Date of Submission

Spring 5-4-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Jo Loomis


Introduction: Hospital wastewater carries a unique composition of pollutants, a burden that includes high chemical and biological residuals. These pollutants are discharged into sewage treatment plants and natural environments where they contaminate human water sources and larger ecosystems. Water treatment plants are not designed to treat the high loads of biomedical waste and persistent organic compounds found in hospital wastewater and therefore pollutants survive in conventionally treated water. Evidence of contaminated soil, municipal wastewater, surface water, ground water, and even drinking water have been demonstrated in studies conducted around the world highlighting the ubiquity of the problem. Hospital effluent as also been implicated in the increase of antimicrobial resistance. This manuscript serves as an integrated literature review investigating the effects of hospital wastewater and its implications on environmental health.

Methods: A literature search was conducted on the effects of hospital effluent through the Scopus, CINAHL, and PubMed databases using the keyword combinations: “hospital” AND “wastewater” OR “effluent”. After set inclusion and exclusion criteria, Scopus yielded 2 results, CINAHL 0, and PubMed 4 (with one duplicate article yielded by both Scopus and PubMed). A synthesis of the articles are explored herein highlighting the effect of hospital effluent on human and ecological health and implications are discussed.

Results: The articles discussed in this manuscript focus on the pathogenic burden of hospital wastewater, the pharmaceutical components found in hospital wastewater and its effects on local and larger ecosystems, and the implication of hospital wastewater on antibiotic resistance.

Conclusion: The management of healthcare wastewater is a topic gaining international attention. Hospital wastewater is unique in that it carries a high burden of pathogens and active pharmaceutical compounds, and provides an ideal environment for promoting antibiotic resistance. Insufficient management and removal of chemical and biological pollutants found in hospital wastewater greatly impacts environmental and human health. These consequences demand that the issue be a high priority concern for public health organizations and to enact strict policies to surveillance and regulate pollutants released into waterways. There remains a strong need to bolster research efforts in order to measure the acute and longitudinal effects of hospital wastewater on human health.