Pierce County keeps growing east and south — Puyallup, South Hill, Frederickson — and its hospitals grow with it. On a suburban anchor campus like MultiCare Good Samaritan in Puyallup, that means a permanent condition most facilities teams know well: construction, somewhere on campus, nearly all the time, inside a hospital that never closes and never gets to pause being a hospital.
Growth work in an operating hospital lives or dies on one discipline: the infection control risk assessment. Here’s how that discipline actually runs on a live campus, and why the current standard — ASHE’s ICRA 2.0 — changed the daily practice.
ICRA 2.0 starts before the project does
The older ICRA habit treated the assessment as a form you completed when construction was already decided. ICRA 2.0 restructured it: a safety risk assessment comes first, weighing how the work touches patients, workflows, utilities, and life safety — and only then does the team classify the job. Construction activity is typed A through D (from inspection-level work up to major demolition and renovation), patient risk groups are ranked by vulnerability, and the combination sets a precaution class from I to V. The class drives everything downstream: barrier type, air handling, cleaning, monitoring, and who signs what.
On a growing campus this matters because the portfolio is never one project. It’s a tower phase, a clinic refresh, an imaging replacement, and a roof job sharing one air handler map — each with its own type, class, and permit, all running at once.
The daily discipline nobody photographs
Barriers and air. The precaution class decides whether the barrier is poly sheeting or a hard wall, and whether the work zone runs negative to the corridor — verified, not assumed, with pressure checks logged on a schedule. A barrier that isn’t sealed is a decoration, and on an occupied floor the corridor side of that wall is somebody’s grandmother’s hallway.
Routes. Debris and materials move on planned paths — a designated elevator, a covered cart, a route that doesn’t cross sterile supply or the NICU’s corridor. On a campus under phased construction, routing is renegotiated every phase, because last month’s clean route is this month’s work zone.
Water and tie-ins. The riskiest moments in hospital construction are utility moments: a water line opened, a system drained and refilled, a tie-in at 2 a.m. Those events plug straight into the facility’s water management program — flushing, disinfection, and documentation before the system returns to patient service.
The permit habit. ICRA 2.0’s companion permit makes the assessment a working document: posted at the job, signed by the team, revisited when scope changes. When the permit and the field disagree, the field stops — that norm, enforced on a tired Tuesday, is the entire culture in one sentence.
When life safety gets touched, the second hat comes out
Construction that breaches a fire barrier, blocks an egress path, or takes a detection system offline leaves ICRA territory and enters interim life safety measures — the ILSM side of the house. The two assessments answer different questions (infection risk versus life-safety risk) and a project of any size usually needs both, run by the same team in the same meeting. If your campus hasn’t read them side by side, our explainer on the difference between ICRA and ILSM — and when you need both is the short version.
The team is the technology
None of this runs on software. It runs on a standing triangle — infection prevention, facilities, and the contractor — that meets before the project, walks the barriers during it, and argues honestly about the schedule when the class says the work can’t be rushed. On a campus like Good Samaritan’s, where growth is the permanent condition, that triangle is less a project structure than a department of its own. The campuses that do this well aren’t the ones with the thickest standards binder. They’re the ones where the 2 a.m. tie-in gets the same rigor as the ribbon cutting.
Good Samaritan’s growth now has a twenty-year shape: in January 2026 the Puyallup City Council authorized a development agreement implementing a master plan that adds a 160-bed patient tower, expands the central utility plant, and starts — tellingly — with the hospital’s kitchen. We walked through the plan here.
Run facilities or build in hospitals around Puyallup or greater Pierce County? Tell us what we missed — corrections and practitioner quotes are credited by name, by org, or fully anonymously, your choice.