Review of hospital effluents: special emphasis on characterization, impact, and treatment of pollutants and antibiotic resistance

Abstract

Health care institutions generate large volumes of liquid effluents from specific activities related to healthcare, analysis, and research. Their direct discharge into the environment has various negative effects on aquatic environments and human health, due to their high organic matter charges and the presence of various emerging contaminants such as disinfectants, drugs, bacteria, viruses, and parasites. Moreover, hospital effluents, by carrying antibiotics, contribute to the development of antibiotic-resistant microorganisms in the environment. This resistance has become a global issue that manifests itself variously in different countries, causing the transmission of different infections. In this respect, an effort is provided to protect water resources by current treatment methods that imply physical–chemical processes such as adsorption and advanced oxidation processes, biological processes such as activated sludge and membrane bioreactors and other hybrid techniques. The purpose of this review is to improve the knowledge on the composition and impact of hospital wastewater on man and the environment, highlighting the different treatment techniques appropriate to this type of disposal before discharge into the environment.

Development of a High-Throughput Analytical Method for Antimicrobials in Wastewater Using an Automated Pipetting and Solid-Phase Extraction System

“…Antimicrobials present in wastewater are partially removed during the water treatment process at WWTPs; however, complete removal tends to be difficult at existing WWTPs, and antimicrobials enter the river environment [54,95]. These findings support the possibility that more advanced wastewater treatment in WWTPs, as well as the implementation of advanced wastewater treatment systems in hospitals and other healthcare facilities, could be effective measures to reduce the risk of nosocomial infections and the environmental impacts associated with AMR [96,97].…”

Wastewater treatment from a science faculty during the COVID-19 pandemic by using ammonium-oxidising and heterotrophic bacteria

“…Ammonium oxidising bacteria (AOB) are a group of microorganisms involved in the oxidative stage of the biogeochemical nitrogen cycle and have valuable (van Kessel et al 2015 ) environmental applications in soil and wastewater treatment (Nsenga Kumwimba and Meng 2019 ; Wright and Lehtovirta-Morley 2023 ; Zhang et al 2024 ). These bacteria are involved in the transformation of NH 4 + produced from nitrogenous organic matter, urea, inorganic fertilisers and quaternary ammonium-based disinfectants (Dong et al 2017 ; Fatimazahra et al 2023 ; Wright and Lehtovirta-Morley 2023 ). AOB are chemoautotrophic bacteria with slow growth rates, form small colonies, and are sensitive to physical and chemical changes both in their natural ecosystem and “in vitro” culture (van Kessel et al 2015 ; Soliman and Eldyasti 2018 ; Elmoutez et al 2023 ).…”

“…The composition of WW can be classified; the micropollutants category includes analgesics, cytostatics, hormones, antibiotics, disinfectants and detergents, among others, and the macro-pollutants which are associated with chemical oxygen demand (COD), 5-day biochemical oxygen demand (BOD 5 ), total suspended solids (TSS), settleable solids (SS) and some nutrients such as orthophosphates (PO 4 -P) and nitrates (NO 3 − ), (Anayah et al 2021 ). Concerning carbonaceous macro-pollutants (COD and BOD 5 ), pollution is also composed of carbohydrates, proteins, oils, fats and TSS (Fatimazahra et al 2023 ). For the removal of this organic matter, biological systems with aerobic, facultative or anaerobic heterotrophic microorganisms are successful (Makowska and Sowinska 2020 ) because they transform organic matter to produce biomass, energy and intermediates such as carbon dioxide (CO 2 ) in aerobic processes and methane (CH 4 ) in the anaerobic ones (Elmoutez et al 2023 ; Li et al 2023 ).…”

Environmental Status of Discharged Hospital Wastewater and its Effects on Morpho-Physiological Characteristics of Vigna unguiculata, Zea mays and Glycine max

“…This can result in the emergence of a number of pathogenic and non-pathogenic organisms that cause the outbreak of several water-related diseases that menace human life, especially in developing countries 7 . According to Fatimazahra et al 8 these effluents have an ecotoxicity 5 to 15 higher than that of urban effluents; in addition to their therapeutic value, the pharmaceutical substances present in the hospital effluents can interfere with specific biological targets, which brings into question the ecotoxicological and health risks associated with their occurrence in the environment 9,10 .…”