ICRA — Infection Control Risk Assessment for Healthcare Construction
ICRA — Infection Control Risk Assessment for healthcare construction
An Infection Control Risk Assessment (ICRA) is a structured process required for any building, maintenance or renovation work carried out in or adjacent to occupied healthcare facilities. It assesses the infection risk that construction or maintenance activity poses to vulnerable patients, residents or service users — and specifies the controls that must be in place before work begins.
ICRA is not a single piece of legislation but a process endorsed by the Department of Health, NHS Estates, and the major infection prevention professional bodies (ICNA, IPS). CQC inspectors consider ICRA compliance as part of their assessment of Regulation 12 (Safe care and treatment). In practice, any contractor carrying out building or maintenance work in an NHS or private healthcare setting will be required to complete an ICRA before starting work.
What ICRA requires in practice
The ICRA process classifies both the type of work being carried out and the risk level of the area in which it will be performed — and the intersection of those two classifications determines the control measures required.
Work type classifications (Type A to D):
- Type A: inspection and non-invasive activities. Dusting, painting without sanding, replacing ceiling tiles without disturbing the plenum. Lowest risk.
- Type B: small-scale, short-duration activities. Small patch plastering, electrical work involving minor ceiling disturbance.
- Type C: work that generates significant dust. New wall construction, major electrical renovation, heavy cutting or drilling. M-Class extraction is the standard minimum for Type C work.
- Type D: major demolition, construction or renovation. Extensive dust generation, structural changes, extended duration. H-Class extraction is required for Type D work in healthcare settings.
Area risk classifications (1 to 4):
- Class 1: low risk areas with healthy patients or staff only.
- Class 2: medium risk. In-patient areas with susceptible patients.
- Class 3: medium-high risk. ICU, oncology, transplant areas.
- Class 4: highest risk. Operating theatres, bone marrow transplant units, clean rooms.
The combination of work type and area risk produces a required control level. Type C or D work in Class 3 or 4 areas always requires H-Class extraction and full containment measures. Even Type B work in Class 4 areas may require H-Class extraction.
Why H-Class extraction is required for ICRA Type C and D work
The primary pathogen risk from construction work in healthcare settings is Aspergillus — a fungal spore that is ubiquitous in the environment but harmless to healthy people. In immunocompromised patients (chemotherapy patients, transplant patients, bone marrow patients), Aspergillus can cause invasive aspergillosis, which has a high mortality rate.
Aspergillus spores are 2.5–3.5 microns in diameter. H-Class extraction at H14 HEPA (99.995% filtration at 0.3 microns) captures these spores reliably. M-Class extraction at H13 HEPA (99.9% at 0.3 microns) is insufficient for the most vulnerable patient populations — 0.1% pass-through on a sustained basis represents an unacceptable spore load in a Class 3 or 4 area.
Asbestos in pre-2000 NHS estates — the dual compliance requirement
NHS estates built before 2000 are required to maintain an asbestos register under the Duty to Manage (CAR 2012 Regulation 4). Maintenance contractors and ICRA-assessed construction teams must check the asbestos register before any Type B, C or D work that could disturb building fabric. In older NHS buildings — particularly those built between the 1950s and 1980s — ACMs are commonly found in textured coatings, ceiling tiles, floor tiles, pipe lagging and fire protection panels.
Where ACMs are present or suspected, H-Class extraction is mandatory under CAR 2012, independently of the ICRA classification. A contractor complying with ICRA at Type C/M-Class level who then disturbs asbestos without H-Class extraction is in breach of both ICRA requirements and CAR 2012. See Control of Asbestos Regulations 2012 →
Recommended V-TUF equipment for ICRA compliance
V-TUF MIDI H-Class — 21L H-Class
H14 HEPA, 99.995% filtration. The required standard for ICRA Type C and D work in Class 2, 3 and 4 healthcare areas, and mandatory for any asbestos work in pre-2000 NHS estates. Sealed filtration and HEPA-certified disposal bags. Available in 110V and 240V. SKU MIDIH110 / MIDIH240.
V-TUF MIGHTY HSV — M-Class, 21L
H13 HEPA, 99.9%. For ICRA Type C work in Class 1 and Class 2 areas where H-Class is not mandated. Also used for site clean-down and preparatory work before containment barriers are erected. SKU MIGHTYHSV110 / MIGHTYHSV240.
Compliance blog — further reading
ICRA in healthcare construction: what contractors working inside hospitals need to know →
Asbestos in construction: CAR 2012, pre-2000 buildings and what H-Class extraction is required →
M-Class or H-Class: why it depends on what the building is made of →
Related legislation
CQC Standards — Regulations 12 and 15 for safe care settings →
HTM — Health Technical Memoranda for healthcare environments →
COSHH Regulations 2002 — dust classification and control →
HSE EH40 Workplace Exposure Limits →
Control of Asbestos Regulations 2012 — H-Class extraction in pre-2000 NHS estates →
Related industries
Healthcare — H-Class extraction for NHS and private healthcare →
Trade accounts for healthcare construction contractors
V-TUF operates trade account terms for healthcare construction contractors, NHS framework contractors and specialist infection control firms. UK warehouse, UK technical support, next-day delivery on stocked items.
Telephone: 01522 787978. Email through the contact page. Mention ICRA, NHS framework or healthcare construction at first contact.