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Recent Trends in Disposal and Treatment Technologies of Emerging-Pollutants- A

Critical Review

Nadeem A. Khan, Saif Ullah Khan, Sirajuddin Ahmed, Izharul Haq Farooqi, Mahmood
Yousefi, Ali Akbar Mohammadi, Fazlollah Changani

PII: S0165-9936(19)30572-2
DOI: https://doi.org/10.1016/j.trac.2019.115744
Reference: TRAC 115744

To appear in: Trends in Analytical Chemistry

Received Date: 2 October 2019

Revised Date: 2 November 2019
Accepted Date: 18 November 2019

Please cite this article as: N.A Khan, S.U. Khan, S. Ahmed, I.H. Farooqi, M. Yousefi, A.A. Mohammadi,
F. Changani, Recent Trends in Disposal and Treatment Technologies of Emerging-Pollutants- A Critical
Review, Trends in Analytical Chemistry, https://doi.org/10.1016/j.trac.2019.115744.

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 Recent Trends in Disposal and Treatment Technologies of
Emerging-Pollutants- A Critical Review
Nadeem A Khan1, Saif Ullah Khan2, Sirajuddin Ahmed1, Izharul Haq Farooqi 2 , Mahmood Yousefi 3 , Ali
Akbar Mohammadi 4, Fazlollah Changani 5,*
1
Civil Engineering Department, Jamia Millia Islamia, New Delhi, India
2
Civil Engineering Department, Aligarh Muslim University, India
3
Department of Environmental Health Engineering, School of Public Health, Iran University of Medical
Sciences, Tehran, Iran
4
Department of Environmental Health Engineering, Neyshabur University of Medical Sciences,
Neyshabur, Iran
5
Department of Environmental Health Engineering, School of Public Health, Tehran University of
Medical Sciences, Tehran, Iran
*
Corresponding author: Department of Environmental Health Engineering, School of Public Health,
Tehran University of Medical Sciences, Tehran, Iran . Email: changani_f@yahoo.com ;
changani39@gmail.com

Abstract

Recently pharmaceuticals are emerging as a major source of pollution for the environment. It has
been well observed that the effluent discharge from hospitals has an eminent quantity of
chemical waste as antibiotics, disinfectants and other treatments wastes. Pharmaceutical effluents
are bioactive and their existence in the environment has been found harmful to both aquatic life
and humans. In developing countries, untreated wastewaters are discharged to local water bodies
by just following the local regulations. The current global challenges including high population
growth rate and climate change have contributed to the widespread epidemics and emergence of
diseases. Besides intractable and decaying antibiotic system, hospitals emit pathogenic waste
during treatment process that can lead to situations where a total ban on hospital effluent are
needed, for instance in multiple cases where discharge lead to strain on nature and quality of
water. In case of pharmaceutical residues, it has been observed that only 18-32% of the
pharmaceutical residues could be degraded by the secondary treatment of these seven
technologies and it has been increased to 30-65% by tertiary treatment. As far as the
pharmaceutical residues are concerned, it has been observed that MBR removes the residues with
the efficiency of 28-100%, varying for each pharmaceutical. This paper reviews the existing
treatment processes, their advantages and future perspective of this emerging area.

Keywords: Micropollutant, Hospital effluent, pharmaceuticals, Treatment Process, regulations.

Contents

1.0 Introduction ..................................................................................................................................... 1

1.1 Antibiotic systems (Ab) and its classification ......................Error! Bookmark not defined.

1.2 Occurrence of Drugs residue ................................................................................................. 3

1.3 Regulations ............................................................................................................................ 4

1.4 Influencing parameters .......................................................................................................... 4

2. Treatment Technologies for HWW ........................................................................................ 6`

2.1 Hospital Wastewater Treatment ............................................................................................ 6

2.2.1 ASP Treatment Techniques ............................................................................................ 7

2.2.2 SBR Treatment Process .................................................................................................. 8

2.2.3 MBR Treatment Process ................................................................................................. 9

2.2.4 Activate Carbon Treatment Techniques ....................................................................... 10

2.2.5 Carbon Nanotubes Treatment Techniques ................................................................... 11

2.2.6 Upflow anaerobic sludge Blanket Treatment Techniques ............................................ 12

2.3 Physio-Chemical Treatment Techniques ......................................................................... 13

2.3.1 UV/H2O2 Treatment Techniques ...................................................................................... 15

2.3.2 Fenton Reagent Treatment Techniques ............................................................................ 16

2.3.3 Ozone Treatment Techniques........................................................................................... 17

3. Treatment of effluent with combination of Processes and its advantages ............................ 18

4. Concluding Remarks with Future Prospective ...................................................................... 24

5. Acknowledgments ................................................................................................................. 25
References: .......................................................................................................................................... 25

Abbreviations
Pharmaceuticals compounds Phcs
Activate Carbon AC
Activate sludge Process ASP
Antibiotics Ab
Anaerobic-anoxic-aerobic A2O
Anaerobic oxidation Process AP
Biological Oxygen Demand BOD
Biological nutrient removal BNR
Chemical Oxygen demand COD
Environmental Protection Agency EPA
Granulated Activate carbon GAC
Hospital wastewater HWW
Moving bed biofilm reactor MBBR
Liquid chromatography-mass spectrometry LC/MS
Upflow anaerobic sludge Blanket UASB
Domestic Wastewater DWW
Wastewater treatment plant WWTP

List of Figures

Fig. 1. Schematic diagram showing types of Phcs ......................................................................... 1

Fig. 2. Fate during sewage and industrial effluent treatment. ........Error! Bookmark not defined.
Fig. 3. Activate Carbon types and uses ......................................................................................... 10
Fig. 4 USBR reactor clubbed with MBR.. .................................................................................... 13
Fig. 5 Physio-chemical Treatment depending upon Total organics carbon and flow rate ........... 14
Fig. 6 Reaction system for UV/H2O2 Treatment Process ............................................................. 15
Fig. 7 Technologies in combination with Fenton process. ........................................................... 16
Fig. 8. Ozone Reaction pathway. .................................................................................................. 17

List of Tables

Table 1 Details and classification of Ab ......................................................................................... 2

Table 2 Influencing parameters detected in HWW......................................................................... 5
Table 3 Nanoparticles properties used in treatment ...................................................................... 11
Table 4 Types of Treatment in different countries. ...................................................................... 18
Table 5 Types of treatment systems adopted in different countries. ............................................ 19
Table 6 Treatment Schemes for HWW........................................................................................ 21
1. Introduction
The Environmental Protection Agency (EPA) says that emerging organic micropollutant as a
new type of chemicals without any regulatory status and its impact is not fully known. Based on
advanced analytical technologies [1], emerging organic micropollutants are generally defined as
non-regulated organic trace pollutants just recently introduced or newly detected in the
environment. Due to their reported deleterious effects on both humans and the environment[2],
the study of this new class of pollutants is imperative[3]. The hospital wastewater generated
during various treatment processes like surgeries, laboratories, wards, administrative offices,
laundries and kitchens. It was well detected that the concentration of micropollutant in HHW is 4
to 150 times higher than domestic wastewater [2] and is considered as a pond for pathogens and
increase Ab resistance. HWW is usually treated with reference to BOD, COD and suspended
solids with, but usually, another micropollutant treatment is ignored [4][5][6]. In many countries,
it is treated as domestic sewage and no specific characteristic where judged in it and it
contributes up to 2% of wastewater for treatment in WWTP[7] but their treatment along with
domestic wastewater is non-efficient [8][9]. The types of HWW is presented in Fig. 1.

