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by HEPACART on Apr 15, 2024
Next to providing your hospital’s patients with high-level, compassionate care, infection control is one of the most critical elements of a facility manager's responsibilities. This is not only because it's the job of a healthcare center to provide a safe and clean environment, but also because Hospital-acquired Infections are a major cause of disease and, unfortunately, deaths in the United States and around the world. For example, there are about 1.7 million HAIs — that lead to 99,000 deaths — in US healthcare facilities each year. With the stakes as high as this, facility managers must consider the weight of infection control and how they will prevent HAIs during normal daily operations and through construction or renovation projects.
Hospital Acquired Infections in the United States
Modern healthcare centers rely on the Infection Control Risk Assessment (ICRA) to provide guidance and procedures to maximize health and safety in their facilities. While historically, ICRA was used primarily for construction-related work to encourage a patient-first culture with infection control embedded into processes, the American Society for Health Care Engineering (ASHE) now recommends a more comprehensive use of ICRA. To make the most out of ICRA in your facility, we recommend not only understanding the 5-step process to implement ICRA but also building a powerful lineup of infection control equipment to support your facility’s goals.
ICRA 2.0 and Its 5-Step Process
Step 1: Define the Activity
Construction and renovation projects don’t need to be synonymous with the risk of infection. With the right safety precautions in place through ICRA 2.0, your facility can prioritize healthy air quality and patient safety through any kind of project. From seemingly harmless projects like opening a ceiling panel to more involved activities like major demolition, ICRA helps your facility identify the specific risk factors and create a strategic plan to limit the impact on your facility. The first step in this process is to identify the activity according to the guidelines provided by ICRA.
Every construction or renovation activity will fit into one of four categories established by ICRA — A, B, C, or D — depending on the level of impact that the activity will have on the facility.
Type A activities will have the lowest impact, while Type D activities are larger-scale or the most invasive. Here is a simplified breakdown of what each type might look like:
- Type A: Simple tasks like inspecting by removing a ceiling tile, painting without sanding, and other minor work that doesn't stir up dust.
- Type B: Short jobs that create minimal dust, like installing cables, minor wall or ceiling cuts, or accessing utility spaces.
- Type C: Activities with more dust and disruption, such as sanding, removing flooring or casework, constructing walls, and extensive electrical or ductwork.
- Type D: Major construction work involving demolition, new construction, or any task that significantly disturbs the building over multiple shifts.
Step 2: Identify Patient Risk
Next, you’ll want to consider the risk of the construction or renovation work to the patients in your facility. ICRA has created a strategic approach to patient risk, recognizing that different patient populations have varying levels of vulnerability to airborne contaminants. By taking into account each type of patient and the areas of the facility that will (or will not) be impacted, you can classify the patient risk into one of four groups: Low risk, medium risk, high risk, and highest risk.
Low Risk (e.g. Office Areas): These spaces are primarily non-patient care areas where the potential for spreading infections is minimal. However, they still require basic ICRA protocols to maintain overall facility safety.
Medium Risk (e.g. Diagnostic and Therapy Areas): This group includes cardiology, echocardiography, endoscopy, nuclear medicine, physical therapy, radiology/MRI, and respiratory therapy departments.
High Risk (e.g. Critical Care and Patient Rooms): Critical care units (CCU), emergency rooms, labor and delivery, specimen laboratories, general medical units, newborn nurseries, outpatient surgery, pediatrics, pharmacies, post-anesthesia care units, and surgical units are typically classified as high risk.
Highest Risk (e.g. Specialized Care Units): These areas are dedicated to the care of the most vulnerable and immunocompromised patients, including burn units, cardiac catheterization labs, central sterile supply areas, intensive care units, negative pressure isolation rooms, oncology departments, and operating rooms.
Step 3: Define the Class of Precaution
Once you have confidently identified both the activity type and the patient risk, you’ll need to use the ICRA matrix to determine the Class of Precaution — otherwise known as the specific set of processes and standards that you’ll need to put in place given the construction work and the potential risk to your facility. ICRA makes the process of determining the Class of Precaution simple. By identifying both the activity type and patient risk on the ICRA matrix, you’ll simply match up where they overlap, and you’ll find the appropriate Class of Precautions to reference and implement. The Classes of Precautions are broken down into five classes based on the intensity of the safety measures that each requires.
