ICRA Plan Checklist: What a Solid Plan Should Include

If you've run an occupied hospital renovation, you've probably seen this play out. A one-page ICRA permit gets stapled to the front of the binder, and the crew installing the barriers has almost nothing else to work from.

The document checks the compliance box, and every practical on-site decision gets made in real time by whoever's holding the tape measure.

A working ICRA plan replaces that thin permit with something the entire project team can execute against. STARC Systems works with healthcare facilities and contractors on the containment side of ICRA compliance every day, and this is the failure pattern we see most often.

What Is an ICRA Plan?

An ICRA plan translates a facility's infection control risk assessment into the specific containment and airflow measures a construction team follows on-site, along with the monitoring schedule that verifies compliance.

The CDC's Guidelines for Environmental Infection Control in Health-Care Facilities direct hospitals to establish a multidisciplinary team, including infection-control staff, before any demolition or renovation project begins. That team's risk assessment becomes the plan.

The Joint Commission's Environment of Care standards require hospitals to manage their environment during demolition, renovation, or new construction specifically to reduce risk to patients and staff, without prescribing a specific assessment format.

Most healthcare systems build their ICRA plans according to CDC guidelines and the Facility Guidelines Institute (FGI) standards to satisfy that requirement.

How an ICRA Plan Works

An ICRA plan is based on a matrix published by the American Society for Health Care Engineering (ASHE) that cross-references the type of construction activity with the risk level to nearby patients.

Construction activity falls into four categories under the ASHE ICRA 2.0 Matrix of Precautions, ranging from Type A (inspection or minor non-invasive work) to Type D (major demolition or new construction).

Patient risk groups run from low to highest, with highest-risk covering areas like ICU, oncology, transplant, and surgical units.

Cross-referencing activity type against patient risk group produces a required precaution class, ranging from Class I through Class V. ASHE overhauled this matrix in its 2.0 update. Class I and II cover low-dust, low-risk work like inspection and small non-invasive tasks where standard practices are sufficient.

Class III requires active measures to prevent airborne dust dispersion, which can include HEPA vacuum devices or isolating the work area, plus removing or isolating return air diffusers so dust doesn't enter the HVAC system.

Class IV steps up to rigid hard-wall containment and continuous negative air pressure. Class V adds anterooms and gowning protocols on top of that.

The CDC guidelines specify that portable HEPA filter units used to augment dust removal should filter at a rate of 300 to 800 cubic feet per minute (CFM), and that negative pressure rooms should maintain a pressure differential of at least 2.5 Pa (0.01-inch water gauge) relative to the corridor.

12 Components an In-Depth ICRA Plan Should Include

A one-page generic ICRA permit tells a crew almost nothing about how to execute the work safely. A complete plan carries specific detail across the following components.

1. Project Narrative and Objectives

The plan opens by stating what the project involves and where it happens. It also names the real constraints on execution, like an occupied phasing schedule or clinical services next door that can't pause.

That gives every stakeholder, from the infection preventionist to the newest sub on-site, the same picture of the job. When it's thin, the crew fills in the details in the field, which is usually where containment slips.

2. Construction Activity Classification

The plan documents which activity type (A through D) applies to the scope of work, as this classification drives all downstream requirements in the matrix.

Type A is inspection and other non-invasive work like pulling a ceiling tile to check a valve. Type D is major demolition or new construction.

Types B and C fall between the two, based on how much dust the work generates and whether it involves cutting into a fixed component like a wall or floor.

A classification error at the plan stage cascades into the wrong precaution class and the wrong barrier spec.

3. Patient Risk Group Assignment

The plan identifies which patient population sits closest to the work area and assigns the corresponding risk group, weighing medical vulnerability alongside physical proximity. A low-traffic hallway near an ICU still carries the ICU's risk classification, because the patients on the other side of the wall are the ones at stake.

4. Precaution Class and Required Controls

Once the activity type and risk group combine on the matrix, the plan specifies the resulting precaution class. It also lists the exact controls that class demands, covering barrier type and negative air requirements alongside PPE protocols and cleaning frequency.

Borderline calls are common, and walking through worked ICRA 2.0 cases helps calibrate them.

5. Roles and Responsibilities

The plan spells out who does what. General contractors, subcontractors, infection preventionists, facilities staff, and clinical department leads each carry distinct responsibilities.

Roles shifted under the ICRA 2.0 update, and projects run better when teams write subcontractor-specific duties directly into bid packages upfront.

6. Pre-Construction Testing and Existing Conditions

Before work starts, the plan documents baseline conditions. That includes air handling unit performance and existing pressure relationships between rooms, plus any pre-existing contamination risks.

Verify that air-handling systems still perform as designed after barriers go up and before the crew sets the space to negative pressure. Without those baseline readings, the crew has no benchmark to check containment against once work begins.

7. Barrier Locations and Composition

The plan specifies exactly where temporary barriers go and what they're made of. Barriers must be impermeable to fungal spores and compliant with local fire codes.

STARC engineers its LiteBarrier™ and RealWall™ systems for occupied hospital renovation. The panels reduce airflow across the wall to hit the airtight, floor-to-deck seal Class IV and V containment requires.

They also attenuate construction noise, which keeps adjacent patient rooms quiet enough for recovery. Plastic sheeting and stud-and-drywall struggle to deliver either, and both generate more dust during setup and teardown.

The plan should also account for physical constraints like bed swing radius and egress paths when placing hospital barriers.