Fig. 1. Schematic diagram showing types of HWW

1
1.1 Antibiotic and its classification

The use of Antibiotics in daily life has increased so much that detection of their residues will be
felt in every field of the environment. The effect is not only restricted to humans or animals but
also to micro level creatures. The new type of resistant bacteria towards Ab are nowadays major
concern among the scientists because if these types of trends will continue then sooner or later,
we will not be able to treat simple medical problems with existing systems of Ab.
Many important indicating parameters are needed to assess the quality of water like NH4, oil,
grease, COD, BOD, Chlorine, Ab residues, radioactive elements, heavy metals, pathogenic
bacteria and some minute traces of biological indicators because their presence also affect the
utility of the water, even if present in traces [10] including adoption of optimum treatment
scheme with environmental implications [11]. India is among top most Phcs generators with the
expected business of 45 billion per year by 2020 with expected growth in this sector by 30%
[12]. Now a day, ‘priority’ pollutant is in the light which has shown detritus effect to human as
well as the environment but is slightly different from emerging pollutants due to
Ecotoxicological effects[13]. Different studies have shown the presence of Phcs in surface
water[14], ground water[15], Tap water[16], soil[17], sediments [18], sewage sludge[19] and
WWTP[20]. The Phcs are not easily degraded even in the sewer system and remain biologically
active for a longer time.
It can be seen that healthcare is improving day by day as new drugs are getting introduced. On
contrary, it has become quite visible that new diseases and antibiotic-resistant bacteria are
persistent in the environment. Antibiotics are the agents who restrain the increase of micro-
organisms. There are numerous outstanding forms of antibiotics and they may be categorized
based on their chemical structure, a movement mechanism, movement spectrum[21]. Out of
these classifications, the prominent one is their mechanism of movement and mostly based on it,
the maximum commonly used are b-lactams, sulfonamides, monobactams, carbapenems,
aminoglycosides, glycopeptides, lincomycin, macrolides, polypeptides, polyenes, rifamycin,
tetracyclines, chloramphenicol, quinolones, and fluoroquinolones[22]. The details and
classification of antibiotics are represented in Table 1.
Table 1 Details and classification of AbS [22].

No. Class of antibiotic Representative drug Mode of action Infection

Cured
1 b–Lactam Phenoxypenicillin, oxacillin, Shows way in the The greater
amoxicillin, carbenicillin, synthesis and sensitive
piperacillin murein assembly reaction,
hemolytic
anaemia,
interstitial
nephritis

2
2 Sulfonamides Sulfamethoxazole, sulfamethazine Producer of beta- Thrombocytop
Acetylsulfamethazine lactamases enia
Sulfadiazine, sulfadimethoxine
Sulfamethoxazole

3 Aminoglycosides Gentamycin Inhibits translation Nephrotoxicit

y
4 Glycopeptides Vancomycin Inhibits steps in pure Red man
in biosynthesis and syndrome
assembly Nephrotoxicity
Ototoxicity
5 Lincosamides Lincomycin Inhibits translation Nephrotoxicit
y Ototoxicity
6 Macrolides Clarithromycin, erythromycin-H2O Inhibits translation Coumadin
Oleandomycin, roxithromycin translation interaction
Spiramycin, tylosin
7 Rifamycins Rifamycin Inhibits transcription Body fluid
discolouration
Hepatoxicity
8 Tetracyclines Chlortetracycline, demolocycline Inhibits translation Hepatotoxicity
Doxycycline, oxytetracycline Tooth
discoloration
Tetracycline Impaired
growth
9 Chloramphenicol Chloramphenicol Inhibits translation baby
syndrome
10 Quinolones Oxolinic acid, nalidixic acid, Inhibits DNA Phototoxicity
pipemidic acid, flumequine, replication Achilles
pefloxacin tendon rupture
Impaired
fracture
healing

1.2 Occurrence of Drugs residue

The occurrence of drug residue in various aspect of life has significantly observed including their
harmful impact on the environment also. In India, the hospital wastewater is considered as
connect with WWTP but not considered in the waste management scheme separately [23]. Their
occurrence and fate generally depend on sources, pathways and environmental matrices. DWW,
hospitals and pharmaceutical factories are a major source of Phcs in the environment [24][25].
Some other minor sources are also there like discarded outdated Phcs, accidental exposure during
packing, handling. There are thousands of Phcs traceable in the environment, hence prioritization
is done considering various parameters like consumption pattern, ecotoxicity, risk,
biodegradation and difficulty in treatments[26].

3
 It is also seen that the quantity and concentration depend upon climatic conditions, but the
micropollutant like Ab characteristically vary in quantity as well as their detection is quite
difficult. Hence multi-class Phcs analytical method is adopted nowadays [27]. Their
development was done keeping in mind the biological characteristics like metabolites, residues
and degraded products which are ecotoxic in nature. The evaluation of wastewater from WWTP
of hospitals in India is of major concern [28]. The WTP that treats the wastewater from both the
healthcare facilities and domestic effluents had concentrations of SMX (13 times), trimethoprim
(6 times) and ofloxacin (5 instances) in its outlet than the treatment plant that received only
health care facilities effluents. Studies [29] on hospital effluents in Portugal, confirms values
similar to that in India.

