PWS_Yap Hospital Mold Mitigation.pdf

PERFORMANCE WORK STATEMENT

YAP MEMORIAL HOSPITAL MOLD MITIGATION

COLONIA, YAP, FEDERATED STATES OF MICRONESIA

OHASIS # 87400

22 MAY 2026

1.0 DESCRIPTION

1.1 Project Description: The objective of this project is for the Contractor to provide all labor, materials and equipment necessary to mitigate existing mold contamination and prevent future mold growth by restoring the heating, ventilation and air conditioning (HVAC) system for the Yap Memorial Hospital. Project must comply with all Federal, State, and local codes and laws and includes preparation of a design as discussed below. The hospital purchased two chillers in 2019 which were not installed and have remained onsite in their protective covers. The Contractor shall inspect the chillers, refurbish as necessary and install them to restore chilled water for the hospital.

1.1.1 Design: The contractor shall prepare a design to clearly describe their plan of work for completing the requirements of this project. The design shall address all aspects of the work to be performed, to include anticipated outages (number and duration), phasing requirements, transition space if required, etc. It is the contractor’s responsibility for verification of all field conditions that affect the execution of their design and disposal of all mold remediation waste. Enclosures/drawings are provided for reference only, not for design purposes. To the extent possible, the following criteria shall be applied:

• ASHRAE 170 Ventilation for Healthcare Facilities

• Facility Designers Guide for Tropical Islands - Designing for Resilience in a

Changing Climate - November 2022

• UFC 3-440-05N Tropical Engineering, Change 2, 28 November 2006

• NAVFAC - MARIANAS NAVY AND MARINE CORPS DESIGN AND CONSTRUCTION

STANDARDS, September 2017

• International Mechanical Code 2024

• ISO 14644-1: Cleanrooms and associated controlled environments (Applicable to

Operating Rooms)

• SMACNA HVAC Duct Construction Standards (Focus on moisture/condensation prevention)

• NFPA 99: Health Care Facilities Code

• NADCA ACR: Standard for Assessment, Cleaning, and Restoration of HVAC Systems

• Facility Guidelines Institute (FGI) Guidelines for Design and Construction of

Hospitals

The Contractor shall document those criteria elements (within the scope of the repair) that cannot be met, including the reason and any mitigations in the design. Submit the list for concurrence and by the owner.

1.1.2 Repair/Construction Action: The Contractor shall decontaminate mold impacted drywall, remove and replace insulation and provide air conditioning for Buildings 7, 8, 2 and TBD and verify that mold is no longer present in the air or on surfaces.

1.1.3 Existing Conditions: The Site Report at Section 7.0 describes the current conditions and estimated quantities of the abandoned air handling system, the chillers and insulation.

1.1.4 Renewal Site Survey and Report: The contractor shall schedule a pre-site survey teleconference prior to the site visit to discuss the information required. Prior to the site survey, the contractor shall document that all required preparations for the site survey have been completed, to include developing a detailed schedule and coordinating with the Contracting Officer’s Representative to identify required documents/information and points of contact.

1.2 Repair Work

1.2.1 Architectural

1. Wash and disinfect interior walls in Buildings 2,3,4,7,8 and 9.

2. Repaint interior walls in Buildings 2,3,4,7,8 and 9 utilizing mold and mildew resistant paints.

3. Replace the attic insulation and establish a continuous plastic vapor barrier on top of the ceiling insulation for buildings 1, 2, 3, 4, and 7.

1.2.2 Mechanical

1.2.2.1 General

1. Repairs are targeted at controlling space conditions (humidity and temperature) to reduce the propagation of mold and other pathogens that have resulted in high rates of HAIs. Previous designs and repair projects have not fully appreciated the harsh marine environment, nor the maintenance challenges in this region. Systems and designs must be simple, such that failure of one element or maintenance task does not fully compromise the patient care environment.

2. The purpose of the scope is to remediate and restore all air handling units to operation, restore the chilled water system, provide a new heating hot water system for reheat to establish temperature and dew-point control in the most critical areas.

1.2.2.2 Chilled Water Plant

1. Demolish and dispose of two existing Carrier air-cooled chillers (approximately 60 tons) included piping, valves, controls and gauges up to the entry of the building. Exact point of demolition to be determined in the field to coordinate with the new chillers, valves, piping and controls. Refrigerant has already been removed.

2. Repair the concrete mounting pads for the new chillers including removing and replacing anchor bolts and repairing any damaged concrete.

3. Prep and install two existing chillers, Carrier Model 30RAP0605CC0096N. Chillers are located on-site adjacent to the existing nonfunctional chillers. Chillers will require a refrigerant (R410A) charge, full start-up and commission as recommended by the manufacturer. Consult with manufacturer and procure seals and other maintenance parts that are recommended for replacement due to extended time in storage. Existing electrical feeder cables from the old chillers are to be reused. Remove surface rust on the enclosure panels and recoat with rust resistant paint as recommended by the manufacturer. Replace any existing screws or bolts which show signs of significant corrosion, taking care to avoid dissimilar metals.

4. Provide and install a chiller plant control system to sequence the two chillers including any necessary valves, sensors and controls to enable regular rotation of the chillers to maintain similar operating hours on each.

5. Disconnect the chilled water supply and return piping from the original 1979 era pumps (qty 2) and install blank flanges to completely isolate the old pumps from the system.

