Performance Work Statement (PWS)
Convert a Convention Center into an Alternate Care Site (ACS) Utilizing Pre-Fabricated Shell, Site-Built-Out, Self-Contained Isolation Units (SCIU’s)
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.)
1. GENERAL
The Contractor shall retrofit the selected space into an Alternate Care Site (ACS) to serve acute care (COVID-19) patients. This effort is to provide an Alternate Care Site meeting basic healthcare functions with an emphasis on patient isolation, infection control, fire protection and life safety. Advantages to the user of this space are greater patient density enabling a reduction in healthcare workers and faster construction time as well as greater use of prefabricated construction (e.g. Portable Bathroom Trailers, conex for patient and support service spaces etc.). The ACS shall serve as a satellite patient ward supported by a nearby full service hospital. The full service hospital will provide the logistics, materials and waste management support, nutrition care etc.
[The Contractor shall be responsible for the demobilization and removal/disposal of all Sites, units, 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 paragraph can be removed or edited as contract and Site lease agreements dictate.
2. FUNCTIONAL REQUIREMENTS
2.1 Concept of Operations
The space shall serve as an Alternate Care Site (ACS) serving COVID-19 utilizing pre-fabricated (offsite) Self-Contained Isolation Units (SCIU’s) in a suite configuration for acute care COVID-19 patients. Spaces are considered to be Category 2 “Plus.”Category 2 “Plus” is defined as NFPA 99 Category 2 (patient care “activities, systems, or equipment whose failure is likely to cause minor injury of patients, staff, or visitors”) (Reference 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.). This Alternate Care Site (ACS) would act as a temporary satellite Ward supported by a nearby full service hospital. The Contractor shall divide the space into “zones” as such: Zone 1 - Utility zone at perimeters, Zone 2 – Support at Perimeter, Zone 3 – (Center) – Patient Care Area. The Contractor shall provide all temporary Sites in order to execute a fully functional ACS within the convention center space. This includes Sites such as: toilets, showers, medical waste, pharmacy, general waste, hand-washing Sites, morgue (refrigerated Sites), and other requirements included herein.
2.2 Site Modifications Required
The following are the anticipated Site modifications needed to convert a convention area space to an ACS. Site selection should be based on confirming the critical technical features to achieve minimum life safety and infection control standards.
The Contractor shall provide all necessary labor, materials, and equipment to provide the following equipment and temporary/portable Sites in order to convert the selected space into an ACS.
2.2.1 Self-Contained Isolation Unit Design (SCIU):
2.2.1.1 – Concept & Layout The SCIU shall be fabricated off-site for delivery by the manufacturer to the project site. SCIU units dimensions to be determined by availability and manufacturer, but shall not be larger than can be delivered by commercial vehicles (53’ trailer). The only off-site fabrication of the SCIU shall be the “shell,” meaning outside modifications (access doors, sight-glass, windows, utility connection points, etc.) and interior modifications to the unit so as to deliver a unit with insulated, cleanable, washable, durable finishes.
The Contractor shall provide all materials, labor, and equipment to construct the interior walls, counters, & architectural appurtenances in order to accept the necessary fixtures and equipment. The Contractor shall submit an interior architectural layout of the unit showing patient spaces, staff anteroom, receptacles, utility connections, and other necessary information to the Government prior to on-site build out.
The unit must be “self-sustaining” for critical care meaning, at a minimum, the SCIU shall have the ability to support the treatment of a patient with an airborne infectious disease fully within the unit. This includes negative air with filtration prior to exhausting to the atmosphere, patient sinks and toilets within the enclosure, sufficient power capacity and quantity of receptacles, and lighting. A single SCIU unit can house more than one patient. However, each patient area shall be completely distinct, independent, and sealed off from the other patient area(s).
The Contractor shall be responsible for offloading, setting, & securing/anchoring each SCIU in the pre-designed configuration and layout. The SCIU units shall be structurally rigid. The concept of the SCIU is a “conex”-type structure customized to hold and treat acute-care COVID-19 patients. Each SCIU shall provide no less than 100 square feet of space for each patient. This space also includes bathroom and sink space. Each unit shall contain a separate ante-room (not included in the minimum 100 square feet of patient space) that can be accessed without entering the patient space first, and contain a hand washing sink for the healthcare providers prior to entering the patient spaces (reference concept drawing for clarity). Patient spaces shall be accessed from the outside by a separate entryway in order to maintain clean/dirty separation.
