Investigation of antibiotics in health care wastewater in Ho ChiMinh City, Vietnam Thi-Dieu-Hien Vo&Xuan-Thanh Bui&Ngoc-Dan-Thanh Cao&Vinh-Phuc Luu& Thanh-Tin Nguyen&Bao-Trong Dang&Minh-
Trang 1Investigation of antibiotics in health care wastewater in Ho Chi
Minh City, Vietnam
Thi-Dieu-Hien Vo&Xuan-Thanh Bui&Ngoc-Dan-Thanh Cao&Vinh-Phuc Luu&
Thanh-Tin Nguyen&Bao-Trong Dang&Minh-Quan Thai&Dinh-Duc Nguyen&
Thanh-Son Nguyen&Quoc-Tuc Dinh&Thanh-Son Dao
Received: 5 May 2016 / Accepted: 16 November 2016
# Springer International Publishing Switzerland 2016
Abstract Hospital wastewater contains huge amounts
of hazardous pollutants which are being discharged
daily to environment with or without treatment
Antibiotics were among the important group of
pharma-ceuticals considered as a potential source of health risk
for human and other living creatures Although the
investigations about the existence of antibiotics in
hos-pital wastewater have gained concern for researchers in
many countries, there is only one research conducted in
Hanoi-Vietnam Hence, in this study, investigations
have been done to fulfill the requirement of real situation
in Vietnam by accomplishing survey for 39 health care facilities in Ho Chi Minh City As results, seven popular antibiotics were detected to exist in all samples such as sulfamethoxazole (2.5 ± 1.9 μg/L), norfloxacin (9.6 ± 9.8 μg/L), ciprofloxacin (5.3 ± 4.8 μg/L),
o f l o x a c i n ( 1 0 9 ± 8 1 μg/L), erythromycin (1.2 ± 1.2 μg/L), tetracycline (0.1 ± 0.0 μg/L), and trimethoprim (1.0 ± 0.9 μg/L) On the other hand, survey also showed that only 64% of health care facil-ities using conventional activate sludge (AS) processes
in wastewater treatment plants (WWTPs) As a conse-quence, basic environmental factors (BOD5, COD, TSS,
NH4 +
-N, or total coliforms) were not effectively re-moved from the hospital wastewater due to problems relating to initial design or operational conditions Therefore, 18% effluent samples of the surveyed WWTPs have exceeded the national standard limits (QCVN 28:2010, level B)
Keywords Antibiotics Hospital Wastewater Ho Chi Minh City
Introduction
Hospitals in Vietnam are classified in three main types depending on some specific criterias such as 39 central hospitals, 394 provincial hospitals, and 640 district hos-pitals (Thu et al.2012) Ho Chi Minh City (HCMC) has about 108 hospitals including 21 central hospitals, 31
DOI 10.1007/s10661-016-5704-6
T <D.<H Vo:T <S Nguyen
Environmental Engineering and Management Research Group,
Ton Duc Thang University, Ho Chi Minh City, Vietnam
T <D.<H Vo
e-mail: vothidieuhien@tdt.edu.vn
T <D.<H Vo
Faculty of Environment and Labour Safety, Ton Duc Thang
University, Ho Chi Minh City, Vietnam
X.<T Bui (*):N.<D.<T Cao:V.<P Luu :Q.<T Dinh :
T.<S Dao
Faculty of Environment and Natural Resources, University of
Technology, Vietnam National University, Ho Chi Minh, Vietnam
e-mail: bxthanh@hcmut.edu.vn
X <T Bui
Faculty of Food and Environment, Dong Nai Technology
University, Dong Nai, Vietnam
N <D.<T Cao:V <P Luu :T <T Nguyen:B <T Dang :
M <Q Thai :D <D Nguyen
Institute of Research and Development, Duy Tan University, Da
Nang, Vietnam
Trang 2hospitals under the Department of Health, 23 district
hospitals, and 33 private hospitals which are in use at
the time In addition, the city has about 285 other types of
health care facilities such as medical centers, polyclinics,
and specialized clinics Hospital wastewater has been
known as highly hazardous waste as its characteristics
are toxic and infectious (Verlicchi et al.2010; Tin et al
2016) HCMC Department of Natural Resources and
Environment (DONRE) estimated that about 23,000 m3
of wastewater generated from hospitals is directly
discharged to environment daily (Saigon Times 2010)
That wastewater consists of 80% of domestic wastewater
and 20% of the hazardous wastes containing
contami-nants from patients, blood products, diagnostic samples,
chemicals arising during surgery, blood dialysis, blood
samples, sample preservatives, disinfection, etc
Moreover, it also contains an emerging source of
multi-resistant bacteria (Huang et al 2012) and antibiotics
(Santos et al 2013) Although the residue individual
