulation. More effective and novel technologies (e.g., new generation bioremediation) for PhAC degradation must be investigated and specially designed for a low-cost and full-scale. Investigating green and eco-friendly PhACs with advantages, e.g., low persistence, no bioaccumulation, less or non-toxicity, and environmentally friendly, is also necessary.

Oxidative treatment of micropollutants present in wastewater: A special emphasis on transformation products, their toxicity, detection, and field-scale investigations

Micropollutants have become ubiquitous in aqueous environments due to the increased use of pharmaceuticals, personal care products, pesticides, and other compounds. In this review, the removal of micropollutants from aqueous matrices using various advanced oxidation processes (AOPs), such as photocatalysis, electrocatalysis, sulfate radical-based AOPs, ozonation, and Fenton-based processes has been comprehensively discussed. Most of the compounds were successfully degraded with an efficiency of more than 90%, resulting in the formation of transformation products (TPs). In this respect, degradation pathways with multiple mechanisms, including decarboxylation, hydroxylation, and halogenation, have been illustrated. Various techniques for the analysis of micropollutants and their TPs have been discussed. Additionally, the ecotoxicity posed by these TPs was determined using the toxicity estimation software tool (T.E.S.T.). Finally, the performance and cost-effectiveness of the AOPs at the pilot scale have been reviewed. The current review will help in understanding the treatment efficacy of different AOPs, degradation pathways, and ecotoxicity of TPs so formed.

Exploring the Economic Aspects of Hospitals: A Comprehensive Examination of Relevant Factors

Financial limitations in the hospital industry have the potential to exacerbate healthcare disparities, impede investments in cutting-edge medical treatments, as well as impair patient outcomes. The interdependent connection between a hospital economy and the general well-being of the community highlights the necessity of careful financial oversight and inventive healthcare policies. Effective collaboration among policymakers, healthcare administrators, and stakeholders is imperative in the development of sustainable economic models that give equal weight to fiscal prudence and optimal patient outcomes. This article aims to underscore the pivotal importance of strategic fund allocation guided by hospital administrators, accentuating several key initiatives capable of revolutionizing healthcare delivery and elevating the institution's stature within the medical community. The other important aspects discussed here are fund allocation in hospitals, the boom of online consultations, and emphasis on the use of sustainable and cost-effective modalities of energy.

Combination of advanced biological systems and photocatalysis for the treatment of real hospital wastewater spiked with carbamazepine: A pilot-scale study

Over the past few decades, the increase in dependency on healthcare facilities has led to the generation of large quantities of hospital wastewater (HWW) rich in chemical oxygen demand (COD), total suspended solids (TSS), ammonia, recalcitrant pharmaceutically active compounds (PhACs), and other disease-causing microorganisms. Conventional treatment methods often cannot effectively remove the PhACs present in wastewater. Hence, hybrid processes comprising of biological treatment and advanced oxidation processes have been used recently to treat complex wastewater. The current study explores the performance of pilot-scale treatment of real HWW (3000 L/d) spiked with carbamazepine (CBZ) using combinations of moving and stationary bed bio-reactor-sedimentation tank (MBSST), aerated horizontal flow constructed wetland (AHFCW), and photocatalysis. The combination of MBSST and AHFCW could remove 85% COD, 93% TSS, 99% ammonia, and 30% CBZ. However, when the effluent of the AHFCW was subjected to photocatalysis, an enhanced CBZ removal of around 85% was observed. Furthermore, the intermediate products (IPs) formed after the photocatalysis was also less toxic than the IPs formed during the biological processes. The results of this study indicated that the developed pilot-scale treatment unit supplemented with photocatalysis could be used effectively to treat HWW.

Removal of pharmaceutical contaminants from hospital wastewater using constructed wetlands: a review

AbstractPharmaceutical compounds are a significant source of environmental pollution, particularly in hospital wastewater, which contains high concentrations of such compounds. Constructed wetlands have emerged as a promising approach to removing pharmaceutical compounds from wastewater. This paper aims to review the current state of knowledge on the removal of pharmaceutical compounds from hospital wastewater using constructed wetlands, including the mechanism of removal, removal efficiency, and future prospects. Pharmaceutical contaminants have been considered to be one of the most emerging pollutants in recent years. In this review article, various studies on constructed wetlands are incorporated in order to remove the pharmaceutical contaminants. The nature of constructed wetland can be explained by understanding the types of constructed wetland, characteristics of hospital wastewater, removal mechanism, and removal efficiency. The results of the review indicate that constructed wetlands are effective in removing pharmaceutical compounds from hospital wastewater. The removal mechanism of these compounds involves a combination of physical, chemical, and biological processes, including adsorption, degradation, and uptake by wetland plants. The removal efficiency of constructed wetlands varies depending on several factors, including the type and concentration of pharmaceutical compounds, the design of the wetland system, and the environmental conditions. Further research is necessary to optimize the performance of these systems, particularly in the removal of emerging contaminants, to ensure their effectiveness and long-term sustainability.

