36C25526R0159 0002.docx

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Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

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is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

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B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

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Contractor

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Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

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Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

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13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 08-27-2026 589A4-25-102 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth

KS

66048 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth

KS

66048 To all Offerors/Bidders

36C25526R0159

X X X ** HOUR & DATE for Receipt of Offers is EXTENDED to: 09-11-2026 2PM CDT Install Dedicated Pharmacy Air Handler, 589A4-25-102 a.This amendmet provides the Pre-bid Questions and Answers and the below listed revised documents:

b. VHA ICRA 1.4; 0100 00 General Requirements; 01-33-23-Shop Drawings, Product Data and Samples; 01 00 10 Medical Center Requirements; Addendum 2 Drawings; 0 91 00 General Commissioning Requirements;

01 32 16.15 Project Schedule; Phasing Information; Finishing Schedule from Drawings; Finishing Schedule from Specifications.

c. Proposal date has been extended to September 11, 2026 due by 2PM CDT.

d. All other terms and conditions remain unchanged.

CONTINUATION PAGE

Q&A for Install Dedicated Pharmacy Air Handler

1. Can we set up ICRA on multiple floors to reduce saw cutting and demo mobilizations? Or will this task need to be performed in different phases?

a. The cutting through the slab will create a pathway for fire to transfer between floors. Fire rated shafts should be built to a complete rated assembly and then the slab cutting can be done all with one mobilization. This will need to be done at off hours due to noise and water.

2. How will we access the 3rd floor penthouse during construction? Should an exterior door be added to create future access from the 2nd floor roof?

a. The new air handler enclosure can be left open (last panel not installed) to allow construction access. The breakroom adjacent to the new enclosure will not be the primary construction point of entrance.

3. Will construction of the chase on each floor need to be completed after hours?

a. Yes.

4. Sheet GI002 says “ENTRANCES, AIR INTAKES AND WINDOWS IS NOT REQUIRED TO BE HEPA-FILTERED. EXHAUSTING DISCHARGED AIR INTO SHARED OR RECIRCULATING HVAC SYSTEMS, OR OTHER SHARED EXHAUST SYSTEMS (E.G., BATHROOM EXHAUST) IS PROHIBITED.” Where will we be able to exhaust the negative air machines in the pharmacy and chase locations?

a. Attached a copy of the VHA ICRA-1.4. Refer to Appendix A: Alternative To Outdoor Exhaust Requirements

5. Sheet GI002 says “INSTALL A DIFFERENTIAL PRESSURE SENSING DEVICE (E.G., MAGNEHELIC, MANOMETER, OR DIGITAL MONITORING)” Does this need to be a digital monitor with a visual alarm or is a manual Manometer acceptable?

a. A manometer is sufficient for external exhaust. If external exhaust is not available, Refer to the requirements of Appendix A: Alternative To Outdoor Exhaust Requirements

6. What are acceptable operating hours for the crane at the main entrance during steel erection?

a. 4 PM to 6 AM Monday through Friday. Anytime on Saturday and Sunday. All crane operations need to be planned and communicated the VA COR with at least 2 weeks notice to notify hospital staff and MU helicopter operations.

7. Please clarify how many full-time employees are expected to be on site by the Prime Contractor at all times during work being performed.

· Specification 01 35 26 1.9.C states “the SSHO has to be a separate qualified individual from the Prime Contractor’s Superintendent and/or Quality Control Manager with duties only as the SSHO.”

· Specification 01 35 26 1.9.D states; “the SSHO or an equally qualified Designated Representative/alternate will maintain a presence on the site during construction operations in accordance with FAR Clause 52.236-6: Superintendence by the Contractor.”

· There does not appear to be a requirement for a QC Manager to be a separate full-time individual.

a. On site the requirement is two (2) Superintendent and SSHO who shall be present during all work. If multiple shifts are planned/expected, these positions should be two deep to ensure coverage. QC manager does not have to be on site at all times, but shall make frequent visits to ensure all materials are as per specs/submittals and craftsmanship is proper. Project Manger does not need to be onsite all the time.

8. Please clarify the days and times a crane can be used overhead. Is it just nights or will weekends and/or holidays during the day be allowed?

a. See answer for question number 6. If the VA allows work to occur on a holiday, there is no restriction of the hours for that day.

9. There is a requirement for temporary air conditioning but there is not a size/tonnage requirement for temporary cooling. Please clarify how much temporary cooling is required.

a. The VA has determined this work can be completed with no temporary cooling units but some temporary ductwork will be required between demolition and installation of new ductwork in a few locations.