antibiotics in the environment are usually at low
concen-trations as 0.4 ng/L to 35.5μg/L, they are still considered
to be important emerging pollutants which can cause high
risk on human health (Hernando et al.2006) This type of
wastewater can destroy environmental sustainability and
create serious ecological destruction if pollutants are not
treated properly before entering into the environment via
effluent or sludge (Lin et al.2010)
More than ten antibiotic classes are in use consisting of
ionophore, aminoglycoside, polypeptide,β-lactam,
quino-lones, tetracycline, macrolide, streptogramin, sulfonamide,
etc Among those antibiotic classes, six classes are often
utilized by both human and animals such as
aminoglyco-side, β-lactam, macrolide, quinolone, sulfonamide, and
tetracycline (Huang et al.2001) In particular,
sulfameth-oxazole (3.5μg/L), norfloxacin (5.9–8.4 μg/L), and
cipro-floxacin (25.8–32.0 μg/L) existed in the Hanoi hospital
wastewaters with high concentrations (Duong et al.2008;
Kovalova et al.2012) In another study, sulfamethoxazole
and ciprofloxacin might not be removed via
biodegrada-tion in the environment after 28 and 40 days (Al Ahmad
et al.1999)
Several investigations have determined the occurrence
and fate of pharmaceuticals in hospital wastewaters in the
world (Lindberg et al.2004; Brown et al.2006; Watkinson
et al.2009; Chang et al.2010; Sim et al.2011; Kovalova
et al.2012; Eslami et al.2015) Until now, in Vietnam, the
study of Duong et al (2008) is certainly the first research
on the occurrence of five antibiotics in the wastewater of
six hospitals in Hanoi The research focused on
fluoroquinolone groups such as ciprofloxacin, norfloxacin, ofloxacin, levofloxacin, and lomefloxacin The results in-dicated that only ciprofloxacin (1.1–4.4 μg/L) and norfloxacin (0.9–17.0 μg/L) were detected in the waste-water samples Therefore, it is essential to understand the level of contaminated antibiotics in hospital wastewaters in HCMC This study aims to investigate the occurrence of seven popular antibiotics (including sulfamethoxazole, norfloxacin, ciprofloxacin, ofloxacin, erythromycin, tetracyclin, and trimethoprim) in raw wastewater collected from 39 health care facilities in HCMC-Vietnam Along with main aim of this survey about antibiotics detection, the physicochemical parameters were analyzed to evaluate the general performance of treatment system
Materials and method
Sampling sites
There were 39 health care facilities (including 12 central hospitals, 3 district hospitals, and 24 clinics) in HCMC targeted to conduct survey (Fig.1) These medical fa-cilities were mostly general hospitals Samples collected
in input and output were analyzed physicochemical properties Without treatment system observed in sam-pling area, untreated samples were collected directly at point of discharge sewer Additionally, antibiotics mea-surement was considered to use raw wastewater to ana-lyze due to impediment relating to confidential informa-tion and unknown reason caused by plant’s operators Sample pretreatment and antibiotics analysis
This study focused on seven common antibiotics such as sulfamethoxazole (SUL), norfloxacin (NOR), ciprofloxa-cin (CIP), ofloxaciprofloxa-cin (OFL), erythromyciprofloxa-cin (ERY), tetracy-cline (TET), and trimethoprim (TRI) (Table1) The
select-ed antibiotics were basselect-ed on the following criteria such as the common presentation and use of antibiotics in the environment (Nikolaou and Fatta2007; GARP- Vietnam National Working Group2010; Hoa et al.2011), achieved results in the previous studies (Duong et al.2008; Chang
et al 2010; Kovalova et al 2012), and the measuring ability of the laboratory analysis (Dinh et al.2011) The samples were contained in 1-L glass bottle and stored in an ice box during transportation All collected samples were analyzed total suspended solids (TSS), chemical oxygen demand (COD), biochemical oxygen
Trang 3demand (BOD5), ammonia nitrogen (NH4 -N), nitrate
nitrogen (NO3 −-N), phosphorus (PO4 −-P), and total
coliforms within 24 h herein to the standard method
(APHA1998)
For antibiotics testing, every sample was adjusted to pH
7 after transporting to the laboratory Then, 100-mL sample