Class I: Light work with minimal disturbance. Essentially, just clean up after finishing the project.
Class II: More significant work requiring dust control measures. Seal areas to prevent dust spread, and ensure thorough cleaning and HVAC reset after completion.
Class III: Intense dust control efforts. Seal the room to prevent any dust escape, maintain negative pressure, and conduct a deep clean before removing barriers, pending safety and infection control inspections.
Class IV: Major construction. Implement intense containment measures including negative pressure and HEPA filtration to prevent any dust leakage, with mandatory post-project inspections and cleaning.
Class V: Comprehensive containment for the highest-risk projects. This class involves the most stringent infection control measures, requiring full facility shutdowns or the isolation of entire wings if necessary.
Step 4: Assess the Surrounding Area
In healthcare facility upgrades or expansions, it’s critical to focus our attention beyond the hammer and nails of construction zones. The ripple effects of construction activities can impact every corner of a facility, potentially placing patients and staff at undue risk.
With ICRA 2.0, facility managers can predict and prevent unnecessary disruptions to daily hospital activities. Construction might affect areas adjacent to, and even far away from, the actual work site. This involves considering how patient areas above, below, and beside construction zones might encounter risks, from air quality changes to noise pollution. Particularly for high-risk or immunocompromised patient groups, this additional layer of consideration is critical for limiting the harmful effects of invasive construction activities. For more information on exactly how to approach the surrounding areas of your construction project, consult the updated ASHE ICRA 2.0 document for more detailed assessment criteria.
Step 5: Establish a Mitigation Plan
Once you understand exactly what processes and strategies are appropriate for your project, patients, and facility, the next step is to put your ICRA-backed plan into action with a solid mitigation plan. According to the Class of Precautions that your project falls under, you’ll build a detailed strategy, informed by the ICRA 2.0 guidelines, to prevent airborne contamination and Hospital-acquired Infections (HAIs).
Implementing your plan effectively may include setting up barriers, improving ventilation, and closely monitoring the work area and its surroundings — again, depending on the specific Class of Precautions and the standards set by ICRA. Based on your specific facility and operations, your mitigation plan may look different between projects, but the key is that collaboration will make or break your approach to construction or renovation projects. Healthcare professionals, facility managers, and construction teams must work together to integrate the mitigation plan smoothly with the facility’s operations, following the updated ICRA 2.0 controls for a comprehensive approach to infection control.
Embracing ICRA 2.0 for Healthier Facilities
No matter what kind of facility you manage, a basic understanding of ICRA principles is essential for maintaining a healthy environment for patients and staff alike, as well as staying compliant through construction and renovation projects. There are a few key ways that your facility can prepare for a successful ICRA implementation in your facility.
Train Your Team
The foundations of a successful infection prevention strategy are education and certification. The more your teams — construction teams, facility teams, and healthcare staff — have a good understanding of ICRA 2.0 processes, the better they’ll be able to implement a powerful infection control strategy. A few great resources for staff education include:
Source Machinery
Your approach to infection control is only as great as the quality of machinery that you employ to support your overall strategy. Once you have a good understanding of your project’s ICRA Class of Precautions, the next step in supporting a successful ICRA construction project is creating a powerful lineup of efficient equipment that will meet or exceed strict ICRA standards. To learn more about curating an infection control equipment dream team, explore this recent blog that dives into the best ways to select the best combination of equipment for your unique facility’s needs.
Monitor Performance
Implementing an ICRA strategy successfully means keeping track of how your project is going as well as reviewing the performance of your teams and the air quality in your facility. This includes creating detailed checklists tailored to different risk levels, establishing clear expectations for contractors with experience in ICRA protocols, and maintaining thorough documentation of all processes. Regular audits and the use of automated monitoring systems are also crucial for upholding ICRA standards, allowing for the real-time management of contaminants and continuous refinement of infection-control practices.
ICRA Is Your Secret to a Healthier Facility
For facility managers and healthcare professionals, mastering ICRA's safety protocols and ensuring your team is aligned are key steps toward limiting risks during healthcare construction projects. Looking for more information on how to keep your facility safe and compliant? Our full indoor air quality guide offers essential insights and strategies right to your inbox. Download your free copy today to implement safer construction practices today.
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