NHS HIGHLAND ESTABLISHED ITSELF AS A LEADER IN THE DEBATE AND PRACTICE OF WATER MANAGEMENT AS AN ESSENTIAL PART OF PUBLIC HEALTH
Environmental Research Institute (ERI) based in Thurso met to discuss emerging contaminants and techniques in water testing and treatment. NHS Highland subsequently decided to seek to implement the AWS Standard and partners from the newly established One Health Breakthrough Partnership including Scottish Water, HIE, ERI and the Scottish Environment Protection Agency (SEPA) worked with the NHSH Environment and Sustainability team.
Work to explore the impacts of the water discharged by Caithness General Hospital on people and the environment started in 2017. The deterioration of water quality due to pharmaceutical residues was identified as the principal water challenge.
Wastewater from the hospital is routed to one water outflow, which then runs into the Wick sewerage system. The whole water pathway was investigated for the presence of pharmaceuticals, by ERI from its source in Loch Calder, to hospital taps, hospital effluent, waste water treatment plant (WWTP) influent and effluent This revealed
the extent of pharmaceutical residues present in the water after treatment. The ERI study supported previous studies showing that rural communities can produce wastewater with significant concentrations of pharmaceuticals, despite having relatively small populations. Wick WWTP releases effluent containing pharmaceutical residues, thereby potentially creating a problem for the marine environment.
The outcomes Based on information garnered during the process, Caithness General Hospital drew up a water improvement plan, which is one aspect of the water stewardship plan under the AWS Standard. Various recommendations were made to improve water efficiency at the hospital – changes that incidentally could result in a 33 per cent saving in annual water-related costs.
NHS Highland is now exploring the installation of a prototype unit to remove pharmaceutical residues. This would have both commercial and public health benefits and such units could be incorporated into the design of new hospitals.
The public health expert advising the Environment & Sustainability team, Sharon Pfleger, Consultant in Pharmaceutical Public Health, is also exploring upstream approaches to tackle the source of the problem. These include public education campaigns to reduce the amount of medicines that are inappropriately flushed down toilets and sinks, an education video on antimicrobial resistance and the environment , a waste campaign to quantify the amount of medicines that are wasted and how this can be avoided, greening the medicine formulary so that prescribed medicines have a reduced impact on the environment but are still safe and effective for patients, researching the use of blue green resources in nature to benefit health.’
‘This is a classic public health approach that is preventative,’ Sharon told SP, ‘tackling the cause of the problem rather than trying to fix it downstream, including educating and persuading prescribers to use medicines that have fewer environmental risks. Where a patient can be given a greener medicine, without detriment to that patient’s health, the message to doctors will be to switch to that. The changes will not be immediate because altering prescribing behaviour often takes some time. That is why we have a ‘basket’ of interventions that we will use to ensure that patients, the general public, healthcare professionals and industry partners all learn about the issue and how they can play a part in reducing the impact of pharmaceuticals on our environment.
‘By adopting the AWS Standard and participating in the broad-based alliance that is part of the AWS, we broke new ground. NHS Highland established itself as a leader in the debate and practice of water management as an essential part of public health – a step ahead of the rest, in line with the evolving standards expected by regulators and the public.’
ohbp.org
The European Union is the second largest market in the world for pharmaceuticals after the United States: a trend, which is expected to increase as EU populations age and grow and new medicines enter the market.
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