Final remarks and perspectives on the management and treatment of hospital effluents

This final contribution highlights the main findings resulting from past studies on the characteristics, management, treatment and environmental implications of hospital effluents. Milestone investigations have been international projects (among which Poseidon, Pills, Nopills, Neptune, Knappe, ENDETECH, and PharmDegrade) as well as specific studies suggesting adequate treatments for the effluents of new hospital facilities or the upgrade of existing treatment plants with the aim of removing targeted pollutants occurring at extremely low concentrations (ng/L to μg/L). The different strategies in managing (a separate or a combined treatment) have been discussed and the debate on the current best technologies (conventional technologies + end-of-pipe treatments or advanced biological and chemical processes) is outlined through the presentation of specific full scale treatment plants. The new frontiers in the treatment of hospital effluents are shown by presenting ongoing lab and pilot scale investigations in different countries. What we expect in the near future are new findings regarding the occurrence and removal of new targeted pharmaceuticals, antibiotic resistant bacteria and genes, environmental risk assessment of the mixture of substances and with regard to chronic exposure, improvement in the removal of (well-known and new) targeted compounds by tested treatment trains.