Healthcare wastewater surveillance: methodological considerations for sampling, feasibility, and implementation

Area of Science:

• Environmental microbiology
• Public health surveillance
• Healthcare epidemiology

Background:

• Wastewater surveillance (WWS) is a developing field for healthcare facilities.
• Knowledge gaps exist regarding WWS feasibility, implementation, and data interpretation in these specialized settings.

Purpose of the Study:

• To pilot and assess the feasibility of wastewater surveillance at skilled nursing and post-acute/long-term care facilities.
• To optimize methods for wastewater collection and data interpretation for healthcare settings.

Main Methods:

• Conducted tracer studies to confirm effluent sources.
• Optimized a low-flow strainer for automated wastewater collection.
• Developed and distributed a wastewater access survey to 16 facilities.

Main Results:

• Low-flow strainers (±0.36 L) demonstrated minimal clogging and consistent wastewater collection.
• Tracer studies confirmed effluent sources with rapid dye detection (1.5–2.5 min).
• 75% (12/16) of surveyed facilities showed feasibility for WWS implementation.

Conclusions:

• Healthcare facility-level WWS requires specialized methodological approaches for effective implementation.
• Wastewater surveillance shows promise for detecting emerging biological threats in healthcare settings.