Occurrence of pharmaceuticals in the wastewater of a Greek hospital: Combining consumption data collection and LC-QTOF-MS analysis

O S Arvaniti; E S Arvaniti; S Gyparakis; I Sabathianakis; E Karagiannis; E Pettas; G Gkotsis; M C Nika; N S Thomaidis; T Manios; M S Fountoulakis; A S Stasinakis

doi:10.1016/j.scitotenv.2022.160153

Occurrence of pharmaceuticals in the wastewater of a Greek hospital: Combining consumption data collection and LC-QTOF-MS analysis

Sci Total Environ. 2023 Feb 1;858(Pt 3):160153. doi: 10.1016/j.scitotenv.2022.160153. Epub 2022 Nov 13.

Authors

O S Arvaniti¹, E S Arvaniti², S Gyparakis³, I Sabathianakis³, E Karagiannis⁴, E Pettas⁴, G Gkotsis⁵, M C Nika⁵, N S Thomaidis⁵, T Manios³, M S Fountoulakis², A S Stasinakis⁶

Affiliations

¹ Water and Air Quality Laboratory, Department of Environment, University of the Aegean, University Hill, Mytilene 81100, Greece; Department of Agricultural Development, Agrofood and Management of Natural Resources, National and Kapodistrian University of Athens, Psachna 34400, Greece. Electronic address: oarvaniti@agro.uoa.gr.
² Water and Air Quality Laboratory, Department of Environment, University of the Aegean, University Hill, Mytilene 81100, Greece.
³ Department of Agriculture, Hellenic Mediterranean University, Estavromenos, Heraklion 71410, Crete, Greece.
⁴ Medical Waste SA, Heraklion Industrial Area, Heraklion 71601, Greece.
⁵ Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens 15771, Greece.
⁶ Water and Air Quality Laboratory, Department of Environment, University of the Aegean, University Hill, Mytilene 81100, Greece. Electronic address: astas@env.aegean.gr.

PMID: 36379345
DOI: 10.1016/j.scitotenv.2022.160153

Abstract

In this article we applied drug consumption approach and chemical analysis in parallel to investigate the concentrations of a large number of pharmaceuticals in different streams of a General Hospital. Drugs consumption data was collected during two periods (Period 1, 2) and the predicted environmental concentrations (PECs) were estimated for the wastewater of a building housing specific medical services (Point A) and for the entire hospital (Point B). Hospital wastewater samples (HWW) samples were also collected from these points and periods and the measured environmental concentrations (MEC) were determined using UHPLC-ESI-QTOF-MS/MS. According to consumption data, the highest number of drugs was consumed in the departments of Hematology, Intensive Care Unit, Cardiology, Internal Medicine, and Oncology, while the number of active substances used in the hospital was 413 (Period 1) and 362 (Period 2). For most substances, much higher PEC and MEC values were found at the HWW of Point A indicating that on-site treatment of this stream could be examined in the future. The application of wide-scope target analysis allowed the quantification of 122 compounds, while 21 additional substances were identified using suspect screening. The highest mean concentrations in Period 1 were found for acetaminophen (1100 μg/L) and rifaximin (723 μg/L), while in Period 2 for iopromide (458 μg/L) and acyclovir (408 μg/L). Among the detected compounds, 19 metabolites were determined. Atenolol acid, 1-hydroxy-midazolam and clopidogrel carboxylic acid were quantified at concentrations much higher than parent compounds indicating the importance of metabolites' monitoring in HWW. Calculation of PEC/MEC ratio for 36 pharmaceuticals showed sufficient correlation of these values for 19 % to 33 % of the substances depending on the examined period and sampling point. The parallel collection of drugs consumption data and chemical analysis give a thorough picture of the substances present in HWW and their main sources, facilitating decision-making for their better management.

Keywords: Drugs consumption; Effluents; Health care units; Micropollutants; Monitoring; PEC/MEC ratio.

MeSH terms

Data Collection
Hospitals
Intensive Care Units
Tandem Mass Spectrometry*
Wastewater*

Substances

Wastewater