Almanac A1C

Drinking Water Types and Human Health: Evaluating the Comparative Benefits, Risks, and Therapeutic Applications of Regular, Demineralized, and High-pH Waters

Posted

by

dr. Karunia Valeriani Japar

Table of Contents
Keywords: , , , , , ,

Introduction

Access to high-quality drinking water is a fundamental requirement for maintaining optimal human health. Water plays a pivotal role in physiological processes including cellular homeostasis, digestion, nutrient transport, water excretion, and thermoregulation, with the average adult body composed of approximately 50-60% water by weight. The World Health Organization recognizes safe and readily available water as essential for public health, with suboptimal water quality contributing to the global burden of disease via diarrheal illnesses, chemical toxicity, and chronic disorders. Contaminants such as pathogenic microorganisms, heavy metals, pesticides, and industrial byproducts remain significant risk factors when water quality is compromised, necessitating rigorous water quality testing and regulation to safeguard health [1,2,3,4].

Within consumer markets, a wide array of drinking water types is available, each characterized by its source, mineral profile, treatment processes, and potential health implications. The most common categories include regular or tap water, which is municipally treated; reverse osmosis (RO) water, which is demineralized via membrane filtration; and alkaline water, which is processed to achieve a higher pH (usually via electrolysis or mineral addition). Additional consumer options include mineral water, distilled water, spring water, well water, and sparkling water, each varying in mineral content and physiochemical attributes. Recent years have seen growing public interest in the comparative health effects of these water types, particularly regarding claims that alkaline and RO water may confer metabolic or disease-preventive benefits beyond those of standard drinking water. However, data from clinical and mechanistic studies remain heterogeneous, underscoring the need for evidence-based evaluation of safety and efficacy [4,5,6,7,8].

This review seeks to synthesize current knowledge on the health implications of regular, RO, and alkaline waters- a task of increasing relevance to consumer safety and chronic disease prevention and amid global shifts in water quality, environmental exposures, and lifestyle factors [2,3,4,7].

Water Types: Definition and Mechanisms

Normal Drinking Water: Sources and Composition

Normal drinking water, also referred to as potable or tap water, is derived from natural sources such as surface water (rivers, lakes, reservoirs) and groundwater (aquifers, wells). The composition of potable water is influenced by geological and environmental characteristics of these sources, with routine municipal treatment processes (e.g., coagulation, filtration, chlorination) ensuring safety and microbiological quality. Chemically, drinking water typically contains a mixture of inorganic salts such as calcium, magnesium, sodium, potassium, bicarbonate, sulfate, and chloride, in concentrations that reflect both natural leaching from soils and anthropogenic factors like agricultural runoff or industrial pollution [9,10,11].

The mineral content in drinking water not only affects taste and hardness but also plays a role in dietary mineral intake, as water may contribute meaningful amounts of essential micronutrients including magnesium, calcium, and trace elements. Regulatory bodies set contaminant limit and monitor quality to ensure public health [9,12].

Reverse Osmosis Water: Purification Process and Mechanism

Reverse osmosis water is produced through a membrane-based filtration process that removes dissolved ions, particles, and impurities from source water. The process involves several sequential steps: pre-filtration (to remove large sediments and chlorine), application of high pressure to force water across a semi-permeable membrane (pore size ~0.0001 microns), and post-filtration or storage. The membrane selectively allows water molecules to pass while blocking dissolved salts, organic compounds, bacteria, viruses, and other contaminants, resulting in highly purified water, effectively demineralized relative to the source [13,14,15,16,17].

While RO technology produces water with significantly reduced total dissolved solids (TDS) and potential contaminants, it also removes virtually all naturally occurring minerals, rendering the water more neutral or slightly acidic. Some systems include post-treatment remineralization stages to restore palatability and nutritional value [15,16,17].

