What Should an ICRA Plan Include? The 12 Components, as a Working Checklist

A one-page ICRA permit authorizes the work. It does not tell the crew how to execute it. When the permit is all a project has, every practical decision — barrier line, exhaust route, debris path — gets made in the field, in real time, by whoever is standing there. A written ICRA plan is the document that makes those decisions in advance. STARC Systems, a containment manufacturer working the ICRA side of occupied renovation daily, puts the count at 12 components, from project narrative to commissioning sign-off. Here they are as a working checklist — what each one must actually specify to be executable, not just named.

The 12 components at a glance

1. Project Narrative and Objectives
2. Construction Activity Classification
3. Patient Risk Group Assignment
4. Precaution Class and Required Controls
5. Roles and Responsibilities
6. Pre-Construction Testing and Existing Conditions
7. Barrier Locations and Composition
8. Negative Air and Exhaust Routing
9. Traffic Flow and Access Routes
10. Monitoring Locations and Documentation
11. Emergency Egress Planning
12. Commissioning and Project Completion Criteria

The permit is not the plan

The permit and the plan come out of the same assessment, but they do different jobs. The permit is the authorization: a signed, posted record that the infection control risk assessment was performed and the work may proceed under a stated class of precautions. Under ASHE ICRA 2.0, an infection control permit is required for Class III work on Type C activities, and for all Class IV and Class V work. The plan is the execution document behind that signature — the assessment translated into barrier locations, airflow measures, routes, monitoring, and completion criteria. A file holding a signed permit and nothing else has permission to start and no shared description of how.

How the matrix class drives everything below

Components 2 through 4 are the ASHE ICRA 2.0 matrix doing its work. The assessment classifies the construction activity (Type A, inspection and non-invasive work, through Type D, major demolition and construction), assigns the patient risk group of the areas affected (Low, Medium, High, or Highest — and where more than one group is affected, the higher group governs), and the two combine into a precaution class from I to V. That class is the plan’s spine: it sets the barrier, airflow, and oversight requirements the rest of the document has to detail. This article treats the matrix briefly because Healthcare Facility Hub’s flagship guide already covers it in full — the ASHE ICRA 2.0 matrix, class by class, with barrier requirements and negative-air sizing — and the step-by-step assessment itself is walked through in how to perform an infection control risk assessment before a hospital renovation. The detailed tables live in ASHE’s own ICRA 2.0 document, which is the governing source.

Components 1–4: the job, and how it classifies

1. Project Narrative and Objectives. The plan opens with what the project involves and where it happens — and, critically, the real constraints on execution: an occupied phasing schedule, clinical services next door that cannot pause, a unit that stays live throughout. A narrative that names the constraints gives the infection preventionist and the newest subcontractor the same picture of the job. A narrative that just names the project leaves the crew to discover the constraints by colliding with them.

2. Construction Activity Classification. The plan records which activity type, A through D, applies to the scope — Type A for inspection and non-invasive work such as lifting a ceiling tile to check a valve, Type D for major demolition or new construction, B and C between them by dust generation and whether the work cuts into fixed building components. This entry must be defensible: a classification error here cascades into the wrong precaution class and the wrong barrier specification.

3. Patient Risk Group Assignment. The plan identifies the patient population closest to the work and assigns its risk group, weighing medical vulnerability alongside physical proximity. STARC’s example is the right test: a low-traffic hallway beside an ICU still carries the ICU’s classification, because the patients on the other side of the wall are the ones at stake. The executable version names the actual adjacent units — above, below, and beside the work — not just the work zone.

4. Precaution Class and Required Controls. With the activity type and risk group set, the plan states the resulting precaution class and then does the part thin plans skip: it lists the exact controls that class demands — barrier type, negative-air requirements, PPE protocols, cleaning frequency. Borderline calls are common, and a plan that shows its reasoning for the class chosen is far easier to defend in a survey than one that states a class with no trail behind it. (What Class IV and Class V require in practice is covered in ICRA Class IV and V requirements.)

Components 5–6: who owns it, and what exists before work starts

5. Roles and Responsibilities. The plan spells out who does what: general contractor, subcontractors, infection preventionist, facilities staff, clinical department leads — each with distinct duties. To be executable, those duties are written per party and per phase (who inspects the barrier, who can stop work, who signs the daily log), and subcontractor duties are carried into bid packages up front, not explained at mobilization.

