Healthcare Construction Containment Guide: ICRA Barriers, Negative Pressure, and Daily Checks

Direct answer: Healthcare construction containment is the physical system that keeps dust, fungal spores, and contaminated air from leaving a work zone in an occupied facility. The barrier, the airflow, the entry path, the housekeeping, and the paperwork all count as part of it. The ASHE ICRA 2.0 matrix tells you which class of precautions a job needs (Class I through V). Containment is how you build that class, keep it working every shift, and take it down without letting dust out at the last minute. In occupied buildings the same barrier is usually also a life-safety element, so Interim Life Safety Measures (ILSM) and NFPA 241 apply to it too.

This guide is for hospital facilities teams, construction project managers, infection preventionists, and the trade contractors who do the work. It goes through containment element by element, shows how each one ties back to the ICRA 2.0 matrix and CDC guidance, marks the places where the published sources stop short of a hard number, and ends with checklists you can drop into a permit packet.

Need the class first? Use the ICRA Class Finder to read your class off the ASHE ICRA 2.0 matrix, or the ICRA Readiness Check to score how ready your project is before mobilization.

What containment is (and what it is not)

An infection control risk assessment (ICRA) is a decision process, and three different bodies stand behind it. The federal starting point is CDC’s 2003 Guidelines for Environmental Infection Control in Health-Care Facilities, developed with HICPAC, which tells facilities that “before the project gets underway, perform an ICRA to define the scope of the project and the need for barrier measures” (CDC, Part II recommendations). For how that assessment turns into a precaution class, see our ICRA matrix breakdown.

The matrix most U.S. hospitals use today is ASHE ICRA 2.0, published in April 2022 by the American Society for Health Care Engineering of the American Hospital Association. It pairs construction activity Types A–D with four patient risk groups to assign Classes I–V, and ASHE makes the matrix and sample permit free to the public (ASHE ICRA 2.0 Toolkit). Our step-by-step guide to the ASHE ICRA 2.0 matrix walks through each step, and the ICRA Class Finder applies it to your project.

ICRA is not new. ASHE notes that “the first formal ICRA was introduced in the 1996 edition of the Facility Guidelines Institute’s Guidelines” (ASHE, April 20, 2022). FGI’s current editions are the 2026 FGI Codes, released August 31, 2026 (FGI). In short: credit CDC/HICPAC for the recommendation to perform an ICRA, ASHE for the 2.0 matrix, and FGI for building the ICRA requirement into design and construction.

Containment is what you build once that decision is made. Treat it as a system with five parts:

• The envelope: barriers, doors, ceiling and floor seals, and every penetration through them.
• The air: HVAC isolation inside the zone, negative pressure, HEPA filtration or outdoor exhaust, and verification that adjacent spaces still meet their design pressure relationships.
• The path: the anteroom or entry, walk-off or adhesive mats, the worker clothing and shoe-cover rules, debris and material routes, and elevators.
• The housekeeping: daily cleaning inside and outside the zone, covered waste, and wiping down tools.
• The proof: permit, pressure records, inspection logs, breach reports, and the sign-off that ends or downgrades precautions.

Containment does not replace the ICRA itself, the life-safety review, or clinical surveillance. For the vocabulary, see ICRA: which one are you looking for? and ICRA meaning in healthcare construction. For how dust actually gets to patients, see how construction projects spread infections in hospitals and why Aspergillus is a construction risk.

From the ICRA 2.0 matrix to a containment package

The ASHE ICRA 2.0 Matrix of Precautions has four steps. You pick the activity type (A to D) from Table 1 and the highest patient risk group affected (Low, Medium, High, Highest) from Table 2. You read the class of precautions from Table 3. Then you assess the surrounding areas (below, above, lateral, behind, in front) in Table 4. Table 5 lists the minimum precautions before and during work, and Table 6 lists what has to happen when the work is complete.

Source: ASHE ICRA 2.0 Matrix of Precautions for Construction, Renovation and Operations (copyright 2022 ASHE). The asterisk is explained in the next list.

Four rules on the matrix pages change the containment package, and teams often miss them:

1. Permit trigger. An infection control permit and approval are required for Class III when the work is Type C, and for every Class IV or V job.
2. Environmental hazards raise the class. Sewage, mold, asbestos, gray water, and black water require Class IV in Low and Medium risk groups and Class V in High and Highest, whatever the activity type. Pair this with the site’s guides on mold remediation containment and asbestos and lead abatement.
3. The asterisk. Class III areas from Type C work in Medium risk or Type D work in Low risk that cannot be sealed and fully isolated from occupied patient-care space should be raised to include the Class IV negative air exhaust requirements.
4. Surroundings can add controls. Table 4 has you consider noise, vibration, dust, ventilation, pressurization, vertical shafts, and elevators and stairs for each neighboring unit, along with impacts on data, mechanical, medical gas, and hot and cold water. Use the higher risk group if more than one is affected.

