Mass Flows of X-ray Contrast Media and Cytostatics in Hospital Wastewater

Little is known about the significance of hospitals as point sources for emission of organic micropollutants into the aquatic environment. A mass flow analysis of pharmaceuticals and diagnostics used in hospitals was performed on the site of a representative Swiss cantonal hospital. Specifically, we analyzed the consumption of iodinated X-ray contrast media (ICM) and cytostatics in their corresponding medical applications of radiology and oncology, respectively, and their discharge into hospital wastewater and eventually into the wastewater of the municipal wastewater treatment plant. Emission levels within one day and over several days were found to correlate with the pharmacokinetic excretion pattern and the consumed amounts in the hospital during these days. ICM total emissions vary substantially from day to day from 255 to 1259 g/d, with a maximum on the day when the highest radiology treatment occurred. Parent cytostatic compounds reach maximal emissions of 8−10 mg/d. A total of 1.1%, 1.4%, and 3.7% of the excreted amounts of the cytostatics 5-fluorouracil, gemcitabine, and 2′,2′-difluorodeoxyuridine (main metabolite of gemcitabine), respectively, were found in the hospital wastewater, whereas 49% of the total ICM was detected, showing a high variability among the compounds. These recoveries can essentially be explained by the high amount administered to out-patients (70% for cytostatics and 50% for ICM); therefore, only part of this dose is expected to be excreted on-site. In addition, this study emphasizes critical issues to consider when sampling in hospital sewer systems. Flow proportional sampling over a longer period is crucial to compute robust hospital mass flows

Occurrence of Cytostatics in Different Water Compartments

The chapter deals with the occurrence of a selection of anticancer drugs in 5 different water environments: hospital wastewater, wastewater treatment plant influ- 6 ents and effluents, surface water, sea water, and drinking water. Unfortunately, no 7 data are available for groundwater up to now. The chapter presents and discusses 8 measured environmental concentrations of anticancer drugs collected in 56 peer- 9 reviewed papers referring to investigations carried out in 18 countries all over the 10 world. It focuses on the variability of observed concentrations in the different 11 environments, and it highlights the importance of planning efficient sampling 12 strategies in order to obtain representative water samples. 13 The highest concentrations in hospital effluents were found for platinum-based 14 compounds and 5-fluorouracil (> 10 15 5 ng L1), in the influent for ciprofloxacin (> 10 16 3 ng L1), in the effluent for platinum-based compounds, ifosfamide and bicalutamide (> 10 17 3 ng L1), and in surface water for cyclophosphamide, tamoxifen, ciprofloxacin, and bicalutamide (> 10 18 2 ng L1). In addition, a comparison is provided between measured and predicted concentrations of some anticancer drugs 19 and a brief discussion of the strengths and weaknesses of the two approaches is 20 reported