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Only a few point sources, such as hospitals and care institutions, can be identified. Actions for removal at these sites can reduce the amount of pharmaceuticals in wastewater, but it will not dramatically affect the total pharmaceutical load on wastewater treatment plants. Consequently, the ability of wastewater treatment plants to remove pharmaceuticals is important for the amount of pharmaceuticals that reach Swedish waters. The removal of pharmaceuticals at wastewater treatment plants depends on the physical, chemical and biological properties of the substance as well as the biochemical processes at the plant, the plant configuration and the operation of the different treatment processes.

Since very few pharmaceuticals are volatile, the removal through evaporation is expected to be insignificant for most pharmaceuticals. Some pharmaceuticals adhere strongly to sludge, which is separated from the water phase at several stages of the treatment process. Pharmaceuticals sorbed to sludge, that has been removed from the wastewater treatment end up in the sludge handling part intravenous oxycodone of the plant. The biological treatment method and the biochemical processes within it are important for the removal of biodegradable pharmaceuticals. Pharmaceuticals cannot be removed biologically in plants operated solely with chemical-mechanical treatment. For activated sludge treatment processes the sludge age has been addressed as an important parameter for the removal of pharmaceuticals, and hydrocodone groin skin rash activated sludge processes with extended nitrogen removal are operated at higher sludge ages than those without extended nitrogen removal. The increased microbial diversity induced by the higher sludge age in activated sludge with extended nitrogen removal increases the probability of degradation of single pharmaceutical substances.

This and the prolonged hydraulic retention time in activated sludge processes with extended nitrogen removal are clearly of interest from a Swedish perspective on pharmaceutical removal, because extended nitrogen removal hydrocodone groin skin rash in Sweden is unevenly distributed over the country and among plants of different sizes. The research in MistraPharma on pharmaceutical removal in activated sludge treatment plants is partly related to these differences in sludge age and nitrogen removal. Evaluation of these differences are expected to provide useful information on pharmaceutical removal at existing plants and it might indicate a need for integration of new treatment technologies. A number of new promising treatment methods with sorbents, membranes, hydrocodone groin skin rash ozone and other chemical oxidants are also investigated in MistraPharma. Current knowledge about the mechanisms and parameters important to the removal of pharmaceuticals in biofilm systems is rather limited and a study on pharmaceutical removal in these systems has therefore been initiated in MistraPharma. For some pharmaceuticals however, removal seems to be less efficient for trickling filters than for activated sludge processes.

Some pharmaceuticals found in the influent of Swedish wastewater treatment plants show limited removal at all existing plants, while other pharmaceuticals show limited removal at some plants or complete removal at most plants. Evaluation of the environmental toxicity of pharmaceuticals found in treated wastewater is important for the identification of the ones that pose a significant risk to the environment. Integration of new suitable methods for the removal of the most problematic pharmaceuticals should then be considered. However, the great variability in removal efficiency between different pharmaceuticals and different groups of treatment plants indicates that pharmaceutical specific and plant specific treatment technologies are needed for the removal of most pharmaceuticals.

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