High pH (Alkaline) Packaged Water: Production and Chemical Properties

Alkaline water is defined as water with a pH higher than typical drinking water, generally in the range of 8-10 compared to the neutral pH of 7. Commercially, alkaline water is produced through several avenues:

  • Electrolysis (using an ionizer to separate acidic and alkaline fractions)
  • Addition of alkalizing minerals such as calcium, magnesium, potassium, and sodium
  • Dissolution of alkaline earth minerals during bottling.

The electrolysis method employs electrodes that induce water molecule dissociation, concentrating hydroxide ions and elevating pH at the cathode; thus, the output is referred as electrolyzed reduced water [18,19,20,21].

Chemically, alkaline water may possess increased concentrations of minerals responsible for its buffering capacity and antioxidant activity, though actual composition varies depending on production method and source water. There is growing consumer interest in alkaline water based on claims of acid-base homeostasis and health benefits, yet the evidence base remains mixed and further research is indicated to corroborate these effects [18,21].

Comparative Health Effects: Evidence and Controversies

Hydration and Body Fluid Regulation

Proper hydration is essential for regulating body fluid compartments and supporting physiological functions, including nutrient transport, thermoregulation, and waste elimination. All water types- whether regular, RO, or alkaline – effectively restore body fluid balance when consumed in adequate amounts, as thirst mechanisms and renal output tightly control total body water. However, water with normal mineral composition may better support electrolyte balance, as minerals such as sodium, calcium and magnesium are involved in optimal hydration and cellular function. RO water, due to its low mineral content, may theoretically pose a risk of disrupting electrolyte homeostasis if consumed exclusively and without adequate dietary compensation, particularly in populations with higher needs [22,23,24].

Impact on Disease Risk: Gastrointestinal, Renal, and Metabolic Effects

Water quality and mineral content may influence disease risk. Mineral-rich waters are associated with improved gastrointestinal function, including promoting motility and supporting digestive health, as documented with bicarbonate or sulphate mineral waters. Alkaline water has shown promise in neutralizing gastric acid (pepsin) and relieving acid reflux symptoms, with some studies indicating comparable efficacy to medications like proton pump inhibitors when combined with dietary interventions. Alkaline water may also possess antioxidant properties that potential disturbances in calcium and magnesium metabolism and increasing the risk of osteoporosis and metabolic syndrome. In diabetes and metabolic disease, mineral-rich and bicarbonate waters may help regulate glycemia and metabolic acidosis although evidence for direct effects of RO or alkaline water on metabolic outcomes remains inconclusive [24,25,26].

Suitability for Vulnerable Populations (children, elderly, patients)

Vulnerable groups- children, elderly, patients with chronic disorders- may have altered physiological needs for minerals and hydration. Studies show that water type can impact serum calcium, magnesium, and alkaline phosphatase levels in children, with RO water potentially associated with a lower mineral status compared to mineral rich water. Similarly, elderly and chronically ill patients may benefit from water containing natural minerals, as exclusive use of RO water may increase risk of mineral deficiency, unless remineralized water or appropriate dietary intake is maintained. Alkaline water may be safe for these populations in moderation, though more research is needed to validate clinical claims and long-term safety. Most experts recommend clean, safe, and mineral-balanced water for all, with careful consideration for specific health states [24,27].

Potential Risks: Mineral Depletion and Stomach Upset

The primary health concerns surrounding RO water relate to its low mineral content, which contribute to mineral depletion over time, particularly calcium and magnesium; deficits could affect bone metabolism, cardiovascular health, and neuromuscular function. RO water, being more acidic, may also increase gastric irritation for some individuals, potentially leading to symptoms of indigestion or discomfort, especially with large volumes or underlying gastrointestinal sensitivity. High-pH alkaline water, although generally well-tolerated, may rarely cause GI upset or interfere with natural stomach acid balance, which could affect digestion or absorption; excessive or artificial alkalinization may also lead to electrolyte disturbances in susceptible individuals [24,28].

