Healthcare settings vary in a number of ways, including type and physical structure of the facility, patient services, community surroundings, and geographical location. Major areas of responsibility of the maintenance and engineering staff relate to buildings, utilities, associated equipment, and property or grounds. Within these components are multiple activities ranging from preventive maintenance through major projects. A strong working relationship between the infection preventionist and maintenance and engineering staff is essential to maintain a safe environment and minimize potential risks. This chapter outlines risk elements that are common in many facilities and provides examples of interventions to address these challenges.