What is ICRA in Construction? How to Protect Projects & Patients
Jun 13
Most contractors walk onto a healthcare job feeling confident they’ve got containment handled. You’ve done dust control before. You seal the space, hang poly, maybe run a fan.
But unless you’ve been properly trained in ICRA, there’s a good chance your setup could be putting patients at serious risk…without you even realizing.
So, what is ICRA in construction, and why does it matter so much in healthcare environments?
ICRA stands for Infection Control Risk Assessment, and it’s a process hospitals use to prevent construction-related infections. It’s not about red tape. It’s about protecting vulnerable patients from airborne contaminants that can turn a renovation into a life-threatening event.
And yes, the risk is real: healthcare-associated infections tied to construction are estimated to contribute to more than 5,000 patient deaths each year in the U.S., according to published medical reviews.
In this post, we’ll break it all down in plain English, from what ICRA actually is to how it works, and how you can use it to not only protect lives but win more healthcare projects. Because when it comes to construction in healthcare environments, good enough isn’t good enough.
But unless you’ve been properly trained in ICRA, there’s a good chance your setup could be putting patients at serious risk…without you even realizing.
So, what is ICRA in construction, and why does it matter so much in healthcare environments?
ICRA stands for Infection Control Risk Assessment, and it’s a process hospitals use to prevent construction-related infections. It’s not about red tape. It’s about protecting vulnerable patients from airborne contaminants that can turn a renovation into a life-threatening event.
And yes, the risk is real: healthcare-associated infections tied to construction are estimated to contribute to more than 5,000 patient deaths each year in the U.S., according to published medical reviews.
In this post, we’ll break it all down in plain English, from what ICRA actually is to how it works, and how you can use it to not only protect lives but win more healthcare projects. Because when it comes to construction in healthcare environments, good enough isn’t good enough.
What is ICRA in Construction?
Let’s set the record straight: ICRA isn’t just paperwork. It’s a full-blown infection prevention system designed specifically for healthcare construction. ICRA stands for Infection Control Risk Assessment, and it’s the hospital’s way of making sure your job site doesn’t become a health hazard for the patients next door.
At its core, ICRA is a risk-based planning process used before and during any construction, renovation, or maintenance work in hospitals or healthcare facilities. The goal? Prevent construction-related contaminants like dust, mold spores, and pathogens from reaching vulnerable patients. This includes things like floor-to-deck barriers, anterooms, negative air machines with HEPA filters, entry and exit protocols, and even work hour restrictions, all based on how risky the project is and who’s nearby.
You’re not working in a vacant office building here. Patients can’t just pack up and leave when you start the demo. Some of them are immunocompromised, recovering from surgery, or hooked up to ventilators down the hall. The smallest containment mistake could lead to serious infections—or worse.
So, when someone asks, what is ICRA in construction? The answer isn’t “some form the hospital fills out.” It’s a detailed, proactive game plan that lives at the intersection of construction logistics and infection prevention. If you want to work in healthcare, you need to understand how to read it, follow it, and most importantly, obtain the knowledge to properly design and build in ways that protect the people you can’t see behind the walls.
Because in healthcare, dust isn’t just dust. It’s a potential biohazard.
At its core, ICRA is a risk-based planning process used before and during any construction, renovation, or maintenance work in hospitals or healthcare facilities. The goal? Prevent construction-related contaminants like dust, mold spores, and pathogens from reaching vulnerable patients. This includes things like floor-to-deck barriers, anterooms, negative air machines with HEPA filters, entry and exit protocols, and even work hour restrictions, all based on how risky the project is and who’s nearby.
You’re not working in a vacant office building here. Patients can’t just pack up and leave when you start the demo. Some of them are immunocompromised, recovering from surgery, or hooked up to ventilators down the hall. The smallest containment mistake could lead to serious infections—or worse.
