New Data Reveals ICRA 2.0 Implementation Challenges

‐

By Janet Haas, PhD, RN, CIC, FSHEA, FAPIC

Infection prevention during healthcare construction and renovation is a cornerstone of patient safety. American Society for Health Care Engineering (ASHE) ICRA 2.0™ guidelines offer a comprehensive, flexible framework to protect patients, staff, and visitors from the risks associated with renovation and maintenance work. But how are healthcare teams applying ICRA 2.0 in the field—and where are they seeking more support?

To answer these questions, STARC partnered with ASHE to conduct a nationwide survey of professionals responsible for managing construction-related infection risks. The results provide a snapshot of ICRA 2.0 adoption, revealing where the guidelines are working well and where real-world complexities demand creative adaptation. What we learned from the survey provides opportunity to strengthen our approach to construction-related infection prevention.

ICRA 2.0 adoption: What’s working

The good news is that more than two-thirds of respondents have integrated the updated framework into their facilities, with Infection Preventionists and Facilities teams leading the charge. Most respondents report that ICRA planning occurs before major projects, and multidisciplinary collaboration is becoming the norm. These are important steps forward in ensuring that patient safety remains front and center during construction and renovation projects.

But as any facility team can attest, even the best frameworks must contend with the realities of busy, diverse healthcare environments. That’s where things get interesting—and where this survey provides valuable insights.

Where real-world challenges emerge

While ICRA 2.0 has given us stronger tools and clearer processes, respondents shared common scenarios where additional clarity, flexibility, or planning is needed. These challenges reflect some common situations outside of acute care, or where work must take place in an active environment. Another big challenge is work in areas where it’s not possible to easily vent to the outside.

Here’s a preview of the top areas where teams are navigating complexity:

  • Non-acute care settings: From behavioral health units to outpatient clinics, applying ICRA 2.0 in non-acute care environments requires careful consideration. Each setting has unique patient needs and operational constraints that don’t always align neatly with a one-size-fits-all approach.
    Emergency departments and active care areas: Construction in spaces that never close, like emergency departments, introduces another layer of difficulty. Ensuring continuous patient care while minimizing disruption and maintaining infection control requires thoughtful scheduling and robust communication plans. The full survey report dives into how teams are balancing these demands while staying aligned with ICRA 2.0.
  • Emergency repairs: When a water leak or urgent system failure occurs, waiting to convene an ICRA meeting isn’t always possible. Yet, even in these high-pressure moments, infection control can’t take a back seat. In the eBook, you’ll find examples of how facilities are establishing rapid-response protocols to protect patients without delaying critical repairs.
  • Airflow, exhaust, and space constraints: Tight, outdated, or otherwise challenging spaces can make it difficult to establish proper airflow and containment. Teams are finding creative ways to work within these limitations while still meeting ICRA 2.0 standards.

Moving forward

Construction-related infection prevention isn’t static. As our environments and care-delivery models evolve, new challenges arise. Our strategies must also evolve, and this survey is a step in the ongoing process of learning and improvement.

For a deeper dive into the survey results and expert insights—including practical strategies for applying ICRA 2.0 in complex environments—I encourage you to download the full eBook, Keeping Up with ASHE ICRA 2.0™ Adoption. In it, my colleague Leon Young, BS, MLS(ASCP), CIC, and I break down these challenges and share actionable solutions that can help your team apply ICRA 2.0 with confidence.

Together, we can continue to refine our processes and protect what matters most.

Dr. Janet Haas is Principal Consulting Epidemiologist at Innovative Infection Prevention and an associate editor of the American Journal of Infection Control (AJIC). Dr. Haas previously served as Director of Epidemiology at three academic medical centers, and as 2018 APIC President. Prior to beginning her nursing and infection prevention professional journey, Dr. Haas also worked as a Journeyman Millwright Mechanic and was a member of the Carpenter’s Union.