2.2.1.2 Utilities The units shall have the capability to quickly connect electrical, potable, and sanitary sewer utilities from the outside. [Sanitary sewer shall be stored in blackwater tanks with a minimum capacity of 110 gallons per patient. These tanks shall have the ability to be pumped out with a standard vacuum truck at regular intervals.] May elect not to have working toilets, only bedside commode. If so, remove sanitary sections and provide area for cleaning/disinfection.
SCIU shall contain interior lighting for all areas. Exterior lighting shall consist of wall-mounted lighting at all entry/exit doors.
Receptacles shall consist of four (4) quadplex surge-resistant receptacles, and six (6) duplex receptacles located along interior walls for each patient room. The SCIU shall contain two power distribution panels per unit, to supply patient beds in accordance with NFPA 70 article 517.18A. One shall be connected to building normal power, which is the normal branch. One shall be connected to the second generator switch board, which is the equipment branch. Panels shall be keyed to limit access. Provide a connection between ground busses in the two panels serving patient care areas, as required by NFPA 70, article 517.14. Normal and equipment receptacles shall be distinguished via labeling or receptacle coloring.
Provide a dedicated circuit using medical grade armored cable from each panel (normal and equipment branches) to each NFPA 99 category 2 SCIU in accordance with NFPA 70 article 517.13A. For NFPA 99 category 3 basic care beds, the equipment branch circuit need not be dedicated and both circuits need not include redundant grounding; therefore other NFPA 70 temporary wiring methods may be considered.
Air conditioning shall be provided by wall mounted package units installed on the exterior of the unit. Each A/C unit shall include a remote thermostat with tamper-proof lock box. Unit shall have no return and utilize 100% make-up air. Negative air scrubbers with HEPA filtration shall be installed within the SCIU (see Mechanical paragraph below).
Plumbing lines shall be sufficient to supply standard velocity and pressure for toilet and sink needs and shall have the ability to be quickly connected to from the outside, utilizing standard means and methods (e.g. ¾” garden hose-style connection), to the Site potable water supply.
SCIU shall contain porcelain, foot flush, low consumption toilets (1 per patient) and minimum 15”x15” stainless steel drop-in sinks with gooseneck faucet and paddle handles.
Electric water heaters, point of use/on demand, shall be installed in the SCIU so as not to reduce 100 square foot patient care area requirement.
SCIU shall have the capability to accept med gas (02) lines from the exterior of the unit into the patient areas while maintaining a negative pressure state within the SCIU.
The SCIU shall have a low-pressure alarm, one per patient room.
The Contractor shall provide one (1) fire extinguisher per room, minimum 5 lb. size.
All electrical, plumbing, telecommunications, and other utility lines shall be run overhead (on top of SCIU’s) utilizing unistrut or other lightweight, commercially available structural members to mount/brace utilities and span walkways and corridors between units. All ingress/egress requirements shall be maintained. Proper clearances between utility lines (e.g. electrical, potable water) shall be maintained while running parallel above SCIU units. This will reduce congestion and open up corridor space while ensuring utility runs are as straight and unimpeded as feasible.
2.2.1.3 Architectural SCIU shall contain exterior patient doors no smaller than 48”x79” per patient room with weather protective neoprene bulb seal, drip shield, continuous hinge with vinyl dust cover, hydraulic closer (hold open version). Air lock/patient room door from anteroom shall be a minimum of 30” x 80” and contain 7” x 22” vision panel. It shall include non-keyed lever set door lock and hydraulic closer (air to pass under door).
The Contractor shall provide exterior access for wheelchairs/gurneys to enter the patient doors. ADA-compliant ramps are acceptable per 48” wide patient door. Steps shall be provided for the staff entrance. Secure and anchor as necessary.