So, when someone asks, what is ICRA in construction? The answer isn’t “some form the hospital fills out.” It’s a detailed, proactive game plan that lives at the intersection of construction logistics and infection prevention. If you want to work in healthcare, you need to understand how to read it, follow it, and most importantly, obtain the knowledge to properly design and build in ways that protect the people you can’t see behind the walls.
Because in healthcare, dust isn’t just dust. It’s a potential biohazard.
Why ICRA Hospital Construction Matters
If you’ve worked in healthcare environments, you know the rules hit differently. There’s a reason for that.
Even routine construction tasks, like cutting into drywall or moving ceiling tiles, can release contaminants that pose a serious risk in healthcare environments. Unlike other job sites, hospitals aren’t filled with healthy adults walking around in steel-toe boots. They’re filled with newborns, transplant recipients, cancer patients, ICU residents—people whose immune systems are often hanging by a thread.
This is where ICRA hospital construction comes in.
Construction dust can carry spores, bacteria, and viruses into patient care areas. One of the most well-documented threats is Aspergillus, a common mold that lives in dust and soil. In healthy folks, exposure might not lead to anything. But for high-risk patients, it can trigger invasive infections like aspergillosis. And the outcomes can be fatal.
In fact, nearly half of Aspergillus outbreaks in hospitals have been tied to nearby renovation or demolition activities. One study found patients were nearly three times more likely to develop a mold infection when heavy excavation work was underway on a hospital campus. And those are just the fungal risks. Disturbed water systems during construction can also release Legionella bacteria, leading to outbreaks of Legionnaires’ disease.
This is why hospital projects don’t mess around with containment. And why every healthcare facility is expected to implement ICRA protocols, as outlined by the CDC, the Joint Commission, and ASHE. These aren’t optional. They’re the foundation of safe construction in patient-occupied spaces.
So when you follow an ICRA plan, you’re not just protecting drywall from dust. You’re protecting lives. That’s the real weight of hospital construction.
Even routine construction tasks, like cutting into drywall or moving ceiling tiles, can release contaminants that pose a serious risk in healthcare environments. Unlike other job sites, hospitals aren’t filled with healthy adults walking around in steel-toe boots. They’re filled with newborns, transplant recipients, cancer patients, ICU residents—people whose immune systems are often hanging by a thread.
This is where ICRA hospital construction comes in.
Construction dust can carry spores, bacteria, and viruses into patient care areas. One of the most well-documented threats is Aspergillus, a common mold that lives in dust and soil. In healthy folks, exposure might not lead to anything. But for high-risk patients, it can trigger invasive infections like aspergillosis. And the outcomes can be fatal.
In fact, nearly half of Aspergillus outbreaks in hospitals have been tied to nearby renovation or demolition activities. One study found patients were nearly three times more likely to develop a mold infection when heavy excavation work was underway on a hospital campus. And those are just the fungal risks. Disturbed water systems during construction can also release Legionella bacteria, leading to outbreaks of Legionnaires’ disease.
This is why hospital projects don’t mess around with containment. And why every healthcare facility is expected to implement ICRA protocols, as outlined by the CDC, the Joint Commission, and ASHE. These aren’t optional. They’re the foundation of safe construction in patient-occupied spaces.
So when you follow an ICRA plan, you’re not just protecting drywall from dust. You’re protecting lives. That’s the real weight of hospital construction.
What Makes ICRA Healthcare Standards Different From Typical Construction?
As we’ve explored, working in a hospital isn’t like working in a school or office. ICRA healthcare standards reflect that reality. Because in a healthcare environment, even one speck of dust can do real harm.
So what makes actual ICRA healthcare protocols so different from typical jobsite containment?
1. The risks are invisible, and the consequences are life-threatening.
On a normal job, dust is mostly a cleanup issue. In a hospital, it’s a carrier of Aspergillus, Mucor, Legionella, and other opportunistic pathogens that can lead to deadly infections. That’s why ICRA healthcare containment isn’t just about barriers. It’s about air quality, pressure management, proper containment design, and strict traffic flow.
