By Dr. Janet Haas, PhD, RN, CIC, FSHEA, FAPIC
The Infection Control Risk Assessment (ICRA) for healthcare construction first appeared in the 1996-97 FGI Guidelines, recognizing the risks that renovation and construction pose to patient safety. Ironically, while healthcare spaces had strict environmental risk guidelines, there was little direction on how to manage construction-related risks. Over time, facilities adopted ICRA guidelines, and accreditors began requiring demonstrated compliance.
The Evolution to ASHE ICRA 2.0™
After years of real-world experience, ASHE convened a multidisciplinary group in 2020 to update the guidelines. The result? ICRA 2.0, launched in late 2021, with:
- New risk groups—including support areas not addressed in the original version.
- Expanded guidance on routine maintenance, water leaks, and air pressure monitoring.
- More detailed processes for infection control in complex healthcare environments.
How Are Healthcare Teams Using ICRA 2.0?
Now that facilities have had time to implement ICRA 2.0, STARC partnered with ASHE to survey members on their experiences:
- How is ICRA 2.0 being used?
- What’s working well?
- Where do teams need more clarification?
Key Survey Findings
Most Infection Preventionists and Facility Managers use ICRA 2.0 as expected, reviewing it before major projects. However, some respondents struggle with real-world implementation, citing challenges such as:
- Clarification needed for non-acute care settings & emergency departments.
- Difficulties applying the guidelines on-site.
- Air handling & measurement concerns, especially when no window is available for exhaust.
ICRA 2.0: A Framework, Not a One-Size-Fits-All Approach
Remember, ICRA 2.0 is a guideline, not a mandate. Your facility’s multi-disciplinary team should adapt it based on specific risks and operational realities.
- A primary care outpatient clinic has different risk factors than an oncology infusion center—guidelines should reflect those differences.
- Timing matters—in areas that aren’t open 24/7, after-hours work may minimize patient care disruption.
- Emergency departments, nursing homes, and behavioral health units require extra planning since they are in constant use.
- HVAC & exhaust solutions may require external expertise—documenting challenges and mitigation strategies helps with compliance and contract specifics.
Looking Ahead: What’s Next?
ICRA 2.0 offers more specific recommendations than ever, but healthcare teams must still adapt it to fit their unique environments. Keep an eye out for STARC’s latest eBook—Keeping Up With ASHE ICRA 2.0™ Adoption: Survey Reveals Key Trends, PLUS Best Practices for Challenging Situations—where Leon Young, BS, MLS(ASCP), CIC, and I break down these challenges and share practical solutions for seamless implementation.
Dr. Haas is Principal Consulting Epidemiologist at Innovative Infection Prevention and an associate editor of the American Journal of Infection Control (AJIC). Dr. Haas previously served as Director of Epidemiology at three academic medical centers, and as 2018 APIC President. Prior to beginning her nursing and infection prevention professional journey, Dr. Haas also worked as a Journeyman Millwright Mechanic and was a member of the Carpenter’s Union.