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Hospital wastewater as a reservoir of environmental hazards for humans: Implications for public and occupational safety and health in the era of One Health
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Hospital wastewater doesn't just carry germs and drug residues—it's also full of tiny plastic particles that can act like "delivery trucks," making harmful chemicals and microbes travel farther and cause more damage in the environment. This review of existing research warns that standard water treatment plants aren't fully equipped to filter out these combined threats, putting wastewater treatment workers and hospital cleaning staff at particular risk of exposure and long-term health effects. The authors call for better monitoring systems that track chemical, biological, and toxic risks together, since protecting these workers ultimately helps protect public health more broadly.
Hospital wastewater (HWW) represents a complex and increasingly relevant source of environmental contamination. These effluents contain a wide range of pollutants, including pharmaceuticals, disinfectants, pathogenic microorganisms, antimicrobial resistance genes, heavy metals, radionuclides, and emerging contaminants such as micro- and nanoplastics (MNPs). Within the evolving European regulatory framework for urban wastewater treatment, HWW is now recognised as a critical matrix requiring targeted management strategies. This review critically examines current evidence on the composition of HWW, highlighting the role of MNPs as vectors for bioactive, toxic, and potentially genotoxic substances. Special attention is devoted to different processes that markedly influence the environmental fate, bioavailability, and toxicity of associated contaminants. Growing experimental evidence indicates that MNPs can enhance the persistence, mobility, and biological effects of hazardous compounds, amplifying potential risks to both environmental and human health, and focusing on the occupational risks associated with HWW for wastewater treatment plant operators and hospital maintenance workers. These workers may be exposed to complex mixtures of chemical and biological agents through aerosols, sludge, and direct contact, with possible oxidative, inflammatory, and genotoxic effects. The limitations of conventional wastewater treatment processes in removing emerging contaminants and MNPs are discussed, together with the potential of advanced technologies such as membrane bioreactors, advanced oxidation processes, and hybrid systems. In conclusion, the review highlights the urgent need for integrated monitoring strategies that combine chemical, biological, and toxicological assessments within a One Health framework to better protect environmental, public, and occupational health and to support future policy development and technological innovation.
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Researchers reviewed how wastewater treatment plants interact with antibiotic-resistant bacteria and emerging contaminants including microplastics, finding that microplastics and heavy metals help antibiotic resistance genes spread through microbial communities. This makes treatment plants hotspots for creating harder-to-treat bacterial strains, posing a broad public health risk that connects environmental pollution to human medicine.
Microplastics and Antibiotic Resistance: The Magnitude of the Problem and the Emerging Role of Hospital Wastewater
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This review examines how microplastics in water can carry antibiotic-resistant bacteria and spread resistance genes, especially through hospital wastewater. Microplastics provide a surface where bacteria easily form colonies and share resistance genes, creating a potential threat to human health. The authors call for better wastewater management to reduce this emerging risk.
Characteristics of Microplastics in a Hospital Wastewater Treatment Plant Effluent and Hazard Risk Assessment
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A characterization study of a hospital wastewater treatment plant found fiber-shaped polypropylene as the dominant microplastic type, with polyethylene terephthalate, polyamide, and polyethylene posing elevated ecological hazard risk compared to other wastewater sources. Hospitals are an overlooked but significant source of MP-laden effluent entering waterways, carrying plastics from medical devices and disposable equipment with higher hazard profiles.
Wastewater Treatment Challenges and Circular Reuse for One Health Sustainability: A Review
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Researchers review global wastewater treatment challenges through a One Health lens, documenting how inadequate treatment releases pathogens, antimicrobial resistance determinants, PFAS, and microplastics into over 380 billion cubic meters of annual discharge, and assessing wastewater-based epidemiology, metagenomics, and green nanobiotechnology as emerging tools for contaminant monitoring and circular resource recovery.
Innovative One-Health Assessment of Microplastic Exposure in Healthcare Workers: Quantifying Risk across Occupational, Environmental, and Dietary Pathways
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