10. Please clarify the expected phasing requirement for the project. The scope of work refers to phasing but not the order in which the mechanical units are to be replaced.

a. The phasing will be up to the GC. One of the compounding rooms SHALL be available and operational at all times. This is means and methods, but logical is the installation and completion of the basement compounding AHU while construction of the mechanical penthouse). After that AHU is commissioned and the compounding room is recertified and operational, mechanical penthouse is built, the 3rd floor compounding AHU could be completed then the large AHU or vice versa. Requirement is one of the compounding areas MUST always be functioning.

11. Please clarify what work need to be completed after hours?

a. Work in public spaces of the building

i. all work in basement hallways

ii. all work on 1st & 2nd floors

iii. all work inside the building on 3rd floor.

12. The floor plan is not correct in the basement drawings. Upon discussion at the site visit it was believed an older set of drawings was used. Will the drawings be updated to the current floor plan?

a. Upon closer review the CAD background in the basement pharmacy is not correct but will not be changed due to time constraints and not affecting the scope of the work.

13. MD101 Note 16 requires electrical demolition that is not reflected on the electrical drawings. This work needs to be reflected on the electrical drawings.

a. This compressor, air dryer and receiver will be removed to clear floor space for the installation of the new AHU-5.

i. Electrical demo will require the removal of the disconnect box and conduit back to the closest junction box.

ii. Piping demo back to the cross connect with the air compressor outboard AHU-4.

iii. The equipment will be delivered to the VA and all re-installation will be performed by the VA.

14. Please identify the existing roof manufacturer and advise whether the existing roof system is currently under warranty. If a warranty is in effect, provide the warranty holder, expiration date, and requirements for penetrations, modifications, and tie-ins associated with this project.

a. installed by Watkins. Carlisle Syntec Systems is the Warranty holder and it expires 11/5/2044

15. Is negative air required to be ran to the exterior of the building? If so, can you provide an acceptable route for temporary ductwork?

a. See answer to question 4.

16. Level 3 Waiting area (F300) requires a new closet and indicates two walls (north and west) to be new and south/east walls existing. The south wall is partially glass (see photo below). Please clarify if we are remove the glass wall and construct a new wall and/or provide details of this tie-in.

a. The glass is NOT to be removed. Chase wall shall be constructed adjacent to this wall. Thermostat shall be relocated.

17. Reference sheet GI003 Basement Level ICRA Floor Plan. The area indicated for the ceiling work does not correspond to the new HVAC duct work plan Sheet MH101. Is the intent to not enclose the main ductwork trunklines in the containment area?

a. [Spur] Mech - Phasing Plan Addendum NO. 02 as a response to pre-bid RFIs.

18. Reference Sheet GI003 Basement Level ICRA Floor Plan. Is the shown ICRA barrier the only ICRA barrier required? How is IRCA to be maintained outside of the shown ICRA barrier.

a. [Spur] Mech - Phasing Plan Addendum NO. 02 as a response to pre-bid RFIs.

19. Reference Sheet AC131. Note 9.170 states to replace ceiling as scheduled. There does not appear to be a finish schedule in the drawings. Can you provide manufacturer and model of the ceiling tile and grid.

a. Armstrong Mesa 680, 2x2 in basement, 1st & 2nd floor hallways

b. Armstrong Ultima 1942, high NRC 2x2 on 3rd floor.

c. Grid – Armstrong Prelude XL, 15/16”, white

20. There are notes throughout the drawings for finishes as scheduled. There does not appear to be a finish schedule for flooring, paint, base etc.. Can you provide a finish schedule for the project?

a. Public hallways are generally Wool skein (Sherwin Williams SW 6148)

b. Finish schedule for pharmacy and 3rd floor hemo/oncology is attached.

21. Please advise if the designated SSHO and Competent Person role can be fulfilled by the site superintendent? Or, will the SSHO be a full time separate person?

a. See answer to question #7.

22. The existing interstitial space has sprayed fireproofing on the existing structural steel members, are we to include fire proofing on the new steel for this project? If so, please indicate on drawings and provide fireproofing specification.

a. [Spur] Spray new steel, match existing hour rating. Product information from previous ACA expansion included as attachment.

23. Sheet AE201elevations 1 and 2 notation 4.03 indicates concrete panel wall to match. Please provide specification and details for these concrete precast panels.

a. [Spur] Note should be removed and construct per wall section 2/AE201. There are no pre-cast panels.

24. Sheet AE201 wall sections 2&4/AE201 do not indicate concrete precast panels. Please advise.

a. [Spur] Note should be removed and construct per wall section 2/AE201. There are no pre-cast panels.

