Urban Water Security Research Alliance Reduction of Pharmaceutical - - PowerPoint PPT Presentation
Urban Water Security Research Alliance Reduction of Pharmaceutical Loads in Municipal Wastewater: Would Onsite Treatment of Hospital Wastewater be Effective? Kristell Le Corre Hospital Wastewater Science Forum, 19-20 June 2012 FROM SEWERS
Hospital Wastewater
Science Forum, 19-20 June 2012
Domestic wastewater Stormwater Industrial effluents Hospital effluents
WWTP Discharge to the environment Water (AWTP) Recycling SEWER Energy (sewage/sludge) Nutrients (P, N)
SUBJECT TO TRADE WASTE APROVALS ???
Wastewater including toilets, showers and hand basins is considered as domestic wastewater. All other waste discharged (labs etc.) from hospitals to the sewer is considered as trade waste.
CURRENT LEGISLATION
Parameters (mg/L) Unit Domestic wastewater Hospital wastewater pH mg/L 7-7.5 7.7-8.1 BOD 100-400 200(average) COD 250-1,000 500 (average) SS 100-350 160 (average) TN 20-85 5-80 TP 4-15 0.2-13 Total coliforms unit/100mL 105-108 106-109 Analgesics µg/L 11.9 100 Antibiotics 1.2 11 Cytostatics 3.0 24 ß-Blockers 3.2 5.9 ICM 7.00 1,008 Gadolimum 0.7 32 Platinum 0.15 13 AOX 150 1371
Verlicchi et al., (2010) Journal of Hydrology, 389, 416-428
BUT…
“…Informed scientists agree that urgent measures must be taken in order to set guidelines for the treatment of HWWs…. Experimental studies are also necessary because there is still a remarkable paucity of data concerning the possible impacts of HWW on the environment.” Verlicchi et al, 2011. Wat. Sci. Tech. “…If, for whatever motivation, hospital wastewater shall be treated separately onsite, it must be noted, that for many substances no major overall reduction can be achieved since many pharmaceuticals are taken on a regular basis at home..” Ort et al., 2010. Water Res.
Excretion WWTP Surface Water Drinking water Human medicine Wastewater
Hospital Wastewater Municipal Wastewater
Caboolture Hospital flow contribution to STP is 1%
n=17 max <5% n=11 5%< max <15% n=2 max >15% n=5 Only detected at hospital n=24 Not detected above LOQ at both sites 59 substances
4900
Active Ingredients
(TGA, 2011)
150
detected Active Ingredients worldwide
(Runnalls et al., 2010)
Analytical methods Diversity and number of active ingredients Access to sewers High flow and concentration variations Site specificity (hospital - catchment)
A novel approach using pharmaceutical consumption audit data in hospitals and by the general population
Mass Consumption Hospital Mass Consumption Hospital Mass Consumption Population
Evaluation of the contribution (%) of a hospital to the loads of pharmaceuticals in municipal wastewater
Excretion ratio
X
Excretion ratio
X
Excretion ratio
X
Mass Consumption Hospital Mass Consumption Hospital Mass Consumption Population
X 100 Contribution (%) =
Mass Consumption Hospital Mass Consumption Population Queensland Public Hospitals Audit Data (Medication Services Queensland) Medicines dispensed annually to in-patients in public hospitals by strength, brand, form and quantity 107 70319 > 2000 Hospitals Entries Distinct generics National Consumption (Medicare Australia – Pharmaceutical benefit scheme - PBS) Annual amount of medicines subsidised by the general population in Australia 923 >733 Entries Distinct generics
Determination of the contribution of the 6 hospitals investigated to the load
Identification and quantification of compounds exclusively used in hospitals (97-100% contribution) that may require further attention.
