Construction-related infections occur when dust, air, or water systems expose patients to pathogens. In 2019, a hospital in Ontario experienced invasive aspergillosis during an HVAC upgrade. Three immunocompromised patients developed life-threatening infections. Construction dust breached containment barriers and carried fungal spores into patient areas.
You cannot separate hospital construction from infection prevention and control (IPAC). Renovations disturb ceilings, walls, ductwork, and plumbing. These activities release microbial reservoirs that healthcare environments normally keep sealed. Dust transports Aspergillus, Penicillium, bacteria, and heavy metals. Water disruption increases Legionella risk. Airflow changes move contaminants across units.
For healthcare teams beginning to build their infection prevention programs, our infection prevention and control guide for healthcare workers
provides essential fundamentals.
IPAC during construction is non-negotiable because hospitals treat vulnerable populations every hour. Surgical patients, oncology patients, transplant recipients, and neonates lack immune defenses against airborne pathogens. A single containment failure can trigger a healthcare-associated infection (HAI) outbreak.
In Canada, regulatory frameworks reinforce this obligation. CSA Z317.13 mandates infection control measures during construction and renovation. Accreditation Canada evaluates compliance. Provincial occupational health laws assign liability to facility operators.
This guide explains how you manage IPAC during construction correctly. You learn why risks escalate, how the ICRA process works, which control measures prevent outbreaks, how to protect high-risk patients, and how to achieve post-construction clearance. The next section explains why construction creates hidden infection risks.
The Hidden Risks of Hospital Renovations
Hospital construction generates large volumes of respirable dust. Studies show demolition activities release millions of particles per square foot. Dust acts as a vehicle for biological and chemical hazards.
Construction dust carries:
- Fungal spores, including Aspergillus fumigatus
- Bacteria from wall cavities and ceilings
- Asbestos fibers in older buildings
- Lead particles from paint and piping
You treat patients who cannot tolerate exposure. Immunocompromised patients develop invasive aspergillosis at mortality rates exceeding 30–50%. Neonates and surgical patients experience severe complications from airborne contamination.
Renovation work also disrupts airflow. Pressure imbalances pull contaminants into clean areas. Unsealed barriers allow migration through ceilings, cable trays, and door gaps. The next subsection explains why regulations make prevention mandatory.
If you’re designing safe construction zones, our construction and renovation IPAC service details the standards for proper containment and risk assessment.
Regulatory and Legal Obligations
You must comply with Canadian healthcare construction standards. CSA Z317.13-17 defines infection control requirements for HVAC systems during construction. The standard mandates pressure control, filtration, and risk assessment.
Accreditation Canada evaluates:
- Documented ICRA processes
- IPAC team involvement
- Construction containment measures
Learn more about maintaining compliance through our IPAC consulting services, helping facilities align with Accreditation Canada standards.
Provincial occupational health legislation assigns responsibility to facility operators. Failure exposes your organization to legal liability, accreditation risk, and regulatory penalties. The next subsection explains the operational cost of failure.
The Cost of Getting It Wrong
Construction-related HAIs cause financial and reputational damage. A single outbreak can cost hundreds of thousands of dollars in treatment, investigations, and unit closures. Facilities may close operating rooms or ICUs for remediation.
A documented Canadian outbreak linked to renovation dust resulted in temporary ward closure and public reporting. Prevention costs less than outbreak response. The next section explains how the ICRA process prevents these outcomes.
Understanding the ICRA Process (Infection Control Risk Assessment)
Before the first wall comes down, you need an ICRA. For teams conducting internal assessments, the IPAC requirements step-by-step guide outlines how to structure effective ICRA documentation.
What Is an ICRA?
An Infection Control Risk Assessment identifies construction-related infection risks and defines control measures. The IPAC team leads the process with facility management and construction leaders.
You require an ICRA for all construction, renovation, and maintenance activities. The assessment occurs before work begins and updates throughout the project lifecycle. The next subsection explains the structured framework.
The 4-Step ICRA Framework
Step 1: Identify the Construction Type
You classify work by dust and disruption level:
- Type A – Inspection or non-invasive work
- Type B – Small-scale, short-duration work
- Type C – Moderate work generating dust
- Type D – Major demolition or construction
Higher types require stronger controls. The next step evaluates patient vulnerability.