25. Sheet AE201elevations 1 and 2 notation 7.06 indicates EIFS. Please verify that the intent is to be EIFS, as the existing appeared to be pre-cast concrete panel and previous projects also had this portion as pre-cast concrete panel.

a. [Spur] Concur. Intent is for this to be EIFS.

26. Are doors C1F22, E210, F300, and F399A intended to be typical Fire rated access panels with Keyed Mortised Cylinder locks, or are they intended to be actual 4- sided welded rabbeted HM frames, with 1-3/4” doors and Best storeroom cylindrical lever locks?

a. 4 sided welded 3’0” HM doors and frames with appropriate rating (2-hr), four hinged, storeroom lock set

27. Please provide a room finish schedule.

a. Finish schedule is attached to these questions.

28. On PL-101, note 12 calls out 3” FD-D, but detail #2 and the schedule shows 4” FD-E. The specifications call out FD-C. Which FD and size is to be used? Please provide correct selection for pricing.

[Spur] Mech

· PL-101, note 12 is incorrect. Keynote 12 will be corrected to, “12 4” DRAIN WITH TRAP UP TO FD-E IN PENTHOUSE.”

· Plan 2 on PL-101, Plumbing Plan – Level 3 – Waste, storm, vent, and floor drain schedule are correct in stating 4” and FD-E.

· Type E floor drain will be added to the specification, 22 13 00 Facility Sanitary and Vent Piping, Section 2.6 Floor Drains:

C. Type E (FD-E) floor drain shall comply with ASME A112.6.3. The type E floor drain shall have a heavy, cast iron body, double drainage pattern, heavy non‑tilting //nickel bronze// //ductile iron// grate not less than 300 mm (12 inches) square, removable sediment bucket. Clearance between body and bucket shall be ample for free flow of waste water. For traffic use, an extra heavy duty load classification ductile iron grate shall be provided.

29. Please advise if OT will be required in the following areas (mech rooms & interstitial assumed to be straight time):

0. Pipe/Duct routing to the pharmacy - Corridor CBE3/Work Room E002B/Office E002H/RCO R&D E002I/Clinical Research E002J/MFMR Exec Office E002K/Clean Storage E002E (MH101/MP101)

0. Corridor must remain open to bed/gurney/cart traffic (4 ft clearance) 24 hours a day. Per discussions with pharmacy and research staff, these locations can be dayshift.

0. Pipe/Duct in Pharmacy & surrounding areas – Pharmacy E001/Corridor CBE2/E001C/E001D (MH101/MP101)

1. Plan for night shift.

0. Pipe/Duct in Level 1 (MH102/MP102)

2. Non disruptive work can occur in the chase on dayshift (no loud noises or impacts. For example: no hammer drilling, chipping, etc…). Material movement of pipe sections and ductwork sections should be done before 7AM or after 4 PM

0. Pipe/Duct in Level 2 (MH102/MP102)

3. See answer to c.

0. Duct in Level 3 (MH104)

4. See answer to c.

0. Duct demo – Men Toilet E008/Women Toilet E010/Elec Room E009/Corridor CBF1 (MD101)

5. Corridor must remain open to bed/gurney/cart traffic (4 ft clearance) 24 hours a day.

30. With the only access to the new penthouse mechanical room through Staff Lounge E305, will this space be vacated for the project?

a. E305 will have a construction barrier put up for the installation of the door to the new mechanical room while maintaining as much of the break room open as can be reasonably maintained. Construction access will be by going down the stairs onto the 3rd floor roof and the final wall panel will remain uninstalled for construction access.

31. What is the allowed egress(s) for the work and materials to be brought into Mechanical Penthouse F399?

a. larger items and bulk construction materials can be lifted by crane. personnel access and smaller materials will be taken out onto the 3rd floor roof via the stairs by Elevator #11.

32. The statement of work in the specifications mentions “Construction Phasing”. Is there a phasing plan that can be provided?

a. Spur altered the existing phasing plan in new addendum No. 2. VA has put together some notes on 1st floor outpatient pharmacy and 3rd floor compounding.

33. The statement of work in the specifications mentions the use of temporary units. If temporary units are to be provided, we will need a phasing schedule, selection/size of units, expected duration for units, and location/tie-ins of units to be able to price. Please provide clarification.

a. The VA has determined this work can be completed with no temporary cooling units but some temporary ductwork will be required between demolition and installation of new ductwork in a few locations.

