DRAFT PWS EL PASO WHEELCHAIR TRANS SERVICES.docx

Performance Work Statement (PWS) Wheelchair Transportation Services VISN 17/Station 756

1. Purpose: The El Paso VA Medical Center (hereafter ELPVAHCS), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of wheelchair transportation services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The ELPVAHCS main campus is located _ 5001 N. Piedras, El Paso, Texas 79930 __., serving over 111,500 veterans, primarily from the _El Paso___ area and it’s five Community-Based Outpatient Clinics. The ELPVAHCS see approximately __534,800_______ outpatient visits a year. Veterans served within this facility lives within the following counties and zip codes.

3. Acronyms CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Contract Administration. The Contractor shall contact the Contracting Officer on all matters pertaining to the contract. The Contracting Officer is the only person authorized to obligate the VA, to issue any changes, which affect the price, quantity, quality, or delivery terms of this contract. The Contracting Officer Representative (COR) shall be included on all communications between the Contractor and the Contracting Officer, and the COR shall be responsible for validation/reconciliation of claims and authorization for payment.

5. General Description. The Contractor shall provide all Wheelchair services, 24 hours per day, 365 days per year, as required per the terms and conditions contained herein. The contractor shall furnish vehicles sufficient to provide full and complete coverage for the pick-up and delivery of all veteran patients requiring transport by Wheelchair as shown in paragraph 1 above.

5.1. Prior to contract performance, the COR shall provide the Contractor with a list of names (or position titles) and phone numbers of authorized Government personnel who may request services. This list shall be updated and submitted to the Contractor as changes occur. Services rendered in response to requests from other than authorized personnel shall be at the risk of the Contractor and any costs related thereto shall be borne by the Contractor.

5.1.2. Pick-up and deliveries shall also be required from community hospitals and VA facilities within and outside the service area to include the patient’s residence as requested by the COR per the procedures specified within this PWS. The trip rate provided in any category shall be all-inclusive regardless of the time of day as agreed to in the price schedule of the resultant award.

5.1. This contract’s ordering period shall be effective from Date of Award through 2029.

5.2. The Place of Performance is variable and may occur within the states of __Texas____, _New Mexico____; ambulance services may be required to or from locations including, but not limited to the following:

5.2.1. (ELPVAHCS) VA Medical Center to include specific Atrium Clinics, Emergency Department, pavilions, or out-buildings on the (ELPVAHCS) campus. The (ELPVAHCS) address is: _5001 N. Piedras St, El Paso TX 79930________.

5.2.2. (ELPVAHCS) Community-Based Outpatient Clinics (CBOCs):

5.2.3. Other Non-VA Medical facilities and Community Care facilities as authorized by the VA.

5.2.4. Veteran’s residence.

5.2.5. Local airports including: ______El Paso International Airport__________________________.

6. VETRide Utilization. The Contractor shall utilize the VetRide Third Party Portal and Vendor Pass with every passenger transported under this contract. The Department of Veteran Affairs shall provide the software and access to the VetRide Third Party Portal for the vendor/contractor in this contract. The Contractor shall utilize the VetRide Third Party Portal fully as instructed.

· Receive and respond to electronic trip requests.

· Receive, use, and ensure the use of the Vendor pass by the dispatcher and air crew.

· Submit claims via the electronic HCFA 1500 in the VetRide Third-Party Portal

6.1. VETRIDE INVOICING PROCEDURE. The awarded Contractor shall invoice the VA North Texas Health Care System by utilizing a secured means of Electronic Data Interchange (EDI). When invoicing, the VA requires that each trip is disclosed with the individual cost, mileage utilized, point of pick-up, and point of drop-off, along with the date of transport and associated patient identification.

6.1.1. At the time of delivery of the patient to their destination, the Contractor shall provide a “Run Sheet” as part of the patient's permanent record. This Run Sheet shall include a record of the patient’s vital signs, medications used, oxygen use, and any changes in the patient’s condition. The Run Sheet shall provide the following information either in this format or in the Contractors’ established format.

6.1.2 The Contractor shall submit an original invoice and three copies (or an electronic invoice, if authorized) to the address designated in the contract to receive invoices.

