In the last decade, greater attention has been paid to the presence in the water of emerging contaminants (including pharmaceutical and personal care products, pesticides, flame retardants…), that are quite often unregulated compounds. Hospitals are one of the most important sources of pharmaceutical compounds (PhCs) in a concentrated area and, together with households and industries, can be seen as significant urban area hotspots for discharging these contaminants into the sewer network and surface waters, with a potential impact on ecosystem. Hospital wastewaters (HWWs) are composed of the effluents of different services: kitchen, internal laundry, heating and cooling systems, laboratories, radiology departments, outpatients departments, transfusion centres and wards. By law, HWWs are often considered to be of the same pollutant nature as urban wastewaters (UWWs), and so they are generally discharged into sewage networks, collected at a wastewater treatment plant (WWTP) and treated along with UWWs. WWTPs were originally built, and more recently upgraded, with the aim of removing C, N and P compounds: the pollutants regularly arriving at the WWTP in concentrations to the order of mg/L. This paper analyses the differences between the wastewater from a hospital and an urban settlement in terms of hydraulic load as well as pollutants load and concentration on the basis of experimental investigations and literature data. Then it discusses if is correct to consider these two effluents of the same pollutant nature and if/when HWWs could be conveyed to a municipal WWTP for cotreatment with UWWs. Moreover it discusses the strategies in treating hospital flow rate (on site or off site, dedicated treatment or cotreatment at a municipal WWTP) on the basis of the hospital pollutant and hydraulic loads and finally it presents the most adequate treatment for HWWs on the basis of the recent results of the researches on the removal of PhCs. Furthermore a case study of the management of the effluent from a large hospital in a small town is also provided and discussed.
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