Pumps may remain in place or be demolished.

6. Replace water pump seals in the 2011 era pumps. Re-commission and balance the pumps for restored service.

7. Chilled water quality - Test domestic water (used as chilled water makeup) for the parameters below. Utilize a water quality expert to recommend water treatment. Install and establish treatment as recommended.

Water Testing Parameters Units Water Temperature F/C Water pH - Total Alkalinity as CaCO3 Total Hardness as CaCO3 Calcium mg/l Magnesium mg/l Sodium mg/l Chlorides mg/l Sulfates mg/l Iron mg/l Manganese mg/l Lead μg/L Copper mg/l Conductivity μS/cm Total Dissolved Solids mg/l Chlorine Residual mg/l Langelier Index Dimensionless Calcium carbonate precipitation potential as CaCO3 Dissolved inorganic carbonate (DIC) as C Equilibrium alkalinity as CaCO3 Rysnar Saturation Index Dimensionless Larson’s Ratio Dimensionless

8. Flush and fill the entire chilled water system to remove rust and debris. Clean all strainers after/during the flushing process including those in the plant and at the air handling units.

Ensure all air has been removed.

9. Chilled water piping, which is replaced during the project, should be PVC where it is feasible for the size and location in the system. Provide di-electrics for dissimilar metals.

1.2.2.3 Air Handling Unit Scope

1. AHU Replacement - Replace four (4) air handling units in-kind. The four proposed for replacement are AHU-T (Bldg 7), AHU-R (Bldg 8), AHU-S (Bldg 2), and a fourth (selection based on field assessment in consultation with FMD). These units have been prioritized due to a combination of degradation, quality, inadequate maintenance access etc.

Validate the selected units through field investigation and consultation with facilities management.

2. Mold remediation – mold within each AHU shall be remediated including replacement/cleaning of coils and filters (as indicated below).

3. Maintenance Access - Ensure that all maintenance access clearances are shown on the drawings including but not limited to electrical clearances per NEC, filter replacement clearances, fan/motor access clearances, clearances to remove the coil for cleaning without needing to cut piping (e.g. isolation valves and flanges to be located to facilitate ease of coil removal).

4. Prefilters - Replace ALL prefilters with washable aluminum or stainless-steel filters MERV-

8 (e.g. Smith filter). Provide 2 sets of filters for all AHUs with one set installed and the second set available for use when the other is being cleaned/washed.

5. Fan belts – replace belts for all air handling units.

6. HEPA Filters - For spaces which are currently served with duct-mounted HEPA filters (e.g.

AHU-A and AHU-B each have a single HEPA filter serving the Operating Rooms, 2 HEPA fan filter units serve Delivery, AHU-S has 2 HEPA filters serving Emergency etc.), install supply diffusers with integral HEPA’s (OR style) where the filter can be accessed and replaced from within the space. Utilize fan filter units if needed to overcome additional static pressure. The existing HEPA filter boxes may be left in place with the filters removed.

7. Terminal reheat – provide reheat within the AHU’s identified under section heating hot water. Other AHU’s/zones will be provided with terminal reheat as indicated.

8. Dew-point control - For all AHU’s where reheat will be added, replace the chilled water control valve and necessary controls to modulate the chilled water coil off supply air dewpoint.

9. Coil replacement – Replace the chilled water-cooling coils in four (4) air handling units.

Select the coils that are in the worst condition as field determined.

10. Coil cleaning – clean all coils to remain.

11. Outside air intakes – clean all outside air intakes to remove mold, dust and debris.

12. Balance dampers – Replace rusted/corroded balance dampers necessary for system balancing as field determined.

13. Air Handling Unit controls – Replace controls where necessary as field determined.

Control systems and sequences should be as simple as possible (e.g. operate AHUs in constant volume without static pressure reset etc.).

14. Condensate drainage – ensure all condensate drains are clear and continuously slope to their discharge point.

15. Testing/adjusting/balancing – Balance the air systems to original design intent. Ensure buildings have a positive air balance.

1.2.2.4 Chilled Water Distribution

1. Replace chilled water piping insulation in Building 8 corridor serving AHU-R. Insulation is currently showing mold growth on the surface. New insulation thickness shall be determined and ensure the outer surface does not reduce below 78F assuming an exterior temperature of 91F dry bulb (1% occurrence). Include protective jacket and vapor barrier.

2. Replace chilled water piping insulation in Building 7 corridor serving AHU-T and Building 8 corridor serving AHU-R. Insulation is currently showing mold growth on the surface due to exposure to outside conditions (unconditioned corridors). New insulation thickness to be as needed to ensure the outer surface does not reduce below the regional dewpoint.

Include vapor barrier.

3. Chilled water piping, which is replaced during the project, should be PVC where it is feasible for the size and location in the system.

4. Where AHU chilled water control valves are replaced, utilize 2-way valves.

5. Flush and clean strainers as detailed above.

1.2.2.5 Heating Hot Water

1. Design and install a new heating hot water recirculating system to serve the new terminal reheat coils for the AHU’s and zones identified.

2. Heating hot water should be produced with electric water heaters. Include an auxiliary coil or heat exchanger for later incorporation of solar hot water heating.

3. Provide and install three terminal reheat coils with individual room thermostat controls for Building 8 Intensive Care, AHU-R, Rooms 117, 118 and 119. Room supply air flows are approximately 220 cfm, 265 cfm and 265 cfm respectively.

