wrong gas to the house manifold. In order to store medical gas cylinders in a safe manner, they must be separated into at least two categories: empty cylinders and full cylinders.Medical gas safety in your hospital (Part-2)
Dr. M Zakirul Karim
Standard Safety Precautions: Medical gas cylinder storage may seem simple, but one wrong move could result in a lot of damage and injuries. Cylinders should be stored by content; so there is no danger of connecting the wrong gas to the house manifold. In order to store medical gas cylinders in a safe manner, they must be separated into at least two categories: empty cylinders and full cylinders.
This can be easily accomplished using separate racks, kept apart through the use of barriers or different enclosures. Another helpful tip is to use a color-coded system of pressure sensitive labels to keep cylinders properly separated. In addition to keeping your cylinders separate, its essential that they be labeled correctly. This means that each cylinder shall be clearly marked with legible labels noting whether they are empty or full, or if they have been opened but still contain gas. Good labels help personnel save time and avoid picking up the wrong cylinder when they are moving quickly. All gas cylinders not connected to the manifold must have the caps screwed on. Towmotors are not allowed to move cylinders.
Cylinders that are open should always be considered empty for safe storage practices. While an opened cylinder may still have perfectly useable gas in it, it should be labeled as such and not stored with full cylinders. Always consider where you are storing your open cylinders allowing a three foot operating space. Handling cryogenic medical gas can be very dangerous if proper precautions are not in place to prevent accidents.
Two of the most common cryogenic medical gases are liquid oxygen and liquid nitrogen. These are cryogenic liquids, meaning that they will freeze any organic material they touch. Standard safety precautions in handling medical gases are essential to prevent frostbite injuries, as well as violent reactions caused by interaction with hydrocarbon-based materials.
Here are 3 factors to consider:
1. By the time the liquid is converted into gas coming from the outside bulk site and moves into the house piping, there is usually no threat of a cryogenic burn. Opening Dewars in house or touching frozen pigtails can cause burns.
2. The pressure within the medical gas piping line from the bulk site can reduce to 50-55 psi for house oxygen. Within the cylinders pressure can reach 2000 psi and with the bulk or cryogenic containers pressure level depends on the application and pressure setting of the container itself. (Generally 250, 350, 500 psi or greater).
3. The temperature of liquid oxygen is -360F and has the ability to immediately ice over copper pipes as well as cause a cryogenic burn to human skin. It is not uncommon or alarming to see an accumulation of ice around joints, unions and leaks. If you see ice, wear insulated gloves.
Standard Construction Requirements: Bulk Tank Medical gas storage requirements also cover the type of enclosure where such gases can be stored. For example, specific restrictions include that stationary tanks have to be seated on masonry foundations or steel structural supports with a firm concrete base. If your medical gases include those with positive pressure equal to or greater than 3,000 square (cubic) feet, structures have even stricter ventilation requirements.
Typical storage structures that dont have additional restrictions are required to:
1. Have indirect heating
2. Allow for the securing of empty cylinders and full cylinders keeping them upright
3. Get power from the essential system
4. Have racks, shelving and supports made of non-combustible materials, or materials with limited combustion potential
5. Every electrical outlet and device must be grounded and have mechanical damage protection
6. See the manifold infographic for more information.
Whether your structure is intended for cryogenic gases or gas cylinders NFPA (The National Fire Protection Association) will determine the construction
requirements and regulations to which it must be constructed and operated.
Dealing with details: In order to make sure patients and staff are as safe as possible, your medical gas safety system must be tested regularly. The New NFPA99-2012 code mandates anyone testing or repairing medical gas systems must be ASSE (the American Society of Sanitary Engineering) series 6000 certified or employees sufficiently trained in house to minimize risks to patients and staff.
The ASSE series 6000, professional qualifications standard for medical Gas System includes standards for medical gas personnel including Vacuum System Generalists, Installers, Inspections, Verifications, Maintenance personnel, and instructor, and for Bulk System Installers and instructions.
The ASSE series 6000 is based on the requirement of NFTA 99 healthcare facilities code which covers requirements for healthcare and fire safety typically found in hospitals, ambulatory care centers, clinics, medical and dental office, nursing homes and limited care facilities.
Hospital must ensure personnel are competent enough to ensure risks to other staff members and patient risks are minimized to avoid the liability for any errors. Training consists of ASSE courses as well as maintenance programs in accordance with the manufacturers recommendation, use and transport of equipment and proper handling, and verification of gas content prior to placing into service. It is recommended that your staff go through continuing education classes to keep up to date on the most recent advances in safety and medical gas systems.