was filtered through 0.45-μm glass fiber filter (Whatman)
to remove its suspended solids (Seifrtova et al 2008)
Filtered samples were adjusted to pH 4 and stored at 4°C
before extraction The off-line solid phase extraction (SPE)
method and LC-MS/MS optimization applied in this study
were based on the protocols of (Dinh et al 2011) The
OASIS HLB cartridges were conditioned with 3 mL of
MeOH (99.5%) and 3 mL of distilled water Samples (pH
4) were injected into the cartridges at a flow rate of 2–3 mL/
min Then, 3 mL of distilled water/MeOH solution (v/v, 95/
5) was used to rinse these cartridges The cartridges were
dried under vacuum condition during 10 min Five
millili-ters of MeOH was injected into the cartridges for elution
process The extracts were evaporated under a nitrogen
stream at 40°C Finally, the extracts were filtered through
0.45-μm glass fiber filters and stored at 4°C for analyzing
with LC-MS/MS system The LC-MS/MS system
(Agilent1200 series) equipped with an Agilent Zorbax
Eclipse Plus C18column (with diameter, length, and pore
size of 2.1 mm, 150 mm, and 3.5μm, respectively) A
sample injection volume was 10μL Mobile phase solvents
were ultrapure water (Solvent A) and acetonitrile (solvent
B), both solvents acidified with 0.01% formic acid (HCOOH) in an initial ratio (A/B) of 90:10 Separation was achieved at 35°C using a flow rate of 0.5 mL/min with the following (A/B) gradient: 90:10 to 75:25 in 2 min, 65:35 at 4 min, 25:75 at 7 min, and 0:100 at 7.1 min for
3 min Then, the system was equilibrated for 2.4 min prior
to the next injection (total run time of 12.5 min) The LC system was coupled to a triple quadruple mass spectrometer (Agilent 6410) with the electrospray ionization (ESI) source, and it was operated in positive mode Argon (99.9%) was used as collision gas, while nitrogen was used
as the nebulizing gas (11.0 L/h, nebulizer pressure 35 psi) and was produced via a nitrogen generator (Parker) Calibration always yielded standard curves with coeffi-cients of determination (R2) greater than 0.99 within exper-imental concentrations used The quantification limit which estimated as ten times the signal of the highest peak gener-ated by the background noise was in the 0.5–10 ng/L range Results and discussions
Wastewater treatment situation at the surveyed health care facilities
The survey results showed that 15/15 hospitals and 11/
24 clinics are fully equipped with wastewater treatment units Treatment capacity was ranging from 70 to
Fig 1 Map of surveyed health
care facilities in Ho Chi Minh
City - Vietnam (yellow crosses:
central hospitals, white crosses:
district hospitals and red crosses:
clinics)
Trang 41000 m3/day for the hospitals and from 0.5 to 7.0 m3/
day for the clinic centers In hospitals, conventional
activated sludge processes (ASP) (aeration tank, moving
bed bioreactor, etc.) are applied in those wastewater
treatment units For the clinics, only septic tank (ST) is
used for wastewater treatment The on-site
three-cham-ber septic tank is the compulsory treatment unit for
individual households in the city Figure2 shows that
pollutant removal efficiencies of WWTPs of the city
hospitals (63 ± 28% of BOD5, 49 ± 2% of COD,
44 ± 30% of TSS, 36 ± 18% of NH4 -N, and
27 ± 16% of PO4 −-P) were lower than those of other
WWTPs applying fluidized bed biofilm aeration
(FBBA), aeration tank, and extended aeration (EA)
reported by Prayitno et al (2013) The removal of
BOD5, COD, TSS, and nutrients in the reported systems
was from low to average so that they did not effectively
treat wastewater from health care facilities in HCMC
In addition, the treatment performance of septic tanks
of clinic centers was greater than that of activated sludge systems in this survey This is clearly explained that a low concentration of organic matters and nitrogen compounds was noticed in the raw wastewater generated from hand washing, cleaning, and toilet flushing from preliminary health check in clinic centers Similarly, Mesdaghinia et al (2009)