The Contractor’s invoice must include:

(1) Contract Number / Purchase Order Number

(2) Date of Trip

7. The Contractor shall provide a receipt or copy of the receipt for all miscellaneous charges. (Waiting time, etc.)

8. Unauthorized charges shall be suspended by the Contracting Officer. Unauthorized charges

9. are those that have not been pre-approved by authorized VA personnel. Supporting documentation may be provided and submitted for payment consideration.

10. Suspended charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges, which are being suspended.

11. Quality Control Plan

11.1. Quality Control

11.1.1. The contractor shall maintain a Quality Control Plan (QCP) that contains, at a minimum, the following:

11.1.1.1. A description of the company’s organizational structure including a description of the roles and responsibilities of management and supervisors.

11.1.1.2. A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service.

11.1.1.3. A description of the specific steps the contractor shall take for corrective action if needed if a deficiency or problem in the quality of service occurs.

11.1.1.4. A description of the company’s records and tracking system used to identify up-to- date background checks, applicable certifications and tests, and training of each employee performing services under this contract.

11.1.1.5. A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability and up to 4 simultaneous transports in accordance with PWS 4.5.1.7).

11.1.1.6. A description of the methods used to identify and prevent radio communication breakdowns and a detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

11.1.1.7. CONTENGENCY PLAN: (In case VetRide Vendor Portal is down) A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm the log will be sent to the COR monthly.

11.1.2. The Government shall evaluate the contractor’s performance under this contract to ensure that the contractor’s QCP is adequate, and that quality is achieved through a Quality Assurance Surveillance Plan (QASP).

11.1.3. The Government shall prepare a QASP after contract award derived from the PWS and contractor’s submitted quality control plan. The QASP is a “living document” and the Government may review and revise it at any time. However, the Government shall coordinate changes to the QASP with the contractor.

11.1.4. The QASP shall specify the work requiring surveillance and the Government’s method of surveillance.

11.2. Minimum Performance Standards

11.2.1. The contractor shall maintain performance standards in accordance with the standards outlined in the table below. Failure to meet the Acceptable Quality Levels (AQL) may result in termination of the contract.

11.2.2. The QASP shall include the standards below as well as others derived from the successful offeror’s quality control plan.

Reference

Provide on- time ambulance services

orders

of monthly invoices/reports

12. COVID-19 Or Other Similar Infectious Diseases

12.1. Contractor shall not refuse transports of COVID-19 positive or other similarly infected patients.

12.2. Contractor shall abide by all additional procedures and precautions that may be implemented by the VA based on VA-issued guidance and/or CDC recommendations. These procedures are subject to change throughout the life of the contract and shall be incorporated via attachment (See S03 VTS Patient Transport PPE and Vehicle Cleaning/Disinfection SOP).

12.3. Contractor shall have written policy of steps they shall take to prevent the spread of COVID-19 or other similarly infectious diseases by their employees and/or vehicles. This policy shall, at a minimum, include procedures of screening drivers before each shift, deliberate decontamination of their vehicles and all other preventative precautions taken by Contractor employees.

12.4. Contractor shall furnish all required PPE throughout the life of the contract.

13. Conformity To Regulations

8.1 The contractor and his/her operators shall conform to all Federal, State, and local regulations governing the performance of contracted services.

8.2 VAMC facilities have been designated NO SMOKING areas in their entirety. Individuals found in violation of this no smoking policy may be subject to a $50.00 federal citation for disregarding posted safety rules and regulations. Furthermore, the contractor may be directed to stop work. The contractor is to notify all of his/her employees and/or sub-contractors of this strict enforcement policy.

14. Wage Rates

9.1. Wage Determination(s) as listed in Section D in this solicitation are applicable to any resulting contract.

9.2. The contractor certifies by signature on this offer that the salaries to be paid workers involved in the performance of the contract are equal to or greater than those specified in the attached Wage Determination(s).

9.3 The Department of Labor has held that contractors must pay their employees the Service Contract Act waged while they are driving both to and from destinations for the VA. The Wage Determination is attached in Section D.

15. Evidence of Coverage

10.1 Before commencing work under the contract, the contractor shall furnish the Contracting Officer with a certification from his/her insurance company indication that the coverage outlined in this contract has been obtained and that it may not be changed of canceled during the term of the contract.