34. Plansheet MD101, note D16 calls out to relocate vacuum/compressor and receiver tank, coordinate new location with owner, and relocate/modify all piping and electrical. Where is the new location? To what extent is the piping and electrical to be modified? Additional information will be needed to price this work. Also, this is believed to be a pneumatic controls air compressor, not vacuum.

a. This compressor, air dryer and receiver will be removed to clear floor space for the installation of the new AHU-5.

i. Electrical demo will require the removal of the disconnect box and conduit back to the closest junction box.

ii. Piping demo back to the cross connect with the air compressor outboard AHU-4.

iii. The equipment will be delivered to the VA and all re-installation will be performed by the VA.

35. Plan sheet MD101, note D12 calls out to demo ACA-AHU-5 and associated duct, controls, and steam piping. Is the associated structural steel, stairs, and walkway to remain?

a. No this is to be demo’d as well

36. Sheet MH104 I believe that there is a supply diffuser and a thermostat existing in the area of the new chase for the new 18x18 ductwork. Do these items need to be relocated? If so, to where?

a. relocate thermostat on the same wall to the north of its current location. COR will approve the relocation. The supply diffuser will be relocated north of its current location in the same N-S grid line.

37. There are discrepancies and missing information pertaining to the humidifiers. Please advise on the following:

0. Sheets MP101 and M-401, note 25 calls out for dispersion tubes to be installed in the ductwork. The schedules on M-601 say there are dispersion grids mounted in the AHU. Which is correct?

0. There is no steam or condensate drain piping shown for 1-HUM-11 or 1-HUM -12. Please provide sizing and routing.

[Spur]Refer to 3 – Level 3 – Penthouse Enlarged HVAC Plan on sheet M-401 HVAC Enlarged Plans and add the following pipe and keynotes. Humidifier 11 is similar.

This will also be officially issued in forthcoming Addendum.

0. There is no detail for the steam or condensate drain piping showing specialties, traps, valves, dispersion grid/tube hook ups, drain coolers, etc. Please provide a detail.

[Spur]

0. The specification for steam piping is for typical generic steam. Is the dispersion piping for this project from the humidifiers to the dispersion grids/tubes the same materials as typical steam?

[Spur] Refer to item h above and manufacturer’s recommendations for piping material and installation.

Attachments:

1. 589a4-25-102_ADDENDUM 02_260828

2. 07_8100-001_Fireproofing_Mfr_Literature

3. Finish schedule from drawings

4. Finish schedule from specs

5. Phasing info

6. VHA ICRA-1.4 (April 14 2026) Introductory Information and Instructions Use this template as a baseline for performing facility Infection Control Risk Assessments (ICRAs) for construction, renovation, and maintenance work (referred to as the “activity” in this document). The template provides minimum requirements for categorizing activity types and patient risk to determine the level of precautions needed to prevent infection risks. Facilities may customize this template to incorporate site-specific information and/or to add more stringent criteria.

This VHA ICRA template pertains specifically to infection prevention. It must be used if required by the VHA Pre-Construction Risk Assessment (PCRA) for the activity. NOTE: The PCRA addresses other activity-related safety concerns (e.g., vibration, noise, hazardous materials) outside the scope of the ICRA.

To complete the template:

1. Use Table 1 to identify the category of the construction, renovation and/or maintenance activity.

2. Use Table 2 to identify the areas affected by the activity.

3. Use Table 3 to identify the overall patient risk category that will be affected by the activity.

4. Use Table 4 to determine the level of infection prevention and control precautions needed for the activity.

Once all 4 steps above are completed: Refer to Table 5 for the minimum required control measures for the level of infection prevention and control precautions needed for the activity. Refer to Table 6 for the minimum infection prevention and control measures required on completion of the activity.

PERMIT: See the last page of this document for a fillable permit form to be used for posting at the activity site as needed.

Table 1 - Construction, Renovation, and/or Maintenance Activity Category

NOTE: If any of the bulleted criteria in a higher activity category pertains to the work that will be done (even if the other criteria are in a lower category), use the higher activity category for the VHA ICRA.

Activity Category determined from Table 1 (A, B, C, or D):

Category A

Inspection and/or facility upkeep generally defined as follows:

· Work can be completed in a single shift, not to exceed 10 hours.

· Patients and/or employees may be in the area depending on the activity.

· Work that does not create dust or debris.

· Removal of ceiling tile or access to mechanical or electrical chase for visual inspection limited to 1 tile per 50 square feet with limited exposure time (not to exceed an hour for each tile) within the shift.

· Minor interior updates (e.g., replacing floor or ceiling tiles, carpentry work to include hanging signage, and painting without sanding) that do not create dust or debris.

· Limited building system maintenance such as basic plumbing on potable systems (e.g., faucet replacement) or basic electrical work such as replacement of light bulbs, receptacles, or switches.

