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All those effluent streams having compromised characteristics pose negative effects on the environment either directly or indirectly. Health care facilities and hospitals also generate a large amount of effluent like other industries containing harmful and toxic pharmaceutical residual compounds due to uncontrolled use of drugs, besides others. The occurrence of antibiotic in the environment is of utmost concern due to development of resistant genes. These get mixed up with ground and surface water due to lack of proper treatment of hospital wastewater. The effect of pharmaceutical compounds on human society and ecosystem as a whole is quite obvious. There are no strict laws regarding discharge of hospital effluent in many countries. Contrary to this, the authors do not have appropriate treatment facilities and solution to solve day by day increasing complexity of this problem. Moreover, water discharged from different health facilities having variable concentration often gets mixed with municipal sewage, thus remains partially untreated even after passing from conventional treatment plants. The purpose of this paper is to highlight the occurrences and fate of such harmful compounds, need of proper effluent management system as well as conventionally adopted treatment technologies nowadays all around the globe. This mini-review would introduce the subject, the need of the study, the motivation for the study, aim, objectives of the research and methodology to be adopted for such a study.

Hospital effluents consisting of pathogens, fecal coliforms, Escherichia coli, etc, including phenols, detergents, toxic elements like cyanide and heavy metals such as copper (Cu), iron (Fe), gadolinium (Gd), nickel (Ni), platinum (Pt), among others are commonly detected nowadays. These unwanted compounds along with emerging pollutants are generally not being regulated before getting discharged caused and spread of diseases. Various chemical and biological characteristics of hospital effluents are assessed keeping in the view the threat posed to ecosystem. Several research studies have been done and few are ongoing to explore the different characteristics and compositions of these effluent streams in comparison so as to suggest the suitable conventional treatment techniques and ways to manage the problem. Several antibiotic groups such as ciprofloxacin, ofloxacin, sulfa pyridine, trimethoprim, metronidazole and their metabolites are reported in higher concentration in hospital effluent. The aquatic system also receives a high concentration of pharmaceutical residues more than 14,000 μg/L from treatment plants also and other surface water or even drinking water in Indian cities. Many rivers in southern parts of India receives treated water have detected high concentration drugs and its metabolites. As far as global constraints that need to be discussed, there are only selected pharmaceuticals compounds generally analyzed, issue regarding management and detection based on method of sampling, frequency of analysis and observation, spatial as well as temporal concentration of these concerned micropollutants, accuracy in detecting these compounds, reliability of results and predictions, prioritization and the method of treatment in use for such type of wastewater stream. The complexity of management and treatment as well need to be addressed with following issues at priority: composition and characterization of effluent, compatible and efficient treatment technology that needs to be adopted and the environment risk posed by them. The problem of drugs and its residues was not seen to be reported in latter part of 20th century, but it might be reported locally in some part of globe. This paper covers some aspect about the disposal and regulatory standard around the world toward hospital effluent discharge, its managements and treatment technologies that are adopted and best suitable nowadays various industries and monitoring the efficiencies of existing treatment systems. This mini-review would introduce the subject, the need, the motivation and objectives of the study and methodology can be adopted for such a study.

The compiled review gives a complete view about the types of antibiotics used in different health care facilities, their residue formation, occurrences in different ecosystems, types of regulations or laws available in different counties related to disposal, different type of treatment technologies, innovative combined treatment schemes and future action needed to tackle such type of effluent after its generation. The thesis also highlights the use of certain innovative materials use for the treatment like nanoparticles. It also discusses about the residues impact on the human health as well as their bioaccumulative nature. If the authors relate the past to the current scenario of pharmaceutical compounds (PhACs) in the environment, the authors will certainly notice that many diseases are nowadays not curable by simple previously prescribed Ab. Many research projects have been done in European countries that have shown the risk of such residues like Pills, Sibell, Poseidon, No pills, Neptune, Knappe, Endetech, etc. In the previous section, it was mentioned that there are no stringent laws for hospital wastewater and in many countries, they are mixed with domestic wastewater. Many difficulties are there with this research due to complex analysis, detection of targeted Ab, affecting waterbodies rate of flow, nature of treatment varies with season to season. The way nature is being degraded and harmful effect are being imposed, it is important to take immediate and decisive steps in this area. Wastewater treatment plants (WWTPs) serves as a nursery for antibiotic-resistant systems, hence monitoring with great attention is also needed. Many trials with different treatment process, in combination, were considered. Many countries are paying great attention to this topic by considering the severity of the risk involved in it.

