March 4th, 2010

Annual Medical Gas Testing and Inspections - The Hospital Lifeline

Among the most critical utilities systems in any hospital are the medical gas and vacuum systems carrying life-supporting gases including oxygen, medical air, medical vacuum, carbon dioxide, nitrous oxide, nitrogen and waste anesthesia gas disposal.  Because failure or improper function of the oxygen or vacuum system poses an immediate threat to patient safety, it is essential that these systems be well-maintained. 

Common Medical Gas Issues:

Working in the medical gas field for almost twenty years, I’ve found a variety of problems when inspecting and testing these systems.  All of these issues, when corrected, improve patient safety and increase energy efficiency; both of which lower operating costs.

Probably the two most common issues we find when performing medical gas testing and inspections are leaking outlets and faulty equipment.  Leaking outlets are usually caused by brittle and worn o-rings that become dry due to exposure to oxygen and other medical gases.  Well-sealed, properly functioning outlets minimize gas loss and diminish wear and tear on medical air compressors and vacuum pumps.  Faulty equipment is usually due to normal wear over time, misuse, and lack of preventative maintenance.

The most critical issues we encounter are improperly labeled valves, contaminants and cross connections.  Accidental shutdowns can occur when incorrectly labeled valves or outdated drawings are relied upon during a shut down.  Tracing pipelines and performing planned temporary shutdowns can be done to verify the areas controlled by each valve.  Moisture and contaminants in medical air systems are also another concern.  Usually caused by faulty dryer equipment at some point during the system’s life time, moisture can get trapped in low points throughout the piping system.  Location of water within the piping network can be found by checking the pressure dew point temperature from various outlets.  New construction is a necessity for any healthcare facility, but if medical gas piping installers do not purge properly with NF Nitrogen during brazing, particulates will be left in the medical gas systems impacting respiratory equipment reliability and patient care quality.  The most serious, life-threatening issues I’ve found are cross connected gases in newly installed piping or even in existing but untested outlets.  Fortunately, cross connects are rare, but in these instances, had the hospitals not followed proper procedures for testing by an ASSE 6030 credentialed verifier to inspect the systems, lives could have been lost.

NFPA and Joint Commission Recommendations:

Because of the critical nature of these utility systems, JCAHO requires periodic testing and inspections of medical gas systems’ components.  NFPA 99 “Annex C” recommends specific testing frequencies for each of the different medical gas systems components.

What happens during our annual medical gas inspection?

Our company likes to work with the hospital’s maintenance departments to evaluate risks and interpret standards concerning various medical gas issues.  We realize the need for the hospital’s testing documentation to include an organized summary of the medical gas deficiencies with the locations, code references, recommended solutions and priorities for each issue.  We discuss with maintenance departments the likeliness of “grandfathering” lower priority deficiencies based on our experience throughout Georgia and the US.  Also and often overlooked is the requirement by JCAHO for a complete inventory of medical gas pipeline components broken down by each system, manufacturer and model.

The “green” future of medical gas:

Among the many challenges healthcare facilities face today is the push to be “green,” and medical gas and vacuum systems are not exempt from this movement.  Performing routine medical gas testing helps incorporate “green” strategies such as improving energy efficiency and eliminating wastes.  Periodic testing ensures that nitrous oxide, a greenhouse gas, does not unnecessarily bleed into the atmosphere causing replacement of cylinders as well as potential employee exposure issues.  A 5 LPM leak equals one “H” cylinder of oxygen loss per day.  Energy efficiency, another “green” concern, can also be improved through periodic inspections.  The identification and repair of worn pumps and compressors reduces their unnecessary power consumption.  During these inspections we sometimes recommend replacement of old energy “hogs” with newer more efficient compressors and vacuum pumps.  These devices produce more flow per horse power than older units, and the use of smaller, multi-plex units accommodates varying hospital flow requirements conserving power when possible.   

Medical gas testing and inspections are not only necessary for ensuring the systems’ reliability and safety, but they are also a key player in moving a hospital into the “gre en” future.  Visit our web site or call us to learn more.

by Steve Bradshaw, ASSE Medical Gas Instructor and Verifier for Evergreen Medical Services, Inc.

Medical Gas Systems Testing, Inspections & Equipment – Environmental Monitoring Services