Municipal wastewaters can generally provide real-time information on drug consumption, the incidence of specific diseases, or establish exposure to certain agents and determine some lifestyle consequences. From this point of view, wastewater-based epidemiology represents a modern diagnostic tool for describing the health status of a certain part of the population in a specific region. Hospital wastewater is a complex mixture of pharmaceuticals, illegal drugs, and their metabolites as well as different susceptible and antibiotic-resistant microorganisms, including viruses. Many studies pointed out that wastewater from healthcare facilities (including hospital wastewater), significantly contributes to higher loads of micropollutants, including bacteria and viruses, in municipal wastewater. In addition, such a mixture can increase the selective pressure on bacteria, thus contributing to the development and dissemination of antimicrobial resistance. Because many pharmaceuticals, drugs, and microorganisms can pass through wastewater treatment plants without any significant change in their structure and toxicity and enter surface waters, treatment technologies need to be improved. This short review summarizes the recent knowledge from studies on micropollutants, pathogens, antibiotic-resistant bacteria, and viruses (including SARS-CoV-2) in wastewater from healthcare facilities. It also proposes several possibilities for improving the wastewater treatment process in terms of efficiency as well as economy.

Department of Analytical Chemistry Faculty of Natural Sciences Comenius University in Bratislava Ilkovičova 6 842 15 Bratislava Slovakia

Department of Environmental Engineering Faculty of Chemical and Food Technology STU Slovak University of Technology in Bratislava Radlinského 9 812 37 Bratislava Slovakia

Department of Inorganic Technology Faculty of Chemical and Food Technology STU Slovak University of Technology in Bratislava Radlinského 9 812 37 Bratislava Slovakia

Department of Nutrition and Food Quality Assessment Faculty of Chemical and Food Technology STU Slovak University of Technology in Bratislava Radlinského 9 812 37 Bratislava Slovakia

Department of Physical Chemistry Faculty of Chemistry University of Bialystok K Ciolkowskiego 1K 15 245 Bialystok Poland

Department of Zoology and Fisheries Faculty of Agrobiology Food and Natural Resources Czech University of Life Sciences Prague Kamýcka 129 165 00 Praha Czech Republic

South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses Faculty of Fisheries and Protection of Waters University of South Bohemia in Ceske Budejovice Zatisi 728 2 CZ 389 25 Vodnany Czech Republic

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