Dissemination of Universal Decolonization in Nursing Homes

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Contract Opportunity

Introduction:

This is a Sources Sought Notice (SSN). This is NOT a solicitation for proposals, proposal abstracts, or quotations. The purpose of this notice is to obtain information regarding: (1) the availability and capability of qualified business sources; (2) whether they are large or small business (HUBZone small businesses; service-disabled, veteran-owned small businesses; 8(a) small businesses; veteran-owned small businesses; woman-owned small businesses; or small disadvantaged businesses); and (3) their small business size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition (if applicable). Your responses to the information requested will assist the Government in determining the appropriate acquisition method.

(1). Project Description and Requirements:

Healthcare-associated infections, or HAIs, contribute to morbidity, mortality, and excess costs at all types of healthcare facilities. Many HAIs are caused by multi-drug resistant organisms (MDROs), which are difficult to treat, linked to higher mortality, and contribute to hospital readmissions. Nursing homes (NH) and long-term acute care facilities (LTACs) bear a substantial burden of HAIs and MDROs, estimated MDRO prevalence reaches 40-65% in NHs and 80% in LTACs. These facilities have limited resources to implement expensive universal surveillance and isolation strategies. Additionally, contact precautions in non-acute care settings can result in social stigma, including feelings of isolation and constraint in what should be a home-like environment. Recently published evidence demonstrated universal decolonization in long term facilities can be a practical and cost-effective way to reduce MDRO infections and infection-related transfers to hospitals.

The effectiveness of universal decolonization with topical chlorhexidine and nasal iodophor in lowering the risk of transfer from a nursing home to a hospital due to infection was demonstrated in the Decolonization in Nursing Homes to Prevent Infection and Hospitalization (PROTECT) trial (https://www.nejm.org/doi/full/10.1056/NEJMoa2215254). This AHRQ-funded study included 28 nursing homes in Los Angeles and Orange Counties in California. The 18-month cluster-randomized trial compared outcomes among residents of 14 control nursing homes (routine care) with those of residents at 14 intervention nursing homes who received decolonization with 10% povidone–iodine (nasal iodophor) and chlorhexidine for bathing. Universal nursing home resident decolonization resulted in an 18% reduction in hospital transfers due to infection and a 23% reduction in the probability of discharge to a hospital. The decolonization group also experienced a 50% reduction in odds of MDRO carriage.

The Shared Healthcare Intervention to Eliminate Life threatening Dissemination of MDROs in Orange County (SHIELD OC) (https://jamanetwork.com/journals/jama/fullarticle/2817010) was a Southern California regional public health collaborative funded and supported by the CDC. SHIELD-OC investigators evaluated whether a coordinated decolonization intervention at facilities with a high degree of patient sharing would result in the reduction of MDROs, infection-related hospitalizations, costs, and deaths over a 25-month period. The interventions involved CHG bathing, nasal decolonization, training, educational materials, checklists, and assessment forms. Comparing the intervention period with baseline periods, MDRO prevalence rates decreased across all types of facilities and associated hospitalization deaths also fell. Additionally, the investigators found while there may be an initial financial investment involved, universal decolonization is a cost savings strategy.

Under this project the contractor shall:

1. Design and develop a toolkit containing written / electronic education and training materials by adapting and augmenting materials from Project PROTECT: Protecting Nursing Homes From Infections and Hospitalization and SHIELD (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of Multi-drug Resistant Organisms [MDROs])--Orange County.


2. Establish centers of excellence learning/training hubs in at least 3 HHS regions (https://www.hhs.gov/about/agencies/iea/regional-offices/index.html) to assist in disseminating the decolonization intervention, including: oversight of product acquisition and use, training of nursing home staff in use of decolonization materials and bathing techniques, and assessment of effectiveness of the intervention.


3. Recruit and retain a minimum of 25 nursing homes in a hub-and-spoke model organized around the local learning/training hubs to participate in a dissemination project to implement universal decolonization in order to reduce transfers to the hospital for infection.
   
   Optional Tasks are included in the SOW, and require additional recruitment and retention of 25 nursing homes and Point Prevalence Testing (See attached SOW).


4. Propose and implement a strategy to support acquisition of chlorhexidine and iodophor by participating nursing homes in a partially subsidized fashion in order to support implementation.


5. Assess the adoption of universal decolonization and evaluate the effectiveness of the intervention in the participating nursing homes.

