SW Presentation Kroening Medical Gas
SW Presentation Kroening Medical Gas
NFPA 99 –2012
Bob Kroening
Over 25 years designing, inspecting, and verifying plumbing systems
in Healthcare Facilities
President of Medical Gas Systems , Inc., A medical gas system
consulting and verification company.
MGS has been consulting, inspecting, testing, and certifying medical gas systems in the United
States and Canada since 1975
Currently credentialed:
Medical Gas System Installer (ASSE 6010) by National Inspection
Testing Certification Corporation (NITC)
Medical Gas System Inspector (ASSE 6020) by National
Inspection Testing Certification Corporation (NITC)
Medical Gas System Verifier (ASSE 6030) by National Inspection
Testing Certification Corporation (NITC)
Credentialed Medical Gas Verifier (CMGV) by Medical Gas
Professional Healthcare Organization (MGPHO)
Bulk Medical Gas System Verifier (ASSE 6035) by Medical Gas
Professional Healthcare Organization (MGPHO)
Medical Gas System Instructor (ASSE 6050) by National
Inspection Testing Certification Corporation (NITC)
Important Notice and
Disclaimer of Liability Concerning
the Use of These Materials
The information in this presentation should not be
confused with Federal, State, Provincial, or Municipal
codes, standards, or regulations; insurance requirements;
or national safety codes. These materials are to be used
on a voluntary basis and should not be considered
absolute. Medical Gas Systems, Inc. (MGS) disclaims
liability for any personal injury, property, or other damages
of any nature, whatsoever, whether special, indirect,
consequential, or compensatory, directly or indirectly
resulting from the publication, use, or reliance on these
materials. MGS makes no guarantee or warranty as to the
accuracy or completeness of any information contained
in this presentation. This presentation was prepared using
the NFPA 99-2012 code document, and ASSE 6000-2012
Qualification Standard
NFPA DISCLAIMER
Although Mr. Kroening is a member of the NFPA, which is responsible for the
applicable sections of NFPA 99: Health Care Facilities Code, the views and
opinions expressed in this presentation are purely the authors and shall not be
considered an official position of the NFPA or any of its Technical Committees
and shall not be considered, nor be relied upon as, a Formal Interpretation or
promotion of the NFPA.
Readers are encouraged to refer to the entire text of all referenced
documents.
Important Notice Regarding the Terms of Use
of These Materials
Copyright
The information in this presentation is protected by copyright:
Copyright © 2016 Medical Gas Systems, Inc. All Rights Reserved.
Except as specifically permitted herein, no portion of the information in this presentation
may be reproduced in any form or by any means without prior written permission from
Medical Gas Systems, Inc. and Robert Kroening.
All materials presented are copyrighted and the exclusive property of Robert Kroening and
Medical Gas Systems, Inc. This document is not to be copied, reproduced, distributed,
used, or displayed, in whole or in part, without the express written consent of Medical Gas
Systems, Inc. and Robert Kroening. Doing so may result in severe civil and criminal penalties
If you do not agree to these terms below, you are not authorized to use the presentation.
NFPA 99 - 2015
Chapter 5 Gas and Vacuum Systems
Category 1 - Hospital type facilities.
Category 2 - Ambulatory Care, Clinic and
Nursing Home facilities.
Category 3 - Medical, Dental offices and
Limited Care facilities.
Category 4 - Non-Health Care Facilities
NFPA = National Fire Protection Association
NFPA 99 “Health Care Facilities Code”, is updated by
the “NFPA Technical Committee” approximately every
three years. (The latest version, 2015 Edition “Health
Care Facility Code” was just released in October 2014
and is widely viewed as the most comprehensive
medical gas system document with patient safety at its
highest).
NFPA 99 is adopted by states, most commonly through,
the adoption of NFPA 101 Life Safety Code
NFPA 101® Life Safety Code® 2012 Edition (CMS has adopted
NFPA 101 – 2012 and NFPA 99 -2012 effective July 5, 2016)
NFPA 101-2012 Chapter 18 NEW HEALTH CARE OCCUPANCIES
101-18.3.2.4 Medical Gas. Medical gas storage and administration
areas shall be protected in accordance with NFPA 99, Standard for
Health Care Facilities.