6. Pre-Construction Testing and Existing Conditions. Before work starts, the plan documents baseline conditions: air-handling unit performance, existing pressure relationships between rooms, and any pre-existing contamination risks. It also schedules verification that air-handling systems still perform as designed after barriers go up, before the space goes negative. Without recorded baselines, the crew has no benchmark — every later pressure reading is a number without a reference.

Components 7–9: what gets built, and how people and debris move

7. Barrier Locations and Composition. The plan specifies exactly where temporary barriers go and what they are made of — drawn on a floor plan, not described in prose — with materials impermeable to fungal spores and compliant with local fire codes. It also accounts for the physical constraints that decide whether a barrier line survives contact with a working hospital: bed swing radius, cart traffic, and egress paths. For the containment itself — barrier types, ceiling and floor-to-deck details, anterooms — see the healthcare construction containment guide.

8. Negative Air and Exhaust Routing. Negative air is what keeps contaminants inside the containment zone once the barriers are up. For Class IV and V work, the plan documents the required airflow, the exhaust routing, and equipment placement — where each machine sits, where its exhaust discharges, and how pressure will be held. A plan that says “provide negative air” without routing and placement leaves the decisions that most affect the occupied side to improvisation.

9. Traffic Flow and Access Routes. The plan maps how staff and construction crews move around the work zone, and how debris exits the building. Executable detail means named routes: the crew entrance, the debris path, the elevator, the times — with pedestrian traffic directed away from patient-care areas and debris covered before it leaves the work zone. Poorly planned routes track dust through patient areas and slow the project when crews detour around clinical operations.

Components 10–12: the proof, the exits, and the finish line

10. Monitoring Locations and Documentation. The plan identifies where pressure and particulate monitors go and sets the documentation schedule: pressure differentials logged daily, records kept available for review — including the review nobody wants, the one after an infection cluster is investigated. Written records protect the facility and the contractor alike; undocumented compliance carries no weight when a question comes up months after teardown.

11. Emergency Egress Planning. Fire and life-safety requirements do not pause for a renovation. The plan addresses secondary exit routes for occupants and, where relevant, a safe path for the construction crew — and it does so at plan stage, by checking barrier placement against the facility’s life-safety drawings. A barrier can satisfy every containment requirement and still block a required egress path; naming egress in the plan forces that review during design instead of after an inspector catches it.

12. Commissioning and Project Completion Criteria. The plan defines what “done” means before anyone has to argue about it: HVAC commissioning before occupancy, with particular attention to operating rooms and other critical-care areas; air-quality verification and surface-cleanliness testing in place of a visual “looks clean” judgment; and a clear sign-off process naming who accepts the space and on what evidence. This is the component that turns teardown from an opinion into a record.

Where plans fail in the field

The failure pattern behind STARC’s list is consistent: the plan exists, but it is thin in the places where the field needs thickness. The recurring gaps are a narrative that names the project but not its constraints; a classification asserted without reasoning, so the first borderline call reopens it; barriers described in words instead of drawn; negative air required but not routed; monitoring promised without locations or a logging schedule; and completion criteria left undefined, so “done” gets negotiated at the end under schedule pressure. Two habits prevent most of it: standardize the plan format across projects, so a component can only be missing visibly, and update the plan whenever scope or conditions change — an outdated plan misrepresents the risk on file. And train the crew on the document: a complete plan still fails if the people installing the barriers were never walked through its entry, exit, and cleaning requirements.

The sign-off is part of the plan

Read the 12 components as one arc: the first four decide what the job is, the middle five build and run it, and the last three prove it — monitored while it ran, escapable while it stood, and verified before the space went back to patients. The permit on the front of the binder says the work was authorized. The plan behind it is what the crew executed, what the surveyor can audit, and what the facility can show when someone asks how the patients on the other side of the wall were protected. Build the plan to that standard, and the final sign-off is a formality. Skip components, and the sign-off is where the missing ones send their bill.

Sources and scope: the 12-component list is from STARC Systems, “ICRA Plan Checklist: What a Solid Plan Should Include” (starcsystems.com). The classification framing follows ASHE ICRA 2.0, the Matrix of Precautions for Construction, Renovation and Operations (© ASHE); the standard’s own tables govern, and facility policy and the authority having jurisdiction apply. This article is informational and is not a substitute for the standard or for your infection prevention team’s assessment.