medical gas systems compliance the changes ahead

10/7/2021

1

Medical Gas Systems Compliance & the Changes AheadNFPA 99 & ASSE 6000

Company Info

• EMGS (Environmental & Medical Gas Services Inc.)

• Based in Villa Rica, GA (West of Atlanta)

• Second office location in Jackson, MS

• Moved into the medical gas market in 1989

• Over 30 years inspecting, verifying and maintaining medical gas systems

1

2

10/7/2021

2

Speaker Info

Cary Darden –📱 404‐229‐2840 –📧[email protected]

20 years of medical gas inspection / verification and maintenance experience

Licensed medical gas installer (6010), inspector (6020), verifier (6030), bulk gas verifier (6035), maintenance tech (6040) and instructor (6050)

For the past 14 years the primary focus has been on helping facilities comply with NFPA 99

Training outline

Explanation of the piped medical gas distribution system from source to patient

New work vs. operation, management & maintenance requirements

System risk categories

Inspection requirements from NFPA 99 & ASSE 6000

Example med gas reports

Major changes within the 2021 edition (RFA & Permit to work system)

NOTE: all references taken fromNFPA 99 – 2012 edition unless otherwise noted.

3

4

10/7/2021

3

Medical Gas Distribution System – central supply systems

Bulk oxygen source

Med gas manifolds (N2O & N2

Med air compressor & med vacuum pump

Emergency Oxygen Supply Connection (EOSC)

Medical Gas Distribution System – valve types

Source valves

Source valvesMain line valves

Riser valves

Service valves

5

6

10/7/2021

4

Medical Gas Distribution System – zone valves

Zone valves Zone Valves

Medical Gas Distribution System – master alarms

24/7 monitored location

2nd panel located in office of personnel responsible for maintaining equipment

Master alarm switches –monitor MAIN LINE PRESSURES

Med gas master alarms – monitor central supply system status

7

8

10/7/2021

5

Medical Gas Distribution System – area alarms

Area alarm panelsArea alarm panels

Area alarm sensorsArea alarm sensors

Medical Gas Distribution System – outlet terminals

Med gas outlet / inlet terminals




9

10

10/7/2021

6

New work & renovation vs. operation, management & maintenance requirements

• Section 5.1.1.6 (TIA 12‐4) lists the requirements for operation, management, and maintenance of med gas systems from NFPA 99 – 2012 edition

• Section changed to 5.1.1.5 in the 2015 edition and has remained there for 2018 & 2021 editions

New work & renovation vs. operation, management & maintenance requirements

Section 5.1.1.6 – applies to work completed prior to 7/1/2016

1. 5.1.2

2. 5.1.3.1

3. 5.1.3.2

4. 5.1.3.3.1.7

5. 5.1.3.3.1.8

6. 5.1.3.3.4

7. 5.1.3.6.2

8. 5.1.3.8.5.2

9. 5.1.14

10. 5.1.15Scan the QR code with your smartphone for access to the

existing facility requirements document

11

12

10/7/2021

7

Risk categories within NFPA 99 & TJC EP 02.05.09 EP1

• Category 1 – system loss = major injury or death to patient

• Category 2 – system loss = minor injury to patient (NFPA 99 annex ref. A.4.1.2 defines minor injury as “not serious or involving risk of life”)

• Category 3 – system loss = no injury to patient, but some discomfort

• Category 4 – system loss = no impact on patient care ‐‐‐ it isn’t likely that medical gas system will ever be category 4

Medical Gas Manifold Source Systems

13

14

10/7/2021

8

Inspection check list by space –manifold rooms indoor

• General Inspection:• Entrance Lockable / Secure • Space dedicated for manifold & cylinder storage

• Cylinder restraints installed for all cylinders in space

• Dedicated mechanical ventilation drawing from within 1 ft. AFF

• Manifold room door sign present

• Signs segregating full / empty cylinders (provided they are stored in the same enclosure)


• Piping Inspection:• Source shut off valve installed and labeled• Piping type properly labeled; relief lines labeled so they can be distinguished from distribution piping

• Cylinder bank shut off valves in place• Relief valves correctly piped (should be piped outside unless only med air manifold)

• Cylinder pigtail age? Remember the 5 year rule

15

16

10/7/2021

9


• Alarms Inspection:

• Annually

• Changeover alarm

• High & low line pressure alarms

• Emergency reserve cylinders in use (liquid x liquid x HP reserve manifolds only)

• Emergency reserve cylinders low (liquid x liquid x HP reserve manifolds only)

• Leak check documentation (note: ASSE 6000 Annex D suggests doing this on a semi‐annual basis)

• Monthly*

• ASSE 6000 Annex D suggests checking manifold audible / visual signals on a monthly basis (test button only, not functional)

Inspection check list by space –manifolds located outdoors

• NFPA 99 2012 edition – ref. 11.6.5.4

• Protection from ground beneath to prevent rusting (note: later editions of NFPA 99 have clarified this requirement. The later editions are requiring protection from direct contact with soil only).