A wrinkle to settle in your policy: Table 5 says Class II “must never be used for construction or renovation activities.” Table 3, however, assigns Class II to Type B and Type C work in Low risk areas, and Type C includes single-room renovation and new drywall. Read literally, the two tables leave a Low-risk Type C renovation without a clear answer. Many programs settle this by applying at least Class III dust controls to any work that meets the Type C definition, wherever it is. Decide this in writing with infection prevention rather than leaving it to each project.

For a step-by-step walkthrough of the matrix, see how to use the ASHE ICRA 2.0 matrix and how to perform an ICRA before a renovation. For who signs, see who should be on the ICRA team and the infection preventionist’s role.

Who the barrier protects: aspergillosis and the severely immunocompromised patient. In a hospital, the people most at risk from construction dust are usually not the workers. They are the patients nearby. The Fungal Infection Trust, a UK charity (registered charity no. 1147658), says Aspergillus infections “can be fatal in people undergoing treatments for cancer, after transplant, and those whose immune system is suppressed for whatever reason, including steroid treatments” (Fungal Infection Trust). Its educational site, the Aspergillus Website, notes that “people with a healthy immune system have little to fear from inhaling the amounts of fungal spores normally present in the air” (Aspergillus Website, 2012).

The link to building work is well documented. The Aspergillus Website is funded by the Trust and maintained by a team at the University of Manchester (About the Aspergillus Website). It states: “It is widely accepted that invasive aspergillosis can be linked to demolition, excavation, construction and refurbishment activities within or close to hospital sites” (Aspergillus Website, 2016). The site also summarized a 2018 outbreak report from a Japanese haematology ward (Kaya et al., Internal Medicine, 2018): “In this case, a partition with sealed windows and HEPA filtration was built between the building works and the patient areas. After the outbreak a negative-pressure unit was added, which appeared to halt the outbreak. The authors note that ceiling demolition is a particularly risky activity as it produces a lot of dust” (Aspergillus Website, 2018).

What that means for the matrix. These are the patients the matrix’s higher risk groups exist to protect. It is why Type C and D work in High and Highest risk areas lands in Class IV or V. At those classes, ICRA 2.0 calls for:

• critical barriers that meet NFPA 241 and reach the deck when ceiling tile is out
• sealed penetrations
• isolated return and supply diffusers
• a negative airflow pattern from the entry, through the anteroom, into the work area
• negative pressure across the whole workspace, held by HEPA exhaust air systems directed outdoors

If exhaust is directed indoors, it must be HEPA filtered, and the filtration must be verified by particulate measurement at no less than 99.97% efficiency before work starts (ASHE ICRA 2.0 matrix, PDF). CDC’s construction recommendations likewise ask for barriers that are “impermeable to fungal spores and in compliance with local fire codes” (CDC/HICPAC, 2003). The ceiling-demolition lesson is the reason above-ceiling access near these units needs its own controls. See ceiling access and penetrations and negative pressure and HEPA exhaust below, and our posts on Aspergillus risk during hospital construction and protecting immunocompromised patients during renovation.

Containment controls by class (I to V)

The table below condenses Table 5 of ASHE ICRA 2.0 into containment elements. “Policy” means ICRA 2.0 leaves the detail to the facility. Your permit should still make the choice explicit.

Deeper class pages: ICRA Class III barrier requirements, Class IV construction barriers, and Class IV and Class V requirements.

Barrier types: soft, rigid, modular, and fire-rated

On barrier material, ASHE’s Class IV and V precautions do not ban plastic. They require that “all (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release,” with barriers meeting NFPA 241 (ASHE ICRA 2.0 matrix, PDF). See how that plays out by class in our matrix breakdown. Whatever the material, the barrier has to be fixed to floor and ceiling, protected from movement or damage, and sealed at the gaps. The CDC guideline is more prescriptive by duration. It says portable plastic enclosures with negative pressure and HEPA-filtered exhaust suit short, low-dust jobs such as above-ceiling cabling. Fire-resistant plastic curtains sealed ceiling to floor with overlapping sheets may be adequate for extensive but short-term work. Rigid noncombustible walls covered with sheet plastic are indicated for long-term projects that produce moderate to large amounts of dust.

Decision rules that hold up in the field:

• Pick the barrier for the longest phase it will see, not the first week. A curtain that holds on day one can billow and tear by week three of demolition.
• If the barrier sits in a corridor that patients, carts, or beds will pass, assume impact and choose rigid.
• If the barrier stands in for part of a required fire or smoke separation, or blocks or changes egress, life safety picks the material and rating first. Infection control then adds seals and pressure. Our fire rating for temporary construction barriers post covers the tiers.
• Whatever the material, treat seams, corners, and the top and bottom tracks as the barrier. Most leaks happen there.

More detail: soft vs. hard containment barriers and polyethylene thickness for ICRA barriers.

