Performance Work Statement (PWS)
Convert a Hotel into an Acute Alternate Care Site (ACS)
Target Audience: NFPA 99 Category 2 “Plus” Patient Space, which is defined as “activities, systems, or equipment whose failure is likely to cause minor injury of patients, staff, or visitors” (NFPA 99 para. 4.1.2) plus additional Category 1 provisions (Critical Care – risk of major injury or death) as relates to the specific needs of a COVID-positive patient on the ventilator (NFPA 99 para. 4.1.).
*USACE: Italicized fonts within this PWS are for directions or recommendations unique to the Government. They generally precede or follow bracketed sections or statements of the PWS. These bracketed sections can be left remaining in the PWS, or removed depending on the site specific conditions and needs. Please remove all brackets and italicized font before issuing to the Contractor.
This PWS provides minimum criteria for “sufficiency of care” to provide a rapid response to the expected need, therefore, it is critical that local authorities and/or Area Fire Marshal are involved in the development of the design and acceptance of this site.
The Contractor shall provide all necessary labor, materials, and equipment in order to convert HOTEL XXXXXX to an Alternate Care Site in order to achieve a “sufficiency of care” model meeting critical elements of healthcare for an infectious COVID-19 patient. Standard hotel layouts provide the opportunity for single patient rooms with negative pressure isolation to meet infection control requirements. Hotel infrastructure has many built-in fire protection and life safety safeguards. An emergency duty generator shall be installed along with essential power circuits to ensure patient safety due to the heavy reliance on ventilators and patient telemetry. Centralized medical gas systems will not be provided and instead medical equipment solutions will be relied upon including Ventilator with integral drive gas generation and oxygen concentrators or bottled oxygen. Communications systems will rely upon hotel WIFI infrastructure. Challenges will be mostly logistical as these ACS’s will need to be supported by a nearby full service hospital to provide logistics, materials, and waste management support and nutrition care.
[The Contractor shall be responsible for the demobilization and removal/disposal of all facilities and equipment upon completion of this work and the restoration of the permanent site as necessary in order to return it to its original state.] – This can be edited, removed, or included as contract and site lease agreements dictate.
2. FUNCTIONAL REQUIRMENTS
2.1 Concept of Operations
This Alternate Care Site (ACS) will act as a temporary satellite Ward supported by a nearby full service hospital. The full service hospital will provide the logistics, materials and waste management support, nutrition care etc. All dirty and clean supplies would be transported to/from the full service hospital. Clinicians will utilize the patient bathroom sinks for hand washing. Family visitation capabilities will not be provided. Acute patient beds would need to be home-care style hospital beds that have the capability to raise/elevate head and foot of the patient on ventilators/respirators. First floor level will be considered a clean zone for staff and support areas. Upper floor levels will be considered Dirty (hot) zones for infected patients and treatment. One (1) stairwell shall be designated as clean and one (1) as dirty, at opposite ends of the building (distinct separation) where practical.
Building shall be free of asbestos, lead paint and mold.
Security measures shall assessed and provided with perimeter fence, site access control, door access control and security guards. Security guards shall be a service contract with local security company procured by the Contractor for the duration of this project.
Patients will be transported to the site via ambulance from local hospital or clinic. No walk in patients allowed.
At a minimum, the conversion will contain the following facilities:
- Ground Floor – On-Duty Quarters, Break Room, Laundry Room, Command/Center, Security, Patient Check-In/Nurses Station, Dining, Sterile Storage, Kitchen, Medical Storage, Pharmacy & Patient Screening.
- Upper Floors - Patient Rooms, Nurse Station, Break Room (respite area), Sterile Storage, Work Room, Dirty Linens, Clean Linens, and Clean Room/Staff De-Con.
2.2 Site Modifications Required
The following are the anticipated site modifications required to convert a modern hotel to achieve ACS standards for an infectious isolation patient (COVID), NFPA 99 Space Category 2 “Plus”. Site selection should be based on confirming the critical assumptions and design intent in Section 3.
