36C24818Q0514-00001003.docx

Performance Work Statement

Background:

The North Florida South Georgia VA Healthcare System maintains and operates three Dental Clinics that are required to have their Dental Chair Water Lines tested for bacteria quarterly. These clinics are located in Gainesville, Lake City and Tallahassee.

Objective:

Obtain the services of a contractor to test all of the Dental Water lines at least once each quarter at all designated facilities. These are the designated facilities:

Disinfecting Lines (estimate)

Retesting Lines (estimate)

Scope of Work:

Perform water line testing using heterotrophic plate counts (spread plating method) and have an EPA certified lab determine the levels of bacteria in each water line. Provide a detailed quarterly report of all findings and actions taken to the COR. If the test sample is positive, clean and retest the line with protocol listed below. If the sample is not positive then no further action is required.

Testing protocol:

1) Test each line separately.

2) Remove all hand pieces and any other equipment reprocessed by SPS before drawing samples from the lines. Air-water syringe tips should be removed. The air-water syringe itself, if not changed between patients (e.g., if barrier + disinfection is accomplished by dental personnel), should remain on the line while drawing the sample.

3) Testing is to be performed quarterly on each water line.

4) Use a lab certified to do water testing

5) Report results to the (COR) and each facility Dental Facility Supervisor (quarterly)

Action Levels:

If >200 cfu but <500 cfu

1) Shock all lines in the unit

2) Leave the air-water syringe on the line if not reprocessed by SPS

3) Line can stay in service

4) No retest needed after shocking

5) Maintain the unit's place in the quarterly testing sequence

If >500 cfu

1) Take line out of service (the >500 cfu line only – other sub-500 cfu lines may stay in service)

2) Shock all lines to unit per manufacturer's instructions

3) Leave the air-water syringe on the line if not reprocessed by SPS

4) Retest the >500 cfu line before returning it to service

5) If shocking and retesting again yields >500 cfu Line remains out of service

Qualifications/ Certifications:

1) Possess all licenses required by state and local government

2) Ensure all equipment is in good working order and not leaking

3) Demonstrates experience and expertise while performing duties

4) EPA Certification and testing location

Safety Regulations:

1) All OSHA safety regulations shall be observed while performing service

2) Provide the necessary barricades -signage where required

3) Wear the Proper PPE while sampling

HOURS OF OPERATION:

The Contractor will conduct work on-site during normal business hours, 0700 till 1530 Monday thru Friday. The Contractor shall coordinate with the COR and/or the POC to determine when work can be performed (two weeks in advance). Special coordination is necessary for sampling of the Dental waterlines due to the impact sampling time may have on patient care.

SECURITY REQUIREMENTS:

The Contractor will be responsible for ensuring compliance by its employees with all VA procedures governing building access and security. Contractor personnel will be escorted by VHA personnel at all times. The COR will assist Contractor personnel in obtaining requisite identification badges to enter the facilities and collect samples. All Contractor employees and subcontractors under this contract or order are required to complete the VA's on-line “Privacy and HIPAA Focused Training” - TMS Code “10203.” Contractors must provide signed certifications of completion to the COR during each year of the contract. This requirement is in addition to any other training that may be required of the contractor and subcontractor(s). Contractor staff is required to conform to VHA’s security and privacy requirements as described below:

The Contractor will be responsible for ensuring compliance by its employees with the security regulations of VA, VHA and other Government installations or Contractor facilities where work is performed under this Contract. This includes the safekeeping and display of a Government-provided photo ID badge for employees of the Contractor and any subcontractors while these employees are on VHA property.

The Contractor will ensure the security of all VHA property, building ID badges, key cards, and standard keys issued to Contractor staff. For employees leaving the project permanently or for an extended period of time, the Contractor will return all badges, property, key cards, parking placards, and keys, etc. the same day the employees leave the project. Background Investigations will be required for the performance of this contract.

The C & A requirements do not apply, and a Security Accreditation Package is not required.

EMPLOYEES

Contractor employees shall present a professional appearance at all times and their conduct shall not reflect discredit upon the United States and or the VA/VHA. The Government may, at its sole discretion, direct the contractor to remove any contractor employee from U.S. VA/VHA facilities for misconduct or for security reasons. Removal does not relieve the Contractor of the responsibility to continue providing the services required under any Contract awarded. The Contracting Officer will provide the contractor with a written explanation to support any request to remove an employee. The Contractor shall not employ any person who is an employee of the United States Government if that employment would appear to cause a conflict of interest.

PERFORMANCE REQUIREMENT SUMMARY:

Required Services (Tasks) Performance Standards Acceptable Quality Levels Methods of Surveillance Incentive (Positive and/or Negative) (Impact on Contractor Payments)

Submit a PM report of scheduled, completed, and outstanding tasks Quarterly.

Submit management reports as required

100% of reports accurately depict current status

Contractor is in compliance with QCP 97% of the time

100%

95%

File reviews, periodic inspections, and random, observations, customer complaints

File reviews, periodic inspections, and random, observations, customer complaints

Documented instance when a report is submitted after the 15th of the month.