Yes, we all think we know what ICRA stands for, but do you know where it came from? As one of the original creators of this concept, I can give you some insight about this much-discussed but little-understood acronym.

First let’s understand that it did NOT come from the Joint Commission, the vast world of Medicare standards, state health organizations, local regulators, ASHE, or the CDC. Its genesis is the 2001 version of the AIA Guidelines for Design and Construction of Health Care Facilities. It was always intended to be an owner’s assessment of risks to patients for infections posed by construction activities. Please read that last sentence again because it contains the critical information that people in the design and construction industry need to know when working in hospitals.

First, the ICRA is to be done by the owner, not the design team, construction manager, contractor, subcontractor, or vendors that might be working in a healthcare facility. The owner is to create a committee of people who have expertise in infection control, direct patient care, risk management, construction, design, safety, and epidemiology. This committee is to look at the risks posed by certain construction activities and take steps to mitigate the risk of infection to the various patient populations who might be impacted by those activities.

Second, it applies ONLY to new and renovation construction activities within or around areas occupied by patients. It was neverintended to apply to normal maintenance activities such as changing filters, operating valves, or checking on systems above ceilings in patient spaces. Many healthcare organizations have elected to apply these principles to all activities and all populations, so it is critical that designers and constructors obtain the owner’s policy and procedure for the ICRA associated with a particular facility. That policy, not some regulatory requirement, will define what the ICRA requirements are and where they apply. The bottom line is, never assume you know what ICRA represents since every owner has the authority to decide for themselves, and those criteria can vary widely.