ICRA stands for Infection Control Risk Assessment. It is the framework used in healthcare facilities to assess the risk that construction and maintenance activities pose to patients and staff — and to specify the controls, including dust extraction equipment, required before work can begin.
If you are a contractor working inside or adjacent to an NHS hospital, private hospital or care home, ICRA is not optional. Work without an ICRA in place — or work that does not comply with the controls an ICRA specifies — is in breach of NHS Estates guidance, the Health Technical Memoranda (HTM) series, and your duty of care under COSHH 2002.
The four ICRA classes
ICRA classifies work by risk level. The dust extraction specification escalates with the class:
- Class I — inspection and non-invasive activity. Standard precautions.
- Class II — small scale, short duration. HEPA vacuum for debris. Contain the area.
- Class III — moderate to large scale work: ceilings, walls, flooring. H-Class HEPA extraction required. Negative pressure air scrubbing required.
- Class IV — major demolition and construction near immunocompromised patients. H-Class HEPA extraction. Sealed containment. Continuous negative pressure air scrubbing.
Why H-Class and not M-Class in healthcare?
Construction dust in a healthcare setting includes biological particulate from disturbed surfaces, HVAC systems and ceiling voids — particularly Aspergillus and other fungal spores. These are biological hazards, not mineral dust. H-Class at 99.995% is the COSHH engineering control for biological agents. M-Class at 99.9% passes biological particulate through its filter and exhausts it back into the clinical environment.
In a Class IV environment with immunocompromised patients, Aspergillus inhalation can be fatal. The engineering control must match the severity of the consequence — and that means H-Class.
Negative pressure — why the air scrubber matters
Negative pressure containment prevents contaminated air from the work zone migrating to adjacent clinical areas. An AEROMAX air scrubber connected to ductwork venting to outside creates negative pressure — air flows into the work zone rather than out of it. In Class IV environments the air scrubber must run continuously. Aspergillus spores disturbed during a shift remain airborne for hours after work stops. The air scrubber must still be running when the operative leaves for the day.
The V-TUF ICRA specification
For Class III and IV environments: H-Class extraction from the MIDI H, GRINDEX or MAXi H-Class range depending on the scale of the project, plus an AEROMAX air scrubber sized to the room volume. The GRINDEX with Longopac sealed bagging is the specification where filter exposure during emptying must be eliminated — which in a clinical environment it must be.
- ICRA full guidance and equipment specification →
- H-Class vacuum cleaners →
- AEROMAX air scrubbers →
- Healthcare sector hub →
- COSHH Regulations 2002 →
This article is for general guidance. Always develop your ICRA with the healthcare facility's infection control team before commencing work.