The Contractor shall provide all necessary labor, equipment and materials in order to provide the following equipment, materials, and services in accordance with this PWS and all applicable guidance, codes, and regulations.
[The Contractor shall validate elevator(s) in order to confirm that an ambulance stretcher and/or patient bed could be accommodated.] This can be removed if the elevator is validated prior to award (preferable). If the elevator cannot accommodate, then the site should not be used.
The Contractor shall convert a minimum of 1 hotel rooms located on each floor to a fully functional Nurse Station. However, when patient rooms on a single floor exceeds ten (10), then additional rooms shall be converted to a Nurse Station. Further, there shall be one Nurse Station per smoke compartment/zone if the floor is divided.
The Contractor shall remove existing carpet and base within each room and corridors on each designated patient floor level and dispose of. The Contractor shall replace with epoxy coating with non‐slip surface with integral epoxy base OR sheet vinyl flooring with welded seams and integral cove base. [Alternate Approach: If keeping the existing carpet and base, install 3/4 inch marine grade plywood or 1/2 inch cement board (seal seams) over carpet for entire areas with a sheet vinyl aseptic flooring material.] The Contractor shall submit for approval to the Government the flooring material to be utilized.
The Contractor shall replace the existing solid room door and replace with a door with a half window (must be either rated or smoke tight for LS Code).
The Contractor shall seal all utility and other wall penetrations to prevent the transfer of air between rooms and corridor.
The Contractor shall provide and install new rooftop isolation exhaust fan unit(s) with High Efficiency Particulate Air (HEPA) filtration and a pre-filter connected to each bathroom exhaust duct riser in order to achieve negative room pressure. Provide for 200 cfm exhaust per patient room or as needed to achieve the 0.01 inches water column negative pressure. Validate duct static pressure limitations during design to ensure the duct integrity will be maintained at the higher static pressures. If Packaged Terminal Air Conditioners (PTAC’s) or other unitary equipment with air intakes are utilized, the fresh air intake shall be sealed off to ensure negative room pressurization. Penetrations between the patient rooms and corridors shall be sealed to ensure room pressurization is achievable. Isolation room pressurization requirement is 0.01 inches water gauge per ASHRAE 170.
Facilities without centralized bathroom exhaust will need to consider alternative engineering solutions to achieve individual room negative pressurization such as the use of “negative pressure machines” with HEPA exhaust.
The Contractor shall provide and install a new rooftop supply air handling unit(s) to augment the corridor make-up air in order to maintain corridors slightly positive to the patient rooms. Include pre-filter (MERV 7) and intermediate filter (MERV 14) in the supply air unit. The increased supply air may require upgrading of the buildings central systems. Contractor shall use readily available AHU equipment such as packaged DX/heat pumps where feasible to minimize site impacts and achieve the construction schedule.
The Contractor shall validate that the return air from the patient floors is not being recirculated to the first floor to maintain the first floor as a clean zone. If the return system cannot be isolated, install a HEPA filter in the return air path or supply AHU’s (filtering both return and outside air).
The HVAC equipment may be either roof mounted or in other mechanical spaces to accommodate the larger supply and exhaust AHU’s.
All testing, adjusting
and balancing shall be performed by qualified HVAC specialist and a certified and accredited TAB specialist.
[The Contractor shall investigate, validate, and provide if required, additional roof framing and support structures to support new larger roof top units (supply and exhaust).] Substantial level of effort. If not required, or already known that no additional structural support is required, this can be removed. Additional structural support will endanger target site readiness of 30 days.
The Contractor shall provide ball-in-wall style visual negative pressure indicators (mechanical) at each room.
The Contractor shall provide and install the electrical system for the period of performance. The Contractor shall provide an NFPA 110, type 10, level 1, emergency generator on a flatbed or on pad with skid mounted tank. Contractor to provide fuel supply in order to maintain continuous operation of generator for 24 hours before refueling. Contractor must meet state and local fuel containment requirements. The Contractor shall provide exterior switch board with automatic transfer switches; and connect switch board to generator power and site normal power to create an NFPA 99, chapter 6, type 2, essential electrical system. If the site does not have normal power, normal power has insufficient capacity, or normal power does not have the required versatility; upgrade normal power as required, including the service transformer. Depending upon existing, a separate normal power switch board may be required. The Contractor shall comply with all municipal codes, including NFPA 70, 99, and 110. The electrical system must be installed to operate for the duration of the emergency and may be installed under NFPA 70 article 590, Temporary Installations, if code compliant. The generator may be configured as a second service as allowed by NFPA 70 article 230.2A, for “special conditions”.