2.2.1.4 Finishes These units shall be Individual Treatment Room/ Pod Designs and conform, at a minimum, to the following requirements: Floor, ceiling, and wall surfaces shall be cleanable and washable for disinfection. Flooring shall be seamless. Interior finishes shall be sealed for a durable, waterproof interior.
2.2.2 Temporary/Portable Sites to Support Patients & Medical Staff:
Hand washing sinks should be provided at nurse’s station areas for hand-washing: The Contractor shall provide 1 sink per 3 nurses at all nurse stations. Temporary/portable hand-washing station shall have the ability to maintain hot water in accordance with all applicable codes/requirements. The Contractor shall either utilize the Site’s potable water/wastewater utilities and tap into these utilities where practicable OR provide the services to provide potable water and wastewater disposal services at a rate of 15 L/per day per Patient & Caregiver. Temporary/portable structures shall be comprised of non-combustible materials and shop drawings/product data sheets shall be submitted to the Government for review and approval. Contractor shall take care that potable/sanitary lines do not interfere with ingress/egress and shall utilize means and methods (e.g. lift stations, etc.) as required by the site-specific conditions in order to achieve this
Temporary/portable bathrooms (Staff Only): The Contractor shall provide and install temporary/portable toilets with sinks to be located inside the space in close proximity to the patient areas. The number of toilets shall be 1 per 20 people and ADA compliance as required. The total number of temporary/portable units is based on the Contractor’s selection per the International Plumbing Code (IPC) with respect to the design/construction of the individual units (i.e. 2 toilets/sink per trailer, etc.). These temporary/portable Sites shall be tied into the existing potable/wastewater utilities where practicable. If this is not practicable, then the Contractor shall provide the services to maintain adequate potable water and waste disposal services for the duration of this requirement. Contractor shall take care that potable/sanitary lines do not interfere with ingress/egress and shall utilize means and methods (e.g. lift stations, etc.) as required by the site-specific conditions in order to achieve this.
Temporary/Portable Showers (Staff Only): The Contractor shall provide and install temporary/portable showers to be located inside the space in close proximity to the patient areas. The total quantity of individual showers shall be based on a need of 3 people per hour for 24 hours and ADA compliance is required per IPC. The total number of temporary/portable units (i.e. 4 showers per trailer/conex, etc.) is based on the Contractor’s selection of the design/construction of the individual units. Contractor shall take care that potable/sanitary lines do not interfere with ingress/egress and shall utilize means and methods (e.g. lift stations, etc.) as required by the site-specific conditions in order to achieve this.
*Note – The following paragraphs may need to be edited contingent on the agreement with the supporting medical care Sites for the operation of laundry/linens/medical waste/general waste. They may be supported by the Site and their existing service contracts OR operated by the Contractor.
[Temporary/Portable Laundry: The Contractor shall provide and install temporary/portable laundry Sites to be located inside the space in close proximity to the patient areas. Laundry Sites shall include automatic washer & dryer (separate or two-in-one style units) and be able to service 250 sets of clothes daily for all patients and caregivers. Water & greywater shall be tied into the Site’s existing potable and sewer utilities where practicable. If not practicable, the Contractor shall provide services for potable water provision and wastewater disposal as necessary to allow for full functionally as described above. Contractor shall take care that potable/sanitary lines do not interfere with ingress/egress and shall utilize means and methods (e.g. lift stations, etc.) as required by the site-specific conditions in order to achieve this.
Temporary/Portable Soiled Linen Storage: The Contractor shall provide/install temporary/portable soiled linen storage to be located inside the space in close proximity to the patient areas. Storage Sites shall be considered hazardous areas per NFPA 101. Provisions shall be provided for protection.
Temporary/Portable Medical Gas (Med Gas): The Contractor shall provide, install, and supply temporary medical gas storage and use Sites to support the patient areas. Temporary/portable structure shall be fabricated from non-combustible materials and conform to all applicable local/state/federal transportation and utilization criteria and laws. Medical gases required for this ACS will be: O2. Oxygen (O2). Med gas storage Sites shall be considered hazardous areas per NFPA 101. Provisions shall be provided for protection based on quantity. Separation of full / empty tanks with appropriate signage, tank restraints or holding container per code.