4. Provide terminal reheat for each of the 3 AHU’s serving Surgery (Operating Rooms and the Clean core.). Provide a thermostat for each operating room and 1 for the clean core, each controlling their respective terminal reheat coil.

1.2.2.6 Miscellaneous HVAC Repairs

1. Provide stand-alone room dehumidifiers in each critical care space or other areas where infection control risk is the highest including each operating room, clean core, ICU room, instrument storage, emergency, etc. Route condensate to the outside or other viable location (e.g. utility sink etc.). Units should be identical and sized for dehumidifying approximately 300sf.

2. Building 2 AHU access (AHU-F and AHU-S) – provide and install additional catwalk framing (wood construction) to facilitate safe filter access and removal/replacement of the cooling coils.

3. Building 2 attic ventilation – provide gable exhaust fan to establish cross ventilation in the attic.

4. AHU-F (Building 2) – existing filter access door is obstructed preventing filter replacement.

Modify door or access area to permit ready access.

5. Drip pans – Ensure positive drainage at each AHU drip pan. Where evidence of standing water or biofilm exists (i.e. lack of slope to drain), correct the slope and increase the size of the drain opening to ensure that condensate does not stand. Ensure drain lines continuously slope to the outside.

6. All diffusers must be cleaned and remediated of any mold present.

1.3 Coordination with Facility: The Contractor shall coordinate all activities with facility personnel prior to beginning any work to minimize disruption to normal operations. All work in conjunction with this contract will provide a complete and usable facility. All utility outages must be coordinated with the facility at least three days prior to the planned outage.

1.4 Technical Criteria: Technical criteria for the above-described work shall be as defined in the contract. All work shall comply with the requirements of applicable codes or standards, and applicable sections of the International Building Code.

2.0 Technical and facility points of contact are listed in the Submittal List below.

3.0 SERVICES TO BE PERFORMED:

3.1 Site Safety and Health Plan: The Contractor shall prepare an Activity Hazard Analysis to cover activities to be performed during the site survey. The AHA shall be submitted to the COR for acceptance prior to departure.

The Contractor shall prepare a Safety Plan and submit at the same time as the 100% design package submittal. The Contractor shall conduct all work in a safe manner in accordance with applicable safety requirements. The plan shall ensure that activity hazard analyses are conducted, and that safety is incorporated into daily work activities and coordination meetings. The contractor shall reference Engineer Manual 385-1-1 for further guidance. The Government shall be notified immediately if any accidents or injuries which occur on site require more than basic first aid.

3.2 Design Quality Control Plan: The Contractor shall prepare a DQCP and submit at the same time as the 100% design package submittal. A minimum outline for the DQCP is provided in Section 8.0. The Contractor is encouraged to develop a more comprehensive project specific DQCP based on the minimum outline proved. The DQCP shall address quality control of both the design and construction aspects of work. In addition, DQCP shall include the Contractor’s processes for verifying the quality of materials and vendor-supplied items. The DQCP shall also address the Contractor’s quality control processes and procedures associated with subcontracted work.

3.3 Permits, Licenses and Certifications: The Contractor shall be responsible for obtaining all necessary national and/or local construction permits, certifications, and/or clearances. This shall include but not be limited to the permitting of the structure design, utility connections and inspections by local authorities during construction. The Contractor shall complete applications and pay necessary fees to local authorities. The Contractor shall comply with any other regulations pertaining to utility location and connection of electrical, sanitary, water, telecommunications, and other service lines to the existing services as applicable.

Fees shall be paid and permits obtained prior to beginning construction on the applicable features of work. A copy of each permit shall be submitted to the Government at least ten

(10) days prior to commencing work on the relevant project component or subcomponent.

The contractor will not begin any intrusive site work prior to obtaining required clearances and/or permits.

3.4 Local Taxes: Depending on the duration of personnel stay on Yap, the Yap State Commerce and Industry Division may require fees for registration, permits, or business licenses. The Point of Contact is the Division Chief at the following email: tonyrutmag@gmail.com.

3.5 Payment estimate shall be signed by the designated COR prior to payment to certify the completion of work described by the invoice.

3.6 Renewal Site Survey Report, Renewal Report, and Work Plan: The Renewal Site Survey Report, Renewal Report, and Work Plan shall be performed in accordance with the requirements found in Sections 9.0-11.0. The Renewal Site Survey Report, Renewal Report, and Work Plan shall serve as the basis of the design for mold mitigation and repairs.

3.7 Design: The design shall be performed in strict accordance with all applicable international, federal, and local requirements, codes, and standards governing healthcare HVAC systems.

This includes engineering for precise temperature and humidity control, required air changes per hour (ACH), and positive/negative space pressurization to ensure the stringent air cleanliness and infection control required for surgical suites, operating rooms, and recovery rooms in a high-humidity tropical environment.

mailto:tonyrutmag@gmail.com

3.8 Mold Mitigation and Air Conditioning Repairs: Remove or decontaminate drywall and

HVAC system. Repair or replace components of the HVAC system to provide a fully functional system capable of maintaining precise temperature and humidity controls, ensuring positive air balance, and meeting critical healthcare ventilation standards to prevent future mold proliferation.

