All FSMT programs are developed and administered in strict compliance with current laws and regulations using equipment and techniques approved by NIOSH (National Institute of Occupational Safety and Health), OSHA (Occupational Safety and Health Administration), NFPA (National Fire Protection Association), AIHA (American Industrial Hygiene Association, and ASSE (American Society of Sanitary Engineers).
Effective in 2006, FSMT implemented the NFPA 99 2005 edition medical gas verification procedures. These changes include revised medical air dryer standards, instrument air requirements, alarm panel revisions and many other substantive technical changes.
Environmental monitoring is performed using recognized procedures for the collection, transporting and reporting of all samples taken during the verification process. Laboratory analysis is done only at nationally recognized AIHA certified facilities.
Equipment used by FSMT during verification and certification studies are selected based on current industry recognized standards, and is maintained and calibrated in accordance with the respective manufacturer’s recommendations. FSMT field technicians are trained and certified to perform testing procedures by N.I.T.C. and MGPHO.
FS Medical Technology’s Med Gas Safe TM program is an innovative approach to the regular inspection, maintenance and record keeping requirements of NFPA 99 2005 edition. Reports are provided in both paper and digital (CD file) format. On line access is available via the FS Medical Technology web site to preferred customers using a login code and password.
Annual inspections are designed to meet all requirements of JCAHO and AAAHC requirements. Medical facilities may select from a wide range of preventative maintenance, predictive maintenance and additional inspection services addressing important risk management factors. Clients may elect to include a task-oriented inspection approach which allows FSMT technicians to make minor repairs and adjustments as the inspection proceeds.
FS Medical Technology’s Mobile Workstation and Electronic Inspection Tablet Computer
used during annual inspections. The Motion Computing tablet includes drop-down Windows software allowing rapid collection of inspection data. The narrow workstation design allows easy access to patient bedsides.
The Med Gas Safe TM annual inspection includes ASSE Series 6000 Preventative Maintenance Guidelines as referenced in NFPA 99 (2005 edition). The following items are included in our inspection scope of work:
Testing of medical gas outlets/inlets. E3.5 (a)
Checking all outlets – leakage, flow, pressure, damage and wear. Particular attention paid to critical care areas (ICU, CCU, NICU, Surgery, Recovery, ER, etc.).
Bulk liquid systems. E3.5(b) & (c)
Test operation of the reserve and reserve-in-use signal. Test proper level activation switch. Test complete system operation in conjunction with the bulk gas supplier.
Manifold systems. E3.5(d) & (e), E3.3(d)
Test proper function of reserve-in-use switch. Test operation of changeover to secondary supply. Leak check valves, pigtails, regulators. Inspect pigtails for physical damage.
Pressure gauges. E3.5(f)
Test accuracy and function of all pressure gauges.
Air compressor. E3.5(g) & E3.3(a)(b)
Conduct performance tests, check intake filters. Function test automatic alternating controls, correct operation of pressure switch. Check for frequency of pump starts and duration of runs and cut in/out. Check hour meters for required maintenance schedule in accordance with manufacturer instructions. Test audible and visual signals.
Dew point and CO monitor. E3.5(h)
Calibrate and test operation. Test audible and visual signals.
Moisture removal systems. E3.1(f)
Check for proper operation of aftercooler, dryer drains, receiver drains, sight gauges, etc.
Vacuum system. E3.3(b)
Conduct performance tests. Function test automatic alternating controls, correct operation
of vacuum switch. Check for frequency of pump starts and duration of runs and cut in/out. Check hour meters for required maintenance schedule in accordance with manufacturer instructions. Test audible and visual signals.
Area and master alarms. E3.2
Activate all audible and visual test buttons, check panel gauges/pressure readouts and compare to line pressures.
Shut-off valves. E3.5
External leakage test. Operation test.
Gas contamination. E2.2
Test for contamination due to debris or accumulated foreign matter (e.g., scale, hydrocarbons, moisture, or particulate matter.
Labeling. E6
Inspection for proper gas label, correct directional flow, proper color code, room (areas) controlled and warning signage.
Benchmark data report.
Both paper and digital report covering all aspects of medical gas inspection results, including complete inventory, performance documentation, comparison of hospital to benchmark for area, analysis, photos and executive summary.
Ethylene Oxide (ETO) gas is widely used as a sterilant by healthcare centers and medical device manufacturers. It is the sterlization method of choice for heat and moisture liable instruments and devices. Care must be taken, however, to maintain monitoring, engineering and work practice controls to provide a safe work environment. The International Agency for Research on Cancer has identified ethylene oxide as an animal carcinogen and probable human carcinogen. ETO is a flammable, potentially explosive gas with a human odor detection threshold that does not provide sufficient warning of hazardous concentrations.