Reported Benefits of High pH Water

Research on high-pH (alkaline) water suggests possible benefits including symptom relief of acid reflux, improved hydration, and potential positive effects on bone density among postmenopausal individual and select patient groups. Alkaline-reduced water demonstrated antioxidant and anti-inflammatory properties in preclinical and clinical studies, with improvements reported in irritable bowel syndrome, gastritis and other GI disorders. Rodent models have linked higher water pH to changes in gut microbiota composition and glucose metabolism, though human data remains preliminary, claims regarding prevention of chronic diseases, anti-aging, or broad metabolic benefits remain controversial and unsupported by large, well-controlled studies-thus, these remain topics of ongoing research and debate [25,28,29].

Practical Recommendations for Lifestyle Medicine and Public Health

Choosing the Right Water Type: Clinical and Preventive Perspectives

Optimal hydration is crucial for health optimization, disease prevention and effective lifestyle medicine interventions. Clean, safe water- whether from municipal sources, regulated wells, or appropriately treated bottled water-forms the foundation of hydration strategies. Public health recommendations focus on microbiological safety and avoidance of contaminants, with the World Health Organization and national agencies emphasizing source protection, robust treatment protocols, and regular monitoring for pathogens such as E.coli, Giardia, and Cryptosporidium [22,30,31,32].

When choosing between water types (normal, RO, alkaline), clinical preventive approaches recommend prioritizing source quality, proven safety, and appropriate mineral content for long-term use. Normal drinking water from regulated sources typically meets these criteria. RO-treated water is recommended when local water quality is poor or contaminated, but remineralization or careful dietary compensation is advised to avoid potential mineral depletion-especially for individuals with increased nutritional needs or limited dietary diversity. Remineralized water, while generally safe when formulated according to health guidelines, may present several risks if not carefully controlled: these include possible imbalance or excess of minerals (raising risks such as kidney stones and electrolyte disturbances), variable mineral bioavailability, inconsistent quality between batches, potential contamination with unwanted elements (like heavy metals), and undesirable taste. Additionally, over-mineralization and inappropriate formulas can cause kidney stress or cardiovascular and nerve issues, and the long-term safety of many commercial products is not as well substantiated as natural mineral water. Therefore, well-monitored remineralization is essential to avoid health hazards from poor quality or improperly balanced products.

Alkaline water may be considered for specific digestive indications (e.g., acid reflux), but evidence does not justify its widespread preventive use over standard, balanced waters [28,29,32,33].

Evidence-Based Guidelines for Different Populations

  • General Population: International guidelines suggest daily fluid intake of roughly 2-2.5 liters for adults (8-10 cups), with variations depending on climate, activity, and overall health. For most healthy adults, any microbiologically safe water meeting regulatory mineral standards is suitable; enjoyment and palatability contribute to consistency in hydration [22,33,34,35].
  • Children: For children, adequate hydration and appropriate mineral intake are especially critical given higher fluid turnover, developmental needs, and susceptibility to dehydration and mineral deficits. Recommended intakes range from 1-1.6 liters (for ages 1-8), with clean, mineral-balanced water preferred. RO water without proper remineralization should be avoided for prolonged use unless necessary for safety [22,33].
  • Elderly: Older adults are at increased risk of dehydration due to lower thirst sensation, reduced renal function, and comorbidities. Daily intake recommendations mirror those for adults (2-2.5 liters), but emphasis is placed on easy access, palatable water, and monitoring for signs of fluid imbalance. Mineral-rich waters may improve bone and cardiovascular health; exclusive use demineralized water is not recommended unless warranted by safety concerns [24,33,34,36].
  • Patients and Vulnerable Groups: For people with chronic illness (e.g., renal, cardiovascular, metabolic diseases), hydration protocols should be tailored: avoiding excessive sodium, ensuring sufficient calcium and magnesium, and addressing any specific contraindications (e.g., volume overload in heart failure). RO or bottled water may be necessary in immunocompromised patients or those in high-risk settings, as microbial safety supersedes other considerations [33,37,38].