2. The rules weren’t written by GCs.
ICRA protocols were developed by infection preventionists, not builders. That means they’re built around patient safety, not construction speed or convenience. For example, you might be required to:
- Build a full containment system with a properly working anteroom
- Use floor-to-deck hard-wall barriers—not painter’s plastic
- Monitor and document negative air pressure daily (e.g., -0.02” WC)
- Test your Portable HEPA exhaust used to create negative pressure
- Wet wipe and vacuum containment room work areas several times a day
- Wear disposable coveralls with hoods and shoe covers inside the containment
- Establish wait times in the anteroom before exiting into the critical area of the hospital
3. The expectations change based on who's nearby.
ICRA planning uses a matrix to determine how strict your setup needs to be, based on the type of construction and the risk level of the nearest patients. You’ll follow different rules if you're demoing a bathroom next to an office vs. next to a bone marrow transplant unit.
4. The containment is clinical-grade.
You might be required to:
- Seal HVAC supply and return vents and wall gaps completely
- Route all demo debris using covered/cleaned, through pre-approved paths
- Shut off plumbing lines and prevent dead-legs to avoid waterborne bacteria
- Use portable HEPA filtration units to create negative pressure, with alarms and failure response
- Install sight windows in doors or walls of the containment and anterooms to make sure that “one door at a time policies” are followed.
This level of control is far beyond what’s expected on most job sites. But in hospitals and other healthcare facilities, it’s non-negotiable.
5. The culture on-site is different.
In hospitals, you’ll often be working alongside clinical staff who monitor your setup daily. Expect infection prevention teams to do walkthroughs, flag containment breaches, and ask for daily pressure readings. A casual “that’s good enough” approach won’t cut it.
Disclaimer: These are just a few examples. ICRA healthcare standards go deep. And while this section offers a high-level overview, the full picture can’t be captured in any blog post. To truly protect patients and win more healthcare jobs, proper training is essential. That’s where our ICRA certification for construction (ICRA-IQ) comes in.
What is an ICRA Plan & What Does it Include?
An ICRA plan is a proactive infection control strategy developed before construction begins in a healthcare facility. Its purpose is to assess how a specific project could expose vulnerable patients to airborne or waterborne contaminants, and to outline detailed measures that prevent those exposures.
Here’s what a typical ICRA plan includes, based on industry guidance from ASHE, CDC, and CPWR:
1. Construction Activity Type
Projects are categorized into Types A through D depending on the scope and dust-generating potential. For example:
- Type A: Inspection or non-invasive activities
- Type D: Major demolition or new construction
2. Patient Risk Group
The four risk groups are based on the medical vulnerability of patients, or procedures, or materials near the construction site. An administrative office might be low-risk, while a transplant unit, surgical suite, or ICU is considered highest-risk.
3. Precaution Class Assignment
Using a standardized risk matrix, the activity type is cross-referenced with the patient risk group to determine the required class of precautions—Class I through V. The higher the risk, the more intensive the controls.
4. Required Controls
Based on the assigned class, the plan specifies detailed controls such as:
- Barriers: Floor-to-deck hard-wall containment
- Ventilation: Negative air pressure with HEPA filtration
- Sealing: Closing off air vents, doors, and containment gaps
- Traffic Flow: Dedicated entry/exit points through properly designed anterooms
- Cleaning: Daily wet wiping and cleaning of debris carts, equipment, and tools leaving the containment system
- PPE: Use of disposable coveralls with hoods, shoe covers, following a protocol
- Monitoring: Use of manometers and particle counters to confirm air pressure, HEPA exhausts and containment system anterioms
5. Oversight and Monitoring
The hospital is responsible for implementing and enforcing the ICRA. Infection prevention staff or safety officers are often tasked with routine checks to ensure compliance. If the project changes, the ICRA plan must be updated immediately and re-communicated to all teams.