1.3 Regulations
The identification of waste and wastewater discharged from Phcs producing industries are quite
difficult and are generally not considered as waste in legislation and its management. But the
complication arises when their treatment does not match with the desired results. There are no
guidelines in Europe’s regarding the hospital wastewater but some operational guidelines are
there[30][31]. In many countries like India and Germany HWW is considered as domestic
sewage and can be discharged to WWTP if meet desired specifications [7]. The existing
guidelines laid by WHO [32] suggest the way for managing the disposal and collection of HWW
and it poses risk in many developing countries due to its mismanagement. These guidelines
reveal the risk involved and types of diseases that might erupt with the discharge of wastewater
as well as solid waste. The guidelines suggest the discharge of HWW into domestic sewage if
meet with locally laid regulation, otherwise onsite treatment is required like primary, secondary
and tertiary followed by sludge disposal including advance treatment like MBR and USBR.
WHO guidelines also suggest a treatment scheme for rural healthcare facilities.
The EPA guidelines regarding this matter are generally governed by Clean Water Act [33] with
special regulation and disposal permit. The effluent limitation is imposed by local or state are
generally technology-based and limit the discharge of wastewater from Industry. Many such new
regulations are imposed on point sources as well as discharge from sewage discharge units to
natural water bodies. The guideline has been modified during past few decades and is very
stringent about it. HWW discharge indirectly in sewer has been regulated by Clean Water
Act[33] and direct discharges to natural water bodies have limitation to certain specific
pollutants. To face the direct discharge complications, a sanatorium is required to be developed
from or within state/country environmental organization or the EPA to set up a complete
wastewater treatment plant. Many radioactive treatments had been additionally given at
fundamental health centres. Radioactive iodine treatment exposure to the general public and
family from sufferers with the exposure of radionuclides. International Commission on
radiological protection posted a guiding principle after treatment from unsealed radionuclides
[34].

1.4 Influencing parameters

HWW is generally a byproduct of various medical and research activities in healthcare facilities.
During these periods various by-product violating various local regulations are emitted to the

4
environment. Nowadays various wastewater parameters are in focus due to the risk associated
with the Phcs and difficulty in Ab biodegradation.
Absorbable organic halides (AOX) are pollutants continuing to persist in the environment, and in
general, they have a tendency of accumulating in the food chain and may prove to be toxic for
both humans as well as aquatic life. A few prescribed drugs and their metabolites also contain
certain halogens and, therefore, make contributions to AOX emissions. Over and above the
discharge of solvents from laboratories, disinfectants, cleaning liquid and pills with chlorine,
counts much less [35].
The removal efficiency of micro-pollutant depends on biodegradability, physicochemical
properties, solubility, adsorption, pH, temperature and retention time. The characteristics of
HWW effluents are dependent on topography and some of the physical, chemical, biological and
microbiological parameters are as mentioned in table 2.
Table 2 Chemical characteristics of HWW.

Ref. No. Parameters observed Conc. Detected, upper

limits
[7][36] COD (mg/L) 7764
[36][2] DOC (mg/L) 130
[37][7] TOC (mg/L) 180
[7][2] BOD5 (mg/L) 2575
[38][39] BOD5/COD 0.4
[2] AOX (µg/L) 10,000
[5][34] Chlorine (mg/L) 400
[7] Nitrite (mg NO2/L) 0.6
[36] Nitrate (mg NO3/L) 2
[37][7] TSS (mg/L) 3260
[7][2] E. coli (MPN /100 mL) 106
[38][39] Total coliform (MPN /100 mL) 107
[39][2] Gd (µg/L) 300
[34] Hg (µg/L) 8
[7][36] Cu (µg/L) 230
[36][2] Ni (µg/L) 71
[37][7] Pb (µg/L) 19
[2] Zn (µg/L) 670
[38][39] Naproxen (µg/L) 11
[39][2] Diclofenac (µg/L) 15
[5][34] Ciprofloxacin (µg/L) 125
[36] Erythromycin (µg/L) 83
[36][2] Norfloxacin (µg/L) 44
[37][7] Ofloxacin (µg/L) 35
[7] Penicillin G (µg/L) 05
[38][39] Tetracycline (µg/L) 04
[39][2] Carbamazepine (µg/L) 02

5
 [5][34] Glibenclamide (µg/L) 11
[7][36] Penciclovir (µg/L) 0.01
[36][2] Cyclophosphamide (µg/L) 02
[37][7] Doxifluridine (µg/L) 0.08
[7][2] Tamoxifen (µg/L) 0.17
[39][2] Tegafur (µg/L) 0.09

2. Treatment Technologies for HWW

The appropriate water quality is required for its desired use and it is the basic need of life. [40].
Still, majority is out of reach to this basic amenity for their living. The wide use of Ab lead to
contamination at different levels and are also difficult to treat by any conventional treatment
process. The occurrence of Phcs in the waterbody is alarming as it deteriorates the natural
environment and is a reminder that use of Phcs must be limited to some extent. The occurrence
of micropollutant is an alarming condition and need to be prioritized as the removal of
micropollutant is still not clear. Phcs are used in an amount similar to those of the insecticides.
The advancement in analytical instrumentation has made it easier to detect the concentration of
certain pharmaceuticals in complex environmental matrices. It is well observed that significant
quantity of Phcs residues is reaching aquatic system through various sources, hence prioritization
methods are used for monitoring and regulation purposes. The selection of combined treatment
or separated treatment will surely be determined by parameter like atmospheric condition and
type including a number of doses prescribed by medical practitioners [41].

2.1 Hospital Wastewater Treatment

Some healthcare facilities use to collect their wastewater and rainwater separately for further
treatment purposes. The strategies adopted for the treatment of HWW faces the multiple barriers
including pre-treatment, biological specially MBR, advanced oxidation treatment process (AP)
(known as micropollutant strategy). This must be incorporated extensively in-order to remove
targeted micropollutant as desired. This scheme implementation will also be dependent upon the
adequate technologies and operational conditions. The minor influential parameter includes
environmental constraint, local legislation and economics of that particular area. In many
developing countries AP, targeted membrane filter development, Reverse Osmosis (R.O) process
and Nanofiltration process are in naive phase for the HWW treatment [42]. In researches [8] the
risk of ineffectiveness in the treatment of many antibiotics is highlighted for HWW. The overall
efficiency of micropollutant treatment strategy will be in the range of 1 to 15 log units.
There is bit concern about the Phcs as they remain untreated in conventional WWT. Nowadays,
various approaches are available like treating HWW separately at origin or mix with domestic
waste and then treating it. It was observed that pseudo-first-order kinetics during Phcs
degradation hence treatment at source is best in order to avoid dilution. So the separated
treatment is now considered for HWW [43][44][45]. HWW treatment commonly starts with a
pretreatment step to cut up the solid fraction, accompanied by way of natural remedy to take
away most DOC, nutrients, and a few Phcs thereby, in the end, it represents the physicochemical
process for removal and sanitizes the effluent.

6
In near future, it is expected that appropriate treatment process for hospital effluent will come up
that will solve the problem of microbial resistance and other impacts of emerging contaminants
present in it. This can be achieved by adopting sustainable and competitively priced strategies.

