• Art Goguen

How Solid is Your Healthcare ICRA Construction Program?

Updated: Mar 12


Undertaking construction projects in operational healthcare facilities is risky business.


Across the U.S., hospital-acquired infections related to construction and renovation activities account for more than 5,000 deaths per year, according to Judene Bartley MS, MPH, CIC.


These deaths are preventable, but effectively managing contractors during healthcare construction projects takes significant preparation and continuous improvement.


What Does an Effective ICRA Program Look Like?


Thoroughly vetting contractors is only the first step to protecting the health and wellbeing of patients and healthcare workers. Program reviews and continued monitoring of contractor compliance with site infection control risk assessment (ICRA) programs are critical to building a comprehensive construction program.


Consider this seven-step framework when creating a comprehensive ICRA program for healthcare construction/renovation projects:

  1. Create a comprehensive construction policy with support of key stakeholders

  2. Prequalify all contractors who will work on the project

  3. Conduct pre-start and recurrent training for all project leaders

  4. Perform periodic, detailed ICRA risk assessments

  5. Maintain diligent incident monitoring

  6. Develop thorough corrective action planning

  7. Make continuous program reviews and improvements

Now that we have a framework, let's expand on a few details.

Prequalification includes conducting a thorough review of the contractor’s own ICRA program to see if it aligns with the standards and objectives of the healthcare facility. This process also involves vetting key superintendents and project managers for adequate healthcare experience, and reviewing the contractor’s OSHA compliance safety programs, including:

  • Job hazard analysis

  • Containment and anteroom design

  • Pre-task planning

  • Work permit systems

  • Periodic review of contractor’s ICRA compliance

  • Ongoing communication with the contractor and client

  • Commitment of staff and time to patient safety and infection control

Contractor training objectives should be defined well in advance of project start and thoroughly reviewed to ensure they closely align with the healthcare facility’s objectives. These training goals should then be periodically reviewed to ensure all new contractors are adequately trained and prepared to properly perform construction work in a healthcare environment.


Finally, there should be a continuous program review with set milestone timeframes for assessing and auditing safety and infection control compliance during critical aspects of the project, such as:


  • Proper containment and anteroom design

  • Maintaining infection control precautions

  • Monitoring possible HEPA efficiencies

  • Closely overseeing contractor compliance

The bottom line is: Never establish goals without following-up on a regular basis to ensure those goals are being met.


Without adequate training, there are many potential pitfalls that can lead to an increase in hospital-acquired infections. Improper containment and anteroom design, for example, is a common vulnerability that often goes unnoticed, potentially allowing significant construction contaminants into the hospital environment.


Every World-Class Construction ICRA Program Involves Setting Protocols, Guidelines, and Best Practices

Higgins and Associates assists clients with proper containment design, ICRA training, containment oversight, contractor training, and air/water sampling during construction projects large and small.


If you are concerned about potential deficiencies in your ICRA plan, we're happy to help. Our EHS experts are trained to perform detailed assessments and help address deficiencies before they become significant problems.


For more information, contact Art Goguen, Director of EHS, at (303) 994-8122.