What’s hiding in your waiting room air, and what to do about it

Primary care physicians diagnose and treat respiratory issues every day, but the conversation rarely turns to the environment where patients wait before the appointment begins. Most physicians don’t control the indoor air quality in their medical offices or think about it as a clinical variable. The evidence suggests they should. The Environmental Protection Agency (EPA) has found that indoor air can be two to five times more polluted than outdoor air, which is a stark reality to face when the room in question is a pediatric waiting room.

Why does indoor air quality matter specifically in a primary care practice?

Primary care waiting rooms bring together a uniquely vulnerable patient mix. Older patients, pediatric patients, immunocompromised individuals and actively infectious patients share air in a small, enclosed space with high turnover. Unlike a commercial office, the people in a medical waiting room are already presenting with symptoms. The air they breathe while waiting can affect how they feel when they reach the exam room — and what they take home with them.

The U.S. Centers for Disease Control and Prevention has noted that many common respiratory illnesses, including influenza, respiratory syncytial virus and COVID-19, spread through airborne particles that remain suspended in poorly ventilated indoor spaces. A primary care practice can see dozens of patients per day with a range of conditions, increasing the potential for exposure in shared waiting areas. Physicians spend years learning to manage clinical risk. The physical environment where patients gather before the visit is part of that risk profile.

What are the most common air quality problems in independent medical practices?

Independent practices that lease space in commercial buildings can face particular indoor air quality challenges because they may have limited control over the mechanical systems serving their space.

These challenges include heating, ventilation and air conditioning (HVAC) systems that haven’t been serviced regularly; waiting rooms with ventilation designed for the building’s original use, which may or may not have been medical occupancy; and cleaning products used at high frequency that release volatile organic compounds (VOCs) between patient visits. Off-gassing from new furniture, carpeting and renovation materials adds a secondary chemical load that can be significant in recently updated spaces.

Odors are often the first signal that something is wrong, and both patient and staff notice them. The source is often external. Loading docks, parking areas or trash collection points near fresh air intakes can push fumes and odors directly into the supply air stream before any filter can intercept them. However, facility teams often assume the odors come from the HVAC system itself. They change filters and clean ductwork, only to find the odor eventually returns.

How does the HVAC system in my practice affect patient and staff health?

The HVAC system in a medical practice does more than regulate temperature. It determines what particles, gases and biological contaminants circulate through the air that every patient and staff member breathes during their time in the building.

HVAC systems use filters with a MERV rating, short for minimum efficiency reporting value, to grade the filter’s ability to capture airborne particles. If filters are rated below MERV-13, fine particulate matter, including particles small enough to penetrate deep into the respiratory system, passes through and recirculates. If humidity isn’t properly managed, mold spore counts can rise and affect patients with asthma, allergies and compromised immune systems.

Staff are affected as well. People working eight or more hours a day in a poorly ventilated space experience the cumulative effects of that exposure. It can result in fatigue, headaches and respiratory symptoms that are easy to attribute to other causes. In a competitive labor market, the quality of the indoor environment can play a role in creating a workplace where experienced staff want to stay.

What do current standards and research say about air quality in medical offices?

Regulations around indoor air quality in health care settings have become more defined in recent years.

ASHRAE Standard 241, Control of Infectious Aerosols, published in 2023, established a formal framework for managing infection risk through ventilation and air cleaning in occupied buildings. Although the standard applies most directly to facilities that choose to develop a documented infection risk management plan, it’s a sign that the field is moving toward verified, documented air quality performance instead of assumed compliance based on equipment age or filter schedules.

The EPA offers guidance on evaluating air cleaning technology, noting that independent third-party certification matters when selecting any active air cleaning device. Specifically, the EPA recommends looking for devices validated to the UL 2998 standard, which certifies that a device produces zero ozone emissions during operation. Ozone is a respiratory irritant, and some air cleaning technologies generate it as a byproduct. That makes zero-ozone certification especially important in medical environments where patients may already have heightened respiratory sensitivity.

What can a physician in an independent practice actually do about air quality?

The good news is that improving air quality doesn’t have to require a capital renovation or a new lease.

The first step is asking questions that most physicians have never asked. Request a copy of the HVAC maintenance schedule from your building manager. Find out the MERV rating of the filters currently in use. MERV-13 is the minimum recommended for medical occupancy by ASHRAE, the professional society that sets ventilation standards for commercial buildings. Ask whether the outside air intakes have been evaluated for proximity to potential odor or pollutant sources.

The second tier of action is available to any practice regardless of lease terms. A calibrated humidity monitor costs less than $50 and tells you whether indoor relative humidity is staying in the 40% to 60% range that the EPA recommends to limit mold growth. Reviewing the cleaning products used by your housekeeping staff for high-VOC formulations and requesting low-VOC alternatives is a conversation that costs nothing. Keeping waiting room windows open when the weather permits can improve air exchange.

In-room air cleaning systems have become more accessible and less intrusive, making them a simple way for practices to improve air quality regardless of the building’s HVAC setup. Some technologies mount directly into a standard 2-by-2 ceiling grid tile and run quietly without taking up valuable floor space. These systems can provide MERV-13 particle filtration, molecular carbon filtration for odors and volatile gases, and soft ionization technology that targets mold spores and certain airborne pathogens. They operate automatically, adjusting output based on what they detect in the room, and require minimal maintenance. In waiting rooms and exam rooms where air quality is a real concern, ceiling-mounted systems can provide an unobtrusive option for addressing indoor air quality.

How does investing in air quality affect the practice as a business?

The business case for investing in indoor air quality is more direct than it might appear. Patient satisfaction scores are increasingly tied to environmental factors that practices can control. A waiting room that smells clean, feels comfortable and demonstrates visible attention to health details sends a message about the care you offer. In a market where patients have choices and online reviews influence new patient decisions, that message can have economic value.

Air quality improvements can also support staff retention, thereby minimizing turnover costs. Environmental quality isn’t the only factor in staff satisfaction, but it is one that practices can address directly without changing compensation structures or schedules.

There is also a regulatory and liability dimension to indoor air quality. As ASHRAE Standard 241 gains adoption in health care settings, practices should get ready by documenting an active approach to infection risk management. That documentation requires knowing the practice’s actual air quality and being able to show what the practice is doing about it.

The waiting room is part of the clinical encounter. Treating indoor air quality as part of that environment is both good medicine and good practice management.

Audwin Cash, MBA, is CEO of GPS Air, a leading provider of indoor air quality solutions. With prior roles at Regal Rexnord and Acuity Brands Lighting in energy-efficient building technologies, he now leads efforts to bring data-driven air cleaning and real-time monitoring systems like smartIAQ to market. Cash holds a bachelor’s degree in computer engineering from Georgia Tech and a master’s degree in business administration from Lehigh University.