HTM-2022-Part-B.pdf
Medical gas pipeline systems Operational management Health Technical Memorandum 2022 London: The Stationery Office © Crown copyright 1997. Published with permission of NHS Estates, an Executive Agency of the Department of Health, on behalf of the Controller of Her Majestys Stationery Office. Applications for reproduction should be made in writing to The Copyright Unit, Her Majestys Stationery Office, St Clements House, 216 Colegate, Norwich NR3 1BQ. First published 1997 ISBN 0-11-322068-5 Standing order service Are you making full use of The Stationery Offices Standing Order Service? The Standing Order Service is a free monitoring of the publications of your choice from over 4000 classifications in 30 major subject areas. We send you your books as they are published, along with an invoice. With a standing order for class 14.02.017 you can be supplied automatically with further titles in this series as they are published. 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Health Technical Memoranda (HTMs) give comprehensive advice and guidance on the design, installation and operation of specialised building and engineering technology used in the delivery of healthcare They are applicable to new and existing sites, and are for use at various stages during the inception, design, construction, refurbishment and maintenance of a building. About this series This volume of Health Technical Memorandum (HTM) 2022 looks at issues of operational management. It covers such issues as statutory requirements, functional responsibilities, operational policy, operational procedures, training and communications, cylinder management, general safety, maintenance and risk assessment control of exposure to anaesthetic agents, giving definitions and working practices throughout. This volume is intended for use by operational managers, engineers, quality controllers, technicians, finance officers and other professionals involved in the day-to-day running of an MGPS. The primary objective of this volume is to ensure the provision of safe and reliable MGPSs and their efficient operation and use. This objective will only be achieved if the medical and nursing users, and estates staff participate in the introduction of an operational policy designed to minimise the hazards likely to arise from misuse of the system. A MGPS is installed to provide a safe, convenient and cost effective system for the provision of medical gases to the clinical and nursing staff at the point of use. It reduces the problems associated with the use of gas cylinders such as safety, porterage, storage and noise. The guidance given in this HTM should be followed for all new installations and refurbishment or upgrading of existing installations. It is not necessary to apply the guidance retrospectively unless patient or staff safety would be compromised. In this case, the guidance given in this HTM should be followed. Existing installations should be assessed for compliance with this HTM. A plan for upgrading the existing system should be prepared taking account of the priority for patient safety. Managers will need to liaise with medical colleagues and take account of other guidance published by the Department of Health in order to assess the system for technical shortcomings. Executive summary Contents About this publication Executive summary 1.0Scope page 3 1.1General 1.10Operational management 1.13Other guidance 2.0Functional overview page 5 2.1Basic description of an MGPS 3.0Statutory requirements page 8 3.2Health and Safety at Work etc Act 3.3Management of Health and Safety at Work Regulations 1992 3.4Work Place (Health, Safety and Welfare) Regulations 1992 3.5Provision and Use of Work Equipment Regulations 1992 3.6Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 3.7Manual Handling Operation Regulations 1992 3.10Personal Protective Equipment at Work Regulations 1992 3.11Electromagnetic Compatibility Regulations 1992 3.12COSHH Regulations 3.16Pressure Systems and Transportable Gas Containers Regulations 3.21Highly Flammable Liquids and Liquid Petroleum Gas Regulations 3.23Medicines Act 4.0Functional responsibilities page 12 4.1General 4.6Management 4.7Key personnel 4.8Executive manager 4.13Estates management 4.15Authorised person (MGPS) 4.24Competent person (MGPS) 4.26Quality controller (QC) 4.28Designated medical or nursing officer 5.0Operational policy page 16 5.1General 5.3Operational considerations 5.20Emergency procedures 5.22Power supply failure 5.23Record drawings 5.26Locking of valves and plantrooms for MGPS 5.31Monitoring of the operational policy 5.33Contractors 5.36Medical equipment purchase 6.0Operational procedures page 21 6.1Permit-to-work procedure 6.61Tests after work on the MGPS 