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The goal of the DUWA project is to treat wastewater discharges from hospitals to minimize the spreading of antimicrobial resistance (AMR) to the environment and to reduce the emission of micropollutants. NIVA assists the start-up company Sustaintech AS in the development and verification of ozonation to remove antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARG) in wastewater decentrally at a Norwegian hospital.

Project period
Regionalt forskningsfond Vestfold og Telemark
Total budget (NOK)

About the project

The DUWA project aims to develop, qualify and test a new concept for removing ARBs, ARGs and drug residues from hospital wastewater. The technology being developed and demonstrated is a technical measure to reduce the spread of antibiotic-resistant organisms, and resistance genes as well as resistance-driving substances (such as antibiotics) and environmentally harmful substances from wastewater discharged by hospitals and is currently ending up in the environment. The intention is to break the chain of transmission of AMR between the clinical and the external environment by cleaning AMR-polluted effluents.

The project thus involves all three sectors of One Health i.e., humans, animals and the external environment.

DUWA builds and installs a new pilot-scale treatment plant at a Norwegian hospital. The pilot will be put into continuous operation, samples will be taken and data analyzed, taking into account fluctuations in water quality and variations between institutions, days and seasons. Key questions to be answered are (a) how much the technology reduces the hazardousness of the purified water, (b) the treatment efficiency of the technology (% removal of ARGs and pharmaceuticals), and (c) quantify how much the technology contributes to reducing discharge of pharmaceuticals and antibiotic resistance.

A number of sub-objectives are investigated, including finding optimal operating conditions, handling of foreign objects in the water, foam and the extent to which cellulose from toilet paper and matriculated disposable equipment affects the purification process.

In addition, the economic aspects of this decentralized treatment is been evaluated.

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More information

Project partners

  • Trond Ingebretsen, Sustaintech AS
  • Carsten Ulrich Schwermer, NIVA
  • Marius Øverland, Trosvik Engineering AS
  • Nina Due, Oslo Universitetssykehus
  • Einar Ramsli, Sykehuset Telemark
  • Vegard Heggem, Sustaintech AS
  • Anja Egeberg, Trosvik Engineering AS
  • Preben Hjallum, Universitet i Sørøst Norge


Ny rensemetode kan få stor betydning for folkehelse og miljø (Sykehuset i Telemark): 

"Ny rensemetode kan få storbetydning for folkehelse og miljø" Forskning og innovasjon til pasientens beste. Nasjonal rapport fra spesialisthelsetjenesten 2023 (side 16): 

Schwermer, C.U., Krzeminski, P. Dette kan være nøkkelen i kampen mot anti­biotika­­resistens. Forskersonen 2023. 

Omsted, G. Resistente bakterier slippes daglig ut i vannet via kloakken. Forskersonen 2019.