2.2.1 ASP Treatment Techniques

The activated sludge process is usually employed for municipal WWTPs. In this treatment
process, the sludge is mixed with wastewater is along with the microorganisms to get rid of
nutrients which oxidize carbonous biological matter and other chemicals during the treatment
process. The treatment starts by mixing the waste with acclimatized microbial cultures in the
aerated tank. The sludge is well acclimatized in order to cope up in case any shock loading
occurs during the treatment process of wastewater.
In experiment under PILLS project, the use of UV/TiO2 was compared with UV alone. The setup
consists of four conical cartridges in fibre in low-pressure UV lamp was a test and seen that
under first cycle marginal removal efficiency was achieved. In respect to the Phcs, global
removal obtained under different treatment process as tertiary of hospital is seen 90% of top Phcs
in wastewater, whereas removal obtained through chlorination and coagulation can be up to
70%and 40% respectively.
Activated sludge Process (ASP) is intended to reduce organic pollutant, suspended solids and
flocculants matter in order to produce efficient effluent in WWTP. Many Phcs [42] are detected
in various treatment plants during the treatment process. The removal efficiency during ASP has
been found to vary from 30% to 70% with long retention time. The performance is dependent on
various parameters like seasonal variations, temperature, pH, dissolved oxygen (DO), natural
load, microbial community[46][47]. In some studies, biodegradation of many Phc’s like
Ibuprofen, naproxen, bezafibrate and estrogens is suggested during aerobic and anaerobic

conditions[48]. At higher concentration, ASP becomes inhibited by active pharmaceutical

ingredients and produce low efficiency during treatment. In the aeration tank, the SRT is

7
manipulated to make sure that removal efficiency of a particular parameter is reached as desired
before undergoing a solid/liquid separation during in the clarifier. The gathered settled activated
sludge is firstly recycled by returning it to the aeration tank to take care of a difficult and high
concentration of depolluting microorganisms. The fate of pharmaceuticals during sewage and
industrial effluent treatment is presented in fig. 2.
Fig. 2. Fate during sewage and industrial effluent treatment[49].

According to some researchers, co-metabolic biodegradations might play a key role in the
effective elimination mechanism of micropollutants throughout activated sludge process of
HWW, as the concentrations of micropollutants might be too low to feature an instantaneous
increase substrate [50].

2.2.2 SBR Treatment Process

Sequencing batch reactor (SBR) is typically sophisticated and modern activated sludge organic
treatment system. This type of approach is now employed in few systems. SBR structures are
hybrid structures having tendencies of CSTR and complete mix systems but they need to be
considered for treatment especially with a different type of wastewater. In SBR cycles are fill,
react, settle, draw and idle, independently[49]. An SBR differs from the traditional treatment
activated sludge system thereby doing all abovesaid processes in one reactor itself. There may be
no decrease in sludge or biomass concentration as compared to activated sludge device in the
SBR process. SBR is helpful for organics and nutrient elimination also. Due to this benefit, it is
used worldwide for WWT from many years.
SBR is a modification in activated sludge approach of treatment such that that separate tanks for
aeration and settling do not appear to be required and there is no sludge return. Such method is
generally done in less area or if there is a shortage of land [51]. In another study, lower
efficiencies between 63-69% for COD was observed due to ill-treatment in SBR technology [42].
The efficiency of BOD5 achieved was 81% with 4hour of aeration and for 90 min SRT. As a
result, the optimum removal efficiency can be achieved under four hours of aeration time and of
60 min of SRT. BOD5 removal was determined to be 82% on the average whereas COD removal
to be half a mile on an average. NH3 removal efficiency determined to be 96% on an average.
The removal of PO3-4 was achieved about 90% at 30 min SRT respectively. SS removal was
determined to be 98% on an average. SBR is determined as a useful system for the treatment of
HWW. Anaerobic sequencing batch reactor (AnSBR) can also employ for the HWW treatment
with the presence of oxygen in dark condition [52]. Different dosing condition utilizes fatty
acids. The Phcs up to 40mg/L can be treated and beyond it results in toxicity to microbial
community. As a result, the effect of dozes on Ab had been visible on the microbial network to
the use of an SBR. It altered and due to which microbial system continues to show stability
beneath high antibiotic effects and prolonged-time period operation with the useful resource of
homoacetogenesis coupled with hydrogenotrophic methanogenesis.

8
2.2.3 MBR Treatment Process
Ab removal during wastewater treatment using membrane biological reactor (MBR) occurs
mainly through biodegradation, sorption to sludge, photodegradation, and volatilization. The
MBR joins ASP treatment with low-pressure membrane causing hindrance to pollutants. This
system is regarded as a most efficient system for HWW treatment as it results in a reduction of
sludge, low suspended solids, high removal of pathogens[53]. Long retention time enables
nitrogen removal and increases the growth of nitrifying bacteria with enhanced removal of
micropollutants. The ratio of VSS/TSS in MBR system is lower in comparison to ASP system of
treatment. In MBR system, removal of physical characteristic from pollutants takes place and
discharges high quality permeates. High COD removal in MBR provides a stable environment
for microorganism for efficient removal of micropollutant. In past decade, MBR process
becomes alternate for ASP, due to its high micropollutant removal efficiency [54]. The removal
efficiency in comparison is greater by 15-42% [54]. But in many cases, it was also found that
the removal of some Ab in both the systems are same [53].
However, Henry values smaller than 10-5 are unaffected by volatilization[55] and due to high
turbidity, biodegradation becomes negligible [56]. In MBR treatment system, Versicolor was
injected in many forms. In sterilized condition fungus carries out biological activities. However,
many types of research are going into this field like aerobic as well anoxic rectors are in
place[57]. MBR treat a wide range of micropollutant with less cost but due to membrane fouling,
it is tedious [58][59][60]. Bio-entrapped membrane salt membrane bioreactor is also used in
HWW treatment with removal efficiency up to 85% [58][61]. Anaerobic membrane bioreactors
are new and innovative technologies for fluctuating load[62]. In a study carried out, COD
removal efficiency was achieved up to 47.2% with low organics removal efficiency[63]. COD
removal efficiency with the addition of methanol up to 78% can be achieved by varying organic
load [64].
Usually, MBR is used as aerobic pretreatment for various physical removal of contaminants like
ozonation, UV/H2O2, and reverse osmosis (RO)[44]. The MBR effectiveness depends on
hydraulic retention time and sludge retention time. However, for HWW, SRT is important[8].
Parameters of aerobic, anoxic, and anaerobic are employed in different stages for removal along
with the type of membrane and material used in them.
Membranes can be used in external modules or be submerged. Membranes can also be defined
by their pore length. Hence microfiltration membranes are classified as having pore sizes of
around 0.2–0.4 µm and, for ultrafiltration membranes it can be 0.03 and 0.06 µm. Smaller pore
can’t ascertain better removal but they are conjointly needed for the treatment of the effluent
(e.g., viruses can’t be eliminated by using ultrafiltration membranes due to its tiny length) and
additionally to get desired quality of the treated effluent, subsequent polishing treatments are
required [65].
In the European-swiss PILLS pilot project plant, more than 65 micropollutants were analyzed in
SP-HPLC-MS/MS with SRT up to 50 days but removal efficiency of all compounds was only
22% can be achieved because of the low percentage of iodinated contrast media degradation[66].
In DENEWA project, the removal efficiency of 40 micropollutants on an average of 80% and
wash-off faecal matter of about 100% is seen for HWW[67]. However, studies recommend that
estrogen and cytostatic gets removed after treatment using MBR[68][69]. In some cases, removal