Anyone handing medical gases must have the proper training and experience before theyre allowed to perform any task with medical gases. Medical gases are classified as a drug product according to the FDA (Food Drug Administration), and fall under their regulations.
This makes continuing education even more important for every employee handling medical gases, and each class should be carefully noted in each individuals employee file. If you prefer to lower the risks associated with managing your own medical gas program, you can work with a specialist in medical gas services. Doing so, will give you the confidence of knowing your medical gas inspection will be in the hands of a certified expert who conducts many inspections throughout the year. These experts are also up to date on the latest codes and equipment.
Medical gas safety program is successfully run one private hospital in Vietnam. The medical gas supplier here is doing monopoly business and thus, havent care about end-user safety process. Even, their supplied cylinders dont follow the international medical gas color code and their cylinder label is not up to the mark.
Therefore, hospital takes its own initiative to establish medical gas safety program. It started with streamlining their medical cylinders storage system as per standards safety precautions, handling and transporting safety, followed by color coding of the cylinders with double checking three identifiers. Cylinder tag was introduced to know the cylinder identification number, size, type of gas, full or in-service or empty cylinder mark. Live tracing of cylinders distribution within the hospital and maintenance department every day audits on central line and storage cylinders. Besides, managers within the end-user department regularly check and do the self-audit and submit report at least once in a month.
Besides, introducing (1) cylinder cover that is followed by standards color code of medical gas cylinder and (2) identify cylinder by three identifiers before use like (i) cylinder color, (ii) cylinder tag and (iii) cylinder gas specific documents (provided by supplier). This checking document is supplementary audited by Quality Assurance (QA) audit team. QA audit team independently do audit every two months interval to check cylinder storage areas both in full and empty location, tracer document of medical gas distribution, color coding process, spot checking of color coding of the cylinders with prescribed check list, cylinder identification number, type of gas certified by supplier, and finally audit hospital wide medical gas usage safety at end-user level. Training on Medical Gas Safety was organized to instruct all staffs who are involved in handling medical gas, including nurses. Any non-compliance is observed within the medical gas safety system, immediately stop using that cylinder, report incident and inform maintenance hot line number for corrective action.
The Medical gas safety poster is introduced to create awareness among the staff. This is considered as one of the Zero Tolerance risk mitigation program in the hospital. The first audit outcome is impressive about 99% compliance and 1% gap was identified at empty cylinder storage site.
Already corrective action taken care off. Well done whole team, this is the initial medical gas safety program run in a most prestigious international private hospital in Vietnam to make sure each patient is safe. Unfortunately, the local regulations about medical gas safety in both supplier and hospital end are not prominent in Vietnam. And also MOH/DOH is not marking any quality assurance (QA) indicator on medical gas safety program within their 83 QA KPIs. So, few private hospitals in Vietnam are following their own safety program as per international recommendation.
Last but not the least: Its important to pay attention to the details of your system and keep your medical gas operation and maintenance (OM) program updated regularly. Your facility type determines inspection frequency, but having everything in order means you will pass if a surprise inspection pops up. Medical gas safety depends on the well-being of your system and gas storage protocols, as well as your handling techniques. With proper safety protocols, good labeling, safe handling and a good OM program, medical gas safety can be properly managed.
If your program runs well without adverse reporting, then that program typically ignored. This is natural attitude of human being. Saying that medical gas system usually runs very smoothly and thats the main reason we may sometimes overlook. We can only realize the depth of the risk when any adverse event occurs.
We learn from history, from incidents of other hospital and we do failure mood effective analysis (FMEA). We score the risk of medical gas system and thus we maintain their proactive checklist to make sure the program not only running safely. But also make sure how it will run perfectly in future. Medical gas system is one such proactive program where risk mitigation should be check regularly to reduce future events. One single incident may cost a lot.
Therefore, hospital should keep attention frequently on safety of this system. Remember, single ignorance will be higher chance of sentinel event and thats why we need to keep our eyes always open on medical gas system of the hospital.
Medical gas safety is like taking care of patient safety under the fuel tank or volcano. Volcano! Yeah, handling medical gas system in the hospital is dealing with live volcano. So, take proactive and accurate measure before it blast.nothing happen yet,,, doesnt mean that it will not blast in future. So, take care of your medical gas system and make sure it is always in SAFE mood. n
(Concluded)