Clinical and Public Health Recommendations

  • Prioritize water quality (microbiological purity, absence of harmful chemicals) above water type for disease prevention [32,39].
  • For routine use, select water with balanced mineral content; avoid exclusive long-term use of highly demineralized (e.g., non-remineralized RO) water in children, elderly, or patients with elevated mineral needs [24,33].
  • Alkaline water may provide symptomatic relief in acid reflux or functional GI disorders but does not replace standard recommendations for general hydration [28,29].
  • Healthcare settings and providers should conduct water risk assessments and actively monitor at-risk populations for signs of dehydration, mineral imbalance, or adverse reaction to water type changes [37,39].

Future Directions and Research Needs

Gaps in Comparative Clinical Evidence

Despite widespread consumption of normal, RO, and alkaline waters, robust clinical evidence directly comparing their long-term health impact remains limited. Most available studies are small, short-term, and often lack adequate control for cofounding dietary, environmental and individual factors. Large-scale randomized controlled trials that rigorously assess hydration, metabolic outcomes, and disease risks associated with different water types are lacking, particularly across diverse populations and vulnerable groups (children, elderly, patients with chronic diseases). Furthermore, biomarkers for population-level hydration status and physiological effects of different water types remain insufficiently validated, impeding accurate, evidence-based guidelines for clinical and public health practice [4,22,40].

Current literature also highlights the need for more comprehensive environmental assessment- safety of so-called “improved” water sources is not always guaranteed, with contamination risk persisting even in ostensibly treated sources. Methodological gaps persist in measuring subtle health effects of mineral composition, acid-base impact, and chronic low-level contaminant exposures in real-world community and hospital settings [4,40].

Innovations in Water Treatment for Health Technology

The future of water treatment for public health is being reshaped by integration with advanced health technologies and Industry 4.0 principles. Recent innovations include implementation of autonomous and decentralized water treatment systems featuring smart sensors, real time quality monitoring, and closed-loop control of water production. Technologies such as UV sterilization, advanced membrane filtration (including next-generation RO and nanofiltration), and real-time contaminant detection allow highly precise adaptation to source water variability and emerging pollutants [41,42,43,44].

Smart system powered by the Internet of Things (IoT), big data analytics, and artificial intelligence improve efficiency, ensure regulatory compliance, and enable proactive risk mitigation before contaminants reach consumers. Future research is focusing on making these advances scalable, affordable, and durable in underserved and remote areas. Additionally, there is growing push for environmentally sustainable water purification technologies that minimize water and energy use, as well as development of remineralization modules to optimize health benefits of demineralized water [41,44,45].

Emerging approaches also seek to integrate water safety with general health monitoring, for example by connecting home or clinical hydration sensors to mobile health platforms, and by enabling personalized water recommendations based on real-time health data [41,44].

Conclusion

Summary of Comparative Efficacy and Safety

The comparative analysis of normal drinking water, reverse osmosis (RO) water, and alkaline water reveals that all types, when microbiologically safe, can effectively support hydration and basic physiological functions. Regular drinking water provides balanced minerals essential for electrolyte homeostasis and is generally considered safest for long-term consumption by the general population. RO water, while highly purified, is demineralized and may increase the risk of mineral deficiencies such as calcium and magnesium if consumed exclusively without remineralization, particularly in vulnerable groups like children, elderly, and patients. Alkaline water, manufactured for increased pH and buffered with minerals, has shown potential benefits for specific digestive symptoms and minor metabolic improvements but lacks strong clinical evidence for broad preventive use. Both RO and alkaline waters are generally well tolerated but may occasionally cause gastrointestinal discomfort or electrolyte disturbances in susceptible individuals, underscoring the need for careful selection and evidence-based use.