9
of Cancerostatic platinum compounds is due to biodegradation[38] increases even after
maintaining SRT from 42 to 300 days. In some studies, [70], low HRT like 3hr has been
observed for removal of Phcs due adsorption process on colloidal particle surface. MBR
treatment can’t remove micropollutant completely alone but need polishing like ozonation,
activated carbon, photodegradation etc. MBR process is a costlier process followed by either
ozonation, packed activated carbon or filtration[45].
Recently a new type of submerged sponge-membrane (sponge MBR), modified and new hybrid
MBR is in use with COD, nitrogen removal, nitrification and denitrification simultaneously.
Here low fouling rate was observed, although Phcs were not included in the study [71].

2.2.4 Activated Carbon Treatment Techniques

Adsorption using activated carbon is quite an old method of treatment of pollutants including
treatment of HWW. It was found to have the capability to remove endocrine disruptors [72].
Many treatment studies were carried out employing different forms of activated carbon to give
efficient results [73][74]. In adsorption, molecular-level attraction leads to binding of the soluble
and gaseous chemical substances on the surface. Activation of carbon results in a porous
structure which enhances the adsorption capabilities. The types and uses of activated carbon are
shown in fig 3.

Fig. 3. Activate Carbon types and uses

In a study employing activated carbon technique, absorbability, chemical structure and
adsorption for bisphenol A were tested with positive results[75]. Many variable parameters were
found effective in the treatment of endocrine disruptors like adsorption capability, micropore
volume and specific surface area. Their life also varies depending upon carbon type and service
lifespan. The Coal-based carbon is most effective among others due to large pore-volume. Some
difference in adsorption capacity was also being observed during study for real and simulated
wastewater regarding various types of endocrine disruptors[76].

10
Pollutant removal from wastewater can be high energy consuming process and the price is the
key area that must be reconsidered for its application. The main removal mechanisms in the ASP
is biodegradation, so it should be a cost-efficient process. Some investigations suggest that high
EDC removal can be achieved by standard biological waste treatment processes, but they are
quite variable. For this, some parameters like temperature, hydraulic retention time, sludge age,
and nitrification setting area unit are important for estrogen removal throughout biological
wastewater treatment. Such process often takes care during removal of EDCs by the optimization
of operational parameters in conventional waste treatment. In order to remove effectively the
EDC from surface water bodies via HWW, it is best suited to use biological waste treatment
processes. It is impractical for that physical and advanced oxidation to be widely employed for
treatment. In some cases, physical process suggests that advanced chemical reaction could also
be advantageous for easy operation and high removal efficiency.

2.2.5 Carbon Nanotubes Treatment Techniques

Single-walled, double-walled and multi-walled carbon nanotubes are used for Phcs removal by
varying important characteristics like temperature & pH. Adsorption capacity increases up to
70% in the pH range 3-7 [77]. Carbon nanotube shows better removal efficiency for Ab up to the
limits of 10-95% [78]. Carbon Nano-tube is new and very promising adsorption technology
nowadays for HWW treatment[79][80]. They can also be clubbed with graphene, graphene oxide
for improving efficiency by increasing the surface area. But some parameters required to be
improved like reducing the steric effect of micropores, regeneration, recycling and decreasing the
cost of production. But due to co-existence of adsorbents and Phcs may be a great threat to
aquatic life. Many AbS are removed by many Nano-absorbent like TiO2, FeO, Aluminum etc. in
step by step process like adsorption on the external surface followed by interparticle
diffusion[81][82]. Due to the high surface area, many metals like arsenic, lead, mercury,
cadmium, chromium also has shown high adsorption capacity. Many other nano-materials are
also used for the same purpose as shown below in Table 3:

Table 3 Nanoparticles properties used in treatment [81][82].

11
 Material used Characteristics Benefits
Efficient specific area, adsorption used as magento-optical
Metallic and mixed oxide
capacity and chemical permanency devices with low cost and
nanoparticles
toxicity
Super paramagnet, Densimetric Biocompatibility, low cost,
Magnetic nanoparticles separation with good surface area easily synthesized

Lower price range and easy

The efficient surface area with the
Carbon nanotubes accessibility and
ability for π-π interactions also
functionalization
Efficient mechanical strength Efficient surface
Graphene and/or Graphene
Efficient surface area adjustment with a low
oxide
water dispersible
Silicon nanoparticles High optoelectronic and electronic Biocompatible low cost
properties
High strength Compostable
Cellulose nano particles
Light weight Replaces toxic materials
Optics transparency and Environmental friendly
Zinc oxide nano materials luminescence effect Easy to synthesis
Efficient Sensitivity
Efficient surface energy
Compact size
Biosensors Efficient reactivity, Efficient
User friendly
Surface conductivity with
Efficient Surface/volume ratio

In a study, the high removal rate of Phcs was achieved in both hospital wastewater and municipal
wastewater (artificially made) within pH range of 4.0 to 10.0 using carbon nanotubes[83]. The
adsorption pattern is rarely affected by the mixed ions and many other thermodynamic
parameters show that the adsorption becomes spontaneous and exothermic. Adsorption rate-
controlling mechanism studies suggest that process is entirely governed by external mass
transfer. The adsorbent is probably efficiently desorbed in ethanol/ sodium hydrate solution with
the recovery possibilities above 93%, and then carbon nanotubes may be reused at the least 8
times with good efficient overall performance. For the future prospect, both kinetics, as well as
thermodynamics studies, can be beneficial for designing and considering HWW treatment
process.

