Municipal wastewaters can generally provide real-time information on drug consumption, the incidence of specific diseases, or establish exposure to certain agents and determine some lifestyle consequences. From this point of view, wastewater-based epidemiology represents a modern diagnostic tool for describing the health status of a certain part of the population in a specific region. Hospital wastewater is a complex mixture of pharmaceuticals, illegal drugs, and their metabolites as well as different susceptible and antibiotic-resistant microorganisms, including viruses. Many studies pointed out that wastewater from healthcare facilities (including hospital wastewater), significantly contributes to higher loads of micropollutants, including bacteria and viruses, in municipal wastewater. In addition, such a mixture can increase the selective pressure on bacteria, thus contributing to the development and dissemination of antimicrobial resistance. Because many pharmaceuticals, drugs, and microorganisms can pass through wastewater treatment plants without any significant change in their structure and toxicity and enter surface waters, treatment technologies need to be improved. This short review summarizes the recent knowledge from studies on micropollutants, pathogens, antibiotic-resistant bacteria, and viruses (including SARS-CoV-2) in wastewater from healthcare facilities. It also proposes several possibilities for improving the wastewater treatment process in terms of efficiency as well as economy.

The contamination of aquatic environments by micropollutants, including pharmaceuticals and illicit drugs, is a growing global issue with significant implications for environmental and public health. This study addresses a critical knowledge gap by examining pharmaceutical and drug contamination in thermal swimming pools, which are often legally discharged into water bodies without treatment. A total of 49 water samples from 19 distinct thermal pools were analysed, targeting 101 compounds, including pharmaceuticals, illicit drugs, and their metabolites. High-frequency contaminants were identified including caffeine, theophylline, cardiovascular medications (bisoprolol, metoprolol, telmisartan), antidepressants (venlafaxine, citalopram), antihistamines (cetirizine, diphenhydramine), the analgesic tramadol, the antiepileptic carbamazepine, and the illicit drug methamphetamine. The study revealed that these substances were present in more than 30% of the samples, with some occurring at relatively high maximum concentrations, e.g. caffeine (69 μg/L), and methamphetamine (1.8 μg/L). Notably, certain categories of targeted micropollutants, such as cardiovascular medications and illicit drugs, were found to be more prevalent in specific pools. A higher occurrence of cardiovascular drugs has been observed in a pool predominantly designed for relaxation and thus probably preferred by older people. In this pool also notably high levels of illicit drugs were found. The presence of illegal drugs was also confirmed in the children's pool. This study contributes valuable insights into the patterns of micropollutant distribution in thermal pools and emphasises the necessity for enhanced monitoring and management strategies to mitigate environmental and public health risks posed by micropollutants, as well as the possible further impact on aquatic ecosystems.

This study investigates the potential contamination of cash register employees in the Slovak Republic with 148 selected pharmaceuticals, illicit drugs, and their metabolites. Of these, 42 substances were detected, and it was found that the target group—cashiers—regularly handle large volumes of banknotes, increasing their exposure to contaminants compared to the general population. This study revealed that commonly prescribed and over-the-counter medications significantly contribute to the contamination of cash registers. This study found that cashiers exhibited notably higher detection rates of antibiotics, including penicillin-V (2×), azithromycin (23×), and erythromycin (up to 64×), than the general population. Additionally, there was an alarming increase in illegal substances, with methamphetamine levels rising fivefold and cocaine up to fifteenfold. This study highlights a broader environmental concern, suggesting that routine handling of contaminated banknotes may lead to the transfer of micropollutants. Furthermore, personal hygiene practices, particularly handwashing, could play a role in introducing pharmaceuticals and narcotics into wastewater, potentially contributing several milligrams of contaminants daily.