CHSP Construction and Renovation Safety (PCRA/ICRA) — Questions and Answers
Question 1: Which tool is used BEFORE beginning a construction or renovation project in a healthcare facility to evaluate the potential impact on patient safety, infection risk, and utility disruptions?
- Infection Control Risk Assessment (ICRA)
- Preconstruction Risk Assessment (PCRA) (Correct answer)
- Job Hazard Analysis (JHA)
- Failure Mode and Effects Analysis (FMEA)
Correct answer: Preconstruction Risk Assessment (PCRA)
The Preconstruction Risk Assessment (PCRA) is the overarching pre-project evaluation mandated by TJC EC.02.06.05 that assesses ALL risk categories — infection, utility, safety, and patient impact — before construction begins. The ICRA is one component of the PCRA focused specifically on infection control. The JHA and FMEA are useful tools but not the primary pre-construction framework.
Question 2: Under The Joint Commission's Environment of Care standards (EC.02.06.05), who must be included in developing the Infection Control Risk Assessment (ICRA) for a major renovation project?
- The facility safety officer and the construction contractor only
- The infection preventionist and the safety officer at a minimum, with other stakeholders as needed (Correct answer)
- The Chief Medical Officer and the Board of Directors
- The state health department and EPA regional office
Correct answer: The infection preventionist and the safety officer at a minimum, with other stakeholders as needed
TJC requires that the ICRA be developed with input from infection prevention and control professionals and the safety officer. For complex projects, the team typically also includes facilities management, nursing leadership, and the contractor. The Chief Medical Officer, Board, state health departments, and EPA are not required members of the ICRA team.
Question 3: An ICRA matrix classifies construction projects into activity types (I–IV) and patient risk groups. A project involving major demolition adjacent to an oncology unit would MOST likely require which controls?
- Activity Type I controls: routine cleaning only
- Activity Type II controls: dust suppression with active HEPA filtration in the work area
- Activity Type III or IV controls: full containment barriers, negative pressure, and HEPA filtration (Correct answer)
- No special controls because demolition generates only construction dust, not infectious particles
Correct answer: Activity Type III or IV controls: full containment barriers, negative pressure, and HEPA filtration
Oncology patients are a high-risk population (immunocompromised), and major demolition is a high-dust Activity Type III or IV project. The combination mandates the highest level of controls: rigid or hard containment barriers, negative air pressure within the work zone, HEPA filtration of exhaust air, sticky mats, dedicated construction worker entry/exit routes, and enhanced monitoring. Lower-level controls are insufficient for this combination.
Question 4: During a hospital renovation, construction workers inadvertently breach a wall containing an active water supply line, causing a brief water intrusion event. The healthcare safety professional's FIRST action should be:
- File an insurance claim and document the incident for future reference
- Notify the infection preventionist and begin a mold and moisture assessment immediately (Correct answer)
- Reassure staff that minor water events do not require any special response
- Wait 72 hours to see if visible mold growth appears before taking action
Correct answer: Notify the infection preventionist and begin a mold and moisture assessment immediately
Water intrusion events in healthcare settings must be addressed immediately — mold (especially Aspergillus) can colonize porous building materials within 24–48 hours and poses a life-threatening risk to immunocompromised patients. The infection preventionist must be notified immediately to assess exposure risk and trigger water damage remediation protocols. Waiting 72 hours or treating it as routine are unacceptable responses.
Question 5: Which of the following is the primary purpose of maintaining negative air pressure in a construction zone adjacent to occupied patient care areas?
- To reduce construction worker noise exposure
- To prevent dust and airborne fungal spores from migrating into occupied areas (Correct answer)
- To meet OSHA confined space requirements for the work area
- To reduce energy consumption during the construction phase
Correct answer: To prevent dust and airborne fungal spores from migrating into occupied areas
Negative air pressure in the construction zone causes air to flow INTO the containment area rather than outward, preventing contaminated air (dust, fungal spores such as Aspergillus) from migrating into occupied patient care areas. This is the primary infection control mechanism for high-risk construction. It has no bearing on noise, confined space classification, or energy use.
Question 6: After completion of a major renovation project in a patient care area, which action is required BEFORE patients are returned to the space?
- Post-construction ICRA clearance inspection including air quality verification and terminal cleaning (Correct answer)
- A 30-day waiting period to allow any residual dust to settle naturally
- Submission of as-built drawings to the state health department for approval
- Replacement of all HVAC filters in the entire hospital, not just the renovated area
Correct answer: Post-construction ICRA clearance inspection including air quality verification and terminal cleaning
TJC and infection control best practices require a post-construction walkthrough and clearance inspection before patients re-enter. This includes verifying that containment barriers are intact until removal, terminal cleaning has been performed, air quality testing (fungal spore counts if indicated) confirms safety, and HVAC filters in the affected zone are replaced. A blanket 30-day wait, statewide filter replacement, or state as-built review are not the standard clearance requirement.
CHSP Construction and Renovation Safety (PCRA/ICRA)
Which tool is used BEFORE beginning a construction or renovation project in a healthcare facility to evaluate the potential impact on patient safety, infection risk, and utility disruptions?