document-ed that characteristics of health care wastewater were influenced by the level, type of service and water de-mand Wastewater from a health care facility is synthe-sized from all hospital activities such as medical activ-ities, emergency, laboratory, radiology, surgery, diagno-sis, laundry, kitchen, etc Main activities of the clinics are often medical examination and prescription for out-patient treatment Therefore, wastewater arises primarily from toilets, cloth washing, and instruments cleaning In general, the concentration of pollutants in the raw
Table 1 Target antibiotics information, EC50values and concentrations in raw health care wastewaters
Antibiotics MW (g/mol) Log K ow EC 50 values (mg/L) Concentration of antibiotics in raw hospital
wastewater
SUL 253.28 0.89 1.5 (72 h, algae) (Eguchi et al 2004 ) 3.5 ± 4.6
0.6 ± 0.1 0.1 –0.3 0.4 –2.1 0.4 –12.8
Kovalova et al 2012
Chang et al 2010
Watkinson et al 2009
Brown et al 2006
Lindberg et al 2004
NOR 319.33 0.46 82.0 ± 10.2 (24 h, mouse) (Radko et al 2013 )
16.6 (72 h, algae) (Eguchi et al 2004 )
8.4 ± 2.5 5.9 ± 3.4 0.7 ± 0.1 0.1 –0.2
Duong et al 2008
Kovalova et al 2012
Chang et al 2010
Watkinson et al 2009
CIP 331.35 0.28 0.017 (24 h, bacteria) (Robinson et al 2005 )
42.1 ± 9.9 (24 h, human cell) (Radko et al 2013 )
25.8 ± 8.1 32.0 ± 14.1 0.1 ± 0.0 2.5 –15.0 0.9 –2.0 3.6 –101.0
Duong et al 2008
Kovalova et al 2012
Chang et al 2010
Watkinson et al 2009
Brown et al 2006
Lindberg et al 2004
OFL 361.37 −0.39 0.021 (24 h, bacteria) (Robinson et al 2005 ) 2.9 ± 0.3
4.9 –35.5 0.2 –7.6
Chang et al 2010
Brown et al 2006
Lindberg et al 2004
ERY 733.94 3.06 0.04 (72 h, algae) (Eguchi et al 2004 ) 0.2 ± 0.3
0.1 ± 0.0
Kovalova et al 2012
Chang et al 2010
TET 444.44 −1.37 4.0 (48 h, bacteria) (Halling-Sørensen 2001 ) ND –0.04 Watkinson et al 2009
TRI 290.32 0.91 80.3 (72 h, algae) (Eguchi et al 2004 ) 0.9 ± 0.9
0.3 –0.3 2.9 –5.0 0.6 –7.6
Kovalova et al 2012
Watkinson et al 2009
Brown et al 2006
Lindberg et al 2004
K ow octanol-water partition coefficient, EC 50 50% effective concentration, ND not detected
Trang 5wastewater of the hospitals was higher than those
de-tected in samples of the clinics
Figure3shows that the concentrations of pollutants
in raw wastewater in HCMC health care facilities were
COD of 133 ± 60 mg/L, BOD5of 54 ± 32 mg/L, and
TSS of 50 ± 36 mg/L, while the nutrient pollution of the
raw wastewater was slightly low compared to those of
domestic wastewater (NH4 -N of 16 ± 14 mg/L and
PO4 −-P of 2 ± 2 mg/L) The total coliforms were
ranging from 7.5 × 103 to 64 × 106 MPN/100 mL
These concentration values were 1.3–3.7 times lower
than those found in raw wastewater of Thailand and
China (Liu et al 2010; Prasertkulsak et al 2016)
Based on the survey results, effluents of 7/39 health care
facilities did not comply with the Vietnam standard
limits (QCVN 28:2010, level B) (MONRE 2010) In
the comparison with national standard (level B),
con-centrations of some parameters analyzed in the effluent
had exceeded standard limits Particularly, the average
values of treated effluents from hospitals were generally
higher than those standard limits (for instance, COD of
1.9 times, BOD5of 2.3 times, TSS of 1.3 times, NH4 -N
of 3.0 times, and total coliforms of 300 times) The
wastewater treatment systems of those hospitals have
not been operated adequately and effectively to meet
required standard limits In addition, treated wastewater
quality at level B cannot be safe for water body
Therefore, a future concern has been focused strictly
on improvement of effluent quality to level A
Overall, the situation of wastewater pollution caused
by health care facilities reached to warning statement
due to various reasons Firstly, 58% clinics implemented
in this survey did not have WWTPs (only septic tank
installed), so wastewater was discharged directly into
the sewage line Secondly, although the WWTP of those
facilities was equipped with the biological treatment
units (aeration tank, moving bed bioreactor) or anaero-bic process (septic tank), items such as COD, BOD5, TSS, and total coliforms could not be removed completely Lack of sufficient equipment in the initial design stage and inappropriate operational conditions (such as insufficient air supply, loss of activated sludge, too long or too short sludge retention time, improper dosage of the chemical in disinfection process, etc.) were the reasons leading to low removal efficiency in those systems Thirdly, the operators of wastewater treatment plants did not access to technical and mana-gerial regularities properly Indeed, treatment efficiency