2.2.6 Upflow anaerobic sludge Blanket Treatment Techniques

Upflow anaerobic sludge blanket (UASB) is widely used owing to increased biomass content,
microbial types, low cost, flexibility and adaptability to pH as well as temperature. By increasing
the organic loading rate leads to increased COD removal up to 91% [88]. When natural loading
rate leads to growth beyond 2.09 kg COD/m3/d, at pH ≥8, efficiency gets affected badly, which
12
allows sulfate lowering microorganism to thrive over the methanogens in the reactor and a
similar observation was also mentioned in literature[84].
UASB reactors are also used as pre-treatment containing various dozing of Ab under high
organic loading up to 21.02 kg COD/m3/d and with pH 8.26 to attain a higher efficiency of COD
and some Phcs residues removal[85]. Some other types of USBR reactor are also in use like
Expanded Granular Sludge Blanket (EGSB), which has high Upflow velocity in order to separate
sludge from granules. In the reactor, the psychrophilic anaerobic digestion was carried out and
COD removal efficiency was found to be up to 70% [85][86]. In a full-scale wastewater
treatment in China plant for the oxytetracycline manufacturing, the usage of EGSB and aerobic
reactors after it is also used[85]. Another similar type of reactor is upflowed anaerobic stage
reactor (UASR), which has combined properties of USBR and anaerobic baffled reactor. It
benefits from separating acidogenesis and methanogenesis and allow reduction of biomass
washout, quick hydraulic recovery and shock loading. The feasibility of upflow anaerobic stage
reactor(UASR) was carried out for pretreatment for HWW containing tylosin and avilamycin
antibiotics and achieved quite efficient results. Observation with different OLR on UASR saw as
a separation of acidogenesis with methanogenesis from sludge and assessed the steadiness of the
reactor [87]. COD removal efficiency up to 75% at low OLRs but with increasing OLRs up to
3.73 kg COD/ m3/d and HRT from 4 to 2 days, the COD removal can be 45% achieved. The
UASB reactor clubbed with MBR is represented in Fig 4.

Figure 4 UASB reactor clubbed with MBR.

Figure 5 UASB reactor clubbed with MBR.

2.3 Physio-Chemical Treatment Techniques

13
HWW physicochemical characteristics are somewhat same as of domestic wastewater. In HWW
dissolved organic carbon, BOD, COD, suspended solids and Chlorides are at a higher end as per

Figure 6 Physio-chemical Treatment depending upon Total organics carbon and flow rate[88]

local legislation but Phcs are much higher in HWW[2][66]. In HWW, the presence of
micropollutants is mainly focused nowadays due to low biodegradability, antibiotic-resistant
genes and associated results like cancer, mutagen and EDCs [89]. Till date, there are hardly any
norms for the concentration of Phcs in HWW. Recently, a few advancements in the domain of
water treatment also encouraged as operation changes in APs for natural contaminants or dealing
with different surface-based media for treatment. APs can be characterized as those treatment
systems able to create inbound hydroxyl radicals. A concoction with high oxidation capacity able
to expel herbal and inorganic mixes. AP’s may be preferred relying on the effect of the oxidizing
agent or the method for utilization in its production.

Some Physicochemical treatment depends upon types of treated HWW as shown in Fig 5.0. It
shows the application range and method to be adopted. It is obvious that UV/H2O2 and
ozonation, are encouraged to deal with solutions at low flow rates and low organic natural carbon
content. Biological treatments can be suggested for effluents with high flow rates. Alternatively,

organic removal is advised having effluents with low flow charge are used. Ultimately, the
mixture of an AP with biological treatment is recommended for a medium organic content and
an intermediate flow rates [88].

14
2.3.1 UV/H2O2 Treatment Techniques
The normal mechanism for the photolysis by H2O2 is the randomness of the peroxide molecules
into hydroxyl radicals with a yield of two HO radicals when radiation absorbed. The energy to
interrupt an O-O bond is 213 kJ/mol, indicates low wavelength radiation (200-280 nm).

Figure 7 Reaction system for UV/H2O2 Treatment Process[90]

The removal of micropollutant from aqueous solution by UV/H2O2 treatment paved the path to
thinking in a new direction. OH, radical play important role in the degradation of Phcs having a
quantum yield to be unity. Several Ab is liable to be removed by either UV, H2O2 or
both[91][92].

In a study, degradation effect is shown under low pressure and polychromatic medium pressure
of UV lamp[93]. The organic contaminants shows lessen tendency for electrophilic addition.
Any difficulty in ultraviolet radiation or low transmission to the waste content material fabric

affects the assembly of free radical, therefore the slight-weight need to be cleaned periodically.
The tool is sensitive to pH scale and the basicity needs to be maintained; hydroxide needs to be
utilized in the vicinity of carbonate because carbonate reacts with radicals [94]. It indicates
15
efficiency in mineralizing natural pollutants but has hazards like terrible ultraviolet light ground
assimilation functionality. Many others like silica-based porous medium show good removal
efficiency towards Phcs and AbS[85]. They usually enhanced specific surface area thereby
absorbing capacity[85].

Fig.8 Technologies in combination with Fenton process.

2.3.2 Fenton Reagent Treatment Techniques

Fenton treatment process involves the reaction of hydrogen peroxide with iron to produce its
radical, which can also be enhanced by photoreduction of Fe+2 and Fe+3. Many studies suggest
that Photo-Fenton is a viable option for HWW treatment [95][96]. Complete mineralization of
some Phcs by this process took 50 min [96]. Penicillin was removed after 40 min with advanced
oxidation along with Fe2+/H2O2 at pH=3, COD and total organic carbon (TOC) removal
efficiency with dark Fe2+/ H2O2 at pH=3 is better than dark Fenton-like Fe3+/H2O2 [97].

In absence of organic ligands, Fe3+ hydroxyl complexes regenerate enough Fe+2 by absorbing
UV/V rays. Fe3+ easily combines to produce complexes with different natural ligands, typically
with polydentate ligands. Photo-Fenton process is economical with ozonation for treating Phcs,
and used for the treatment of membrane rejected effluents having immoderate concentrations of
micro contaminants [96][110]. But there are some flaws also like pH adjustment, disposal of
sludge, the high cost of H2O2 and use of catalysts. Many other treatment options are also possible
as shown in Fig.7. Photo-Fenton process is promising AP in the elimination of a various type of
Phcs. As in HWW treatment, the main challenge is to treat micropollutant effectively as per the
local or National legislations considering the cost aspect. Fenton process not only used in the
elimination of various micro contaminants dissolved in water or wastewater but is also simpler
method. In few cases, it is not needed to collect separately soluble iron species from the treated
waste and it depends upon regulative limits of effluent set by Local/national authorities. Majority
of studies have shown the effectiveness of hydrogen ion for Photo-Fenton reactions. However,
Fe3+ with higher molar absorption coefficients within the wide range of UV spectrum has seen
many areas that have aquo complexes, identical time of radiation as much as 580 nm shown
good effect. Introduction of chelation complexes with natural ligands is needed for iron in the
surrounding, regulating iron transport, specification, and accessibility, particularly in moderate
waters our bodies. New approach is economical as the chemical rate for hydrogen ion requires
great attention for modification, mainly for the procedure of treatment process. The immoderate
Photo-Fenton efficiency in the course of elimination of micro pollutants has brought about
improvement in its pilot-scale studies and methods of concentrating parabolic superstar
approach. The use of different process has been intensely considered for the low cost approach
and has considered many options in this path. [98].
The pilot-scale project considered the entire removal of a surplus of prescription drugs generally
in HWW, just like antibiotics, nonsteroidal anti-inflammatory drug, medicinal drug, analgesic
pills, hormones, x-ray steady difference media [99] and others have been quite satisfactory. In
some pilot-scale studies, Photo-Fenton system for HWW treatment for prescription drugs inside
16
the concentrate is used and applied LCMS for analysis of the mechanics in a partner in nursing
monetary assessment [100]. Pretreatment of effluent, enabled Photo-Fenton can act at lower
costs and with better starting megacycle according to per second concentrations, thereby
decreasing photo reactor length and additionally the amount of reagents required in keeping
kiloliter of treated effluent. These effects give a boost to the notion that remedy of very small
concentrations of contaminants, similar to the ones found in HWW, needs special operative ideas
from the equipment of AP’s to high-organic-load business wastewaters.