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

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

Multidrug antibiotic resistance in hospital wastewater as a reflection of antibiotic prescription and infection cases

Antimicrobial resistance (AMR) is an escalating issue that can render illnesses more difficult to treat if effective antibiotics become resistant. Many studies have explored antibiotic resistance in bacteria (ARB) in wastewater, comparing results with clinical data to ascertain the public health risk. However, few investigations have linked the prevalence of ARB in hospital wastewater (HWW) with these outcomes. This study aimed to bridge this gap by assessing the prevalence of ARB in HWW and its receiving waters. Among the 144 isolates examined, 24 were obtained from each of the six sites (untreated wastewater, aeration tank, sedimentation tank, effluent after disinfection, upstream canal, and downstream canal). A significant portion (87.5 %) belonged to the Enterobacteriaceae family, with Klebsiella pneumoniae as the predominant species (47.9 %). The antimicrobial sensitivity testing (AST) showed that 57.6 % of the isolates were resistant to amoxicillin/clavulanic acid (AMX), the most prevalent antibiotic used within the studied hospital. The total resistance rate before and after treatment was 27.7 % and 28.0 %, respectively, with an overall multi-drug resistance (MDR) rate of 33.3 %. The multiple antibiotic resistance index (MARI) range varied between 0.0 and 0.9. The outpatient ward's three-day mean bacterial infection cases showed a significant association (Spearman's rho = 0.98) with the MARI in the sedimentation tank. Moreover, a strong correlation (Spearman's rho = 0.88) was found between hospital effluent's MARI and the seven-day mean inpatient ward case. These findings indicate that applying wastewater-based epidemiology (WBE) to hospital wastewater could provide valuable insights into understanding ARB contamination across human domains and water cycles. Future studies, including more comprehensive collection data on symptomatic patients and asymptomatic carriers, will be crucial in fully unravelling the complexities between human health and environmental impacts related to AMR.

Acute inhibition of hospital and medical laboratory wastewater on activated sludge

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

Polysaccharide nanocomposites in wastewater treatment: A review

In modern times, wastewater treatment is vital due to increased water contamination arising from pollutants such as nutrients, pathogens, heavy metals, and pharmaceutical residues. Polysaccharides (PSAs) are natural, renewable, and non-toxic biopolymers used in wastewater treatment in the field of gas separation, liquid filtration, adsorption processes, pervaporation, and proton exchange membranes. Since addition of nanoparticles to PSAs improves their sustainability and strength, nanocomposite PSAs has gained significant attention for wastewater treatment in the past decade. This review presents a comprehensive analysis of PSA-based nanocomposites used for efficient wastewater treatment, focusing on adsorption, photocatalysis, and membrane-based methods. It also discusses potential future applications, challenges, and opportunities in adsorption, filtration, and photocatalysis. Recently, PSAs have shown promise as adsorbents in biological-based systems, effectively removing heavy metals that could hinder microbial activity. Cellulose-mediated adsorbents have successfully removed various pollutants from wastewater, including heavy metals, dyes, oil, organic solvents, pesticides, and pharmaceutical residues. Thus, PSA nanocomposites would support biological processes in wastewater treatment plants. A major concern is the discharge of antibiotic wastes from pharmaceutical industries, posing significant environmental and health risks. PSA-mediated bio-adsorbents, like clay polymeric nanocomposite hydrogel beads, efficiently remove antibiotics from wastewater, ensuring water quality and ecosystem balance. The successful use of PSA-mediated bio-adsorbents in wastewater treatment depends on ongoing research to optimize their application and evaluate their potential environmental impacts. Implementing these eco-friendly adsorbents on a large scale holds great promise in significantly reducing water pollution, safeguarding ecosystems, and protecting human health.

Characterization of bacterial resistance in treated hospital wastewater

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

Tracing COVID-19 drugs in the environment: Are we focusing on the right environmental compartment?

The Coronavirus Disease 2019 (COVID-19) pandemic led to over 770 million confirmed cases, straining public healthcare systems and necessitating extensive and prolonged use of synthetic chemical drugs around the globe for medical treatment and symptom relief. Concerns have arisen regarding the massive release of active pharmaceutical ingredients (APIs) and their metabolites into the environment, particularly through domestic sewage. While discussions surrounding this issue have primarily centered on their discharge into aquatic environments, particularly through treated effluent from municipal wastewater treatment plants (WWTPs), one often overlooked aspect is the terrestrial environment as a significant receptor of pharmaceutical-laden waste. This occurs through the disposal of sewage sludge, for instance, by applying biosolids to land or non-compliant disposal of sewage sludge, in addition to the routine disposal of expired and unused medications in municipal solid wastes. In this article, we surveyed sixteen approved pharmaceuticals for treating COVID-19 and bacterial co-infections, along with their primary metabolites. For this, we delved into their physiochemical properties, ecological toxicities, environmental persistence, and fate within municipal WWTPs. Emphasis was given on lipophilic substances with log Kow >3.0, which are more likely to be found in sewage sludge at significant factions (25.2%-75.0%) of their inputs in raw sewage and subsequently enter the terrestrial environment through land application of biosolids, e.g., 43% in the United States and as high as 96% in Ireland or non-compliant practices of sewage sludge disposal in developing communities, such as open dumping and land application without prior anaerobic digestion. The available evidence underscores the importance of adequately treating and disposing of sewage sludge before its final disposal or land application in an epidemic or pandemic scenario, as mismanaged sewage sludge could be a significant vector for releasing pharmaceutical compounds and their metabolites into the terrestrial environment.

Distinctive hospital and community resistomes in Scottish urban wastewater: Metagenomics of a paired wastewater sampling design

The wastewater microbiome contains a multitude of resistant bacteria of human origin, presenting an opportunity for surveillance of resistance in the general population. However, wastewater microbial communities are also influenced by clinical sources, such as hospitals. Identifying signatures of the community and hospital resistome in wastewater is needed for interpretation and risk analysis. In this study, we compare the resistome and microbiome of hospital, community, and mixed municipal wastewater to investigate how and why the composition of these different sites differ. We conducted shotgun metagenomic analysis on wastewater samples from eight wastewater treatment plants (WWTPs), four hospitals, and four community sites in Scotland, using a paired sampling design. Cluster analysis and source attribution random forest models demonstrated that the hospital resistome was distinct from community and WWTP resistomes. Hospital wastewater had a higher abundance and diversity of resistance genes, in keeping with evidence that hospitals act as a reservoir and enricher of resistance. However, this distinctive 'hospital' signature appeared to be weak in the resistome of downstream WWTPs, likely due to dilution. We conclude that hospital and community wastewater resistomes differ, with the hospital wastewater representing a reservoir of patient- and hospital environment-associated bacteria. However, this 'hospital' signature is transient and does not overwhelm the community signature in the resistome of the downstream WWTP influent.