Recommendations for Healthy Lifestyle and Disease Prevention

  • Prioritize microbial safety and absence of chemical contaminants when selecting water types. Source quality and effective treatment protocols (municipal or certified filtration) remain paramount for disease prevention.
  • For routine use, choose water with balanced mineral content. Normal drinking water or remineralized RO water is preferred for the general public, while highly demineralized water should be avoided for exclusive, long-term consumption in children, elderly, and other other vulnerable population unless clinically indicated.
  • Alkaline water may be considered for symptomatic relief in acid reflux or as part of therapeutic strategies for certain digestive disorders, but current data do not support its widespread use for metabolic or chronic disease prevention.
  • Individual fluid intake should follow age-specific and health-specific guidelines, typically 2-2.5 liters daily for healthy adults, with adjustments for climate, activity, and disease states.
  • Clinicians and public health professional should conduct water risk assessments for their populations, monitors for signs of dehydration or mineral imbalances, and tailor recommendations accordingly.
  • Future research should focus on comparative long-term clinical trials across diverse populations, and innovations in sustainable water treatment and remineralization technologies to ensure safety and optimize health for all.

References

  1. World Health Organization. Drinking-water [Internet]. World Health Organization. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/drinking-water
  2. What is Water Quality | Sidon Water [Internet]. Sidon Water. 2023. Available from: https://sidonwater.com/what-is-water-quality-and-why-is-it-important/
  3. The Importance of Water Quality Testing: Ensuring Health and Safety – Medbury Medicals [Internet]. Medburymedicals.com. 2024. Available from: https://medburymedicals.com/the-importance-of-water-quality-testing-ensuring-health-and-safety/
  4. wisdomlib.org. Alkaline water vs. normal and RO water: health effectiveness. [Internet]. Wisdomlib.org. 2024 [cited 2025 Sep 25]. Available from: https://www.wisdomlib.org/science/journal/world-journal-of-pharmaceutical-research/d/doc1384200.html
  5. Ohashi Y, Sakai K, Hase H, Joki N. Dry weight targeting: The art and science of conventional hemodialysis. Seminars in Dialysis. 2018 Jun 6;31(6):551–6.
  6. Sunardi D, Dian Novita Chandra, Bernie Endyarni Medise, Nurul Ratna Mutu Manikam, Dewi Friska, Wiji Lestari, et al. Health effects of alkaline, oxygenated, and demineralized water compared to mineral water among healthy population: a systematic review. Reviews on environmental health. 2022 Dec 27;0(0).
  7. Still J. Types of Water: 9 Different Sources and Brands, Plus Benefits & Risks [Internet]. Healthline. 2019. Available from: https://www.healthline.com/health/food-nutrition/nine-types-of-drinking-water
  8. Chan YM, Shariff ZM, Chin YS, Ghazali SS, Lee PY, Chan KS. Associations of alkaline water with metabolic risks, sleep quality, muscle strength: A cross-sectional study among postmenopausal women. Matsumura K, editor. PLOS ONE. 2022 Oct 31;17(10):e0275640.
  9. Pehrsson P, Patterson K, Perry C. NDBC32 WaterMin [Internet]. 2008. Available from: https://www.ars.usda.gov/ARSUserFiles/80400525/Articles/NDBC32_WaterMin.pdf
  10. Naseem F, Zobia Zia H, Ishtiaq Tariq M, Amjad Bashir M, Amber Hameed S, Samiullah K, et al. Role of chemical composition of drinking water in human health of the community. Journal of King Saud University – Science [Internet]. 2022 Oct 1;34(7):102232. Available from: https://www.sciencedirect.com/science/article/pii/S101836472200413X
