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ABSTRACT
Introduction: Negative environmental effects of active pharmaceutical ingredients (APIs) are increasingly recognized, especially concerning antibiotics, and hospitals are important point sources. “pCure” is a toilet rim block containing API-degrading enzymes; the producing company claims positive in vitro results but no implementation studies have been performed. Materials and methods: In a university hospital setting, 16 weeks were randomized to installation or no installation of pCure in all 261 toilets connected to the same cesspit where sewage water was sampled daily. Ninety-six samples were analyzed for 102 APIs using liquid chromatography/tandem mass spectrometry. Results and Discussion: Fifty-one APIs were detected with a large variation in levels but no significant differences in the initial statistical analysis. More statistical testing of API level ratios (pCure installed/not installed) yielded some cases of significant decrease. Differences were small and not consistent when comparing means and medians. We cannot exclude a small pCure effect but clearly pCure has no effect of biological importance. Conclusion: pCure is not useful to reduce drug residue discharge in a hospital setting. In a bigger perspective, our study exemplifies that products claiming to reduce an environmental problem need to be tested in on-site implementation studies by independent researchers before reaching the market.
Acknowledgments
We wish to thank all staff at the technical department at UUH for excellent help in collecting waste water samples, and all patients and staff who participated in the study. We are grateful to Marta Fallgren for important contributions in planning and evaluating the project, and Jonas Eriksson, Margareta Öhrvall, and Christian Baresel for important input. We also wish to thank the Department of Chemistry, Umeå University, and especially Richard Lindberg, for excellent assistance with API measurements.
Disclosure statement
No potential conflict of interest was reported by the authors.
Supplementary material
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Notes on contributors
Sofia Svebrant
Sofia Svebrant has an MSc in Environmental Science and is working as Environmental Coordinator at Uppsala University Hospital. She has a strong interest in environmental impact of hospitals and the possibilities for mitigation.
Therese Olsen
Therese Olsen has an M Sc in Molecular Biology and is the Chief Environmental Officer at Uppsala University Hospital. She is particularly focused on the impact of drug residues in the environment and potential control strategies in the health care sector.
Jim Larsson
Jim Larsson is a technical engineer responsible for sewage systems at Uppsala University Hospital. He has a strong interest in practical solutions to complex technical problems regarding sewage and sewage treatment.
Patrik Öhagen
Patrik Öhagen is working as a statistician at Uppsala Clinical Research with previous experience as a statistician at the Medical Products Agency and the Biostatistics Working Party (EMA). His main interests are statistical methods for clinical trials.
Hanna Söderström
Hanna Söderström has a PhD in Environmental Chemistry and more than ten years’ experience of research on drug residues in the environment. She is currently working as occupational hygienist at Umeå University Hospital.
Josef D. Järhult
Josef Järhult MD, PhD, is working as a specialized infectious diseases physician at Uppsala University Hospital and a Senior Lecturer and Associate Professor at Uppsala University. His main research focus is antimicrobial resistance in the human/animal/environment interface.