6. Collaborative Development
ICRA plans are developed by a multidisciplinary team, typically including:
- Infection preventionists
- Design & construction
- Facility management
- Clinical staff from nearby units
- Safety officers or industrial hygienists
- Department leaders from impacted areas
- Contractor project management & superintendents
The contractor’s role is not to author the plan but, as a team member, to understand, follow, and implement every measure as specified.
Remember, this is a high-level overview. The full ICRA process is highly detailed and varies by facility, risk level, and project scope. Proper training is the best way to ensure your team is equipped to follow it correctly.
ICRA Barriers: More Than Just Dust Control
If you’ve made it this far, you already know ICRA isn’t just a checklist. It’s a detailed system for keeping patients safe during construction. One of the clearest illustrations of that detail?
The containment system barriers.
In this section, we’ll take a closer look at what an ICRA barrier actually involves. Because once you see how specific and controlled even the walls around a jobsite need to be, you start to understand just how different healthcare construction really is.
Here’s what sets a true healthcare ICRA barrier apart:
Sealed, Floor-to-Deck Containment
Temporary barriers must be sealed airtight from floor to deck, with no gaps around vents, pipes, or ceiling grids. Common standards include hard-wall barriers made of rigid materials like drywall, corrugated plastic panels, or prefabricated containment wall systems. In many cases, soft plastic sheeting is only allowed for low-risk work zones, and only if it’s fully sealed and reinforced.
Negative Air Pressure and HEPA Filtration
A key requirement of most ICRA Class IV and V precautions is continuous negative air pressure inside the containment system. That means air flows into the space, but never out, ensuring that contaminated particles stay contained when small gaps are in the containment system’s walls, ceiling or floors. To maintain this, teams must install portable negative air machines equipped with HEPA filters, monitor pressure differentials (usually at -0.02” WC or more), and verify performance using manometers or digital gauges.
Negative Air fails when the containment door or anteroom door is opened. There is no negative pressure or adequate airflow at an open door. So high-risk projects often require properly designed anterooms: small vestibules that act as transition zones between clean and contaminated areas. These are used for donning and doffing PPE, wet-cleaning gear, and equipped with a high air exchange rate HEPA air recirculating scrubber. Sticky mats placed at exits help trap large debris particles on footwear and equipment wheels. Workers may also need to wear disposable coveralls and shoe protection and change them regularly to prevent cross-contamination.
Debris Control and Pathway Management
ICRA plans often specify that debris must exit the hospital through pre-approved, sealed routes—sometimes via cleaned and covered carts. These pathways are designed to prevent dust from spreading through hallways, elevators, or other shared spaces. Cleaning teams may be assigned to follow and wet-wipe down surfaces of the debris transport carts in both directions. Wait times and one door at a time protocols are also essential to preventing a breach of the containment system.
Daily Cleaning and Continuous Oversight
Barriers are only as effective as the maintenance supporting them. That’s why ICRA protocols call for frequent cleaning: wet-wet wiping surfaces, and dust removal multiple times per day, depending on the activity and containment class. Infection prevention staff or designated safety officers typically inspect these setups daily to ensure all protocols are met and maintained.
The containment system barriers.
In this section, we’ll take a closer look at what an ICRA barrier actually involves. Because once you see how specific and controlled even the walls around a jobsite need to be, you start to understand just how different healthcare construction really is.
Here’s what sets a true healthcare ICRA barrier apart:
Sealed, Floor-to-Deck Containment
Temporary barriers must be sealed airtight from floor to deck, with no gaps around vents, pipes, or ceiling grids. Common standards include hard-wall barriers made of rigid materials like drywall, corrugated plastic panels, or prefabricated containment wall systems. In many cases, soft plastic sheeting is only allowed for low-risk work zones, and only if it’s fully sealed and reinforced.
Negative Air Pressure and HEPA Filtration
A key requirement of most ICRA Class IV and V precautions is continuous negative air pressure inside the containment system. That means air flows into the space, but never out, ensuring that contaminated particles stay contained when small gaps are in the containment system’s walls, ceiling or floors. To maintain this, teams must install portable negative air machines equipped with HEPA filters, monitor pressure differentials (usually at -0.02” WC or more), and verify performance using manometers or digital gauges.
