Air Quality in Infection Prevention:
Innovations, Efficacy, and Limitations


New insights into pathogen-specific transmission dynamics and innovations in ventilation, filtration, and monitoring systems offer promising tools for effective infection control.

City skyline and the air pollution   (Adobe Stock 622964966 by nilanka)

City skyline and the air pollution

(Adobe Stock 622964966 by nilanka)

Air quality directly impacts the transmission of pathogens and respiratory illnesses, making it crucial in preventing infections. When the air we breathe is of good quality, it acts as a barrier, hindering the easy movement of harmful microorganisms and viruses. On the contrary, poor air quality creates an environment conducive to the rapid spread of these diseases. Therefore, maintaining high air quality benefits our overall well-being and actively curbs infection transmission among individuals.

In recent years, significant advancements have been made in understanding the dynamics of air quality management within health care settings.1 This article aims to delve into the latest developments, effective strategies, and potential limitations concerning air quality, tailored for infection preventionists.

New Insights and Innovations

Different germs, different travels

Investigators have found that certain germs are transmitted on big respiratory droplets when people cough or sneeze, whereas others spread through tiny aerosol particles.2-4 Understanding this distinction is crucial to preventing the spread of disease. For example, COVID-19 demonstrated the importance of good ventilation and air filters because diseases can spread through tiny aerosols. SARS-CoV-2, the virus responsible for COVID-19, can be transmitted through both respiratory droplets and aerosols, making it important to consider multiple modes

of transmission in public health measures.

Better air filters and UV lights

Two superstars have emerged in the air cleaning world: high-efficiency particulate air (HEPA) filters and ultraviolet germicidal irradiation (UVGI) systems. HEPA filters are like microscopic bouncers that catch even the tiniest particles, including germs as small as 0.3 µm.5 UVGI systems use a special light to zap germs; these technologies significantly reduce the risk of germs spreading through the air.

Monitoring air quality in real-time

Imagine having a digital watchdog that constantly checks the air quality and examines dust, humidity, and carbon dioxide levels.6 These devices help infection experts make quick decisions about keeping the air clean and safe, ensuring everyone stays healthy.

Specific Air Quality Technologies

HEPA filters

In health care, HEPA filters shine with exemplary efficiency. Products like Honeywell True HEPA Air Purifiers7 and Dyson Pure Cool TP04 HEPA air purifiers8 have garnered acclaim for their prowess in eliminating airborne particles, ensuring pristine air quality for patients and staff.

UVGI systems

R-Zero’s Arc UV-C Disinfection system9 has taken center stage, harnessing UV-C light’s potent prowess to neutralize pathogens in the air and on surfaces. Its innovative approach has garnered attention as a pioneering solution for infection control.

Real-time monitoring systems

Companies such as Airthings present cutting-edge real-time air quality monitoring solutions. The Airthings Wave Plus10 product particularly stands out for its ability to continuously assess various air quality parameters, providing invaluable insights to enhance environmental well-being.

Recent Innovations

Nanotechnology filters

Nanotechnology has revolutionized air filtration by enabling the creation of tiny, efficient filters. Using nanoscale materials and structures, these filters trap even the smallest particles, including viruses and bacteria. They are increasingly used in air purifiers and HVAC systems to improve indoor air quality, making them a crucial innovation in addressing health concerns related to air pollution and airborne pathogens.

Smart ventilation systems

Smart ventilation systems leverage sensors and automation to optimize building airflow. They can adjust ventilation rates based on real-time data, such as occupancy levels and air quality measurements. By dynamically managing airflow, these systems enhance energy efficiency and ensure occupants breathe cleaner, healthier air. This innovation is especially valuable for sustainable building practices and reducing the spread of airborne contaminants.

Advanced sensors

Advanced sensors are pivotal in monitoring and controlling indoor environments. These sensors detect various parameters, including temperature, humidity, carbon dioxide levels, and volatile organic compounds. With their data, building management systems can make real-time adjustments to maintain optimal conditions for comfort, well-being, and energy efficiency.

Air disinfection technologies

Air disinfection technologies have seen significant advancements in response to the COVID-19 pandemic and increasing concerns about airborne pathogens. UV-C light, photocatalytic oxidation (ie, a process using light energy to catalyze the oxidation of pollutants, purifying air and water), and other methods are being integrated into air purification systems to kill or inactivate viruses and bacteria. These technologies are crucial for improving the safety of indoor spaces such as hospitals, offices, and public transportation.

