By Devon Marks, business development manager, Draeger
A medical gas system is the backbone of any healthcare facility. Without this life support system there would be no hospital.
Failure of this system would have catastrophic consequences hence the requirement for high quality standards and safety features. A medical gas management system is supposed to deliver all required medical gases continually and securely at the required flow, pressure and quality.
The areas in which medical gases are most commonly found in a healthcare facility are operating theatres, recovery areas, intensive care units, high care areas, ward areas. Medical gas can be found in almost every space where patients are present in the hospital.
A functional medical gas system is essential for any healthcare facility. | All images by Devon Marks
South African standards relating to medical gas are found in SANS 7396-1 and 2 as well as Pressure Equipment Regulations of 2009. These are the only standards for South Africa. This standard is derived from the ISO 7396-1 and 2 and South Africa is a member body of International Organization for Standardization (ISO). Guidelines such as the R158 and IUSS exist which define minimum requirements, but these make reference to SANS 7396. There are other South African Standards which deal with specific aspects of the entire system for example SANS 1409 and 1453.
The medical gas system is a complex network made up of hundreds to thousands of metres of copper pipes, alarms cables as well as plant equipment such as compressors, vacuum pumps and manifolds. While installing these during construction phase or even during an expansion to existing facilities there are many challenges faced. Some of these include extremely tight deadlines, leakages in almost impossible to access spaces, routing issues and cross connections of gases if care is not taken.
Installation of the system is more than just placing gas cylinders in a ward.
Implementation in South Africa
South Africa’s medical gas division is a very grey area as there is little to no regulation over how installations are performed as well as minimal information available to assist with a proper design. Essentially what must happen is the design should be undertaken or at least approved by a qualified engineer as this is a life support system. Thereafter the equipment installed needs to be specifically for medical applications. This installation needs to be performed by certified and qualified gas practitioners to ensure a safe and reliable system as per the approved design. By following these steps all parties involved can be assured that the system has been designed, installed and tested according to the correct standard. The SANS 7396-1 and 2 as well as the qualification for gas practitioners is currently being reviewed so this should hopefully prevent further installations which are not according to standard from occurring.
Efficiency of local systems depends entirely on the design of the system. It is often found that most systems are either totally over- or under-engineered. The ideal situation is to have a system that is fit for purpose. For example, installing a bulk oxygen tank at a 10-bed clinic is complete overkill. If the systems are properly designed, installed and maintained, wastage will be minimal, and efficiency increased.
Copper pipes, alarms, compressors, vacuum pumps and manifolds make up parts of a medical gas system.
Private vs Public facilities
The private facilities seem to look after their systems more carefully – probably because they have a limited budget allocated to this function. There are some state facilities that are still well maintained but sadly the vast majority of them are in a very poor condition.
As previously mentioned, the medical gas system is the backbone of the hospital and it is essential that these systems are well maintained. Most suppliers or contractors offer extended warranties, which is a good option to prolong the longevity of the system. The cost may seem high at first but if you consider the cost of broken hospital equipment or loss of life this cost is well worth incurring.
Proper installation of these system are far and wide in between.
Getting it right
In order for a drastic improvement in our medical gas systems to be seen, both designers and installers need to take responsibility for their scope of work and should inform the client of the relevant standards which exist as the clients are often unaware or unfamiliar with these. Anyone seeking additional advice regarding this is welcome to contact me.