Sustainability Assessment of Hospital Wastewater Treatment Techniques: A Comprehensive Review

Abstract

Hospitals discharge wastewater containing toxic pollutants that pose risks to human health and the environment if not properly treated. Therefore, effective treatment techniques are essential. Although various reviews have explored hospital wastewater treatment (HWWT) methods, few have comprehensively assessed their sustainability—including technical, environmental, economic, and social aspects. This paper reviews the literature on these dimensions and identifies critical research gaps. Technically, the combination of biological and tertiary techniques can achieve removal efficiencies between 60% and 99% for emerging contaminants. Environmentally, electricity consumption is a major concern, ranging from 0.2 to 3 kWh/m3, depending on the technique. Economically, costs rise with energy-intensive methods; ultraviolet disinfection operates at 0.016 €/m3, while Fenton treatment reaches 23.38 €/m3. No dedicated social assessments exist for HWWT; therefore, municipal wastewater studies were used as references. This paper proposes public health-related social indicators tailored for HWWT. Two key research gaps are identified: the lack of integrated sustainability and social assessments and limited comparability across studies. This review adapts the life cycle sustainability assessment framework to HWWT and offers recommendations for improved comparability and targeted future research. Addressing these gaps will support more holistic evaluations and guide effective and informed decision-making in hospital wastewater management.