Category B

General maintenance and repair work generally defined as follows:

· Prolonged inspection and work that may take longer than a single shift but not exceeding a week.

· Patients and employees are not to be in the area until activity is completed.

· Work that creates minimal dust and debris.

· Interior finish or surface repairs, updates, or modifications such as repair of firewalls and barriers, and new flooring that produces minimal dust and debris. Controlled sanding activities (e.g., wet or dry sanding) that produce minimal dust and debris.

· Plumbing work such as installation or replacement of a single fixture or piping for a single fixture. Any work on sanitary plumbing including snaking of drains.

· Electrical work such as installation of cabling/wiring/conduit for a single device, installation of new device such as a light fixture that produces minimal dust and debris.

· Air Handler and/or fan shutdown/startup and HVAC work such as replacement of a single diffuser, single terminal unit or a single device that produces minimal dust and debris.

Category C

Small-scale construction, renovation, or maintenance generally defined as follows:

· Work requiring longer than a single week to complete but not exceeding 6 months.

· Patients and employees are not to be in the area until activity is completed.

· Demolition/removal of preexisting floor covering, casework, lay-in ceiling, or other architectural elements.

· Demolition/removal of more than 32 ft2 of drywall/framing, hard ceilings, and doors/framing and minimal infrastructure such as electrical circuits and branch piping.

· Installation of new walls, ceilings and doors including framing, drywall/plaster and associated work.

· Plumbing work such as the installation of new sinks, showers and toilets and associated plumbing.

· Shut down of sections of potable water systems.

· Electrical work such as installation of conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc.

· Modification of existing fire alarm and suppression systems.

· Mechanical work such as the installation of ductwork, diffusers, and terminal units for an area.

Category D

Large-scale construction, renovation, or maintenance generally defined as follows:

· Work exceeding 6 months in duration.

· Patients and employees are not to be in the area until activity is completed.

· Large-scale demolition of building components and infrastructure including removal of multiple doors, walls, framing, ceilings, flooring, piping, electrical and HVAC.

· The installation building components such as new walls, ceilings and doors including framing, drywall and associated plaster work.

· Plumbing work such as the installation of:

· new medical gas systems,

· steam/heating hot water, condensate systems,

· multiple sinks, showers and toilets including associated plumbing.

· Shutdown of potable water, steam/heating hot water, condensate, and medical gas systems.

· Electrical work such as installation of electrical feeders, distribution panels, conduit and wire for lighting, receptacles and switches for an area, the installation of conduit and wire for new devices such as terminal units, fans etc.

· Installation of fire alarm and suppression systems.

· Electrical shutdown of multiple panels.

· Mechanical work such as the installation of air handling equipment, associated ductwork, diffusers, heat exchangers, terminal units and controls.

Table 2 - Affected Area Assessment

Identify the areas and associated patients that will be affected by the construction/renovation/maintenance activity (see the Figure for a visual representation of adjacent affected areas).

Figure: Isometric drawing of affected area assessment

(e.g., OR, Unit/Ward, Sterile Processing, Administrative, etc.)*

Activity Area**

Area Above

Area Below

Adjacent Area 1

Adjacent Area 2

Adjacent Area 3

Adjacent Area 4

* There may be more than one Service/type of area for each row. List all.

** List the area(s) in which the construction/renovation/maintenance activity will occur. NOTE: When the Activity Category is B, C, or D, the control measures are determined by the Patient Risk in the adjacent affected areas.

Table 3 - Patient Risk Category Using Table 3, identify the patient risk category for each area listed in Table 2. Of the patient risk categories identified, select the one with the greatest risk as the overall Patient Risk Category for the activity.

Overall Patient Risk Category determined from Table 3 (Low, Medium, High, or Highest):

Low Risk

Non-patient care areas such as:

Medium Risk

Patient care support areas such as:

High Risk

Patient care areas such as:

Highest Risk

Procedural, invasive, sterile support and highly compromised patient care areas such as:

· Public hallways and gathering areas not in clinical areas

· Office areas not in clinical areas

· Breakrooms not in clinical areas

· Bathrooms or locker rooms not in clinical areas

· Mechanical/electrical rooms not in clinical areas

· Waiting areas

· Clinical engineering (biomedical)

