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Review
. 2021 Apr;9(2):104812.
doi: 10.1016/j.jece.2020.104812. Epub 2020 Nov 22.

A review on hospital wastewater treatment: A special emphasis on occurrence and removal of pharmaceutically active compounds, resistant microorganisms, and SARS-CoV-2

Abhradeep Majumder  1 , Ashok Kumar Gupta  2 , Partha Sarathi Ghosal  3 , Mahesh Varma  2
Affiliations
Review

A review on hospital wastewater treatment: A special emphasis on occurrence and removal of pharmaceutically active compounds, resistant microorganisms, and SARS-CoV-2

Abhradeep Majumder et al. J Environ Chem Eng. 2021 Apr.

Abstract

The hospital wastewater imposes a potent threat to the security of human health concerning its high vulnerability towards the outbreak of several diseases. Furthermore, the outbreak of COVID-19 pandemic demanded a global attention towards monitoring viruses and other infectious pathogens in hospital wastewater and their removal. Apart from that, the presence of various recalcitrant organics, pharmaceutically active compounds (PhACs), etc. imparts a complex pollution load to water resources and ecosystem. In this review, an insight into the occurrence, persistence and removal of drug-resistant microorganisms and infectious viruses as well as other micro-pollutants have been documented. The performance of various pilot/full-scale studies have been evaluated in terms of removal of biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), PhACs, pathogens, etc. It was found that many biological processes, such as membrane bioreactor, activated sludge process, constructed wetlands, etc. provided more than 80% removal of BOD, COD, TSS, etc. However, the removal of several recalcitrant organic pollutants are less responsive to those processes and demands the application of tertiary treatments, such as adsorption, ozone treatment, UV treatment, etc. Antibiotic-resistant microorganisms, viruses were found to be persistent even after the treatment of hospital wastewater, and high dose of chlorination or UV treatment was required to inactivate them. This article circumscribes the various emerging technologies, which have been used to treat PhACs and pathogens. The present review also emphasized the global concern of the presence of SARS-CoV-2 RNA in hospital wastewater and its removal by the existing treatment facilities.

Keywords: Advanced oxidation processes; Antibiotic-resistant bacteria; Antibiotic-resistant genes; Biological processes; Pharmaceutically active compounds; SARS-CoV-2 RNA.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

ga1
Graphical abstract
Fig. 1
Fig. 1
Characteristics of hospital wastewater: a) range of COD, BOD, ammonia, TSS, nitrate, TOC, TKN, TN b) variation of average concentration of COD, BOD, ammonia, TSS, nitrate, TOC, TKN, TN in different continents, c) range of pharmaceutically active compounds, and d) variation of average concentration of pharmaceutically active compounds in different continents.
Fig. 2
Fig. 2
a) The BOD/COD ratio of effluents from various hospitals, b) correlation between percentage of population affected by COVID-19 and percentage of positive samples of SARS-CoV-2 RNA in water of different countries
Fig. 3
Fig. 3
Pathways of pharmaceutically active compounds, antibiotic-resistant microorganisms and viruses in hospital wastewater.
Fig. 4
Fig. 4
Performance of pilot-scale and full-scale studies in terms of a) TSS removal b) COD removal, c) BOD removal, d) ammonia removal, and e) PhACs removal from hospital wastewater
Fig. 5
Fig. 5
Schematic representation of different pilot/full-scale treatment units implemented for removing various pollutants in hospital wastewater generated from different sources.
Fig. 6
Fig. 6
Chlorine dose required for efficient inactivation of antibiotic-resistant bacteria, antibiotic-resistant genes, viruses and other microorganisms
See this image and copyright information in PMC

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