• During winter, protection from ice & snow buildup

• During summer, screened against continuous exposure to direct rays of the sun IN THOSE LOCALITIES WHERE EXTREME TEMPERATURE PREVAIL

• The portion regarding summer protections has been clarified in later editions of NFPA 99 to state that cylinders stored outdoors must simply be protected from reaching temps higher that 125 F.

17

18

10/7/2021

10

Example report for medical gas manifold system

Medical Air Compressor Source Systems

19

20

10/7/2021

11

Inspection check list by space –mechanical room ‐medical air compressor

• General Inspection

• Adequate room ventilation

• Room secured against unauthorized entry

• Central Supply System piping

• Intake located properly, turned down and screened

• At least two compressors are operational with at least one in reserve

• Intake piping labeled so it can be distinguished from distribution piping

• Source labeled as to area(s) served and emergency contact #

• Source shut off valve (and any other valves visible in mechanical room) labeled properly

• Receiver Tank

• No excess moisture is present (i.e. it isn’t full of water)

• Auto drain functions properly (test button)

• Air Treatment System & Monitoring

• Dryers are at least duplex with only 1 set valved on at a time

• Dryers maintain dew point below +32 F at all times (alarm point is +35 F)

• Dew point alarm is functioning properly (should have documentation showing this)

• CO monitor has been calibrated per manufacturer’s recommended intervals

Medical air quality monitorsCarbon Monoxide Calibration

CO monitor calibrations are almost always asked for now during document review. Note that different manufacturer’s of CO monitors have different calibration frequency requirements and some may require different cal gas.

21

22

10/7/2021

12

Medical air quality monitorsCarbon Monoxide Calibration

Make sure your documentation states that you have calibrated your CO monitors and that you have documentation for the required frequencies. For example, if the monitor requires quarterly calibrations then you should have (4) documented calibration documents for a given year.

Example report for medical air source system

23

24

10/7/2021

13

Medical Vacuum & WAGD Source Systems

Inspection check list by space –mechanical room ‐medical vacuum pump

• General Inspection

• Adequate room ventilation (very important for medical vacuum)

• Room secured against unauthorized entry

• Central Supply System piping

• Exhaust located properly, turned down and screened (minimum 25 ft. away from med air intake)

• At least two pumps are operational with at least one in reserve

• Exhaust piping labeled so it can be distinguished from distribution piping

• Source labeled as to area(s) served and emergency contact #

• Source shut off valve (and any other valves visible in mechanical room) labeled properly

• NOTE: depending on local code adoption, medical vacuum filtration may be required (NFPA 99 – 2018 edition and newer editions)

25

26

10/7/2021

14

Example report for medical vacuum source system

Bulk Cryogenic Oxygen Source Systems

27

28

10/7/2021

15

Bulk Cryogenic Supplier Responsibilities• Facility must request vaporizing sizing criteria

• An annual review of the bulk system capacity is a requirement – this should be done by the bulk gas supplier / service company

Inspection check list by space – bulk gas pad (oxygen)

• Primarily rely on bulk gas service provider for the following:

• Annual review of system with full documentation required by NFPA 99 ref. 5.1.14.4.3

• Ensure the documentation is also included for the vaporizer sizing criteria, tank size is appropriate and all interconnecting piping is correctly sized – NFPA 99 ref. 5.1.14.4.2

• Facility should periodically round to be aware of the following:

• Vaporizing icing under various loads

• Liquid level gauges for main and reserve tanks

• How to adjust final line pressures in case of emergency

• Aware of regular delivery schedules of liquid oxygen

• OXYGEN SOURCE VALVE TAGGED

29

30

10/7/2021

16

Example report for bulk cryogenic oxygen source system

Example report for emergency oxygen supply connection (EOSC)

31

32

10/7/2021

17

Patient Care Space Equipment – Outlet, Area Alarms & Zone Valves• You can’t put medical gas outlets just anywhere (ref. 5.1.3.5.2)

• Medical air may only be used for patient respiration and calibrating respiratory equipment (ref. 5.1.3.6.2)

• Medical vacuum may only be used for medical‐surgical vacuum purposes (ref. 5.1.14.1.4)

• Should not be located in scope cleaning rooms, decon, SPD, etc.

