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ICRA Class IV Infection Control Solutions for Healthcare Construction

Infection control is the process of maintaining a healthcare environment that is safe and clean. Proper infection control means taking precautions in virtually every aspect of hospital maintenance in order to minimize patient exposure to dangerous pathogens, microbes, air pollution, and any other potentially harmful materials.

Most hospitals use the infection control risk assessment matrix to determine which precautions to use throughout the facility. The ICRA (Infection Control Risk Assessment) matrix divides infection control protocol for construction activities into four different categories, each one more stringent than the next. This post will discuss the different levels of infection control with specific attention on the most stringent requirements at Level IV.

What Makes a Project Class IV?

The ICRA Matrix gives a few different cases in which Class IV infection control must be used.

Because Class IV is the most involved level of infection control protocol, it is reserved for those cases where either:

  1. the construction or maintenance project is extremely involved
  2. the patients potentially impacted are high risk (e.g., burn units, oncology, etc.), or
  3. both 1 and 2

These cases put patients at high risk of developing HAIs, which means the strictest infection control policies possible must be put into place.

Class IV Infection Control Requirements

Infection control requirements for a Class IV project include tasks for both before the project begins and after it has been completed.

Before & During Construction

  1. Isolate local HVAC system to prevent contamination of duct system.
  2. Put barriers in place to seal the work area off from the non-work area.
  3. Maintain negative air pressure within the construction area with HEPA filtration units.
  4. Seal any holes, pipes, conduits or punctures opening into the non-work area.
  5. Put in place an anteroom where all personnel must pass through and be vacuumed by a HEPA vacuum cleaner. Alternatively, workers can wear cloth or paper coveralls that are removed upon leaving the worksite.
  6. All personnel must wear shoe covers within the worksite, and those covers must be changed each time someone leaves the work area.
  7. All safety barriers must stay in place until the completed project has passed inspection by the facility Safety Department and Infection Control Department. Barriers must also be thoroughly cleaned prior to break down.

After Construction

  1. Remove all barriers carefully to minimize the spread of any dirt and debris that has accumulated.
  2. Collect construction waste in tightly covered containers prior to transport.
  3. Cover all transport receptacles, taping covers down when necessary.
  4. Vacuum work area with HEPA vacuums.
  5. Use a wet mop and disinfectant to clean the area.
  6. Remove HVAC isolation measures.

Solutions for Class IV Requirements

For class IV infection control requirements to be met, all of the above precautions must be taken. To take these precautions and minimize the risk that patients face in this particular healthcare environment, the right tools and materials are necessary. Following are a few solutions that can make the setup and teardown of a Class IV infection control area somewhat easier.

Dust Containment Cart

A dust containment cart, also known as a control cube in some infection control protocol can be extremely useful for Class IV construction areas that require ceiling access. The portable dust containment unit is entirely enclosed and can be equipped with negative air machines and HEPA filtration.

Negative Air Machine

Keeping negative air pressure in a Class IV construction area is the best way to ensure that pathogens and microbes do not escape into patient areas. Negative air machines are critical to maintaining air changes per hour within the isolated environment to keep fresh air circulating and prevent infection.


Keeping the work area separate from facility patients and staff is perhaps the most critical part of maintaining the integrity of the infection control protocol. A reusable anteroom like the HEPACART™ AnteRoom acts as an external passageway that keeps  work area air separate from the rest of the facility. The AnteRoom is easy to setup, move, clean, and use. With external negative air machine adapters on either side of the enclosure, the HEPACART™ AnteRoom provides air filtration, dust collection and infection control, meeting Class IV requirements. Unlike other anteroom options, no additional construction or disposal of materials is necessary to use the AnteRoom.

If you think an AnteRoom might be the right choice for your next project, fill out our free project assessment and we can guide you to the right unique solution. 

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