36C25919R0029_0001.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION

OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

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.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office 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.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADM

INISTRATIVE 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 d ate specified.

C. THIS SUPPLEMENTAL AGREEMENT IS

ENTERED INTO

PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 3

PREVIOUS EDITION NOT USABLE

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.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

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) 12-17-2018 N/A 36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village CO 80111 To all Offerors/Bidders

36C25919R0029

X

The purpose of this amendment is to clarify the closing date of this solicitation of December 19, 2018 at 5:00PM MT and to answer questions.

Ronnie R. Jones

Pest control Questions:

1. Is the VA requesting a specific amount of totals man hours to provide the pest services to all areas outlined within the scope of service?

The VA is not asking for total man hours. Vendor will determine how much time is necessary to meet the terms of the SOW. Preventive maintenance shall occur weekly at each location. This is the performance requirement.

2. How many afterhours service request has then been in the past 12 months?

There has been an average of 4 emergency service requests per month.

3. Who is the current pest vendor?

Marathon Medical / Sprague Pest Management

4. Can you provide the square footage of areas of treatment coverage?

RMRVAMC = 1.2 Million Sq. Ft.

Denver VAMC = 950,000 Sq. Ft.

Fisher House = 50,000 Sq. Ft.

5. Has any of the scope of service changed from this Solicitation compared to that of the last awarded contract?

Two buildings at the Denver VAMC have been demolished with an additional two schedule for demolition next calendar year.

6. If bed bugs are included in this scope how many Bed Bug services have been performed over the past 12 months?

There has been only one full scale Bed Bug Infestation call. All other Bed Bug calls have been isolated rooms and were treated as emergency calls. However, the Bed Bug Policy has been included.

7. If termites are included in this scope how many termite services have been performed over the past 12 months?

There have been no termite calls for the past 12 months.

8. Solicitation states: Fumigation treatments may require separate approval..... Does there need to be a separate line item for termite treatments or will the VA pay separate on an as needed basis?

Line item for termite treatments please.

9. Does the VA want fumigation which includes tenting whole building (more expensive) or spot treatment of affected area(s)?

Fumigation will be spot treatment of affected areas.

10. Please define the role of the contractor for Bed Bugs under this contract as was indicated during the site visit that inspection only was the only responsibility of the pest contractor for bed bugs.

Full scale Bed Bug Infestations will require either room heating, fumigation, or traps… or any combination thereof. Full scale Bed Bug Infestation is defined by pest being inside walls, receptacles, furniture, etc.…. Isolated bed bug sightings will be handle as an Emergency Call.

BED BUG IDENTIFICATION, CONTAINMENT AND TREATMENT

1. PURPOSE: To establish policies and procedures for identification, containment and treatment of bed bugs. This includes a comprehensive approach of staff education/training, containment and isolation procedures, and guidelines for inpatients and outpatient clinics within the Eastern Colorado Health Care System (ECHCS).

2. POLICY: Clothing, bedding, personal articles, and furniture that have encountered bed bugs will be handled as described in the procedures section below. Patients receiving medical care at ECHCS must consent to cooperating with the eradication process. Patients that are identified as having bed bug harborage in the clinic or Community-Based Outpatient Clinic (CBOC) setting will be handled as described in the procedures section below.

3. DEFINITIONS:

a. Bed Bugs – ¼ inch long, oval, wingless insects of the family Cimicidae, which have a flat, reddish-brown body and feed on human and animal blood. Bedbugs are active at night and will hide during the day or in well lighted rooms. Bedbugs can infest a home and hide in crevices, cracks, mattress seams and folds, wall outlets, window door frames draperies, baseboards, telephones, carpeting and behind hung picture frames. Bedbugs bite any areas of exposed skin. While some bites may go unnoticed, bedbug bites may also result in localized swelling and itching, and the areas may become inflamed or infected when scratched. Bedbugs are not believed to transmit diseases to humans.

b. Bed Bug Oven – a heated device used to contain and eradicate bed bugs from personal items such as clothing, shoes, etc. (See attachment A – list of items that cannot be heated).

c. Bed Bug Personal Protective Equipment (PPE) – equipment used to prevent the transmission of bed bugs to include gown or jumpsuit, hair covering, foot covering, and gloves.