Ceiling access, floor-to-deck, and MEP penetrations

Ceiling access

ICRA 2.0 defines Type A ceiling work narrowly: removing ceiling tile for visual inspection, limited to one tile per 50 square feet, with limited exposure time. Prolonged above-ceiling work, such as running conduit or cable, repairing firewalls and barriers, or accessing mechanical or electrical chases, is Type B. Opening a new cable pathway or doing invasive electrical work above ceilings is Type C. Class I requires any displaced tile to be replaced immediately before leaving or at the end of the work. The CDC guideline lists crawling into ceiling spaces in a way that may dislodge dust as an activity that needs a barrier. For major ceiling work in patient-care areas, it calls for plastic sheets or prefabricated plastic units with negative pressure, exhausting through a portable industrial-grade HEPA unit rated for 300 to 800 cfm or directly outdoors.

• Use an above-ceiling permit that records the tile count, location, duration, and class.
• Put a containment cart or tent under the opening for Type B work and above in patient areas.
• HEPA vacuum tile tops and the grid around the opening before closing up.
• Never leave open tiles overnight in a patient area.

Floor-to-deck

Class IV and V barriers must reach the ceiling, or the deck above when tile is removed. The CDC guideline goes further for rigid long-term barriers. It calls for running them floor to floor, which accounts for the space of roughly 2 to 8 feet above the lay-in ceiling. In practice, if the plenum above the work zone connects to occupied space, a barrier that stops at the grid does not contain the air. Air will travel over the top. Seal at the deck, around flutes in metal decking, and around everything passing through the plenum.

MEP penetrations

ICRA 2.0 requires sealing all penetrations in containment barriers, including floors and ceilings, using approved materials. It adds UL-listed firestop “if applicable for barrier type.” Two different reviews apply to one hole:

• Infection control: is the hole airtight under negative pressure? Pipe, conduit, cable bundle, duct, and sprinkler drops all count.
• Life safety: does the hole pass through a rated assembly, whether existing or temporary? If so, a listed firestop system for that assembly and penetrant is required, and it must be documented. A temporary penetration through an existing rated wall is a life-safety impairment until it is restored. Assess it under your ILSM policy.

Keep a penetration log for the containment: location, penetrant, seal or firestop system used, installer, date, and the date of re-inspection.

Anterooms and the entry path

ICRA 2.0 explicitly requires a constructed anteroom for Class V. It must be large enough for equipment staging, cart cleaning, and workers, and it must sit next to the entrance of the work area. The Class IV text requires the negative airflow pattern to run “from the entry point to the anteroom and into the construction area,” and requires shoe covers to be changed “prior to exiting the anteroom.” In other words, the Class IV text assumes there is an anteroom without spelling out how to build one. Many facility policies require an anteroom or vestibule for every Class IV job. Write your rule into the permit template so contractors are not left guessing.

Build details are in building an anteroom for healthcare construction.

Negative pressure, HVAC isolation, and HEPA exhaust

Isolate the HVAC first

ICRA 2.0 Classes III to V require removing or isolating return diffusers, so dust does not enter the building system, and supply diffusers, so the space does not go positive. The CDC guideline adds two steps. Make sure the air-handling system in the affected area is working properly after the barriers go up and before the area is set to negative pressure. When vibration work could dislodge dust in ductwork serving occupied spaces, or when that ductwork is modified, temporarily filter the supply grilles. Coordinate with controls staff. Capping diffusers changes static pressure in the duct system and can move air balance in nearby rooms, including rooms with design pressure relationships under ASHRAE 170.

Route the exhaust

• Outdoors, 25 ft or more from entrances, air intakes, and windows: ICRA 2.0 does not require HEPA filtration on this stream.
• Indoors: must be HEPA filtered. Before work starts, filtration must be verified by particulate measurement as no less than 99.97% efficient, and it must not change airflow or pressure relationships in other areas.
• Never into shared or recirculating HVAC, or shared exhaust such as bathroom exhaust.
• The CDC guideline notes window chutes for large debris are acceptable only while the negative pressure differential is maintained. It also recommends sealing work-zone windows where practical.

Size the machines

Neither ICRA 2.0 nor the CDC guideline sets a construction-zone air change rate. Size the equipment so it holds the target differential with the barrier you actually built, after allowing for leakage and duct losses. A working approach engineers use:

1. Start from zone volume and a design air change rate set in your ICRA plan (for example, the value your engineer or policy chooses). Required flow in cfm equals volume in cubic feet times air changes per hour, divided by 60.
2. Add margin for leakage. Soft barriers leak more than gasketed rigid panels.
3. Derate for flexible duct runs and loaded filters, and confirm actual flow at the discharge, not just the nameplate.
4. Verify with the differential reading, not the calculation.

