Inside the high-stakes world of hospital construction, where specialized training, strict protocols, and experienced construction professionals protect patients while keeping New York’s healthcare system evolving.

Before anyone picks up a tool, the first step in a hospital construction project isn’t demolition. It’s a meeting.

At a recent virtual training session in New York City, contractors, carpenters, and healthcare professionals walked through what happens when construction meets patient care. They talked about airflow, containment zones, and something most people never consider: how a layer of dust, barely visible in the air, can carry spores that put vulnerable patients at risk.

The goal isn’t just to build. It’s to build without harm.

Across the five boroughs, healthcare facilities are constantly being upgraded, expanded, and modernized. From new cancer centers and operating rooms to critical infrastructure upgrades, the work never really stops. At major systems like New York-Presbyterian, Mount Sinai, and NYU Langone, multiple construction projects can be underway at any given time.

The System That Keeps Patients Safe

Like any construction project, teams at healthcare facilities are balancing safety, schedule, and logistics.

In a hospital, they’re also working to control invisible risks — airborne contaminants, dust, vibration, and potential disruptions to critical systems. To manage those risks, hospitals rely on Infection Control Risk Assessment, or ICRA.

“The biggest risk is dust,” said Richard Vogel, an infection control professional who advises union carpenters and contractors on ICRA training programs after decades of experience coordinating infection prevention efforts on major healthcare construction projects. “It can contain spores from fungi, most notably aspergillus, which can be very dangerous for immunocompromised patients.”

Something as routine as opening a ceiling or cutting into drywall can release particles into the air. Without proper containment, those particles can travel beyond the work zone and into patient areas.

At the same time, construction can affect airflow systems, disturb hazardous materials, or interrupt essential services like power, water, and ventilation — all of which must remain stable in a functioning hospital.

“You have to know what’s above you, what’s below you,” said Michael Mattia, a senior superintendent at LF Driscoll, a construction management firm specializing in complex healthcare projects. “Is there an operating room? Can you drill? Will vibration affect equipment or a procedure?”

That’s why healthcare construction demands extensive planning before any work begins.

“It’s basically a team sitting down and figuring out how to protect patients, employees, and visitors,” Vogel said.

While ICRA applies broadly to infection prevention in healthcare settings, construction is one of its most complex and high-risk components — requiring close coordination between infection control teams, facility staff, and contractors.

The process begins early, often during planning and design, and continues throughout construction. It determines how a project is classified, what level of containment is required, and how to prevent contaminants from escaping the work area.

It can also shape how spaces are built — from the placement of isolation rooms to the materials used in floors, walls, and ceilings.

Training That Makes a Difference

For contractors and workers, building in a hospital requires a completely different mindset.

“It’s much different working in a hospital than any other type of construction project,” Vogel said. “Workers are used to moving freely. In a hospital, they have to understand where they can go, how they operate, and why.”

Through CCA Metro, the Carpenter Contractor Alliance of Metropolitan New York, and the New York City District Council of Carpenters Training Center, union contractors, carpenters, and healthcare professionals can access no-cost ICRA training programs tailored to this environment.

These sessions bring together infection control experts and construction professionals to focus on both the science and the practice of safe healthcare construction. Workers learn how infections spread, how airborne particles behave, and how everyday construction tasks can impact patient safety.

They also learn how to build containment barriers, maintain negative air pressure to keep contaminants contained, control entry and exit points, and safely navigate active hospital environments.

At Ronsco, a third-generation New York contractor specializing in healthcare work, that training is central to how the company operates.

“We fully embraced the ICRA training early on,” said Ronsco president Lee Zaretzky. “It’s about raising the bar — making sure our people are prepared and that we’re delivering the safest possible

environment for patients and staff.”

“It’s about vigilance and repetition,” he added. “You’re working in an environment where people are vulnerable. You have to approach everything with that in mind.”

Raising the Standard Across the Industry

Over the past two decades, healthcare construction has become far more structured and standardized.

“Early on, there wasn’t a formal system,” Vogel said. “Now there are established programs, guidelines, and training that have significantly improved how this work is done.”

Today, ICRA is widely required by accrediting bodies and adopted across the country. In New York, where healthcare construction continues at a steady pace, that evolution has been essential.

The state consistently ranks among the most active in healthcare construction, with billions of dollars invested in hospital projects in recent years — and more in development.

As demand grows, so does the need for trained contractors and tradespeople who understand how to operate in these environments.

“Everything is built around controlling the environment,” Zaretzky said. “You’re creating barriers, maintaining airflow, and making sure the work stays contained.”

Coordination at Every Level

Even with strong planning and training, healthcare construction requires constant coordination.

Contractors and their workforce must carefully manage noise, vibration, and movement while maintaining strict separation between construction zones and patient areas.

“You’re coordinating with facilities, with staff, with infection control — everyone,” Mattia said. “Without that communication, the project can fail.”

That coordination extends to every worker on site.

“You’re always teaching,” Mattia said. “Making sure everyone understands what kind of environment they’re in and what’s at stake.”

What’s at Stake

At its core, healthcare construction is about more than delivering a project.

“It’s life safety,” Zaretzky said. “If this work isn’t done properly, the consequences can be serious.”

That responsibility shapes how union contractors approach every phase of the work — from training and planning to execution.

“We’re guests in these facilities,” he said. “Our job is to protect the patients, the staff, and our own workers.”

In a city that never stops building, the difference comes down to who’s doing the work — and how well they’re trained to do it.