2.3.3 Ozone Treatment Techniques

In this method, ozone oxidizes micropollutants directly or indirectly on hydroxyl radical acting
as strong oxidizing agent. It reacts selectively with double chain bonds, –OH, –CH3, –OCH3),
and N, P, O and S anions but in alkaline condition, the indirect reaction occurs. In the study, the
ozone concentration of about 5 to 15 mg/L was maintained and observed that some Phcs removal
efficiency achieved to 96%[101]. Ozone can provoke and participate in many organic and
inorganic substances via its reaction all through its era. Ozone molecule is a triatomic molecule
having lewis resonance bureaucracy in popular. At room temperature, it is quite unstable and
human can discover it even in low concentration. Ozone switch efficiency from gas to liquid is
managed through pH, temperature, float charge, bubble length, ozone stress and ionic strength
[101].

Fig. 9. Ozone Reaction pathway[102].

Recently in Europe, many treatment plants have been upgraded with a combination of a physical
and biological process for effective removal of micropollutants. It has been found that they
convert them into an unknown product of uncertain toxicity [43][103]. But they are very low in
quantity, having insignificant estrogenic and antimicrobial activities. It was also observed that
17
the end result could be formaldehyde, ketones, phenols, nitromethanes and other types of
carcinogenic substances [104]. A pilot-scale HWW with pretreatment, membrane bioreactor, and
post-treatment technologies, with ozone, was operated. Elimination required 1.08 mg O3/mg
dissolved organic carbon in general [105]. In general, greater dissolved organic carbon will lead
to more ozone doze for HWW treatment. In a recent study, it was observed that its concentration
will be in the range of 0.50–4.7 mg O3/mg dissolved organic carbon in HWW treatment[106]. It
was also observed that low pH plays important role in its lifetime by increasing it from 1min to
10min and the removal efficiency is also having a negative effect at high pH in the range of 5-9
in HWW treatment. But some shortcoming is also with this technology like its costly production,
heat production and its conversion efficiency is low (1 kg of O3 production need requires 12
kWh)[107]. The upgradation value of small to medium scale WWTP for HWW, with a
retrofitted ozonation degree, may want to boom by means of up to 50% and energy consumption
is reduced up to 30% [108]. After mixing with water paths as direct response as molecular fuel
and by indirect reaction through oxidants reminiscent of radical species with reactions can take
vicinity at the regular time. Someday reaction can dominate counting on various factors like
temperature, pH and chemical composition of the waste. Acidic conditions decorate gas to react
directly through selective reactions.

3. Treatment of effluent with a combination of Processes and its advantages

As discussed in the previous section about the individual process and their treating efficiency of
different Phcs from HWW, it is obvious that individual treatment process is less effective.
Hence, a combination of processes are in practice and various researches[109][110][111] has
been published in this respect. This section deals with the treatment strategies adopted by
different countries and their efficiency in combination with each other. Table 4.0 indicates the
treatment strategies nowadays in use by different countries.
Table 4 Types of Treatment in different countries [8].

S.No. Country Treatment adopted to date Reference

1. India Direct disposal to the natural [112][113][28][114]
waterbody or send to the
Treatment Plant
2. Indonesia Direct disposal to the natural [115][116][117]
waterbody or send to the
Treatment Plant
3. Bangladesh Direct disposal to a natural [118][119], [120]
waterbody
4. Pakistan Direct disposal to a natural [121][122], [123]
waterbody
5. Nepal Direct disposal to a natural [124][125], [126]
waterbody
6. China Treatment facility [127][128][129]
7. Republic of Treatment facility [130][131], [132]
Korea
8. Japan Treatment along with domestic [133][134], [135]

18
 wastewater
9. Australia Treatment along with domestic [136][137], [138]
wastewater
10. Egypt Treatment along with domestic [139][140], [141]
wastewater
11. Thailand Treatment along with domestic [142][137], [143]
wastewater
12. South Africa Treatment along with domestic [144][145], [146]
wastewater

The type of sequences that are adopted for the combination of various treatments related to
HWW, depends on the economic condition of that country. In general, full-scale plant like
Combined activate sludge process is prevalent in India, China & Iran; MBR process followed by
disinfection is widespread especially in China; Flocculation followed by Combined activated
sludge process in the Republic of Korea; Septic tank followed by Horizontal or vertical surface
flow bed reactor in Nepal; Facultative Ponds in Ethiopia, Activated sludge process or septic
tanks in Iran [147]. Few pilot-scale studies like Combined activated sludge process followed by
Filtration and Chlorination in India is also reported; Aerated Biofilters followed by Ozonation in
Indonesia, combined activated sludge process followed fixed film bioreactor also reported in
Iran.
Table 5 Types of treatment systems adopted in different countries [8].

S.No. Country System Adopted till date

1. India Combined Activated Sludge Process followed by
Sand Filtration+ Chlorination [4]
Or
Coagulation followed by Filtration+
Chlorination [148]
Or
Combined Activated Sludge Process [112]
2. Nepal Septic tank followed by Horizontal or vertical
surface flow bed reactor [124][149]
3. Thailand Photo-Fenton
Or
Photo-Fenton followed by Combined Activated
Sludge Process [142][150]

4. Iraq MBR[151][152], [153]

Many studies [148][124][142] regarding treatment of HWW treatment has been published for
full scale, pilot and as well as lab scale [8]. Since most of the research in this regard was
published based on pilot/lab scale while a few related to the full scale treatment plant, so a lot of
improvement is still needed to correctly access the methodology and effectiveness using
optimization techniques. Many parameters in designing for the full-scale plant are considered
like characteristics, temperature conditions and economic feasibility of HWW. Trends in this

19
field are like the monitoring of emerging contaminants, adopting new and innovative treatment
technologies as well as future perspective has been burning topic nowadays.