Anterooms, Sticky Mats, and PPE Protocols
Negative Air fails when the containment door or anteroom door is opened. There is no negative pressure or adequate airflow at an open door. So high-risk projects often require properly designed anterooms: small vestibules that act as transition zones between clean and contaminated areas. These are used for donning and doffing PPE, wet-cleaning gear, and equipped with a high air exchange rate HEPA air recirculating scrubber. Sticky mats placed at exits help trap large debris particles on footwear and equipment wheels. Workers may also need to wear disposable coveralls and shoe protection and change them regularly to prevent cross-contamination.
Debris Control and Pathway Management
ICRA plans often specify that debris must exit the hospital through pre-approved, sealed routes—sometimes via cleaned and covered carts. These pathways are designed to prevent dust from spreading through hallways, elevators, or other shared spaces. Cleaning teams may be assigned to follow and wet-wipe down surfaces of the debris transport carts in both directions. Wait times and one door at a time protocols are also essential to preventing a breach of the containment system.
Daily Cleaning and Continuous Oversight
Barriers are only as effective as the maintenance supporting them. That’s why ICRA protocols call for frequent cleaning: wet-wet wiping surfaces, and dust removal multiple times per day, depending on the activity and containment class. Infection prevention staff or designated safety officers typically inspect these setups daily to ensure all protocols are met and maintained.
How ICRA Certification for Construction Changes the Game
As we’ve covered, in healthcare construction, knowing how to build isn’t good enough in healthcare construction or restoration. You also need to understand how to protect the patients just beyond the containment. That’s where ICRA certification comes in.
While healthcare facilities are responsible for developing and enforcing ICRA plans, they rely on contractors to carry them out accurately. Increasingly, facilities are asking for proof that your crew knows the proper protocols before they ever step on-site. For many, that means completing an ICRA training or certification program.
While healthcare facilities are responsible for developing and enforcing ICRA plans, they rely on contractors to carry them out accurately. Increasingly, facilities are asking for proof that your crew knows the proper protocols before they ever step on-site. For many, that means completing an ICRA training or certification program.
Why Certification Matters
- It builds trust. When your team is trained in ICRA, hospital staff know you’re speaking the same language. And that you won’t cut corners that put patients at risk.
- It can be a requirement. Some healthcare systems now require all contractor personnel to complete ICRA awareness training before being badged or approved to work on-site. These expectations are often written directly into contracts or permits.
- It prevents shutdowns. Jobs have been shut-down mid-project due to containment failures, pressure violations, or infection risk concerns. Proper training helps your team avoid these costly missteps.
What ICRA Training Actually Covers
Reputable training programs like ours typically include both foundational knowledge and hands-on best practices:
- Understanding how hospital-acquired infections occur
- Identifying key pathogens and patient risk groups
- Reviewing CDC, Joint Commission, and hospital compliance guidelines
- Learning how to build proper containment barriers and anterooms
- Installing and monitoring negative air pressure systems
- Airborne particulate testing of portable HEPA filtered units
- Proper placement and use of HEPA filters, tacky mats, and PPE
- Practicing daily routines like inspections, documentation, wet-cleaning, and breach response
- Using proper entry and exit procedures.
Who Benefits from ICRA Certification?
- Foremen and crew leads tasked with daily compliance
- Subs or trades working in sensitive areas
- Project managers responsible for client coordination
- Contractors pursuing hospital bids for the first time
Ultimately, the investment is about equipping your team with the tools to work safely in a patient-occupied environment. Certification doesn’t just help win the job. It helps make sure you keep it.
Ready to Build Safer? Start with Your Crew
Containment isn't just about sealing a space. It’s about understanding why it matters.
On healthcare projects, even a perfectly installed containment barrier can fall short if the team behind it doesn’t understand the science designing it. That’s why crew culture is essential. It’s the difference between checking a box and truly protecting patients.
