The Next Pathogen Is Already on Its Way

Every infection preventionist I know keeps a mental list of the pathogens that got too close: Ebola reaching a Dallas emergency department in 2014, Candida auris quietly colonizing units before most labs can identify it, and the Mpox outbreak in 2022. Each time, the same uncomfortable truth surfaces: we built the response while the patient was already in the building.

The next emerging pathogen, whether it is a filovirus like Ebola or Marburg, a hantavirus from rural exposure, or a respiratory virus we have not yet encountered, will not politely announce itself. It may appear as an undifferentiated fever, a vague travel history, or a cluster no one connects until the third case. Preparedness is not about predicting which microbe comes next. It is about building a system that holds up no matter what comes through the door.

When the Diagnosis Is Unknown, Start with Controls You Can Rely on

The CDC’s hierarchy of controls remains the most useful framework, because it doesn’t depend on knowing the organism. Personal protective equipment, administrative and engineering controls, each carry part of the load, and the order matters.

We reach for PPE first because it’s visible and reassuring, but it’s the least reliable layer. It fails when a mask doesn’t seal, when supplies run short, or when a tired nurse breaks technique at the eleventh hour.

Administrative controls are cheap to strengthen but easy to neglect. Triage questions that actually flag travel and exposure. Clear isolation criteria that a charge nurse can act on without waiting for an ID consult. Drills that work for real life, not on paper 

During the 2014 Ebola response, the hospitals that did the best weren’t the ones with the most equipment. They were the ones who had practiced the workflow, including the unglamorous parts like doffing and waste handling.

Engineering controls sit higher in the hierarchy for a reason: they operate continuously, without requiring human intervention. Ventilation is the backbone. For airborne precautions, guidance has long recommended a minimum of 12 air changes per hour, and airborne infection isolation rooms feature negative pressure with HEPA-filtered or 100% outside exhaust. The CDC’s more recent ventilation guidance for general building spaces sets a minimum of 5 air changes per hour of clean air. These numbers are worth committing to memory because when a suspected case appears, you won’t have time to look them up.

Air Is the Layer We Underestimate

Here’s what gets me about airborne risk: it’s invisible, and we mostly treat it as being solved. The room has an HVAC system, so we assume the air must be fine. But “fixed” ventilation was designed for a building, not for the moment a patient with an unknown respiratory pathogen is coughing in a procedure room, or for the open surgical field where airborne particulate can settle directly into a wound. 

The operating room is a particular blind spot. Perioperative nurses know how much disruption a single case generates: door openings, staff movement, instrument traffic, all of it stirring particles that the HVAC wasn’t sized to clear in real time. Surgical site infections are the expensive, painful reminder that air quality at the table is a patient safety issue, not a facility footnote. 

Continuous air disinfection has a clear place in the infection prevention plan. Autonomous systems can monitor and disinfect air throughout by pulling room air through HEPA filtration and a UV photolytic chamber, inactivating bacteria, viruses, and spores before returning filtered air to the space.

In several published evaluations, a mobile unit of this type measurably reduced airborne particulate matter and Surgical Site Infections. This level of value is not tied to a single number. It is the consistency: air disinfection runs the whole case, every case, without anyone having to remember to switch it on.

Why Monitoring Changes the Conversation

What I find most valuable for an “Infection Prevention and Control” program is the monitoring piece. Continuous air-quality sensing turns assumption into data. Instead of trusting that the room is clean, you can see particle counts respond when a door opens, when traffic spikes, when something in the workflow drifts. That visibility does two things simultaneously. It protects patients and the team, who deserve to know the air they’re breathing during a long case is being actively managed.

For an emerging pathogen, monitoring also gives you a defensible record. When Leadership asks whether the environment was controlled during a suspected exposure, “we believe so” is an insufficient answer. Having a continuous data trail is strong. It supports root-cause review, and it builds the kind of institutional trust that keeps your staff showing up during a frightening outbreak. 

Build Your System Now, Not During the Surge

The AORN Guidelines for Perioperative Practice already frame air quality as part of a safe surgical environment, and that framing should extend to your broader preparedness plan. Map your isolation capacity before you need it. Confirm your AIIR pressures actually hold. Layer continuous air disinfection and monitoring into your highest-risk spaces, the OR and procedural areas especially, so that protection doesn’t depend on a correct diagnosis or a perfectly executed checklist. 

We won’t get advance notice of the next pathogen threat. What we can control is whether the building is already working in our favor the day it arrives. The clean air, the negative pressure, the data on the screen: those should be running long before anyone says the word “outbreak.”