title: Dynamics of active pharmaceutical ingredients loads in a Swiss university hospital wastewaters and prediction of the related environmental risk for the aquatic ecosystems.
abstract: The wastewater contamination of a Swiss university hospital by active pharmaceutical ingredient (API) residues was evaluated with a three months monitoring campaign at the outlet of the main building. Flow-proportional samples were collected with an automatic refrigerated sampler and analyzed for 15 API, including antibiotics, analgesics, antiepileptic and anti-inflammatory drugs, by using a validated LC-MS/MS method. The metals Gd and Pt were also analyzed using ICP-MS. Measured concentrations were compared to the predicted ones calculated after the drug average consumption data obtained from the hospital pharmacy. The hospital contribution to the total urban load was calculated according to the consumption data obtained from city pharmacies. Lastly, the environmental hazard and risk quotients (RQ) related to the hospital fraction and the total urban consumption were calculated. Median concentrations of the 15 selected compounds were ranging from 0.04 to 675 μg/L, with a mean detection frequency of 84%. The ratio between predicted and measured environmental concentrations (PEC/MEC) has shown a good accuracy for 5 out of 15 compounds, revealing over- and under-estimations of the PEC model. Mean daily loads were ranging between 0.01 and 14.2g/d, with the exception of paracetamol (109.7 g/d). The hospital contribution to the total urban loads varied from 2.1 to 100% according to the compound. While taking into account dilution and removal efficiencies in wastewater treatment plant, only the hospital fraction of the antibiotics ciprofloxacin and sulfamethoxazole showed, respectively, a high (RQ>1) and moderate (RQ>0.1) risk for the aquatic ecosystems. Nevertheless, when considering the total urban consumption, 7 compounds showed potential deleterious effects on aquatic organisms (RQ>1): gabapentin, sulfamethoxazole, ciprofloxacin, piperacillin, ibuprofen, diclofenac and mefenamic acid. In order to reduce inputs of API residues originating from hospitals various solutions can be envisioned. With results of the present study, hospital managers can start handling this important issue.
authors.affiliation: Geneva University Hospitals (HUG), Pharmacy, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. Electronic address: Silwan.Daouk@unil.ch.
authors.forename: Silwan
authors.initials: S
authors.lastname: Daouk
authors.affiliation: University of Lausanne (UNIL), Institute of Earth Surface Dynamics, Geopolis, CH-1015 Lausanne, Switzerland.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chèvre
authors.affiliation: Geneva University Hospitals (HUG), Medical Direction and Quality, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vernaz
authors.affiliation: Geneva University, University Center of Legal Medicine (CUMRL), Rue Michel-Servet 1, CH-1211 Geneva 4, Switzerland.
authors.forename: Christèle
authors.initials: C
authors.lastname: Widmer
authors.affiliation: Geneva University Hospitals (HUG), Clinical Pharmacology and Toxicology, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Daali
authors.affiliation: Geneva University Hospitals (HUG), Pharmacy, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Fleury-Souverain
mesh_terms: D017753:Ecosystem; D004784:Environmental Monitoring; D006785:Hospitals, University; D004364:Pharmaceutical Preparations / Q000032:analysis*; D018570:Risk Assessment; D013557:Switzerland; D014865:Waste Disposal, Fluid; D062065:Wastewater / Q000737:chemistry*; D014874:Water Pollutants, Chemical / Q000032:analysis*
chemical_list: D004364:Pharmaceutical Preparations; D062065:Wastewater; D014874:Water Pollutants, Chemical
keywords: Hazard; Hospital effluents; PEC; Pharmaceuticals; Risk assessment