OSHA requires regular monitoring to establish employees are not over-exposed to airborne concentrations of ethylene oxide gas. Documentation of employee exposure monitoring must be maintained by the facility and employees must be informed of study results.
NIOSH regards formaldehyde as a potential occupational carcinogen. Formaldehyde is used for cold sterilization of some instruments, but it is not used as a general disinfectant because it is very caustic. Formaldehyde may be encountered in the laboratory or morgue as a tissue preservative, in central supply as a sterilant, and in the dialysis unit as a sterilant.
Low ambient concentrations of formaldehyde ).1 to 5 ppm, may cause burning and tearing of the eyes and irritation of the upper respiratory tract. Higher concentrations, 10 to 20 ppm, may cause coughing, chest tightness, increased heart rate, and a sensation of pressure in the head. Exposures of 50 to 100 ppm may cause pulmonary edema, pneumonitis, and death. NIOSH recommends that engineering controls and stringent work practices be used to reduce occupational exposure to the lowest feasible limit.
Federal regulation requires, at least, initial monitoring; and repeat monitoring when changes are made in … employees, equipment, environmental conditions, etc. It is strongly recommended that policies and procedures be established for employee monitoring.
OSHA requires that facilities monitor work areas to establish that employees are not over-exposed to airborne concentrations of formaldehyde. Validation data must be kept on file documenting the monitoring method used.
Glutaraldehyde is a powerful biocidal agent having the advantage of continued activity in the presence of organic material. It displays a broad spectrum of activity and rapid kill rate against the majority of microorganisms.
NIOSH recommends that employees should avoid breathing glutaraldehyde vapor and only use the agent with adequate ventilation – preferably under a fume hood. Glutaraldehyde may also be absorbed into the body via skin contact and ingestion. Protective clothing should be worn including splash goggles and/or face shield and gloves.
A 1994 study showed an increase in skin rashes, eye irritations, headaches, shortness of breath, chest pain/discomfort, cough and fatigue due to glutaraldehyde exposure. Tests have shown that workers can be subjected to high glutaraldehyde exposure levels during the process of pouring waste glutaraldehyde.
OSHA recommends diagnostic on-site monitoring and air quality/balance analysis to aid in safety and compliance. Further, OSHA recommends that monitoring programs be performed on a regular basis to assure a safe work place environment for workers.
Methylene chloride is a solvent which is colorless and volatile with a penetrating ether-like odor. Workers should avoid breathing its vapor and use adequate ventilation. Prolonged skin contact may cause chemical burns. There is no antidote for methylene chloride, with the only known treatment being supportive. Methylene chloride can cause acute central nervous system and respiratory depression, with resultant cardiac dysrhythmias. The EPA has determined that methylene chloride is a probable carcinogen to humans.
Federal regulations require, at least, initial monitoring; and repeat monitoring when changes are made in … employees, equipment, environmental conditions, etc.
Solvents are used in medical laboratories, some housekeeping applications and certain maintenance functions. These chemicals are an eye, skin and respiratory-tract irritant. Symptoms of central nervous system toxicity are apparent immediately after inhalation of high concentrations. Inhalation of massive does of solvents can cause cardiac abnormalities.
Short term exposure can cause difficulty in breathing, impaired function of the lungs, delayed response to a visual stimulus, impaired memory, stomach discomfort and possible changes in the liver and kidneys. Severe effects from high concentrations of solvents include tremors, respiratory depression, confusion, loss of consciousness, coma and death.
Repeated solvent exposure is a major concern. OSHA requires that monitoring be performed to establish that employees are not over exposed to airborne concentrations of xylene, toluene and benzene.
Isopropanol is a colorless liquid with the odor of rubbing alcohol. It is an irritant of the eyes and mucous membranes. At high doses it causes central nervous system depression. When workers are exposed to 400 ppm for 3 to 5 minutes mild irritation of the eyes, nose and throat are notices. At 800 ppm workers consider the atmosphere uncomfortable. Renal insufficiency, including anuria and edema may be complications of isopropanol poisoning by ingestion.
Nitrous oxide is used as an anesthetic agent in medical, dental and veterinary operatories. The gas is also used as an oxidant for organic compounds and is a component of certain rocket fuels. NIOSH has issued a wide range of warnings to the hundreds of thousands of medical, dental and veterinary professionals who work with nitrous oxide. The Institute warns that even with preventative measures such as scavenging systems in place these workers may be at risk for serious health effects due to their exposure.
Studies of workers have shown that occupational exposure to nitrous oxide causes adverse effects such as reduced fertility, spontaneous abortions, and neurologic, renal and liver disease. NIOSH has concluded that exposure to nitrous oxide causes decreases in mental performance, audiovisual ability, and manual dexterity.
