HIPPOCRATEs

Recent evidence strongly indicates that treated wastewater is a significant vector for the dissemination of pharmaceuticals, viruses, antibiotic-resistant bacteria (ARB), and resistance genes (ARGs) into the environment. These chemical and biological contaminants of emerging concern (CECs) have been detected in crops and aquatic ecosystems, posing considerable risks to human health and environmental safety. The scale of urban wastewater discharge correlates with a heightened cumulative burden of antimicrobial resistance (AMR), contributing to over 35,000 premature deaths annually across Europe.

Addressing this urgent public health challenge requires strategic interventions. Two primary mitigation pathways are available: (a) upgrading centralized wastewater treatment plants with additional advanced treatment stages capable of targeting low concentrations of CECs amid high flow volumes; or (b) implementing onsite treatment solutions at key sources, notably healthcare facilities such as hospitals, which discharge concentrated volumes of these contaminants. Prioritizing these approaches is essential to curtail AMR proliferation and safeguard both public health and ecological integrity in the EU.

The project’s innovation lies in deploying and validating, at large demonstration scale and year-round continuous operation, an integrated on-site treatment system combining an anoxic moving bed biofilm reactor, aerobic membrane biological reactor (MBR), and advanced oxidation process to achieve high-efficiency removal of contaminants of emerging concern (CECs) such as pharmaceuticals and ARB/ARGs directly from hospital wastewater before it reaches municipal sewage systems.

LIST plays a pivotal role by hosting and validating one of the prototype demonstration plants in Luxembourg, leveraging its extensive expertise and prior research on hospital wastewater pollution and CEC removal technologies, including patented solutions (WO2017067882, WO2019234182) previously developed in partnership with industry. This project not only advances innovative wastewater treatment technology implementation in two contrasting European environments—rural Crete and urban Luxembourg—but also supports the development and enforcement of EU water policies like the Water Framework Directive (WFD), Urban Wastewater Treatment Directive (UWWTD), and Regulation 2020/741 on minimum requirements for water reuse.

HIPPOCRATES' holistic approach to hospital wastewater treatment, with a focus beyond pharmaceuticals to include all CECs and antimicrobial resistance, positions it as a key initiative to protect human health and the environment while promoting scalable, energy-efficient, and cost-effective solutions suitable for replication across the EU. The outcomes will inform policy, guide national legislation, and catalyze wider adoption of innovative technologies such as the commercial MEDIX solution developed by LIST, helping to curb the spread of AMR from a critical point-source sector.

HIPPOCRATES will deliver two full-scale operational demonstration units for onsite hospital wastewater treatment in diverse European environments (rural Crete and urban Luxembourg) over a period of around two years, treating significant wastewater volumes with advanced combined technologies targeting pharmaceuticals, antibiotic-resistant bacteria (ARB), resistance genes (ARGs), and other contaminants of emerging concern (CECs). This innovative approach is expected to significantly reduce the environmental release of harmful micropollutants and pathogens, thereby mitigating the development and spread of antimicrobial resistance (AMR).

The project will provide key data and a profound understanding of hospital wastewater pollution dynamics, including the fate and degradation of CECs in conventional wastewater treatment plants and in advanced quaternary treatment processes, some developed by LIST. HIPPOCRATES will underpin new EU policy and regulatory developments, pushing towards mandatory onsite wastewater treatment in healthcare facilities to enhance environmental and public health protections.

From a socio-economic perspective, the project anticipates creating a new market worth billions of euros across the EU and globally, fostering investment in innovative water treatment technologies, and generating thousands of new permanent jobs in construction, operation, and maintenance. The project’s approach transfers treatment costs and responsibilities to pollution sources, promoting efficiency and safeguarding municipal wastewater treatment affordability.

Furthermore, the results will support and potentially expand wastewater reuse in the EU by providing reliable, cost-effective treatment solutions that reduce contaminants to safe levels, aligning with the EU Water Framework Directive and related reuse regulations.

Overall, HIPPOCRATES represents a holistic, scalable, and innovative response to a pressing environmental health challenge, with broad implications for policy, industry, public health, and sustainable water management across Europe and beyond.

Learn more about the project.