Hospital Wastewater Treatment Strategies for Mitigation of Antimicrobial Resistance From a one-Health Perspective: a Literature Review

Objective: The objective of this study is to discuss the main wastewater treatment technologies capable of removing antimicrobials, resistance genes, and antimicrobial-resistant microorganisms. Theoretical Framework: Antimicrobial resistance is considered one of the greatest threats to global public health in the 21st century. Hospital wastewater acts as a large reservoir of antimicrobial-resistant microorganisms, resistance genes, and antimicrobial residues. The ineffectiveness of conventional wastewater treatment methods in removing these contaminants represents a threat to public and environmental health. Method: The methodology adopted comprises a narrative literature review, with references published in the last ten years and collected in Portuguese, English, and Spanish. Results and Discussion: Advanced technologies demonstrate superior potential in removing these pollutants. The most promising approach is the implementation of combined or hybrid systems, ensuring a higher quality final effluent. Furthermore, the implementation of discharge limits for such contaminants is crucial for adequate investment in more effective treatment technologies in Brazilian hospitals. Research Implications: Controlling hospital effluents is a key element in protecting public health and the sustainability of global water resources, mitigating the impact of bacterial resistance in different sectors of the population. Originality/Value: This study can serve as a basis for health managers in making decisions about the best technology to implement in hospitals and health centers to mitigate the environmental and public health effects caused by the discharge of untreated effluents.