We appreciate the thoughtful comments from Ms. Baier and Dr. Lagoudas. ^{Reference Baier and Lagoudas1} We agree with elevating indoor air quality (IAQ) and ventilation as core components of IPC programs in nursing homes and we welcome the growing attention to this area. The guidance emphasizes a layered approach to infection prevention with ventilation considered alongside other core strategies such as vaccination, hand hygiene, environmental cleaning, and early identification and management of pathogens.

In the guidance ^{Reference Mody, Advani and Ashraf2} we state that “the IPC program should play a role in enhancing and maintaining building air quality.” Starting with baseline expectations, the guidance states that nursing homes should ensure compliance with heating, ventilation, and air conditioning requirements, regularly monitor system performance, and collaborate with facility management on needed improvements. The nursing home also should evaluate heating, ventilation, and air conditioning as part of the annual IPC risk assessment. Furthermore, we say that nursing homes should consider enhancements to IAQ.

The COVID-19 pandemic underscored how indoor air affects the spread of respiratory diseases; yet ventilation and IAQ remain understudied in nursing homes and data are preliminary for this setting. Given nursing homes’ differences in building infrastructure, staffing, resources, and local epidemiology, a nursing home’s IPC program must evaluate interventions for their feasibility and impact in assigning resources. To support this process, we direct readers to complementary frameworks for prioritizing and sequencing IPC investments. ^{Reference Schaffzin, McMullen and Kyle3} The guidance refers readers to standards from the American Society of Heating, Refrigerating, and Air-Conditioning Engineers for air changes per hour by room type and filtration levels to optimize airflow and air quality. ⁴ We intentionally refer readers to these standards and other regularly updated, relevant guidelines to help develop a personalized plan appropriate for their facilities. In addition to the inclusion of guidance for IPC considerations related to IAQ (recommendations 4, 5, 28) as well as related recommendations for facility risk assessments and outbreak preparedness and response, the Supplementary Materials include a summary of all the recommendations (Table 1)Reference Mody, Advani and Ashraf ² and a “quick reference” guide by topic categories (Table 7), which includes ventilation, to help focus readers on priority practices. ^{Reference Mody, Advani and Ashraf2}

We thank Ms. Baier and Dr. Lagoudas for their engagement in this important topic.