of the WWTPs was not inspected and maintained regu-larly Finally, managers and operators of WWTPs were not specialized in the field of waste treatment engineer-ing Therefore, the quality of wastewater discharged into water environment at 18% facilities did not satisfy the requirement of national standard (level B) for health care wastewater
Fig 2 Removal efficiencies in
health care wastewater treatment
plants (ASP activated sludge
processes, ST septic tank —data
from this study, FBBA* fluidized
bed biofilm aeration, AS*
activated sludge, EA* extended
aeration —data reported by
Prayitno et al ( 2013 ))
Fig 3 Effluent characteristic of health care facilities in Ho Chi Minh City, Vietnam (Eff effluent, ASP activated sludge processes,
ST septic tank, no WWTP no wastewater treatment plant)
Trang 6Today’s health care systems must be developed
to meet the increasing demand of patients That
fact results in high volume of wastewater produced
from those facilities This could lead to hydraulic
shock load in the WWTPs On the other hand,
without upgrading of wastewater treatment
sys-tems, there will be a significant negative impact
on the environment due to high risk of infection
caused by increase of untreated wastewater
Sharma et al (2015) strongly recommended to
apply an efficient and advanced on-site treatment
for health care wastewater instead of dumping the
wastewater into the sewage system Apart from
typical physio-chemical parameters, health care
wastewater also includes hazardous micro
pollut-ants such as antibiotics
Occurrence of antibiotics in health care wastewater
Figure 4 shows concentrations of antibiotics
de-tected in the healthcare wastewater in HCMC and
previous studies in other countries Detection fre-quency of these antibiotics reached 100% for all samples in this study, especially, sulfamethoxazole, norfloxacin, and ciprofloxacin were found in all samples Moreover, detection frequency was 90%
of trimethoprim, 80% of erythromycin, and 20% of tetracyclin This research also showed that the occurrence of seven antibiotics in health care wastewater in HCMC was 1.0–3.3 times higher than those in Rio Grande, New Mexico (Brown
et al 2006), South East Queensland, Australia (Watkinson et al 2009), Liestal, Switzerland (Kovalova et al 2012), and Chongqing, China (Chang et al 2010) According to results of Van Boeckel et al (2014), antibiotics consumption of Vietnam was 0.7–11.3 billion standard units (a standard unit is a measure of volume based
broad-ly on the smallest identifiable dose given to a patient, dependent on the pharmaceutical form such as pill, capsule, or ampoule), being 1–157 times higher than New Mexico, Switzerland, and
Fig 4 Detection frequency of antibiotics in raw wastewater of
health care facilities in Ho Chi Minh City, Vietnam (SUL
sulfa-methoxazole, NOR norfloxacin, CIP ciprofloxacin, OFL
ofloxacin, ERY erythromycin, TET tetracyclin, TRI trimethoprim,
n numbers of samples analyzed)
Fig 5 Concentrations of antibiotics in the raw wastewaters from
health care facilities in Ho Chi Minh City, Vietnam (SUL
sulfa-methoxazole, NOR norfloxacin, CIP ciprofloxacin, OFL
ofloxacin, ERY erythromycin, TET tetracyclin, TRI trimethoprim,
n numbers of samples analyzed)
Trang 7China in 2010 This can explain the high detection
frequency of antibiotics in hospital wastewater in
HCMC-Vietnam
Figure5shows that the concentrations of
sulfameth-oxazole, norfloxacin, ciprofloxacin, ofloxacin,
erythro-mycin, tetracyclin, and trimethoprim were 2.5 ± 1.9,
9.6 ± 9.8, 5.3 ± 4.8, 10.9 ± 8.1, 1.2 ± 1.2, 0.1 ± 0.0,
and 1.0 ± 0.9 μg/L, respectively Three remarkable
antibiotics with high concentrations were norfloxacin,
ciprofloxacin, and ofloxacin These results also found
that ciprofloxacin concentrations in hospital
wastewa-ters in HCMC-Vietnam were lower than in
Hanoi-Vietnam (25.8 ± 8.1 μg/L) (Duong et al 2008),
Liestal-Switzerland (32.0 ± 14.1 μg/L) (Kovalova
et al 2012), South East Queensland-Australia
