Construction, Water & Air: The Environment Is Not Neutral
Air handling, water systems, and construction activity are infection prevention controls, not background conditions. Each one creates potential infection transmission pathways that hand hygiene, transmission-based precautions, and device bundles cannot close. When these systems fail, they fail quietly, and the resulting cases are often attributed to clinical practice rather than to the building.
Construction and renovation are among the most common causes of healthcare-associated fungal outbreaks. Invasive aspergillosis carries roughly 50% mortality overall, with mortality approaching 100% when diagnosis is delayed or missed. There is a risk of transmission within healthcare setting related to construction and renovation, when dust is released from wall openings or penetrations.
Reducing Infection Risks Related to Construction, Renovation and Repair
The infection control risk assessment (ICRA) was introduced in the 1996 Facility Guidelines Institute (FGI) Guidelines for Design and Construction and has been standard practice for nearly three decades. The American Society for Health Care Engineering (ASHE) rebuilt the process as ICRA 2.0, structured as five steps completed at the onset of project design, before any work begins. In practice, the ICRA frequently arrives as a permit to be signed. An infection preventionist is asked to approve a class of precautions for a project that is already scheduled, and occasionally already started.
Signs the process has become paperwork rather than prevention:
Infection prevention sees the project at permit stage rather than at design phase
No one re-assesses when project scope changes mid-build
Barriers, negative air machines, and traffic routes are verified at installation but not during the work
The contractor receives the permit, but no one confirms the crew understands what it is for
An ICRA completed after the schedule is fixed can document risk. It cannot help reduce it.
Water Management Programs
Since 2017, the Centers for Medicare & Medicaid Services (CMS) has required hospitals, critical access hospitals, and long-term care facilities to maintain water management programs to reduce Legionella risk, under memo QSO-17-30 (revised July 2018). Programs must be based on ASHRAE Standard 188 and the CDC toolkit, and must specify testing protocols, acceptable ranges for control measures, and the corrective actions taken when those ranges are not maintained.
The document almost always exists, but the more challenging issues are operational and process related:
Who reviews control measure results, and how quickly does an out-of-range finding reach infection prevention?
Are low-use water sources — such as is closed units, rarely used showers, decommissioned rooms — on a documented and verified flush schedule?
Does the water management program get re-evaluated when construction disturbs the water system, or only on an annual cycle?
That last question points to a well-documented gap. Construction affects water systems as reliably as it affects air, and most water management programs were not designed to account for project work. Published tools now exist to extend ICRA thinking to waterborne pathogens, but adoption remains uneven.
Air Balance and Ventilation
Ventilation requirements in healthcare setting are specified by room type and use. Pressure relationships, filtration, and air change rate requirement differ for operating rooms, airborne infection isolation rooms, sterile processing areas, and protective environments. Renovation can change rooms and their function. A storage room converted to a procedure space, an isolation room taken offline during a census surge, a corridor door propped open for equipment access — these situations are not uncommon, but often they done trigger an airflow review, and pressure relationships drift, which can put patients (and regulatory compliance) at risk.
One practical exercise: pull your room pressure monitoring log and compare it against a current list of what each of those rooms is actually being used for today to see if your air handling meets your expectgations. If you have mismatches in that comparison, that’s usually a survey finding.
The environment is not neutral
The physical, built environment of your healthcare facility either supports your infection prevention program or quietly works against it, and the difference is rarely visible from a policy binder or a chart review.
If your facility is planning updates, or has renovated, repurposed space, or changed service lines in the past few years, an infection prevention gap assessment can identify where the physical environment has drifted from what your program assumes. IP&MA reviews construction and renovation processes, water management implementation, ventilation and pressure relationships, and the workflows that move through those spaces. We deliver a written findings report with prioritized, practical recommendations or support you through the full construction and renovation process.
Request a discovery call to talk through a walkthrough of your facility.