Medical Gas Systems
Many specifying engineers will design, and require
that their installations meet the most current version
of NFPA 99 - 2015.
All medical gas equipment manufactures typically
update their equipment to meet the most current
version of NFPA 99 - 2015.
Two medical gas equipment manufacturers (Ohio
Medical and Allied Healthcare – Chemetron) have
not updated their product lines to meet the current
NFPA 99 -2012 requirements (specifically 5.1.9.3.5)
Area alarm panels are required to indicate an error in
the event that a gas specific sensor/transducer is
inadvertently connected to an alarm panel circuit
board for another gas type.
NFPA 99 – 2012 Health Care
Facilities Code
ExistingFacilities directive to adhere to
specific requirements within this code
document NFPA 99 -2012 – 5.1.1.6
NFPA 99 – 2012 – 5.1.1.6 was revised by
NFPA via TIA 12-4 and is a replacement for
the text that was issued with the NFPA 99-
2012 Health Care Facilities Code book
Existing Facilities (Per TIA 12-4)
5.1.1.6 The following subsections of this chapter shall apply to
the operation, management, and maintenance of Category
1 medical gas and vacuum systems in existing facilities:
(1) 5.1.2
(2) 5.1.3.1
(3) 5.1.3.2
(4) 5.1.3.3.1.7
(5) 5.1.3.3.1.8
(6) 5.1.3.3.4
(7) 5.1.3.6.2
(8) 5.1.3.8.5.2
(9) 5.1.14
(10) 5.1.15
Nature of Hazards of Gas
and Vacuum Systems
5.1.2 Nature of Hazards of Gas and
Vacuum Systems. Potential fire and
explosion hazards associated with positive
pressure gas central piping systems and
medical–surgical vacuum systems shall be
considered in the design, installation,
testing, operation, and maintenance of
these systems.
Central Supply System
Identification and Labeling
5.1.3.1 Central Supply System Identification and Labeling.
5.1.3.1.1* Containers, cylinders, and tanks shall be designed,
fabricated, tested, and marked (stamped) in accordance with
regulations of DOT, Transport Canada (TC) Transportation of
Dangerous Goods Regulations, or the ASME Boiler and Pressure
Vessel Code, “Rules for the Construction of Unfired Pressure
Vessels,” Section VIII. [55:7.1.5.1]
5.1.3.1.2 Cylinder contents shall be identified by attached
labels or stencils naming the contents in accordance with CGA
C-7, Guide to the Preparation of Precautionary Labeling and
Marking of Compressed Gas Containers.
5.1.3.1.3 Liquid containers shall have additional product
identification visible from all directions with a minimum of 51
mm (2 in.) high letters such as a 360-degree wraparound tape
for medical liquid containers.
Central Supply System
Identification and Labeling
5.1.3.1.4 Cryogenic liquid containers shall be provided with gas-
specific outlet connections in accordance with CGA V-5,
Diameter-Index Safety System (Non-interchangeable Low
Pressure Connections for Medical Gas Applications), or CGA V-
1, Compressed Gas Association Standard for Compressed Gas
Cylinder Valve Outlet and Inlet Connections.
5.1.3.1.5 Cylinder and cryogenic liquid container outlet
connections shall be affixed in such a manner as to be integral
to the valve(s), un-removable with ordinary tools, or so
designed as to render the attachment point unusable when
removed.
5.1.3.1.6 The contents of cylinders and cryogenic liquid
containers shall be verified prior to use.
5.1.3.1.7 Labels shall not be defaced, altered, or removed, and
connecting fittings shall not be modified.
Central Supply System
Identification and Labeling
5.1.3.1.8 Locations containing positive pressure gases other
than oxygen and medical air shall have their door(s) labeled as
follows:
Positive Pressure Gases
NO Smoking or Open Flame
Room May Have Insufficient Oxygen
Open Door and Allow Room to Ventilate Before Entering
5.1.3.1.9 Locations containing central supply systems or
cylinders containing only oxygen or medical air shall have their
door(s) labeled as follows:
Medical Gases
NO Smoking or Open Flame
Central Supply System
Operations
5.1.3.2 Central Supply System Operations.
5.1.3.2.1 The use of adapters or conversion fittings to adapt one
gas-specific fitting to another shall be prohibited.
