Free ASHE Infection Control Risk Assessment Questions and Answers — Questions and Answers
Question 1: An ICRA team is assessing a project that involves demolishing a wall in a hallway adjacent to the hospital's oncology unit. According to the ASHE ICRA 2.0 matrix, which two factors are MOST critical for determining the required Class of Precautions?
- Project duration and total cost
- Construction activity type and patient risk group (Correct answer)
- Number of workers and time of day
- Type of demolition equipment and utility shutdown requirements
Correct answer: Construction activity type and patient risk group
The core of the ICRA process involves using a matrix that cross-references the type of construction activity (e.g., Type A, B, C, D) with the risk level of the adjacent patient population (e.g., Low, Medium, High, Highest). The intersection of these two factors on the matrix determines the required Class of Precautions (e.g., I, II, III, IV, or V), which then dictates the specific infection control measures needed.
Question 2: A hospital is preparing for a major, multi-month renovation of its operating rooms. The ICRA team determines this project falls under the highest patient risk group and involves significant demolition and construction. Which of the following precautions is specifically associated with the highest level of risk, such as ICRA Class V?
- Placing a tacky mat at the entrance to the work area.
- Wiping down tools with disinfectant before removal from the site.
- Requiring all workers to wear standard construction hard hats.
- Implementing real-time air pressure monitoring in the anteroom. (Correct answer)
Correct answer: Implementing real-time air pressure monitoring in the anteroom.
ICRA Class V is reserved for the highest-risk, long-duration projects in sensitive areas. A key requirement for this class is the use of an anteroom with real-time, digital monitoring to ensure negative air pressure is constantly maintained, preventing any potential contaminants from escaping the construction zone into the patient care area. While the other options are good practices, they are associated with lower precaution classes.
Question 3: Which of the following has been an important change introduced in the ASHE ICRA 2.0 update compared to previous versions?
- The requirement of a multidisciplinary team.
- The introduction of a fifth class of precautions (Class V). (Correct answer)
- The consideration of dust as a potential contaminant.
- The use of a matrix to assess risk.
Correct answer: The introduction of a fifth class of precautions (Class V).
A significant update in ASHE ICRA 2.0 was the addition of Class V. This new class was created to provide more specific and stringent guidelines for high-risk, long-duration projects in the most sensitive patient areas, addressing a gap in the previous four-class system. The other elements were fundamental parts of the original ICRA process.
Question 4: During a project requiring Class IV precautions, the facility manager observes that the single plastic sheeting barrier is torn and that the negative air machine has been turned off. What is the MOST immediate concern the facility manager should address?
- The project timeline being delayed.
- The budget for construction materials.
- A breach of containment and potential for contamination. (Correct answer)
- The contractor receiving a disciplinary write-up.
Correct answer: A breach of containment and potential for contamination.
The primary purpose of the ICRA process and its required precautions is to protect vulnerable patients from healthcare-associated infections (HAIs) by preventing the migration of contaminants from construction areas. A torn barrier and a disabled negative air machine constitute a critical breach of containment, creating an immediate risk of airborne pathogens (like Aspergillus) entering patient care areas.
Question 5: The ICRA process requires a multidisciplinary team to assess risks. Which of the following team compositions is MOST effective for this purpose?
- Hospital CEO, Chief Financial Officer, and Marketing Director
- Contractor, Architect, and Interior Designer
- Infection Preventionist, Facility Manager, and Construction Project Manager (Correct answer)
- Head Nurse, Lead Surgeon, and a Patient Advocate
Correct answer: Infection Preventionist, Facility Manager, and Construction Project Manager
An effective ICRA team requires collaboration between clinical and construction experts. The Infection Preventionist provides expertise on patient vulnerability and pathogen transmission; the Facility Manager understands the building's systems and operational impacts; and the Construction Project Manager understands the means, methods, and risks of the work itself. This combination ensures all facets of risk are considered.
Question 6: Beyond dust and airborne pathogens, the expanded scope of an ICRA 2.0 assessment requires the team to evaluate and mitigate which additional environmental factors?
- Impact on staff parking and cafeteria services
- Changes in the hospital's branding and color scheme
- Aesthetic appeal of the construction barriers
- Noise, vibration, and utility interruptions (Correct answer)
Correct answer: Noise, vibration, and utility interruptions
ASHE ICRA 2.0 formally expanded the scope of the risk assessment beyond just infection control to include other environmental factors that can impact patient care and safety. This includes assessing and planning for the mitigation of noise, vibration, and the impact of utility interruptions (e.g., water, electrical, medical gas) on surrounding areas.