Inspection check list by space – patient care space (outlets, area alarms, zone valves)

• OUTLET TESTING FREQUENCIES

• Outlets must be checked on a periodic basis. There is no requirement for annual testing in NFPA 99.

• ASSE 6000 Annex D.3.5 recommends ANNUALLY checking all outlets in critical care areas (ICU, CCU, NICU, Surgery, Recovery, ER) for flow, pressure, damage and wear.

• The facility policy should dictate how often outlets are tested

• Recommendation is to test 100% of outlets in facility within a 4 year period – need a good way of tracking this, the annual med gas testing vendor should be able to do this for the facility.

33

34

10/7/2021

18

Inspection check list by space – patient care space (outlets, area alarms, zone valves)

• Outlet testing

• Flow

• Latching / de‐latching

• Pressure / vacuum level

• Proper labeling

• Leaks

• Area alarms

• Proper labeling

• Signal operation (high / low line activation at proper levels)

• This can be performed without changing system line pressure, provided the sensors are accessible

• Zone valves

• Proper labeling

• Leak check…maybe – not a requirement within NFPA 99 on an ongoing basis

Example report for area alarms

35

36

10/7/2021

19

Example report for zone valves

Example report for outlets

37

38

10/7/2021

20

Master Alarms

Monitors the operation and condition of the source of supply, the reserve source (if any), and the pressure in the main lines of each medical gas and vacuum piping system. A minimum of (2) panels are required in (2) separate locations and are to be wired independently to each initiating device.

Inspection check list by space –medical gas master alarms

• Must have a minimum of (2) master alarm panels

• 1 located in an area of 24 hour surveillance (i.e. PBX, security, ER nurses station)

• 1 located in the area of the person responsible for the maintenance of the med gas systems (i.e. facilities engineering shop or office)

• Master alarms should be functionally tested annually

• No interruption of gas or modification of line pressures should be necessary for this to occur

39

40

10/7/2021

21

Example report for master alarms

ASSE 6000 Professional Qualifications Standard Annex D

41

42

10/7/2021

22

Responsible Facility Authority

• New requirement for 2021

• Health care facility shall designate ONE or MORE individuals

• RFA is responsible for implementing the requirements of NFPA 99 as they apply to the piped medical gas systems

• Shall be qualified to interpret the requirements of NFPA 99 AND be technically competent on the equipment installed

• Plant vs. Floor (patient care space) responsibilities can be very different

Responsible Facility Authority ‐ Responsibilities

• Advising on section 1.3

• Application of code

• Health Care Facility’s policies regarding the code

• Categorizing patient care space based on level or risk to patients and / or caregivers

• Designating anesthetizing locations within the facility

• Advising on section 4.2

• Will be a part of the HCF team that performs risk assessments

• Will be a part of the team that determines what risk category different spaces fall under

43

44

10/7/2021

23

Responsible Facility Authority ‐ Responsibilities

• The RFA should be the point person for interpreting sections 5.1 ‐ 5.3 as they apply to the HCF

• 5.1 Category 1 requirements



• The RFA shall be responsible for writing and upkeep of the HCF emergency plan as it applies to piped medical gas systems.

• Medical gas and vacuum QUALITY, QUANTITY & CONTINUITY OF SUPPLY

• Addressing requirements for patient and staff safety that arise due to construction projects

• Developing the permit to work system as it pertains to piped medical gas systems

• Evaluation and acceptance of all test and PM reports

Permit‐to‐work system

• New requirement for 2021

• The RFA shall be responsible for developing, maintaining and managing the facilities permit‐to‐work system as it applies to piped medical gas systems

• The permit‐to‐work system shall be used anytime the following occur to the med gas and vac systems:

• Maintenance

• Repair

• Construction

45

46

10/7/2021

24

Permit‐to‐work system minimum requirements

• Communication to the affected medical staff and facility admin about the work being performed

• Alternative supply in place prior to system interruption

• Qualifications check for all involved parties (6010 installer, 6020 inspector, 6030 verifier, 6040 maintenance tech as applicable)

• Shutdown and restoration procedures shall be fully described, communicated and followed by all parties involved in work

• Safety procedures established and followed by all parties involved in work

• Follow all applicable sections of NFPA 99 during work (work is defined here as maintenance, repair or construction services)

• Proper testing procedures are executed after work is performed

Questions?Thank you for the opportunity to speak to you!

Main: 770‐459‐5920Website: www.emgsi.com

Contact [email protected] more education

47

48

medical gas systems compliance the changes ahead

Documents