ICRA 2.0: What the ICT Network Designer and Installer Needs to Know – Part 1

June 02, 2022

ICRA 2.0: What the ICT Network Designer and Installer Needs to Know – Part 1

Most professionals in the ICT industry who have worked in hospital and healthcare environments are familiar with the Infection Control Risk Assessment (ICRA) procedures and processes. ICRA procedures are intended to protect patients from the consequences of anything stemming from the routine maintenance or large renovation and construction projects in healthcare environments. These can include the release of dust, fungal and mold spores, bacterium and other pathogens into air and water supplies, which can then have serious, and sometimes fatal consequences for patients.

In this first part of a two-part series, we’ll take a closer look at what these changes are (Part 1), and then, how ICT network designers, installers and more can help address and plan for these important changes in any upcoming healthcare project where new or retrofit wireless infrastructure is needed (Part 2).

What’s the Background?

ICRA procedures were first called for by the Facilities Guidelines Institute (FGI) in 2001, where the procedures were implemented throughout project planning, design and construction. Implementation was (and still is) managed by a team of experts, who help identify activity types and patient risk groups, then maps precautions required into classes.

What’s New (and Why)?

Recently, the FGI Guidelines were updated with a new ICRA 2.0 Matrix of Precautions for Construction Renovation and Operations. Among several significant changes (outlined below), it’s also important to remember that ICRA 2.0 also aims to provide more concise language for previous ICRA 1.0 procedures, many of which further encourage more collaboration between facilities, construction, infection prevention, designers and healthcare professionals to create more precise guidelines and processes in ICRA 2.0.

Just like the original ICRA guideline, ICRA 2.0 is a 3-step process. Below is a summary of the 3-step process, plus the details that ICT designers, installers, and integrators should be aware.

Step 1: Identify the Construction Project Activity Type (Types A, B, C, D)

The activity type ranges from Type A, simple and non-invasive activities, to Type D, major demolition and construction activities.

  • ICRA 2.0 provides more thorough descriptions of activities than the original ICRA, with some wording specific to above ceiling work and cabling pathways.
    • It’s particularly important to understand ICRA procedures before installing and servicing wireless devices, edge devices and associated cabling and connectivity in clinical (patient occupied) areas in hospitals.


Step 2: Identify Patient Risk Group (Low Risk, Medium Risk, High Risk, Highest Risk)

The Patient Risk Groups range from Low Risk, which are non-clinical office spaces and mechanical rooms, to Highest Risk, were invasive procedures are performed.

  • In ICRA 2.0, ALL patient care areas have been moved to the High-Risk Category, and all invasive patient care areas to Highest Risk. This means that a much larger area of the hospital is now categorized as High or Highest Risk, and a different class of precautions will now apply.
  • In the original ICRA, High Risk areas were only for certain procedures, but now, in ICRA 2.0, this includes any location where patients may be present.
  • In the original ICRA, Highest-Risk areas were only where the most vulnerable immunocompromised patients would reside. In ICRA 2.0, any invasive patient care activity is moved to the Highest-Risk category.


Step 3: Identify Class of Precautions (Class I, II, III, IV, and V)

In this step, the Class of Precaution is identified by mapping the Activity Type and Patient Risk Group in the ICRA Matrix.

  • Certain activities now require a higher class of precautions in ICRA 2.0. For example, even the simplest Type A activity (such as removing a ceiling tile for inspection), in a Highest-Risk patient area, has been changed from a Class II precaution in ICRA 1.0 to a Class III precaution in ICRA 2.0.
  • Likewise, a rather simple Type B activity (such as replacing a wireless access points or testing cable above a ceiling), in a High-Risk patient area has been changed from a Class II precaution in the original ICRA to a Class III Precaution in ICRA 2.0.
  • Infection control permit and approval will be required when Class of Precautions III (Type C) and all Class of Precautions IV or V are necessary.
  • Environmental conditions that could affect human health, such as sewage, mold, asbestos, gray water and black water will require Class of Precautions IV for Low and Medium Risk Groups and Class of Precautions V for High and Highest Risk Groups.


For complete information, including detailed tables and illustrative representations of all changes in ICRA 2.0, be sure to review on the ASHE website at