Air quality management in hospitals is a critical determinant of patient safety, infection control, and staff well-being. Traditional systems relying solely on fixed HEPA filtration and standard HVAC operations are increasingly insufficient to address dynamic challenges such as airborne pathogens, infiltration of urban pollutants, and fluctuating occupancy loads. Smart hospital air quality systems represent a paradigm shift, integrating high-efficiency filtration with Internet of Things (IoT)-enabled sensors, real-time particulate and microbial monitoring, and automated ventilation controls. These adaptive systems optimize airflow, humidity, and pressure gradients in critical zones such as operating theatres, intensive care units, and isolation wards. Emerging technologies—including ultraviolet germicidal irradiation (UVGI), AI-driven predictive analytics, and green energy integration—further enhance resilience and sustainability. By shifting from static to intelligent, responsive infrastructure, hospitals can reduce the risk of airborne infections, minimize energy costs, and create healthier environments for patients and healthcare workers. This frontier in hospital design aligns with global goals of sustainable healthcare and preparedness for future airborne health threats.