4. RESPONSIBILITIES:

a. The Director will ensure education and training for the identification, treatment and protective gear for bed bug containment is available to staff.

b. Physicians will perform a physical check on patients who self-report observing for bugs and eggs while focusing on the patients face, arms, chest, back and ankles.

c. Nursing Staff will notify Environmental Management Service (EMS) if bed bugs are present or if found in patient belongings.

d. EMS is responsible for cleaning the environment after identification of bed bugs, initiating and providing oversight for pest management services, and conducting periodic monitoring through the Environment of Care (EOC) rounds process for possible bed bug infestations.

e. Staff members authorized to operate a government owned vehicle will immediately notify the ECHCS Transportation Manager in all instances where patients with bed bugs are transported.

f. All employees are responsible for practicing standard precautions.

5. PROCEDURES:

a. New hospital admission: if a patient is admitted to the hospital from the Emergency Department and bed bugs are found on the patient or in the patient's belongings; the following actions are to occur:

(1) The room should be designated as a Contact Precaution room. Use gown and gloves to enter the room and remove the gown and gloves prior to leaving. Perform hand hygiene prior to leaving the room and close room off from traffic. Keep non-essential staff out.

(2) If possible, collect a bed bug for inspection by EMS staff in a clear plastic container. Do not smash the bug.

(3) All patient clothing (no personal items or toiletries) will be double bagged, individually tied and sealed with surgical tape. EMS can provide clear plastic trash bags. Do not use red bio-hazard bags for this step. The tape should be signed and labeled with the following: date, patient name and last four (4) of the Social Security number (SSN), RN signature and patient signature.

(4) Notify EMS by calling the EMS duty cell at 303-328-5348. EMS will treat patient clothing for bedbugs and return to appropriate nursing staff.

(5) The patient will shower in their admitted patient room shower and issued a new set of hospital-laundered change of clothing. EMS will treat the patient room while the patient is showering. EMS will then immediately treat shower area upon completion. If the patient is unable to shower, a comfort bath should be provided prior to placement in a patient room. EMS will treat the location where comfort bath is provided.

(6) Nursing staff or physician will educate the patient about bed bug detection, prevention and control.

(7) Talent Management System (TMS) course VA 1376326 “Bed Bug Education” provides information to the provider about the prevention and management of bed bugs, awareness of where they hide, how to conduct self-inspection, containment and isolation procedures, and procedures for notifying EMS for appropriate treatment. These guidelines include the practice of thorough hand washing before and after all patient contact and vigilance in identification of potential infestations.

b. Admission for Surgical Procedure: if the patient reports to the facility prior to a surgical procedure and found to have bed bugs, the following actions are to occur:

(1) Patient will be directed to the designated “Contact Precautions” changing room.

(2) Patient will be instructed to remove clothing and place in a clear plastic double bag, individual tied and sealed. EMS can provide clear plastic trash bags. Do not use red bio-hazard bags for this step. Bag should be signed and labeled with the following: date, patient name and last four (4) of the Social Security number (SSN), RN signature and patient signature.

(3) Provide the patient with a transport gown, directed to the closest designated shower and provided an additional gown for procedure.

(4) Use gown and gloves to enter the room and remove the gown and gloves prior to leaving. Perform hand hygiene prior to leaving the room and close room off from traffic. Keep non-essential staff out. Room will be designated as a Contact Precaution room and closed off from further use.

(5) If possible, collect a bed bug for inspection by EMS staff in a clear plastic container. Do not smash the bug.