Site shall have existing power panels on floors, for at least one circuit each room (normal power), to supply bed receptacles described below. A 20 ampere normal power circuit, shall be extended to each room, in order that there are no more than 6 receptacles on the circuit at the patient bed and redundant grounding is provided per NFPA 70 article 517.13A. May consider medical grade armored cable. Circuits may be mixed by patient rooms, but no more than 6 receptacles per circuit at the bed. Other existing receptacles must have an equipment grounding conductor; older hotels without grounded receptacles shall not be considered.
The temporary exterior switchboard with transfer switches shall create life safety and equipment branches. The Contractor shall provide, equipment branch and life safety branch panels on each floor. Contractor may consider corridor location for panels. Provide feeders to panels from the exterior switch board. The Contractor may consider exterior risers and feed through panels to reduce cost. Provide keyed panels to limit access. Use the existing normal branch power panel with the new equipment branch power panel to supply patient beds in accordance with NFPA 70 article 517.18A. Provide a connection between ground busses in the normal and equipment branch panels serving patient care areas, as required by NFPA 70 article 517.14.
Provide a dedicated circuit from each equipment branch panel to each patient room, to nursing stations, and to medication room. For each NFPA 99 category 2, general care, patient bed, the circuit must be provided with mechanical protection and redundant grounding in accordance with NFPA 70 article 517.13A. Medical grade armored cable may be considered.
The Contractor shall intercept emergency lighting circuits on each floor and extend to life safety panels. The Contractor shall perform the same for fire alarm, plus other alarm and altering systems required by NFPA 70. If the site contains elevator(s), one shall be connected to the life safety branch.
Bedrooms: The Contractor shall provide 8 receptacles by each bed (4 each side). Circuit half of the receptacles to an existing normal power panel and the other half to generator equipment branch panel. Add surface mount light fixture over each bed to serve as an examination light (1100 lux) and connect to generator equipment branch. Add a second fixture in each room to provide ambient general lighting (300 lux) and a night light connected to generator equipment branch, to allow nurses check on patients.
Nurse stations: The Contractor shall add new surface mounted light fixtures (700 lux) and receptacles at nurse stations and circuit to generator equipment branch.
Medication rooms: The Contractor shall add new surface mounted lighting (1100 lux) and receptacles. Circuit all to generator equipment branch.
Provide electrical connections to equipment in place and mechanical equipment, including heating and cooling equipment, and isolation exhaust AHU’s. Connect isolation exhaust AHU’s to the equipment power. Connect other mechanical equipment to normal power.
Receptacles shall be duplex 20 ampere. Minimum size #12 branch circuits. No more than 6 receptacles in patient care areas shall be connected to a single circuit. Light fixtures shall be 90 CRI minimum. Illumination levels shall comply with IESNA unless more stringent levels are specified herein. Egress and emergency illumination shall be provided as required by NFPA 101. Provide independent switching for general, task, examination, and night lights.
Temporary power plan. The Contractor shall prepare a Temporary Power Plan, before beginning work, and make the plan available to the Government. Contractor is responsible for design, selection, and sizing of equipment to meet this PWS and municipal codes. Contractor shall prepare drawing(s) showing locations of all new equipment, connections to existing equipment, one-line diagrams with sizes, supporting calculations, and proposed installation methods for wiring and equipment.
2.6 Plumbing / Medical Gas
The Contractor shall adjust domestic hot water supply to 140 deg. F at generation where feasible with minimum 124 deg. F at return to meet Legionella prevention standards. Contractor shall provide and take measures to ensure scald prevention devices are in place.
Provide water and sanitary connections as needed to serve medical equipment and nutrition care.
