Reducing Pharmaceutical Pollution at the Source: Wastewater Treatment in Hospitals

Hospital wastewater is increasingly recognised as a distinct source of pharmaceutical pollution and antimicrobial resistance (AMR), with implications for environmental protection, public health, and healthcare sustainability more generally.

While approximately 80% of pharmaceutical residues in municipal wastewater originate from households and around 20% from healthcare facilities (HCWH, 2021), hospitals act as pollution hotspots due to their intensive and specialised use of high-risk substances, including antibiotics, cytostatics, and contrast agents. For example, drugs such as carbamazepine and sulfamethoxazole are highly resistant and can pass through wastewater treatment plants (WWTPs) unchanged (Hai et al., 2018).

Most hospital wastewater is discharged directly into municipal wastewater systems, where it is treated with urban effluent. WHY HOSPITAL WASTEWATER MATTERS However, conventional WWTPs are not designed to effectively remove pharmaceutical compounds, resistant bacteria, or resistance genes. As a result, active pharmaceutical ingredients, metabolites, and transformation products can persist through treatment processes and enter surface waters, groundwater sediments, and, in some cases, drinking water sources. The environmental exposure to complex mixtures of pharmaceuticals and other contaminants further complicates risk assessment and management.

Although EU policy frameworks such as the Water Framework Directive and the revised Urban Wastewater Treatment Directive acknowledge pharmaceutical pollution and AMR, implementation timelines extend over several decades. This creates a gap in practice for hospitals today, where awareness of the problem has increased, but clear guidance on what hospitals can realistically do, considering existing operational, financial, and infrastructural constraints, remains limited.