3.9 Testing and Balancing (TAB): After operating the system for a minimum of three days and upon verification that the system is stable and operating according to the design parameters, the contractor shall conduct testing and balancing of the system. At a minimum, the Contractor shall:

• Ensure all volume and splitter dampers are open

• Verify the correct fan speed is engaged

• Take static pressure readings or perform a duct traverse to confirm Cubic Feet per

Minute and pressure are within design limits

• Check that temperature differentials fall within the acceptable range

• Confirm all required accessories are properly installed, including:

Air filters (clean and correct size) Grilles and registers Access panels (securely closed)

• Measure and record airflow at each grille and register in the system

• Note deviations, adjust until all outlet airflows are within 10% of the design specifications

• Document all final readings and include in the O&M Manual

3.10 Post Construction Contamination Verification: The Contractor shall verify the safety of the air handling system by conducting post-remediation verification which includes visual inspection, surface sampling and air sampling utilizing petri dishes which are incubated for a minimum of 72 hours.

3.11 Contractor to provide one year of quarterly preventive maintenance (per code and manufacturer's recommendation).

4.0 SITE SECURITY AND SAFETY: Site security shall be in accordance with the local requirements and/or as defined/instructed by the Contracting Officer. Site safety shall be in accordance with the primary contract and the approved site safety and health plan as modified by the project site safety and health plan submitted for approval.

4.1 Physical Site Safety Requirements: The Contractor shall include any necessary security barriers or fencing to ensure that equipment and materials are secured and features or structures are protected from damage or theft to the extent possible. Applicable safety signage shall be posted as appropriate.

4.2 Visitors to Site: A visitor is someone other than a site worker who has obtained pre-approval from the site superintendent, or the Contractor’s designated representative, to enter the construction site for a short period of time. The Contractor shall designate a site worker to be responsible for escorting the visitor(s) while on site, educating the visitor(s) on the possible hazards of the site, and ensuring the visitor(s) is/are wearing or are provided with the appropriate PPE. A visitor sign-in/out log shall be maintained on site and made available to the Quality Assurance Contractor and / or the US Government Designated Authority (GDA) upon request.

4.3 Safety Meetings & Demonstrations: The Site Safety and Health Officer (SSHO) or supervisors shall conduct daily safety meetings with all workers prior to starting work. These meetings shall focus on one or more of the following topics: (1) safety lessons learned, (2) personal protective equipment (PPE), and (3) demonstrating safe work methods prior to the commencement of new work activities and discussing the anticipated hazards.

Documentation of all safety meetings is required, and the document shall include the date, the names of people in attendance, a brief description of subjects discussed, and names and signatures of individual(s) who conducted the meeting. Documentation shall be maintained on site and made available to the Quality Assurance Contractor and / or the GDA upon request.

5.0 PERFORMANCE AND DOCUMENT SCHEDULE

Days after NTP Milestone Note

14 Virtual Kickoff Meeting 45 Site Survey Visit

100 Site Survey Report 120 Draft Workplan Design Submittal 140 Comment Resolution Meeting 150 Final Workplan Design Submittal 180 Ready for Construction Package, QCP, Safety Plan

200 Mobilize Within 5 days of the end of the reporting month

Monthly Progress Reports

320 Construction Complete 360 As Builts Submitted 440 Contract Complete

5.1 Deliverables:

5.1.1 Following completion of each submittal, the Government will perform a review. The

Government will review and approve, with or without comments, each schedule item prior to the Contractor's initial work on the subsequent item.

5.1.2 The site-specific construction report, list of standard equipment and service organizations, operation and maintenance manuals, as-built drawings (both hard copy and electronic format), and other required close-out documents shall be submitted within two weeks after completion of construction. In the proposal schedule, include 21 days for a government review of draft and final plans and 14 days for a government review of 100% plans. Provide in the schedule when construction starts and stops to clearly indicate the total number of days in construction. Contract duration to be determined by the contractor’s proposal schedule.

Provide the following:

a. All design, construction, and as-built drawings in its native CAD format and PDF format. Preferred CAD is Microstation, then AutoCAD, in that order.

b. As-built drawings set.

c. Monthly progress and completion reports.

d. Monthly updated schedules.

e. Digital photographs (pre-construction, during construction and post-construction) in jpeg format.

f. O&M manuals, equipment and construction warranties, submittals, and closeout documentation.

g. Results of system/equipment testing.

h. Training provided and sign-in roster.

i. Provide all deliverables and correspondence on a DVD and within a binder.

j. Provide two copies of as-builts/manuals in separate binders for the Utilities

Maintenance Section.

5.2 Presentations , Reports, and Meetings:

5.2.1 Prior to the initial site visit, the contractor shall conduct a pre-site survey teleconference.

The date and time for the teleconference shall be coordinated with the Government in advance. Review conferences may be held as required after completion of one or more of the reviews described in paragraph 5.1. The Contractor will be required to attend these Conferences unless otherwise notified by the Contracting Officer. The time and place of these conferences shall be established by the Government.

5.2.2 A pre-construction conference will be scheduled at the facility for a date to be determined by the Contracting Officer’s Representative. Representatives from the contractor and any responsible sub-contractors shall attend. The previously provided pre-construction checklist shall be completed prior to the conference and shall be used as the basis for the meeting agenda.

