Plan an occupied-campus healthcare renovation as two interdependent projects: a controlled construction project and a continuity-of-care operation. Before demolition or repair, define what must remain open, convene infection-prevention, clinical, facilities, engineering, construction and campus-operations leaders, and complete a project-specific infection-control risk assessment (ICRA). Convert that assessment into barriers, airflow and moisture controls, routes, notices, training, inspections and breach responses. Keep the assessment current as conditions change. Before patients and staff return, commission HVAC systems, verify pressure and ventilation conditions, clean the area, flush affected water systems and complete the facility’s documented release process.
Why an occupied college campus requires a different renovation plan
A healthcare renovation on a college campus affects people who do not share the same risk profile or movement patterns. Patients may be medically vulnerable, clinical services may need to continue beside the work, and students, faculty, visitors, deliveries and emergency responders may use the same campus roads and building approaches. Dust, moisture, noise, vibration, utility interruptions and blocked routes can therefore become clinical, safety and academic-operational problems at the same time.
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There is no universal phasing plan for every college. The correct sequence depends on the healthcare service, patient population, building systems, work methods, adjacent occupancy and jurisdiction. The project team must establish applicable building, fire and life-safety, accessibility, environmental, licensing, accreditation, procurement and campus-approval requirements with the relevant authorities.
Use the sequence below as a planning framework, then adapt each control to the facility and the ICRA findings.
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1. Define the scope and operating constraints before design is finalized
Map the physical work and the care that must continue
Describe the work area at room and system level. Identify demolition, drilling, ceiling work, utility shutdowns, plumbing changes, air-distribution changes, finish removal and any work above or below occupied rooms. Map adjacent patient-care spaces, treatment and diagnostic functions, medication and supply storage, staff work areas, public circulation and service corridors.
At the same time, document which clinical services must remain in place, which can move temporarily and which require uninterrupted access. Record operating hours, patient-transfer requirements, isolation or protective-environment needs, medication and specimen routes, emergency access and cleaning schedules. A room that appears outside the construction footprint may still be affected by shared air pathways, water risers, elevators or delivery routes.
Set continuity priorities and decision triggers
Agree in writing on the conditions that require a pause, relocation or escalation. Examples include loss of a required access route, a barrier breach, uncontrolled dust or moisture, an unplanned utility outage, a change in adjacent occupancy or a work method that differs from the ICRA assumptions. Assign one person to authorize a stop-work or clinical relocation decision and specify who must be notified.
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Identify campus interfaces early
List campus events, class schedules, athletic activity, residence-hall traffic, deliveries, parking restrictions and security conditions that could intersect with the work. Reserve routes for ambulances and service vehicles, and determine how accessible travel will be maintained when sidewalks, entrances or elevators are affected. These details require institution-specific planning; infection-control guidance does not establish a universal campus traffic plan.
2. Convene the interdisciplinary team and complete the ICRA
Include the people who understand both care and construction
CDC guidance calls for a multidisciplinary team with infection-control expertise from the inception of demolition, construction or renovation planning. Include, at minimum:
- Infection prevention and control staff.
- Leaders of affected clinical departments and, where relevant, representatives for immunocompromised or otherwise vulnerable patients.
- Facilities management, facility engineering and building-automation specialists.
- Project leadership, the designer or engineer of record and the construction manager or general contractor.
- Environmental services and the staff responsible for cleaning and room release.
- Safety, occupational-health, risk-management, security, accessibility and emergency-management representatives as the project requires.
- Campus operations representatives who control events, transportation, utilities, communications and public access.
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Use the ICRA to evaluate exposure, not just the construction category
An infection-control risk assessment completed before repair, demolition, construction or renovation identifies potential patient exposure to dust and moisture and determines the containment and operational precautions needed. Evaluate the type and extent of work, the vulnerability of patients, the occupancy and function of nearby spaces, and the ways particles or water could travel.
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The ASHE ICRA 2.0 Toolkit provides a matrix, sample assessment and permit materials, process guidance and education. ASHE reported publication of the updated ICRA 2.0 on April 20, 2022; that date describes the toolkit release, not a performance result.
Record the assessment as a live project document
Keep the approved ICRA, drawings, phasing plan, permits and revisions in the project-control system. Identify who can change the assessment and require infection-prevention and facilities review when scope, work methods, adjacent occupancy, pathways or air and water conditions change.
3. Convert ICRA findings into enforceable field controls
Contain the work area according to the assessed hazard
Specify the barriers, access points, seals, doors, vestibules, pressure strategy, waste route and material-delivery route required for this project. Do not select one barrier or pressure arrangement by habit; the ICRA and facility engineers must determine what is appropriate for the work and surrounding spaces.
Define how barriers will be installed, inspected, repaired and removed. Show them on the drawings and identify every penetration for pipes, cables, ducts and temporary services. Establish a controlled worker entrance and a method for moving tools, debris and materials without passing through patient-care areas unless the plan explicitly permits it.