20
 Table 6 Treatment Schemes for HWW

Ref. Treatment Scheme for HWW*

Biological Treatment Removal Physicochemical Treatment Removal Recommendation drawn from
adopted Efficiency of Efficiency of results about Treatment train
Phcs on an Phcs using
average combination
[111] MBR 57-81% H2O2/UV MBR+ H2O2/Fe2+/UV+O3
H2O2/Fe2+ 12-100%
/H2O2/Fe2+/UV/UV-O3
[154] MBR 39-60% -------- MBR#
[155] MBR 34-100% -------- MBR#
[96] -------- O3 91% O3#
[156] MBR Upto 60% GAC + O3/H2O2+UV Upto 90% MBR + GAC + UV
Or
GAC + UV
[157] MBR Upto 60% O3 + PAC + sand Upto 80%
filtration
PAC + sand
Filtration
[158] MBR Upto 90% O3 + GAC Upto 70% MBR + GAC + O3
[41] MBR Upto 74% O3 + UV 50-90% MBR + UV+ O3
[159] CAS Aver.55% Chlorination Aver.65% CAS + Chlorination
[160] Septic Tank Aver.42% Oxidation Ponds Aver.54% Septic Tank + Oxidation Ponds
[124] Septic Tank Upto 39% Wetlands Upto 77% Oxidation Ponds + Wetlands
[161] MBR Upto 74% Chlorination 95% MBR + Chlorination
[162] MBR -------- Anaerobic -Oxidation -------- MBR + Anaerobic -Oxidation
Ditch Ditch
[163] Filtration + CAS 59%–76% -------- Filtration + CAS
[130] Flocculation + CAS + 80% -------- 21 -------- Flocculation + CAS + Activated
 Activated Carbon Carbon
[164] Septic Tank Aver.42% Anaerobic Filters 65% Septic Tank + Anaerobic Filters
[165] UASB Upto 67.5% Anaerobic Filters 64% UASB+ Anaerobic Filters
[166] CAS Aver.58% Chlorination 92% CAS + Chlorination
[167] CAS Aver.62% Chlorination 91% CAS + Chlorination

22
Different Physical, as well as Phcs, are considered in studies, # Further improvement can be done, CAS-Combined activated sludge
process, MBR- Membrane Biological Reactor, GAC- granulated activate Carbon, UV- ultraviolet radiation, O3-Ozonation Process,
H2O2- Fenton Process,

It is well understood that individual treatment processes are not very effective in removal of micropollutants. Due to which, newer
alternative technologies are under investigation and that too with different combinations. Like, the addition of activated carbon can
improve the elimination of less biologically degraded by adsorption [168][123], [169], [170]. It was also observed that suspended
biomass combined with suspended one can enhance biodegradation of micropollutants. The biofilters with fixed biofilms are also
considered as the main focus on sand biofilms processes [171]. Many important parameters like SRT also imposed performance risk
while exciting effects were found by developing diverse microorganisms within the system; as a result of which the biofilm reactor
compensated higher biomass concentration.
In hybrid biofilm activated sludge processes, bacteria with low growth enhanced removal with ammonia and nitrite oxidizing bacteria.
Moving bed biofilm reactors (MBBR) is also promising technology with biofilm growth in the tank and it can be enhanced by ASP for
improving nitrification and denitrification [171][172], [173]. Some studies based on MBBR clubbed with MBR in which physical
parameters were analyzed with different detention time had shown promising trends due to their biodegradation pathways. Besides
MBR has some physical complications in operation as discussed in previous sections. UASB is also a good alternative coupled with
aerobic MBR with low HRT. This system can achieve efficient micropollutant removal as compared with conventional process
[174][123], [175], [175]. Involving all the hybrid and combined processes, cost of technology involved, types of wastewater,
temperature and most importantly financial condition for running these projects play a vital role.

23
4. Concluding Remarks with Future Perspective
If we relate the past to the current scenario of Phcs in the environment, we will certainly notice
that many diseases are now days not curable by simple previously prescribed Ab. Many research
projects have been done in European countries that have shown the risk of such residues like
Pills, Sibell, Poseidon, No pills, Neptune, Knappe, Endetech etc. In the previous section it was
mentioned that there are no stringent laws for HWW and in many countries, they are mixed with
domestic wastewater. Many difficulties are there with this research due to complex analysis,
detection of targeted Ab, affecting waterbodies rate of flow, nature of treatment varies with
season to season. The way nature is being degraded and harmful effect are being imposed, it is
important to take immediate and decisive steps in this area. WWTP serves as a nursery for
antibiotic-resistant systems hence monitoring with great attention is also needed. Many trial with
different treatment process, in combination, were considered. Many countries are paying great
attention to this topic by considering the severity of the risk involved in it. Research can have
future prospect involving below said direction for the attainment of better efficiency regarding
HWW:
1. The effect of Physio-chemical parameters on Phcs concentrations.
2. Aerobic, Anaerobic and Facultative ponds can have future in the removal of Ab with fewer
energy requirements.
3. Proper studies can be performed about the intermediate compounds that are formed during
various treatment processes. Their chemical identity can be established with full-scale
investigations.
4. Sludge matrix on Phcs can also be studied keeping in mind the removal efficiency of the
different treatment process.
5. Degradation of Phcs and Ab in natural environments can be further studied considering the
nature and types of microbiological activities taking place.
6. During degradation process, formic acid and acetic acid formation were reported in many
studies which can be further investigated and correlation can be developed with a model.

The different technologies employed for HWW treatment including pre-treatment, MBR and
other advanced oxidation processes have been discussed in the paper. Due to uneven nature of
HWW, different removal mechanisms would be needed. In many countries upgradation of
previous treatment systems is underway like Switzerland. By considering the risk associated with
HWW management, it will be possible with efficient removal of Ab that can be achieved by
adopting sustainable, most economic and less energy required technologies. Further
technological advancement can henceforth produce a viable implication and make a strong
national policy with proper legislation towards production and disposal of HWW. Their longer-
term risk due to acute and regular exposure needed to be considered with proper metabolic
pathways determination.

24
5. Acknowledgements
This study not only considered various treatment technologies with their proper effect during the
removal process for HWW. During this study, co-authors helped by motivating with providing
correct direction. They also helped by giving proper support in order to complete this research.

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Figure 1 UASB reactor clubbed with MBR

Fig.2 Technologies in combination with Fenton process.

• The effect of Physio-chemical parameters on Phcs concentrations.
• Aerobic, Anaerobic and Facultative ponds can have future in removal of AbS with
less energy requirements.
• Proper studies can be performed about the intermediate compounds that are formed
during various treatment processes. Their chemical identity can be established with
full scale investigations.
Declaration of interests

☒ The authors declare that they have no known competing financial interests or personal relationships
that could have appeared to influence the work reported in this paper.

☐The authors declare the following financial interests/personal relationships which may be considered
as potential competing interests:

Corresponding author
F.Changani