Position Statement: Integrating Planetary Health into Infection Prevention and Control in Healthcare Settings - Toward a Balanced and Evidence-Based Approach.

Abstract

Background: Infection prevention and control (IPC) is fundamental for patient safety. Effective IPC generates direct ecological benefits by preventing healthcare-associated infections (HAIs), thereby reducing prolonged hospitalisation, antibiotic use, and resource consumption. Paradoxically, IPC measures: single-use materials, chemical disinfectants, and resource-intensive waste streams, contribute to healthcare's greenhouse-gas emissions and environmental burden. As climate change and environmental degradation threaten human and ecosystem health, there is growing urgency to evaluate IPC measures through a planetary health lens, ensuring sustainability considerations complement rather than compromise infection prevention outcomes.

Aims: This position paper by the ESCMID Study Group for Nosocomial Infections (ESGNI) examines intersections between IPC practice and planetary health. Drawing on a synthesis of current evidence and expert consensus, it identifies opportunities to reduce the environmental footprint of IPC where evidence supports equivalent or superior IPC outcomes, and outlines research and policy priorities where evidence remains insufficient.

Content: The paper analyses five key domains at the IPC-planetary health interface: 1) single-use versus reusable, 2) biocides and environmental contamination, 3) healthcare waste, 4) AMR: IPC priorities within a One Health framework, and 5) IPC and planetary health in low- and middle-income countries. Cross-cutting themes, including circular economy principles, life-cycle assessment, regulatory barriers, and climate-related risks are explored, with implications for regulation, procurement, infrastructure, and workforce competencies.

Implications: Sustainability considerations in IPC must function as a complement to, not a substitute for, infection prevention outcomes. Where evidence supports equivalent safety with a reduced environmental footprint, change is justified and should be pursued through evidence-based, risk-stratified, and context-specific approaches. Achieving this requires regulatory reform, interdisciplinary collaboration, and targeted investment in research, education, and capacity building. Positioning IPC as a partner in sustainable healthcare offers a pathway to reduce avoidable environmental harm while strengthening resilience against infectious threats - with patient safety as the primary and non-negotiable objective.