The Complete ICRA Construction Checklist for Contractors
A well-executed ICRA construction checklist can help keep a healthcare renovation on schedule. Missing critical infection-control precautions can lead to corrective action, work stoppages, and costly delays.
Healthcare facilities establish project-specific approval and permitting requirements. Once work begins, a compromised barrier or failed pressure reading can jeopardize containment and disrupt construction.
STARC builds temporary containment systems used by contractors like Mortenson and W.E. Bowman on active healthcare renovation projects. Here are six key phases of ICRA-related construction planning and execution, along with practical considerations for contractors working under facility-approved infection control plans.
How ICRA Risk Classification Works
ICRA risk classification starts with two key factors. The ICRA precautions matrix cross-references these factors to determine an initial Class of Precautions:
Construction Activity Type (A–D). Type A covers minor, non-invasive work. Type D covers major demolition or construction that generates heavy dust over an extended period.
Patient Risk Group (Low, Medium, High, Highest). Risk groups reflect the vulnerability of patients in or near the affected area. Intensive care, oncology, and neonatal intensive care units are examples of higher-risk environments.
Class of Precautions (I–V). Based on the combination of construction activity type and patient risk group, the matrix identifies the applicable Class of Precautions. For example, Type D construction affecting the Highest Risk Patient Group corresponds to Class V.
The facility's ICRA team then evaluates site-specific conditions and determines the precautions required for the project.
The facility-approved Class of Precautions helps guide subsequent decisions, including containment barriers, negative air pressure controls, and monitoring requirements.
ASHE released a 2022 update to the framework called ICRA 2.0, which pushed infection prevention earlier into project planning and clarified how these classes translate into physical requirements on-site.
ICRA Class Requirements at a Glance
Here's a general overview of the five ICRA precaution classes and the types of controls they may involve. Specific requirements depend on the facility's ICRA assessment and approved infection control plan.
Precaution class | General description | Key considerations |
Class I | Basic precautions for limited, noninvasive activities | Minimize dust and disruption; follow facility-approved precautions |
Class II | Precautions for certain maintenance and facilities activities | Control dust and debris using facility-approved methods |
Class III | More extensive precautions for activities with increased infection-control risk | Dust containment and other controls appropriate to the activity and affected patient population |
Class IV | Stringent precautions for higher-risk construction activities | Containment barriers, negative-pressure controls, HVAC protections, and monitoring as specified by the facility |
Class V | Most stringent precautions for high-risk environments | Enhanced containment controls, including anteroom and worker protection measures |
This table is intended as a general overview, not a substitute for the ASHE ICRA 2.0 guidelines or a facility-approved ICRA plan. The healthcare facility's designated ICRA team determines the precautions required for each project.
The ICRA Construction Checklist, Phase by Phase
Facility policies vary, so no single sequence works universally. The process generally moves through six phases. Here's a checklist contractors can adapt to their own project workflow.
Phase 1: Pre-Construction Planning and Risk Assessment
Most preventable ICRA failures start here. A planning meeting that skips a step creates problems that will show up weeks later.
Tasks:
Review project scope, drawings, and timeline to flag every area requiring ICRA evaluation.
Pull permits and facility approvals required for work in occupied or licensed healthcare space.
Loop in the facility's Infection Preventionist (IP) or infection control committee before drafting the permit.
Review the facility's existing infection control policies. Specific requirements vary by health system.
Identify critical utilities (HVAC zones, electrical) that need to stay operational throughout the work.
Complete the pre-construction risk assessments, permits, and documentation required by the healthcare facility and applicable accreditation standards, including assessment of infection-control risks and potential impacts on air quality and critical utilities.
Determine Activity Type (A–D) and Patient Risk Group (Low–Highest) using the ICRA matrix.
Confirm the resulting Class of Precautions (I–V) and obtain approval through the facility's designated ICRA process, including review by Infection Prevention.
Getting Class IV and V requirements right at this stage carries the most weight. Higher-class specs are hard to retrofit once work is underway.
Phase 2: ICRA Plan Development
With classification set, the plan converts it into concrete site requirements.
What to do:
Document the specific infection control measures required for each phase of construction.
Define containment zone boundaries and mark them on facility drawings.
Specify PPE requirements for construction crews and any clinical staff entering adjacent areas.
Select the containment barrier type based on precaution class.