16. Worker’s Compensation

11.1 The Act of June 25, 1936, 42 Stat. 1938 (40 USC 290), authorized the constituted authority of the several states to apply their workmen’s compensation laws to all lands and premises owned or held by the United States. The contractor agrees to procure and maintain while the contract is in effect, Worker’s Compensation and Employers Public Liability insurance. The policy shall provide coverage for Public Liability Limits of not less than the statutory limitations for any one accident, and at least meet the statutory limitations if more than one person is involved. , Upon award of the contract, the contractor shall furnish to the Contracting Officer a certificate from its insurance company indicating that this coverage has been obtained and that such coverage may not be changed or canceled unless 30 day advance written notice is provided to the Contracting Officer.

17. Contractor Personnel Security Requirements

12.1 All contractor employees who require access to the Department of Veterans Affair's computer systems or who come into contact with veteran/beneficiaries shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed prior to the start date of the contract, the contractor shall be responsible for the actions of those individuals they provide to perform work for the VA.

Position Sensitivity - The position sensitivity for this contract has been designated as LOW RISK.

Background Investigation - The level of background investigation commensurate with the required level of access for this contract is National Agency Check with Written Inquiries.

Contractor Responsibilities:

• The contractor shall pre-screen all personnel requiring VA access to ensure they maintain a U.S. citizenship and are able to read, write, speak, and understand the English language.

• The contractor shall submit or have their employees submit the following required forms requested by Department of Veterans Affairs, Office of Security and Law Enforcement, Security and Investigations Center, 2200 Fort Roots Drive Bldg. 104, North Little Rock, AR 72114 within 30 days of receipt:

• All documents completed and submitted at the following website: http://www.va.gov/SECURITYINVESTIGATIONSCENTER/

• The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the contractor personnel security requirements may result in termination of the contract or cause.

The contractor shall agree that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of this task order are the property of the United States Government. The contractor shall agree that all individually identifiable health information shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract, all copies of individually identifiable health records shall be destroyed or returned to the VA. Any individually identifiable health records shall be deleted from computers not belonging to the VA. The contractor shall comply with the Privacy Act, 38 U.S.C. 5701, 38 U.S.C. 7332, and 5 U.S.C. 552(a) et. Seq. Contractor staff shall sign confidentiality statements before the start date of the contract. The contractor shall comply with all provisions of the Health Information Portability and Accountability Act (HIPAA), including but not limited to privacy, security of electronic health data, and adherence to standards and code sets as required by HIPAA. The contractor shall ensure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality. Any person, who knowingly or willingly discloses confidential information obtained from the VA with non-essential persons, may be subject to fines.

12.1.1 HIPAA COMPLIANCE. HIPAA compliance is required. The contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health, and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the contractor may be required to enter into a Business Associate Agreement (BAA) with VA.

12.1.2 BLOOD BORNE PATHOGENS: The contractor and the employees provided, pursuant to this contract, shall comply with the effective VAMC Policy (and Occupational Health requirements in accordance with OSHA Blood Borne Pathogens (BBP) Law and the OSHA Tuberculosis Compliance Directive, enforceable under OSHA’s General Duty Clause) governing health care workers infected with a blood borne pathogen. If the contractor obtains information that a health care worker providing care pursuant to this agreement may be infected with a blood borne pathogen, the contractor shall advise the Contracting Officer immediately.

18. Medical Liabilities Insurance

13.1 The contractor shall carry required insurance (See VAAR Clause 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE) and vehicle insurance in accordance with the (_Texas_) Department of State Health Services.

19. Annual VHA Training

14.1 In accordance with VHA Directive 2003-028 "Compliance and Business Integrity Program", its updates or replacement directives, IG Guidance at 8994, Section II(C); Guidance at 4875, Section III (B)(4) Sentencing Guidelines, Section 8B2.1 (b) (4) (B) annual compliance training is to be provided to all contractors within the scope of their work. The medical center COTR’s are to coordinate the annual training with their respective Contracting Officer and Compliance and Business Integrity Officers. A copy of the documentation of the completed annual training is to be provided to the Compliance and Business Integrity Officers for their files.

In accordance with VHA Directive 1605.1 “Privacy and Release of Information”, updates or replacement directives annual VHA Privacy Policy Training is to be provide to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility Privacy Officer for their files.