(6) Notify EMS by calling the EMS duty cell at 303-328-5348 of the bedbug contaminated area. EMS will treat contaminated areas (including shower) and release the spaces after the completion of treatment.

c. Outpatient Setting: if the patient is in the facility for a clinic (outpatient) appointment or activity and found to have bed bugs, the following actions are to occur:

(1) If the Veteran states they have bed bugs, it is okay for the medical staff to screen patients upon their arrival privately, looking for signs of possible bed bug activity. Visible signs could be in the form of bites or actual bed bug activity. If discovered, it is ok to gown patient during their appointment.

(2) Collect a bed bug for inspection by EMS staff in a clear plastic container. Do not smash the bug. Areas identified as having bed bugs will require treatment. If no bed bugs are present, area will be cleared for utilization and no treatment of the space will be required. EMS staff will be contacted to make this determination.

(3) Notify EMS by calling the EMS duty cell at 303-328-5348 of the bedbug contaminated area. EMS will treat contaminated areas and release the space after the completion of treatment.

d. Community Based Outpatient Clinic/Community Resource and Referral Center Appointments:

(1) If it is a known bed bug patient, schedule appointments towards the end of the day, staff should meet the veteran and escort the veteran directly to the exam room to avoid exposing additional areas to possible bed bug resettlement.

(a) If the patient is already in the exam room, it should be designated as a Contact Precaution room and closed off from further use after the exam is complete until it can be deep cleaned and chemically treated by a pest control company. Keep non-essential staff out.

(2) Collect a bed bug for inspection by Pest Management in a clear plastic container. Do not smash the bug. Areas identified as having bed bugs present will require treatment. Areas identified as bed bugs not being present will be cleared for utilization and no treatment of the space will be required. CBOC housekeeping staff are not ECHCS employees and are contracted through the building owner.

(3) Notify the Facility Management Service Liaison 719-924-4257 of the bed bug contaminated area, providing the room number to be deep cleaned by the contracted housekeeping staff and chemically treated by a pest control company.

e. Home Based Primary Care (HBPC), Housing and Urban Development-Veterans Affairs Supported Housing (HUDVASH), Mental Health Intensive Care Management (MHICM): for all staff visiting veterans in their homes as part of their assignment, it is recommended to put together a bed bug containment and isolation kit to include:

(1) A portable hard surface chair or stool;

(2) A satchel for holding personal items such as identification, cell phone, plastic clipboard and pen, additional booties and gloves;

(3) A change of clothes and shoes (kept in the vehicle);

(4) A plastic storage container with a sealed lid that will contain the items listed below or items that you might suspect to be infested:

(a) Disposable protective booties and Tyvek® type disposable coveralls;

(b) Disposable gloves;

(c) A roll of plastic 50-gallon garbage bags to be used for the transport of belongings suspected to be infested with bed bugs;

(d) Flashlight;

(e) Container of Sani Hands wipes and PDI purple-topped Sani-Cloths® if reusable medical equipment (RME) is used during the home visit.

(5) After you arrive: it is recommended to wear protective booties when you are uncertain about the presence of an infestation in the client’s home. A coverall or a Tyvek® suit can be worn if you are entering a home where you know there is an infestation. Do not sit on upholstered furniture or the bed, use the stool. Take only essential items into the client home. Avoid placing any items on upholstered furniture, bedding or carpeted floors without a plastic barrier between your items and the surface.

(6) Upon completion of visit: remove booties and coverall or Tyvek® suit if worn taking care to remove it so it is turned inside out as it is taken off to trap any bugs inside the suit, place items in a plastic trash bag and seal for disposal. Perform a self-inspection for pests immediately after leaving and before entering another facility or your vehicle. Pay attention to the inside/outside of shoes, socks, pant legs, etc. Check any items taken into the client’s home and sanitize them before placing them back in the vehicle. Clean and sanitize all RME per RME cleaning protocol. If signs of an infestation were noted or live bugs seen, provide the client with bed bug information.

(7) The employee who may have contracted bed bugs should notify their supervisor and take the following precautions once home: immediately place clothes in a plastic bag that can be tightly closed via a knot or twist tie. Wash contaminated clothing in hot, soapy water and dry in a dryer using the highest heat setting that the fabric can safely withstand. Any clothing or items taken into the home that cannot be washed or dry cleaned should be placed in a dryer on medium-high for at least 20 minutes. Disposable scrubs should be placed in an air tight bag and discarded. If items are taken to a dry cleaner, inform the cleaner of the possibility of bed bugs. The employee should take a shower or bath.