HEPA machine operations

• Check pre-filters at start-up every shift. Loaded pre-filters cut airflow and pressure.
• Bag spent filters before transport. The CDC guideline says to bag old filters before moving them.
• Keep negative air running after dust-producing work ends and before critical barriers come down. ICRA 2.0 Table 6 requires this.
• Plan power so machines are not on circuits that will be shut down. Put machines on emergency power if your ICRA calls for it.

Why the pressure matters beyond the zone: the CDC guideline describes an aspergillosis outbreak among oncology patients that was traced to depressurization of the building housing the HSCT unit during construction in an adjacent building. Pressure readings there ranged from 0.1 to 5.8 Pa, and unfiltered outdoor air entered through doors and windows. Containment design has to account for the building pressure balance as well as the box. See negative air pressure in hospital construction and HEPA-filtered negative air machines. For design-side ventilation context, see ASHRAE 170 ventilation, pressure, and air changes and how ASHRAE 170 interacts with FGI.

Pressure monitoring: what is required and what is practice

What ICRA 2.0 requires: for Class IV and V, a device on the exterior of the containment that continuously monitors negative pressure. A visual pressure indicator is recommended so anyone can see the pressure is being held. For Class III, the contained area must be neutral to negative at all times.

What CDC says: create and maintain negative pressure in work zones next to patient-care areas, monitor negative airflow inside rigid barriers, and monitor the construction area daily for compliance with the infection-control plan. CDC also recommends daily monitoring and documentation of negative airflow in airborne infection isolation rooms and of positive airflow in protective environment rooms near construction.

What neither sets: a numeric minimum differential for construction containment. The 2.5 Pa (0.01 in. w.c.) figure that appears in many hospital construction policies comes from CDC’s design values for AII and protective environment rooms, not from a construction requirement in the CDC guideline or ICRA 2.0. Vendor and trade articles that cite a single “required” construction number, such as minus 0.03 in. w.c. “per FGI and ICRA 2.0”, are not supported by the ICRA 2.0 tool text. Put your set point and alarm threshold in the ICRA permit, and have engineering and infection prevention sign it.

• Measure between the work zone and the space you are protecting, usually the corridor or the anteroom. Record which pair the reading represents.
• Zero and calibrate per the manufacturer and your policy, and keep the records with the project file.
• Decide in advance who receives after-hours alarms and how quickly someone must respond. A data log nobody reads protects no one.
• If a protective environment or AII room is nearby, trend that room’s pressure for the length of the project too.

Setup and records: monitoring pressure differentials during hospital construction. AII context: ASHRAE 170 requirements for AII rooms.

Dust control, walk-off mats, debris, and traffic

The barrier contains dust, and dust control keeps the barrier from being overwhelmed. The CDC guideline’s construction table and its numbered recommendations give the operational core:

• Mats: tacky or adhesive mats inside the entrance, big enough that both feet land on them. ICRA 2.0 requires an adhesive mat at the entrance of contained work areas per facility policy, changed routinely and when visibly soiled. Keep a separate walk-off mat on the clean side if your policy calls for one.
• Cleaning: clean the work zone and its entrances daily or more often. Wet mop, or HEPA vacuum carpeted areas daily. Outside non-contained areas, ICRA 2.0 calls for damp mopping or HEPA vacuuming.
• Tools and carts: damp-wipe before they leave the zone.
• Debris: keep it contained in the work area. Move it in smooth, hard-lidded containers damp-wiped before they leave. Mist and cover debris carts. Schedule removal for times when patient exposure is lowest, and use a designated route.
• Traffic: designated construction entrances, corridors, and elevators where practical. Do not transport patients on the same elevator with construction materials and debris. Provide essential services (such as toilets) inside the zone on long projects to cut traffic.
• Clothing: protective outer clothing comes off before entering clean areas. ICRA 2.0 Class IV allows HEPA vacuuming or cover suits, and Class V requires disposable coveralls.
• Moisture: store materials dry, do not install wet porous materials, and replace water-damaged porous materials that cannot be dried within 72 hours.
• Laboratories: the CDC guideline cites pseudo-outbreaks traced to construction dust near labs and blood culture storage. Treat labs, pharmacy compounding, and sterile storage next to a project as protected spaces in Table 4.

The ICRA 2.0 matrix also lists noise and vibration strategies that double as dust strategies: wet core drilling instead of dry or percussion, wet diamond saws instead of jackhammering, beam clamps instead of powder-actuated fasteners, HEPA vacuums instead of standard wet/dry vacuums, and prefabrication where possible.

Utility shutdowns and system impacts

Table 4 of ICRA 2.0 requires you to identify impacts on data, mechanical, medical gases, and hot and cold water for every surrounding unit. Its mitigation strategies are to schedule outages, provide temporary systems, and back-feed electricity or medical gases. Fan shutdown and startup are listed as Type B activities in their own right. A short HVAC outage near a high-risk unit therefore needs its own ICRA, not just a maintenance ticket.

