title: Mass flows of X-ray contrast media and cytostatics in hospital wastewater.
abstract: Little is known about the significance of hospitals as point sources for emission of organic micropollutants into the aquatic environment. A mass flow analysis of pharmaceuticals and diagnostics used in hospitals was performed on the site of a representative Swiss cantonal hospital. Specifically, we analyzed the consumption of iodinated X-ray contrast media (ICM) and cytostatics in their corresponding medical applications of radiology and oncology, respectively, and their discharge into hospital wastewater and eventually into the wastewater of the municipal wastewater treatment plant. Emission levels within one day and over several days were found to correlate with the pharmacokinetic excretion pattern and the consumed amounts in the hospital during these days. ICM total emissions vary substantially from day to day from 255 to 1259 g/d, with a maximum on the day when the highest radiology treatment occurred. Parent cytostatic compounds reach maximal emissions of 8-10 mg/d. A total of 1.1%, 1.4%, and 3.7% of the excreted amounts of the cytostatics 5-fluorouracil, gemcitabine, and 2',2'-difluorodeoxyuridine (main metabolite of gemcitabine), respectively, were found in the hospital wastewater, whereas 49% of the total ICM was detected, showing a high variability among the compounds. These recoveries can essentially be explained by the high amount administered to out-patients (70% for cytostatics and 50% for ICM); therefore, only part of this dose is expected to be excreted on-site. In addition, this study emphasizes critical issues to consider when sampling in hospital sewer systems. Flow proportional sampling over a longer period is crucial to compute robust hospital mass flows.
authors: Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Duebendorf, Switzerland.
authors: David
authors: D
authors: Weissbrodt
authors: Lubomira
authors: L
authors: Kovalova
authors: Christoph
authors: C
authors: Ort
authors: Vinitha
authors: V
authors: Pazhepurackel
authors: Ruedi
authors: R
authors: Moser
authors: Juliane
authors: J
authors: Hollender
authors: Hansruedi
authors: H
authors: Siegrist
authors: Christa S
authors: CS
authors: Mcardell
mesh_terms: D003287:Contrast Media / Q000032:analysis*; D054697:Cytostatic Agents / Q000032:analysis*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000032:analysis; D004784:Environmental Monitoring / Q000379:methods; D005467:Floxuridine / Q000031:analogs & derivatives / Q000032:analysis; D005472:Fluorouracil / Q000032:analysis; D006761:Hospitals; D017744:Medical Waste Disposal / Q000379:methods; D014865:Waste Disposal, Fluid / Q000379:methods; D014873:Water Pollutants / Q000032:analysis*; D014877:Water Pollution, Chemical / Q000032:analysis*; D018508:Water Purification; D014965:X-Rays; D000093542:Gemcitabine
chemical_list: D003287:Contrast Media; D054697:Cytostatic Agents; D017744:Medical Waste Disposal; D014873:Water Pollutants; D005467:Floxuridine; D003841:Deoxycytidine; D005472:Fluorouracil; C084565:2',2'-difluoro-2'-deoxyuridine; D000093542:Gemcitabine