INFECTION CONTROL
Following activation of the system, a rapid reduction was observed. Within approximately 30–50 minutes, levels fell to around 200–400 CFU/m³. The speed and magnitude of this reduction highlight
the potential for continuous air treatment to stabilise environments that would otherwise be considered highly contaminated. Together, these findings suggest that continuous air management may be relevant across a wide spectrum of clinical environments – from highly controlled intensive care units to more heavily burdened ward settings.
Rethinking air quality: beyond ventilation alone These findings align with a broader shift in thinking around indoor air quality. Research from the Harvard T.H. Chan School of Public Health ‘Healthy Buildings’ programme has highlighted the importance of air changes per hour (ACH) in reducing airborne risk, suggesting that levels of 4–6 ACH represent good to ideal conditions in many healthcare environments. However, achieving these levels consistently across all clinical spaces is not always feasible, particularly in older infrastructure or high-occupancy settings. As a result, increasing attention is being given to the
role of localised air treatment solutions as a complement to central ventilation systems. These approaches aim to reduce microbial load directly within the occupied zone, rather than relying solely on dilution through air exchange.
From episodic to continuous control Traditional infection prevention strategies are largely episodic in nature. Cleaning, disinfection, and sterilisation are typically performed at defined intervals or following specific events. While these interventions are essential, they may not address continuous sources of contamination originating from environmental systems. Persistent contamination may instead be driven by ongoing inputs from infrastructure systems, including air and water. In such cases, episodic interventions alone may not be sufficient to achieve sustained control. This has led to increasing interest in approaches that provide continuous environmental
management, complementing existing protocols rather than replacing them.
Implications for operating theatres Operating theatres represent some of the most highly controlled environments within healthcare. Strict protocols, advanced ventilation systems, and controlled workflows are designed to minimise infection risk. However, even in these environments, contamination
pathways may still exist. Airborne particles, staff movement, and interaction with equipment all contribute to the dynamic nature of the operating theatre environment. Even small fluctuations in airborne microbial load during procedures may have implications for surgical site infection risk, particularly in longer or more complex operations. While ventilation systems provide essential background
control, localised microbial load may still vary significantly within the occupied zone. The ability to continuously reduce airborne microbial
load, even in already controlled environments, may therefore represent an additional layer of protection. This raises an important consideration: should infection
prevention strategies in operating theatres evolve to include continuous environmental control alongside existing episodic interventions?
Conclusion Infection prevention has achieved significant progress through improvements in clinical protocols, cleaning, and sterilisation. However, growing evidence suggests that hidden
environmental reservoirs within infrastructure systems may play a more important role than previously recognised. Addressing these challenges does not require replacing
existing practices, but expanding them. By integrating infrastructure-focused strategies alongside established protocols, healthcare systems may be better equipped to reduce persistent contamination and improve patient safety. The question is no longer whether surfaces are clean – but whether the entire clinical environment is truly under control.
Jørn Terkelsen
Jørn Terkelsen is the founder and CEO of Dolphin Care. Over the past decade, he has worked in close collaboration with clinical microbiologists and infection prevention specialists at Copenhagen University Hospital (Rigshospitalet) and other healthcare institutions to develop UV-C-based technologies addressing hidden environmental reservoirs of contamination in clinical settings. His work focuses on translating clinical microbiology insights into practical engineering solutions for infection prevention and environmental control.
September 2026 Health Estate Journal 81
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