Quick Guides
Quick Guide, Chapter 1: Infection Control Risk Assessments
Expanded information, case studies, references and other important items related to infection
control risk assessments are available in Chapter 1 of this publication.
The design and construction of health care facilities influence infection outcomes. To help
reduce infection risks, health care organizations should perform an infection control risk
assessment (ICRA) when designing, renovating or constructing a health care facility. An ICRA is
required by many jurisdictions through the adoption or use of the Facility Guidelines Institute
(FGI) Guidelines for the Design and Construction of Hospital, Outpatient and Residential Health
Care Facilities (three separate documents). Using the ICRA process can help hospitals identify
infection risks and potential solutions.
An interdisciplinary ICRA team should include experts in both medical and building sciences,
such as front-line caregivers from clinical departments affected by the project, facility
management, quality improvement representatives, environmental safety specialists, infection
preventionists, epidemiologists, architects, interior designers, engineers, human factors
specialists, environmental services staff, and contractors. Other disciplines, such as risk
management or lab personnel, may be helpful on an ad hoc basis.
The ICRA team is responsible for conducting a health care risk assessment. A common
approach to this process includes five steps:
1. Identify the hazards.
2. Decide who might be harmed and how.
3. Evaluate the risks and decide on the precautions.
4. Record findings, propose action and identify who will lead on what action.
5. Review the assessment and update if necessary.
Design solutions may be straightforward (such as choosing plumbing fixtures that can reduce
the risk of contaminated water) or they may be more nuanced (such as locating a hand hygiene
sink in a space within a patient room that promotes hand hygiene compliance).
Solutions to mitigate risks during construction may be more prescriptive and can be identified
through tools such as an ICRA precautions matrix. An ICRA precautions matrix can help
determine steps to take when conducting a construction or renovation project in a health care
facility. Using the American Society for Heath Care Engineering (ASHE) ICRA precautions
matrix as an example, an ICRA team would rate the type of construction (i.e., painting, sanding,
duct work or new construction) and the risk of the patient groups affected (e.g., office areas,
emergency rooms, operating rooms, burn unit). The precautions matrix would determine
precautions needed (i.e., minimizing dust, cleaning the area after project completing,
maintaining negative air pressure, using high efficiency particulate air (HEPA)-equipped air
filtration units).
Best practices related to ICRA processes include:
• Ensure the ICRA team is interdisciplinary. Get infection prevention involved early in the
design process.
• Involve the ICRA team to address minimum standards identified in several guidance
Excerpt from: Using the Health Care Physical Environment to Prevent and Control Infection [Link]/infectionprevention
sources, including the Centers for Disease Control (CDC) and FGI Guidelines.
• Use the ICRA precautions matrix to determine precautions needed during construction
activity.
• Include construction-related requirements of the ICRA into contract documents.
• Since safe design relies not only on the ICRA process but also on other aspects of a
health system as well (organizational policies, staff, etc.), consider different perspectives
and take a systems view of safety.
Excerpt from: Using the Health Care Physical Environment to Prevent and Control Infection [Link]/infectionprevention