Hospital QEII CAB IPS PC PA RBWH Catchment Oxley CAB IPS Luggage Point
Total mass used in hospitals (g/day)
481 340 556 2,640 1,948 2,324
Total mass consumed by the general population (g/day)
35,624 5,725 9,542 72,775 72,775 72,775
Total mass in the corresponding STP influent (g/day)
36,105 6,065 10,098 79,688
Overall contribution
1% 6% 6% 9%
Contribution <15% 15 % < Contribution <50% 50 < Contribution <97% Contribution >97%
%
Y axis = Percentage of compounds per contribution classes
ABACAVIR - ANTIVIRAL (HIV treatment) Contribution 100% Consumption 0.06 g y-1 bed-1 to 0.3 g y-1 bed-1 Predicted ConcentrationHeff 0.3 µg L-1 to 1.0 µg L-1 Predicted ConcentrationSTPinf 0.003 µg L-1 to 0.004 µg L-1 Prescription mode Qualified medical practitioners through hospital-based pharmacies (HSDP, 2011) Comment Most likely excreted at home Overestimated contribution 153 Hospital-specific compounds
Percentage of compounds returning a hospital contribution between 97 and 100%
Prediction of concentrations (µg L-1) in hospital effluents and influents of the corresponding STPs Determination of an effect threshold (µg L-1) for each of the hospital-specific compounds Comparison of predicted concentrations with effect thresholds as margin of exposure (MOE) MOE Effect threshold Predicted concentration (Heff or STPinf ) = MOE >100 Unlikely to cause concern for human health
Method derived from the Australian guidelines for water recycling: augmentation of water supply (NRMC2008)
153 Hospital-specific compounds
Percentage of compounds returning a hospital contribution between 97 and 100%
Hospitals QEII CAB IPS PC PA RBWH Number of hospital-specific compounds 54 56 74 92 112 123 Number of compounds with a MOE in Hospital Effluent ≤100 15 26 33 32 28 41 Number of compounds with a MOE in STP influent ≤100 3 3 8 9 9 Generic name Therapeutic class MOE Bupivacaine Anaesthetic 33663 71 47 69 69 69 Piperacillin Antibiotic 7599 79 2058 8 8 8 Tazobactam Antibiotic 3030 32 820 3 3 3 Oxybuprocaine Anaesthetic 594 248 126 71 71 71 Pancuronium
1122 NU 912 48 48 48 Ropivacaine Anaesthetic 532 365 892 68 68 68 Tropicamide Mydriatic 2121 1415 519 53 53 53 Cefazolin Antibiotic NC NC NC 32 NC NC Infliximab Immunosuppressant NU NU NU NU 81 81 Vincristine Sulphate Antineoplastic NU NU NU NU 0.4 0.4 Levobupivacaine Anaesthetic 67325 447 100 NU NU 2978 Suxamethonium Anaesthetic 15213 256 98 371 357 357
Results available Le Corre et al., (2012), Environment International 45, 99–111
Case Study Predictions
Compounds investigated 59 over 4 days 589 Selection of compounds Analytically measurable Consumed at the hospital Overall results For 47% of the compounds CAB Hospital contributed less than 15% For 78% of the compounds CAB Hospital contributes less than 15% Specific results 5 compounds exclusively detected at the hospital site 2 compounds, roxithromycin and trimethoprim, with a contribution > 15% 56 hospital specific- compounds 3 compounds (bupivacaine / piperacillin / tazobactam) with MOE<100. Comparison of contribution results Contributions for 75%
experimentally in good agreement with predictions Roxithromycin Trimethoprim Mean 26% - Max 56 % Mean 10% - Max 18 % 19% 13% Main conclusion Caboolture Hospital is not a major point source
STP
Ipswich Hospital flow contribution to STP is 1.2 % 3.9 beds / 1000 inhabitants Population in sewer catchment area
~ 1 2 k m
Control box Data logger Flow measurement Manhole
Inside view of the system Outside view of the system
Flow [L/s] Time [h-min-s]
(1 record every 10 second)
10:00 pm to 5:30 am 5:30 am to 5:10 pm 5:10 pm to 10:00 pm
Start of wastewater collection Collection of 8L bottle
Acetaminophen Atenolol Caffeine Carbamazepine Cephalexin Ciprofloxacin Citalopram Dapson DEET Diatrizoate Diclofenac Doxylamine Enrofloxacin Erythromycin Fluoxetine Furosemide Gabapentin Gemfibrozil Hydrochlorothiazide Ibuprofen Indomethacin Iopromide Ketoprofen Lincomycin Metoprolol Naproxen Norfloxacin Perindopril Phenytoin Praziquantel Propanolol Ranitidine Roxithromycin Sertraline Sulfadiazine Sulfamethoxazole Sulfasalazine Tramadol Trimethoprim Venlafaxine Warfarin
This requires the development of a new analytical method.
0.9 2.6 0.1 1.7 0.2 1.9 2.0 0.1 0.8 0.1 1.6 5.9 4.3 12.7 5.6 2.5 1.9 1.0 0.6 2.6 1.3 4.2 4.8 4.8 5.2 2.7 2.4 0.8 0.8 2.1 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 Hospital contribution (%) Measured contribution Predicted contribution (2008) Predicted contribution (2009)
Would onsite treatment of hospital wastewater be an effective way to reduce pharmaceutical loads in municipal wastewater, hence in the feed of AWTP?
According to the previous results, no. Additional aspects (propogation of antibiotic-resistant bacteria) to consider.
Experimental approach
Caboolture : > 80% of pharmaceutical loads do not originate from hospital. Ipswich: - preliminary results suggest low contributions of this hospital .
Sampling pharmaceuticals in hospital wastewater is time consuming and requires thorough planning to minimise uncertainties. Limited to a certain number of compounds that are analysable.
Predictive approach
Allows screening silmutaneously numerous pharmaceuticals used in hospitals and identifying potential compounds of concern (specificially used in hospitals) that may require monitoring. Results compare well with experimental results obtained to date.
Urban Water Security Research Alliance Queensland Health Medication Services Queensland Drug Utilisation Sub Committee (DUSC) of the Pharmaceutical Benefits advisory committee (PNAC), Department of Health and Ageing Queensland Urban Utilities Lend Lease / Conneq Advanced Water Management Centre