5.1.3.2.2 Cylinders and containers shall be handled in strict
accordance with 11.6.2.
5.1.3.2.3 Only gas cylinders, reusable shipping containers, and
their accessories shall be permitted to be stored in rooms
containing central supply systems or gas cylinders.
5.1.3.2.4 No flammable materials, cylinders containing
flammable gases, or containers containing flammable liquids
shall be stored in rooms with gas cylinders.
5.1.3.2.5 If cylinders are wrapped when received, the wrappers
shall be removed prior to storage.
5.1.3.2.6 Cylinders without correct markings or whose markings
and gas-specific fittings do not match shall not be used.
Central Supply System
Operations
5.1.3.2.7 Cryogenic liquid storage units intended to supply gas
to the facility shall not be used to transfill other liquid storage
vessels.
5.1.3.2.8 Care shall be exercised when handling cylinders that
have been exposed to freezing temperatures or containers
that contain cryogenic liquids to prevent injury to the skin.
5.1.3.2.9 Cylinders containing compressed gases and
containers for volatile liquids shall be kept away from radiators,
steam piping, and like sources of heat.
5.1.3.2.10 When cylinder valve protection caps are supplied,
they shall be secured tightly in place unless the cylinder is
connected for use.
5.1.3.2.11 Containers shall not be stored in a tightly closed
space.
Cylinder Storage Location
Temperature Requirements
5.1.3.3.1.7 Cylinders in use and in storage shall be prevented
from reaching temperatures in excess of 54°C (130°F).
(5) 5.1.3.3.1.8 Central supply systems for nitrous oxide and
carbon dioxide using cylinders or portable containers shall be
prevented from reaching temperatures lower than the
recommendations of the central supply system's manufacturer,
but shall never be lower than −29°C (−20°F) or greater than
51.6°C (125°F).
Storage
5.1.3.3.4 Storage.
5.1.3.3.4.1 Full or empty medical gas cylinders, when not
connected, shall be stored in locations complying with 5.1.3.3.2
through 5.1.3.3.3 and shall be permitted to be in the same
rooms or enclosures as their respective central supply systems.
5.1.3.3.4.2 Cylinders, whether full or empty, shall not be stored in
enclosures containing motor-driven machinery, with the
exception of cylinders intended for instrument air reserve
headers complying with 5.1.3.9.5, which shall be permitted to
be placed in the same location containing an instrument air
compressor when it is the only motor-driven machinery located
within the room. Only cylinders intended for instrument air
reserve headers complying with 5.1.3.9.5 shall be permitted to
be stored in enclosures containing instrument air compressors.
Storage
5.1.3.4 Control Equipment. For control equipment, as specified
in 5.1.3.5.5, 5.1.3.5.6, and 5.1.3.5.7, that is physically remote from
the supply system, the control equipment shall be installed
within a secure enclosure to prevent unauthorized access in
accordance with 5.1.3.3.2(2).
5.1.3.4.1 The enclosure shall provide enough space to perform
maintenance and repair.
5.1.3.4.2 The location of the enclosure for control equipment
other than for medical air shall not communicate with
combustible or flammable materials.
Uses of Medical Air
5.1.3.6.2*Uses of Medical Air. Medical air
sources shall be connected to the
medical air distribution system only and
shall be used only for air in the application
of human respiration and calibration of
medical devices for respiratory
application.
WAGD Producers
5.1.3.8.5.2 Automatic or manual
alternation of producers shall allow
division of operating time. If automatic
alternation of producers is not provided,
the facility staff shall arrange a schedule
for manual alternation.
Category 1 Operation and
Management
5.1.14.1 Special Precautions — Patient Gas, Vacuum, WAGD,
and Medical Support Gas Systems.
5.1.14.1.1* Piping systems shall not be used for the distribution of
flammable anesthetic gases.
5.1.14.1.2 Piping systems shall not be used as a grounding
electrode.