Step 2: Assess Patient Risk Groups
You classify nearby populations:
- Low risk – Offices, administrative zones
- Medium risk – General inpatient units
- High risk – ICUs, emergency departments
- Highest risk – Oncology, transplant, operating rooms
Risk group determines precaution class. The next step defines controls.
Step 3: Determine Required Precautions
You apply a risk matrix that assigns Class I–IV precautions. Higher classes require:
- Rigid barriers
- Negative pressure
- HEPA filtration
- Continuous monitoring
| Construction Type | Patient Risk | Required Class |
| Type B | Medium | Class II |
| Type C | High | Class III |
| Type D | Highest | Class IV |
The final step ensures accountability.
Step 4: Document and Communicate
You document:
- ICRA forms
- Control measures
- Monitoring plans
You communicate requirements to contractors, clinical leaders, and environmental services. The next section explains how you implement these controls on site.
Essential IPAC Control Measures During Construction
The ICRA tells you the risk level. These measures tell you how to manage it.
Physical Barriers and Containment
You must isolate construction zones from occupied areas.
Effective barriers include:
- Solid drywall or plywood for Class III–IV work
- Floor-to-ceiling sealing at all penetrations
- Anterooms and airlocks for high-risk zones
Plastic sheeting alone fails under negative pressure. You inspect barriers daily. Barrier failure equals immediate work stoppage. The next subsection explains airflow control.
Air Pressure Management
Construction zones must operate under negative pressure relative to patient areas. CSA standards specify a minimum differential of -2.5 Pascals.
You implement:
- Continuous pressure monitoring
- Audible and visual alarms
- Documented daily logs
Exhaust air requires filtration before discharge. The next subsection explains filtration requirements.
HEPA Filtration Systems
HEPA filtration removes airborne pathogens.
You require HEPA systems for:
- All Class III and IV projects
- Work adjacent to high-risk units
- Any demolition activity
HEPA units must achieve 99.97% efficiency at 0.3 microns. You size units based on room volume and required air changes. Improper placement creates dead zones. The next subsection explains dust suppression. Our infection control and prevention audit service can validate these physical controls and air safety systems on-site.
Dust Control and Suppression
Dust control prevents particle spread.
Best practices include:
- Wet cutting and drilling methods
- HEPA-filtered vacuums only
- Sealed debris carts
- Dedicated construction routes
- Sticky mats at exits
You never use standard shop vacuums. The next subsection addresses water risk.
Water Management
Water disruption introduces microbial growth.
You implement:
- Planned water shutoffs
- Immediate leak response
- Drying within 24–48 hours
- Legionella risk assessment during plumbing work
Moisture control protects both air and surfaces. The next section focuses on patient protection.
Protecting Vulnerable Patient Populations
Identifying High-Risk Areas
You prioritize protection for:
- Oncology and transplant units
- ICUs
- Operating rooms
- NICUs
- Long-term care residents with lung disease
These areas tolerate zero dust exposure. The next subsection explains enhanced precautions.
Special Precautions for High-Risk Zones
Patient protection strategies include:
- Temporary relocation during high-dust work
- Portable HEPA units in patient rooms
- Scheduling disruptive work after hours
For more on preventing outbreaks in critical units, review our infection prevention guide for long-term care.
Staff and visitor controls include:
- Restricted construction worker access
- PPE when entering occupied areas
- Dedicated corridors and elevators
The next subsection explains how you verify safety.
Air Quality Monitoring
You monitor airborne particles continuously.
Standard thresholds include:
- <500 particles/m³ at 0.5 microns in critical areas
You perform baseline, active, and post-work testing. Exceedances trigger investigation and corrective action. The next section explains IPAC team responsibilities.
The Role of Your IPAC Team in Construction Projects
Your IPAC team functions as a risk control authority.
Key IPAC Responsibilities
Pre-construction, the team:
- Leads the ICRA
- Reviews drawings
- Trains contractors
During construction, the team:
- Inspects barriers daily
- Reviews air monitoring data
- Tracks HAIs in adjacent units
Post-construction, the team:
- Conducts final clearance
- Verifies cleaning
- Documents compliance
The next subsection explains contractor accountability.