Previous studies by several scientists show that the pharmaceutical residues in the discharged effluent displayed direct toxic effects, and sometimes, detrimental effects in the mixture were also observed. The discharge of untreated effluent from hospitals and pharmaceuticals and personal care products in the natural ecosystem poses a significant threat to human beings. The pharmaceuticals, like antibiotics, in the aquatic environment, accelerate the development of the antibiotic-resistant genes in bacteria, which causes fatal health risks to animals and human beings. Others, like analgesics, are known to affect development in fishes. They also degrade the water quality and may lead to DNA damage, toxicity in lower organisms like daphnia and have the potential to bioaccumulate. A few commonly used nanoadsorbents for water and wastewater treatment along with their specific properties can also be used. The main advantages of them are high adsorption capacity and superior efficiency, their high reusability, synthesis at room temperatures, super magnetism, quantum confinement effect as well as eco-toxicity. This review will focus on the applicability of different nanoscale materials and their uses in treating wastewater polluted by organic and inorganic compounds, heavy metals, bacteria and viruses. Moreover, the use of various nanoadsorbents and nano-based filtration membranes is also examined.

A number of different pharmaceutical residues derived from various activities like production facilities, domestic use and hospitals have been reported earlier to be present in groundwater, effluents and rivers, they include antibiotics, psycho-actives, analgesics, illicit drugs, antihistamine, etc. In past few years environmental scientists are more concerned toward the effluents generated from medical care facilities, community health centers and hospitals. Various chemical and biological characteristics of hospital effluents have been assessed keeping in the view the common threats pose by them to the entire ecosystem. In this study, seven multispecialty hospitals with nonidentical pretreatment were selected for three aspects i.e. conventional wastewater characteristics, high priority pharmaceuticals and microbial analyses. The present work is to evaluate efficacy of advanced wastewater treatment methods with regard to removal of these three aspects from hospital effluents before discharge into a sewage treatment plant (STP). Based on test results, two out of seven treatment technologies, i.e. MBR and CW effectively reducing conventional parameters and pharmaceuticals from secondary and tertiary treatments except regeneration of microbes were observed in tertiary level by these two treatments.

This review has aimed to identify the emerging contaminants, including pharmaceutical residues, highly consumed chemicals that are present in the hospital effluent, along with their physicochemical and biological characteristics. In this, the main objective was to review the occurrences and fate of common drugs and antibiotics present in effluents from hospital wastewaters. As far as global constraints that need to be discussed, there are only selected pharmaceuticals compounds generally analyzed, issue regarding management and detection based on method of sampling, frequency of analysis and observation, spatial as well as temporal concentration of these concerned micropollutants, accuracy in detecting these compounds, reliability of results and predictions, prioritization and the method of treatment in use for such type of wastewater stream are among the major issues (Akter et al., 2012; Ashfaq et al., 2016; García-Mateos et al., 2015; Liu et al., 2014; Mubedi et al., 2013; Prabhasankar et al., 2016; Sun et al., 2016; Suriyanon et al., 2015; Wang et al., 2016; Wen et al., 2004). This paper covers some aspect about the disposal and regulatory standard around the world toward hospital effluent discharge, its managements and treatment technologies that are adopted and best suitable nowadays.

This study many multispecialty hospitals with nonidentical pretreatment were selected for three aspects i.e. conventional wastewater characteristics high priority pharmaceuticals and microbial analyses. The present work is to evaluate efficacy of advanced wastewater treatment methods with regard to removal of these three aspects from hospital effluents before discharge into an STP. Based on test results, two out of different treatment effectively reducing conventional parameters and pharmaceuticals from secondary and tertiary treatments except regeneration of microbes were observed in the tertiary level by these two treatments were studies followed by ozonation and ultraviolet-ray treatment.