5.1.14.1.3* Liquid or debris shall not be introduced into the
medical–surgical vacuum or WAGD systems for disposal.
5.1.14.1.4* The medical–surgical vacuum and WAGD systems
shall not be used for nonmedical applications (e.g., vacuum
steam condensate return).
Category 1 Operation and
Management
5.1.14.2 Maintenance of Medical Gas, Vacuum, WAGD, and
Medical Support Gas Systems.
5.1.14.2.1* General. Health care facilities with installed medical
gas, vacuum, WAGD, or medical support gas systems, or
combinations thereof, shall develop and document periodic
maintenance programs for these systems and their
subcomponents as appropriate to the equipment installed.
Category 1 Operation and
Management
5.1.14.2.2 Maintenance Programs.
5.1.14.2.2.1 Inventories. Inventories of medical gas, vacuum,
WAGD, and medical support gas systems shall include at least
all source subsystems, control valves, alarms, manufactured
assemblies containing patient gases, and outlets.
Category 1 Operation and
Management
5.1.14.2.2 Maintenance Programs.
5.1.14.2.2.2* Inspection Schedules. Scheduled inspections for
equipment and procedures shall be established through the
risk assessment of the facility and developed with consideration
of the original equipment manufacturer recommendations and
other recommendations as required by the authority having
jurisdiction.
Category 1 Operation and
Management
5.1.14.2.2.3 Inspection Procedures. The facility shall be
permitted to use any inspection procedure(s) or testing
methods established through its own risk assessment.
The facility shall be permitted to use any inspec0on procedure(s) or tes0ng methods
established
through its own risk assessment.
5.1.14.2.2.3 – Maintenance Programs: Inspection Procedures
Ex: Vacuum Pump Inspection
• Document Inlet Performance Criteria (Flow, Labeling, Latch, Leaks, etc.)
• Document Area Alarm Settings
• Document Master Alarm Settings
• Etc.
Category 1 Operation and
Management
5.1.14.2.2.4 Maintenance Schedules. Scheduled maintenance
for equipment and procedures shall be established through the
risk assessment of the facility and developed with consideration
of the original equipment manufacturer recommendations and
other recommendations as required by the authority having
jurisdiction.
Scheduled maintenance for equipment and procedures shall be established through
the risk
assessment of the facility and developed with consideration of the original equipment
manufacturer recommendations and other recommendations as required by the
authority having
jurisdiction.
5.1.14.2.2.4 – Maintenance Programs: Maintenance Schedules
Ex: Vacuum Pump Maintenance
• Check Hours
• Check Amps
• Check Volts
• Check Vane Wear/Oil
• Check Filters
• Check Lead/Lag Settings
Category 1 Operation and
Management
5.1.14.2.2.5 Qualifications. Persons maintaining these systems
shall be qualified to perform these operations. Appropriate
qualification shall be demonstrated by any of the following:
