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Cashins & Associates Blog

Infectious Control Safety and Health Risk Assessment

Posted by Mike Cashins on Fri, Apr, 26, 2013 @ 12:04 PM

ContainmentIn 2002, the Joint Commission implemented the 2001 AIA health care Guidelines as the required documents for the Infection Control compliance during construction. Below are a few key terms you should know.


  • ICRA (Infection Control Risk Assessment): This is a process that includes: 
  1. The risk of patient exposure.
  2. The classification of the work involved on a project.
  3. The impact of patient areas above, below and adjacent to the project work area.


  • HEPA (High Efficiency Particulate Air):  Healthcare projects typically incorporate these filtered fans to create negative pressure.  The airflow moves clean air through the construction area to the outdoors keeping dust and contaminants out of the building.


  • JC (Joint Commission): Non-profit organization that ensures that all required safety measures of health care facilities are met.


  • PCRA (Preconstruction Risk Assessment): This JC term requires hospitals to assess and mitigate fire safety, air quality, utility impact, noise, and vibration in addition to infection control.


The ICRA and PCRA procedure should be incorporated into any health care renovation or construction project.  This can be accomplished by adding a specification section or matrix to the ICRA/PCRA procedure.  The goal here is to give the contractor specific guidance for compliance during the project.   Project phasing is often required in the health care setting.   Phasing will minimize patient disturbance, ensure the flow of clean air to dirty air is attained, emergency procedures are followed, and noise and vibration control are addressed.

A Sample ICRA Procedure (EC 02.06.05: reference, AIA 2001 Health Care Guidelines)

Determine the required Infection Control precautions by Class.  ICRA measures are always changing do to constant change to the scope of work.  The construction phase requires periodic documented inspections to determine if contractors are following ICRA requirements.  A well designed ICRA procedure will require an Above Ceiling Permit for any work that is performed above the ceiling.  A HEPA filtration unit is required for every 50 square feet of work area.  The HEPA filter must also be vented to an outside area. Under certain circumstance a HEPA filter can be used to scrub the interior air if no outside source is possible.  


During Construction Project

Upon Completion of Project


Use work methods that minimize the raising of dust.  Replace tile when not working in ceiling, even if job is not complete.

Ensure all ceiling tiles are put back in place with a tight fit If any ceiling tiles have been damaged the must be replaced.


Includes Class I Actions

Includes Class I Actions

Spray water mist on work surfaces to control dust while drilling or cutting, use vacuum if sanding.

Wipe all work surfaces with disinfectant.

Seal unused doors with air-tight barriers.

Contain all construction debris in tightly covered containers before transport.

Seal any natural air vents.

Wet mop or vacuum entire area with HEPA filtered vacuum before leaving work area.

Isolate or remove HVAC systems in areas where work is being performed.

Put HVAC back in operation.  Remove any duct tape, plastic or other barriers.

Place construction walk-off mat at entrance/exit of work area.


Wet mop construction route at least multiple times daily.


Includes Class I and II Actions

Includes Class I and II Actions

Install critical non-flammable barriers, such as, sheetrock, plywood or plastic to seal off work area from non-work area.

Barriers shall only be removed when project is complete and has been disinfected by environmental cleaning company and approved by Infection Control.

Maintain negative air pressure within work site utilizing HEPA filtration units.

Vacuum work area with HEPA filtered vacuums.

Contain construction waste before transport in tightly covered containers or carts.  Covering must be taped if not solid lid.

Wet mop area with disinfectant.


Barriers shall be removed carefully to minimize spreading of dirt and debris associated with construction. 

Restore HVAC systems and replace fan coil filters in areas where work has been performed.


Includes Class I, II and III Actions

Includes Class I, II and III Actions

Construct anteroom where all workers must pass through and to be cleaned with HEPA vacuum prior to leaving work area.

Disassemble anteroom only after area has been disinfected and approved by Infection Control.

All workers must wear shoe covers.  Shoe covers must be changed each time the worker exits the work area.

If you have any questions about hospital renovation containment and monitoring strategies we would be happy to assist. Contact a knowledgeable industrial hygiene and safety consultant now by calling 781-245-1400 Ext. 111 or fill out our easy to use web form and someone will respond within 24 hours. 

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Topics: indoor air quality, Hospital

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