Pan American Health Organization · 2023
Pan American Health Organization guidance on managing airborne chemical and microbiological contaminants in health care settings.
- Issuer
- Pan American Health Organization
- Edition
- 2023
- Audience
- Health care facility managers, infection prevention and control staff, public health professionals
- Reviewed
- 17 Oct 2026 · GMJ
What this guideline says
GMJ summary
This guidance addresses the critical need for healthy indoor environmental quality (IEQ) in health care facilities to protect patients, visitors, health care workers and support personnel. Given that patients have reduced immunity and both patients and staff spend extended periods indoors, maintaining optimal IEQ is essential for infection prevention and occupational health.
The document analyses airborne chemical and microbiological contaminants of concern in health care settings. Potential sources include office equipment, cleaning products, construction activities, furnishings, cigarette smoke, water-damaged materials, microbial growth (fungal, mould and bacterial), and outdoor pollutants. The guidance also considers how indoor temperature, relative humidity and ventilation levels influence individual responses to the indoor environment.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Health care facility indoor environments require special attention due to patients' reduced immunity and extended occupancy periods
- Airborne contaminants include both chemical pollutants (from office machines, cleaning products, construction, furnishings, smoke) and microbiological agents (fungal, mould, bacterial)
- Water-damaged building materials represent a significant source of microbial contamination requiring monitoring
- Indoor temperature, relative humidity and ventilation levels are critical factors affecting occupant health responses
- Both health care workers and support personnel require protection alongside patients and visitors
From the guideline
Verbatim
“IEQ in a health care facility is critical, since patients have less immunity.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia, I recognise that many Georgian health facilities, particularly those outside Tbilisi, face challenges with ageing infrastructure, inadequate ventilation systems and moisture problems that directly impact indoor environmental quality. This PAHO guidance provides a framework for systematic assessment of airborne contaminants and environmental parameters that should be integrated into our national health facility standards and infection prevention protocols. I would emphasise to Georgian facility managers the critical connection between water damage, microbial growth and patient safety, particularly in tuberculosis and oncology wards where patients are highly vulnerable. The primary implementation challenge will be securing resources for environmental monitoring equipment and ventilation system upgrades in regional facilities operating under constrained budgets, requiring a phased approach prioritising high-risk clinical areas.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 17 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is particularly relevant given ongoing health infrastructure modernisation and the prevalence of older facilities that may have ventilation, humidity control and water damage issues. National health facility accreditation programmes should incorporate IEQ assessments, including monitoring of indoor air quality, ventilation adequacy and microbial contamination, especially in immunocompromised patient areas. Implementation will require establishing baseline IEQ standards, training facilities managers and integrating routine environmental monitoring into infection prevention and control protocols.
Questions this guideline answers
Quick answers
Why is indoor environmental quality especially important in health care facilities?
Patients have reduced immunity and both patients and health care staff remain in buildings for extended periods, making them more vulnerable to indoor contaminants and requiring higher environmental quality standards than other buildings.
What are the main sources of indoor air contamination in health care facilities?
Contaminants come from office machines, cleaning products, construction activities, carpets and furnishings, perfumes, cigarette smoke, water-damaged materials, microbial growth (fungal, mould, bacterial), insects, and outdoor pollutants entering the building.
What environmental factors affect how people respond to indoor air quality?
Indoor temperatures, relative humidity levels and ventilation rates significantly influence how building occupants respond to the indoor environment and contaminant exposures.
Who needs protection from poor indoor environmental quality in health facilities?
Patients, visitors, health care workers and support personnel all require protection, as all groups may experience extended exposure to the indoor environment.
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2023-01-01
- Audience
- Health care facility managers, infection prevention and control staff, public health professionals
- Licence
- CC BY-NC-SA 3.0 IGO
- Record history
- Created 17 Oct 2026 · updated 17 Oct 2026 · next check Apr 2027
Pan American Health Organization. Guidance on Indoor Environmental Quality in Health Care Facilities. Washington, D.C.: PAHO; 2023. Available from: https://iris.paho.org/handle/10665.2/57420GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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