6.72Procedure for cleaning contaminated vacuum systems 7.0Training and communications page 32 7.1Training 7.8Communications 8.0Cylinder management page 33 8.1Cylinder storage and handling 8.10Accommodation for medical gas cylinders 8.18Hazchem/warning signs 8.11Design and construction of cylinder stores 8.23Handling of cylinders 8.45Equipment for use with medical gas cylinders 8.47Precautions against leakage of gas 8.55Precautions against fire, heat and chemicals 8.61Cylinders involved in incidents 8.62Storage of cylinders in manifold rooms 8.64Storage of cylinders in ready-to-use stores 8.71Stock control and receipt of cylinders into stock 8.72Ordering from suppliers 8.73Returns to suppliers 8.74Issue from stores 8.75Return of cylinders to stores 8.76Receipt of cylinders into stock 8.78Labelling/marking of cylinders 8.83Restriction on use of storage accommodation 8.86Notices 8.89Access to manifold rooms and liquid oxygen storage areas 8.90Fire detection system 8.91Classification of hazardous areas for the selection of electrical equipment based on BS5345: Part 1: 1976 9.0General safety and fire precautions page 47 9.1General safety 9.9Safety statement for users of oxygen equipment 9.16Material compatibility 9.17Protective clothing for handling cryogenic gases 9.20Other medical gases 9.21Fire precautions 9.34Ventilation 10.0Maintenance page 52 10.1General 10.7Organisation 10.10 Preparation of a maintenance contract 10.18 General work procedures 10.26 Competency of contractors staff 10.42 Test equipment 10.47 Services 10.59 Method statement 10.63 Records 10.71 Emergency call-out procedures 10.79 Responsibilities of the trust to monitor the service 10.86 Preparation of a PPM schedule 10.93 Specific maintenance checks 10.109Medical vacuum systems: bacterial filters standard operating procedure for filter changing 10.117Schedule of maintenance services 11.0Risk assessment control of exposure to anaesthetic agents page 66 10.1General 10.5Risk assessment 10.10 Methods of control 10.13 Monitoring 12.0Definitionspage 69 Appendix I General safety requirementspage 73 Medical compressed air and surgical air plant Medical gas manifolds Medical vacuum plant Pipeline distribution system Warning and alarm systems Anaesthetic gas scavenging systems Yearly tasks in addition to quarterly tasks Medical compressed air plant including surgical air plant Appendix II Procedure for breaking into an existing systempage 83 Referencespage 85 Other publications in this series page 87 About NHS Estates page 88 Contents 3 General 1.1This volume of Health Technical Memorandum (HTM) 2022 covers the operational management and maintenance of systems for the supply by pipeline of: a.medical oxygen, b.nitrous oxide, c.nitrous oxide/oxygen mixture (50% v/v), d.nitric oxide (currently 1000 vpm in nitrogen), e.medical compressed air for both respirable applications and surgical tools (at 400 kPa and 700 kPa respectively), f.oxygen/carbon dioxide mixture (5% CO2), g.medical vacuum; h.waste anaesthetic gas scavenging systems (AGSS). 1.2Throughout this volume, the phrase Medical Gas Pipeline Systems (MGPS) will be used as a generic term to describe these systems. 1.3 The guidance in this volume applies to all MGPS installed in healthcare premises. 1.4An MGPS is intended to be a safe, convenient and cost-effective alternative to the use of “portable” cylinders, portable compressors and portable suction units, providing gas or vacuum for clinical needs without the associated problems of porterage, noise and space wastage. 1.5The guidance given in this volume should be followed for all new installations and refurbishment or upgrading of existing installations. 1.6It is not necessary to apply the guidance retrospectively unless patient or staff safety would be compromised. In this case, the guidance given in this volume should be followed. 1.7Existing installations should be assessed for compliance with this volume. A plan for upgrading the existing system should be prepared, taking account of the priority for patient safety. Managers will need to liaise with medical colleagues and take account of the latest guidance published by the Department of Health in order to assess the system for technical shortcomings. 1.8This volume also contains details of the design equipment and operational parameters of systems which form the basis for Model Engineering Specification C11. This specification is intended for the procurement of an MGPS. As technology develops, this HTM and C11 will be revised from time-to-time, but not necessarily simultaneously. Whichever document is the most current takes precedence. 