Genotoxicity of wastewater from health care facilities

Health care facilities use for therapeutic purposes, diagnostics, research, and disinfection a high number of chemical compounds, such as pharmaceuticals (e.g. antibiotics, cytostatics, antidepressants), disinfectants, surfactants, metals, radioactive elements, bleach preparations, etc. Hospitals consume significant amounts of water (in the range of 400 to 1200 liters/day/bed) corresponding to the amount of wastewater discharge. Some of these chemicals are not eliminated in wastewater treatment plants and are the source of pollution for surface and groundwater supplies. Hospital wastewater represents chemical and biological risks for public and environmental health as many of these compounds might be genotoxic and are suspected to contribute to the increased incidence of cancer observed during the last decades. The changes of the genetic information can have a lethal effect, but more often cause tumor processes or mutations in embryonic development causing serious defects. A review of the available literature on the mutagenicity/genotoxicity of medical facilities wastewater is presented in this article.