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Control dust, debris and moisture
- Use the assessed containment and housekeeping procedures for demolition, cutting, drilling, ceiling access and debris removal.
- Protect occupied spaces from dust migration and promptly correct any visible escape.
- Plan for leaks, wet materials, condensation and water intrusion; assign who isolates a source, protects patients and equipment, removes wet materials and documents the response.
- Keep construction debris covered or otherwise controlled during movement and define where it may be staged.
- Coordinate cleaning frequency and methods with environmental services rather than leaving cleanup to an undefined end-of-shift task.
Manage air movement and consider supplemental HEPA filtration
Understand the existing and temporary airflow and pressure relationships before work begins. Facility engineers should determine whether portable, industrial-grade HEPA units are needed as a supplemental measure, where they should be placed, how they will discharge air, how filters will be serviced and how operation will be monitored. A portable unit does not replace engineered containment, correct pressure relationships, sealed barriers or disciplined work practices.
CDC describes portable industrial-grade HEPA filtration as a possible way to remove respirable particles when needed. Selection and placement must follow the ICRA, the building systems design and the facility engineer’s judgment; the guidance does not establish a single consumer product or model for all renovations. See CDC air and ICRA guidance.
Train workers and staff before they enter the work zone
Provide orientation for construction workers, subcontractors, affected healthcare staff and any campus employees whose routes or duties change. Cover the approved access route, personal protective requirements, barrier rules, cleaning expectations, prohibited activities, reporting contacts and the immediate response to a breach, spill, leak or unplanned alarm. Keep attendance and competency records.
Put infection-control obligations in contracts
Construction agreements should incorporate the applicable ICRA requirements, inspection access, housekeeping standards, notification duties, stop-work authority, correction deadlines and consequences for noncompliance. Require subcontractors to flow the same obligations to their own workers. Define how a deficiency is logged, who verifies correction and when the work may resume.
Post clear hazard notices
Post notices at construction entrances, affected corridors and approach routes. Identify the hazard, restricted area, alternate route, required authorization and contact for questions. Update signs whenever phasing or access changes. CDC specifically recommends hazard notices and pedestrian routing that keeps people away from work areas; see the CDC environmental infection-control recommendations.
4. Coordinate clinical care, campus movement and communications
Build a phasing plan around real movements
Draw the routes used by patients, staff, visitors, emergency responders, deliveries, waste, specimens, equipment and construction crews. For each phase, show the open entrance, accessible path, elevator, restroom access, fire-exit path, loading location and temporary clinical destination. Test the route with the people who will actually use it, including wheelchair users and patient-transport staff.
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Separate construction traffic from patient and public traffic wherever the building and campus allow. Schedule noisy or disruptive work around treatment and teaching activities only after clinical leaders confirm that the proposed hours are workable. Coordinate utility shutdowns with clinical departments, information technology, laboratory services, security and campus utilities; document contingency plans for each interruption.
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If a service moves, verify that the temporary location supports the required equipment, hand hygiene, privacy, medication and specimen workflows, emergency response, accessibility and environmental conditions. Establish the move and return dates, signage, patient notifications, staff instructions and approval authority. Do not assume that a nearby room is clinically equivalent merely because it has similar square footage.
Use a communication cadence that matches the risk
- Hold a preconstruction meeting with all affected disciplines and the contractor.
- Issue a phase notice before every route, utility, access or occupancy change.
- Use daily or shift-level coordination for high-risk work, shutdowns and barrier changes.
- Provide a single escalation channel for dust, moisture, pressure, noise, access and safety incidents.
- Keep a decision log showing the issue, owner, action, verification and date closed.
Campus event coordination, traffic control, temporary locations and institutional approvals are local decisions. Confirm them with the college’s facilities, accessibility, security, emergency-management and communications offices rather than treating CDC guidance as a complete campus design or code manual.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.5. Inspect and reassess as conditions change
Use routine field checks to detect small failures
Inspect barriers, doors, seals, pressure indicators, routes, notices, housekeeping, waste handling and equipment at a frequency appropriate to the risk. Record findings with photographs or other evidence, assign corrective actions and verify closure. Include infection-prevention and facilities personnel in inspections where the ICRA requires it.
Reopen the ICRA when assumptions change
Reassess before adopting a new demolition method, opening a ceiling beyond the planned area, changing a barrier, occupying an adjacent room, rerouting air or water, extending work hours or responding to a leak. A change that seems minor to the contractor can alter exposure for a nearby patient population.
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Understand what air sampling can and cannot establish
CDC identifies airborne-particle sampling as a tool for evaluating barrier integrity. Use it as part of a defined investigation or verification plan, not as an all-purpose guarantee of safety. CDC states that it offers no recommendation on routine microbiologic air sampling before, during or after construction or before or during occupancy of areas housing immunocompromised patients. Sampling decisions should therefore be tied to the project’s hazards, clinical needs and facility procedures.