Temporary/Portable Ice Machines: The Contractor shall provide, install, maintain, and supply temporary/portable ice machines in order to provide ice at a rate of 5 lbs/day per patient, not to exceed 3,100 lbs/day. The Contractor shall tie the temporary/portable ice machine into the Site potable water utility where practicable. If not practicable, the Contractor shall supply the ice machine with potable water in order to fulfill the requirements above. Contractor shall take care that potable/sanitary lines do not interfere with ingress/egress and shall utilize means and methods (e.g. lift stations, etc.) as required by the site-specific conditions in order to achieve this.
Temporary/Portable Medical Waste: The Contractor shall provide, install, and maintain temporary/portable medical waste Sites for the collection, storage, and removal of medical waste generated by this ACS. Medical waste storage Sites shall be considered hazardous areas per NFPA 101. Provisions shall be provided for protection.
Temporary/Portable General Waste: The Contractor shall provide, install, and maintain general waste Sites for the collection, storage, and removal of all general waste generated by this ACS.
All temporary/portable Sites listed above can be, but are not limited to, prefabricated units (“off the shelf”), “conex”-type units converted for the uses required above, custom-build units for the applications required above, or a combination thereof. The units shall be fire-rated and comprised of sturdy, non-combustible, washable, materials that can be maintained and disinfected.
Nurse’s Stations: The Contractor shall provide, install, and maintain centralized nurse’s stations that can be fully equipped (by others) to accept all required equipment and materials for full-functionality of a typical primary-care Site Nurses Station.]
3.0 Architectural
[The Contractor shall, prior to mobilization and execution of the Sites and units described above, place rubber, sheet vinyl, or other acceptable material that has the ability to be seamless (welded seams or other method of achievement) as the flooring for the entire space, including temporary/portable support Sites. The proposed flooring material shall be washable and cleanable while maintaining a safe, non-slip surface.] This is optional and dependent on site conditions. As patients are confined to SCIU’s, only corridors or nurse stations may require non-slip flooring surfaces provided by the Contractor.
The Contractor shall provide SCIU’s as described above. Arrangement of patient care shall be such that each SCIU maintains full visibility from the nurse’s station. This could be, but is not limited to, a layout where there is a centralized nurse’s station surrounded by SCIU’s to form a patient “block.” Or, this could be achieved via remote cameras from the SCIU to the nurse’s station, with the station having the ability to have full visibility of the patient room and have the ability to determine which SCIU is being monitored. The Contractor shall propose a layout that maximizes patient density while maintaining ingress/egress requirements, life safety code requirements, patient access and visibility requirements, and ensures temporary/portable support Sites can be maintained in close proximity to the patient zone. The minimum corridor/walkway widths shall be 9 feet. These patient care SCIU’s can be aligned/ arranged in rows or larger groupings to create multiple and larger capacity patient care areas.
Each patient area or “block” shall contain SCIU’s for isolation patients, nurse station with monitoring station, team collaboration room, laboratory, medication room, decontamination, gas cylinder storage, clean utility, staff lounge, janitors closet and all necessary equipment (Crash cart, Blanket warmer, wheelchair, patient lift, portable x-ray and circulation, hand washing stations and vestibule for donning and doffing. Acute patient beds need to have the capability to raise/elevate both the head and feet of the acute patient.
4.0 Mechanical
The Contractor shall provide, install, and maintain all labor, equipment, and materials as described herein: Each 100 square foot of patient space in the SCIU shall be provided with a minimum of 200 cfm HEPA-filtered exhaust to maintain space conditioning and negative pressurization. Make-up air shall be provided from the SCIU’s independent systems. The Contractor shall validate and, if necessary, adjust, test, and balance the existing Site HVAC systems to ensure patient and staff comfort considering the number of patients and caregivers in the Site. Space temperature requirements are 68 deg. F winter and 72 deg. F summer.
The Contractor shall adjust, test, and balance the existing Site AHU systems to minimize exhaust/relief air and maximize outside air to ensure sufficient make-up air is available to account for the individual units on each SCIU. This shall be performed by qualified HVAC specialist and a certified and accredited TAB specialist. The Contractor shall provide mechanical exhaust in order to route any shower, toiler, and laundry, and other applicable temporary/portable support Site exhaust to the exterior or exhaust system. The Contractor shall not utilize the isolation exhaust system for any wet exhaust (e.g. shower or laundry) as the moisture will degrade the HEPA filters.