Build a communication plan so facility staff, IPs, and security know what's happening and when.
Establish a documented response procedure for containment breaches or unexpected incidents.
Phase 3: Barrier Installation and Containment Setup
Classes I and II address limited activities involving basic precautions or routine maintenance rather than construction and renovation. Class III introduces additional dust-control measures, which may include physical containment barriers depending on the work and facility conditions. Classes IV and V generally require more stringent containment and environmental controls, with specific barrier requirements established through the facility's approved ICRA plan.
Plastic sheeting goes up fast and cheap but tears on active sites, blocks almost no sound, and gets thrown out after one phase. Drywall looks more finished and blocks more noise, but building it generates the exact dust ICRA exists to prevent and takes real labor to frame.
Before switching to STARC, W.E. Bowman's team had to build a temporary plastic wall to create a negative air environment before they could even start framing the metal stud wall behind it.
Reusable modular wall systems lock together during installation, minimize dust during setup, and provide airtight seals and options for integrating negative-air equipment to support stringent ICRA Class IV and V containment requirements. STARC's RealWall™ system was engineered with these capabilities and carries an ASTM E84 Class A fire safety rating as a tested assembly.
W.E. Bowman standardized on it across a 5,200-foot, seven-phase renovation. The investment paid for itself by phase five and saved 75% versus drywall over the project.
Even with the right system, the setup itself has to hit these marks:
Install barriers that match the assigned precaution class, and seal them floor to ceiling with no gaps.
Seal all barrier joints, floor tracks, and ceiling penetrations.
Set up an anteroom for Class V zones. Many facilities require the same for Class IV, so confirm the exact requirement with the facility's Infection Preventionist before mobilizing.
Establish negative air pressure and monitor it before dust-generating work begins.
Place adhesive dust mats at every entry and exit point, and set a schedule for replacing them.
Corridor work adds its own complications. A hallway containment run has to seal against doorframes and utility chases over a long span, not just a single room. Crews can assemble an 8-foot corridor barrier kit from modular panels to cover the span without on-site custom fabrication.
Phase 4: Team Training and Site Controls
A well-written ICRA plan means nothing if the crew doesn't execute it consistently.
You should:
Train every worker on ICRA requirements specific to the assigned precaution class before they enter the site.
Train crews on PPE use, including gowning and de-gowning procedures for Class V anteroom entry and exit.
Brief clinical staff on how to safely route around or interact with the construction zone.
Post clear signage marking containment boundaries and PPE requirements at every access point.
Control foot traffic in and out of the containment zone. Every extra door opening is a pressure breach risk.
At Abbott Northwestern Hospital, Mortenson took drywall off the table before starting the renovation of the central sterile processing area, working under Class IV containment on an active campus.
Field Superintendent Peter Hauer put it plainly: "With a conventional temporary wall installation like drywall, if you bump into it, you will have cuts and tears. There's no infection control when there's a breach in the wall."
The STARC panels held up to that contact, cut sound transfer, and matched the surrounding space closely enough that hospital staff never noticed the renovation was happening.
Phase 5: Ongoing Monitoring, Waste, and Noise Control
ICRA compliance has to hold for the full project duration. ASHE built its ILSM-ICRA daily monitoring checklist for a simple reason. Containment measures degrade over time. Crews bypass them, too, when nobody's tracking things closely.
Perform the following:
Conduct daily visual inspections of barrier integrity, checking for gaps and tears.
Monitor negative air pressure continuously for Class IV and V per ICRA 2.0, and log readings at the cadence specified in the ICRA permit.
Conduct air particulate monitoring when required by the facility's approved ICRA plan to help assess the effectiveness of containment measures.
Keep debris and trash contained within the work zone at all times.
Transport waste in sealed, hard-lid containers. Open bins moving through occupied corridors defeat the purpose.
Schedule high-noise or high-vibration activities during off-peak hours where possible.
Use compression fittings and HEPA vacuums on the job to cut both noise and airborne particulates.
Hold regular check-ins with facilities and the IP to flag issues before they escalate.
Phase 6: Post-Construction Cleanup, Verification, and Barrier Removal
Barrier removal is a critical stage of healthcare construction. Taking down containment too early or without appropriate precautions can release accumulated dust into occupied areas. Careful coordination with the facility's ICRA team helps ensure controls remain in place until they're no longer needed.
