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Infection control risk assessment (ICRA)

Definitions and elements

Definition: An ICRA is multidisciplinary, organizational, documented process that after considering the facility's patient population and program:

The ICRA elements required for consideration are located in Chapter 1.5 of the 2006 AIA Guidelines. In the 2006 edition, the ICRA elements are divided into three areas: processes for design, construction, and mitigation.


The design area requires "long-range planning" for new or renovated buildings and adds a new element "finishes and surfaces" a critical feature over the lifetime of the facility. Considerations include:


The building and site areas anticipated to be affected by construction shall include consideration of the following:

Infection Control Risk Mitigation

The mitigation recommendations from the ICRA panel shall address the following:

Finally, the ICRA panel must inspect the installation of infection control measures and provide continuous monitoring of their effectiveness throughout the project. The monitoring may be conducted by in-house infection control and safety staff or by independent consultants. Provisions must contain written procedures for emergency suspension of work, indicating responsibilities of each party—owner, designer, constructor and monitor.

Numerous resources are available to assist organizations with development and implementation of an ICRA. This includes ASHE/AIA workshops and other professional organizations that provide continuing education on the topic. See Links.

Tools and resources

ICRA matrix

The ICRA matrix is a published assessment method that is widely accepted by engineers and architects, and is one effective method for completing an ICRA. Although the ICRA does not have to be done as a matrix, it does help non-clinical staff understand management of patient groups without requiring specific diagnoses.

Each facility should categorize patients per group within a specific patient population. The development of the "patient risk groups" is quite relative--and the criteria are dependent on the facility's mix of patients. Nursing homes and ambulatory care delivery sites have very different populations, and risk is relative.

The key principle used for categorizing patients considers:

The construction matrix tool includes a sample permit which follows the format of the matrix, assessing patient risk categories and environmental risk groups to determine appropriate class or level of precautions.


Construction videos - Safety and ICRA

The ICRA matrix as described above and promoted by the the Association for Professionals in Infection Control and Epidemiology (APIC) and the American Society for Healthcare Engineering (ASHE) is available in 2 training videos; one directed to healthcare professionals and one for construction personal, with availability in English and Spanish. Go to

Airborne, biologic, chemical and radiologic building protection

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