· Materials management

· Sterile processing department – dirty side

· Kitchen, cafeteria, gift shop, coffee shop, and food kiosks

· Patient care rooms and areas, including spinal cord injury units

· All acute care units, including mental health

· All outpatient units and clinics

· Emergency department

· Community Living Centers, domiciliaries, and transitional residences

· Employee health

· Pharmacy – general work zone

· Medication rooms and clean utility rooms

· Imaging suites – diagnostic imaging

· Laboratory

· All transplant units

· All intensive care units

· All oncology units and chemotherapy/infusion centers

· OR theaters and restricted areas

· Hemodialysis units

· Procedural rooms*

· Pharmacy compounding area

· Sterile processing department – clean side

· Transfusion services

· Imaging suites – interventional imaging

· Dedicated isolation wards/units for infectious diseases

* Procedural Rooms are designated for the performance of patient care activities that may require high-level disinfected or sterile instruments and some environmental controls but is not required to be performed with the environmental controls of an operating room (OR). The room is intended for procedures that are performed in an aseptic surgical field and penetrates the protective surfaces of a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea) or entry into or opening of a sterile body cavity. Examples of these spaces include, and are not limited to, Cardiac Catheterization Suites, Electrophysiology Suites, Endovascular/GI Suites, Angio Suites and other spaces which may have high risk patient populations.

Table 4 - Level of Infection Prevention and Control Precautions Match the Overall Patient Risk Category (Low, Medium, High, Highest) determined from Table 3 with the planned Construction/Renovation/Maintenance Activity Category (A, B, C, D) from Table 1 to determine the minimum Level of Infection Prevention and Control Precautions (I, II, III, or IV) using Table 4 below.

Level of Precautions determined from Table 4 (I, II, III, or IV):

An infection prevention and control permit is required for Level III and Level IV. Consult with Infection Prevention and Control for Level I and Level II.

Table 5 - Required Infection Prevention and Control Measures, by Level of Precautions Controls defined below for the Level of Precautions identified for the activity must be in place before the activity begins and maintained until work is completed and the area is activated. Control measures for each Precaution Level must also include the control measures in the preceding Level(s).

As the activity progresses, a full re-evaluation of remaining activity type and patient risk is required prior to downgrading the Level of Precautions.

Level I

1. Perform work activity in a manner that does not create dust.

2. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

3. Any materials and equipment being brought into the facility must be free of contaminants and loose material.

Level II

All control measures in Level I and the following:

1. Provide active means to control airborne dust from dispersing into occupied areas and/or water mist surface to control dust (e.g., Mobile Dust Containment Cart or some other system).

2. Ensure worker clothing is clean and free of visible dust before leaving the work area.

3. Remove or isolate air diffusers (supply and return) to protect the HVAC system from dust and reduce air turbulence. Rebalance system to address diffuser isolation.

4. When the work involves or impacts potable water systems including stagnation due to reduced usage, the piping shall be flushed twice a week or isolated from the main system.

5. Seal doors to prevent dust migration.

6. Contain all trash and debris in the work area. Perform daily cleaning and disposal of trash (covered) from work area using an identified exit route.

7. Any equipment, tools, or materials removed from the work area must be in sealed containers and/or cleaned of dust and debris prior to removal from the area.

8. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

9. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy. Sticky mats must be changed routinely and when visibly soiled.

10. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces at least daily.

Level III

All control measures in Levels I and II and the following:

1. Ensure availability of equipment for cleaning hands.

2. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

3. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to floor and ceiling (or floor/roof deck above) and secure from movement or damage.

4. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

5. Maintain .01 inches /water gauge negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors, or comply with the alternative method outlined in Appendix A of this document. These control measures must be maintained continuously 24/7 for the duration of the project. HEPA filtered exhaust if discharged directly to the outdoors must be at a distance of 25 feet or greater from entrances, air intakes and operable windows. Exhausting discharged air into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is prohibited.

6. Install a differential pressure sensing device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor and document negative pressurization. The “ball in the wall” or similar apparatus are not acceptable.

Level IV

All control measures in Levels I, II and III and the following:

1. Barriers must be hard barriers unless temporary to install final barrier.

2. Containment must include an anteroom to ensure pressure control. Anteroom must be large enough for equipment staging, cart cleaning, workers’ PPE and cleaning.

3. Worker clothing and/or PPE must be removed or clean and free of visible dust before leaving the work area anteroom. HEPA vacuuming of clothing or use of cover suits is acceptable.

4. Workers must wear shoe covers or have a method to clean shoes in anteroom. Shoe covers must be removed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be changed immediately.

Table 6 - Minimum Infection Prevention and Control Measures Required Upon Completion of the Activity

Controls defined below shall be completed upon completion of the activity and inspected prior to terminating measures defined in Table 5.

Levels I - II Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and flooring materials.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air diffuser surfaces.

HVAC Systems:

1. Remove isolation of HVAC system in areas where work is being performed. Verify that HVAC systems are clean and operational.

