Infection Control during Construction

The ICRA process has become a key focus of healthcare, construction, and governmental organizations. Best understood as a strategic plan, the ICRA is meant to protect patients, personnel, and visitors from infection during construction, demolition, renovation, and plant maintenance. An ICRA begins at project conception, lasts until its completion, and identifies, assesses, and provides the contingencies appropriate for the following areas of concern (FGI):

The underlying reason for conducting an ICRA is to prevent an exposure event, which involves contact between a concentration of potentially infectious microorganisms, especially from an unidentified, unsuspected reservoir and an at-risk patient population. The key factors are the presence of at-risk patients and opportunistic pathogens and the potential for construction activities to increase contact between those two groups unless interventions are planned. The amount of time that a construction project takes is important, but it is not the most decisive factor influencing exposure. Major, long-term projects may increase the probability that exposure will occur when construction workers unexpectedly disturb potential sources of contamination (e.g., dust, corroded water pipes). However, bursts of fungal spores can be released from newly disturbed dust, in even a very short time, exposing critical patients to potential pathogens under certain conditions.

Infection prevention activities should begin well before construction activities start, and the ICRA team should actively look for areas where construction might encounter a concentration of potentially infectious microorganisms. Because this survey will require a broad knowledge of the types of locations where pathogens are likely to grow and of the indications of their presence, the ICRA team must include individuals from a range of backgrounds; what seems like innocuous rust to an engineer may signal to an infection control practitioner the presence of a moist environment above the tiles ideal for microbial or fungal colonization. As necessary, the team should determine if areas suspected of harboring such microorganisms need cleaning or containment before construction or renovation activities are begun.

Conducting an ICRA is already a regulatory and accreditation requirement for many facilities. The Centers for Disease Control and Prevention (CDC) strongly recommends that facilities conduct an ICRA (Sehulster and Chinn), and more than 40 states and some local healthcare licensing agencies have adopted FGI standards requiring a preconstruction ICRA into their own rules (Greene). A brief description of these guidelines is available as follows, and additional information can be found in Resource List.

Accrediting organizations. The Joint Commission's hospital accreditation standards require a proactive preconstruction risk assessment of hazards from construction, demolition, or renovation that could compromise care, treatment, and services in occupied areas of the hospital's buildings, as stated in the Joint Commission's environment of care standard EC.02.06.05. The standard recommends that state regulations and FGI guidelines* be used for new construction or renovation and that "air quality requirements, infection control, utility requirements, noise, vibration, and other hazards that affect care, treatment, and services" be reviewed during the risk assessment. (Joint...