Contractor Education and Accountability
You require mandatory IPAC orientation. Workers sign compliance forms. Violations trigger corrective action or stop-work orders. Documentation protects accreditation readiness. The next section explains communication strategies. If you’re developing internal IPAC training, see our IPAC staff training guide for templates and checklists.
Stakeholder Communication Plan
You communicate with:
- Clinical staff
- Environmental services
- Patients and families
- Contractors
- Leadership
You explain:
- Scope and timeline
- Safety measures
- Restricted areas
- Reporting pathways
You use meetings, signage, emails, and patient information sheets. The next subsection explains issue management.
Managing Complaints and Concerns
You log noise, dust, and access complaints. You escalate clinical concerns immediately. Documentation supports quality improvement. The next section explains how you close projects safely.
Post-Construction Validation and Clearance
The construction is done. But you are not finished yet.
Environmental Cleaning Protocols
You perform terminal cleaning:
- HEPA vacuuming all surfaces
- Damp wiping horizontal areas
- Cleaning diffusers and grilles
- Replacing filters
High-risk areas require multiple passes. The next subsection explains testing.
Air Quality Testing
Before occupancy, you verify:
- Particle counts
- Air changes per hour
- Pressure differentials
Some projects require microbial air sampling. Clearance requires IPAC sign-off. The next subsection explains re-occupancy.
Phased Re-Occupancy
You reopen areas gradually. You monitor for 7–14 days. You track infection indicators. The next section addresses common challenges.
Common Challenges and How to Solve Them
Challenge 1: Contractor Non-Compliance
You solve non-compliance through:
- Daily inspections
- Contractual penalties
- Stop-work authority
Challenge 2: Budget Constraints
You justify costs using:
- Outbreak cost comparisons
- Regulatory requirements
- Delay prevention data
Challenge 3: Emergency Repairs
You manage emergencies with:
- Rapid ICRA protocols
- Pre-staged containment kits
- Enhanced monitoring
Challenge 4: Dust Migration
You respond with:
- Immediate work stoppage
- Barrier repair
- Increased negative pressure
- Root cause analysis
The next section demonstrates success in practice.
Real-World Case Study: Successful IPAC During Major Renovation
A 400-bed hospital replaced its entire HVAC system over two years. Construction affected all departments while ICUs, oncology, and NICU remained operational.
The IPAC team implemented:
- Phase-specific ICRAs
- One-floor-at-a-time scheduling
- Dedicated IPAC monitors
- Real-time particle counting
Results included:
- Zero construction-related HAIs
- No service disruptions
- Successful accreditation with commendation
Leadership support and contractor buy-in enabled success. The next section provides a practical checklist.
Your IPAC During Construction Checklist
Pre-Construction
☐ ICRA completed
☐ IPAC involved
☐ Contractor training scheduled
☐ Barriers specified
☐ Communication plan ready
During Construction
☐ Daily inspections
☐ Pressure monitoring
☐ Weekly air testing
☐ Surveillance active
☐ Compliance audits
Post-Construction
☐ Terminal cleaning
☐ Air testing passed
☐ IPAC clearance
☐ Documentation archived
☐ Lessons recorded
The next section explains how expert support simplifies this process.
How Infection Shield Consulting Supports Your Construction Projects
Managing IPAC during construction requires expertise. Infection Shield Consulting supports healthcare facilities across Canada. For broader organizational IPAC improvement, explore our general IPAC consulting services and IPAC education and certification programs.
Services include:
- Comprehensive ICRA assessments
- Construction IPAC protocols
- Contractor education
- On-site monitoring
- Post-construction validation
Dr. Kamyab Ghatan, MD, CIC, leads all programs. Projects range from minor renovations to full hospital builds. Clients achieve zero construction-related outbreaks and streamlined compliance. The next section summarizes key takeaways.
Conclusion
IPAC during construction protects patients and ensures compliance with regulatory obligations. The ICRA process identifies risk and defines controls. Physical barriers, negative pressure, and HEPA filtration form the primary defense against airborne contaminants. Your IPAC team must lead from planning through clearance.
Hospital renovations will continue. Construction-related infections do not have to. Proper planning, execution, and monitoring allow you to modernize facilities without compromising patient safety.