Third-party audit of Medical Gas Pipeline System (MGPS) in healthcare facilities: An important tool for quality improvement in provisioning of medical gas services
Year: 2025
Type: article
Abstract: INTRODUCTION Medical Gas Pipeline System (MGPS) is a vital support service with an emphasis on the safety, reliability and purity of medical gases for use in healthcare facilities; however, these gases are often inadequately planned and underutilised.[1,2] This case report explores the role of third-party audits in improving MGPS services, given the need for a comprehensive assessment of MGPS, including sources of medical oxygen during the coronavirus disease 2019 (COVID-19) pandemic.[3] CASE DESCRIPTION A consultancy firm was engaged to perform an audit of MGPS, including the plant room, from August to October 2023 at an Institute of National Importance as per the National Fire Protection Agency (NFPA) 99 Guidelines and Health Care Facilities Code (2015/2018/2021), USA. Personnel engaged in the audit were certified by the American Society of Sanitary Engineers and registered with the Medical Gas Testing and Certificate, Charlotte, USA. The audit included examining the organisation and functionality of the MGPS services, which included machinery for generating compressed air and vacuum, including its storage tanks, manifold system for distributing medical gases, alarms and safety mechanisms, terminal outlets, design and stress analysis of pipe distribution system, maintenance system, updating the MGPS drawings, etc. MGPS plant supplies a total of 1977 inpatient beds (including intensive care units), emergency services and an operation theatre complex having various gas outlets, that is, oxygen (1005 outlets), nitrous oxide gas (63 outlets), carbon dioxide gas (28 outlets), vacuum (957 outlets) and medical air at 4 bar (319 outlets) and 7 bar (30 outlets). It scavenges anaesthetic gases from 33 outlets. There are zonal valve boxes (ranging from two to five gases), isolation valves of various sizes (12–54 mm), a copper pipeline distribution network and a medical gases alarm system. Medical oxygen is supplied by converting liquid medical oxygen (LMO) into a gaseous state using a vacuum insulated evaporator, while other gases are supplied using steel cylinders (D type- 1.7 m3). No adverse events were observed that could be linked to MGPS. Maintenance of MGPS has been outsourced to a technical agency and is being supervised by a faculty member from the Department of Hospital Administration [Table 1].Table 1: Strengths of the existing medical gases supply system at the InstituteImprovement opportunities included securing the MGPS riser, installing isolation valves on each floor, ensuring adequate spacing of pipelines, providing alarm systems at each nursing station, ensuring isolation valves are at an accessible height, utilising wall boxes for gas valves, and properly colour-coding pipelines throughout the network. The compressors used for generating medical air and vacuum were being operated alternately using an automatic controller device to prevent the risk of sudden failure. Compressor filters were being replaced at the end of their service life. The requirement for a vacuum has exceeded the plant’s designed capacity and necessitates expansion. Anaesthetic gas scavenging system was functional; however, it had high estimated repair costs, indicating a need for replacement. The plant’s piping needs restructuring for minimal rotation to prevent congestion. Given the significant expansion of the patient care facilities, the diameter of the main supply lines has become inadequate; as a result, medical oxygen is being supplied at higher pressures, which might lead to system inefficiency. Medical gas pipelines exposed to the external environment must be properly protected from environmental hazards, including disruption by monkeys and occasional thefts. The alarm needle on the carbon dioxide control panel needs adjustment to the correct ratio, while the control panels for nitrous oxide were found to experience operational issues. Tailpipes connecting cylinders to the non-return valves of the manifold system need maintenance. DISCUSSION This study highlights the importance of evaluating the performance of MGPS services in healthcare facilities to ensure a continuous supply of medical gases. Empirically, it has been observed that MGPS, being an engineering system with statutory obligations, is often not understood properly by healthcare providers. Leading standards and guidelines pertaining to the design and operation of the MGPS services are prescribed by the NFPA, USA, and the Health Technical Memorandum of the UK. At the same time, medical gas cylinders should adhere to the standards prescribed by the American Society for Testing and Materials, and copper pipes should have Lloyd’s certification as per BS 2871.[4] During the installation phase, a battery of rigorous and comprehensive testing is conducted to examine the effectiveness of the installed system [Table 2]. MGPS plant room should have adequate fire safety measures, an alternate power source with an uninterrupted supply of electricity and an acoustic enclosure. It should provide ear mufflers to healthcare personnel to prevent any auditory damage.[5]Table 2: Details of the processes and tests performed to assess the performance of MGPS[ 6 , 7 ]According to BS EN 737-3:2000, there should be three independent supply sources for medical gases, that is, primary, secondary and a reserve source.[6] Medical gas cylinders should be tested periodically at intervals of 5 years.[8,9] LMO is an economical form of medical oxygen, which is stored in capacity tanks according to the hospital’s requirements.[10] These are installed in accordance with the provisions prescribed by the Petroleum and Explosives Safety Organisation under the Explosives Act, which mandates a statutory licence for their operationalisation.[6,11] A safe and reliable medical gas system should encompass formulating standard operating procedures, quality medical gases and equipment operation reliability through maintenance contracts and a periodic third-party audit.[12] There should be at least an annual audit of the medical gas pipeline system system as well as staff training. Regular mock drills of the contingency plan should also be conducted.[13] The maintenance agency should carry out periodic preventive maintenance. If any deficiency is found during the third-party audit, the agency should be held accountable and should bear the expenditure for carrying out repairs. The various recommendations were presented to the hospital team and are being addressed by categorising them into short-term and long-term measures. With the COVID-19 pandemic exposing the limitations of MGPS, the government has taken various steps to strengthen the MGPS services by establishing oxygen cells at the state level and carrying out oxygen audits, capacity-building programmes for healthcare workers, etc.[7] CONCLUSION The third-party audit emphasised the importance of overhauls, maintenance and safety for reliable MGPS operations. Health policymakers should establish a simplified framework and agencies supporting healthcare facilities in planning and managing these services efficiently and effectively. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Indian Journal of Anaesthesia
Institution: All India Institute of Medical Sciences
Language: English
Subfield: Medical Laboratory Technology
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411193449