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Respond immediately to a breach
- Stop the activity that caused or is worsening the breach.
- Protect patients, staff and the public by restricting the affected route or area as needed.
- Notify the designated infection-prevention, facilities, clinical and project contacts.
- Control dust, moisture, debris or airflow through the approved corrective method.
- Inspect adjacent spaces and determine whether cleaning, relocation, ventilation adjustment or further assessment is required.
- Document the event, corrective action, verification and decision to resume.
6. Prepare HVAC and water systems for return to service
Commission renovated HVAC systems before occupancy
Commission the HVAC systems serving renovated healthcare spaces before occupancy and use. Verify the air changes, humidity, pressure differentials, supply and return operation, controls, alarms and filter condition required for the space and its clinical function. Pay particular attention to ventilation serving operating rooms, airborne infection isolation rooms and protective-environment areas.
Restore the intended system configuration after temporary construction arrangements are removed. Clean or replace filters as required, dispose of spent filters safely and retain commissioning records, balancing results, control settings and unresolved-item logs. The CDC recommendations describe these commissioning and environmental-control expectations.
Flush and verify affected water systems
Construction can disturb sediment in piping. CDC recommends flushing water systems to clear sediment. Coordinate the flushing sequence with facility engineering, infection prevention, clinical users and any applicable water-management program. Record outlets or branches flushed, dates, responsible personnel and any follow-up testing or corrective work required by the facility’s procedures.
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7. Clean, release and reopen the renovated space
Barrier removal is a controlled clinical decision, not the final contractor task. Use the facility’s documented cleaning and release procedure, with infection prevention, environmental services, facilities engineering and the affected clinical leader involved as required.
- Confirm that construction is complete or that any remaining work is isolated from the release area.
- Remove debris, tools, temporary protection and spent filters using the approved route.
- Perform the specified terminal or post-construction cleaning, including surfaces, equipment exteriors, ceiling spaces or other areas identified by the facility procedure.
- Inspect for dust, moisture, damaged finishes, penetrations, leaks and incomplete sealing.
- Verify HVAC operation, air changes, humidity, pressure differentials, controls and filters for the renovated space.
- Complete required water-system flushing and document the result.
- Obtain clinical, infection-prevention, environmental-services and facilities sign-offs required by the facility’s release process.
- Remove barriers and construction notices only after approval, then restore normal patient, staff, delivery and emergency routes.
- Update room inventories, drawings, operating procedures, emergency plans and maintenance records before routine use resumes.
The release record should identify the area, date, approving roles, cleaning completion, HVAC and water verification, outstanding restrictions and the person authorized to return the space to service. Keep it with the project closeout and facilities documentation.
Practical decision points for portable HEPA equipment
Portable industrial-grade HEPA filtration may be appropriate when the ICRA identifies a need for supplemental particle removal. Decide with the facility engineer and infection-prevention lead by considering:
- The hazard and work method generating particles.
- The vulnerability and function of adjacent patient-care spaces.
- Existing airflow and pressure relationships.
- Available electrical power, noise, heat and physical space.
- Where filtered air will discharge and whether that discharge changes room pressures.
- Access for inspection, operation, filter changes and safe disposal of spent filters.
- How operation will be documented and what condition triggers adjustment or removal.
The equipment category sometimes described as a portable HEPA air scrubber is not a substitute for sealed barriers, appropriate pressure control, worker training, housekeeping and route separation. The CDC air guidance treats portable industrial-grade HEPA units as a possible supplemental control, not a universal solution.
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A complete handover package lets the college operate the renovated space safely after the construction team leaves. Assemble:
- Approved ICRA, revisions and permits or assessments.
- Phasing, access, detour and emergency-route plans.
- Training rosters and worker-orientation materials.
- Barrier, housekeeping, pressure and route inspection logs.
- Incident, breach and corrective-action records.
- HVAC commissioning, balancing, controls, pressure and filter records.
- Water-system flushing records and related water-management documentation.
- Cleaning completion and clinical release approvals.
- Updated drawings, equipment information, maintenance requirements and operating restrictions.
Retain these records according to the college, healthcare operator, licensing authority and accreditation requirements that apply to the project.
Quick Recap
Planning references
- CDC: C. Air | Infection Control — air pathways, ICRA considerations, particle control and HEPA filtration.
- CDC: Part II. Recommendations for Environmental Infection Control in Health-Care Facilities — multidisciplinary planning, construction precautions, commissioning and operational controls.
- CDC: Summary of Recommendations — summarized environmental-control recommendations, including sampling and water-system considerations.
- ASHE ICRA 2.0 Toolkit — assessment matrix, sample permit, process guidance and education.
- ASHE announcement dated April 20, 2022 — publication notice for the updated ICRA resource.
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