A state-of-art-review on emerging contaminants: Environmental chemistry, health effect, and modern treatment methods

Pollution problems are increasingly becoming e a priority issue from both scientific and technological points of view. The dispersion and frequency of pollutants in the environment are on the rise, leading to the emergence have been increasing, including of a new class of contaminants that not only impact the environment but also pose risks to people's health. Therefore, developing new methods for identifying and quantifying these pollutants classified as emerging contaminants is imperative. These methods enable regulatory actions that effectively minimize their adverse effects to take steps to regulate and reduce their impact. On the other hand, these new contaminants represent a challenge for current technologies to be adapted to control and remove emerging contaminants and involve innovative, eco-friendly, and sustainable remediation technologies. There is a vast amount of information collected in this review on emerging pollutants, comparing the identification and quantification methods, the technologies applied for their control and remediation, and the policies and regulations necessary for their operation and application. In addition, This review will deal with different aspects of emerging contaminants, their origin, nature, detection, and treatment concerning water and wastewater.

The role of marine pollution on the emergence of fish bacterial diseases

Marine pollution and bacterial disease outbreaks are two closely related dilemmas that impact marine fish production from fisheries and mariculture. Oil, heavy metals, agrochemicals, sewage, medical wastes, plastics, algal blooms, atmospheric pollutants, mariculture-related pollutants, as well as thermal and noise pollution are the most threatening marine pollutants. The release of these pollutants into the marine aquatic environment leads to significant ecological degradation and a range of non-infectious disorders in fish. Marine pollutants trigger numerous fish bacterial diseases by increasing microbial multiplication in the aquatic environment and suppressing fish immune defense mechanisms. The greater part of these microorganisms is naturally occurring in the aquatic environment. Most disease outbreaks are caused by opportunistic bacterial agents that attack stressed fish. Some infections are more serious and occur in the absence of environmental stressors. Gram-negative bacteria are the most frequent causes of these epizootics, while gram-positive bacterial agents rank second on the critical pathogens list. Vibrio spp., Photobacterium damselae subsp. Piscicida, Tenacibaculum maritimum, Edwardsiella spp., Streptococcus spp., Renibacterium salmoninarum, Pseudomonas spp., Aeromonas spp., and Mycobacterium spp. Are the most dangerous pathogens that attack fish in polluted marine aquatic environments. Effective management strategies and stringent regulations are required to prevent or mitigate the impacts of marine pollutants on aquatic animal health. This review will increase stakeholder awareness about marine pollutants and their impacts on aquatic animal health. It will support competent authorities in developing effective management strategies to mitigate marine pollution, promote the sustainability of commercial marine fisheries, and protect aquatic animal health.

Increased Range of Catalytic Activities of Immobilized Compared to Colloidal Gold Nanoparticles

Gold nanoparticles (AuNPs) can be described as nanozymes, species that are able to mimic the catalytic activities of several enzymes, such as oxidase/peroxidase, reductase, or catalase. Most studies in the literature focus on the colloidal suspension of AuNPs, and it is obvious that their immobilization could open the doors to new applications thanks to their increased stability in this state. This work aimed to investigate the behavior of surfaces covered by immobilized AuNPs (iAuNPs). Citrate-stabilized AuNPs (AuNPs-cit) were synthesized and immobilized on glass slides using a simple dip coating method. The resulting iAuNPs were characterized (surface plasmon resonance, microscopy, quantification of immobilized AuNPs), and their multi-enzymatic-like activities (oxidase-, peroxidase-, and catalase-like activity) were evaluated. The comparison of their activities versus AuNPs-cit highlighted their added value, especially the preservation of their activity in some reaction media, and their ease of reuse. The huge potential of iAuNPs for heterogeneous catalysis was then applied to the degradation of two model molecules of hospital pollutants: metronidazole and methylene blue.

Synthesis of an enediyne carbon-allotrope surface for photo-thermal degradation of DNA

The improper disposal of hospital waste products containing genetic materials poses a serious safety threat. We present herein an environmentally friendly technology using a graphene-based novel carbon-allotropic surface to remediate such wastes. The used carbon-allotrope is decorated with an enediyne (EDE-1) enriched aromatic pi-conjugated structure to create an efficient and active surface for cleaving DNA strands. Under controlled exposure of ultraviolet (UV) radiation and heat, the developed surface influences genetic degradation without disturbing the bacterial populations present downstream of the water treatment system. The designed material has been extensively characterized using physicochemical and biological tools. Our results indicate that this approach can possibly be introduced in large scale hospital waste disposal streams for remediating genetic hazards and thereby developing a portable self-contained system.