In accordance with VA Directive 6500, “Information Security Program”, updates or replacement directives annual VHA Cyber and Security Information Training is to be provided to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility Information Security Officer for their files.

20. Conformance with Environmental Management Systems

15.1 The contractor shall perform work under this contract consistent with the relevant policy and objectives identified in the agency, organizational, or facility environmental management system (EMS) applicable for your contract. The contractor shall perform work in a manner that conforms to all appropriate Environmental Management Programs and Operational Controls identified by the agency, organizational, or facility EMS, and provide monitoring and measurement information as necessary for the organization to address environmental performance relative to the environmental, energy, and transportation management goals. In the event an environmental nonconformance or noncompliance associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the contractor shall respond and take corrective action immediately. In the case of a nonconformance, the contractor shall respond and take corrective action based on the time schedule established by the EMS Site Coordinator. In addition, the Contractor shall ensure that their employees are aware of the roles and responsibilities identified by the environmental management system and how these requirements affect their work performed under this contract.

All on-site contractor personnel shall complete yearly EPA sponsored environmental training specified for the type of work conducted on-site. Upon contract award, the Contracting Officer's Representative shall notify the facility-level Environmental Management Systems Coordinator to arrange EMS training for appropriate staff.

21. Contractor Performance Assessment Rating System (CPARS) Required Registration with Contractor Performance Assessment Rating System (CPARS)

16.1 As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates contractor past performance on all contracts that exceed $1,000,000 and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database. The CPARS database information is shared with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal Agencies.

16.2 ach contractor whose contract award is estimated to exceed $1,000,000 is required to register with the Contractor Performance Assessment Rating System (CPARS) database at the following https://www.cpars.gov/ or by calling (207) 438-1690. Registration should occur no later than thirty days after contract award and must be kept current should there be any change to the contractor’s registered representative.

16.3 For contracts with a period of one year or less, the contracting officer shall perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer shall evaluate the contractor’s performance annually. Interim reports shall be filed each year until the last year of the contract when the final report shall be completed. The report shall be assigned in CPARS to the contractor’s designated representative for comment. The contractor representative shall have thirty days to submit any comments and re-assign the report to the VA contracting officer.

16.4 Failure to have a current registration in the CPARS database, or to re-assign the report to the VA contracting officer within those thirty days, will result in the Government’s evaluation being placed on file in the database with a statement that the contractor failed to respond.

Surveillance Checklist

(ELPVAHCS)

Government POC Primary: Melvin Milton Government POC Alternate: Christine Rodriguez

Organization:

(ELPVAHCS)

Location: 5001 N Piedras St, El Paso TX 79930

Surveillance

Attachment A Version 2.0 August 7, 2020

Veterans Transportation Service (VTS) Patient Transport PPE and Vehicle Cleaning/Disinfection Standard Operating Procedure Following the tenets of Standard Precautions as described by the Centers for Disease Control and Prevention (CDC), everyone should be thoughtful and aware of potential situations or interactions where there is the potential for transmission of an infectious disease and should take appropriate actions to mitigate the potential for spread of those infectious diseases. Standard Precautions set the foundation for prevention of transmission of infectious agents. The concept of Standard Precautions includes a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered. These practices include the following: hand hygiene; respiratory etiquette; use of personal protective equipment (PPE) such as gloves, gown, mask, eye protection, or face shield, depending on the anticipated infectious exposure; along with principles of environmental cleaning and disinfection.

VTS Operator/Driver PPE During the COVID-19 pandemic, below please find considerations for PPE usage for VTS following tenets of Standard Precautions from CDC.

ROUTINE TRANSPORTS:

When VTS or a VA station employee driver/operator is transporting any patient who is not diagnosed as a COVID-19, the following PPE is required for transport:

· Facemask at all times (universal source control).

· Eye Protection (e.g., goggles or face shield) when loading, securing, and unloading wheelchair or stretcher patients, but does not need to be worn during actual driving to reduce risk of a visual hazard.

· Gown as needed (based on exposure to body fluids or contact with patient when loading, securing, and unloading wheelchair and stretcher patients).

· Gloves as needed (based on exposure to body fluids or contact with the patient when loading, securing, and unloading wheelchair or stretcher patients).

