Numerous marine sessile organisms adhere to ship hulls and increase the sailing resistance. Antibiofouling paints are employed to maintain the ship performance. However, the chemicals employed for antifouling purposes are becoming increasingly diverse, lacking clear toxicological information. Particularly, the imperfect antibiofouling efficacies of these chemicals necessitate periodic hull cleaning to dislodge attached marine organisms. This hull cleaning process inadvertently releases a plethora of hazardous substances, including antibiofouling chemicals, heavy metals, and cleaning agents, alongside exotic microorganisms. This results in profound marine pollution and ecosystem disruption. Specifically, these exotic microorganisms pose a novel ecological threat in coastal waters. However, despite the gravity of ship hull cleaning-related issues, comprehensive investigations have been lacking, and international regulatory measures are gaining attention recently. Aiming to provide solutions to the emerging challenges associated with hull cleaning, this review endeavors to comprehensively address the biofouling organisms and their mechanisms, potential antifouling paint hazards, and effective hull cleaning methodologies. Display omitted •Marine sessile organisms are responsible for biofouling on hull surfaces.•Regular hull cleaning is essential to remove biofouling from the hull.•Hull cleaning processes can lead to the release of pollutants into the sea.•Hull cleaning wastewater recovery and treatment are required.