In light of widely recognized concerns of increased healthcare-associated infection risks during healthcare construction and/or renovation activities, the Joint Commission, which accredits most U.S. hospitals, requires hospitals to conduct an Infection Control Risk Assessment (ICRA) whenever construction, renovation, or major maintenance could affect infection risks as described in its Environment of Care and Infection Prevention & Control standards. Also, the Facility Guidelines Institute (FGI), which develops and maintains the nationally recognized “Guidelines for Design and Construction” of healthcare facilities in the U.S., requires an ICRA during planning, design and construction activities. In addition, a number of state health departments adopt the FGI guidelines into their state health facility construction codes. Accordingly, an ICRA is not optional but likely mandatory for many, if not most, hospitals and other healthcare facilities planning or involved with construction and/or renovation activities.
What is a Healthcare-Associated Infection?
A healthcare-associated (or acquired) infection (HAI) is an infection that a patient acquires during a hospital stay or at another healthcare facility (such as an ambulatory surgical center, outpatient clinic, or a long-term care facility), which was not present at the time of admission. HAIs, which can be caused by bacteria, fungi, and viruses, pose significant risks of illness and possibly death. In fact, it has been estimated that at any given time about one in 31 hospital inpatients has an HAI.1
Cost of HAIs
HAIs not only lead to increased illnesses and deaths but also create a significant financial burden on the healthcare system. The estimated direct annual cost of treating HAIs in the United States ranges from $28.4 billion to $45 billion. Such infections are unnecessary and can be avoided through proper healthcare worker behavior and adherence to prevention procedures and guidelines.2
Infection Prevention
In the U.S., the discipline of infection control was established in the 1950s in response to a nationwide epidemic of nosocomial Staphylococcus aureus and the recognition of the need for nosocomial infection surveillance.3 Hospital infections became a recognized public health problem in post-World War II America; and in 1958 the American Heart Association published its first manual on hospital infection control. Infection prevention is a young medical profession dating back to 1970. The Association for Practitioners in Infection Control was founded in 1972.4
Infection prevention traditionally focuses on patient safety. Specifically, infection preventionists are responsible for using surveillance to track infection trends, planning appropriate interventions, measuring success, and reporting data to public health agencies. In recent years, the scope of infection control has expanded to include mitigation of emerging infectious diseases, environmental monitoring, and increased oversight of facility and construction-related infection issues.3
What is an ICRA?
An Infection Control Risk Assessment is essentially a step-by-step, multidisciplinary assessment that identifies and describes potential infection hazards and their locations and then specifies control measures to protect patients, staff, and visitors. The basic steps for conducting an ICRA include:
- Assemble a qualified, multi-disciplinary ICRA team
- Define project scope: Type of activity (maintenance, renovation, demolition, new construction); location/ proximity to patient-care areas; duration; etc.
- Identify risks & potential hazards: Procedures or construction activities that might release dust, water aerosols, or pathogens; patient populations that could be exposed to such releases
- Assess nearby patient risk groups: Low Risk (offices, healthy outpatients) to Highest Risk (transplant, oncology, burn units)
- Develop written ICRA plan and implement control measures
- Ongoing monitoring, inspections & documentation during project
- Closeout and verification at project completion: Remove safety barriers; clean and disinfect the areas; verify air/water systems are safe; document that all ICRA measures were followed 5
Resources from HETI
The U.S. healthcare industry is growing rapidly, which thereby increases the overall risks of HAIs and the associated economic burden on the industry. ICRAs during construction, renovation, and maintenance activities are considered essential for preventing HAIs and are mandated by various national and state standards, regulations, codes and guidelines. Accordingly, it is essential to ensure that a team assembled for conducting and implementing an ICRA comprise qualified, multidisciplinary, and experienced experts, professionals and practitioners.
HETI has an exceptionally well-qualified staff of industrial hygiene & safety professionals and experts with extensive experience in a wide variety of healthcare-related services. We are readily available to work with clients to provide as-needed professional services to develop and implement effective and comprehensive ICRA programs.
References
- 1 Healthcare-Associated Infections, HHS.gov
- 2 Clinical and economic burden of healthcare-associated infections: A prospective cohort study, PMC
- 3 History of infection prevention and control, PMC
- 4 Better Together, The Synergist, February 2025
- 5 Using the Healthcare Physical Environment to Prevent and Control Infection: A Best Practice Guide to Help Healthcare Organizations Create Safe, Healing Environments, ASHE
Mark Ostapczuk, CIH, CSP Director, Life Sciences Practice