The infection control risk assessment (ICRA) has existed in some form for over 20 years. Since 1996 an ICRA has been required by the Facility Guidelines Institute’s (FGI’s) Guidelines. In 2003, the Centers for Disease Control and Prevention included ICRA in its Guidelines for Environmental Infection Control in Health-Care Facilities. Health care facilities now have a greater understanding of the importance of a comprehensive ICRA that begins with planning and design and continues to the end of the project, during commissioning and beyond.

The ICRA process is guided by a collaborative, multidisciplinary team. Central to the team is the infection preventionist, who should be involved at all stages and serve as more than just a “rubber stamp” for architectural drawings or the ICRA matrix put together by the construction manager.

For example, many years ago, one 300-bed replacement hospital facility located dietary on the floor directly above surgery. Although state plan reviewers suggested this might be problematic, the design was not changed, resulting in repeated flooding of surgery areas from equipment water leaks and failed sewer lines. Input from infection control along with a water infection control risk assessment during the design phase could possibly have avoided this mess. The new ICRA 2.0 matrix from the American Society for Health Care Engineering includes a section on assessment of surrounding areas and is helpful in identifying issues. 

After risk assessments are made and the matrix is completed, the job is not over. The ICRA is more than just a line item on the monthly meeting agenda. Project managers and infection preventionists should routinely survey work sites and comment on potential issues.

When physical constraints or other changes surrounding a construction project occur, also reevaluate the ICRA. A change in design, such as the location of a sink or placement of air diffusers in the ceiling grid, may sound trivial but they are critical design elements, particularly for the immunocompromised patient. Taking these steps will ensure continual infection control compliance.