Infection Control Risk Assessment

Infection Control Risk Assessment

5 years ago

Dan Culp, ASHE Certification
Ellen McCulley, AIA, LEED AP, NCARB

By Ellen McCulley, AIA, LEED AP, NCARB
and Dan Culp, ASHE-Certified Healthcare Engineer

The Centers for Disease Control (CDC) estimates there were 687,000 hospital acquired infections (HAI) in 2015 and 72,000 of those infected patients died during their hospitalization. While construction and maintenance activities are not the main cause of HAI, they do share a portion of the responsibility.

Two primary principles of infection control during construction are containment of the particulates and controlling the air flow. Containment can be implemented through several strategies such as erecting barriers that separate the construction area from adjacent areas, providing containment for construction debris removal, and having construction workers properly clean their shoes and clothing before entering into adjoining occupied areas. The air flow is controlled by creating a negative pressure environment in the construction area by exhausting air out of the area. Then the clean air in the surrounding areas naturally flows into the construction areas and not vice versa.

For any healthcare facility planning a construction or renovation project, it is important to have an Infection Control Risk Assessment (ICRA) performed with all key players involved, such as: the health care facilities infection prevention person, facilities management, and the contractor. Once the plan is established it is essential to have both the hospital staff affected by the construction and the construction workers made aware of the plan and to delegate responsibilities so the plan may be properly implemented.

Regulatory agencies do not define a specific format for an Infection Control Risk Assessment in order to meet their requirements; however, there are many universal elements. The American Society for Healthcare Engineering of the American Hospital Association identified the following ten factors that need to be considered when performing an ICRA.

1. Identify the types of construction activity involved.

2. Identify the patient risk group, which is usually completed by the healthcare facility’s infection control professional.

3. Determine what precautions and control measures need to be implemented based on the type of construction activity and the patient risk group.

4. Assess the potential impact of areas adjacent to the work zone.

5. Determine the specific areas, materials, and worker transportation routes that will be involved.

6. Determine how utility interruptions could influence infection control.

7. Identify proper containment measures based on the risk assessment.

8. Identify possible causes of water damage and implement preventative measures to reduce risk.

9. Determine the best time to perform the work.

10. Consider issues relating to containment such as planning for debris removal.

The establishment and implementation of an Infection Control Risk Assessment is vital for healthcare facility undergoing any construction or maintenance work. It not only helps the job run more smoothly, more importantly it helps to avoid any situation that could negatively impact patient care and patient health.

Ellen McCulley graduated magna cum laude with a Bachelor of Architecture from Iowa State University where she received the Pella Architectural Award from the Department of Architecture. She is a registered architect in Iowa, Illinois, and Nebraska. Ms. McCulley joined Carl A. Nelson & Company in 2012. Dan Culp is a graduate of Iowa State University with a B.S. in Construction Engineering. Mr. Culp has a Healthcare Construction Certificatie from the American Society of Healthcare Engineering. Dan has 28 years of construction experience. 

For more information, you may contact Ellen or Dan at 319-754-8415, or write to