Characterisation of the ecotoxicity of hospital effluents: A review

The multiple activities that take place in hospitals (surgery, drug treatments, radiology, cleaning of premises and linen, chemical and biological analysis laboratories, etc.), are a major source of pollutant emissions into the environment (disinfectants, detergents, drug residues, etc.). Most of these pollutants can be found in hospital effluents (HWW), then in urban sewer networks and WWTP (weakly adapted for their treatment) and finally in aquatic environments. In view to evaluating the impact of these pollutants on aquatic ecosystems, it is necessary to characterise their ecotoxicity. Several reviews have focused on the quantitative and qualitative characterisation of pollutants present in HWW. However, none have focused specifically on the characterisation of their experimental ecotoxicity. We have evaluated this according to two complementary approaches: (i) a "substance" approach based on the identification of the experimental data in the literature for different substances found in hospital effluents, and on the calculation of their PNEC (Predicted Non Effect Concentration), (ii) a "matrix" approach for which we have synthesised ecotoxicity data obtained from the hospital effluents directly. This work first highlights the diversity of the substances present within hospital effluents, and the very high ecotoxicity of some of them (minimum PNEC observed close to 0,01 pg/L). We also observed that the consumption of drugs in hospitals was a predominant factor chosen by authors to prioritise the compounds to be sought. Other criteria such as biodegradability, excretion rate and the bioaccumulability of pollutants are considered, though more rarely. Studies of the ecotoxicity of the particulate phase of effluents must also be taken into account. It is also necessary to monitor the effluents of each of the specialised departments of the hospital studied. These steps is necessary to define realistic environmental management policies for hospitals (replacement of toxic products by less pollutant ones, etc.).