BIOENGINEERING AND HEALTH SERVICE MANAGEMENT IN HOSPITAL WASTEWATER TREATMENT: A NARRATIVE REVIEW OF BIOLOGICAL PROCESS PERFORMANCE AND INSTITUTIONAL DETERMINANTS

Abdullahi Yusuf; Adetona Yuusuf Oluwaseun

doi:10.5281/zenodo.22664540

Abstract

Hospital wastewater contains pharmaceuticals, pathogens, and antibiotic-resistant organisms, creating significant
public health risks despite the availability of mature biological treatment technologies. This narrative review
examines why systems that perform effectively in research settings often underperform in real-world applications,
particularly in low- and middle-income countries. It integrates treatment performance with health service
management, reviewing suspended-growth and attached-growth systems, membrane bioreactors, aerobic granular
sludge, anaerobic treatment, and biological nutrient removal. Evidence indicates that organic-load removal is
consistently high, while nitrogen removal is generally achievable. However, phosphorus removal remains
challenging because of microbial competition and irregular carbon availability. Conventional disinfection based
on indicator organisms may also fail to eliminate clinically important resistant pathogens. Furthermore, sludge
management standards often overlook pharmaceuticals and antibiotic-resistance genes. Four key management
factors—governance, operating finance, operator competence, and infection prevention—strongly influence
treatment outcomes. The review concludes that technology selection should consider not only removal efficiency
but also long-term institutional capacity to finance, operate, regulate, and monitor treatment systems.

Keywords

hospital wastewater; biological treatment; antimicrobial resistance; enhanced biological phosphorus removal;

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