The presence of pharmaceutically active compounds in the aquatic environment has become well established, and their presence is of potential concern because they are designed to produce biological response in the target receptor, may bear intrinsic toxicity (e.g. cytostatic agents, antibiotics) and they possess the potential to foster and maintain drug resistance. For both risk assessment and risk management purposes, it is important to identify the major sources of pharmaceuticals in the environment. Healthcare facilities may be major sources of the discharges of these compounds into municipal sewers. In this study, we investigated the contributions to the wastewater treatment plant (WWTP) influents from two hospitals and two long-term care homes of nine compounds. Twenty-four hour composite samples were collected over 5 consecutive days from the effluents of these facilities. The WWTPs receiving sewage from these facilities were also sampled on the same days to facilitate mass balance calculations. The results showed that the healthcare facilities contributed a greater proportion of the antibiotic compounds to the WWTPs than the other target compounds; with maximum contributions of ciprofloxacin by hospitals and long-term care homes of 26.7 and 37%, respectively.
Nurse Practitioner and Physician Collaboration in Long-Term Care Homes: Survey Results
