The University of Queensland, Advanced Water Management Centre (AWMC), Brisbane, QLD 4072, Australia.
Environ Int. 2012 Sep 15;45:99-111. doi: 10.1016/j.envint.2012.03.008. Epub 2012 May 11.
Hospitals are considered as major sources of pharmaceutical residues discharged to municipal wastewater, but recent experimental studies showed that the contribution of hospitals to the loads of selected, quantifiable pharmaceuticals in sewage treatment plant (STP) influents was limited. However such conclusions are made based on the experimental analysis of pharmaceuticals in hospital wastewater which is hindered by a number of factors such as access to suitable sampling sites, difficulties in obtaining representative samples and availability of analytical methods. Therefore, this study explores a refined and extended consumption-based approach to predict the contribution of six selected Australian hospitals to the loads of 589 pharmaceuticals in municipal wastewater. In addition, the possibility that hospital-specific substances are present at levels that may pose a risk for human health was evaluated. For 63 to 84% of the pharmaceuticals investigated, the selected hospitals are not a major point source with individual contributions likely to be less than 15% which is in line with previous experimental studies. In contrast, between 10 and 20% of the pharmaceuticals consumed in the selected hospitals are exclusively used in these hospitals. For these hospital-specific substances, 57 distinct pharmaceuticals may cause concerns for human health as concentrations predicted in hospital effluents are less than 100-fold lower than effect thresholds. However, when concentrations were predicted in the influent of the corresponding STP, only 12 compounds (including the antineoplastic vincristine, the antibiotics tazobactam and piperacillin) remain in concentration close to effect thresholds, but further decrease is expected after removal in STP, dilution in the receiving stream and drinking water treatment. The results of this study suggest that risks of human exposure to the pharmaceuticals exclusively administered in the investigated hospitals are limited and decentralised wastewater treatment at these sites would not have a substantial impact on pharmaceutical loads entering STPs, and finally the environment. Overall, our approach demonstrates a unique opportunity to screen for pharmaceuticals used in hospitals and identifying priority pollutants in hospital wastewater explicitly accounting for site-specific conditions. Being based on consumption and loads discharged by hospitals into municipal wastewater, it is not limited by 1) the big effort to obtain representative samples from sewers, 2) the availability of sensitive chemical analysis or 3) a pre-selection of consumption data (e.g. consumption volume).
医院被认为是向城市污水中排放药物残留的主要来源，但最近的实验研究表明，医院对污水处理厂（STP）进水所选定的、可量化药物负荷的贡献是有限的。然而，这些结论是基于对医院废水药物的实验分析得出的，由于一些因素的限制，如难以获得合适的采样点、难以获得有代表性的样本以及缺乏分析方法等，使得这种分析变得复杂。因此，本研究探索了一种经过改进和扩展的基于消费的方法，以预测澳大利亚六家选定医院对城市废水中 589 种药物负荷的贡献。此外，还评估了医院特有的物质是否存在于可能对人类健康构成风险的水平。对于研究的 63%至 84%的药物，选定的医院不是主要的点状污染源，个别医院的贡献可能小于 15%，这与以前的实验研究结果一致。相比之下，在选定的医院中使用的药物中有 10%至 20%是专门用于这些医院的。对于这些医院特有的物质，有 57 种不同的药物可能会对人类健康造成关注，因为预测的医院废水中的浓度比效应阈值低 100 倍以下。然而，当在相应 STP 的进水浓度进行预测时，只有 12 种化合物（包括抗癌药物长春新碱、抗生素他唑巴坦和哌拉西林）仍接近效应阈值，但是在 STP 中去除、在接收流中稀释以及饮用水处理后，预计浓度会进一步降低。本研究的结果表明，专门在研究医院使用的药物对人类暴露的风险是有限的，并且在这些医院进行分散式污水处理对进入 STP 的药物负荷不会产生实质性影响，最终对环境也不会产生实质性影响。总的来说，我们的方法提供了一个独特的机会，可以筛选医院使用的药物，并明确考虑特定地点条件，确定医院废水中的优先污染物。该方法基于医院向城市污水中排放的药物消费和负荷，不受以下因素的限制：1）从污水中获得有代表性样本的巨大努力；2）敏感化学分析的可用性；3）消费数据的预先选择（例如，消费数量）。
