Medical gas safety in hospital (Part-1)

Medical gas technology provides the backbone to many of the major systems within a healthcare facility. Over time, these technologies have improved to provide more consistent and accurate medical gas delivery systems. However, the future of medical gas management still depends greatly on the human element that designs and controls the systems today. Even as technology continues to march forward, humans will continue to play a pivotal role in making individualized decisions around medical gas management.

The introduction of new vacuum pumps and metering technology in modern medical gas systems is a major step towards efficiency and safety. But these elements are not sufficient on their own to guarantee a well-designed system. Going forward, medical gas management will be needed to redesign systems to take advantage of the latest advancements. New healthcare facilities will require the insight of experienced management personnel to properly implement and train medical professionals on how their gas delivery systems work. Technology itself doesn’t improve the healthcare environment; the healthcare professionals do.

… new vacuum pumps and metering technology in modern medical gas systems is a major step towards efficiency and safety. But these elements are not sufficient on their own to guarantee a well-designed system. Going forward, medical gas management will be needed to redesign systems to take advantage of the latest advancements.

While new technology is being installed to make your life easier overall, it is not completely fail safe. Medical gas systems will still need to be inspected, verified and maintained by individuals to ensure that each component continues to work as designed. This means regular inspections of pumps, valves and filters in the system that tends to build up debris over time. Alarm systems and panels also require regular checks to identify points in the system that are not operating properly. Even as these alarms get more accurate and are better able to identify issues within the system, there is still a requirement to locate and repair any problems. Regardless of how many alarms, gauges and pressure sensors are installed in a given medical gas system, the reality is all medical gas comes with liability for the healthcare facility and professionals who use it.

Even under the best circumstances, it is inadvisable to hand over control of such a complicated life safety system to machines and computerized systems alone. “Technology should enable not replace the human element”. There will always be a need for oversight by a trained and skilled medical gas management professional to ensure safety of all parties. Otherwise, any incident where the gas system fails to perform as expected will be considered reckless and negligent when it comes time to discuss the damages.

Beyond the regular operation of a medical gas system, there are a myriad of CMS (the centers for Medicare and Medicaid Services), Joint Commission, state and local MOH regulations governing the way medical gases are to be maintained. While new metering technology and testing capabilities may make it easier to manage gas systems independently, these technologies are not able to provide documentation on their own status attributes. Instead, medical gas management professionals are tasked with documenting and recording the inspections, maintenance and repairs as they are being completed.

Improper documentation and safety protocols will result in fines or even temporary shut downs until the system is found to be in compliance. Ultimately, the future of medical gas management is sure to include new means of testing, metering, filtering and controlling gas systems. These advancements in technology will serve to assist professionals in maintaining the systems overall. However, they will never be able to completely replace the human element if you are managing your facility proactively. It is important to understand that complete dependence on technology can actually work against you.

One of the most crucial elements of training is those real life discussions that take place between directors, managers and staff. The need for experienced management will continue to be a requirement for safety and compliance of all regulations in the foreseeable future. Well trained facility managers will be needed to oversee new medical gas systems as new technologies are adopted. Each new generation of technology will require the knowledge of previous generations’ struggles to be properly and effectively adapted.

According to Dr. Seuss, sometimes the questions are complicated and the answers are simple. When it comes to storage requirements for freestanding medical gas cylinders in the ambulatory setting, here’s a simple way to understand the Joint Commission’s requirements. The ABCs of medical gas safety:

A: Always physically separate full and empty medical gas cylinders. Ambulatory organizations can do this by using separate racks, physical barriers or color-coding the storage rack. If empty and full cylinders are stored within the same enclosure, they must be segregated from each other.

B: Be sure to label the cylinders clearly (open/empty or full/unopened), so that busy staff don’t have to spend time choosing between full, partial and empty cylinders. Proper labeling also helps avoid confusion and delay if a full cylinder is needed quickly.  

C: Consider any open cylinders as “empty.” It is OK to use partially-filled cylinders, but they should not be stored with unopened ones.

Another thing to consider when reviewing medical gas cylinder safety is the potential for fire risk. “It’s important to monitor and manage the amount of nonflammable medical gases stored in patient care areas,” says Joint Commission Engineer George Mills, M.B.A., FASHE. “The National Fire Protection Association (NFPA) limits the number of medical gas cylinders and the amount of nonflammable medical gas that can be stored in egress corridors to 300 cubic feet or 12 E cylinders.” During your ambulatory organization’s accreditation survey, Joint Commission surveyors will review compliance with NPFA requirements under Environment of Care standard 02.06.01, element of performance (EP) 1, and EC.02.03.01, EP 1. The basic safety guidance on this page is not intended as a substitute for the necessary comprehensive training that is required for portering staff, nurses and other personnel regularly involved in handling medical gases.