  11. Drinking Water Sources: An Overview [Internet]. Drinking Water. 2024. Available from: https://www.cdc.gov/drinking-water/about/drinking-water-sources-an-overview.html
  12. Committee NRC (US) SDW. The Contribution of Drinking Water to Mineral Nutrition in Humans [Internet]. www.ncbi.nlm.nih.gov. National Academies Press (US); 1980. Available from: https://www.ncbi.nlm.nih.gov/books/NBK216589/
  13. National Primary Drinking Water Regulations | US EPA [Internet]. US EPA. 2024. Available from: https://www.epa.gov/ground-water-and-drinking-water/national-primary-drinking-water-regulations
  14. What Is Reverse Osmosis and How Does It Work | Veolia [Internet]. Watertechnologies.com. 2025. Available from: https://www.watertechnologies.com/knowledge-hub/what-is-reverse-osmosis
  15. The Basics of Reverse Osmosis [Internet]. Puretec Industrial Water. 2024. Available from: https://puretecwater.com/resources/the-basics-of-reverse-osmosis/
  16. Woodard J. What Is a Reverse Osmosis System and How Does It Work? [Internet]. Fresh Water Systems. 2023. Available from: https://www.freshwatersystems.com/blogs/blog/what-is-reverse-osmosis
  17. Olszak N. What is Reverse Osmosis (RO) and How It Works? [Internet]. Complete Water Solutions. 2020. Available from: https://complete-water.com/resources/what-is-reverse-osmosis
  18. Rokhmalia F, Hermiyanti P. Analysis of Biological and Chemical Parameters in Alkaline Water of Various Brands in Indonesia. International Journal of Advanced Health Science and Technology. 2022 Jun 15;2(3):209–13.
  19. Umair SM, Elnajjar E, Abu-Nabah BA, Hamdan MO. Electrochemical and thermodynamic analysis of alkaline water electrolysis: Design and performance optimization. International Journal of Hydrogen Energy [Internet]. 2025 Apr 18;128:643–55. Available from: https://www.sciencedirect.com/science/article/pii/S0360319925019500
  20. Pongsa P, Tangtreamjitmun N. PREPARATION AND CHEMICAL COMPOSITION OF ALKALINE WATER FROM PLANT COMBUSTION ASH (Penyediaan dan Komposisi Kimia Air Beralkali dari Abu Loji Pembakaran). Malaysian Journal of Analytical Sciences [Internet]. 2021;25:129–37. Available from: https://mjas.analis.com.my/mjas/v25_n1/pdf/Pongsa_25_1_12.pdf
  21. Savira Rinda Erliana, Noor I, Indra Sakti Pangestu, Atik D, Almas Diqya Wafa. Optimization of Alkaline Water Production from Rainwater through Electrolysis Method: Effect of Voltage and Time on pH and TDS. Sainteknol Jurnal Sains dan Teknologi. 2024 Jun 23;22(1):43–9.
  22. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutrition Reviews [Internet]. 2010;68(8):439–58. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908954/
  23. Tobias A, Mohiuddin SS. Physiology, water balance [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541059/
  24. Thippeswamy HM, Shanbhog R, Kumar MN, Prashanth SN, Smitha P. Comparison of serum calcium, magnesium, phosphate, alkaline phosphatase, and vitamin D levels in children consuming reverse osmosis, non reverse osmosis, and high fluoride drinking water. Scientific Reports [Internet]. 2025 Mar 28 [cited 2025 Aug 12];15(1). Available from: https://www.nature.com/articles/s41598-025-94758-9?utm_source=chatgpt.com
  25. LeWine HE. Is alkaline water better? [Internet]. Harvard Health. 2024. Available from: https://www.health.harvard.edu/staying-healthy/is-alkaline-water-better
  26. Narciso L, Martinelli A, Flavio Torriani, Paolo Frassanito, Bernardini R, Chiarotti F, et al. Natural Mineral Waters and Metabolic Syndrome: Insights From Obese Male and Female C57BL/6 Mice on Caloric Restriction. Frontiers in Nutrition [Internet]. 2022 May 24 [cited 2024 Oct 7];9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9172593/
