Determining the fraction of pharmaceutical residues in wastewater originating from a hospital.

Pharmaceutical residues in water are frequently analysed and discussed in connection with sewage treatment, ecotoxicity and, natural and drinking water quality. Among different localities hospitals are suspected, or implied, to be a major and highly variable source of pharmaceuticals that substantially contribute to the total wastewater load. In this study, the contribution of pharmaceuticals from a hospital to a sewage treatment plant (STP) serving around 45,000 inhabitants was evaluated. Approximately 200 hospital beds result in a hospital bed density of 4.4 beds per 1000 inhabitants, which is a typical value for developed world countries. Prior to sampling, a sound systems analysis was performed, and a sophisticated continuous flow-proportional sampling regime was applied. Hence, overall experimental uncertainty was reduced to a minimum, and measurements provide clear evidence that, for 28 of 59 investigated substances, over 85% of the pharmaceutical residue loads do not originate from the hospital when applying a conservative error estimation. Only for 2 substances, trimethoprim (18%) and roxithromycin (56%), was the maximum observed contribution of the hospital >15%. On average, the contribution of the hospital for the compounds detected in both, hospital effluent and sewage treatment plant influent was small and fairly constant. Five compounds were only detected in hospital wastewater, and 24 neither in the hospital wastewater nor in the total wastewater at the influent of the STP. For these compounds no experimental contribution could be calculated. For the compounds where audit data for both the national consumption and the specific hospital under investigation were available, a prediction of the fraction of pharmaceuticals originating from the hospital was performed. Three quarters of the compounds, classified with the existing audit data, were in the same "hospital contribution category" as determined by measurements. For most of the other compounds, plausible reasons could be identified to explain the observed deviations.