Medical gas cylinder store design: Health Technology Memorandum 02 (HTM02) provides comprehensive guidance on the design and construction of medical gas cylinders stores. Below is a summary of the key requirements for the design of a medical gas cylinder store.  Medical gas cylinders should be kept in a purpose built cylinder store that should allow the cylinders to be kept dry and in a clean condition. When designing the cylinder store a risk assessment should be carried out to ensure that the chosen location is as safe as is practicable and that any manual handling issues are engineered out at the planning stage. As far as possible the medical gas cylinder store should:

Allow cylinders to be stored under cover, preferably enclosed and not subjected to extremes of temperature

Be kept dry, clean and well ventilated (both top and bottom)

Have good access for delivery vehicles and reasonably level floor areas

Be large enough to allow for segregation of full and empty cylinders and permit separation of different medical gases within the store

Be totally separate from any non-medical cylinder storage areas

Be sited away from storage areas containing highly flammable liquids and other combustible materials and any sources of heat or ignition

Have warning notices posted prohibiting smoking and naked lights within the vicinity of the store

Be secure enough to prevent theft and misuse

Medical gas cylinder store operation: The layout and racking within the medical gas cylinder store should:

Allow for strict stock rotation of full cylinders to enable the cylinders with the shortest expiry time to be used first

Allow large size cylinders (such as F, HX, ZX, G and J sizes) to be stored vertically on concrete floored pens

Allow small size cylinders (such as C, CD, D and E sizes) to be stored horizontally on shelves (made of a material that will not damage the surface of the cylinders)

Allow for all ENTONOX cylinders to be stored at above 10°C for 24 hours prior to use. (Where this is not feasible, it is important to consult the ENTONOX Medical Gas Data Sheet for further information before using the cylinders

Advice should be sought from the local authorities regarding any specific regulations pertaining to the design and location of the cylinder store.

Brin’s Oxygen Company (BOC) limited, a member of Linde group can provide assistance with the appropriate warning signs required for cylinder stores. Additional information about the layout and operation of the store is available in HTM 02. The Emergency Services should be advised of the location and contents of the cylinder store.

Handling cylinders: In order to comply with current manual handling regulations, it is advisable that when handling medical gas cylinders, the following precautions are followed:

Allow cylinders to be stored under cover, preferably enclosed and not subjected to extremes of temperature

Be kept dry, clean and well ventilated (both top and bottom)

Have good access for delivery vehicles and reasonably level floor areas

Be large enough to allow for segregation of full and empty cylinders and permit separation of different medical gases within the store

Be totally separate from any non-medical cylinder storage areas

Be sited away from storage areas containing highly flammable liquids and other combustible materials and any sources of heat or ignition

Have warning notices posted prohibiting smoking and naked lights within the vicinity of the store

Be secure enough to prevent theft and misuse.

(…to be continued)

 

Medical gas safety in hospital (Part-1)

