Infection control and prevention are cornerstones of healthcare facilities management as these facilities house sick and vulnerable patients. With this, there are many standards and frameworks that aim to keep healthcare facilities in line with infection control requirements. One of these is the Infection Control Risk Assessment (ICRA) framework, which is currently being updated to meet modern standards. To stay abreast of the coming changes in ICRA 2.0, Anthony Ortery, DHA, business development director at Red E Services, will be presenting a session on the framework at NFMT Remix in Las Vegas from October 29 to 30.
FacilitiesNet: How does the ICRA 2.0 framework improve upon the traditional ICRA framework in managing infection risks in healthcare settings?
Anthony Ortery: Well, the ICRA concept began in the 1996-1997 edition ASHE’s guidelines for construction where contractors were required to submit a risk assessment of the work they were performing within the project as it would impact occupants of the building and - more specifically in hospitals - patients. It was not until 2001 when ASHE stepped in and formalized the process for the occupants or the hospital's employees, which then brought in the partnership between the two.
It was understood that the contractors knew the work they were going to perform. However, they are only as aware as the engineers, infection preventionists or leaders of facilities departments would be of any issues or existing conditions within the hospital. So, it was suggested that hospitals assess the work being performed and how it would impact the infection control processes in place at the time of construction.
From that time, it evolved into self-performing contractors or engineers working with those contractors. Infection preventionist would perhaps do the pre-risk assessments and suggest things that needed to be implemented. There are a lot of high performing healthcare organizations out there that would go the extra mile to implement policy on the ICRA process or project management.
What 2.0 does is it adds another layer of understanding where we are not just looking at projects. We are also looking at anything that may create dust or may impact utilities – especially with work that would involve gray or black water, sewage work and any work that would impact air balances within the hospital. This means negative air pressure spaces may become positive air pressure spaces or positive spaces may become negative, which has a huge impact on the hospital operations or patient care.
Additionally, we are now including the infection preventionist in every step of the way. So, we are not just saying, would you look at this and see if we can do this? We are instead asking infection preventionists to add a daily inspection to the space to ensure that the continuation of those requirements set at the project's start is maintained.
FaciltiesNet: What innovative methodologies and advanced technologies are integrated into the ICRA 2.0 approach to enhance infection control?
Ortery: Prior to 2.0, we were only looking at projects, but now we are looking at all work that has an impact on a patient unit. With patients that have an immune compromised or just weak immune system, we wanted the air to be negative. Well, now those spaces where there are invasive procedures or at-risk patients are considered at the greatest risk.
With that, there are requirements that the air filtration or negative air in the space meet a parameter of 99.97 percent efficiency or cleaning the air so the particulate matter is so small it would not impact the spaces. At Level 4, we would say we want this air to be negative or neutral. At Level 5, we would say this space must always be negative.
Then at Level 5, we are also saying that any project or construction work that impacts those spaces that they are protected during this work with an ante room. This is so contractors or engineers working in and out of the space would not only leave the space clean, but they had a space in the ante room to perform that work.
Another requirement for Level 5 is ongoing monitoring; one of the things we have noticed in the past was what we call ball on the walls. When you are installing a ball on the wall, the premise behind that is if the air is negative, the ball will go into a designated space. If the space is positive, the ball will move out of the designated space. Well, angles can move up and down out of that device, so what is negative may be perceived as positive.
If the negative air cannot overcome this improper installation, we want to put in a magnehelic gauge. These gauges are great because we can see actual air pressure differences between the space outside of the work area and the space inside the work area. This also helps provide the project with a visual, while also telling them when to stop working if the space is not properly ventilated or does not have the requirements set by infection preventionists.
To learn more about the ICRA 2.0 framework, be sure to check out Ortery’s session at NFMT Remix in Las Vegas this October. Register for Remix here.
Jeff Wardon, Jr. is the assistant editor for the facilities market.
