The impact of bacteriophage on pathogen reduction in indoor built environments: a systematic scoping review

Healthcare acquired infections and antimicrobial resistance remain major challenges in the built environment of clinical settings. Recent interest in microbiome engineering has highlighted bacteriophages as a promising, targeted biocontrol strategy; however, their application in healthcare infrastructure and medical devices has not been comprehensively assessed. This systematic scoping review aims to evaluate existing evidence on the effectiveness of bacteriophage interventions for controlling ESKAPEE pathogens in healthcare facility built environments. We will search PubMed, Scopus, and Embase using a structured set of terms that capture bacteriophage applications, ESKAPEE taxa, microbial control outcomes, and healthcare associated settings. Eligible studies must assess phage based control of one or more ESKAPEE pathogens on environmental surfaces, fixtures, plumbing, durable medical equipment, or laboratory simulations thereof. Primary outcomes include changes in microbial burden, biofilm disruption, and shifts in microbial community composition. Secondary outcomes encompass delivery mechanisms, engineered phage modifications, phage–pathogen interactions, resistance dynamics, synergistic treatments, and performance indicators relevant to environmental deployment. Data will be narratively synthesized to characterize the landscape of evidence and identify opportunities and challenges for integrating bacteriophage based microbial control strategies in healthcare built environments.