2. Verify the HVAC systems meet original airflow and air exchange design specifications.

Water systems:

1. Until the potable water system is activated and in use, flushing shall continue at least twice per week in accordance with VHA Directive 1061.

Levels III - IV

Construction areas must be inspected by an infection preventionist and engineering representative (and others as determined by the facility) for final activity/project close out and removal of infection prevention and control measures.

Work Area Cleaning:

1. Clean work areas including all environmental surfaces, high horizontal surfaces and flooring materials.

2. Check all supply and return air registers for dust accumulation on upper surfaces as well as air diffuser surfaces.

Removal of Critical Barriers:

1. Critical barriers must remain in place during all work involving drywall removal, creation of dust and activities beyond simple touch-up work. The barrier may NOT be removed until a work area cleaning has been performed. Additional cleaning may be needed after removal of barrier.

2. All (plastic or hard) barrier removal activities must be completed in a manner that prevents dust release. Use the following precautions when removing hard barriers:

i. Carefully remove screws and painter tape.

ii. If dust will be generated during screw removal, use hand-held HEPA vacuum.

iii. Drywall cutting is prohibited during removal process.

iv. Clean all stud tracks with HEPA vacuum before removing outer hard barrier.

v. Use a plastic barrier to enclose area if dust could be generated.

Negative Air Requirements:

1. The use of negative air must be designed to remove contaminants from the work area.

2. Negative air devices (fans, filters, monitoring and documentation equipment) must remain operational at all times and in place for a period after completion of dust creating activities to remove contaminants from the work area and before removal of critical barriers.

HVAC systems:

1. Upon removal of critical barriers, remove isolation of HVAC system in areas where work is being performed.

2. Verify that HVAC systems are clean and operational.

3. Verify and document through a TAB the HVAC systems meets original airflow and air exchange design specifications.

Water systems:

1. Until the potable water system is activated and in use, flushing shall continue at least twice per week in accordance with VHA Directive 1061.

VHA Infection Control Risk Assessment for Construction, Renovation and Maintenance

VHA ICRA-1.4 (April 2026) Page 21 of 7

Infection Prevention and Control Construction/Renovation/Maintenance Permit

This page must be posted at the entrance to the project area for Level III and Level IV activities.

Unique permit number:

Location of construction/renovation/maintenance

Project manager

Project start date

Contact phone number

Completion date

Contractor

Permit expiration date

Activity Category (A, B, C, or D)

Overall Patient Risk Category (Low, Medium, High, or Highest)

Level of Infection Prevention and Control Precautions (I, II, III, or IV)

(Check the box for the activity’s Level of Precautions to indicate the Control Measures)

Level I

1. Perform work activity in a manner that does not create dust.

2. Immediately replace any ceiling tile, close access panels, etc., upon completion of work.

3. Any materials and equipment being brought into the facility must be free of contaminants and loose material.

Level II

All control measures in Level I and the following:

1. Provide active means to control airborne dust from dispersing into occupied areas and/or water mist surface to control dust (e.g., Mobile Dust Containment Cart or some other system).

2. Ensure worker clothing is clean and free of visible dust before leaving the work area.

3. Remove or isolate air diffusers (supply and return) to protect the HVAC system from dust and reduce air turbulence. Rebalance system to address diffuser isolation.

4. When the work involves or impacts potable water systems including stagnation due to reduced usage, the piping shall be flushed twice a week or isolated from the main system

5. Seal doors, to prevent dust migration.

6. Contain all trash and debris in the work area. Perform daily cleaning and disposal of trash (covered) from work area using an identified exit route.

7. Any equipment, tools, or materials removed from the work area must be in sealed containers and/or cleaned of dust and debris prior to removal from the area.

8. Nonporous/smooth and cleanable containers (with a hard lid) must be used to transport trash and debris from the construction areas. These containers must be damp-wiped cleaned and free of visible dust/debris before leaving the contained work area.

9. Install a sticky (dust collection) mat at entrance of contained work area based on facility policy. Sticky mats must be changed routinely and when visibly soiled.

10. Maintain clean surroundings when area is not contained by damp mopping or HEPA vacuuming surfaces at least daily.

Level III

All control measures in Levels I and II and the following:

1. Ensure availability of equipment for cleaning hands.

2. Construct and complete critical barriers meeting NFPA 241 requirements. Barriers must extend to the ceiling or if ceiling tile is removed, to the deck above.

3. All (plastic or hard) barrier construction activities must be completed in a manner that prevents dust release. Plastic barriers must be effectively affixed to floor and ceiling (or floor/roof deck above) and secure from movement or damage.