5.2.3 Monthly Construction Progress Reports: The Contractor shall submit monthly construction progress reports within the RMS 3.0 reports section. The monthly construction progress reports shall be submitted in a PDF format and follow the QCP, the project schedule, submittal register, and the Safety Plan. Submission of the monthly construction progress reports shall begin after the issuance of the Government’s NTP for construction. The monthly progress reports shall be submitted no later than fifteen (15) days after the end of the reporting month. The report shall include, but is not limited to, the information detailed below.

5.2.4 Progress: Percent of work complete, dates of reporting period, planned work for next reporting period, major issues encountered and recommendations for resolution, weather delays, and visitors. Include the start and completion of definable features of work.

5.2.5 Contractor Labor: Report the number and type of laborers on-site. Include the Contractor’s management and staff.

5.2.6 Photographs: The Contractor shall provide date stamped photographs of the features of work completed during the reporting period. The Contractor shall collect some photographs at a wide-angle to demonstrate overall progress made. Wide-angle photographs shall be taken at the same angles over time.

5.2.7 Schedule Updates: The Contractor shall provide updates to the project schedule based on actual dates of work completed.

5.2.8 Materials: Describe materials received and any materials that were deficient or rejected and the measures taken to correct the identified deficiencies. Verify that deficient materials are removed from the project site.

5.3 SUBMITTAL LIST

The Contractor shall submit the indicated number of copies of all deliverables to the following agencies:

TABLE 8.5.3

Key Feature of Work Photo Documentation Site Survey Report Main features of work Pre demolition Above ceiling, outside chiller pads

Decontamination Interior of ductwork undergoing sterilization

Post construction Above ceiling, outside chiller pads

Post Construction Verification Samples

Locations and petri dishes numbered; pre inoculation and 72 hours post inoculation.

Time and date stamped.

Decontamination of Operating Room walls Pre and post

Post Construction Verification Samples

Locations and petri dishes numbered; pre inoculation and 72 hours post inoculation.

Time and date stamped.

Agencies No of Copies

a. U.S. Government Point of Contact Project Manager – Colby M. Thurston U.S. Army Engineer District, Alaska Attn: CEPOA-PME 2204 3rd Street

JBER, AK 99505

(907) 753-5565

b. Facility Point of Contact ..................................… Facility Manager – Augustino Harongochem Yap DHS Maintenance Unit Supervisor PO Box 148 1 Keng Street Colonia Yap FSM 96943 Tel: (691) 350-2115/3446 Cell: (691) 950-1222 Email: aharong@fsmhealth.fm

6.0 Ceremonies: The Contractor shall coordinate all ceremony details with the partner nation government, the QA, and the Government. Ceremonies to coordinate include:

6.1 Groundbreaking: Conduct a groundbreaking ceremony if this is customary in this country.

The Contractor shall take photographs of the groundbreaking ceremony and include them in the next monthly report.

6.2 Grand Opening/Ribbon Cutting: Upon completion of work, the Contractor shall plan for and provide all labor, materials, and supplies to conduct a Grand Opening Ceremony. The Contractor shall take photographs of the grand opening ceremony.

6.3 Dedication Plaque: The Contractor shall install a dedication plaque near the front entrance to the building prior to the grand opening ceremony. The plaque shall be designed as specified in Section 12.

mailto:aharong@fsmhealth.fm

7.0 Site Report

DSCA Number Identifier: FM-HA-2025-00087400 Overseas

Humanitarian, Disaster, and Civic Aid (OHDACA) Program

Yap Memorial Hospital Mold Mitigation

Federated States of Micronesia

Funding Fiscal Year(s): Fiscal Year 25 / 26

Report Author: Donald Schlack, Project Manager, USACE, donald.w.schlack@usace.army.mil

Date: August 22, 2025 mailto:donald.w.schlack@usace.army.mil

Section 1 Basic Information

Executive Summary. Due to a long period of use of inappropriate air conditioning equipment, most of the walls in patient care areas have some mold contamination and the air conditioning units are also contaminated with mold, mildew and bacteria. This has contributed to a high rate of hospital acquired infections. The proposed project will sterilize and decontaminate walls in the patient areas of the Yap State Hospital and repair the Air Conditioning System so that patients will have properly conditioned and filtered air.

Points of Contact

Hospital Administrator: Mr. Theo Thinnifel

Maintenance Unit Supervisor: Mr. Augustino Harongochem

Project Type: Humanitarian Assistance, Small Scale Construction

Primary Sector: Health Support

Lead Subsector: Medical

Project Location: Colonia, Yap, Federated States of Micronesia

GPS Coordinates: 9.52337, 138.12536 N 9°31'23.66" E 138° 7'32.23"

Figure 1: Regional View

Figure 2: Yap Island

Figure 3: Yap Memorial Hospital Complex

Section 2.0 Field Observations and Site Data

Date of Scoping Visit: 25-28 June 2025

Scoping Visit Participants: Don Schlack (USACE, Honolulu District), David Braidich (USACE, Medical Center of Expertise), Augustino Harong (Facilities Manager), LTC Kyle Sullivan (Oceanic Engagement Team, FSM)

Current Demographics: Yap state has a population of approximately 11,000, most of which are on Yap Island. The population of the state consists mainly of the local Yapanese, Ulithians, Woleaians and Satawalese people; however, the state has been seeing a rise in the number of foreign citizens from countries such as the United States, Japan, Palau and the Philippines.

