Supporting Information

Supporting Information to Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., McArdell C.S., “Mass flows of X-ray contrast media and cytostatics in hospital wastewater”, Environ. Sci. Technol. 2009. SUPPORTING INFORMATION Mass flows of X-ray contrast media and cytostatics in hospital wastewater David Weissbrodt1, Lubomira Kovalova1,2, Christoph Ort1, Vinitha Pazhepurackel3, Ruedi Moser3, Juliane Hollender1, Hansruedi Siegrist1, Christa S. McArdell1,* 1 Eawag, Swiss Federal Institute of Aquatic Science and Technology, CH-8600 Duebendorf, Switzerland 2 RWTH Aachen University, Institute of Hygiene and Environmental Health, D-52074 Aachen, Germany 3 Hunziker Betatech AG, CH-8411 Winterthur, Switzerland * Corresponding author phone: +41 44 823 5483; fax: +41 44 823 5311; e-mail address: [email protected] Number of pages: 17 Number of Figures: 3 Number of Tables: 8 Environmental Science & Technology Manuscript ID es-2008-036725 Page S1 Supporting Information to Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., McArdell C.S., “Mass flows of X-ray contrast media and cytostatics in hospital wastewater”, Environ. Sci. Technol. 2009. S1 Biosafety Hospital wastewater is highly contaminated. It contains concentrated amounts of pharmaceuticals, disinfectants, and pathogen agents such as multiresistant bacteria and viruses. Considerations of full safety measures (1) are recommended for the work with hospital wastewater during the sampling and filtration. For the sampling phase, overall protection of the operator, protection of the sampling area, and protection of the sampling instruments were considered. In particular, single use FFP3 valved respirators (Type 9332, 3M™, Rüschlikon, Switzerland) were worn to avoid the operator contamination through bioaerosols. Two types of gloves, a single use nitrile lab glove (Type 92-500, 0.12 mm Touch N Tuff®, Ansell Ltd, Richmond, Australia) and a reusable nitrile protection glove (Type 37-185, 0.56 mm, Sol-Vex®, Ansell Ltd, Richmond, Australia), were worn superimposed. The work within the confined area of the hospital canalization had to be reduced to the strict minimum, and second collaborator had to be present on the sampling site. As samples could not be thermo sterilized because of the instability of organic compounds at elevated temperature, the sterilization was done by filtration. The raw samples were filtrated, in a biological safety class 2 sterile bench under laminar flow, successively on a 0.7 μm GF/F glass micro fiber circle filter (90 mm diameter, Whatman, Maidstone, UK) and on a 0.2 μm cellulose acetate filter (90 mm diameter, Sartorius AG, Goettingen, Germany). All instruments were autoclaved or chemically disinfected when thermal sterilization was not applicable. The glass bottles were inserted each in plastic freezer bags as safety in case of bottle breakage. S2 Hospital wastewater sampling scheme and flow profile The sampling scheme is shown in Tab.S1. The hospital wastewater flow profile (Fig.S1) measured during the sampling phase, under dry weather conditions, is typical for the daily activities of an institution. One rain event occurred over the whole day of Saturday 05th of May. Between 6:00-8:00 am, the flow rate is increasing rapidly from 5 m3/h (1.4 l/s) to reach 20 m3/h (5.5 l/s), due to the beginning of the first activities at the Page S2 Supporting Information to Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., McArdell C.S., “Mass flows of X-ray contrast media and cytostatics in hospital wastewater”, Environ. Sci. Technol. 2009. hospital and to the awakening of the patients. Successive peaks are present at 11:30, between 14:00-17:00, and at 21:00. As many hospital departments are also active during the week-end, the daily flow profile is similar during the week and during the week-end. The average wastewater flow rate over the whole sampling period was 15.8±14.8 m3/h, with minimal and maximal instantaneous values of 4.0 m3/h and 205.7 m3/h at the rainy day, respectively. An average flow rate of 17.2±8.8 m3/h was measured over the eighteen hours day periods (05:00-23:00) and 11.9±6.1 m3/h over the six hours night periods (23:00-5:00). Under dry weather conditions the wastewater flow rate amounted in average to 13.7±8.1 m3/h, which gives an effective amount of wastewater per hospital bed of 0.8 m3/(bed·day) during the sampling period. During the test phase, peaks up to 130-140 m3/h were regularly detected in the night. The hospital sanitary service explained these periodic peaks as back flushes from reverse osmosis installations