Water-side risks: water system risks during healthcare construction, ASHRAE 188 water management plan requirements, and Legionella water management programs. Medical gas: medical gas systems under NFPA 99. Downtime planning: reducing downtime across critical systems.

Sterile processing and surgical suites. ICRA 2.0 places the clean side of sterile processing, OR theaters and restricted areas, procedural suites, and pharmacy compounding in the Highest risk group. The dirty side of SPD is Medium. Work near the clean side or sterile storage usually lands in Class IV or V, and utility outages there can affect steam, water quality, humidity, and pressure. See sterile processing and AAMI ST79, operating room HVAC, and filtration for surgical suites under ASHRAE 170.

ILSM and life-safety overlap

In an occupied hospital, every containment barrier is also a life-safety question. Barriers can block exits, lengthen travel distance, hide fire extinguishers and pull stations, interrupt smoke compartments, or add combustible material. ICRA 2.0 itself ties Class IV and V critical barriers to NFPA 241, the Standard for Safeguarding Construction, Alteration, and Demolition Operations.

Regulatory frame. CMS requires hospitals to meet the Life Safety Code (NFPA 101, 2012 edition, with listed TIAs) under 42 CFR 482.41(b). Federal regulations don’t use the term “ICRA.” The hospital infection-control Condition of Participation requires programs that “demonstrate adherence to nationally recognized infection prevention and control guidelines” (42 CFR 482.42). Under the Joint Commission’s Accreditation 360 hospital manual, effective January 1, 2026, the former Environment of Care and Life Safety chapters were combined into a Physical Environment (PE) chapter. Interim life safety measures now sit at PE.03.02.01 (formerly LS.01.02.01), which covers protecting occupants when the Life Safety Code is not met or during construction. Building safety and facility management, including Health Care Facilities Code expectations, sits at PE.04.01.01. ICRA itself stays an infection prevention and control obligation, separate from PE. For the chapter-level picture, see Accreditation 360: the 2026 Physical Environment standards. For the federal side, see CMS CoP environment of care requirements.

Run the ILSM assessment and the ICRA from the same drawings and keep them in the same packet. The site’s ILSM series goes deeper: what ILSM are, when ILSM are required, ILSM on small projects, documenting ILSM, who is responsible for ILSM, ILSM and the fire safety plan, ILSM staff training, how long ILSM stay in effect, and common ILSM deficiencies. For the side-by-side, see ILSM vs. ICRA in healthcare construction. For the code background, see NFPA 241 and healthcare construction, the NFPA 101 Life Safety Code guide for healthcare, and defend-in-place strategy.

Fire alarm and sprinkler outages: two different clocks. Utility shutdowns, tie-ins, and above-ceiling work often impair fire protection while containment is up. CMS’s fire safety survey report for hospitals, Form CMS-2786R, sets the fire alarm threshold at tag K346: “Where required fire alarm system is out of services for more than 4 hours in a 24 hour period, the authority having jurisdiction shall be notified, and the building shall be evacuated or an approved fire watch shall be provided for all parties left unprotected by the shutdown until the fire alarm system has been returned to service” (Form CMS-2786R (07/2018), K346, page 22).

For sprinklers, the hospital Condition of Participation states: “When a sprinkler system is shut down for more than 10 hours, the hospital must: (i) Evacuate the building or portion of the building affected by the system outage until the system is back in service, or (ii) Establish a fire watch until the system is back in service” (42 CFR 482.41(b)(8)). The same form carries the sprinkler outage rule at tag K354 (Form CMS-2786R, K354, page 24). Put the impairment start time, the authority notification, any fire watch log, and the ILSM assessment in the same packet as the ICRA permit. That way a shutdown that runs long does not cross a threshold unnoticed.

Trade reading (not a primary source): Life Safety Express, a healthcare life-safety consultancy in Gallatin, Tennessee, adds two field cautions.

• A short outage still needs a risk assessment. “Facilities should not treat four hours as a permission to ignore a shorter shutdown; risk assessment, notification, and temporary measures can be necessary immediately based on the condition.”
• A fire watch is not the same as an ILSM. “A fire watch is a specific temporary compensatory measure involving assigned personnel and an approved procedure.” And: “A fire watch may be one action within a larger interim plan, but completing an ILSM form does not by itself satisfy a required fire watch.”

Source: Life Safety Express, “Temporary Fire Protection Impairments: Fire Watch Requirements and ILSM Decision Paths” (2026).