Ownership of Property: Land ownership in Yap is by family or household groups who hold the right to immediate possession and use. The majority of land and near-shore marine around Yap is owned by citizens of the Federated States of Micronesia. The land on which the hospital is located is owned fee-simple by the State of Yap.

Figure 4: Hospital Building Locations

Existing Site Conditions: The YSH is on the island of Yap in the state capital of Colonia. The YSH is operated by the YDHS, an agency of the Government of the State of Yap. The 2022 budget for YSH was $6.4M with most of the funding coming from the US Compact of Free Association. The hospital provided services for about 23,535 outpatients and had 1,200 admissions in 2022.

The YSH campus is located on a small, 2.6-acre campus on the eastern part of the island of Yap Proper, to the north of the Yap capital of Colonia. The hospital is the only hospital in the State of Yap. The main hospital was originally constructed in 1979 with 33 beds. and has experienced two renovations and additions since.

The main hospital campus consists of 12 buildings and 8 isolation units . The total main hospital floor area is approximately 52,000 square feet (SF). The main hospital’s parking lot is congested with a number of stalls used for the oxygen generator, container storage and inoperable vehicles.

The primary patient care areas are Buildings 3, 7, 8 and 9. Building 3 includes two surgeries, a recovery room, central sterilization and locker rooms.

The hospital was constructed in 1979. The original design of the hospital included an air conditioning (AC) system although only cooling is required in Yap. Central water-cooled chillers, attic / above ceiling mounted air handling units ducted to individual spaces and multiple individual electric tank type domestic water heaters are all part of the system. Air-conditioned spaces included the Operating Suite, Central Sterile, Laboratory, ED, and Administration. Neither the original AC system nor the 2011 renovation included reheat of chilled air which led to high levels of humidity and condensation in conditioned spaces.

Maintenance staff are generally knowledgeable about the systems and can perform routine maintenance with proper training.

The Patient wings are open air with operable windows and ceiling fans. Air movement in the wards is minimal, and the conditions can be stifling due to heat and humidity. Building 7 has been modified to include an intensive care unit and two private rooms, all conditioned with split units. The walls of the units lack sufficient insulation, causing water to condense on the outside, and are contaminated with mold.

The chillers were replaced in 2011, but the system was not balanced, which led to excessive energy consumption. To conserve energy and decrease the electricity bills, the hospital frequently shut off the AC in some areas during times of disuse. This led to condensation on walls and in some ducts. The chillers needed replacement again in 2021. New chillers were procured and on-site, but installation was interrupted because of COVID-19. Once travel restrictions were lifted, Yap has been unable to fund the installation of the chillers.

Air conditioning is now provided in critical areas through individual split systems installed where needed. These systems only last maximum of five years due to the corrosive environment and lack of preventative maintenance but are easily replaced when they fail.

Newer models split systems with inverter style motors do not work well with the power quality available at the hospital and typically last less than five years. The split units are meeting the need but also are causing localized problems with condensation, mold, and mildew.

Steel chilled water piping has been open and unprotected while the chillers have been disconnected. Some piping will need to be replaced before the chillers and air handling units are put back in service. Electrical loading will need to be evaluated to ensure that both the chillers and new incremental split systems now connected don’t create unintended overloads.

The hospital walls are painted Cementous plaster. Most walls had some mold growth, especially around the split air-conditioning units. Wipe samples of both walls and splits produced abundant colonies of both mold and bacteria when placed on agar media.

Central air handling units installed in the attic spaces will need commissioned before they are put back in service. Duct and air handler interiors should be cleaned, belts and filters should be replaced.

Site Photos:

Emergency Generators

Abandoned Chillers

New Chillers

Transformer

Figure 5. Placement of Chillers Outside Building 3

Figure 6. Ductwork in Building 7 Attic Space Figure 7. Mold and Dirt in 65Discharge Louvers, OR1

Figure 8. Mold Around Door to Operating Room

Section 3 Scope of Proposed Small Scale Construction Repairs

Building Codes and Standards: The Federated States of Micronesia has not adopted a building code for the country. This project will utilize and reference the International Building Code, 2018 to the extent practicable. In cases where the code cannot be met, the Contractor will propose mitigations to meet the intent of the code.

Demolition: Demolition will include the removal of approximately 300 LF of ductwork, 65,000 SF of ceiling insulation, and the abandoned chillers and ancillary equipment. All demolished materials can be disposed of at the Yap island dumpsite, which is approximately five miles from the hospital.

Mold Mitigation Requirements: Walls in patient areas including the wards, operating rooms, recovery and x-ray all need to be washed and sterilized with a diluted bleach solution before being repainted with mold resistant paint. These represent approximately 65,000 SF of wall surface.

AC Requirements: The air conditioning system needs to be repaired so it is properly conditioned and filtered before discharge into the patient areas. The existing new chillers are in good condition but will need to be inspected and some seals and gaskets will need to be replaced. In addition, some ductwork will need to be demolished and replaced with well-insulated replacements.

Ductwork interiors will need to be inspected and cleaned. The existing ductwork placement in some locations makes the system unmaintainable (no access to filters or air handlers so it will need to be moved to more appropriate locations. Some air-handlers are in poor condition and will need to be replaced. This work, together with the chilled water system will require some design.