Medical gas technology provides the backbone to many of the major systems within a healthcare facility. Over time, these technologies have improved to provide more consistent and accurate medical gas delivery systems. However, the future of medical gas management still depends greatly on the human element that designs and controls the systems today. Even as technology continues to march forward, humans will continue to play a pivotal role in making individualized decisions around medical gas management. The introduction of new vacuum pumps and metering technology in modern medical gas systems is a major step towards efficiency and safety. But these elements are not sufficient on their own to guarantee a well-designed system. Going forward, medical gas management will be needed to redesign systems to take advantage of the latest advancements. New healthcare facilities will require the insight of experienced management personnel to properly implement and train medical professionals on how their gas delivery systems work. Technology itself doesnt improve the healthcare environment; the healthcare professionals do. new vacuum pumps and metering technology in modern medical gas systems is a major step towards efficiency and safety. But these elements are not sufficient on their own to guarantee a well-designed system. Going forward, medical gas management will be needed to redesign systems to take advantage of the latest advancements. While new technology is being installed to make your life easier overall, it is not completely fail safe. Medical gas systems will still need to be inspected, verified and maintained by individuals to ensure that each component continues to work as designed. This means regular inspections of pumps, valves and filters in the system that tends to build up debris over time. Alarm systems and panels also require regular checks to identify points in the system that are not operating properly. Even as these alarms get more accurate and are better able to identify issues within the system, there is still a requirement to locate and repair any problems. Regardless of how many alarms, gauges and pressure sensors are installed in a given medical gas system, the reality is all medical gas comes with liability for the healthcare facility and professionals who use it. Even under the best circumstances, it is inadvisable to hand over control of such a complicated life safety system to machines and computerized systems alone. Technology should enable not replace the human element. There will always be a need for oversight by a trained and skilled medical gas management professional to ensure safety of all parties. Otherwise, any incident where the gas system fails to perform as expected will be considered reckless and negligent when it comes time to discuss the damages. Beyond the regular operation of a medical gas system, there are a myriad of CMS (the centers for Medicare and Medicaid Services), Joint Commission, state and local MOH regulations governing the way medical gases are to be maintained. While new metering technology and testing capabilities may make it easier to manage gas systems independently, these technologies are not able to provide documentation on their own status attributes. Instead, medical gas management professionals are tasked with documenting and recording the inspections, maintenance and repairs as they are being completed. Improper documentation and safety protocols will result in fines or even temporary shut downs until the system is found to be in compliance. Ultimately, the future of medical gas management is sure to include new means of testing, metering, filtering and controlling gas systems. These advancements in technology will serve to assist professionals in maintaining the systems overall. However, they will never be able to completely replace the human element if you are managing your facility proactively. It is important to understand that complete dependence on technology can actually work against you. One of the most crucial elements of training is those real life discussions that take place between directors, managers and staff. The need for experienced management will continue to be a requirement for safety and compliance of all regulations in the foreseeable future. Well trained facility managers will be needed to oversee new medical gas systems as new technologies are adopted. Each new generation of technology will require the knowledge of previous generations struggles to be properly and effectively adapted. According to Dr. Seuss, sometimes the questions are complicated and the answers are simple. When it comes to storage requirements for freestanding medical gas cylinders in the ambulatory setting, heres a simple way to understand the Joint Commissions requirements. The ABCs of medical gas safety: A: Always physically separate full and empty medical gas cylinders. Ambulatory organizations can do this by using separate racks, physical barriers or color-coding the storage rack. If empty and full cylinders are stored within the same enclosure, they must be segregated from each other. B: Be sure to label the cylinders clearly (open/empty or full/unopened), so that busy staff dont have to spend time choosing between full, partial and empty cylinders. Proper labeling also helps avoid confusion and delay if a full cylinder is needed quickly. C: Consider any open cylinders as empty. It is OK to use partially-filled cylinders, but they should not be stored with unopened ones. Another thing to consider when reviewing medical gas cylinder safety is the potential for fire risk. Its important to monitor and manage the amount of nonflammable medical gases stored in patient care areas, says Joint Commission Engineer George Mills, M.B.A., FASHE. The National Fire Protection Association (NFPA) limits the number of medical gas cylinders and the amount of nonflammable medical gas that can be stored in egress corridors to 300 cubic feet or 12 E cylinders. During your ambulatory organizations accreditation survey, Joint Commission surveyors will review compliance with NPFA requirements under Environment of Care standard 02.06.01, element of performance (EP) 1, and EC.02.03.01, EP 1. The basic safety guidance on this page is not intended as a substitute for the necessary comprehensive training that is required for portering staff, nurses and other personnel regularly involved in handling medical gases. Medical gas cylinder store design: Health Technology Memorandum 02 (HTM02) provides comprehensive guidance on the design and construction of medical gas cylinders stores. Below is a summary of the key requirements for the design of a medical gas cylinder store. Medical gas cylinders should be kept in a purpose built cylinder store that should allow the cylinders to be kept dry and in a clean condition. When designing the cylinder store a risk assessment should be carried out to ensure that the chosen location is as safe as is practicable and that any manual handling issues are engineered out at the planning stage. As far as possible the medical gas cylinder store should: Allow cylinders to be stored under cover, preferably enclosed and not subjected to extremes of temperature Be kept dry, clean and well ventilated (both top and bottom) Have good access for delivery vehicles and reasonably level floor areas Be large enough to allow for segregation of full and empty cylinders and permit separation of different medical gases within the store Be totally separate from any non-medical cylinder storage areas Be sited away from storage areas containing highly flammable liquids and other combustible materials and any sources of heat or ignition Have warning notices posted prohibiting smoking and naked lights within the vicinity of the store Be secure enough to prevent theft and misuse Medical gas cylinder store operation: The layout and racking within the medical gas cylinder store should: Allow for strict stock rotation of full cylinders to enable the cylinders with the shortest expiry time to be used first Allow large size cylinders (such as F, HX, ZX, G and J sizes) to be stored vertically on concrete floored pens Allow small size cylinders (such as C, CD, D and E sizes) to be stored horizontally on shelves (made of a material that will not damage the surface of the cylinders) Allow for all ENTONOX cylinders to be stored at above 10C for 24 hours prior to use. (Where this is not feasible, it is important to consult the ENTONOX Medical Gas Data Sheet for further information before using the cylinders Advice should be sought from the local authorities regarding any specific regulations pertaining to the design and location of the cylinder store. Brins Oxygen Company (BOC) limited, a member of Linde group can provide assistance with the appropriate warning signs required for cylinder stores. Additional information about the layout and operation of the store is available in HTM 02. The Emergency Services should be advised of the location and contents of the cylinder store. Handling cylinders: In order to comply with current manual handling regulations, it is advisable that when handling medical gas cylinders, the following precautions are followed: Allow cylinders to be stored under cover, preferably enclosed and not subjected to extremes of temperature Be kept dry, clean and well ventilated (both top and bottom) Have good access for delivery vehicles and reasonably level floor areas Be large enough to allow for segregation of full and empty cylinders and permit separation of different medical gases within the store Be totally separate from any non-medical cylinder storage areas Be sited away from storage areas containing highly flammable liquids and other combustible materials and any sources of heat or ignition Have warning notices posted prohibiting smoking and naked lights within the vicinity of the store Be secure enough to prevent theft and misuse. (to be continued)