As we move into 2021, there continues to be an increased demand for oxygen delivery systems. Oxygen remains a critical resource in any disaster management. With the COVID-19 pandemic still heavily prevalent, the oxygen delivery infrastructure is nearly collapsing under pressure.
Strategic management of oxygen supplies in this time remains a priority. Hospitals have large supplies of liquid oxygen and a supply of compressed gas oxygen cylinders that allow several days of the reserve, but a large influx of patients from the pandemic is straining these resources.
As a leader in the control, management, and monitoring of medical gas systems, our commitment to the healthcare facility managers' encourages us to stay on top of preventative measures you can take to keep this from happening to your facility's oxygen and medical gas systems.
Maintaining Gas Flow Through Extraordinary Use
Oxygen is often stored as a liquid around minus 300 degrees Fahrenheit to take up less space.
The amount of cold liquid oxygen needed to be delivered through the pipes during stressful times, as in a pandemic, could freeze the equipment.
Some healthcare professionals may think they are experiencing an oxygen shortage when, in reality, it’s not a shortage of oxygen that is the problem.
The gas flow currently is so high that the liquid oxygen doesn’t have time to vaporize and freezes the regulators, therefore causing a lack of flow.
As healthcare facility managers, there are ways to mitigate and take preventative measures to keep the oxygen and medical gas systems running effectively and efficiently during unusual times.
13 Preventative Measures You Can Do Today to Focus on Tomorrow's Patient Needs
Extreme stress has been placed on hospital's medical gas systems due to the crucial treatments required by COVID-19 patients. The concern lies with the problem that medical oxygen supply systems may not be scaled for the pandemic's increasing demand.
There eventually comes a critical point in which safe operation of the system will reach its limit, which could cause a shutdown of the entire bulk medical oxygen system.
The strategies outlined below can be implemented today or can be planned for the future to help alleviate the problem. The mitigation steps will impact the medical gas infrastructure for the better.
1. Deice the vaporizers/monitor for excess ice buildup
An increased high flow of oxygen can be the cause of ice accumulation on the vaporizers. A quick observation of your bulk medical oxygen system will show any distress or signs of icing. Spray your vaporizer with a hose to melt the ice. Another way to gain control is to deice using steam.
Do not chip at the ice with hammers or ice picks. It may cause a hazard due to falling ice or potentially damaging the equipment. Talk to your supplier about getting the vaporizer deiced.
Note: Portable heaters should not be used on oxygen systems.
The video is meant to help medical gas professionals and healthcare facilities better understand the impact of treating COVID-19 patients on a hospital's medical gas systems.
Source: MGPHO Medical Gas, Impact of COVID-19 on Medical Gas System, via YouTube
2. Increase the size of the facility's vaporizers or switch between vaporizers
Switching between vaporizers (most hospitals have a couple) more frequently such as every six hours instead of 12 hours, prevents ice buildup.
(source: The Cold, Hard Work of Delivering Oxygen to Ventilators)
3. Increase the number of canisters at the hospital, if possible
Extra storage of canisters can serve as a back up in emergencies.
Oxygen gas can be compressed and stored in cylinders. If possible, switch to larger oxygen cylinders (although oxygen cylinders are cumbersome and can be dangerous if mishandled). Cylinders can be installed within patient areas or by connecting them to manifold systems.
Determine if the gas can be piped directly to the patients through the piping system or if it can be compressed and used in gas cylinders.
4. Adjust the final line regulators to increase the entire system pressure
If this approach is taken, it is vital to remain within the NFPA 99 limits of 50-55 psi, and adjust all area and master alarm high and low-pressure set points to stay ±20% of the operating pressure.
Do not raise line pressure if the gauge and regulator show signs of freezing or ice buildup.
5. Keep hospital pipes updated
Keep hospital pipes updated, so they are less apt to break down and can maintain the pressure needed to keep up with patients' high demand during a crisis.
Buildings are aging, and some are not equipped to house a large number of critical patients.
6. Increase air circulation around the vaporizers
Most vaporizers rely on ambient air movement around the fins to allow the liquid oxygen to convert to gas. In times of increased demand, there are options available to combat excessive icing.
Place fans around the vaporizer to increase airflow. This will continue to blow air through the vaporizers at a greater rate and help keep the icing down.
7. Ensure proper timing of alternating type systems (if installed)
Hospitals are expected to maintain and continue their operation without any interruptions or long delays.
"For larger hospitals, it is highly recommended to use multiple generators controlled by paralleling switchgear with intelligence (supervisory control and data acquisition and programmable logic controller). This will not only improve the reliability of the alternate source of power but also provide flexibility to add or shed loads as required among many other benefits." (source: Emergency and standby power in hospitals)
8. Supply additional capacity of oxygen through the emergency oxygen supply connection (EOSC)
Installing a supplemental supply system can add extra capacity to the oxygen system.
Emergency oxygen supply connections (EOSC) are required by NFPA 99. They should be checked that they are readily accessible to allow connection of a temporary auxiliary mobile source and that all facility and security staff are aware of the location. (source)
9. Back-feed medical gas individual zones
Back-feed areas of the hospital as needed to accommodate overconsumption.
Tri-Tech Medical offers their E Z Backfeed™ zone valve boxes and ball valves that provide a safe, fast method for back-feeding medical gases without shutting down the gas supply or disrupting patients and an easy to locate and test location for transducers.
10. Installation of electric or steam vaporizer systems
In order to use gases from a bulk cryogenic vessel, the liquid must be changed into a gas. Cryogenic liquids are converted to a gas state utilizing a vaporizer. The most common type of vaporizer is the ambient finned tube vaporizer.
However, as a more permanent solution, it may be worth assessing the installation of electric or steam vaporizer systems.
11. Analysis of the existing piping systems
Analyze the current piping systems. Identify areas of the facility that could be used for patients requiring ventilators or any potential improvement areas.
12. Identify and evaluate potential risks
Evaluate current and projected peak flows.
The Medical Gas Professional Healthcare Organization (MGPHO) cites,
"Recognizing the ‘choke points’ is key for deciding where surge patients requiring high consumption of medical gases should be located. Recognize that the ‘choke point’ could be in the distribution system, since the design of medical gas systems for standard patient rooms does not anticipate full flow at every outlet.”
(source: Maximizing Medical Gas Flow Capacity)
13. Ongoing inspection, testing, and maintenance
It's pertinent to have complete confidence in your medical gas program. Maintenance, inspection, and testing of the gas system must be conducted by a professional certified by the American Society of Sanitary Engineers (ASSE).
NFPA 99-2018, 22.214.171.124, requires that inspection and testing on all new piped gas systems, additions, renovations, temporary installations, or repaired systems. Ensuring the proper installation and testing of these systems is paramount to delivering safe patient care.
The surge in oxygen demand (amount of oxygen being used at hospitals) is causing the vaporizers to freeze up, and the liquid oxygen is not turning into its gas form...
This is causing oxygen systems to fail.
Health care facilities need to ensure their medical gas supply systems can deliver larger amounts of oxygen. While it certainly is not business as usual in healthcare right now, it is essential to continue addressing risk and staying focused on patients' needs.
While this can require thinking outside the box or considering different aspects of your medical gas system, it can also be a time to evaluate your existing system, develop new best practices, and determine how to be better prepared moving forward.
CHT remains committed to assisting our partners in navigating these difficult times to battle this pandemic together.
CHT's certified technicians conduct medical gas inspections and testing to help you meet NFPA 99 regulations, pass the Joint Commission and CMS, and help prepare you for the worse circumstances.