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Pharmaceuticals Residues in Hospital Wastewater (Europe)

The healthcare sector has a unique healing mission, yet hospitals are key point sources for specialised pharmaceutical residues entering the environment, a serious source of pollution that can threaten ecosystems and the environment, as well as drive the development of antimicrobial resistance (AMR) – a serious public health threat.

Up to 90% of orally administered pharmaceuticals are excreted into wastewater as active substances in the faeces and urine of patients. Wastewater treatment plants widely vary in their capacity to eliminate these active substances; one study recorded removal rates ranging from 0%-97%. This means that parent compounds or their metabolites can be discharged into the aquatic ecosystem through effluents and enter the water cycle.

Pharmaceuticals are biologically active, often mobile (particularly in the case of metabolites), and not readily biodegradable in the environment. As they are designed to interact with living systems at low doses, even low concentrations in the environment are a concern. Whilst common medicines are often consumed in the community, more specialised pharmaceutical products such as cytostatic drugs, some antibiotics, and X-ray contrast agents are mainly administered in hospitals.

This report explores how hospital wastewater contributes to the pharmaceutical load released into the environment and features five case studies illustrating how European hospitals are dealing with pharmaceutical residues in their wastewater. It also looks at resistant bacteria because of their potential link with antibiotic residues in hospital effluents.