Attachment 1K - VHA ICRA Update - Nov 2024.pptx

VHA ICRA Update – October 2024

VETERANS HEALTH ADMINISTRATION

VHA ICRA Update A revision of the D 7715 required VHA ICRA Template form was finalized in October of 2024: VHA Infection Control Risk Assessment (ICRA) | Healthcare Environment and Facilities Programs (va.gov).

Key revision pertains to Table 5, Level III Class of Precautions, item #5 concerning directing exhaust outdoors.

If the facility is not able to exhaust to the building exterior, an alternate procedure has been identified and is contained in Appendix A of the template form.

Appendix A: Alternative To Outdoor Exhaust Requirements If exhaust is directed indoors, then the system must be HEPA filtered.

A 99.97% HEPA Filter (standard) should discharge little or no particulate at 0.3 microns or greater in size.

Prior to start of work, including assembly of the ICRA barriers, initial baseline air sampling measurements for particulate levels must be taken in the planned area of discharge.

A particle counter with multi-channel capabilities and measure down to 0.3 microns is required to determine baseline levels and levels discharged from the HEPA filtered air.

Appendix A: Alternative To Outdoor Exhaust Requirements Multi-Channel Particle Counter can be found at such retailers as Grainger: Particle Counters - Grainger Industrial Supply.

Most measure at 0.3, .5, 1.0, 2.5, 5 and 10 microns.

Appendix A: Alternative To Outdoor Exhaust Requirements Verification of not exceeding background particulate levels must continue at least three times per day (once every 8 hours), 7 days per week, during the use of the negative air machine and HEPA filter.

Any exceedance must trigger a work stoppage and an immediate response and resolution. All particulate measurements, including the baseline measurement, must be documented and retrievable.

Appendix A: Alternative To Outdoor Exhaust Requirements Potential causes exceedance of background levels:

Improper filter placement Filter braces or clips not properly installed.

Tears or damage in the filter media Worn-out or broken gaskets/clips Improper installation of filter spacers Failed Gasket or seals around the HEPA filter

Appendix A: Alternative To Outdoor Exhaust Requirements Potential causes exceedance of background levels:

Incorrectly installed HEPA Filter Dirty discharge ductwork HEPA filter at end of life

Appendix A: Alternative To Outdoor Exhaust Requirements To accommodate the sampling, the negative air pressure machine must be fitted with a 2 ft section of ridged ductwork at the discharge.

The sample port for monitoring must be in the ridged ductwork section.

Vapor generating processes must be assessed and appropriate filtration must be installed to mitigate transmission to the facility.

Appendix A: Alternative To Outdoor Exhaust Requirements HCE must do a complete flow and pressure analysis and document the area to which the air is being discharged to ensure the flow and pressure relationships in that area are not being adversely impacted by the additional flow.

Install device on exterior of work containment to continually monitor negative pressurization. To ensure proper pressure is continuously maintained, the device(s) shall have a visual pressure indicator, data collection and alarm. Same requirement as when exhausting outdoor.

Appendix A: Alternative To Outdoor Exhaust Requirements Exhaust must be directed to Low-Risk areas as defined in Table 3 of the VHA ICRA template.

Ideally this discharge must be located so as not to impinge on high traffic areas or create a nuisance with noise or excessive airflow.

NOTE: Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is not acceptable.

VHA ICRA Resources ICRA FAQ Document: PCRA ICRA FAQs updated October 2024 | Healthcare Environment and Facilities Programs (va.gov) HCE SharePoint under category of Construction Safety: Submitted Questions (sharepoint.com).

VHA PCRA and VHA ICRA template Recorded Training: VHA PCRA and ICRA Form Training.

Additional infection prevention and control guidance and resources: http://vaww.va.gov/InfectiousDiseases/IPC.asp.

ASHE ICRA 2.0™ Process Guide | ASHE image2.jpg image3.png image1.jpeg