Imagine the scene: a bustling hospital operating room where a team of surgeons performs critical heart surgery. Every move is calculated, every instrument pristine, and the atmosphere is tense with concentration. Amid this orchestrated chaos, there is one constant laboring quietly in the background — the medical gas system. It is the lifeline, ensuring a steady stream of oxygen, nitrous oxide flow and suctioning, and other essential systems that sustain patient-saving medical equipment.

Now, picture the unimaginable: a sudden failure in this system. The impact is immediate and catastrophic, likely leading to loss of life. This stark scenario underscores the indispensable role of regular maintenance in medical gas systems.

As medical gas professionals, you are the unsung heroes behind the scenes, ensuring these systems function flawlessly. Your expertise not only keeps the machinery running but also safeguards patient lives and upholds the integrity of healthcare facilities, which is why regular maintenance is a critical necessity, not just a best practice. In fact, it comes with its own regulatory requirements, benefits, standard practices, and challenges.

Overview of medical gas systems

Medical gas systems are central to healthcare, providing essential gases crucial for various medical procedures and the proper patient support for some of the most sensitive areas in a hospital, such as intensive care units. Understanding their components and functions is not just important, it allows you to appreciate the importance of their maintenance and its impact on patient care.

System components

The four main components of a medical gas system are:

• Gas supply sources. High-pressure cylinders or bulk liquid containers store gases such as oxygen, nitrous oxide, helium, carbon dioxide, and medical air.
• Distribution pipelines. These piping systems transport gases and suction services from their source to the patient care areas of the hospital.
• Control panels and alarm systems. These systems monitor the gas supply sources and the patient care areas to ensure safe and efficient delivery of these services.
• Terminal units. These are the outlets through which gases are administered to patients or used in medical procedures.

Each component plays a vital role in maintaining the overall functionality and safety of the system. For instance, oxygen is used in most every medical procedure, from supporting breathing during surgeries to aiding in recovery in intensive care units. Nitrous oxide, commonly known as laughing gas, is used for pain relief and low levels of sedation. Medical air is often used with ventilator patients.

NFPA 99 requirements for maintenance

The maintenance of medical gas systems is governed by rigorous regulatory standards designed to ensure safety and compliance. The National Fire Protection Association’s NFPA 99, Health Care Facilities Code, provides a comprehensive framework that categorizes systems based on risk and outlines specific maintenance protocols.

NFPA 99 sets the bar for medical gas system maintenance, categorizing systems into three risk levels — Category 1, Category 2, and Category 3 — based on the potential impact of system failure on patient safety.

• Category 1 systems. These systems serve critical care areas where a failure could result in a significant injury or death. Maintenance requirements are the most stringent here, involving frequent inspections and testing.
• Category 2 systems. This category applies to systems serving noncritical patients where a failure is less likely to result in significant harm. The maintenance schedule is strict but slightly less demanding than Category 1.
• Category 3 systems. These systems support areas where an interruption might cause some discomfort but does not create life-threatening situations. Maintenance requirements are still essential but less frequent.

Specific maintenance tasks

NFPA 99 mandates various maintenance tasks, including:

• Regular inspections. Daily or weekly checks ensure systems are in proper working order and help to identify and address potential issues.
• Performance testing. Testing confirms all components operate within specified parameters.
• Documentation. Detailed records of all maintenance activities, inspections, and repairs are also required.
• Emergency drills. Regular drills ensure staff can respond effectively to system failures.

Benefits of regular medical gas system maintenance

Regular medical gas system maintenance offers numerous benefits beyond regulatory compliance. It enhances patient safety, improves system efficiency, reduces overall costs, and ensures equipment longevity.

Enhanced patient safety

Two types of regular maintenance will ensure medical gas systems function flawlessly, preventing potential failures that could endanger patients. First, daily inspections involve routine checks to detect minor issues before they escalate into major problems. The second is system redundancy. This verifies backup systems are always operational, providing an additional layer of safety.

Improved efficiency

Well-maintained systems operate more efficiently, ensuring that the required operating pressures and flow rates of medical gases are consistently met. Maintenance staff will want to conduct regular performance testing to verify that all components are performing optimally and as designed. In addition, calibrating control panels and alarms so they are accurately set, reduces the risk of unnoticed equipment failures and over-pressurization of distribution pipelines.