1.9Whenever appropriate, British Standards specifications should be used. 1.0Scope 4 1.0 Scope Operational management 1.10This volume of HTM 2022 covers such issues as statutory requirements, functional responsibilities, operational policy, operational procedures, training and communications, cylinder management, general safety, maintenance and risk assessment control of exposure to anaesthetic agents, giving definitions and working practices throughout. 1.11This volume is intended for use by operational managers, engineers, quality controllers (QCs), technicians, finance officers and other professionals involved in the day-to-day running of an MGPS. 1.12The primary objective of this volume is to ensure the provision of safe and reliable MGPS and their efficient operation and use. This objective will only be achieved if the medical and nursing users and estates staff participate in the introduction of an operational policy designed to minimise the hazards likely to arise from misuse of the system. Other guidance 1.13Guidance on provision of MGPS is given in the Health Building Notes. Basic description of an MGPS 2.1An MPGS comprises a source of supply, pipeline distribution system, terminal units (to which the user connects and disconnects medical equipment) and a warning/alarm system. 2.2Systems are provided for oxygen (O2), nitrous oxide (N2O), nitrous oxide/oxygen (N2O/O2) mixture, medical air (MA4), nitric oxide (NO), oxygen/carbon dioxide (O2/CO2) mixture at 400 kPa for respirable applications and air at 700 kPa (SA7) for surgical tool applications, and medical vacuum at a pressure of 400 mm Hg (53 kPa) below atmospheric pressure. Anaesthetic gas scavenging (AGS) is also provided where nitrous oxide is used for anaesthetic purposes, but not when provided for analgesic purposes. 2.3A schematic diagram of a typical system is shown in Figure 1. 2.4Details of the quality requirements for medical gases are given in Chapter 2 of Design considerations. These requirements are summarised as follows: a.medical gases supplied from cylinder or liquid sources should comply with the appropriate European Pharmacopoeia (Ph Eur) monograph; b.medical air and pressure swing adsorber (PSA) systems should comply with the requirements given in Table 1 of Design considerations. 2.5For oxygen systems the source of supply can be bulk liquid oxygen in a vacuum insulated evaporator (VIE), liquid or gaseous cylinders, or an oxygen concentrator (PSA) system. When cylinder supply systems are used, the source of supply comprises a primary and a secondary bank/group of cylinders which automatically change over to ensure continuity of supply. 2.6An oxygen concentrator (PSA) system may be used to supply an oxygen pipeline system, even though the percentage concentration of oxygen is lower than that derived from liquid or gaseous sources, typically 94% or higher. 2.7Nitric oxide, nitrous oxide, nitrous oxide/oxygen mixture and oxygen/carbon dioxide mixture supply systems are usually supplied from a medical gas manifold system, in two banks. When full, nitrous oxide cylinders contain or hold liquid and gaseous product with a liquid/gaseous boundary and they must be used upright. Nitrous oxide can also be supplied in liquid cylinders or VIEs. Nitrous oxide/oxygen mixture could also be supplied by means of nitrous oxide and oxygen mixing systems, similar to those used for the production of synthetic air. 2.8For medical air systems for respirable use, the source of supply can be either a medical gas manifold system or a medical compressor system, or an oxygen and nitrogen mixing system (referred to as synthetic air). When air powered ventilators are used regularly, the consumption of air is high and cylinder supply systems are not recommended. Throughout this volume, the phrase Design considerations is used as a generic term to describe the Design, installation, validation and verification volume of HTM 2022 5 2.0Functional overview 2.9Emergency/reserve manifold systems are provided for all gases and medical air for respiratory application, except for nitric oxide. 2.10Air or nitrogen for surgical tools is required at 700 kPa. The supply can be provided by either a small automatic manifold system or a small dedicated compressed air system. No reserve supply is required since the surgical air is not used in a life-support role. A free-standing cylinder complete with regulator should be available in the event of system failure. 2.11A non-user adjustable pressure control unit is required to maintain pressure over the range of flows required for different tools. The control unit can be installed at the supply system or locally within the theatre control panel, be mounted separately or be incorporated into theatre multi-purpose fittings. 2.12Medical vacuum is provided by means of a central vacuum plant. The vacuum system should alwa