Oxygen vacancy-rich CeO2 decorated with Cu3BiS3 nanoparticles: Outstanding visible-light photocatalytic performance towards tetracycline degradation

Recently, the degradation of antibiotics has attracted a lot of attention all over the world, because the accumulation of these recalcitrant compounds in the environment, and their entry into the food chain have severely affected on human health. Herein, oxygen vacancy-rich CeO2 was decorated with Cu3BiS3 nanoparticles to fabricate Z-scheme CeO2-x/Cu3BiS3 photocatalysts with a simple procedure. Intriguingly, photocatalytic ability of CeO2-x/Cu3BiS3 (30%) nanocomposite in the detoxification of tetracycline hydrochloride, cephalexin, azithromycin, and rhodamine B was elevated 31.3, 28.2, 45.2, and 10.1-folds as much as CeO2, and 5.19, 5.97, 32.2, and 4.69-folds compared with the CeO2-x photocatalyst, respectively. The admirable activity of CeO2-x/Cu3BiS3 (30%) nanocomposite was ascribed to the production of many charge carriers, efficacious segregation and transfer of charges, and improved textural features, which were confirmed by UV-vis DRS, EIS, photocurrent density, PL, and BET analyses. In addition, the TC degradation pathway was investigated with LC-MS analysis, and also the biocompatibility of the purified solution was displayed with wheat seed cultivation. Regarding outstanding activity and facile synthesis, the CeO2-x/Cu3BiS3 (30%) photocatalyst could be utilized for wastewater treatment.

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

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

Effective stabilization of electrochemically prepared ecological oxidizing agent-ferrate(VI)-by encapsulation in zeolite and its application to water containing SARS-CoV-2 virus

Improper and insufficient treatment of infectious hospital wastewater could seriously endanger public health and the environment. Ferrate(VI), a strong oxidizing, disinfecting, and coagulating agent, has the potential as a green solution for decontamination of water and wastewater. In this paper, electrochemically prepared potassium ferrate (K2 FeO4 ) with high purity was successfully encapsulated and applied to the water contaminated by SARS-CoV-2. Natural zeolite was chosen as an appropriate ecological material for ferrate encapsulation. The stability of encapsulated ferrate (in tablet form) was monitored for an extended time period (290 days) and has significantly increased in contrast with free potassium ferrate by almost 30%. Subsequently, the K2 FeO4 encapsulated with zeolite in tablet form was applied to the water and municipal water samples containing the SARS-CoV-2 virus. The removal efficiency reached up to 98.5% and 86.7%, respectively, under natural conditions. Combination of environmentally friendly oxidizing agent and natural excellent adsorbent leads to the creation of very effective water treatment matter. These findings are essentially immediate and especially important for immediate water treatment in urgent situations such as natural disasters or military conflict. PRACTITIONER POINTS: Electrochemical preparation of oxidizing agent, K2 FeO4 , in high purity by own constructed electrolyzer. Encapsulation of ferrate(VI) to natural zeolite threefold improving the stability during 9 months. SARS-CoV-2 virus was successfully removed from various contaminated types of water. High degradation efficiency of virus fragments by Fe(VI) was achieved without additional water adjustment, in natural pH range.

Nanostructured copper-organic frameworks for the generation of sulphate radicals: application in wastewater disinfection

In recent years, the presence of pathogens in the environment has become an issue of widespread concern in society. Thus, new research lines have been developed regarding the removal of pathogens and persistent pollutants in water. In this research, the efficacy of nanostructure copper-organic framework, HKUST-1, has been evaluated for its ability to eliminate Escherichia coli and generate sulphate radicals as catalyst for the treatment of effluents with a high microbiological load via peroxymonosulphate (PMS) activation. The disinfection process has been optimized, achieving complete elimination of Escherichia coli growth after 30 min of testing using a concentration of 60.5 mg/L HKUST-1 and 0.1 mM of PMS. To overcome the operational limitations of this system and facilitate its handling and reutilization in a flow disinfection process, HKUST-1 has been efficiently encapsulated on polyacrylonitrile as a novel development that could be scaled up to achieve continuous treatment.

Pharmaceuticals in hospital wastewaters: an analysis of the UBA's pharmaceutical database

The presence of pharmaceuticals in hospital wastewaters (HWW) has been a focus of interest for researchers in the last decades. Certain therapeutic classes, such as X-ray contrast media, broad-spectrum antimicrobials and cytotoxics among others, are mainly used in hospitals-health care facilities. This study is focused on available studies monitoring the presence of pharmaceuticals in HWW around the world. To that end, the last available version (v3. 2021) of the "Pharmaceuticals in the Environment" database published by the Federal German Environment Agency (Umweltbundesamt) has been used. Almost half of all studies included (107) have been conducted in Europe. Pharmaceuticals have been monitored in HWW in 38 different countries across all five continents. The country with the greatest number of studies is Brazil (11), followed by Spain (8), China (7), and France (6). Our analysis revealed that 271 different pharmaceuticals have been detected at least once in HWW. The five drugs with more studies showing a positive detection are ciprofloxacin (38), sulfamethoxazole (36), diclofenac (34), ibuprofen (29), and trimethoprim (27). A total of 47 out of 271 drugs are considered in the NIOSH "Hazardous drug" list. However, monitoring data for some widely used drugs in hospital settings such as muscle relaxants, anesthetics, and antidotes is lacking. In conclusion, this study provides the first large-scale metadata analysis for the pharmaceuticals in HWW worldwide.

Temporal study of wastewater surveillance from September 2020 to March 2021: an estimation of COVID-19 patients in Lahore, Pakistan

The first aim of study was to quantify the viral load in the wastewater samples by RT-qPCR testing in Lahore population to estimate the number of patients affected and predict the next resurgence of COVID-19 wave in the city. The second aim of the study was to determine the hotspot areas of Lahore which remained positive more often for virus with high viral load. In this study, n = 420 sewage samples were collected on an average of two weeks intervals from 30 different sewage water disposal stations (14 sampling events) from Sept 2020 to March 2021. RNA was extracted and quantified by RT-qPCR without concentrating the virus in samples. Number of positive disposal sites (7-93%), viral load from sewage samples (100.296 to 103.034), and estimated patients (660-17,030) ranged from low to high according to the surge and restrain of 2nd and 3rd COVID-19 waves in the country. The viral load and estimated patients were reported high in January 2021 and March 2021 which were similar to the peak of 2nd and 3rd waves in Pakistan. Site 18 (Niaz Baig village DS) showed the highest viral load among all sites. Findings of the present study helped to estimate the number of patients and track the resurgence in COVID-19 waves in Lahore particularly, and in Punjab generally. Furthermore, it emphasizes the role of wastewater-based epidemiology to help policymakers strengthen the quarantine measures along with immunization to overcome enteric viral diseases. Local and national stake holders should work in collaboration to improve the environmental hygiene to control the disease.

