Pharmaceutical residues in wastewater pose a challenge to wastewater treatment technologies. Constructed wetlands (CWs) are common wastewater treatment systems in rural areas and they discharge often in small water courses in which the ecology can be adversely affected by the discharged pharmaceuticals. Hence, there is a need for studies aiming to improve the removal of pharmaceuticals in CWs. In this study, the performance of a full-scale aerated sub-surface flow hybrid CW treating wastewater from a healthcare facility was studied in terms of common water parameters and pharmaceutical removal. In addition, a preliminary aquatic risk assessment based on hazard quotients was performed to estimate the likelihood of adverse effects on aquatic organisms in the forest creek where this CW discharges. The (combined) effect of aeration and hydraulic retention time (HRT) was evaluated in a laboratory-scale batch experiment. Excellent removal of the targeted pharmaceuticals was obtained in the full-scale CW (>90%) and, as a result, the aquatic risk was estimated low. The removal efficiency of only a few of the targeted pharmaceuticals was found to be dependent on the applied aeration (namely gabapentin, metformin and sotalol). Longer and the HRT increased the removal of carbamazepine, diclofenac and tramadol.

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