Our ICRA-IQ course helps bridge that gap. Built by Higgins and Associates, LLC and approved by ASHE and APIC’s CBIC, this four-module training digs deeper than most infection control programs. It doesn’t just tell you what to build. It explains how and why each containment measure works, from airflow dynamics to bioaerosol movement.
Participants learn how to:
On healthcare projects, even a perfectly installed containment barrier can fall short if the team behind it doesn’t understand the science designing it. That’s why crew culture is essential. It’s the difference between checking a box and truly protecting patients.
Our ICRA-IQ course helps bridge that gap. Built by Higgins and Associates, LLC and approved by ASHE and APIC’s CBIC, this four-module training digs deeper than most infection control programs. It doesn’t just tell you what to build. It explains how and why each containment measure works, from airflow dynamics to bioaerosol movement.
Participants learn how to:
- Design and maintain containment that actually controls airborne pathogens
- Understand and apply ASHE ICRA 2.0 protocols on active healthcare job sites
- Monitor pressure, adjust ventilation, and proactively prevent failures
- Align with CDC and Joint Commission standards
- See risk through a clinical lens, not just a construction one
The result? Crews that don’t just follow the rules. They live by them. And that mindset means preventing breaches, fewer slowdowns, and a safer hospital environment.
Training like this helps raise the bar across the board, so that crews lead with knowledge, and working in a containment becomes second nature.
ICRA Construction FAQs
What does ICRA mean in construction?
ICRA stands for Infection Control Risk Assessment. In construction, it refers to a planning and containment process required in healthcare facilities to protect patients from dust-borne and waterborne contaminants during renovation, maintenance, or new builds.
How does an ICRA work?
An ICRA evaluates the type of construction work and the vulnerability of nearby patients using a risk matrix. Based on the results, the hospital assigns a class of precautions (Class I–V) and specifies controls such as containment barriers, HEPA-filtered negative air machines, PPE, and cleaning protocols.
Do all hospital construction jobs require ICRA compliance?
Yes, ICRA compliance is required by hospitals and is considered the industry standard for meeting infection control regulations during construction, renovation or restoration activities. Agencies like the CDC, The Joint Commission, and CMS require healthcare facilities to assess and control infection risks during renovation and construction, and ICRA is the established consensus standard method for patient safety.
How is ICRA different from general construction safety standards?
Traditional construction safety focuses on worker injury prevention. ICRA adds a layer of infection prevention for patients, staff, and visitors. It addresses invisible hazards—like airborne pathogens and bioaerosols—that standard jobsite safety plans don’t cover.
What happens if ICRA protocols aren’t followed?
Failure to follow ICRA can result in hospital-acquired infections, patient harm, shutdowns, or liability. Outbreaks of diseases like aspergillosis and Legionellosis have been directly tied to poor construction containment practices.
Can ICRA training really help my crew win more bids?
Yes. Many healthcare facilities now require contractors to show proof of ICRA training or certification during the vetting process. Teams that understand ICRA are seen as lower risk, more professional, and better prepared for healthcare environments.
How long does ICRA training take?
Training length varies. Our ICRA-IQ course, for example, is self-paced and structured into four modules covering everything from regulatory standards to the science of bioaerosols and containment. Participants can complete it in a few focused sessions and receive lifetime access and receive 4 ASHE CEUs or 4 APIC IPUs.
What is the ICRA construction matrix?
An ICRA matrix is a checklist which typically includes, at minimum: construction type classification, patient risk group, precaution class assignment, containment and airflow controls, PPE requirements, cleaning schedules, debris handling plans, and monitoring protocols. The matrix leads to an ICRA permit which ensures all required infection prevention measures are implemented before work begins and controls the work throughout the project.
Have More Questions About ICRA?
If you’re navigating healthcare construction or want to better understand how ICRA training can support your team, reach out to us here. We’re happy to answer your questions or help you decide if our ICRA-IQ course is the right fit for your crew.