Workers and employers should take the following steps to reduce nitrous oxide exposure in the workplace. Anesthetic equipment should be monitored when installed and every 3 months thereafter. This testing should include leak test of the equipment, monitoring air in the worker’s personal breathing zone, and monitoring the environment (room air). Tests should inspect connections and identify loose joints, replace defective or worn seals, gaskets, breathing bags, and hoses.
Anesthetic agents pose both fire and medical risks to employees. Since anesthetic agents are not metabolized with in the body, these chemicals have been found in the exhaled breath of both patients and operating room staff for periods ranging from hours to several days after administration of the anesthetic.
Inhalation of excessive amounts of anesthetic agents can cause drowsiness, irritability, depression, headache, fatigue and problems of judgment and coordination. Epidemiological studies have found increased incidences of embryo toxicity, liver and kidney disease, and cancer among groups of female personnel working in the operating room.
NFPA studies indicate that anesthetic agents are nonflammable under almost all conditions encountered in clinical anesthesia. High concentrations of nitrous oxide increase the range of flammability.
Room Exchange Rate
Air distribution for hospital operating rooms is much more critical and specialized than for a typical air conditioned office building space. In the hospital operating room, the control of airborne contaminants is a consideration in addition to the room comfort conditions.
FSMT operating room exchange rate studies measure the amount of fresh ventilation via supply air compared to return air. Laboratory and cleaning room exchange rate studies also make this comparison with a negative rather than positive pressure delta. Study results assist facility staff in assuring that the differential between return and supply air volumes is not too great as this could impede the dilution of contaminated air.
Some healthcare facilities do not have the in-house personnel to provide manufacturer recommended preventative maintenance services for medical gas and vacuum systems. FSMT provides these services to ensure safe and proper operation of medical gas systems is clearly included in a facility’s routine inspections. Our preventative maintenance activities are carefully documented and fully explained to facility staff.
Preventative maintenance includes lubrication programs, cleaning, proactive replacements, routine inspections and adjustments. FSMT engineers apply these techniques to allow time based potential problems to be corrected before they occur resulting in improved equipment performance.
A major benefit of a comprehensive preventative maintenance is a reduction of energy consumption to its lowest possible level. Well-serviced equipment requires less energy to operate because all bearings, mechanical drives, and shaft alignments receive timely attention. Proper adjustment of shut off switches and lead/lag settings reduce energy drains. Leak prevention reduces compressor and pump run times. Using these techniques reduces kilowatt hour consumption and can reduce energy use between 5 to 35%.
Examples of FSMT preventative maintenance techniques include:
Failure Finding
Certain medical gas equipment can fail without immediate effect. These hidden failures can mask inoperative protective systems such as alarms, pressure relief valves and shut off valves. FSMT technicians provide “detective maintenance” to test these components using techniques including failure simulations, function testing and valve stroking.
In large complex systems and facilities, these hidden failures can be experienced in the course of normal operations without any one knowing such failures had occurred. Backup systems, emergency systems, and infrequently used equipment constitute the major source of potential hidden failures. Thus it is beneficial to exercise a prescheduled option to check and see if all is in proper working order – such an option is known as “failure finding.
Predictive maintenance allows failures to be forecast through analysis of the equipment’s condition. In 2006 FS Medical Technology added an innovative set of trending parameters supporting such studies. These techniques include vibration, temperature and flow. Because electronic and pneumatic equipment failures tend to be random in nature, preventative maintenance techniques fail to catch these non-time based conditions.
Using predictive maintenance techniques, condition assessments are available to reduce unscheduled downtime, improve reliability, reduce costs and reduce overall risk associated with medical gas systems.
The Med Gas Safe TM predictive maintenance inspections include:
Vibration analysis
Using component status collector/vibration analyzer technology, pumps and electric motors are tested for all forms of machine vibrations, mounting, bearing conditions, run-up and coast–down measurements.
Spectrographic oil analysis
Samples are taken from live or turbulent fluid zones within medical/surgical oil sealed vacuum systems (typically return or drain lines, upstream of filters) to check for contamination and wear debris present. Filter performance is assessed. Consistent and representative sampling is the key to receiving quality oil analysis results and recommendations.
Infrared scanning analysis
Inspections are made of electrical and mechanical components with microbolometer infrared digital camera. Mechanical surveys include such systems as motors, pumps and other types of rotating equipment for heat, alignment and cooling problems. Electrical surveys inspect for a wide range of problems including loose connections, corroded elements, load imbalance, short circuits and other potentially dangerous faults that typically create heat. Abnormal heating associated with high resistance or excessive current flow is a primary indicator of many problems in electrical circuits. Thermal imaging enables customers to see the invisible thermal radiation that may portend impending damage before the condition becomes critical.