Daily monitoring and breach response

The CDC guideline calls for monitoring the construction area daily for compliance with the infection-control plan. It also calls for monitoring barriers, repairing gaps or breaks in barrier joints, and building infection-control adherence into construction contracts, with penalties for noncompliance and ways to make sure problems get corrected promptly. ICRA 2.0 leaves the inspection frequency to the facility. A workable split:

Breach response sequence:

1. Stop dust-producing work in the affected zone.
2. Restore the seal or pressure, and find the cause (torn poly, propped door, loaded filter, power loss, HVAC change).
3. Clean outside the barrier as far as dust may have traveled, using HEPA vacuuming and damp wiping.
4. Notify infection prevention and the affected unit. Decide with the IP whether to relocate patients, check pressures in nearby protective rooms, or add particle counts.
5. Document the time found, duration, cause, actions, and who approved restarting.
6. If a healthcare-associated aspergillosis or other airborne fungal case occurs during or right after construction, the CDC guideline recommends reviewing the pressure differential records for the construction zone and protective environment rooms and correcting the engineering problems. The logs are evidence, so keep them.

Cadence by class: how often ICRA monitoring should be done. Rounding practice: environment of care rounds and corrective action.

Checklists: pre-construction, daily, teardown, sign-off

Pre-construction checklist

• ICRA completed on the current ASHE ICRA 2.0 tool: activity type, highest patient risk group, class, Table 4 surrounding-area assessment.
• Environmental hazards checked (mold, asbestos, sewage, gray and black water), with the class raised if present.
• Asterisk rule applied for Class III areas that cannot be sealed from patient space.
• Permit signed by infection prevention and facilities (required for Class III Type C, IV, and V).
• ILSM assessment completed on the same drawings, with measures listed.
• Barrier material, rating, and drawings approved, including anteroom layout, doors, and egress changes.
• HVAC isolation plan: which supply and return diffusers are capped, and whether adjacent space balance is checked.
• Exhaust route chosen: outdoors at 25 ft or more from openings, or HEPA indoors with pre-start particle verification.
• Pressure set point, alarm threshold, monitoring device, after-hours alert recipient, and response time written into the permit.
• Utility outages identified and scheduled with affected units, with temporary systems arranged.
• Traffic routes, construction elevator, debris route and times, and worker entrance designated.
• Patients in high-risk adjacent rooms assessed for relocation (CDC). Unit staff briefed.
• Contractor and staff education done. Infection-control adherence clause is in the contract.
• Baseline readings recorded: adjacent protective room pressures, and particle counts if your program uses them.
• Barrier built without releasing dust, inspected, and pressure verified before any dust-producing work begins.

Daily inspection checklist

• Permit and class posted and current. Scope has not grown beyond the permit.
• Barrier intact: no tears, gaps, or loose tape at floor, ceiling, seams, corners. Rigid panels and gaskets seated.
• Barrier continuous to the deck where tile is removed. Plenum openings sealed.
• Penetrations sealed. New penetrations logged.
• Doors self-close and latch, nothing propped, one anteroom door open at a time.
• Pressure display reading within set point. Log reviewed for overnight excursions. Alarm tested per policy.
• Airflow direction confirmed at doors with a smoke tube or tissue.
• Negative air machines running, pre-filters acceptable, ducting intact, discharge at the approved location.
• Supply and return diffusers in zone still capped.
• Adhesive mats clean and changed when soiled.
• Housekeeping: inside zone cleaned, corridor outside clean, no tracking.
• Debris contained, carts covered, containers damp-wiped before leaving.
• Workers following clothing and shoe-cover rules for the class.
• ILSM items in place: exits clear, alternate routes signed, extinguishers accessible, fire watch if required.
• Any breach or complaint documented with corrective action.

Barrier teardown and cleaning checklist (from ICRA 2.0 Table 6 and CDC)

• All drywall removal, dust-producing work, and anything beyond simple touch-up is finished. Barriers stay up until then.
• Work area cleaned: all environmental surfaces, high horizontal surfaces, and flooring. Supply and return registers checked for dust.
• Negative air kept running for a period after dust-producing work ends and before critical barriers are removed.
• Visible mold checked for and eliminated if present (CDC).
• For rigid barriers: barrier curtains in place to contain dust before removal (CDC). Screws and painter tape removed carefully. Hand-held HEPA vacuum used where screw removal raises dust. No drywall cutting during removal. Stud tracks HEPA vacuumed before the outer hard barrier comes down. Plastic enclosure used if dust could be generated.
• Area cleaned again of any dust generated during removal.
• HVAC isolation removed after the critical barriers come down. Filters cleaned or replaced with dust containment. Spent filters bagged.
• Water system flushed where lines were affected (CDC).

Sign-off checklist

• Class III (Type C only), IV, and V: area inspected by an infection preventionist or designee and an engineering representative before precautions are discontinued or downgraded (ICRA 2.0 Table 6). Inspection documented.
• HVAC verified clean and operational and meeting original airflow and air exchange design specifications (ICRA 2.0 Table 6). Appropriate ACH, humidity, and pressure differentials restored (CDC).
• For ORs and protective environments: designed air balance achieved and space commissioned before occupancy (CDC).
• Fire and smoke separations restored, penetrations firestopped, ILSM closed out and documented.
• Environmental services terminal clean completed before patients return.
• Project file closed out: permit, pressure logs, inspection logs, breach reports, HEPA verification, penetration log, sign-offs.

