Construction, renovation, and maintenance work within active healthcare facilities presents a unique and significant danger to patient safety. These activities inevitably disturb dust, soil, and debris, which can contain harmful airborne pathogens, most notably the spores of molds like Aspergillus. For patients with compromised immune systems, inhaling these spores can lead to severe, life-threatening infections. The Infection Control Risk Assessment (ICRA) is the standardized, mandatory process designed to manage and mitigate this specific environmental risk before any disruptive work begins.
Defining Infection Control Risk Assessment (ICRA)
The Infection Control Risk Assessment is a systematic, documented planning tool that must be completed for any activity that could potentially affect the indoor environment of a healthcare facility. Its core purpose is to proactively protect vulnerable patient populations from the hazards associated with construction-related contaminants, like dust-borne fungi and waterborne bacteria. Patients undergoing surgery or those who are immunocompromised are particularly susceptible to healthcare-associated infections (HAIs) transmitted via these environmental routes.
The ICRA process ensures that appropriate infection prevention measures are factored into the project design and planning phases. By mandating this assessment before a project starts, facilities can identify the potential impact on surrounding patient care areas and establish clear control strategies. This planning is a requirement enforced by accreditation bodies like The Joint Commission and is recognized by guidelines from the Facility Guidelines Institute (FGI).
Determining Risk: The ICRA Matrix
The ICRA process employs a matrix to systematically determine the level of infection control precautions required for a project. This matrix combines two key variables to calculate a final risk classification, typically resulting in a Class I, II, III, IV, or V designation.
The first variable is the Type of Construction Activity, which is categorized from Type A through Type D based on the scope of work and the amount of dust generated. Type A activities are non-invasive, such as limited visual inspections or minor electrical trim work that does not generate dust. Type B involves small-scale, short-duration tasks that create minimal dust, like pulling cables or controlled cutting of walls. Type C projects generate moderate to high dust levels and may require the demolition of fixed components, such as removing flooring or new wall construction. The most extensive category, Type D, includes major demolition, new building construction, or work requiring consecutive shifts, creating the highest level of environmental disruption.
The second variable is the Patient Risk Group, which evaluates the vulnerability of patients in the area of work. Low-risk areas might be administrative offices, while high-risk areas include specialized patient care units. The highest-risk areas include operating rooms, intensive care units (ICU), burn units, or sterile processing departments. The intersection of these two variables dictates the required Class of Precautions. For example, combining a High-Risk Patient Group with a Type C construction activity would elevate the project to a Class IV precaution level. This systematic calculation ensures that the control measures are precisely proportional to the threat posed to the most susceptible patients nearby.
Implementing Required Control Measures
The risk classification determined by the ICRA matrix directly dictates specific physical containment and work practice standards.
Class I requires minimal controls, such as immediate replacement of ceiling tiles removed for inspection and prompt cleaning of debris. Class II precautions involve limited dust work and require basic containment measures, such as sealing the work area and using a HEPA-filtered vacuum upon completion.
Class III requires more robust controls, which usually involve constructing a solid barrier to isolate the work zone from occupied patient spaces. Workers must also contain construction waste before transport and use a HEPA-filtered vacuum daily to maintain a clean workspace.
The most stringent levels, Class IV and Class V, are reserved for high-risk projects and demand comprehensive environmental isolation. These high-level precautions require a sealed, hard-wall barrier extending from floor to deck, often including a dedicated anteroom at the entrance. The work area must be maintained under negative air pressure, meaning air is continuously exhausted from the containment zone using specialized HEPA filtration units. This negative pressure ensures that if any air leaks, it flows into the construction area, preventing dust and pathogens from escaping. Additionally, all personnel must follow strict entry and exit protocols, which can include vacuuming their clothing with a HEPA vacuum before leaving the anteroom.
Key Roles and Responsibilities in the ICRA Process
The successful execution of an ICRA relies on a collaborative, multidisciplinary team with clearly defined responsibilities.
The Infection Control Professional (ICP) plays a decisive part in the initial assessment. This individual is responsible for accurately determining the Patient Risk Group based on the clinical function and patient vulnerability in the areas adjacent to the construction.
Facilities or Engineering staff contribute by defining the Type of Construction Activity, assessing the project’s scope, and coordinating necessary infrastructure shutdowns, such as HVAC or water systems. They ensure the proposed work is accurately categorized to determine the correct level of required precautions.
The Contractor or Construction Manager is responsible for the physical implementation and ongoing maintenance of the specified control measures. This includes erecting the required barriers, ensuring negative air pressure is continuously monitored, and adhering to all cleaning and debris removal protocols throughout the entire project duration.