The purpose of this paper is to cover some aspects about the disposal and regulatory standard around the world toward hospital effluent discharge, its managements and treatment technologies that are adopted and best suitable nowadays.

Due to large and variety of antibiotics available in the market nowadays it is difficult to control its use, thereby risking the whole ecosystem and its components. The regulation pattern is variable depending upon the various factors in different countries. The permissible limit of these emerging pollutants found in sewage as compared to in hospital effluent streams having active pharmaceutical ingredients is very narrow and is a debatable issue.

The disparity in the available legislation for hospital waste management in different countries makes it difficult to compare pro’s and con’s of methods adopted. Strict laws need to be framed for hospital wastewater management and its treatment, as it contains harmful compounds in higher concentrations resulting in development of resistant genes. The guideline applicable nowadays makes it clear that, specific management guidelines with respect to HWW, but also indicate certain characteristics that can be represented to specify their nature and indicator.

Determination of effluent characteristic for each specialized treatment need to be analyzed for meeting the framed regulatory standards. Up-gradation of existing treatment facilities, adopting new technologies and improving operation, maintained is a viable option. As there are no specific treatment schemes available hence combination and optimization of treatment methods may solve the problem to certain extent.

There is some flexibility also there so that law framework can be modified accordingly. For any health facilities direct discharges into natural water bodies it effluent need to follow national discharge standards. These are quite strict as compared to indirect standards and generally not meet by such facilities. This is quite logical because they are not being monitored or treated by municipal systems.

The law indicates that hospital needed to collect and treat effluent according to the treatment standards. But on other hand the law was made making it consideration about the HWW collection in water bodies.

The best way of management as described, is to treat HWW onsite-dividing into primary, secondary and tertiary. The document also provides details about sludge disposal, possible reuse, including the application of new and innovative treatment technologies for HWW. It also provides guidance for minimum approach for HWW management because developing countries patients do not have proper sanitation facilities.

Pharmaceutical and personal care products (PPCPs) and phosphorus are pollutants that can cause a wide array of negative environmental impacts. Phosphorus is a regulated pollutant in many industrial countries, while PPCPs are widely unregulated. Many technologies designed to remove phosphorus from wastewater can remove PPCPs, therefore the purpose of this paper is to explore the ability of these technologies to also reduce the emission of unregulated PPCPs.

Through meta-analysis, the authors use the PPCPs’ risk quotient (RQ) to measure and compare the effectiveness of different wastewater treatment technologies. The RQ data are then applied via a case study that uses phosphorus effluent regulations to determine the ability of the recommended technologies to also mitigate PPCPs.

The tertiary membrane bioreactor and nanofiltration processes recommended to remove phosphorus can reduce the median RQ from PPCPs by 71 and 81 percent, respectively. The ultrafiltration technology was estimated to reduce the median RQ from PPCPs by 28 percent with no cost in addition to the costs expected under the current phosphorus effluent regulations. RQ reduction is expected with a membrane bioreactor and the cost of upgrading to this technology was found to be $11.76 per capita/year.

The authors discuss the management implications, including watershed management, alternative PPCPs reduction strategies, and water quality trading.

The evaluation of the co-management of priority and emerging pollutants illuminates how the removal of regulated pollutants from wastewater could significantly reduce the emission of unregulated PPCPs.

This paper aims to evaluate the performance of the Mashhad No. 5 wastewater treatment plant (WWTP) using a combination of data mining (regression) algorithms and artificial neural networks.

In this research, the performance of WWTP located in Mashhad, Iran, has been evaluated using two data mining models, neural network and regression model.

The proposed model has the potential of implementing in other WWTPs in Iran or other countries.

The authors would also like to thank Mashhad No.5 WWTP for data access.

The purpose of this paper is to assess the occurrence and risk of dispersion in the environment of antibiotic-resistant microorganisms from sanitary sewage sludge produced in two conventional wastewater treatment systems adopted in the West of the State of Paraná, Brazil.

