Sharon Pfleger (NHS Highland, OHBP Co-Founder) presented at CleanMed Europe’s session “Developing strategies to deal with pharmaceutical residues in hospital wastewater” on the OHBP and our case study at Caithness General Hospital. Healthcare Without Harm’s annual online conference CleanMed Europe is Europe’s leading conference on sustainable healthcare, and the OHBP is closely tied to HCWH’s SaferPharma strategic focus area.
Today’s SaferPharma session focussed on pharmaceuticals (and other micropollutants) in hospital wastewater, and the burden this poses to municipal wastewater treatment plants which are unable to completely eliminate these compounds. Due to this, hospitals are key point sources for specialised pharmaceutical residues entering the environment, a serious source of pollution that can threaten ecosystems and environmental health.
Sharon’s presentation called on the healthcare sector’s responsibility to be good water stewards (i.e., to improve water use and water quality) – and the need to address the dual pollution and sustainability challenges. Currently healthcare can negatively impact planetary health and environmental health, going against the United Nation’s Sustainable Development Goals around water and climate change. But it is important to recognise that no one sector can solve the issue of pharmaceutical pollution – and cross-sector groups working with the healthcare sector (like the OHBP) are vital to progressing the field in addressing these large and interconnected One Health issues.
Working in partnership at Caithness General Hospital lead to the hospital achieving accreditation with the Alliance for Water Stewardship – the first hospital and first public agency to do this. This work has heightened awareness around pharmaceutical pollution in the UK and globally. The OHBP will continue working with AWS to further develop the standard for use in healthcare to enable hospitals around the world (especially in low/middle income countries) implement the standard and improve water use and water quality in healthcare globally.
NHS Highland and the OHBP have an up-stream action plan to reduce loads of pharmaceuticals entering municipal wastewater, and subsequently the environment. This includes:
- Educating clinicians & public about the issue of pharmaceuticals in the environment
- Developing information on prescribing choices with less environmental impact
- Promoting appropriate prescribing & good stewardship of medicines
- Preventing improper disposal of medicines & developing good waste management systems (e.g., pharmacy return schemes where unused/expired medicines can be safely disposed)
By working together and adopting the One Health concept, the OHBP and NHS Highland seek to reduce not only pharmaceutical pollution in the environment, but also address other One Health issues including antimicrobial resistance, access to clean water, climate change, and biodiversity loss. This will contribute to the Scottish Government, and NHS Scotland’s, net-zero, climate, and environment targets.
Sharon presented alongside Martien Graumans (PhD Researcher – Radboud University, advanced treatment options and thermal plasma for removal of pharmaceuticals in wastewater), Tim aus der Beek (Senior Researcher – IWW Water Centre, reducing loads of contrast media in wastewater through urine bags), and Peter Kelly (Chief Commercial Officer – Pharmafilter, decentralised waste and wastewater treatment unit for healthcare sector).
The presentations were followed by a short Q&A, which focussed on at-source treatment and up-stream interventions to reduce pharmaceuticals in wastewater.
Some take-aways:
- At source treatment is not a silver bullet for pharmaceuticals, and this requires case-by-case assessment and proof of efficient, effective, value-based, and net-zero practice.
- New technologies and at-source treatment are able to match and compliment removal and degradation of many compounds within municipal WWTPs. This also includes microorganisms of concern.
- There is not a single solution, and combining up-stream and end of pipeline solutions is the best way forward. Additionally, multiple treatment systems and various configurations will offer the best chance at removing the most compounds.
- Reinforcing that healthcare has a social responsibility to ensure that is does not harm the environment which we rely on for ecosystem services, especially water. Working with stakeholders and the community is vital for interventions to work.
There is no one solution going forward, and combination of up-stream approaches is important. Green formulary development (prioritising pharmaceuticals based on environmental impact), public awareness, educating clinicians/healthcare practitioners, promoting appropriate prescribing, separate collection systems of waste (urine bags, medicines disposal etc.), stewardship activities, social prescribing, and potential separate treatment of sewage – these all have an important part to play in reducing medicines entering wastewater – and subsequently the environment.
For more information about CleanMed Europe 2021:
This online conference showcases cutting-edge practices and new initiatives to address the most pressing issues in the healthcare sector – and offers a unique opportunity for researchers, healthcare practitioners, prescribers, innovators, and private sector representatives to network and share knowledge on ways to drive change and promote sustainability in healthcare.
