Although we commend Mody et al. for including airborne transmission in their “Multisociety Guidance for Infection Prevention and Control in Nursing Homes,” ^{Reference Mody, Advani and Ashraf1} we call for greater emphasis on the importance of ventilation, air filtration, and air disinfection in reducing respiratory infection risk. Guidance can meaningfully elevate indoor air quality (IAQ) so that it is not treated as an afterthought but recognized as an essential component of nursing home infection prevention and control (IPC) programs and of ongoing risk assessment and mitigation.

Our collective challenge is to elevate nursing homes’ understanding of IAQ and to support practical, sustainable action. In a recent Centers for Disease Control and Prevention-funded project, we spoke with leaders who described viewing IAQ primarily as a facilities or maintenance concern, rather than a core element of infection prevention or outbreak response (unpublished data). However, when presented with evidence linking IAQ with respiratory virus transmission—such as a study reporting up to an 80% lower relative risk of COVID-19 in well-ventilated classrooms ^{Reference Buonanno, Ricolfi, Morawska and Stabile2} —they expressed strong interest and identified a need for clear, practical guidance and resources to act. However, many of the nation’s 15,000 nursing homes operate in aging buildings, with thin operating margins, and without in-house engineering expertise. Absent clear guidelines, IAQ changes are difficult to prioritize or sustain, even when motivation is high.

To advance this guidance from principle to practice, we call for future multisociety guidance to further prioritize ventilation in the core recommendations for infection prevention, alongside hand washing, surface cleaning, vaccination, and personal protective equipment. Ventilation is a passive, unobtrusive measure that can reduce disease transmission and protect against all airborne threats in indoor settings such as offices and daycares. ^{Reference Milton, Glencross and Walters3,Reference Haverinen-Shaughnessy, Borras-Santos and Turunen4} There is emerging evidence for nursing homes, too. ^{Reference Jutkowitz, Shewmaker, Reddy, Braun and Baier5–Reference Khadar, Sim, McDonald, McDonagh, Clapham and Mitchell7}

Recommendations should also be paired with practical, scalable supports: clear ventilation targets, accessible tools for assessing IAQ, low-cost interventions such as portable air cleaners or high-efficiency Heating, Ventilation, and Air Conditioning filters, and funding mechanisms to promote equitable, sustained implementation. The airborne infection isolation rooms mentioned in the guidance, while effective, cannot be the only ventilation tool nursing home leaders use. Simple measures such as portable air cleaners can provide an added protective layer, even before outbreaks. ^{Reference Gettings, Czarnik and Morris8–10}

Together we can equip industry leaders with the knowledge, tools, and resources to integrate IAQ into IPC programs and elevate air quality to the same level of priority as other infection control practices, strengthening infection prevention year-round and improving the health and well-being of nursing home residents and staff.