Section 5 Issues and Challenges

Contracting. While there are no competent and capable HVAC contractors on Yap, there are several on nearby Guam. The prime contractor will need to be from Guam. Contracting may be expedited through the use of the identified 8(a) contractors.

Workforce: As described in Section 4 above, the local workforce does not include skilled tradesmen. Ducting and AC installers will need to come from Guam. Wallboard cleaning, disinfection and repainting can be accomplished by local laborers with the appropriate training and personal protective equipment.

Logistics: Yap is remote and serviced by twice weekly United Airlines flights from Guam.

Surface shipping from Guam is typically weekly. Hotel space is limited on Yap and must be booked in advance. Rooms within Per Diem are frequently not available.

Costs: Costs were estimated utilizing Davis Bacon labor rates assuming onsite work 6 days a week and 10 hours per day using standard construction methods for hot humid climates.

Standard escalation, profit and contractor markups were used and the Yap excise tax of 10% was used for local materials.

Continuity of Service: The construction period will be approximately 10 months, during which the hospital functions will need to continue. During that period, the split AC systems will remain in operation but minor disruptions due to overhead work are expected. The operating room will need to be shut down during the drywall removal and decontamination processes. Coordination with the surgical staff will be required.

Construction Oversight: Quality assurance will either be provided by a USACE Construction Representative or via contract. If USACE has ongoing construction projects in Guam when the project goes into construction, the former will be used otherwise a services contract will be established.

Sustainment Plan:

The maintenance staff of YSH are all generalists and none have special training in AC maintenance or repair. However, they can provide routine preventative maintenance for the system with proper training as part of the commissioning program. The YSH facilities team utilizes preventative maintenance plans and checklists for their equipment and facilities and will develop one for the AC system. Periodic inspections and service by trained technicians will be required and the Hospital Administrator stated that they would be included in future budgets.

Appendix

1. Mechanical Engineers Report

2. Sampling Report

3. Laboratory Report

APPENDIX 1-13

APPENDIX 1

Yap Memorial Hospital – Mechanical Assessment 25-28 June 2025 General

Mechanical

Climate – Yap, FSM is a marine climate with extreme humidity and relatively constant temperature and dewpoint throughout the year (mean dewpoint all year is ~77 F, mean dry bulb temp ~82F). This leads to an extremely high latent load (345,000 btu/cfm/yr compared with 100,000 btu/cfm/yr for Honolulu) which must be meticulously addressed in the HVAC design as well as building envelope, piping insulation etc. There is no heating season.

Construction History – The original Yap Memorial Hospital (YMH) buildings were constructed in 1979 and included centralized HVAC system served by a chilled water system. The most recent major mechanical renovation occurred in 2011 which included 2 new chillers, expansion of the chiller water system, several new air handling units as well as AHU component replacement.

Building 10A was also constructed at that time.

Infection Control and HVAC

The facility is known to have high rates of hospital acquired infections (HAI’s). HAI’s have several transmission vectors including direct contact, contaminated surfaces, contaminated surgical instruments, as well as airborne transmission. The focus of this assessment is on the airborne transmission path (e.g. pathogens propagated and distributed through the HVAC system), and the space conditions produced by the HVAC systems which can enable pathogens to multiply and thrive on surfaces.

Healthcare HVAC systems are designed not only to maintain a comfortable environment for the patient but with critical emphasis on maintaining relative humidities, which are least favorable to pathogen growth. Relative humidity must be kept between 30% and 60% to minimize virus, mold and bacteria growth. Above 65% relative humidity, pathogens (fungi, bacteria, etc.) begin to grow and multiply, and above 70% of viruses and other pathogens thrive as demonstrated in the classic Sterling Chart. Many areas of the hospital were found to be well above 70% relative humidity which has produced visually evident thriving mold and pathogen colonies.

HVAC systems can also propagate pathogens with dirty filters, dirty cooling coils, and poor condensate drainage where mold, viruses and bacteria can establish, grow, multiply and distribute directly to the patients breathing zone. Although the central HVAC system is currently off, evidence of such contamination and propagation of pathogens was clear and the exact same issues are occurring with the temporary split systems.

The central HVAC system has been disabled since approximately 2020 due to non-functional

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chillers (awaiting replacement). As an interim HVAC measure, the facility has installed numerous DX split systems throughout the facility including in the Operating Rooms and other critical care locations. These help with occupant comfort but are very poor at controlling space humidity and in fact are a proven source of mold growth and propagation of mold spores and airborne bacteria/viruses of many kinds.

Such devices are prohibited for use in many patient care spaces by ASHRAE 170 Ventilation for Healthcare Facilities due to their inability to control humidity, inadequate filtration, and risk of propagating mold, bacteria and viruses. This hospital has extensive evidence of mold, bacteria and viruses both on surfaces (e.g. walls, ceilings, piping, diffusers, plumbing etc.) and airborne throughout the facility including the spaces where patients are at highest risk (e.g. operating rooms, intensive care, trauma etc.). Also, condensate pumps (serving the DX units) within clinical spaces (e.g. in the Operating Rooms) provide another perfect environment for pathogen and mold growth.

