An Infection Control Risk Assessment, or ICRA, is a systematic planning process used in healthcare facilities before any construction or renovation begins. Its purpose is to proactively identify and control the potential for infectious hazards that construction activities can introduce into environments where patients are highly vulnerable. Since physical changes can disrupt air and water systems, the ICRA ensures that the safety of patients, staff, and visitors remains the priority throughout the project. This assessment is a requirement for facilities, especially when work is conducted near patient care areas.
Defining ICRA and Its Core Purpose
The primary goal of the ICRA is preventing Healthcare-Associated Infections (HAIs) triggered by construction contamination. Unlike typical safety protocols focused on worker injury, ICRA centers on the unique environmental susceptibility of a medical setting. It functions as a proactive planning tool designed to anticipate and eliminate infection risks before work starts. Construction activities can aerosolize pathogens, and the ICRA coordinates engineering, infection prevention, and facility management teams to counter this threat. This process is required by regulatory bodies, such as The Joint Commission and the Centers for Medicare & Medicaid Services (CMS), ensuring patient safety standards are upheld and appropriate containment measures are implemented.
Identifying Environmental Risk Factors
Construction and renovation disturb settled dust and building materials, releasing biological hazards into the air and water systems. One airborne risk is the fungal genus Aspergillus, which forms spores found in soil and on demolition debris. When inhaled, these spores can cause severe, often fatal, invasive aspergillosis, particularly in immunocompromised patients. Water-borne pathogens, such as Legionella species, also pose a significant risk, as plumbing disruptions and stagnant water allow them to multiply and be aerosolized. The ICRA must also consider physical stressors like noise and vibration, which can negatively affect patient recovery.
The Structured ICRA Assessment Process
The core of the ICRA is a matrix-based methodology that cross-references two primary variables to determine the required level of precaution. The first variable is the Patient Risk Group, which categorizes patient susceptibility, ranging from Low Risk (e.g., administrative offices) to Highest Risk (e.g., operating rooms and intensive care units). The second variable is the Type of Project Activity, which classifies the project’s invasiveness and dust generation potential into four main categories, Type A through Type D. Type A activities are non-invasive tasks, while Type D involves major demolition that generates significant dust. The intersection of these variables determines the necessary Infection Control Class, typically ranging from Class I to Class V, with the highest risk combinations necessitating the most rigorous containment.
Mitigation and Containment Strategies
Once the ICRA classifies the risk, it specifies actions to mitigate the hazards. Engineering controls, the most visible measure, involve installing temporary, sealed barriers, such as rigid walls, to isolate the work zone from patient areas. Air quality is controlled by maintaining negative air pressure, ensuring air flows into the construction area and not towards patients. This negative pressure is achieved using HEPA-equipped air filtration units, which continuously scrub the air and prevent particle escape. Work practice controls and administrative controls mandate strict protocols for crews, including wet mopping, using HEPA vacuums, designated entry routes, specific worker training, and continuous monitoring of air pressure differentials.