  27. Best Guide on Water Purifiers for Essential Family Health [Internet]. drinkprime.in. 2024 [cited 2025 Sep 25]. Available from: https://drinkprime.in/blog/water-purifiers-for-family-health/
  28. Goldman R. Alkaline Water: Benefits, Side Effects, and Dangers [Internet]. Healthline. 2018. Available from: https://www.healthline.com/health/food-nutrition/alkaline-water-benefits-risks
  29. Bonvissuto D. What Is Alkaline Water? [Internet]. WebMD. WebMD; 2019. Available from: https://www.webmd.com/diet/what-is-alkaline-water
  30. World Health Organization. Introduction [Internet]. www.ncbi.nlm.nih.gov. World Health Organization; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK579464/
  31. Vroomen Durning M. The Science of Hydration [Internet]. Default. 2021. Available from: https://www.physiology.org/publications/news/the-physiologist-magazine/2021/july/the-science-of-hydration?SSO=Y
  32. Health Canada. Guidelines for Canadian Drinking Water Quality – Summary Table – Canada.ca [Internet]. Canada.ca. 2017. Available from: https://www.canada.ca/en/health-canada/services/environmental-workplace-health/reports-publications/water-quality/guidelines-canadian-drinking-water-quality-summary-table.html
  33. Gandy J. Water intake: validity of population assessment and recommendations. European Journal of Nutrition. 2015 Jun;54(S2):11–6.
  34. Harvard Health Publishing. How much water should you drink? [Internet]. Harvard Health. Harvard Health; 2023. Available from: https://www.health.harvard.edu/staying-healthy/how-much-water-should-you-drink
  35. Hennessy N. What should I drink to stay hydrated? [Internet]. www.bupa.co.uk. 2023. Available from: https://www.bupa.co.uk/newsroom/ourviews/keeping-hydrated
  36. Garcia D. Health promotion and hydration: A systematic review about hydration care. Florence Nightingale Journal of Nursing. 2022 Aug 15;30(3).
  37. Considerations for Reducing Risk: Water in Healthcare Facilities [Internet]. Healthcare-Associated Infections (HAIs). 2024. Available from: https://www.cdc.gov/healthcare-associated-infections/php/toolkit/water-management.html
  38. D. Water [Internet]. Infection Control. 2024. Available from: https://www.cdc.gov/infection-control/hcp/environmental-control/water.html
  39. World Health Organization. Guidelines for Drinking-water Quality FOURTH EDITION [Internet]. 2011. Available from: https://iris.who.int/bitstream/handle/10665/44584/9789241548151_eng.pdf
  40. Ambel AA, Bain R, Degefu TB, Donmez A, Johnston R, Slaymaker T. Addressing gaps in data on drinking water quality through data integration and machine learning: evidence from Ethiopia. npj Clean Water [Internet]. 2023 Sep 8;6(1):1–9. Available from: https://www.nature.com/articles/s41545-023-00272-8
  41. Guth D, Herák D. Modern Water Treatment Technology Based on Industry 4.0. Sensors. 2025 Mar 20;25(6):1925.
  42. Jaweria shamshad, Rehman RU. Innovative Approaches to Sustainable Wastewater Treatment: A Comprehensive Exploration of Conventional and Emerging Technologies. Environmental Science Advances [Internet]. 2024 Jan 1; Available from: https://pubs.rsc.org/en/content/articlehtml/2025/va/d4va00136b
  43. Drewnowski J, Szeląg B, Sabba F, Piłat-Rożek M, Piotrowicz A, Łagód G. Innovations in Wastewater Treatment: Harnessing Mathematical Modeling and Computer Simulations with Cutting-Edge Technologies and Advanced Control Systems. Journal of Ecological Engineering. 2023 Dec 1;24(12):208–22.
  44. Amin Mojiri, Trzcinski AP, Mohammed, Salem. Editorial: Innovative treatment technologies for sustainable water and wastewater management. Frontiers in water. 2024 Mar 8;6.
  45. Innovations in Water Treatment [Internet]. Scilight Press. 2025 [cited 2025 Sep 25]. Available from: https://www.sciltp.com/journals/iwt