(8) HPBC and HUDVASH may have additional service-specific guidelines for staff.

f. Government vehicles: please report vehicles with suspect bed bug infestation or a recent transport with suspect bed bug infested belongings to the Traffic Manager in Denver/Aurora and the Fleet Manager in the CBOCs. If a government vehicle is used to transport a veteran with known bed bugs, the veterans’ belongings should be contained during transport. This can be accomplished by placing the belongings in a large plastic storage container or a large plastic garbage bag.

6. CONCURRENCES: Deputy Director, Chief of Staff, Associate Directors, Associate Director for Patient Care Services, Regional Manager Southern Clinics, Facility Management Service, Environmental Management Service, Chief Nurses, Infection Control, Imaging, Cardiology, Dental Service, Dermatology Service, Neurology Service, Audiology, Ophthalmology, Orthopedics, Physical Medicine Rehabilitation Service, Podiatry, Pulmonary Service, Social Work Service, Women Veterans Health Program, AFGE 2241 and 2430, NNU, Health Information Management Section, Privacy, Human Resources, Patient Safety, Quality Management.

7. REFERENCES:

Under Secretary for Health’s Information Letter (IL) on Bed Bugs, IL 10-2008-011, August 8, 2008.

Miller, D. Kells, S., Bed Bug Action Plan for Home Health Care and Social Workers, Departments of Entomology Virginia Teck and University of Minnesota, http://www.vdacs.virginia.gov/pdf/bb-healthcare1.pdf, accessed 09/13/2017.

Munoz-Price, L.S., Safdar, N., Beier, J., Doggett, S., Bed Bugs in Healthcare Settings, Infection Control and Hospital Epidemiology, November 2012, Vol. 33, No. 11.

Centers for Disease Control and Prevention, https://www.cdc.gov/parasites/bedbugs/faqs.html, accessed 09/13/2017.

Environmental Protection Agency, https://www.epa.gov/bedbugs/introduction-bed-bugs, accessed 09/13/2017.

8. RESCISSION: N/A

9. REVIEW DATE: January 2021 Sallie A. Houser-Hanfelder, FACHE Director

Attachment: A – Bed Bug Information Sheet

??-??? (EMS)

Bed Bug Information

a. Adult bed bugs are a reddish brown, flattened, oval, and wingless, with microscopic hairs that give them a banded appearance. Adults grow to 4 to 5 mm (one-eighth to three-sixteenths of an inch) in length and do not move quickly enough to escape the notice of an attentive observer.

b. The bed bug only feeds on blood. The main source for blood meals is humans, although other mammals and birds can serve as a source. The bed bug is attracted to the host by detecting body heat and carbon dioxide. A blood meal is required for the female to produce eggs, and for progression of nymphs to each of the five developmental stages. However, an adult bed bug can survive for a year between feedings.

c. Bed bugs are nocturnal and hide during the day unless extremely hungry. Preferred harborages are relatively close to the host, such as mattress seams and folds. However, bed bugs can travel several feet from a host and have been known to conceal themselves in outlets, window and door frames, bed frames, drapery, baseboards, floors and wall cracks, drawers, electrical boxes, telephones, furniture, wall-to-wall carpeting, loose wallpaper, and behind wall hangings and headboards.

d. Bed bugs are not known to transmit any significant diseases. However, they are a nuisance and the bed bugs themselves may infest a persons’ clothing and potentially invade the environment.

e. Bed bug bites: In most observed cases a small, hard, swollen, white welt may develop at the site of each bedbug bite. This is often surrounded by a slightly raised red bump and is usually accompanied by severe itching that lasts for several hours to days. Welts do not have a red spot in the center such as is characteristic of flea bites.

Bed bugs are an infestation, NOT an infection. They are not known to transmit disease to humans.