costs of the medical gas systems and prevent natural resources from being needlessly consumed. A new 400-bed NSH project designed

by Mazzetti has approximately 72 medical gas zone valve boxes with 322 valves in them. If NFPA required these only on oxidising gases, 210 of these valves in ZVBs could be replaced with simple service valves in the ceiling, eliminating approximately 6,300 linear feet of copper pipe, 1,260 elbows, and 2,520 brazed joints. All of this piping and fittings could have been high grade copper-cleaned and capped for oxygen service and shipped from a factory on the east coast. Many facility engineers agree that the non- oxidising gases would be acceptable with only service valves in the ceiling and an access panel. Another benefit is reducing the number of valves to be switched off in the event of a fire. Important items to consider as it

relates to reducing the medical gas piping scope: l Each brazed joint represents time, cost, smoke, waste material, fire risk.

l Visual pressure gauges installed in ZVBs would be reduced.

l As it relates to the facility above, 210 ceiling panels would have to be installed. The cost of these new ceiling panels is nearly offset by the size and cost of the ZVBs.

A major plumbing contractor working in California estimated the average cost of installing medical gas piping is around $56 per linear foot for average sized, brazed, medical gas grade copper piping and joints. If that number was applied to the 6,300 linear feet of piping in the NSH facility, this would result in a savings of over $350,000, not to mention the major reduction of natural resources consumed, and carbon footprint associated with those resources.

Disposal system strategies The most commonly used inhaled anesthetic agents during surgery are halogenated ethers. These substances are supplied as a liquid, which is then vaporised by the anesthesia machine into a gaseous state prior to its delivery to the patient. The three most commonly used inhaled anesthetics are isoflurane, sevoflurane, and desflurane. These inhalant anesthetics undergo an insignificant amount of metabolic change in the body; the gases exhaled by the patient are almost identical to those administered by the anesthetist. (100% of these gases are eventually exhaled by the patient to the atmosphere.) Because of their chlorofluorocarbon

based structures, these anesthetics are dangerous for the ozone layer, and, more significantly, are highly potent greenhouse gases. Most of the organic anesthetic


Medical gas systems have been seen as highly regulated and too intimately involved in patient care to be tampered with in the name of environmental sustainability. But this impression is wrong

gases remain in the atmosphere for an extended amount of time, creating potential to act as greenhouse gases.2 Moreover, the gases themselves consume great amounts of energy, and their production creates waste streams of their own. No good data is currently available from any anesthetic manufacturer regarding the environmental footprint of their products. The primary downstream opportunity

for sustainable medical gasses is to recover and reuse them. Doing so prevents their escape into the atmosphere and prevents the need for their expensive, environmentally destructive manufacture. Two effective recovery systems on the market include Blue-Zone’s Centralsorb Anesthetic Recovery System and Anesthetic Gas Reclamation (AGR), both systems enable recovery of waste anesthetic gases from a central location in a hospital. These captured anesthetics are

subsequently extracted, liquefied and used as raw material in the production of new, validated generic anesthetics at Blue- Zone’s facility. This ability to reprocess the recovered halogenated anesthetics offers additional economic and security of supply benefits for hospitals that use Blue-Zone’s patented technology. AGR, founded by anesthesiologist

Dr James Berry, has developed a special scavenging interface for anesthesia machines called the DGSS (Dynamic Gas Scavenging System), reducing the energy consumption used by hospital waste anesthetic gas disposal systems, up to 90%. Mazzetti has partnered with AGR to

develop and refine these technologies for future widespread use by hospitals. As part of this partnership, Mazzetti will

facilitate coordination and installation of DGSS valves, provide engineering design support for the complete AGR reclamation system (which includes DGSS valves and gas capture), and perform demonstration projects and pilot installations of the complete AGR system. This new technology developed by

AGR can provide a big benefit to a hospital’s bottom line, to patients and staff, and to the wider community. A recent case study performed at

Baptist DeSoto Surgery Center in Southhaven, Mississippi in three operating rooms demonstrated a 65% savings in energy consumption for a universal medical vacuum system. In comparison, it was shown that if the DGSS was applied to a dedicated WAGD (Waste Anesthetic Gas Disposal) system, the savings would have been closer to 90%. Important to note, any facility that

utilises anesthetic gas recovery must be responsible and place an effective maintenance programme that routinely audits all anesthesia equipment, including the medical gas scavenging system. The savings that accumulate almost immediately pay for cost of the recovery systems.

Conclusion Healthcare, both in low-resource areas, and in high-resource areas, can no longer afford a culture of waste. Traditional green building strategies have not adequately addressed medical gas systems. This paper suggests a number of strategies – many unconventional – to start eliminating waste from these systems and to make them, more clinically and environmentally appropriate. This paper is intended to prompt conversation to advance these ideas and others, so that we can (better) take care of our patients and our planet.

References 1 Baumert JH, Hein M, Hecker KE, Satlow S, Neef P, Rossaint R. Xenon or propofol anaesthesia for patients at cardiovascular risk in non-cardiac surgery. Br J Anaesth 2008; 100 (5): 605–11.

Oxygen concentrator.

2 Brown AC, Canosa-Mas CE, Parr AD, Pierce JM, Wayne RP. Tropospheric lifetimes of halogenated anaesthetics. Nature 1989; 341 (6243): 635–7. [Available from: tract/82/1/66] (PubMed: 2797189).



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