and from warm baths. During the sampling phase, however, these peaks were no more present. Table S1. Sampling scheme: 18h-day (05:00-23:00) and 6h-night (23:00-05:00) flow proportional composite samples were collected during one week, and 2h- to 4h- composite samples were collected during one day. 18h-day and 6h-night 2h- to 4h- composite samples composite samples Monday, 30.4.2007 06:55-09:35 Tuesday, 1.5.2007 09:35-11:45 Wednesday, 2.5.2007 12:05-14:25 Thursday, 3.5.2007 14:25-17:05 Friday, 4.5.2007 17:05-20:35 Saturday, 5.5.2007 20:35-00:05 Sunday, 6.5.2007 00:05-04:25 Monday, 7.5.2007 Monday, 7.5.2007 04:25-07:55 Tuesday, 8.5.2007 07:55-09:55 Page S3 Supporting Information to Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., McArdell C.S., “Mass flows of X-ray contrast media and cytostatics in hospital wastewater”, Environ. Sci. Technol. 2009. 400 380 Test phase Sampling phase 360 50 45 340 40 /h) 320 3 35 300 /h) 30 3 280 25 260 20 240 15 05.05 Rain event 220 10 (m flow wastewater Hospital 200 5 180 0 00 03:00 06:00 09:00 12:00 15:00 18:00 21:00 00 03 06:00 09:00 12:00 15:00 18:00 21:00 00 03 06:00 09:00 12:00 15:00 18:00 21:00 00:00 :00 :00 :0 :00 :00 160 0 Mon 07.05.2007 Tue 08.05.2007 Wed 09.05.2007 140 120 100 Hospital wastewater flow (m 80 60 40 20 0 17.04 18.04 19.04 20.04 21.04 22.04 23.04 24.04 25.04 26.04 27.04 28.04 29.04 30.04 01.05 02.05 03.05 04.05 05.05 06.05 07.05 08.05 09.05 10.05 11.05 Monday Monday Monday Figure S1. Hospital wastewater flow rate at the sampling point during the test phase (18.04-23.04) and the sampling phase (29.04-10.05). Page S4 Supporting Information to Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., McArdell C.S., “Mass flows of X-ray contrast media and cytostatics in hospital wastewater”, Environ. Sci. Technol. 2009. Table S2. Input data for the sampling optimization modelling (adapted from Ort and Guier (2)). Information Source Values used in this study Initial duration of hydraulic Assumption 3-5 seconds toilet flush σinit Duration of toilet flush in Tracer experiment at a 5-30 seconds (to cover a reasonable sewer σup house connection resulted range). in a duration of 10 seconds (single standard deviation of a gaussian pulse) Average flow distance in Sewer layout from hospital 200 m (no buffer or retention tank in sewer (L) map hospital sewer network) Dispersion coefficient (D) Assumption for average 0.1 m2/s conditions, (3) Average velocity in sewer Measured 0.5 m/s (u) Duration of toilet flush in Calculated with: 20-35 seconds sewer at the sampling point (95% of a total toilet flush can pass the 2 t σ = σ + 2D σdown down up u 2 sampling point in 4 σdown, i.e. in a time of 80-140 seconds) With t = L/u Number of patients Assumption or hospital Z, can be calculated for each drug for excreting in the hospital details each day with the following information: number of patients receiving drug: see Table 1 half-live and excretion rate from pharmacokinetic information: see Table 2 number of out-patients: ICM: 50% on average cytostatics: 70% on average, details in Table 1 Number of toilet flushes Assumption: 4.5 toilet Z * 4.5 containing drugs flushes per person per day for a normal, healthy person (4,5). Consumed amount of drugs hospital details see Table 1 during sampling period Elimination in hospital ICM: negligible (persistent compounds) sewer (hydrolysis, Cytostatics: unknown biodegradation, sorption) Page S5 Supporting Information to Weissbrodt D., Kovalova L., Ort C., Pazhepurackel V., Moser R., Hollender J., Siegrist H., McArdell C.S., “Mass flows of X-ray contrast media and cytostatics in hospital wastewater”, Environ. Sci. Technol. 2009. S3 Analytical methods The wastewater samples were brought daily to the laboratory and stored at 0-5 °C for maximal 8 hours. After the successive filtrations to 0.7 and 0.2 μm under a sterile bench (S1), the samples were stored at -20°C until analysis. The analytical sample preparation was done within two months after the end of the sampling phase. All samples were prepared in duplicate. The analytical method for the measurement of iodinated X-ray contrast media (ICM) was adapted from Ternes et al. (6). Characteristics of the selected compounds are given in Tab.S3. The homogeneous hospital wastewater samples were diluted by a factor 1:100 (w:w) with uncontaminated tap water (pH 7.4, TOC 0.8 mg/L, 12.7 mg/L Cl-), while WWTP wastewater samples were taken undiluted (100 mL), because hospital wastewater is about 100 times more concentrated than urban wastewater.

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