Pattern recognition via trend studies
Reporting down to the department level allows time period to time period comparisons for equipment repairs. Analysis provides information projecting functional failure of medical gas pipeline and source equipment. Detection of potential failure is identified. Reports highlight departments requiring staff training, equipment replacement and potential failures.
Ultrasound studies
Ultrasonic inspection is a versatile technology for maintenance and protection of vital mechanical assets. Compressed gas leaks are the most expensive waste in medical gas usage. Ultrasound testing identifies the turbulent rushing sound of leaking using headphones which allow pinpointing of all pressurized gas and vacuum leaks while eliminating ambient background noise. Ultrasound allows monitoring of bearing condition, lubrication levels, proper valve operation and tightness integrity.
Included in each Med Gas Safe TM report is a quotation summarizing required repairs. Facility engineers use this information to determine which repairs may be done by in-house staff and those items which require outside support. FSMT technicians are factory trained to troubleshoot and repair mechanical, pneumatic, electrical and electronic components on complex equipment such as vacuum pumps, air compressors, source gas manifolds and alarm systems. In addition, our staff can perform complete system shutdowns and backfeeds.
All current medical gas equipment lines including: Allied Chemetron, Amico, Western, Squire-Cogswell can be serviced by FSMT technicians. Parts may be available for earlier items including Ohio, NGC, Ohmeda and Medaes.
Alarm panel installation and conversion services are available to upgrade and convert area and master alarm installations. Since many manufacturers have discontinued their older alarms, spare parts to fix these aging systems are a rare commodity. By retro-fitting, a facility can replace the existing alarm often without cutting the pipeline and breaking into the existing wall. FSMT technicians are veterans of alarm panel conversion projects and can coordinate electrical and plumbing work if required.
FSMT senior installation project managers are available to meet with facility staff and determine scope of project. We are also able to work with qualified mechanical engineers experienced in medical gas design. FSMT can arrange for permits and general contractor services. Our field supervision of medical gas installations by contractors aids in assuring NFPA requirement compliance.
Emergency call out services are available for rush requirements. Senior technicians can handle pipeline breaches, source and bulk failures, outlet repairs and a wide range of time critical testing services.
Medical gas pipelines can become contaminated in a variety of ways. Some common sources of contamination are condensed water from inadequate drying and dirt from poor filtration in the medical compressed air pipeline; dirt, water, and hydrocarbons left in any pipeline from poor construction techniques; and leaking inlet valves or inadequate trapping of suctioned body fluids in vacuum lines.
FSMT is equipped to purge pipelines of particulate materials including tough-to-remove contaminates: hydrocarbons, oxides, molds and bacteria. Baseline and post cleaning laboratory sampling provides confirmation of cleaning effectiveness. Injection cleaning equipment is used to remove vacuum restrictions.
Although pipeline cleaning interrupts the activity of the medical facility, the alternative – replacing the pipeline – can be even more disruptive, as well as expensive.
The location, gas type and flow direction of the various pipelines should be carefully documented relative to walls and floors of the facility. Often, remodeling results in medical gas pipeline changes never updated on master engineering drawings. Fire and safety issues are thus compromised when staff are not clear regarding zone valve and alarm system coverage. FSMT provides CAD documentation of zone boundaries and medical gas control and monitoring functions.
Reporting
It has been said that:
To manage, you must have controls.
To have controls, you must have measurement.
To have measurement, you must have information.
To have information, you must collect data.
Data … information … facts. Whatever term is used, knowledge is required to make good decisions.
FSMT data reports are designed to provide data to our clients to assist in making good maintenance management decisions.
The comprehensive annual medical gas inspection report, Med Gas Safe TM 4.0, is composed of modules which include: equipment inventory, preventative maintenance, discrepancy work order, operations parameters and executive summary. A benchmarking module compares the inspected facility to other like facilities within the FSMT service area.
Verification reports provide a summary of all data required and recommended by NFPA 99 and ASSE 6000 Series guidelines. Each report meets California OSHPD reporting requirements.
All FSMT data is collected using tablet PCs. Reports are formatted in clear, concise tables with associated management analysis. Reports are available on-line via the internet using a FSMT assigned account code and password. Reports are produced timely (usually within 3 weeks of data collection) and are accompanied by repair proposals, if required.
Both OSHA and JCAHO require yearly training programs for those employees involved with piped medical gas systems. FSMT provides a complete in-service training program for medical gas products and waste anesthetic gases. The slide presentation program includes history, current regulation and safe handling procedures. A written test provides employee documentation to comply with OSHA and JCAHO requirements. These programs can be provided for all shifts.