COVID-19 TRANSPORTS:

When VTS and VA station employee driver/operator is transporting a patient with COVID-19, the following PPE is required for transport.

· Fit-tested N95 Respirator or equivalent (if available) or Facemask at all times*

· Eye Protection (e.g., goggles or face shield) *

· Gloves (based on exposure to body fluids or contact with the passenger)

· Gown (based on exposure to body fluids or contact with the passenger) *CDC recommends that drivers wear an N95 respirator or facemask (if respirator is not available) and eye protection such as a face shield or goggles (as long as they do not create a driving hazard).

https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/disinfecting-transport-vehicles.html OTHER POTENTIAL INFECTIOUS DISEASES TRANSPORTS (e.g., tuberculosis, chickenpox or disseminated shingles, measles, etc.):

Please refer to your local medical center policies and procedures for these other agents to be consistent with your established practices.

Face Covering of Patients/Passengers

· All passengers (patients and accompanying family members/caregivers) must wear a facemask or cloth face covering to cover both of mouth and nose constantly during the transportation regardless the presence or absence of respiratory symptoms.

· If the passenger refuses to wear a facemask or cloth face covering during the transportation, the VTS and VA station employee driver/operator should decline providing the transportation.

· If the passenger needs medical exemption of mask/cloth face covering, the exemption must be directly from a Licensed Medical Provider with prescriptive authority at VA. Self-report of medical exemption from the Veteran or family/caregiver is not acceptable.

VTS Donning of Personal Protective Equipment Before Transport

· Note: Driver/Operator will Don PPE prior to entering the vehicle, engaging patient VTS procedures for Donning of PPE is as follows:

1. Donning (Putting on):

· Perform hand hygiene before putting on any PPE

· General approach to putting on this PPE combination for respiratory pathogens

· Gown

· Respirator or Facemask (if not worn already)

· Goggles or face shield

· Gloves Additional Considerations for Transport of Patients with Potential Infectious Diseases: If VTS or station Operators/Drivers become aware of a patient who is infected or possibly infected with a respiratory infectious disease, they should notify the receiving health care facility that the patient is a confirmed or suspected COVID-19 patient or other infectious respiratory disease, so that appropriate infection prevention and control precautions may be taken prior to patient arrival.

· Keep the patient separated from other people as much as possible.

· The patient should wear a facemask (if not available, a cloth face covering at minimum) to cover both the nose and mouth constantly during the transport to contain any droplets generated during coughing or sneezing.

· Family members and other contacts of patients with confirmed or suspected COVID-19 or other infectious respiratory disease should not ride in the transport vehicle. If a family member or other contacts must ride in the transport vehicle, they should wear a facemask (if not available, a cloth face covering at minimum).

· Whenever possible, use vehicles that have isolated driver and patient compartments that can provide separate ventilation to each area.

· Close the door/window between these compartments before bringing the patient on board.

· During transport, vehicle ventilation in both compartments should be on non-recirculated mode to maximize air changes that reduce potentially infectious particles in the vehicle.

· If the vehicle has a rear exhaust fan, use it to draw air away from the cab, toward the patient-care area, and out the back end of the vehicle.

· Some vehicles are equipped with a supplemental recirculating ventilation unit that passes air through HEPA filters before returning it to the vehicle. Such a unit can be used to increase the number of air changes per hour (ACH). If so equipped, replacement of filters should occur per manufactures instructions. Link: (https://www.cdc.gov/niosh/hhe/reports/pdfs/1995-0031-2601.pdf).

· If a vehicle without an isolated driver compartment and ventilation must be used, open the outside air vents in the driver area and turn on the rear exhaust ventilation fans to the highest setting. This will create a negative pressure gradient in the patient area.

· Follow routine procedures for a transfer of the patient to the receiving health care facility (e.g., wheel the patient directly into an examination room).

Cleaning and Disinfecting VTS Transport Vehicles after Transporting a Patient The following are guidelines for cleaning or maintaining VTS transport vehicles and equipment after transporting a patient:

· After transporting the patient, leave the rear doors of the transport vehicle open to allow for sufficient air changes to remove potentially infectious particles.

· The time to complete transfer of the patient to the receiving facility and complete all documentation should provide sufficient air changes.

