MEDICAL GAS SYSTEMS
Is a review of MGPS guidance now overdue?
Dr Scott Brown CEng CSci, managing director and lead consultant at Health Tech Solutions, considers whether the existing HTM guidance on medical gas pipeline systems is due for review in the light of advances in medical equipment technology, changes in clinical practice, and ‘what we have learnt from dealing with the pandemic’.
Medical gases in the frontline – and in particular oxygen – were once only really considered by healthcare professionals working in a hospital environment, and, even then, only in noting their continued availability when required for treatment or therapy. The worldwide pandemic as a result of the SARS-CoV-2 (COVID-19) virus has seen a sea change, with medical gases promoted to a prominent position at the forefront of both the public’s minds and the popular press – but only because there were grave concerns that they would run out and lead to potentially fatal consequences. Unfortunately, this was the case in Zefta General Hospital, in Gharbiya governorate, north-east of Cairo, where in their ICU the supply of oxygen had literally run out, leading to deaths.1
Similar
and more recently in India. Other countries such as Africa are known to have poor infrastructure for their medical gases. However, the majority of people, including healthcare professionals, are blissfully unaware of the machinery to control and generate medical gases. let alone the design of the medical gas pipeline system to distribute it to the clinical settings. This is not meant as a criticism, but, because of the robust design of the system, and regular scheduled maintenance of the associated plant, its continuity of supply throughout the hospital is taken for granted.
reports of severe shortage of oxygen were also reported from the Manaus city in Brazil,2
The guidance
The first national guidance on the design, installation, and commissioning of medical gases was published in 1972 by the Department of Health and Social Security (DHSS), and was named Health Technical Memorandum (HTM) 22, while the current HTM 02-01 was published in 2006, some 15 years ago. Perhaps the question needs to be asked that with advances in medical equipment technology, changes in clinical practice, and what we have learnt from dealing with the pandemic, is the guidance still valid, or would it in fact benefit from a review?
Figure 1: A piston-driven anaesthetic ventilator.
The operating theatre environment – moving to low or minimal flow techniques
Oxygen requirements The design flows of oxygen (O2
) for the
operating theatre are generous, and are based on the anaesthetic techniques at the time of publication of HTM 02-01.3 That guidance was informed by the technology employed in the anaesthetic workstations that were available on the market at the time, and the flow rates adopted clinically.
Technological advances with
anaesthetic workstations have seen many manufacturers move away from using the
gas-driven bellows for ventilation, and instead incorporating electrically-driven piston assemblies (Fig 1).
We have also seen as a result of the pandemic guidance issued by the Institute of Physics and Engineering in Medicine4 on how to convert those ventilator bellows that were deigned to be driven from oxygen to be now driven from medical air. As elective surgery was stood down, we saw, nationally, anaesthetic workstations being transported and redeployed in Critical Care Units to supplement the shortage of patient ventilators. It is unlikely as we start the roadmap to recovery from the pandemic
January 2022 Health Estate Journal 59
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