Hospital wastewater as a source of environmental contamination: An overview of management practices, environmental risks, and treatment processes

A wide range of emerging contaminants (ECs), such as pharmaceutically active compounds, personal care products (PCPs), endocrine-disrupting compounds (EDCs), and hormones are released into hospital wastewater (HWW). These contaminants can enter into natural environments, such as aquatic and terrestrial ones, thereby threatening human health and aquatic life. Conventional wastewater treatment plants are not designed to treat all types of chemical and biological contaminants, thereby allowing the release of these contaminants into water bodies, such as rivers, streams, and groundwater. Accordingly, adequate measures and advanced technologies should be implemented to prevent the discharge of ECs into aquatic environments. Reducing environmental health risks of HWW is particularly important amid the persistence of the COVID-19 pandemic. Although the necessary guidelines and legislation for wastewater treatment are available, efficient removal of ECs from HWW requires the applications of advanced treatment technologies. This paper provides a comprehensive review of the existing healthcare structures, ECs pathways to the environment, management practices, and effective treatment options for removing ECs from HWW. A critical evaluation of the current research advances, knowledge gaps, and directions for future research is also presented.