Machine learning integration

Machine learning is being integrated into various aspects of HVAC and air quality control systems. By analyzing vast datasets from sensors and historical usage patterns, machine learning algorithms can predict when maintenance is needed, optimize energy consumption, and even anticipate changes in air quality. This integration enhances system efficiency, reduces operating costs, and ensures a healthier indoor environment.

Effective Strategies

Optimized ventilation systems

Well-designed ventilation systems focusing on air exchange rates and proper clean air distribution can dilute indoor contaminants.11 Dilution ventilation, which involves increasing the outdoor air supply, can significantly reduce the concentration of airborne pathogens.

Air filtration

When appropriately selected and maintained, HEPA filters can effectively reduce the concentration of particles carrying pathogens. Regular filter replacement and maintenance are crucial to ensure optimal filtration efficiency.

UVGI systems

These systems are proven to inactivate many pathogens. When placed strategically within ventilation systems, they can help mitigate the risk of airborne transmission.

Negative pressure rooms

Negative pressure rooms are vital in isolating contagious patients and preventing the spread of airborne infections to the surrounding environment. These rooms ensure that air flows from the corridor into the isolation room, minimizing the escape of pathogens.

Limitations and Challenges

High costs

Implementing advanced air quality control measures can be expensive. High-quality ventilation systems, HEPA filters, and UVGI systems require substantial up-front investments, potentially straining health care budgets.

Maintenance complexity

Complex air quality systems demand regular maintenance to function optimally. Filters need replacement, UV lamps require periodic changes, and ventilation systems must undergo routine inspections. Inadequate maintenance can lead to decreased efficiency and compromised infection prevention.

Limited retrofitting options

Retrofitting health care facilities with advanced air quality systems can be challenging due to architectural constraints. Older buildings might need structural provisions to effectively accommodate new ventilation or filtration systems.

Pathogen variability

Some pathogens remain viable in aerosols for extended periods, whereas others have shorter survival times. Tailoring air quality interventions to different pathogens’ characteristics is crucial but complex.


Infection preventionists play a pivotal role in safeguarding health care environments against transmitting pathogens through the air. New insights into pathogen-specific transmission dynamics and innovations in ventilation, filtration, and monitoring systems offer promising tools for effective infection control. Optimizing ventilation, employing air filtration technologies, and integrating real-time monitoring can enhance air quality management strategies.

However, challenges such as high costs, maintenance complexity, and retrofitting limitations warrant careful consideration. As our understanding of airborne transmission continues to evolve, infection preventionists must stay abreast of the latest research and advancements in air quality management. By balancing innovation and practicality, health care facilities can create safer environments that minimize the risk of airborne infections and protect patients and health care workers.


  1. Gola M, Settimo G, Capolongo S. Indoor air quality in inpatient environments: a systematic review on factors that influence chemical pollution in inpatient wards. J Healthc Eng. 2019;2019:8358306. doi:10.1155/2019/8358306
  2. Gralton J, Tovey E, McLaws ML, Rawlinson WD. The role of particle size in aerosolized pathogen transmission: a review. J Infect. 2011;62(1):1-13. doi:10.1016/j.jinf.2010.11.010
  3. Morawska L, Tang JW, Bahnfleth W, et al. How can airborne transmission of COVID-19 indoors be minimized? Environ Int. 2020;142:105832. doi:10.1016/j.envint.2020.105832
  4. Whitacre Martonicz T. Investigation of air dispersal during a rhinovirus outbreak in a pediatric intensive care unit. Infection Control Today. Accessed November 15, 2023.
  5. What is a HEPA filter? Environmental Protection Agency. Updated March 13, 2023. Accessed August 30, 2023.,penetrating%20particle%20size%20(MPPS)
  6. Hiwar W, King MF, Shuweihdi F, Fletcher LA, Dancer SJ, Noakes DJ. What is the relationship between indoor air quality parameters and airborne microorganisms in hospital environments? a systematic review and meta-analysis. Indoor Air. 2021;31(5):1308-1322. doi:10.1111/ina.12846
  7. Air purifiers. Honeywell. Accessed October 7, 2023.
  8. Dyson Pure Cool, TP04 - HEPA air purifier and tower fan, white/silver. Amazon. Accessed October 7, 2023.
  9. Arc whole-room UVC disinfection system. R-Zero. Accessed October 15, 2023.
  10. Wave plus. Airthings. Accessed October 15, 2023.
  11. Izadyar N, Miller W. Ventilation strategies and design impacts on indoor airborne transmission: a review. Build Environ. 2022;218:109158. doi:10.1016/j.buildenv.2022.109158

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