· When cleaning the vehicle, VTS operators should wear a disposable gown and gloves. A face shield or facemask and goggles should also be worn if splashes or sprays during cleaning are anticipated.

· Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly, to include the provision of adequate ventilation when chemicals are in use.

· Clean and disinfect the vehicle in accordance with standard operating procedures. All surfaces that may have come in contact with the patient or materials contaminated during patient care (e.g., stretcher, rails, control panels, windows, floors, walls, seat belts, work surfaces) should be thoroughly cleaned and disinfected using an EPA-registered hospital grade disinfectant in accordance with the product label.

· Disinfection products with EPA-approved emerging viral pathogens claims for use against SARS-CoV-2 are to be used. Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2. Check with local infection prevention and control professional if there are any questions.

· Clean and disinfect reusable patient-care equipment before use on another patient, according to manufacturer’s instructions.

· Follow Standard Operating Procedures for the containment and disposal of used PPE and regulated medical waste.

· Follow Standard Operating Procedures for containing and laundering used linen. Avoid shaking the linen.

VTS procedures for Doffing of PPE after transport is as follows:

· Note: Operator/Driver shall maintain all PPE until after the vehicle is Fully Terminal Cleaned. Upon the completion of PPE Doffing procedure, the operator shall dispose of all contaminated PPE inside a regular trash container, unless the PPE is wet/saturated with body fluids, in which case it shall need to be disposed of in a Bio-Hazard container.

2. Doffing (Taking off): See the following link to CDC guidelines:

https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE_11x17.pdf

· First: Remove gloves and discard directly in a trash receptacle

· Second: Remove gown and discard directly in a trash receptacle

· Third: Perform hand hygiene

· Fourth: Remove face shield / eye goggles

· Fifth: Remove respirator/facemask if necessary and discard directly in a trash receptacle

· Sixth: Perform hand hygiene Documentation and Reporting of Vehicle Cleaning/Disinfection Mobility Managers or the facility management official in charge of vehicles shall create a cleaning or disinfecting Checklist to be completed and submitted by VTS /Station Drivers/Operators after each vehicle cleaning and disinfection.

The checklist shall contain at minimum the following:

· Date and Time of Cleaning /Disinfection:

· Vehicle Identification:

· Driver/Operator Name:

· Cleaning Method Used:

· Wipe down

· Spray

· UVC Light:

· Duration while on the floor

· Duration while hanging from the ceiling

· Verification that all windows and doors were closed during UVC operation

· Driver/Operator Signature:

Use of UVC Disinfecting Unit for Cleaning and Disinfecting VTS Transport Vehicles (Optional) ONLY use the UVC Disinfecting Unit AFTER MANUAL CLEANING !!!!!!!!

Use of UVC Units should occur at the end of each transport day if the facility decides to implement it.

· Note: See manufacturer instructions on use of the UVC Unit. A copy is enclosed with each unit and become familiar with the processes contained in the Instructional Video at: https://www.youtube.com/watch?v=c0Fn3a_lHcA&feature=youtu.be

· Use of the provided UVC Disinfectant/Decontamination portable unit:

· Park vehicle in an area where there is no human pedestrian traffic to prevent UV light exposure to eyes of passersby—but which allows for an electrical extension cord to access the vehicle for the UVC Unit.

· Set UVC Unit on the floor in the center of the vehicle

· Startup vehicle and turn the AC/Heat fan on High Setting

· Close all doors and windows

· Place UVC Warning Signs on Windshield Dashboard, windows, and door(s).

· Set timer on UVC Unit for 10 minutes

· The units have a timer on them that allows for one minute to leave the vehicle after it has been started.

· Exit vehicle immediately closing door behind you.

· If there is an urgent need for an employee to enter the vehicle when the light unit is operating, they will need to be wearing full length pants, a long sleeve shirt, gloves that cover their entire hands, and sunglasses that wrap around the eye area.

· Once initial UVC Unit operation is complete—USE THE HANDLE TO PREVENT BURNS FROM THE UVC UNIT BEING HOT FROM OPERATION. ----Hang UVC unit from the ceiling OR from a IV pole in the center of the vehicle and set timer for 10 minutes.

· Exit vehicle and close door behind you.