4. Seal all penetrations in containment barriers, including floors and ceiling, using approved materials (UL schedule firestop if applicable for barrier type).

5. Maintain .01 inches /water gauge negative pressurization of the entire workspace by use of HEPA exhaust air systems directed outdoors, or comply with the alternative method outline in Appendix A of the VHA ICRA template. These control measures must be maintained continuously 24/7 for the duration of the project. Exhausting discharged air into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is prohibited.

Check box to indicate exhaust method: Exterior ☐ Alternative Interior Method ☐

6. Install a differential pressure sensing device (e.g., magnehelic, manometer, or digital monitoring) on exterior of work containment to continually monitor and document negative pressurization. The “ball in the wall” or similar apparatus are not acceptable.

Level IV

All control measures in Levels I, II and III and the following:

1. Barriers must be hard barriers unless temporary to install final barrier.

2. Containment must include an anteroom to ensure pressure control, Anteroom must be large enough for equipment staging, cart cleaning, workers’ PPE and cleaning.

3. Worker clothing and/or PPE must be removed or clean and free of visible dust before leaving the work area anteroom. HEPA vacuuming of clothing or use of cover suits is acceptable.

4. Workers must wear shoe covers or have a method to clean shoes in anteroom Shoe covers must be removed prior to exiting the anteroom to the occupied space (non-work area). Damaged shoe covers must be changed immediately.

Additional requirements:

Project Manager signature

Date

Infection Preventionist signature

Date

Appendix A: Alternative To Outdoor Exhaust Requirements

This Appendix provides an equivalent ICRA control measure to requirements detailed in this VHA ICRA template (Table 5 Level III, item 5) that would allow interior construction space exhaust.

Interior Construction Space Exhaust:

If the facility is not able to exhaust to the building exterior, the Healthcare Environment and Facilities program office has identified an alternate industry-recognized standard interior exhaust procedure that is accepted as providing an equivalent level of infection prevention and control (IPC), and safety. The alternate interior exhaust procedure is implemented by completing the following:

1. If exhaust is directed indoors, then the system must be HEPA filtered. Maintain .01 inches water gauge negative pressurization of the entire workspace by use of HEPA exhaust. These control measures must be maintained continuously 24/7 for the duration of the project.

1. Prior to start of work, including assembly of the ICRA barriers, initial baseline air sampling measurements for particulate levels must be taken in the planned area of discharge. Once containment is erected and completed, HEPA filtration must then be verified by particulate measurement, using a particle counter with multi-channel capabilities to measure down to 0.3 microns, to confirm that the discharge of the HEPA unit does not exceed the baseline particulate count of the area to which the exhaust is directed. Verification must continue at least once per 8 hour shift when there is construction activity. Any exceedance must trigger a work stoppage and an immediate response and resolution. All particulate measurements, including the baseline measurement, must be documented and retrievable.

1. To accommodate the sampling, the negative air pressure machine must be fitted with a 2 ft section of rigid ductwork at the discharge. The sample port for monitoring must be in the rigid ductwork section.

1. Vapor generating processes must be assessed and appropriate filtration must be installed to mitigate transmission to the facility.

1. Engineering must do a complete flow and pressure analysis and document the area to which the air is being discharged to ensure the flow and pressure relationships in that area are not being adversely impacted by the additional flow. Ideally, this is done as part of the construction package to ensure the design is implementable and no additional HVAC changes are required to accommodate the exhaust from the negative air equipment.

1. Install device on exterior of work containment to continually monitor negative pressurization. To ensure proper pressure is continuously maintained, the device(s) shall have a visual pressure indicator, data collection and alarm.

1. Exhaust must be directed to Low Risk areas as defined in Table 3 in this VHA ICRA template. Ideally this discharge must be located so as not to impinge on high traffic areas or create a nuisance with noise or excessive airflow.

NOTE: Exhaust into shared or recirculating HVAC systems, or other shared exhaust systems (e.g., bathroom exhaust) is not acceptable.

See attached document: 01 00 00 General Requirements RX.

See attached document: 01 33 23- Shop Drawings Product DAta and Samples.

See attached document: 01 00 10 - MEDICAL CENTER REQUIREMENTS RX.

See attached document: 589a4-25-102_Addendum 02_260828.

See attached document: 01 91 00 General Commissioning Requirements RX.

See attached document: 01 32 16-15 Project Schedules RX.

See attached document: 07_8100-001_Fireproofing_Mfr_Literature.

See attached document: Phasing info.

See attached document: Finish schedule from drawings.

See attached document: finish schedule from specs.

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