title: Monitoring, removal and risk assessment of cytostatic drugs in hospital wastewater.
abstract: Cytostatic agents are applied in cancer therapy and subsequently excreted into hospital wastewater. As these substances are known to be carcinogenic, mutagenic and toxic for reproduction, they should be removed from wastewater at their source of origin. In this study the fate and effects of the cancerostatic platinum compounds (CPC) cisplatin, carboplatin, oxaliplatin, 5-fluorouracil (5-FU) and the anthracyclines doxorubicin, daunorubicin and epirubicin were investigated in hospital wastewater. Wastewater from the in-patient treatment ward of a hospital in Vienna was collected and monitored for the occurrence of the selected drugs. A calculation model was established to spot the correlation between administered dosage and measured concentrations. To investigate the fate of the selected substances during wastewater treatment, the oncologic wastewater was treated in a pilot membrane bioreactor system (MBR) and in downstream advanced wastewater treatment processes (adsorption to activated carbon and UV-treatment). Genotoxic effects of the oncologic wastewater were assessed before and after wastewater treatment followed by a risk assessment. Monitoring concentrations of the selected cytostatics in the oncologic wastewater were in line with calculated concentrations. Due to different mechanisms (adsorption, biodegradation) in the MBR-system 5 - FU and the anthracyclines were removed < LOD, whereas CPC were removed by 60%. In parallel, genotoxic effects could be reduced significantly by the MBR-system. The risk for humans, the aquatic and terrestrial environment by hospital wastewater containing cytostatic drugs was classified as small in a preliminary risk assessment.
authors: Umweltbundesamt Vienna, Spittelauer Lände 5, 1090 Vienna, Austria.
authors: K
authors: K
authors: Lenz
authors: S N
authors: SN
authors: Mahnik
authors: N
authors: N
authors: Weissenbacher
authors: R M
authors: RM
authors: Mader
authors: P
authors: P
authors: Krenn
authors: S
authors: S
authors: Hann
authors: G
authors: G
authors: Koellensperger
authors: M
authors: M
authors: Uhl
authors: S
authors: S
authors: Knasmüller
authors: F
authors: F
authors: Ferk
authors: W
authors: W
authors: Bursch
authors: M
authors: M
authors: Fuerhacker
mesh_terms: D019149:Bioreactors; D054697:Cytostatic Agents / Q000032:analysis* / Q000302:isolation & purification*; D004784:Environmental Monitoring / Q000379:methods; D006761:Hospitals; D017744:Medical Waste Disposal / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D014865:Waste Disposal, Fluid / Q000379:methods*; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000302:isolation & purification
chemical_list: D054697:Cytostatic Agents; D017744:Medical Waste Disposal; D014874:Water Pollutants, Chemical