MEDICAL GAS SYSTEMS ANTHONY MITTEN – MANAGING DIRECTOR, MIG MEDICAL INSTALLATIONS, UK


Safelyassessingsite-wide oxygen flow for hospitals


MIG Medical Installations managing director Anthony Mitten explains how oxygen flow in hospitals came under pressure during the pandemic and the importance of system resilience and testing to ensure supply at safe levels during times of increased demand.


A regular theme in the global response to COVID-19 has been the concern around the ability of hospitals to maintain the necessary flow rate from oxygen gas pipelines. Older radial systems have consistently struggled to deliver the pressure required by the increased demand over the last 18 months. In the UK, NHS estates guidance for medical gas pipeline systems (HTM 02-01) usually ensures the system can supply at safe levels during times of increased demand. Yet the additional stress placed upon wards by COVID-19 patients has highlighted weaknesses in a number of designs.


As hospitals evolve, departments are


moved and new wards are added. These changes can place additional stress on the medical gas system, where the pipes and mains are now having to deliver flows that they were not designed to handle. Over the course of the pandemic,


healthcare engineering company MIG Medical Installations has conducted more than 20 oxygen flow capacity tests for 12 hospitals throughout the UK. MIG engineers found that many hospital estate teams were facing impediments ranging from system bottlenecks to pipes of insufficient diameter. In some cases, it was clear that the pipeline would struggle to deliver the required flow capacity without significant modification. These issues reinforced the need for hospitals to have a robust testing strategy


in place. Yet confusion around what constituted an effective approach to load testing added to the risk of hospitals failing to deliver the necessary flow at the crucial moment. In the summer of 2020, the NHS


COVID-19 Working Group published guidance that recommended testing a single ward or department only.1


Yet


depending on a hospital’s COVID-19 plan, flow may be directed not just into areas where patients are most in need,


Anthony Mitten


Anthony Mitten is managing director of MIG Medical Installations, based in Manchester, UK. In his role, Anthony has completed more than 600 healthcare engineering projects throughout Europe, Asia and the Middle East over the past ten years. A specialist in healthcare engineering and construction, Anthony and his team have played a key role in the UK’s


response to COVID-19. This ranges from helping to deliver oxygen systems within 14 days, to the supply, installation, testing and commission of medical gas pipelines. His team also specialises in


fitting out wards and operating theatres, modular hospital buildings and containerised solutions including treatment clinics and self-contained manifold and plant pods.


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but to additional wards designated as contingency areas. By testing discrete locations instead of the entire site, it becomes impossible to learn whether this would starve other wards of the oxygen they require. To properly calculate usage, it is necessary to test whether each area can simultaneously meet the required flow rate.


Maintaining patient safety during a site-wide test The NHS guidance describes testing multiple wards or departments as “practicably difficult and potentially hazardous.” This is absolutely correct. As patient safety is the primary, overriding priority, a site-wide test must only be conducted by a team of trained, experienced engineers following a full risk assessment. Each individual ward should be tested


first before conducting the site-wide test, so that the team is already aware of any individual performance issues that they may need to mitigate. The method of test and flow recommendations should also be


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