Cost savings

Preventive maintenance helps avoid expensive emergency repairs and reduces downtime, which can be very costly for healthcare facilities. Preventive measures include replacing worn-out parts and addressing issues early to prevent costly breakdowns. Taking these steps can also lead to greater energy efficiency, since well-maintained systems consume less energy, lowering utility bills.

Longevity of equipment

Regular maintenance also extends the life span of medical gas systems and their components. Routine servicing keeps parts in good working order, delaying the need for replacements and maintaining the system’s integrity to ensure it remains functional and reliable for longer.

Common maintenance practices

Standard operating procedures and maintenance practices are essential for achieving optimal performance and safety of medical gas systems. These practices include routine inspections, regular testing, and scheduled servicing to maintain system reliability and compliance.

Daily inspections

Routine daily inspections are the first line of defense in identifying potential issues before they escalate. Here are three things that should be included in daily inspections:

• Leak detection. Use ultrasonic or leak detection solutions to identify leaks in pipelines and connections.
• Pressure checks. Monitor and record pressure levels to ensure they remain consistent and are within safe operational ranges.
• Alarm testing. Verify all alarm systems are working correctly and set to the appropriate thresholds.

Regular testing protocols

Regular testing is crucial to verify that all medical gas system components function correctly. Two types of testing should be performed. Performance testing is done monthly or quarterly to assess the system’s functionality, and purity testing ensures that the gases used meet the required specification and purity standards, which is vital for patient safety.

Scheduled servicing

Scheduled servicing involves more in-depth maintenance tasks, which are typically performed semi-annually or annually. For instance, regularly replacing filters prevents contamination and supports the clean delivery of gases. Staff should also perform component checkout, which means to check out various system parts to ensure proper operation. Lastly, recalibrating sensors will produce accurate readings and reliable system performance.

Challenges in maintenance

Maintaining medical gas systems in healthcare facilities presents several challenges, including keeping up with evolving regulatory standards and balancing maintenance schedules with the hospital’s operational needs. Addressing these challenges is essential for ensuring the reliability and safety of medical gas systems.

Evolving regulatory standards

Regulatory standards for medical gas systems are continually updated to reflect new safety protocols and technological advancements. Keeping up with these changes can be challenging for healthcare facilities. To stay up to date, facilities will want to commit to:

• Compliance tracking. Regularly monitor changes in standards such as NFPA 99 and ensure all maintenance practices comply with the latest requirements.
• Training and certification. Continuous education and certification updates for maintenance staff will keep them current with new regulations.
• Permit-to-work procedures. Adherence to the permit-to-work requirements mandated by NFPA 99 for all maintenance activities protects the well-being of both patients and hospital personnel.

Balancing maintenance with hospital operations

Healthcare facilities operate around the clock, and scheduling maintenance without disrupting hospital operations is a constant challenge.

To manage scheduling conflicts, find suitable times to perform maintenance tasks that don’t interfere with patient care and hospital activities. Also, be sure that maintenance work does not cause operational disruptions, compromising the functionality of medical gas systems during critical periods.

By addressing these challenges head-on, healthcare facilities can improve their maintenance practices and ensure that their medical gas systems remain continuously safe, reliable, and compliant. Overcoming these obstacles is crucial for maintaining healthcare operations safety and efficiency, benefiting patients, staff, and the bottom line.

Authored by:

Jonathan C. Willard has worked in the medical gas industry for over 25 years, including regulatory compliance, consulting, design, construction, commissioning, training, and emergency preparedness. His involvement in health care projects has taken him all over the world, including a combat zone in Afghanistan; the Naval Hospital in Guantanamo Bay, Cuba; the Korean Peninsula; and, his personal favorite, St. Lucia. Jonathan is chair of the Technical Committee on Industrial and Medical Gases (NFPA 55, Compressed Gases and Cryogenic Fluids Code) and a principal voting member of the Technical Committee on Medical Gas and Vacuum Piping Systems (NFPA 99, Health Care Facilities Code). His credentials include being a certified Project Management Professional, a Certified Healthcare Constructor, and a LEED Accredited Professional with an MS degree in business education. He also proudly serves on the Medical Gas Professional Healthcare Organization board of directors.