July 8th Recording Presentation

Infection Control Risk Assessment
We are the patient Advocate!
What is an ICRA?
• It is a strategic proactive multidisciplinary organizational
process to show you are considering the patient population
and the potential Construction, renovation and demolition
may have on patients and employees in the healthcare
environment. A group should discuss this process, including
Infection Control, Engineering, the Construction group,
Safety officer, and Administration to come up with a plan.
• ICRA involves a matrix that allows you to assess how a
construction project may effect the facility varying with
degrees of activity versus the type of exposure risk
potential for varying patient population types. This will
determine the type or degree of intervention and
mitigation that should happen to keep patients and
employees safe. The goal is to reduce risk of infection,
coordinate mitigation of potential exposure, and to
establish expectations of the Construction group while they
are inside your facility.
Who Recommends an ICRA
• CDC (Centers for Disease Control and Prevention)
• HICPAC (Healthcare Infection Control Practice Advisory Committee)
• APIC (Association for Professionals in Infection Control and
• AIA (American Institute of Architects)
• ASHRAE (American Society of Heating, Refrigeration, and Air
Conditioning Engineers)
• ASHE (American Society for Healthcare Engineering)
• NIOSH (National Institute for Occupational Safety and Health)
• FGI GUIDELINES (Facility Guidelines Institute)
• US Department of Health and Human Services
• The Joint Commission
• And Washington State Department of Health
….. to name a few…..
Infection Preventionists must be
involved in the process
• The risk of exposure to the patient must be understood
and considered.
• Avenues of mitigation of dust, looking for disturbances
in air flow, and awareness of molds and water bugs
that others might not consider are prominent.
• Disruption of essential services must be minimized
with planning. Changes in traffic flow may help.
• Normal patient population and disease prevalence are
known to IP’s.
• IP’s are focused on prevention of cross transmission
and are proactive involving Environment of Care with
isolation and containment in their every day duties.
How to use the ICRA
• Gather all the parties for the project in a meeting and
have them all go over the assessment together.
• Once decisions are made about the Type of
Construction and Patient Risk, then the Matrix is used
to determine the Class of Precautions necessary.
• Once the Class is determined, plan and agree what
types of mitigation should be implemented for the
phases of construction, and any other needs that will
• Last, fill out a permit and have all parties initial and
sign it. Review this often as meetings progress in the
construction. This is only necessary if its determined
the construction project is type III or type IV.
Step One- Type of Construction
What type of activities are going to be needed during the Construction
Type A - Inspection and Non invasive activities.
(individual ceiling tile removal, painting, electrical trim work, very little dust)
Type B – Small scale short duration creating minimal dust.
(installation of wires and cables, crawl spaces, cutting of walls and ceilings
where dust can be controlled.)
Type C- Work with moderate to high levels of dust and demolition or removal
of fixed building components.
( sanding of walls, pulling up floors, new wall construction, duct work above
ceilings, major cabling or anything that may not be completed in a single
Type D – Major demolition and construction projects.
(activities with consecutive work shifts and requires heavy demolition,
removal of cables, or new construction)
Step Two – Patient Risk
Determine how patients will be affected
-Low Risk – office areas, minimal patient traffic, no healthcare supplies
are kept.
-Medium Risk- Ambulatory patients, for Physical Therapy, Radiology,
Respiratory Therapy, Cardiology, Non Immunocompromised.
-High Risk – ER, Labor and Delivery, Laboratory, Medical Units,
Outpatient Surgery, Surgical units, Pharmacy. Acutely ill patients at
risk for contracting illnesses or facing breathing hardships.
-Highest Risk – Immunocompromised patients, Burn Units, Cardiac Cath
Lab, ICU, Sterile Supply, Oncology, Operating Room. Seriously ill
patients who should not be exposed .