(15 μg/L) (Watkinson et al 2009), and
Kalmar-Sweden (3.6–101.0 μg/L) (Lindberg et al 2004)
Conversely, norfloxacin concentrations in this study
were higher than in Hanoi-Vietnam (8.4 ± 2.5 μg/L)
( D u o n g e t a l 2 0 0 8) , L i e s t a l - S w i t z e r l a n d
(5.9 ± 3.4 μg/L) (Kovalova et al 2012),
Chongqing-China (0.7 ± 0.1μg/L) (Chang et al.2010), and South
East Queensland-Australia (0.2μg/L) (Watkinson et al
2009) The occurrence of ofloxacin in this study was
higher than in Chongqing-China (2.9 ± 0.3 μg/L)
(Chang et al 2010) and Kalmar-Sweden (0.2–
7.6μg/L) (Lindberg et al.2004) (Table1)
Dealing with technical guidance of EU Directive 93/
67/EEC (CEC 1996), the effective concentrations
(EC50) were used to establish different risk classes
EC50 value was classified such as below 1 mg/L of
Bvery toxic to aquatic organisms^; 1–10 mg/L of
Btoxic^ and 10–100 mg/L of Bharmful to aquatic
organisms.^ The value of EC50greater than 100 mg/L
was not classified Previous studies showed that almost
EC50 values of studied antibiotics were less than
100 mg/L (Table1) Hence, if these antibiotics in health
care wastewater are not removed effectively, they will
be potentially harmful to aquatic organisms
The occurrence of antibiotics in the environment
was due to antibiotic drug usage to protect human
and animal health As reported by Thu et al
(2012), in 36 hospitals in Vietnam, 5104/7571
(67.4%) of surveyed patients used antibiotics for
their treatment Hoa et al (2011) announced that
in the Northern Vietnam, 566/821 (69%) of
sur-veyed children clinical records used antibiotics
Van Boeckel et al (2014) demonstrated that the
consumption of antibiotic drugs increased by 36%
all over the world from 2000 to 2010 Dramatic rise observed in antibiotics use has led to increasing their potential occurrence in the environment for many years Currently, Vietnam has not compiled any standard or regulation for antibiotics residue in health care wastewater yet Topal and Topal (2015) stated that conventional activated sludge process was not efficient for tetracyclin removal WHO (2012) also mentions that pharmaceuticals were able to be removed about 21–50% by the conven-tional biological treatment processes such as acti-vated sludge and biofiltration depending on such factors as sludge retention time, temperature, and hydraulic retention time If pollutant removal of treatment plants is incomplete, antibiotics will be discharged into water body Potential impacts of antibiotics are genotoxic effects, destruction of aqua ecology, increase of antibiotic resistance, and even increase of human heath risks in the long run
Conclusions
In summary, this study introduces an overview of waste-water treatment situation in the health care facilities in HCMC-Vietnam and especially the occurrence of anti-biotics in their wastewaters
& Sulfamethoxazole, norfloxacin, ciprofloxacin, ofloxacin, trimethoprim, erythromycin, and tetracyclin were introduced in the high concentra-tion (up to 23.7μg/L) in raw wastewater which was higher than 4–53 times compared to those of hospi-tals wastewater at other Asian countries as China and Australia
& Thirty-six percent of the surveyed health care facil-ities were not fully equipped with decentralized wastewater treatment units
& Eighteen percent of discharged effluent does not
c o m p l y w i t h n a t i o n a l s t a n d a r d l i m i t s (QCVN28:2010/BTNMT, level B) due to insuffi-cient initial design and inappropriate operational conditions as well
& Current applied treatment technologies do not per-form well in removal of trace organic compounds as well as the antibiotics Thus, advanced wastewater treatment technologies should be considered to in-troduce in removing antibiotics from hospital waste-waters in the future
Trang 8Acknowledgements The authors would like to thank for the
research grant from National Foundation for Science and
Tech-nology Development (NAFOSTED) No 105.99-2015.16,
Minis-try of Science and Technology – Vietnam This study has been
conducted under the framework of CARE-RESCIF initiative In
addition, the laboratory support of Mr Tin and Mr Thao are highly
appreciated.
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