Cleaning standards: terminal cleaning protocols. Commissioning: HVAC commissioning, testing, and balancing.

Infection prevention during renovation: the clinical side

A tight barrier does not finish the job. The CDC guideline’s construction recommendations reach into clinical practice. Its points, in plain terms:

• Multidisciplinary team from the start. Include infection control staff in coordinating demolition, construction, and renovation, and keep a record of the team’s activities.
• Education both ways. Teach the construction team and staff in immunocompromised care areas about airborne infection risks from construction, how fungal spores spread, and how to control them.
• Surveillance. Establish surveillance for airborne environmental disease such as aspergillosis during construction, including active surveillance in immunocompromised patients and periodic review of microbiology, histopathology, and postmortem data. CDC makes no recommendation for routine microbiologic air sampling before, during, or after construction. It lists that as unresolved.
• Relocation decisions. Relocate patients whose rooms are adjacent to work zones depending on immune status, project scope, and dust or water aerosol potential. CDC notes N95 respirators were well tolerated by patients in one outbreak response but says routine patient respirator use remains unresolved.
• External work counts. For outdoor demolition and excavation: decide whether the facility can temporarily run on recirculated air and seal nearby intakes. If not, check and change roughing filters more often. Seal windows and reduce outside-air entry, especially in protective environment areas.

Related: protecting immunocompromised patients during renovation, should patients be relocated?, communicating construction risks to clinical staff, coordinating clinical and facility teams, how FGI affects renovation projects, and the infection control professional guide. For survey context, see how The Joint Commission surveys infection control.

Where containment fails in the field

Products and systems (not endorsements)

The companies and resources below are listed for information only. They are not endorsements, Healthcare Facility Hub has no affiliation with them, and performance statements are each company’s own claims. ASHE does not certify products against ICRA 2.0. The project’s ICRA team decides whether an installed system meets the precautions for its class.

Rapid Room: a reusable, tool-free temporary wall system for occupied healthcare renovation, made by Imperial Privacy Systems in Pompano Beach, Florida. The company says it installs three times faster than drywall and offers an optional cloud-connected differential-pressure monitor that logs readings and sends alerts. It sells the system outright or rents it. rapidroom.com

STARC Systems: reusable modular containment walls in four lines (RealWall, LiteBarrier, FireblockWall, StackBarrier). The company says FireblockWall is listed by Intertek to ASTM E119 for a one-hour rating. The company says two workers can install about 100 feet of RealWall in an hour, and it publishes healthcare case studies, including Abbott Northwestern Hospital. STARC FireblockWall

Construction Containment Services (5DCCS): a San Jose, California subcontractor founded in 2024 that rents, installs, and removes modular containment walls across the Bay Area and Northern California. The company says it is a service-disabled veteran-owned small business, and federal contractor registration data list it that way. The company says it also holds California DVBE certification and supports VA medical center projects. 5DCCS healthcare containment

Healthcare Facilities Today: a trade publication from Trade Press Media Group covering healthcare facility management, design, and construction. It is a useful source for project news and operations articles. healthcarefacilitiestoday.com

Facility Guidelines Institute (FGI): the not-for-profit that develops the FGI Codes used by many states for healthcare design and construction. The 2026 FGI Codes and companion Handbooks were released August 31, 2026. FGI

FAQ

What is healthcare construction containment?

Healthcare construction containment is the set of barriers, airflow controls, entry procedures, cleaning, and records that keep construction dust and contaminated air inside a work zone in an occupied healthcare facility. The CDC/HICPAC Guidelines for Environmental Infection Control in Health-Care Facilities (2003), Part II tell facilities to construct barriers that keep construction dust out of patient-care areas. An infection control risk assessment (ICRA) sets the class of precautions; containment is how that class is built and maintained.

Which ICRA classes require negative pressure?

Under ASHE ICRA 2.0 (2022), Table 5, Class IV and Class V require the entire construction area to remain negatively pressurized, with airflow cascading from outside to inside. Class III requires a contained work area to be neutral to negative at all times. A note to Table 3 adds that Class III areas from Medium-risk Type C or Low-risk Type D work that cannot be sealed from occupied patient space should add the Class IV negative air exhaust requirements.

Is there a required pressure number for construction containment?

No. ASHE ICRA 2.0 (2022), Table 5 sets no numeric pressure for construction containment. For Class IV and V it requires a device on the outside of the containment that continually monitors negative pressurization, and recommends a visual pressure indicator. The 2.5 Pa (0.01 in. w.c.) value in the CDC/HICPAC Guidelines for Environmental Infection Control (2003) is a design value for isolation and protective environment rooms, not a construction requirement. Record your set point and alarm threshold in the ICRA permit.

Does Class IV require an anteroom?