The sludge samples were collected for three months from two wastewater treatment plants, totaling six sample points, and sent to the laboratory where the physical-chemical and biological determinations were performed.

This work made possible to find that the sludge produced in the sewage treatment plants presents potential risks related to the spread of microorganisms due to the occurrence of resistant isolates of Escherichia coli and Salmonella sp. It was also possible to detect that the largest concentrations of metal ions in the sludge favored the occurrence of bacterial resistance to antibiotics. The occurrence of pathogens, heavy metals and other emerging pollutants in sewage indicates that the sludge requires proper treatment, to provide safe agricultural reuse or disposal.

The techniques applied for monitoring sludge were effective to check the risk of resistant microorganisms input into the environment. Studies concerning sewage treatment plants’ final effluents can bring additional data about the incorporation of such microorganisms into aquatic environments.

The results made possible to observe the need to provide post-treatment for the sludge, especially of the sludge obtained from the anaerobic fluidized bed reactor, since the removal of pathogens, as well as the nutrients, is not satisfactory.

A direct correlation exists between waste disposal, disease spread and public health. This article systematically reviewed healthcare waste and its implication for public health. This review identified and described the associations and impact of waste disposal on public health.

This paper systematically reviewed the literature on waste disposal and its implications for public health by searching Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), PubMed, Web of Science, Scopus and ScienceDirect databases. Of a total of 1,583 studies, 59 articles were selected and reviewed.

The review revealed the spread of infectious diseases and environmental degradation as the most typical implications of improper waste disposal to public health. The impact of waste includes infectious diseases such as cholera, Hepatitis B, respiratory problems, food and metal poisoning, skin infections, and bacteremia, and environmental degradation such as land, water, and air pollution, flooding, drainage obstruction, climate change, and harm to marine and wildlife.

Infectious diseases such as cholera, hepatitis B, respiratory problems, food and metal poisoning, skin infections, bacteremia and environmental degradation such as land, water, and air pollution, flooding, drainage obstruction, climate change, and harm to marine and wildlife are some of the public impacts of improper waste disposal.

Healthcare industry waste is a significant waste that can harm the environment and public health if not properly collected, stored, treated, managed and disposed of. There is a need for knowledge and skills applicable to proper healthcare waste disposal and management. Policies must be developed to implement appropriate waste management to prevent public health threats.

Increasing pressure from the stakeholders makes the inclusion and evaluation of sustainable practices in the service supply chain (SSC) inevitable. Therefore, this paper aims to evaluate the sustainability status of a case organization and discover the barrier to sustainability in the SSC.

From the literature review, five sustainability dimensions, seventeen attributes and sixty-five subattributes of the SSC are identified. A three-level conceptual model drawn on human perception is developed. The overall sustainability status of the SSC is determined by using the multigrade fuzzy logic approach. The fuzzy concept incorporated helps in overcoming the challenges of vagueness and impreciseness in the responses. The case SSC is a WestIndia–based hospital.

The study evaluates the case hospital to be “very sustainable” but far from the “extremely sustainable” level. Six barriers are identified which are reduction in solid waste, compliance with applicable environmental laws and regulations, water usage efficiency, training and education of employees, return on investment and safety equipment for employees. These barriers hinder the hospital from achieving an “extremely sustainable” level.

This paper evaluates, helps the management in identifying the barriers and thus enabling them to work upon these barriers and achieve a greater level of sustainability.

The sustainability practices adopted in this paper for the evaluation of the sustainability status of the SSC have not been used in previous studies. In this study apart from environmental, social and economic aspects, customer management and health, safety and risk management are also incorporated for evaluating the performance of the SSC which makes this study unique. The proposed model can be taken as a benchmark for evaluating the sustainability performance of any SSC.

The purpose of this paper is to determine water availability, sanitation and hygiene (WSH) services, and healthcare waste management in Jordan healthcare facilities.

In total, 19 hospitals (15 public and four private) were selected. The WSH services were assessed in hospitals using the WSH in health facilities assessment tool developed for this purpose.