It is critical that the contractor has experience with implementation of infection prevention strategies, ideally decolonization, in the nursing home setting. The contractor should have experience recruiting nursing homes for implementation trials. The ability to engage front line staff, offer in person, hands-on training, expert guidance, and awareness of the potential challenges are all vital to success. Resources and resident population vary across nursing homes. The contractor should anticipate these differences and address issue as they arise. Incorporating a proven organizational structure such as hubs and coordinating centers will also be essential to the project’s success.

(2). Anticipated period of performance:

The Period of Performance is 45 months, and may be extended for an additional 15 months if the optional task is exercised.

(3). Capability Information Sought:

Capabilities necessary to fulfill this requirement include:

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  • Expertise related to decolonization in the nursing home setting
    
    
    
    • Specifically, capability to include as subject matter expert and conceptual lead, who shall be a researcher with demonstrated leadership of multiple large trials and/or implementation projects of decolonization in multiple settings, including decolonization in both rigorous randomized trial and pragmatic implementation approaches in the nursing home setting.
    
    
    
    
  
  
  • Ability to support an implementation project of the prescribed size and scope, while providing technical support, implementation guidance, quality improvement support, and educational materials, including both in-person, hands-on training and virtual technical assistance to nursing home staff regarding the decolonization intervention.
  
  
  • Experience in recruiting; demonstrated capability to recruit at least 25 nursing homes at least 3 Health and Human Services (HHS) regions (https://www.hhs.gov/about/agencies/iea/regional-offices/index.html) surrounding centers of excellence learning/training hubs.
  
  
  • Capability to obtain, distribute, and monitor use of decolonization supplies (chlorhexidine and iodophor)
  
  
  • Proficiency in developing and implementing an Assessment Plan to evaluate changes in recruited facilities’ process and outcome measures in decolonization and transfers to the hospital for infection while participating in implementation efforts.
  
  
  • Capacity to store data, develop educational materials, and manage content securely, including management of personal identifiable information (PII), and if necessary, protected health information (PHI).
  
  
  • Understanding of and demonstrated proficiency with federal government public posting requirements, including section 508 accessibility.
  
  
  • Expertise in project management in the areas of patient safety, implementing quality improvement projects in many facilities, knowledge of healthcare associated infections and multidrug resistant organisms in nursing homes, recruitment of sites for voluntary participation.
  
  
  
  

The capability statement response to this Sources Sought notice should include the following information:

a) Staff expertise, including their availability, experience, and formal and other training; including demonstrated leadership of multiple large trials and/or implementation projects of decolonization in multiple settings, including decolonization in both rigorous randomized trial and pragmatic implementation approaches in the nursing home setting.

b) Current in-house capability (listed above under Capability Information Sought) and capacity to perform the work;

c) Corporate experience and information on prior projects of similar size and complexity;

d) List any Government wide contracting vehicle for which the respondent has a contract (example, GSA schedule, etc);

e) A separate section for questions or comments related to the clarity of the draft SOW (attached to this SAM.gov notice).

Note: AHRQ will accept no more than 10 questions or comments per respondent. Any more than 10 will not be read or considered.

(4). Information Submission Instructions:

Interested qualified organizations should submit a tailored capability statement for this requirement.

The cover page must include the following:

• UEI number


• Organization name


• Organization address


• Size of business (large, small or nonprofit pursuant to NAICS code 541990). If small business, please indicate all socioeconomic categories that apply. (e.g., 8(a), HUBZone, etc.)


• Technical point(s) of contact, including names, titles, addresses, telephone, and e-mail addresses.

All Capability Statements sent in response to this SOURCES SOUGHT notice must be submitted electronically (via e-mail) to David Goodno, Contract Specialist, david.goodno@ahrq.hhs.gov in MS Word, or Adobe Portable Document Format (PDF), no later than 12:00 PM on Thursday, January 9, 2025. Responses should not exceed 20 single-sided pages (including the cover page, all attachments, resumes, charts, etc.) presented in single-space and using a 11-point font size minimum, that clearly details the ability to perform the aspects of the notice described above.

(5). Disclaimer and Important Notes:

This notice does not obligate the Government to award a contract or otherwise pay for the information provided in response. The Government reserves the right to use information provided by respondents for any purpose deemed necessary and legally appropriate. Any organization responding to this notice should ensure that its response is complete and sufficiently detailed to allow the Government to determine the organization’s qualifications to perform the work. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. After a review of the responses received, a pre-solicitation synopsis and solicitation may be published in SAM.gov. However, responses to this notice will not be considered adequate responses to a solicitation.

(6). Confidentiality:

No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).

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