Infection Control Risk Assessment, or most commonly referred to as its acronym ICRA, formally came about in the 1990s.
ICRA is commonly associated with safety. The concept was first recommended by the American Institute of Architecture and Centers for Disease Control; it then became a requirement of the Agency for Health Care Administration (AHCA)/Office of Plans and Construction (OPC) here in Florida in 1999. Former AHCA/OPC Bureau Chief Skip Gregory and others working in long term care recognized the necessity of ICRA and worked on developing and implementing ICRA requirements. In a nutshell, an ICRA involves a facility’s interdisciplinary team and other potential project players (i.e. ICRA Consultant, architects and engineers, contractors, etc.) identifying and defining the relationship between at-risk residents and any construction project at hand. Its main goal is to reduce the spread of construction dust, which commonly carries aspergillus, and debris into the occupied health care setting, thus mitigating nosocomial infections. Secondly, it focuses intensely on resident, employee and visitor safety during the construction project.
All AHCA/OPC construction projects require ICRA documentation. Any changes to the physical plant, to include puff and powder renovations, are required to be submitted to AHCA/OPC, and projects submitted without ICRA documentation will be rejected. In addition to AHCA/OPC’s requirement for ICRA, this documentation, when compiled and implemented correctly, should keep your facility in conformity with OSHA’s requirements for controlling airborne contaminants. After acting as the ICRA Consultant and Owner’s Representative to dozens of facilities as a result of the 2004 and 2005 hurricanes, Hathaway Resources found that utilizing the ICRA appropriately after a catastrophic event can be an extremely valuable tool. The ICRA has the user evaluate how to develop and implement detailed phasing plans for construction and/or restoration. These comprehensive phasing plans include resident relocation, minimum required square footages for spaces, temporary ancillary services, staff management, closure of and containment of affected facility wings, utilization of negative air pressure, physical plant evaluations, etc. The aforementioned elements can allow a facility to remain in operation when it may have otherwise been deemed “uninhabitable” and require an evacuation due to “unsafe” conditions. In other words, the environment of care has
been compromised. These evacuations are generally determined by AHCA/OPC or AHCA Licensure.
These evacuations, or even just the closure of compromised wings, are a health care provider’s worst nightmare. It can result in a partial or total loss of revenue, the health care provider’s license becoming jeopardized, code upgrades to the physical plant, resident base going away, etc. In some instances, providers can find themselves in a position where the use and implementation of proper ICRA planning/phasing and documentation could have saved them millions.
Duane Hathaway, Sr.