ASHE ICRA 2.0 (2022), Table 5 explicitly requires a constructed anteroom only for Class V, built next to the work-area entrance and large enough for equipment staging, cart cleaning, and workers. The Class IV precautions still assume one: negative airflow must run from the entry point to the anteroom and into the construction area, and shoe covers must be changed before exiting the anteroom. Write your facility’s Class IV anteroom rule into policy.

Can plastic sheeting be used for Class IV or V?

Yes. ASHE ICRA 2.0 (2022), Table 5 allows plastic or hard barriers for Class IV and V if construction prevents dust release, plastic is affixed to floor and ceiling and secured from movement or damage, gaps are sealed with residue-free tape, and barriers meet NFPA 241. Separately, the CDC/HICPAC Guidelines for Environmental Infection Control (2003), Table 9, recommend durable rigid barriers for ongoing, long-term projects. Check your accreditor’s and authority having jurisdiction’s fire requirements for plastic barriers.

Where should HEPA exhaust go?

Outdoors, by preference. For Class IV and V, ASHE ICRA 2.0 (2022), Table 5 calls for HEPA exhaust directed outdoors, and exhaust discharged directly outdoors 25 feet or more from entrances, air intakes, and windows does not need HEPA filtration. Exhaust directed indoors must be HEPA filtered and verified by particulate measurement at no less than 99.97 percent efficiency before work starts. Exhaust into shared or recirculating HVAC or other shared exhaust systems is not acceptable.

How often should containment be inspected?

Daily, at minimum, under CDC guidance. The CDC/HICPAC Guidelines for Environmental Infection Control in Health-Care Facilities (2003), Table 9 say to monitor the construction area daily for compliance with the infection-control plan, and CDC also recommends monitoring barriers and repairing gaps in barrier joints. ASHE ICRA 2.0 (2022) sets no inspection frequency, so set the cadence, and who inspects, in the ICRA permit and facility policy.

Who can take containment down?

For Class III (Type C activities only), IV, and V, ASHE ICRA 2.0 (2022), Table 6 requires an infection preventionist or designee and an engineering representative to inspect the area, with documentation, before precautions are discontinued or downgraded. Critical barriers may not come down until the work area has been cleaned, and negative air devices must keep running after dust-creating work ends and until the critical barriers are removed.

How do ILSM and ICRA interact on the same barrier?

They are two separate reviews of one barrier. The ICRA sets dust and pressure controls. For Joint Commission-accredited hospitals, interim life safety measures fall under PE.03.02.01, which the Joint Commission Accreditation 360 Physical Environment webinar transcript (2025) describes as protecting occupants when the Life Safety Code is not met or during construction. Review both on the same drawings, because barrier location, material, doors, and penetrations matter to both.

Does a utility shutdown need an ICRA?

Often, yes. ASHE ICRA 2.0 (2022), Table 1 lists fan shutdown and startup as a Type B activity, so an HVAC outage near patient areas needs its own risk assessment and class. Table 4 of ICRA 2.0 also asks the team to identify impacts on data, mechanical, medical gas, and hot and cold water systems serving surrounding units, with mitigations such as scheduled outages and temporary systems.

References and further reading

Primary and authoritative sources used

• Facility Guidelines Institute. 2026 FGI Codes for Planning and Design (Hospital, Outpatient, Residential), released August 31, 2026; FGI is the primary source for the ICRA requirement in U.S. healthcare design and construction. fgicodes.org. Release announcement: FGI launches 2026 FGI Codes and Handbooks.
• American Society for Health Care Engineering. ASHE ICRA 2.0 Matrix of Precautions for Construction, Renovation and Operations (published April 20, 2022). ashe.org/icra2. Announcement: ASHE publishes updated infection control risk assessment.
• Centers for Disease Control and Prevention and HICPAC. Guidelines for Environmental Infection Control in Health-Care Facilities (2003, updated July 2019), developed with HICPAC. Part II recommendations: cdc.gov
• The Joint Commission. Accreditation 360, Updated Accreditation Manual: Physical Environment Chapter (webinar slides and transcript, 2025). jointcommission.org (webinar slides, PDF)
• Centers for Medicare and Medicaid Services. 42 CFR 482.41, Condition of participation: Physical environment (ecfr.gov), and 42 CFR 482.42, Infection prevention and control and antibiotic stewardship programs (ecfr.gov).
• National Fire Protection Association. NFPA 241, Standard for Safeguarding Construction, Alteration, and Demolition Operations. nfpa.org
• National Fire Protection Association. NFPA 101, Life Safety Code. nfpa.org
• ASHRAE. ANSI/ASHRAE/ASHE Standard 170-2025, Ventilation of Health Care Facilities (read-only access page). ashrae.org

Optional trade reading

• Healthcare Facilities Today: facilities management, design, and construction news for healthcare buildings. healthcarefacilitiestoday.com

This guide is general information for planning and field use. It does not replace your facility’s ICRA policy, your authority having jurisdiction, or the current editions of the codes and standards adopted where you operate.