Use the Matrix to determine the Class
• Class I- minimize dust, one ceiling tile at a time
• Class II- prevent dust dispersion, mist to control dust,
seal unused areas with Duct Tape, block vents, sticky
mats, turn off or isolate HVAC in areas of construction
• Class III- remove or isolate HVAC so the system won’t
be contaminated, create and seal barriers, HEPA
vacuum, filtered air, negative pressure, cover transport
• Class IV- isolate HVAC, create and seal barriers,
vacuum and filter air, negative pressure seal holes,
create an anteroom for workers to be vacuumed with a
HEPA filter, require PPE, Shoe covers donned and
doffed when entering and leaving work area.
Step 4 through 8 - Questions
4. Questions about adjacent areas to construction to
assess impact. Do they need to be considered?
5. Type of area under construction (patient room, med
room, etc.). Each area could need different treatment.
6. Identify areas of ventilation, plumbing and electrical
power outages as a potential. Preparedness is key.
7. Identify containment barriers such as solid walls, and
will HEPA filtration be required? The construction
should be isolated from occupied areas and should be
negatively pressurized
8. Is there risk of water damage or compromising
structural integrity of walls, ceiling or roof?
Step 9 through 14 – Questions
9. Is it possible to complete this during non-patient care
10. Do plans allow for an adequate number of isolation or
negative airflow rooms? May just do a little at a time.
11. Do plans allow for the required number and type of Hand
washing sinks? Hand Hygiene can’t be compromised.
12. Does IC agree with the minimum number of sinks for this
13. Does IC agree with plans relative to clean and soiled utility
rooms? Storage in areas may need to be altered.
14. Discuss containment issues with the project team, such as
traffic flow, housekeeping and debris removal.
Does an ICRA form need to be signed?
Once all parties feel the whole project and
potential have been discussed, was a Class III
or Class IV determined to be the case?
If so, signatures should be obtained and the
paperwork should be kept on file.
Infection Control and other members of the
committee should help do periodic
surveillance of the construction area to ensure
compliance with the established plan.
Focus of the ICRA
• Design – project planning for the IC future
• Mitigation – knowledge of barriers and
• Airflow – pressure needs and requirements
are considered.
• Water- Knowledge that disruption of the
system allows for microbe entry, and stagnant
water leads to biofilm buildup
Clean Up is Important
• Carry out waste in covered bins.
• Waste must be addressed every day of the
construction project, as well as after it is
• Construction crews better understand their
role in this area, it is not up to your
housekeeping to clean up their mess.
Why is Construction the norm ?
• Who doesn’t want a fancy shiny new hospital? If its
new equipment, the care is better isn’t it? Expansion.
• Baby boomers, aging and acuity changes. More of
them to care for, so are we equipped to handle them?
Decentralized nursing stations to be closer to patient
rooms and affecting the care the patient recieves.
• Single occupancy rooms are better for Infection Control
needs, less contamination, bathroom in the room, sink
accessible only to those in room, patient sleeps better,
etc. Patient Centered Care in acute care settings now
finds ways to accommodate families and visitors.
• Surge capacity indicates rooms should have multiple
uses, so new equipment must be brought in are there
enough amenities for two in each room if needed?.
What does technology bring?
• New technology is needing requirements. WIFI
and Cable in rooms now, Patient Portals to look at
their health records.
• Sustainability programs and “going green” have
effected Healthcare. Grants are available if
designed to improve efficiency of heating,
ventilation and air flow.
• LEAPT, LEAN and Six Sigma methods and
principals trying to create maximum value and
reducing waste through improved quality,
efficiency and safety.
New ideas – are they good?
• Sink basins, should be to where they don’t
splash, and water should not hit directly on
the drain.
• Automatic sinks- is the temperature and water
pressure correct? Will it have enough force to
wash contaminants down the sink?
• New flooring and finnishes – are they
compatible with hospital grade cleaners?
Wrap Up
• Get involved with new construction, in the
planning and execution of it. Take authority.
• Know your patient population, and how the
needs of your facility may be different then
the last hospital the construction crew
• Be prepared to change plans at any time.
• Do surveillance, make yourself known.
• Remember, patients and safety come first!
Any Questions or Comments?
Tara Dockery, MT (ASCP), IP, BS
Infection Prevention Consultant
[email protected]

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