· Once UVC Unit operation is complete:

· Turn off vehicle AC/Heater fan

· Turn off vehicle

· Disconnect from electrical extension cord and place the UVC Unit and extension cord in a safe/secure area where it will not be damaged.

Any broken bulbs should be treated as a hazardous material and appropriate gloves and disposal of bulb pieces should be performed as specified by your local GEMS Program Manager or Safety Officer.

USE OF UVC UNIT DOES NOT REPLACE /ENVIRONMENTAL SURFACE CLEANING AND DISINFECTING !!

CDC Guidance for Disinfecting NEMT and EMS Vehicles (ambulances): See Link below:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html Follow-up and/or Reporting Measures by VTS Operators/Drivers After Caring for a Patient with Confirmed or Suspected COVID-19 VTS and station Operators/Drivers should be aware of the follow-up and/or reporting measures they should take after caring for a patient with confirmed or suspected COVID-19:

· VA facilities should develop policies for assessing exposure risk and management of VTS personnel potentially exposed to SARS-CoV-2 in coordination with state and/or local public health authorities and local VA facility infection prevention and control professional. Decisions for monitoring, excluding from work, or other public health actions for VTS Operators with potential exposure to SARS-CoV-2 should be made in consultation with Transportation Chief, Executive Leadership Team, and local VA facility Occupational Health. Refer to CDC guidance, Interim U.S. Guidance for Risk Assessment and Public Health Management of Health care Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19), for additional information.

· VTS personnel who have been exposed to a patient with suspected or confirmed COVID-19 should immediately notify their chain of command to ensure appropriate follow-up.

· Any unprotected exposure (e.g., not wearing recommended PPE) should be reported to Occupational Health Services, a supervisor, or a designated infection control officer for evaluation.

· VTS and station Operators/Drivers should be alert for fever or other symptoms of COVID-19 (e.g., respiratory symptoms such as cough, shortness of breath, sore throat). See CDC link for further information about COVID-19 symptoms: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. If symptoms develop, they should self-isolate and notify their supervisor and Occupational Health Services. In addition, it may be required that the local Public Health Authority be notified to arrange for appropriate evaluation.

· Based on local assessment of the situation and actions taken (e.g., self-quarantine), appropriate OSHA documentation may need to be completed.

Definition of Terms:

Source Control: Use of cloth face coverings or facemasks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing, or coughing. If a person has a tracheostomy (trach), it is important to cover the tracheostomy as well as the nose and mouth.

Personal Protective Equipment (PPE): Personal protective equipment (PPE) is used every day by health care personnel (HCP) to protect themselves, patients, and others when providing care. PPE helps protect HCP from many hazards encountered in health care facilities (e.g., gown, gloves, mask, eye protection).

Face Covering: Typically, textile (cloth) covers that are intended for source control (e.g., bandanas, cloth masks). Face coverings are not personal protective equipment (PPE).

Facemask: Facemasks are personal protective equipment (PPE) and are often referred to as surgical masks or procedure masks. Facemasks are designed to protect against splashes and sprays to the nose and mouth and also can provide source control.

N95 Respirator or equivalent: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in health care. Health care personal should be medically cleared and fit tested if using respirators with tight-fitting facepieces (e.g., NIOSH-approved N95 respirator) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use.

Eye Protection: Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) protect the eyes from splashes or sprays. Reusable face shields and goggles should be cleaned and disinfected after each use. Face shields are not a substitute for a facemask. Note: Protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face likely do not protect the eyes from all splashes and sprays and not considered as eye protection. Regular reading glasses, prescription lenses or glasses, and sunglasses are also not typically considered eye protection.

NARA Records Management Language for Contracts

a. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

b. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

c. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

d. El Paso Veteran Affairs Health Care System (EPVAHCS) and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of EPVAHCS or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701.

In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to EPVAHCS. The agency must report promptly to NARA in accordance with 36 CFR 1230.

e. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to EPVAHCS control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

f. The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and EPVAHCS guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

i. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with EPVAHCS policy.

j. The Contractor shall not create or maintain any records containing any non-public EPVAHCS information that are not specifically tied to or authorized by the contract.

k. The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

l. The EPVAHCS owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which EPVAHCS shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

m. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take VHA-provided records management training, Talent Management System (TMS) Item #10176, Privacy and Information Security, Rules of Behavior. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

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