Healthcare Without Harm (Europe) published a report “Pharmaceuticals residues in hospital wastewater“, demonstrating how hospitals are dealing with pharmaceutical residues in their wastewater. The report features the OHBP’s Caithness General Hospital study “A testbed for best practices to reduce pharmaceutical pollution” (pgs 29-31), alongside four other case studies from hospitals in Belgium, Denmark, Germany, and the Netherlands.
The report explores how hospital wastewater contributes to the pharmaceutical load released into the environment, and in particular discusses the risk of antimicrobial resistant bacteria in hospital effluents. Case studies included in the report have developed innovative on-site treatment technologies in the Netherlands and Belgium, methods to remove AMR bacteria from hospital wastewater in Denmark, and piloted urine bags to reduce contrast media entering hospital effluents in Germany.
Some highlights from the report include identifying actions which individual hospitals can take to reduce pharmaceuticals entering their wastewater, and subsequently being discharged to municipal wastewater treatment plants. The report discusses that decentralised point-source treatment “is not a silver bullet”, and case-by-case studies are required to assess the benefits against criteria such as AMR/ecotoxicity, cost, efficiency, life-cycle assessment, and electrical consumption.
Actions that hospitals can take to significantly reduce the discharge of high-risk pharmaceuticals into municipal sewers, and the wider environmental impacts, include:
• Adhering to green formularies (e.g. the Wise List in Region Stockholm)
• Implementing separate collection systems such as urine bags
• Following protocols to safely dispose pharmaceutical waste
• Promoting procurement practices that favour greener pharmaceuticals
• Developing stewardship activities to curb inappropriate prescribing
• Embedding green social prescribing in healthcare
Drawing from the case studies featured in the report, HCWH Europe proposes five courses of action for hospitals to develop strategies to deal with pharmaceutical residues in their wastewater:
- Investigate on a case-by-case basis pharmaceutical use and pollution to identify priority compounds;
- Educate clinicians about the environmental effects of pharmaceuticals pollution, and teach medicine stewardship;
- Develop cross-sector partnerships to research and develop solutions;
- Raise awareness of the public and environmental health issue posed by pharmaceutical pollution, particularly around appropriate methods of medicine disposal;
- Leverage your influence to promote the development of greener pharmaceuticals by the manufacturing industries, and advocate for legislation towards zero pollution in the healthcare sector.
Full report available at: https://noharm-europe.org/documents/pharmaceutical-residues-hospital-wastewater