Effect of resistance difference on distribution of antibiotics in bacterial cell and conjugative gene transfer risks during electrochemical flow through reaction

The occurrences and spread of antibiotic resistance (AR) mediated by horizontal gene transfer (HGT) of antibiotic resistance genes (ARGs) in aquatic environment have been aggravated because of the abuse of antibiotics. While the pressure of different antibiotics is known to induce the spread of AR in bacteria, whether distribution of different antibiotics in cell structure could affect HGT risks is not clear. Here, a significant difference between the distribution of tetracycline hydrochloride (Tet) and sulfamethoxazole (Sul) in cell structure during electrochemical flow through reaction (EFTR) process was firstly reported. Meanwhile, EFTR treatment possessed excellent disinfection performance and consequently controlled the HGT risks. The intracellular Tet (iTet) was discharged through efflux pumps to increase the content of extracellular Tet (eTet) due to the resistance of donor E. coli DH5α under the selective pressure of Tet, declining the damage of donor and plasmid RP4. The HGT frequency was 8.18-fold increase compared with that by EFTR treatment alone. While the secretion of intracellular Sul (iSul) was inhibited by blocking the formation of efflux pumps to inactivate the donor under the Sul pressure, and the total content of iSul and adsorbed Sul (aSul) to be 1.36-fold higher than that of eSul. Therefore, the reactive oxygen species (ROS) generation and cell membrane permeability were improved to release ARGs, and •OH attacked plasmid RP4 in the EFTR process, inhibiting the HGT risks. This study advances the awareness of the interaction between distribution of different antibiotics in cell structure and the HGT risks in the EFTR process.

SARS-CoV-2 detection and inactivation in water and wastewater: Review on analytical methods, limitations and future research recommendations

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in wastewater. Wastewater-based epidemiology (WBE) is a practical and cost-effective tool for the assessment and controlling of pandemics and probably for examining SARS-CoV-2 presence. Implementation of WBE during the outbreaks is not without limitations. Temperature, suspended solids, pH, and disinfectants affect the stability of viruses in wastewater. Due to these limitations, instruments and techniques have been utilized to detect SARS-CoV-2. SARS-CoV-2 has been detected in sewage using various concentration methods and computer-aided analyzes. RT-qPCR, ddRT-PCR, multiplex PCR, RT-LAMP, and electrochemical immunosensors have been employed to detect low levels of viral contamination. Inactivation of SARS-CoV-2 is a crucial preventive measure against coronavirus disease 2019 (COVID-19). To better assess the role of wastewater as a transmission route, detection, and quantification methods need to be refined. In this paper, the latest improvements in quantification, detection, and inactivation of SARS-CoV-2 in wastewater are explained. Finally, limitations and future research recommendations are thoroughly described.

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

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

Multi-target analysis of cytostatics in hospital effluents over a 9-month period

The consumption of cytostatics, pharmaceuticals prescribed in chemotherapy, is increasing every year and worldwide, along with the incidence of cancer. The presence and the temporal evolution of cytostatics in wastewaters from a Portuguese hospital center was evaluated through a 9-month sampling campaign, comprising a total of one hundred and twenty-nine samples, collected from May 2019 to February 2020. Eleven cytostatics out of thirteen pharmaceuticals were studied, including flutamide, mycophenolate mofetil and mycophenolic acid, which have never been monitored before. Target analytes were extracted and quantified by solid-phase extraction coupled to liquid-chromatography-tandem mass spectrometry analysis; the method was fully validated. All pharmaceuticals were detected in at least one sample, bicalutamide being the one found with higher frequency (detected in all samples), followed by mycophenolic acid, which was also the compound detected at higher concentrations (up to 5340 ± 211 ng/L). Etoposide, classified as carcinogenic to humans, was detected in 60% of the samples at concentrations up to 142 ± 15 ng/L. The risk from exposure to cytostatics was estimated for aquatic organisms living in receiving bodies. Cyclophosphamide, doxorubicin, etoposide, flutamide, megestrol and mycophenolic acid are suspected to induce risk. Long-term and synergic effects should not be neglected, even for the cytostatics for which no risk was estimated.

Dependency of sanitation infrastructure on the discharge of faecal coliform and SARS-CoV-2 viral RNA in wastewater from COVID and non-COVID hospitals in Dhaka, Bangladesh

The detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA in wastewater can be used as an indicator of the presence of SARS-CoV-2 infection in specific catchment areas. We conducted a hospital-based study to explore wastewater management in healthcare facilities and analyzed SARS-CoV-2 RNA in the hospital wastewater in Dhaka city during the Coronavirus disease (COVID-19) outbreak between September 2020-January 2021. We selected three COVID-hospitals, two non-COVID-hospitals, and one non-COVID-hospital with COVID wards, conducted spot-checks of the sanitation systems (i.e., toilets, drainage, and septic-tank), and collected 90 untreated wastewater effluent samples (68 from COVID and 22 from non-COVID hospitals). E. coli was detected using a membrane filtration technique and reported as colony forming unit (CFU). SARS-CoV-2 RNA was detected using the iTaq Universal Probes One-Step kit for RT-qPCR amplification of the SARS-CoV-2 ORF1ab and N gene targets and quantified for SARS-CoV-2 genome equivalent copies (GEC) per mL of sample. None of the six hospitals had a primary wastewater treatment facility; two COVID hospitals had functional septic tanks, and the rest of the hospitals had either broken onsite systems or no containment of wastewater. Overall, 100 % of wastewater samples were positive with a high concentration of E. coli (mean = 7.0 log₁₀ CFU/100 mL). Overall, 67 % (60/90) samples were positive for SARS-CoV-2. The highest SARS-CoV-2 concentrations (median: 141 GEC/mL; range: 13-18,214) were detected in wastewater from COVID-hospitals, and in non-COVID-hospitals, the median SARS-CoV-2 concentration was 108 GEC/mL (range: 30-1829). Our results indicate that high concentrations of E. coli and SARS-CoV-2 were discharged through the hospital wastewater (both COVID and non-COVID) without treatment into the ambient water bodies. Although there is no evidence for transmission of SARS-CoV-2 via wastewater, this study highlights the significant risk posed by wastewater from health care facilities in Dhaka for the many other diseases that are spread via faecal oral route. Hospitals in low-income settings could function as sentinel sites to monitor outbreaks through wastewater-based epidemiological surveillance systems. Hospitals should aim to adopt the appropriate wastewater treatment technologies to reduce the discharge of pathogens into the environment and mitigate environmental exposures.

Mass flow and consumption calculations of pharmaceuticals in sewage treatment plant with emphasis on the fate and risk quotient assessment

In Egypt, pharmaceuticals consumption increased dramatically owing to the population growth and the unrestricted sale manner. Accordingly, the occurrence and fate of nine common pharmaceutical active compounds (PhACs) were scrutinized at a sewage treatment plant (STP) in Giza, Egypt. The levels of these PhACs were assessed in different the wastewater treatment stages and dewatered sludge phase using high-performance liquid chromatography coupled with photodiode arrays detector. The average concentrations of the total PhACs detected in influent, primary sedimentation effluent (PSE) and final effluent (FE) were 227, 155 and 89 µg L^-1, respectively. The overall removal efficiency of the individual PhACs ranged from 18 to 72% removal. The occurrence trend revealed that biodegradation and adsorption are the concurrently removal mechanisms of the studied PhACs. The overall consumption per day in West of Greater Cairo was estimated based on influent concentration of STP. Sulfamethoxazole, paracetamol and diclofenac were detected with the highest levels in the influent of STP, PSE and FE as well as in the dewatered sludge. Furthermore, the high concentrations of these compounds in the sludge confirm the adsorption pathway removal of theses PhACs. The risk quotient (RQ) assessment for the detected PhACs in FE is greatly higher than the predicted non-effect concentration (PNEC). Conclusively, the FE of STP is considered a risky source for PhACs in adjacent surface water.

Hospital wastewater treatment methods and its impact on human health and environments

The scientific development and economic advances have led to the identification of many pathogenic agents in hospital effluents. Hospital wastewaters are qualitatively similar to municipal wastewaters, with the difference that these wastewaters contain toxic and infectious substances and compounds that can be dangerous for the health of the environment, employees of these centers, and the entire community. Therefore, in the last few years, it has been emphasized that all hospitals and medical and health centers should have a treatment facility for their produced wastewater so that the health of the society and people is not threatened. An issue that is not paid attention to has become one of the environmental problems and concerns of the world today. The present study focused on the investigate hospital wastewater treatment methods and its impact on human health and the environment. In this narrative study, the first literature search was performed with four hundred and twenty-three articles were retrieved based on PubMed, Elsevier, Web of science, Spring, and Google Scholar databases. The results of this study showed that wastewater from hospitals and medical centers can play a significant impress in polluting soil and aquatic environments and spreading infectious diseases. According to the mentioned contents, collection and treatment of hospital wastewater is essential. In addition, if hospital wastewater enters the wastewater collection network without knowing its characteristics or with incomplete treatment and finally enters the municipal wastewater treatment plant. It causes many problems, including disturbing the balance of the biological system of the treatment plant. Purification and disposal of hospital wastewater is considered a vital action based on environmental standards. The results of this study also showed that the treatment methods of this type of hospital wastewater can play a significant role in reducing the spread of diseases caused by hospital wastewater treatment, including infectious diseases. The results of this study can be very useful for politicians, the managers of the Ministry of Energy and Health and the Environmental Organization in choosing the appropriate methods and process to reduce hospital wastewater and increase the efficiency of hospital wastewater treatment plants.

Review of hospital effluents: special emphasis on characterization, impact, and treatment of pollutants and antibiotic resistance

Health care institutions generate large volumes of liquid effluents from specific activities related to healthcare, analysis, and research. Their direct discharge into the environment has various negative effects on aquatic environments and human health, due to their high organic matter charges and the presence of various emerging contaminants such as disinfectants, drugs, bacteria, viruses, and parasites. Moreover, hospital effluents, by carrying antibiotics, contribute to the development of antibiotic-resistant microorganisms in the environment. This resistance has become a global issue that manifests itself variously in different countries, causing the transmission of different infections. In this respect, an effort is provided to protect water resources by current treatment methods that imply physical-chemical processes such as adsorption and advanced oxidation processes, biological processes such as activated sludge and membrane bioreactors and other hybrid techniques. The purpose of this review is to improve the knowledge on the composition and impact of hospital wastewater on man and the environment, highlighting the different treatment techniques appropriate to this type of disposal before discharge into the environment.