All hospitals (100 percent) had a safe water source and most (84.2 percent) had functional water sources to provide enough water for users’ needs. All hospitals had appropriate and sufficient gender separated toilets in the wards and 84.2 percent had the same in outpatient settings. Overall, 84.2 percent had sufficient and functioning handwashing basins with soap and water, and 79.0 percent had sufficient showers. Healthcare waste management was appropriately practiced in all hospitals.

Jordan hospital managers achieved major achievements providing access to drinking water and improved sanitation. However, there are still areas that need improvements, such as providing toilets for patients with special needs, establishing handwashing basins with water and soap near toilets, toilet maintenance and providing sufficient trolleys for collecting hazardous waste. Efforts are needed to integrate WSH service policies with existing national policies on environmental health in health facilities, establish national standards and targets for the various healthcare facilities to increase access and improve services.

There are limited WSH data on healthcare facilities and targets for basic coverage in healthcare facilities are also lacking. A new assessment tool was developed to generate core WSH indicators and to assess WSH services in Jordan’s healthcare facilities. This tool can be used by a non-WSH specialist to quickly assess healthcare facility-related WSH services and sanitary hazards in other countries. This tool identified some areas that need improvements.

This paper aims to propose a new framework to define relevant and meaningful indicators for monitoring and assessing environmental performance to improve health-care systems and operations.

A comprehensive literature review followed by field studies conducted with ten hospitals in the southern region of Brazil underlined the scarcity of consistent frameworks applied in practice to measure, monitor and improve environmental performance. A new framework was developed and proposed to address this issue. The proposed framework is operationalized through a “process approach” and evaluated in terms of feasibility (Can the process be followed?), usability (Is the approach easily followed?) and utility (Are the results useful for managers?).

The paper proposes a framework and a process to evaluate the environmental performance in hospitals.

The proposed framework represents meaningful guidance to managers for strategy formalization, goal setting and environmental performance assessment and monitoring.

The paper proposes a systematic framework for measuring environmental performance in hospitals drawn from the literature review, current legislation and best practices reported in literature.

Pakistan is an agricultural country having the world's largest canal irrigation system. Indus basin that covers 70 percent of irrigated area for crop production is the major source of water in the country. Owing to rapid increase in population and uncertain environmental conditions, this water is not adequate to cope with the crop water requirement and needs additional means to provide extra water for agricultural purposes. The main source of irrigation is canal and ground water but the quality of ground water is so poor for the sustainability of agriculture system. To cope with the present demand, use of municipal sewage water that consists of domestic liquid waste, as well as industrial effluents, is becoming a common practice. The present study aims to reflect the hazardous effects of sewage water on the environment, with the main focus on heavy metals and chemical composition of soil and vegetables.

Industrial effluent was collected from one ghee mill, one flour mill, three textile industries and three hosieries located in Faisalabad, an industrial city of Pakistan highly affected with water pollution. All water samples were analyzed for pH, EC, SAR and RSC. Water analysis was also carried out for various nutrients and heavy metals (K⁺¹, P²⁺, Fe²⁺, Cu²⁺, Zn²⁺, Mn²⁺, Ni²⁺ and Pb²⁺). Soil samples from various depths (0‐15, 15‐30, 30‐60, 60‐90 and 90‐120 cm) were taken to analyze for EC, pH, SAR, Na⁺¹, SO₄, K⁺¹, P²⁺, Fe²⁺, Cu²⁺, Zn²⁺, Mn²⁺, Ni²⁺ and Pb²⁺ after irrigation with canal water and sewage water. Cadmium, lead and copper concentration was determined in various vegetables grown in areas irrigated with canal water and industrial effluents to determine their final concentration in the final product ultimately affecting the human health.

Although the sewage water is a source of many nutrients, it also includes a significant amount of heavy metals like Fe²⁺, Cu²⁺, Zn²⁺, Mn²⁺, Ni²⁺, Pb²⁺ and pathogens. Extensive use of this effluent for irrigation purpose has resulted in an upsurge of such metals in soils and various crops, which ultimately resulted in clinical problems in human beings.

The present study reflects the composition of sewage water and heavy metal accumulation in soil, as well as crops. It further highlights the different potential hazards to humans due to these contaminants.