You must:
Perform a full terminal clean of the entire work area before containment barriers are removed, as required by the approved ICRA closeout process.
Clear dust from all supply and return air registers in and around the work zone.
Coordinate changes to HVAC isolation and negative-pressure controls with the facility's ICRA team. Maintain required controls until the team authorizes their modification or removal.
Confirm required cleaning and environmental verification are complete before discontinuing controls, following the facility-approved sequence.
Remove containment barriers using methods that minimize dust release, following the facility-approved removal procedures and the barrier manufacturer's instructions.
Conduct a final joint walkthrough with facilities and IP staff before signing off that the space is ready for clinical use.
Document lessons learned for the next project. What worked well? What caused delays? What needs to change in the plan template?
Common Mistakes That Derail ICRA Compliance
Even experienced contractors run into the same failure points repeatedly:
Skipping IP involvement until the permit stage. Containment decisions should already reflect infection prevention input by the time someone drafts the ICRA permit.
Misclassifying activity type to avoid stricter precautions. Incorrectly classifying construction activities can result in inadequate infection-control measures, potentially putting patients at risk and creating liability for contractors.
Using single-use barriers for multi-phase projects. Rebuilding drywall or plastic sheeting for every phase can increase costs, installation time, and the potential for dust generation.
Treating monitoring as a checkbox instead of a daily discipline. Crews who fill out negative air logs after the fact miss pressure failures while they're still fixable.
Removing barriers before required clearance procedures are complete. Premature barrier removal can allow accumulated dust and debris to migrate into occupied areas, undermining otherwise effective containment.
Many of these mistakes stem from underestimating the demands placed on containment systems in active healthcare environments. A damaged barrier or failed pressure reading can trigger corrective action, additional inspections, and costly project delays.
Get Your Next Project ICRA-Ready
Even with a solid ICRA construction checklist in hand, containment is only as reliable as the barrier system itself. Plastic can tear and drywall can crack at the seams. Either issue can compromise containment, trigger corrective action, and potentially delay the project.
STARC builds containment that holds up under the pressure.
STARC offers temporary wall systems tested and certified as installed assemblies for applicable ASTM E84 flame-spread and smoke-developed classifications. Specific fire safety ratings vary by product and configuration. Reusable panels lock together on-site, eliminating the need to build and tear down new containment walls for every phase.
For projects requiring fire-rated temporary containment, STARC's FireblockWall™ delivers a certified one-hour fire-resistance rating tested to ASTM E119, combining fire protection with the durability and reusability of STARC's containment systems.
Request a quote to explore STARC temporary containment solutions designed to support your healthcare facility's approved ICRA requirements.
Frequently Asked Questions
Who is responsible for completing the ICRA checklist?
The healthcare facility is responsible for conducting the ICRA through its designated multidisciplinary team, which typically includes Infection Prevention, Facilities, and other relevant stakeholders. Contractors are responsible for implementing the applicable precautions outlined in the facility-approved plan.
Does every construction project in a hospital require an ICRA?
Healthcare facilities should assess construction, renovation, and maintenance activities for potential infection-control risks. The level of documentation, permit requirements, and precautions depends on the activity, affected patient populations, and facility policies. Some routine maintenance activities may be covered by facility-approved standing orders.
What's the difference between ICRA Class III and Class IV?
Class III involves precautions to control dust and reduce its spread during construction activities. Class IV calls for more stringent containment, ventilation, negative-pressure, and monitoring measures. Specific barrier and control requirements are established through the facility's approved ICRA plan.
Can contractors use plastic sheeting for Class IV or V containment?
Acceptable barrier materials depend on the project's ICRA precautions, facility requirements, and applicable fire and life safety standards. Contractors should confirm approved materials with the facility's ICRA team. STARC's reusable, rigid containment systems are designed to support the stringent requirements associated with Class IV and V projects.
How often should crews monitor negative air pressure during a Class IV project?
ASHE ICRA 2.0 calls for continuous negative-pressure monitoring during Class IV construction activities. The facility's approved ICRA plan should establish monitoring, documentation, and response procedures, including how frequently readings must be recorded.
Where can I find a standardized ICRA permit template?
ASHE publishes an ICRA 2.0 permit template, and the Joint Commission offers a Pre-Construction Risk Assessment Checklist. Once your facility's ICRA precautions and containment requirements are established, STARC's team can help identify temporary wall solutions suited to your project.
