INFECTION CONTROL


Above: Patient environment at a cystic fibrosis unit illustrating the challenges of maintaining low airborne microbial load within occupied healthcare spaces.


Above right: Clinical environment at a cystic fibrosis unit used during evaluation of continuous air treatment technologies in occupied patient areas.


Clinical environments: when infrastructure becomes part of infection prevention One of the challenges in addressing environmental contamination is that infrastructure systems are often not considered part of routine infection prevention strategy. Water systems, drainage, and air handling are typically viewed as engineering functions rather than clinical risk factors. However, growing attention is now being given to


the role of hospital infrastructure in supporting infection prevention and antimicrobial resistance (AMR) strategies. Recent European discussions around AMR preparedness have highlighted the importance of integrating infection prevention expertise into hospital design, environmental management, and infrastructure planning. In practice, this means recognising that contamination


pathways may originate from the built environment itself. In one clinical investigation involving an endoscope


reprocessing environment, repeated microbiological findings persisted despite established cleaning protocols. Attention eventually shifted away from equipment and staff procedures towards the drainage infrastructure beneath the sink environment. Following installation of targeted UV-C-based


intervention within the drainage system, no further cases were detected during more than three years of follow-up.


Similar observations have been made in airborne contamination studies. In one highly controlled intensive care unit environment, continuous air treatment resulted in reductions in airborne microbial load of more than 80 per cent, despite already low baseline levels. In a separate NHS hospital evaluation, airborne contamination levels exceeding 1300 CFU/m³ were reduced dramatically within the first hour of operation. Together, these examples illustrate how infrastructure- focused interventions may complement traditional infection prevention strategies by addressing continuous environmental contamination pathways that are otherwise difficult to control through episodic cleaning alone.


Airborne contamination in controlled environments Airborne transmission is another pathway that has gained increasing attention, particularly in the context of respiratory infections. However, even outside of pandemic scenarios, airborne microbial load may play a role in environmental contamination. A key assumption in many healthcare environments is


A key assumption in many healthcare environments is that modern ventilation systems provide sufficient control of airborne contamination. While ventilation is critical, it may not fully eliminate localised microbial load within occupied spaces.


80 Health Estate Journal September 2026


that modern ventilation systems provide sufficient control of airborne contamination. While ventilation is critical, it may not fully eliminate localised microbial load within occupied spaces. Testing conducted in a highly controlled intensive care unit environment demonstrated that even where baseline contamination levels were relatively low, continuous air treatment could achieve significant further reductions. Within the first two weeks, reductions in airborne microbial load of more than 80 per cent were observed. This finding suggests that even ‘clean’ environments may still contain a measurable and reducible microbial burden.


Rapid reduction in high-load environments The impact of continuous air treatment is not limited to low baseline environments. In an independent evaluation conducted within an


NHS hospital setting, baseline airborne microbial levels exceeded the upper detection limits of the sampling method (>1300 CFU/m³).


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