Strategies for safe management of hospital wastewater during the COVID-19 pandemic

Management of hospital wastewater is a challenging task, particularly during the situations like coronavirus 2019 (COVID-19) pandemic. The hospital effluent streams are likely to contain many known and unknown contaminants including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along with a variety of pollutants arising from pharmaceuticals, life-style chemicals, drugs, radioactive species, and human excreta from the patients. The effluents are a mixed bag of contaminants with some of them capable of infecting through contact. Hence, it is essential to identify appropriate treatment strategies for hospital waste streams. In this work, various pollutants emerging in the context of COVID-19 are examined. A methodical review is conducted on the occurrence and disinfection methods of SARS-CoV-2 in wastewater. An emphasis is given to the necessity of addressing the challenges of handling hospital effluents dynamically involved during the pandemic scenario to ensure human and environmental safety. A comparative evaluation of disinfection strategies makes it evident that the non-contact methods like ultraviolet irradiation, hydrogen peroxide vapor, and preventive approaches such as the usage of antimicrobial surface coating offer promise in reducing the chance of disease transmission. These methods are also highly efficient in comparison with other strategies. Chemical disinfection strategies such as chlorination may lead to further disinfection byproducts, complicating the treatment processes. An overall analysis of various disinfection methods is presented here, including developing methods such as membrane technologies, highlighting the merits and demerits of each of these processes. Finally, the wastewater surveillance adopted during the COVID-19 outbreak is discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-023-04803-1.

Towards Effective, Sustainable Solution for Hospital Wastewater Treatment to Cope with the Post-Pandemic Era

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has spread across the globe since the end of 2019, posing significant challenges for global medical facilities and human health. Treatment of hospital wastewater is vitally important under this special circumstance. However, there is a shortage of studies on the sustainable wastewater treatment processes utilized by hospitals. Based on a review of the research trends regarding hospital wastewater treatment in the past three years of the COVID-19 outbreak, this review overviews the existing hospital wastewater treatment processes. It is clear that activated sludge processes (ASPs) and the use of membrane bioreactors (MBRs) are the major and effective treatment techniques applied to hospital wastewater. Advanced technology (such as Fenton oxidation, electrocoagulation, etc.) has also achieved good results, but the use of such technology remains small scale for the moment and poses some side effects, including increased cost. More interestingly, this review reveals the increased use of constructed wetlands (CWs) as an eco-solution for hospital wastewater treatment and then focuses in slightly more detail on examining the roles and mechanisms of CWs' components with respect to purifying hospital wastewater and compares their removal efficiency with other treatment processes. It is believed that a multi-stage CW system with various intensifications or CWs incorporated with other treatment processes constitute an effective, sustainable solution for hospital wastewater treatment in order to cope with the post-pandemic era.

Wastewater generation and treatment by various eco-friendly technologies: Possible health hazards and further reuse for environmental safety

The discharge of untreated wastewater as a result of various developmental activities such as urbanization, industrialization and changes in lifestyle poses great threats to aquatic ecosystems as well as humans. Currently, ∼380 billion m³ (380 trillion liters) of wastewater is generated globally every year. Around 70% of freshwater withdrawals are used for agricultural production throughout the world. The wastewater generated through agricultural run-off further pollutes freshwater resources. However, only 24% of the total wastewater generated from households and industries is treated before its disposal in rivers or reused in agriculture. The most problematic contaminants associated with ecological toxicity are heavy metals such as Cd, Cr, Cu, Ni, Zn, Fe, Pb, Hg, As and Mn. One of the most important issues linked with wastewater generation is the residual presence of pathogenic microorganisms which pose potential health hazards to consumers when they enter into the food chain. It is estimated that in India almost USD 600 million (48.60 billion INR) is spent per year to tackle waterborne diseases (WBD). In light of this, immediate action is needed to effectively treat wastewater and develop safer reuse prospects. Various wastewater treatment technologies have been established and they work well to provide an alternative water source to meet the growing demand. The main concern towards treating wastewater is to eliminate inorganic and organic substances and lower the nutrient concentration, total solids, and microbial pathogens to prevent freshwater pollution and health risks.

Occurrence of pharmaceuticals in the wastewater of a Greek hospital: Combining consumption data collection and LC-QTOF-MS analysis

In this article we applied drug consumption approach and chemical analysis in parallel to investigate the concentrations of a large number of pharmaceuticals in different streams of a General Hospital. Drugs consumption data was collected during two periods (Period 1, 2) and the predicted environmental concentrations (PECs) were estimated for the wastewater of a building housing specific medical services (Point A) and for the entire hospital (Point B). Hospital wastewater samples (HWW) samples were also collected from these points and periods and the measured environmental concentrations (MEC) were determined using UHPLC-ESI-QTOF-MS/MS. According to consumption data, the highest number of drugs was consumed in the departments of Hematology, Intensive Care Unit, Cardiology, Internal Medicine, and Oncology, while the number of active substances used in the hospital was 413 (Period 1) and 362 (Period 2). For most substances, much higher PEC and MEC values were found at the HWW of Point A indicating that on-site treatment of this stream could be examined in the future. The application of wide-scope target analysis allowed the quantification of 122 compounds, while 21 additional substances were identified using suspect screening. The highest mean concentrations in Period 1 were found for acetaminophen (1100 μg/L) and rifaximin (723 μg/L), while in Period 2 for iopromide (458 μg/L) and acyclovir (408 μg/L). Among the detected compounds, 19 metabolites were determined. Atenolol acid, 1-hydroxy-midazolam and clopidogrel carboxylic acid were quantified at concentrations much higher than parent compounds indicating the importance of metabolites' monitoring in HWW. Calculation of PEC/MEC ratio for 36 pharmaceuticals showed sufficient correlation of these values for 19 % to 33 % of the substances depending on the examined period and sampling point. The parallel collection of drugs consumption data and chemical analysis give a thorough picture of the substances present in HWW and their main sources, facilitating decision-making for their better management.

