Rethinking Sustainability in Infection Prevention: Behavioral Change as the Missing Link

Infection preventionists (IPs) are accustomed to thinking about sustainability in terms of preventing avoidable infections and reducing downstream burdens on patients and health systems. But sustainability also has another dimension, its ecological footprint. Climate change is increasingly recognized as the most significant health threat of the 21^st century, and health care is both a responder to its consequences and a significant contributor to carbon emissions and waste.

A new study by Bludau and colleagues (2025), “Applying the Theoretical Framework Of Behavioural Change on Sustainable Infection Prevention and Control Based on a Binational Workshop,” published in the Journal of Hospital Infection, explores how behavioral change theory can be applied to sustainable infection prevention and control (IPC), offering a framework that empowers IPs to drive change without compromising patient safety.

About the Study

The Joint Forum, a 2-day networking event organized by the European Centre for Advanced Studies (ECAS) in collaboration with Leuphana University Lüneburg and the University of Glasgow, aims to foster cooperation among higher education institutions in Lower Saxony and Scotland. In 2024, it featured a workshop led by a team from the University Medical Centre Goettingen (UMG), with seven IPC specialists from UMG, ARHAI Scotland, and the University of Greifswald Medical School, focused on making IPC more sustainable.

Participants from diverse backgrounds, including IPC specialists and nonhealth care workers, engaged in a two-part workshop. The first part featured presentations on successful interventions aimed at building common knowledge. The second part encouraged idea-sharing on overcoming barriers to sustainable IPC. Following the World Café method, participants, grouped by professional background to promote dialogue and prevent dominance by ‘experts,’ discussed questions facilitated by a workshop organizer. Nonspecialists contributed insights from their professional, social, and healthcare experiences.

The workshop had 16 participants, with 11 from Germany and 5 from Scotland, according to the authors. The largest group consisted of 7 health care workers, while the other attendees came from fields outside health care, such as energy, social sciences, and psychology. When asked about their motivation for attending the workshop, 8 participants cited professional interest in the topic, 6 mentioned personal interest, and 9 each expressed a desire to network and collaborate, as well as to explore new concepts and ideas.

Why Behavior Matters in Sustainable IPC

The study applied the capability, opportunity, motivation, and behavior (COM-B) model, a behavioral change framework, to discussions from a binational workshop of IPC specialists and multidisciplinary experts. The COM-B model recognizes that for any behavior to change, people must (1) know how to act (capability), (2) have the physical and social structures to enable the behavior (opportunity), and (3) be motivated to carry it out (motivation).

In IPC, this means sustainable practices cannot be achieved through policy or technology alone. Staff must be capable of using new products and practices correctly. Opportunities must exist within the workflow and infrastructure, and motivation must align with patient safety goals rather than being perceived as a purely economic or cosmetic exercise.

“A growing desire to reduce the negative impact of the health care system on the environment translates into a higher expectation for health care workers to contribute to various sustainable projects and interventions,” the authors wrote.

Overcoming Misconceptions

One of the strongest themes from the workshop was trust. Many frontline staff and patients fear that “sustainability” means cutting costs or lowering the quality of care. To counter this, the group emphasized transparent communication backed by strong data.

For IPs, this means advocating for high-quality evidence that weighs both safety and sustainability before implementing changes. For example, reusable gowns or redesigned cleaning products must not only meet infection control standards but also be introduced with clear messaging about their proven safety. As the study notes, emotional framing, highlighting both patient safety and environmental benefits, can help address skepticism and build buy-in.

Engaging Patients and Visitors

Sustainability in health care is not only the responsibility of staff. Patients and visitors can also contribute, whether by using public transportation, choosing eco-friendly food and gifts, or participating in digital visits when appropriate. The workshop suggested hospitals can lead by modelling sustainable behavior, offering greener options, and visibly communicating their impact.

IPs also play a role here. Infection prevention signage and patient education can include reminders that environmentally conscious choices support both health and safety. Just as patients are asked to clean their hands, they can also be encouraged to consider their environmental impact.

IPC Practitioners as Enablers

Perhaps the most striking insight from the study was the need for IPs to be seen as enablers, not obstacles. Too often, IPC is brought into sustainability projects late, when interventions already feel “finished.” At that stage, necessary infection safety adjustments may be perceived as barriers.

The solution was early and visible involvement of IPC in sustainability planning. Round tables, hospital-wide hotlines, and checklists were among the practical suggestions to position IPC as leaders. By initiating and guiding projects—rather than only reacting—IPs can demonstrate that sustainability and infection control are not competing priorities but mutually reinforcing goals.

The Role of Data

A recurring message from participants was the urgent need for a structured, high-quality database that captures both patient safety and ecological outcomes. Without this evidence, IPs are left in a reactive position, unable to challenge unsustainable practices that may not even improve safety. The call is clear: IPC leaders must advocate for funded research that combines sustainability measures (such as life cycle assessments) with infection outcomes.

Why This Matters Now

For IPs, this study serves as a reminder that infection prevention is already a sustainability strategy—we reduce wasteful treatments and prevent avoidable harm. But in the era of climate change, we must expand this perspective. Behavioral change models, such as COM-B, provide us with the tools to address cultural, social, and practical barriers to greener practices while maintaining a firm focus on patient safety.

Much can be done by IPC teams themselves, from education and modelling to redesigning workflows. Yet, as the study emphasizes, top-down support is also essential. Hospital management, policymakers, and national curricula must integrate sustainability into IPC training and regulation.

Final Thought

The path to sustainable IPC isn’t about choosing between infection safety and environmental responsibility—it’s about proving they can reinforce each other. As Bludau et al, conclude, “Much can be done by IPC teams but a top down approach is also necessary and policy makers inside and outside of the hospital need to get involved. The creation of national and international curricula that address planetary and sustainable health care is imperative for reaching this goal.” For IPs, this means stepping into the role of changemakers, demanding data, leading conversations, and modeling practices that protect both patients and the planet.

Find the original study here.