Furthermore, all buildings are negatively pressurized due to the lack of centralized HVAC (e.g. no building makeup air) in combination with operational exhaust fans (e.g. bathroom and laboratory exhaust). This condition draws in unconditioned outside air through door gaps, cracks and building envelope imperfections which readily condenses on any surface below 77 F (the outside air dewpoint!) and creates local areas of high humidity, all evident by surface mold. Many spaces also have the DX units set far below normal (evidence of lack of humidity control), which is further contributing to the walls and door sweating and growing mildew/mold (e.g. Bldg 3 medical storage was at 64 F with the exterior door severely condensing).

The surgery suite is ramped with mold, fungi and bacteria on the walls, ceiling and the DX units.

Field testing positively identified Penicillin, Mucor, Aspergillus Niger, and other bacteria. Space conditions in most areas of surgery exceed 60% relative humidity with the one Operating Room, the Janitors Closets and areas of the clean corridor exceeding 70% relative humidity (highest level recorded was 90%!).

These conditions far exceed U.S. healthcare codes (e.g. FGI, ASHRAE 170 etc.) and are ideal conditions to harbor and propagate mold, bacteria and viruses which create a high-risk environment for HAIs.

HVAC Overview

There are ~18 air handling units ranging from 700 to 2400 CFM. They are all draw-thru configuration, most equipped with only a prefilter (some metal washable and others are pleated ~Merv 8). They are equipped with a chilled water-cooling coil. Nearly all units are in unconditioned attic areas directly exposed to the outside conditions. Units have considerable surface rust particularly at screws and where dissimilar metals exist. Evidence of surface condensation is throughout and expected due to exposure to the outside conditions. All units have drip-pans which are critical to mitigate the expected surface condensation which will otherwise damage ceilings and the patient environment. Many of these were not part of the

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original construction but were added later.

Most pleated prefilters are fully loaded and/or destroyed such that outside contaminants and organics will pass directly to the cooling coil. This creates the perfect conditions for mold growth (i.e. high humidity with an organic food source). The metal filters were physically intact but were often loaded and could not be cleaned due to poor maintenance access coordination (e.g. access door couldn’t be fully open for removal). Furthermore, facilities staff were concerned that the metal filters don’t capture enough.

Final filters are only provided for the Operating Rooms and Delivery Room with the filter boxes (HEPA filters) located in the attic area, nearly inaccessible. These filters typically require annual replacement but appear to have never been replaced. The HEPA filters need to be relocated where they can be easily accessed.

None of the AHU’s include reheat, which is a fundamental design flaw from the original design resulting in the system having no ability to control space dewpoint (or relative humidity). The original design concept was to control the AHU cooling coil directly off the zone thermostat (1 per AHU). This arrangement controls space sensible temperature ONLY but not dewpoint. As the sensible temperature is met, the control valve reduces chilled water flow, maintaining the sensible temperature but allowing the space dewpoint to rise! In this climate, that is a major flaw as mean dewpoint for Yap is above 75F throughout the year (extremely high!). Dew-point control (and therefore infection control!) can only be achieved with a system that includes both a cooling coil and reheat to control both dewpoint and space sensible temperature.

Each AHU has a drip pan below to collect the condensate from the exterior of the unit as they are almost all located in areas that are open to the outside and have insufficient insulation to prevent such condensate. Several of the drip pans appear to have inadequate slope to drain and/or undersized drains causing the undrained water to collect and create biofilm which is still present after 5 years of none-use.

E.g. AHU-S.

Chilled water controls are a mixture of 2-way and 3-way valves. The original construction utilized 3-way valves and the 2011 project utilized 2-way valves. Chilled water piping is a combination of PVC, Steel and some copper. It was indicated that the steel piping was only introduced in 2011.

FMD indicated that the original PVC did not have any water quality issues (no staining, rusting, or clogging of strainers). The steel piping introduced in 2011 was said to be causing pipe rusting, staining and clogging strainers at the coils. It does not appear that any water quality test or treatment has been performed over the years although a chemical feed tank is present. The municipal source water was indicated to be rainwater which is naturally acidic and aggressive to piping due to the dissolved atmospheric CO2 and low dissolved solids. Water quality analysis and chemical treatment are a very specialized field, requiring expertise that even most U.S. based hospitals do not have. This issue is typically addressed by contract to a water quality specialist.

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Building exhaust (e.g. bathroom exhaust) was originally ducted through the roof but due to leaks and difficulty maintaining the roof penetrations, facilities have cut these within the attic space and have sealed the penetrations. This means that exhaust air is being directly discharged into the attic. While this is violation of ASHRAE 170 and not normally recommended, it creates several advantages in this marine climate. In addition to the elimination of the penetration, the discharged air has a lower dewpoint than the outside air which helps to reduce the condensation on the AHU’s that sit in these attic spaces. It is therefore recommended to keep these discharges as is.

Building 3 - Surgery

Three AHUs serve surgery. AHU-A serves OR Room 253 at 1200 cfm (for ~20 acph). AHU-B serves OR Room 252 at 1200 cfm. AHU-C serves the remainder of surgery including the clean core and central sterilization. All AHUs are currently intended to be disabled due to the lack of chilled water but one was found in-operation (serving the clean core). All the supply, return and exhaust diffusers were unsealed within the spaces allowing for migration of warm moist outside air directly into the spaces. In other buildings, the diffusers were sealed with plastic creating a better environment. The DX units cannot maintain an ideal temperature AND relative humidity (or dewpoint) to minimize the risk of mold growth. In fact, many areas in surgery have relative humidities above 70% (ideal for mold growth).