Research progress of electrochemical oxidation and self-action of electric field for medical wastewater treatment

A large number of pathogenic microorganisms exist in medical wastewater, which could invade the human body through the water and cause harm to human health. With the global pandemic coronavirus (COVID-19), public health safety become particularly important, and medical wastewater treatment is an important part of it. In particular, electrochemical disinfection technology has been widely studied in medical wastewater treatment due to its greenness, high efficiency, convenient operation, and other advantages. In this paper, the development status of electrochemical disinfection technology in the treatment of medical wastewater is reviewed, and an electrochemical three-stage disinfection system is proposed for the treatment of medical wastewater. Moreover, prospects for the electrochemical treatment of medical wastewater will be presented. It is hoped that this review could provide insight and guidance for the research and application of electrochemical disinfection technology to treat medical wastewater.GRAPHICAL ABSTRACT.

COVID-19 and Water Variables: Review and Scientometric Analysis

COVID-19 has changed the world since 2020, and the field of water specifically, boosting scientific productivity (in terms of published articles). This paper focuses on the influence of COVID-19 on scientific productivity with respect to four water variables: (i) wastewater, (ii) renewable water resources, (iii) freshwater withdrawal, and (iv) access to improved and safe drinking water. The field's literature was firstly reviewed, and then the maps were built, emphasizing the strong connections between COVID-19 and water-related variables. A total of 94 countries with publications that assess COVID-19 vs. water were considered and evaluated for how they clustered. The final step of the research shows that, on average, scientific productivity on the water topic was mostly conducted in countries with lower COVID-19 infection rates but higher development levels as represented by gross domestic product (GDP) per capita and the human development index (HDI). According to the statistical analysis, the water-related variables are highly significant, with positive coefficients. This validates that countries with higher water-related values conducted more research on the relationship with COVID-19. Wastewater and freshwater withdrawal had the highest impact on the scientific productivity with respect to COVID-19. Access to safe drinking water becomes insignificant in the presence of the development parameters.

Application of a new baffled horizontal flow constructed wetland-filter unit (BHFCW-FU) for treatment and reuse of petrochemical industry wastewater

The shortage of water resources and generation of large quantum of wastewater has posed a significant concern to the environment and public health. Recent research on wastewater treatment has started to focus on reusing wastewater for different activities to reduce the stress on natural water resources. Constructed wetland (CWs) is a low-cost wastewater treatment option. However, some drawbacks include large areal requirements and the need for tertiary treatment units for reusable effluent. In this study, a novel composite baffled horizontal flow CW filter unit (BHFCW-FU) was developed to overcome the drawbacks of the conventional CW. The BHFCW-FU planted with Chrysopogon zizanioides provided a nine times longer flow path, and the adjoined variable depth dual media filter reduced the total area requirement and served as a polishing unit. On average, the BHFCW-FU with horizontal sub-surface flow regime could efficiently remove around 93.93%, 87.20%, and 66.25% of turbidity, phenol, and COD, respectively, from real petrochemical wastewater (initial turbidity: 29.6 NTU, phenol: 4.52 mg/L, and COD: 381 mg/L) and rendered the effluent quality reusable for irrigation, industrial, and other environmental purposes. In synthetic wastewater (initial turbidity: 754 NTU, phenol: 10.87 mg/L, and COD: 1691 mg/L), the removal efficiency of turbidity, phenol, and COD were 99.50%, 93.73%, and 87.05%, respectively. In-depth substrate characterization was done to study the removal mechanism. The developed BHFCW-FU required less space and maintenance, provided reusable effluent, and overcame the drawbacks of conventional CWs. Hence, it may show immense potential as an effective wastewater treatment.

Comparison of constructed wetland performance coupled with aeration and tubesettler for pharmaceutical compound removal from hospital wastewater

Pharmaceutical compounds being able to alter, retard, and enhance metabolism has gained attention in recent time as emerging pollutant. However, hospitals which are part of every urban landscape have yet to gain attention in terms of its hospital wastewater treatment to inhibit pharmaceutical compounds from reaching environment. Hence this study evaluated performance of constructed wetland in combination with tubesettler and aeration based on removal efficiency and ecological risk assessment (HQ). The removal efficiency of constructed wetland with plantation was higher by 31% (paracetamol), 102% (ibuprofen), 46%, (carbamazepine), 57% (lorazepam), 54% (erythromycin), 31% (ciprofloxacin) and 20% (simvastatin) against constructed wetland without plantation. Constructed wetland with aeration efficiency increased for paracetamol, ibuprofen, carbamazepine, lorazepam, erythromycin, ciprofloxacin, and simvastatin removal efficiency were higher by 58%, 130%, 52%, 79%, 107%, 57%, and 29% respectively. In constructed wetland with plantation, removal efficiency was higher by 20% (paracetamol), 13% (ibuprofen), 4% (carbamazepine), 14% (lorazepam), 34% (erythromycin), 19% (ciprofloxacin) and 7% (simvastatin). High ecological risk was observed for algae, invertebrate and fish with hazard quotient values in range of 2.5-484, 10-631 and 1-78 respectively. This study concludes that if space is the limitation at hospitals aeration with constructed wetland can be adopted. If space is available, constructed wetland with tubesettler is suitable, economic and environmentally friendly option. Future research works can focus on evaluating other processes combination with constructed wetland.