[No centralized medical gas shall be provided. Bottled oxygen shall be utilized and stored in dedicated hazardous storage room. Patient daily demands for storage and logistics is estimate at 25,000 liters per day.] Select this paragraph or the next two paragraphs
[Medical gas demands will be initially met with portable bottles and therefore hazardous storage areas shall be provided by Contractor. Patient daily demands for storage and logistics is estimate at 25,000 liters per patient per day.
Provide piped oxygen systems to all patient rooms compliant with NFPA 99 as a Category 1 system. Separate systems shall be provided for clusters of rooms, with each system serving no more than 100 patients. Each system must be piped to an outside connection point where it is feasible to site a bulk oxygen tank with vaporizer (coordinate location with the bulk oxygen supplier). Provide one oxygen outlet per patient bed at 20 liters/min. Connection style to be coordinated with the State Health department. No diversity should be applied to the design demand. Medical gas verifier shall not be hired by the installing contractor but shall be hired directly by the prime contractor. Provide an emergency oxygen supply connection on the building exterior near a loading dock or other logical connection point. Valves and pressure control devices must be in accordance with NFPA 99. A zone valve box with area alarm shall be provided for each floor or wing. Master alarm shall be provided at the main Nurse Station. Area alarms shall be both at the nurses station (if on the floor) and at the master alarm panel.]
2.7 Fire Protection / Life Safety
This is a conceptual design, therefore, it is critical that local authorities and/or Area Fire Marshal must be involved in the development of the final design and acceptance of this site.
The following items must be coordinated with the local authorities and/ or Area Fire Marshal prior to acceptance of this site.
• Provide a Fire Safety Plan in compliance with NFPA 101 or with local/State/Federal Regulations for each site.
• Dedicated fire watch must be provided 24/7 on-site. This fire watch person cannot be part of the medical staff.
• Medical staff and fire watch personal must be trained to the Fire Safety Plan.
• Fire department Operations
A life safety plan shall be provided prior to the beginning of work for review and approval by the Area Fire Marshall.
When not existing, the Contractor shall provide non-combustible partitions with 1 ¾ inch thick solid-bonded wood core doors within the corridor to divide every story used for sleeping rooms for more than 30 patients into not less than two compartments. This feature will provide safeguards for the horizontal relocation of patients while waiting for evacuation by emergency services. Contractor shall, where feasible, locate these non-combustible partitions near elevator lobby areas. Optional upon site selection, existing conditions may be deemed adequate. Adjust language as necessary.
Contractor shall properly firestop all penetrations within the floor/ceiling assemblies and the corridor walls.
Hazardous areas in accordance with NFPA 101 shall be separated from adjacent areas via 1- hour fire resistance rating and provided with a ¾ hour fire rated door assembly, i.e., central/bulk laundries, larger than 100 square feet, pharmacy, rooms with soiled linen in volumes exceeding 64 gallons, storage rooms larger than 100 square feet and storing combustible material, rooms with collected trash in volume exceeding 64 gallons, and laboratories employing flammable and combustible materials in quantities that would be classified as severe hazard.
Medical gas storage shall comply with NFPA 99.
The Contractor shall provide and install emergency lighting in areas which patients would require the use of life support systems.
The Contractor shall utilize broadband capabilities for clinicians to VPN into their regional center for health record accessibility and other needs. This VPN connection will enable leveraging the main hospital's cybersecurity posture. The Contractor shall provide and install wireless cameras throughout each floor for viewing at nurse stations. Existing outside plant cabling shall consist of 12 strand fiber optic cabling upgradable to at least 1 Gbps otherwise it shall be provided as part of the contract.
The Contractor shall provide and install a simplified nurse call system that allows each patient to communicate with/signal to the nurse’s station and allows the nurse’s station to identify the specific patient/location of the call.
Contractor will provide wireless video monitoring/conferencing system from each patient room to the nurse station. Video call quality in HD capable operating at least 1.5 Mbps.
The Contractor shall submit a schedule to the Government within 24 hours of Notice-To-Proceed (NTP).
updated March 30, 2020