Further, the Contractor shall provide the existing Site AHU’s with HEPA filters throughout the use of this Site as an ACS. The maintenance of the existing Site AHU’s is the responsibility of others.
5.0 Electrical
The Contractor shall provide, install, and maintain an NFPA 110 type 10 level 1 emergency generator on a flatbed or on pad with skid-mounted tank. The Contractor shall provide exterior switch board(s) with automatic transfer switch(es); and connect switch board to generator power and Site normal power to create an NFPA 99 chapter 6 type 2 essential electrical system. The Contractor shall provide, install, and maintain the temporary electrical system under NFPA 70 article 590, Temporary Installations. Configure the generator as 2nd service, as allowed by NFPA 70 article 230.2A, for “special conditions”. [Contractor to provide fuel supply in order to maintain continuous operation of generator]. Supplying of fuel can be Contractor-provided or provided by some other means based on Contract agreement.
If the Site is NFPA 101 assembly occupancy it should have an existing emergency generator supplying NFPA 101 emergency lighting and NFPA 70 alarm and alerting systems. This system may be considered the life safety branch and remain as is with no connection to the roll up generator.
Provide nurse stations with task lights and receptacles circuited to equipment branch. Showers and toilets shall be provided with general illumination connected to normal power and a low level light connected to equipment branch. All temporary/portable Sites and/or containers for soiled utility, storage, etc. get illumination connected to normal power.
6.0 Plumbing / Medical Gas
The Contractor shall provide, install, and maintain water and sanitary services to serve the temporary/portable Sites and all SCIU units as required and in accordance with the International Plumbing Code. [Contractor shall provide blackwater tank emptying services] (This service can either be placed on this contract or established via separate service contract), OR provide sanitary collection tanks and lift stations as needed to continuously pump waste to a sanitary sewer connection, to avoid the need for gravity drainage, enabling routing of utilities without obstruction of egress areas.
Medical gases shall be bottled only stored in hazardous storage areas to be provided by Contractor.
7.0 Fire Protection / Life Safety
For All areas, the Contractor shall provide and maintain the following:
Fire extinguishers shall be provided in circulation corridors throughout the arena floor area IAW NFPA 10.
Manual fire alarm stations shall be extended into the arena floor area and located near nurses stations IAW NFPA 72.
Circulation corridors shall be constructed and maintained to allow egress and circulation of patients. Equipment cannot block or inhibit egress. Travel distances from patient areas shall not exceed 100’ from any point to an exit or to an adjacent module.
Not less than two exits shall be accessible from patient areas, and egress shall be permitted through adjacent patient areas modules, provided that the two required egress paths are arranged so that both do not pass through the same adjacent modules. Marking of means of egress shall be provided IAW NFPA 101. Dead ends are prohibited.
Nurse’s station shall be arranged to provide a direct line of sight of the patients and minimize staff travel distances and increase efficiency during code emergencies. Where direct line of sight cannot be maintained, a 120 vac smoke alarms within the SCIU shall be provided with a remote visual notification appliance located just outside of the unit door for quick identification.
Hazardous areas shall be separated from adjacent areas via 1 hour fire resistance rating and provided with ¾ hour fire rated doors and the room shall be less than 100 square feet.( i.e. central/bulk laundries, soiled linen, pharmacy, and bio-hazard waste.
Medical gas storage greater than 300 cubic feet shall be provided in a separate and secured room. Medical gas storage greater than 3000 cubic feet shall be separated from adjacent areas via 1 hour fire rated construction with ventilation.
8.0 Communications
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 the floor for viewing at nurse stations. Existing outside plant cabling shall consist of 12 strand fiber optic cabling upgradable to at least 1 Gbps.
The Contractor shall provide, install, and maintain 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.
9.0 Schedule
The Contractor shall submit a schedule to the Government within 24 hours of Notice-To-Proceed (NTP).