8. Negative Air and Exhaust Routing

Negative air is what keeps contaminants inside the containment zone once the barriers go up. For Class IV and V precautions, the plan documents required airflow in cubic feet per minute, plus exhaust routing and equipment placement, calibrated to the 300 to 800 CFM benchmark for portable HEPA units.

A containment system that supports HEPA machine integration and pressure-monitoring accessories at the panel level lets teams maintain the required pressure differential without improvising equipment mid-project.

9. Traffic Flow and Access Routes

The plan maps how hospital staff and construction crews move around the work zone, plus how debris exits the building. Best practice is to direct pedestrian traffic away from patient-care areas and cover debris before it leaves the work zone.

Poorly planned access routes track dust and dirt through patient areas and slow the project down when crews have to detour around clinical operations.

10. Monitoring Locations and Documentation

A proper ICRA plan identifies where manometers and particulate monitors go, and it establishes a documentation schedule for quality assurance. Pressure differentials in construction zones get logged daily, with records available for review if an infection cluster occurs later.

Written records protect the facility and the contractor alike, since undocumented compliance carries no weight if a question comes up.

11. Emergency Egress Planning

Fire and life safety requirements don't pause during a renovation. The plan addresses secondary exit routes for occupants and, where relevant, a safe path for the construction crew.

Barriers that satisfy ICRA containment can still block a required egress path if the placement isn't reviewed against the facility's life-safety drawings. Naming egress in the plan forces that review during design, so barriers don't have to come down later when an inspector catches it.

When fire code drives the containment spec, STARC's FireblockWall™ is the industry's only reusable one-hour fire-rated barrier. Speccing it at the plan stage avoids a field swap when the code review lands.

12. Commissioning and Project Completion Criteria

The plan defines what "done" actually means. HVAC commissioning happens before occupancy, with particular attention to operating rooms and other critical-care areas.

Air quality verification and surface cleanliness testing replace a visual "it looks clean enough" judgment call, backed by a clear sign-off process.

What’s at Stake When the Plan Falls Short

An ICRA plan is a patient-safety document. When the plan is thin, the patients on the other side of the wall are the ones who pay for it. Construction-related infections cause more than 5,000 deaths a year in the US, and roughly half of hospital Aspergillus outbreaks trace back to nearby construction or renovation.

Invasive aspergillosis, the infection most tied to construction dust, carries a 50% mortality rate overall and climbs higher when clinicians miss or delay the diagnosis. The patients with the least margin to fight it off, like blood cancer and stem cell transplant patients, are often the same patients sitting closest to a renovation zone.

Exposure isn't confined to interior demolition. Excavation outside the building raises mold infection rates too (HR 2.8 in a CCJM-cited study), so the ICRA plan has to account for site work happening beyond the walls it governs.

Best Practices for Building an ICRA Plan

The ICRA plans that hold up in occupied hospital renovations share a handful of habits. Build them into every project template so nothing depends on whoever wrote the last plan remembering them:

• Bring infection prevention in early. Establish a multidisciplinary team with infection control staff at project inception, not after the design locks in. Projects that follow this approach catch containment problems before they reach the field.

• Standardize the plan format across projects. Healthcare systems running multiple renovations benefit from a consistent template that speeds up review and reduces the chance that a critical component gets left out.

• Choose containment built for occupied environments. Drywall takes longer to set up and generates its own dust during install and teardown. Reusable systems, such as STARC’s, install faster and are rated for 50+ reuses. A system pays off after three or four projects without sacrificing the airtight seal Class IV and V require.

• Train the crew to execute the plan. A well-written plan still fails if the crew installing barriers lacks training on negative air procedures, entry and exit protocols, or daily cleaning requirements.

• Update the plan as conditions change. An ICRA plan written before scope changes becomes a liability once the actual work no longer matches the document on file. Test the plan against real scenarios before problems surface in the field, so the document keeps pace with the jobsite.

Where Your ICRA Plan Meets the Jobsite

A complete ICRA plan only works if the containment on-site matches what the document specifies.

STARC Systems builds the barrier systems healthcare teams rely on to execute infection-control precautions in the field, from initial planning through final commissioning sign-off.

Tucson Medical Center used STARC's RealWall to contain an active ER renovation with zero disruption to patient care.

If you're planning a Class III, IV, or V renovation, request a quote from STARC to spec the containment before the project timeline locks in.

Frequently Asked Questions

What should a well put together ICRA plan include?

A well put together ICRA plan covers 12 components, from project narrative to commissioning sign-off, that give field crews clear direction on-site. The plan documents risk classification, barrier specs, air-handling tests, negative air routing, daily monitoring, and emergency egress.

Who is responsible for creating an ICRA plan?

Infection preventionists, facilities leaders, and clinical staff are responsible for creating an ICRA plan, with contractors executing it. STARC supplies the containment systems that turn the plan's barrier requirements into real jobsite protection.

What is the difference between ICRA Class III and Class IV?

The difference between ICRA Class III and Class IV is containment intensity: Class IV adds rigid hard-wall barriers and continuous negative air. STARC's RealWall™ and LiteBarrier™ systems exceed ICRA Class IV containment standards.

Does an ICRA plan need updates during a project?

Yes, an ICRA plan needs updates whenever project scope or conditions change, since an outdated plan misrepresents on-site risk. Reusable containment systems designed for phased renovation adjust without rebuilding barriers from scratch.

What barriers satisfy ICRA Class IV and V requirements?

ICRA Class IV and V require barriers that support panel-level HEPA integration and floor-to-deck sealing that plastic sheeting and standard drywall containment can't reliably deliver. STARC engineers its LiteBarrier™ and RealWall™ panels to exceed that standard.