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This study investigates the performance of a full-scale, on-site treatment plant, consisting of a membrane bioreactor and a subsequent ozonation, at a German hospital. We analysed the elimination of pharmaceutical residues, microbiological parameters and SARS-CoV-2 RNA fragments. Additionally, we conducted an orienting study on the practicability of implementing targeted wastewater monitoring at a hospital. Our results demonstrate that after 10 years of stable operation, the treatment plant works highly efficiently regarding the elimination of pharmaceuticals and bacterial indicators. Elimination rates for pharmaceutical substances were above 90%, and log reductions of up to 6 log10 units for microbiological parameters were achieved. SARS-CoV-2 RNA could be detected and quantified in the influent but not in the effluent. The RNA load in the raw wastewater showed good correspondence with COVID-19 case numbers in the hospital. We showed that the full-scale on-site treatment of hospital wastewater is technically feasible and contributes to sustainable hospital effluent management and that monitoring biological markers on the building level might be a useful complementary tool for disease surveillance.<\/jats:p>","DOI":"10.2166\/wst.2023.088","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T16:14:16Z","timestamp":1679674456000},"page":"1747-1763","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":10,"title":["On-site treatment of hospital wastewater in a full-scale treatment plant in Germany: SARS-CoV-2 and treatment performance"],"prefix":"10.2166","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3910-0845","authenticated-orcid":false,"given":"Sarah","family":"Haeusser","sequence":"first","affiliation":[{"name":"a Department Hamm 2, Hamm-Lippstadt University of Applied Sciences, Hamm D-59063, Germany"},{"name":"b Bauhaus-Institute for infrastructure solutions (b.is), Bauhaus-Universit\u00e4t Weimar, Weimar D-99421, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Weber","sequence":"additional","affiliation":[{"name":"c Aggerverband, Gummersbach D-51645, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Mauer","sequence":"additional","affiliation":[{"name":"d Weber-Ingenieure GmbH, Pforzheim D-75177, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Linnemann","sequence":"additional","affiliation":[{"name":"e Institute of Environmental Engineering, RWTH Aachen University, Aachen D-52074, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Pfannstiel","sequence":"additional","affiliation":[{"name":"b Bauhaus-Institute for infrastructure solutions (b.is), Bauhaus-Universit\u00e4t Weimar, Weimar D-99421, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Pinnekamp","sequence":"additional","affiliation":[{"name":"e Institute of Environmental Engineering, RWTH Aachen University, Aachen D-52074, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wintgens","sequence":"additional","affiliation":[{"name":"e Institute of Environmental Engineering, RWTH Aachen University, Aachen D-52074, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Kl\u00fcmper","sequence":"additional","affiliation":[{"name":"a Department Hamm 2, Hamm-Lippstadt University of Applied Sciences, Hamm D-59063, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Beier","sequence":"additional","affiliation":[{"name":"b Bauhaus-Institute for infrastructure solutions (b.is), Bauhaus-Universit\u00e4t Weimar, Weimar D-99421, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"key-10.2166\/wst.2023.088-1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2020.143192"},{"key":"key-10.2166\/wst.2023.088-2","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2021.117369"},{"key":"key-10.2166\/wst.2023.088-3","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-84914-2"},{"key":"key-10.2166\/wst.2023.088-4","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2020.110092"},{"key":"key-10.2166\/wst.2023.088-5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jece.2018.02.007"},{"key":"key-10.2166\/wst.2023.088-6","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-021-04304-4"},{"key":"key-10.2166\/wst.2023.088-7","doi-asserted-by":"publisher","DOI":"10.2166\/wst.2021.343"},{"key":"key-10.2166\/wst.2023.088-8","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-04254-z"},{"key":"key-10.2166\/wst.2023.088-9","doi-asserted-by":"crossref","first-page":"145268","DOI":"10.1016\/j.scitotenv.2021.145268","article-title":"The fate of SARS-CoV-2 in WWTPs points out the sludge line as a suitable spot for detection of COVID-19","volume":"772","author":"Balboa","year":"2021","journal-title":"The Science of the Total Environment"},{"key":"key-10.2166\/wst.2023.088-10","doi-asserted-by":"publisher","DOI":"10.1080\/01919512.2020.1794794"},{"key":"key-10.2166\/wst.2023.088-11","doi-asserted-by":"publisher","DOI":"10.1021\/es5008388"},{"key":"key-10.2166\/wst.2023.088-12","doi-asserted-by":"publisher","DOI":"10.2166\/wst.2011.010"},{"key":"key-10.2166\/wst.2023.088-13","doi-asserted-by":"publisher","DOI":"10.2166\/wst.2012.880"},{"key":"key-10.2166\/wst.2023.088-14","unstructured":"Centers for Disease Control and Prevention 2021 Waterborne Disease & Outbreak Surveillance Reporting: Targeted Wastewater Surveillance at Facilities, Institutions, and Workplaces. 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