The problem: Facilities host MR germs

• 1 in 7 patients will develop a HAIs during and

hospitalization in LMCIs
• MR germs are a frequent cause of HAIs
• Unprepared facilities offers lots of
opportunities for germs to contaminate
constructions and colonize patients/providers
• The SARS pandemic has put a lot of pressure on
hospital design and flow

Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of

endemic health-care-associated infection in developing countries: systematic review and meta-analysis.
Lancet. 2011 Jan 15;377(9761):228-41.

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Figure 3: The chain of transmission adapted from Zimring et al., 2013

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ICRA - Infection Control Risk Assesment -
• Definition: An ICRA is multidisciplinary, organizational, documented
process that after considering the facility’s patient population and
program:
• Focuses on reduction of risk from infection,
• Acts through phases of facility planning, design, construction,
renovation, facility maintenance, and
• Coordinates and weighs knowledge about infection, infectious agents,
and care environment, permitting the organization to anticipate
potential impact.
https://www.premiersafetyinstitute.org/safety-topics-
az/building-design/infection-control-risk-assessment-icra/
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ICRA: Design Phase
• The design area requires “long-range planning” for new or renovated buildings
and adds a new element “finishes and surfaces” a critical feature over the lifetime
of the facility. Considerations include:
• Number, location, and type of airborne infection isolation and protective
environment rooms.
• Location of special ventilation and filtration such as emergency department
waiting and intake areas.
• Air handling and ventilation needs in surgical services, airborne infection
isolation and protective environment rooms, laboratories, local exhaust systems
for hazardous agents, and other special areas.
• Water systems to limit Legionella sp. and other waterborne opportunistic
pathogens.
• Finishes and surfaces. https://www.premiersafetyinstitute.org/safety-topics-
az/building-design/infection-control-risk-assessment-icra/
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