(1) Training and certification through the health care facility by
which such persons are employed to work with specific
equipment as installed in that facility
(2) Credentialing to the requirements of ASSE 6040, Professional
Qualification Standard for Medical Gas Maintenance
Personnel
(3) Credentialing to the requirements of ASSE 6030, Professional
Qualification Standard for Medical Gas Systems Verifiers
Category 1 Operation and
Management
5.1.14.2.3 Inspection and Testing Operations.
5.1.14.2.3.1 General. The elements in 5.1.14.2.2.2 through 5.1.15
shall be inspected or tested as part of the maintenance
program as follows:
(1)*Medical air source, as follows:
(a) Room temperature
(b) Shaft seal condition
(c) Filter condition
(d) Presence of hydrocarbons
(e) Room ventilation
(f) Water quality, if so equipped
(g) Intake location
(h) Carbon monoxide monitor calibration
(i) Air purity
(j) Dew point
Category 1 Operation and
Management
A.5.1.14.2.3.1(1) Additional inspections for medical air sources include the following:
(1) Air-coolers (condition, opera0on of automatic drains)
(2) Operating pressures (cut-in, cut-out, and control pressures)
(3) Electrical opera0tin
(4) Receiver elements (auto drain, manual drain, sight glass, pressure gauge)
(5) Pressure regulators (condition)
(6) Dryer (operation, outlet dew point, condi0on, housekeeping)
(7) Dew point calibration
(8) Housekeeping around compressors
Category 1 Operation and
Management
(2)*Medical vacuum source — exhaust location
A.5.1.14.2.3.1(2) Additional inspections for medical vacuum sources and WAGD sources
include the following:
The elements in 5.1.14.2.2.2 through 5.1.15 shall be inspected or tested as part of the
maintenance program as follows:
(1) Operating vacuum (cut-in, cut-out, and control pressures)
(2) Electrical operation
(3) Receiver elements (manual drain, sight glass, vacuum gauge)
(4) Housekeeping around pump
(3) WAGD source — exhaust location
(4)*Instrument air source — filter condition
Category 1 Operation and
Management
Category 1 Operation and
Management
(5)*Manifold sources (including systems complying with
5.1.3.5.10, 5.1.3.5.11, 5.1.3.5.12, and 5.1.3.5.13), as follows:
(a) Ventilation
(b) Enclosure labeling
A.5.1.14.2.3.1(5) Addi0onal inspec0ons for manifold sources include the following:
(1) Cylinder leads (condition)
(2) Cascade (switching from one header to another)
(3) Source valve (labeling)
(4) Relief valves (discharge location and condition)
(5) Leaks
(6) Security (door or gate locks and signage)
(7) Housekeeping around manifolds
Facility
systems in which failure of such
equipment is likely to cause minor injury to
patients or caregivers shall be designed to
meet system Category 2 requirements as
defined in the code.
Category 2: Systems are expected to provide a high level of reliability; however,
limited short durations of equipment downtime can be tolerated without
significant impact on patient care. Category 2 systems support patient needs
but are not critical for life support.
Category 3 Systems(Dental)
Facility
systems in which failure of such
equipment is not likely to cause injury to patient
or caregivers, but can cause patient discomfort,
shall be designed to meet system Category 3
requirements as defined in the code.
Category 3: Normal building system reliabilities are expected.
Such systems support patient needs, but failure of such
equipment would not immediately affect patient care. Such
equipment is not critical for life support.
Category 4 Systems (Non-
Patient Care)
Facility
systems in which failure of such
equipment would have no impact on
patient care shall be designed to meet
system Category 4 requirements as
defined in the code.
Medical Gases
Standard designation colors and operating pressures for
Category 1 Gas and Vacuum Systems
GAS Abbreviation Colors (background/Text) Pressures
Medical Air MA Yellow/black 50-55 psig
BOC underlined that it is conducting a full internal inquiry and has appointed a
dedicated investigation team to clearly identify the root cause of the issue. The
company also stated that it will work with the Ministry of Health throughout the
investigations.
South Western Sydney Local Health District is also conducting a formal investigation
to determine if staff at Bankstown-Lidcombe Hospital followed protocols which
could have detected the installation error last year.
Cross Connection causes severe injury:
On March 30, High School student went to the dental office to have his wisdom teeth removed. After being
sedated with medical gas, complications occurred. The student was taken to a Hospital after he stopped
breathing, and later was taken to a University Hospital.
Building inspection leaders confirmed that they have no record of whether a required third-party inspection
of the medical gas system was ever conducted at the dental surgery center. The International Plumbing Code
adopted by the city requires a certified inspector — often a privately owned inspection company — to test the
medical gas system.
But the city’s director of planning and development services said he believes the law does not require the city
to ensure that the test actually has been done.
Instead, that responsibility is left solely in the hands of private builders and contractors.
“Events like this highlight the importance of contractors knowing and understanding the code and fulfilling
its own requirements,” said the city’s director of planning and development services.
An attorney for the company that installed the system — said he did not know whether a third-party
inspection had been done on the medical gas system. A representative for the general contractor —declined to
comment.
The dentist did not receive a certificate of inspection from the contractors, and was unaware that he was
supposed to receive a certificate showing the system had been tested.
Cross Connection Found in
Operating Room
Oxygen Tank installation
mishap
Medical Air System found
with 95psi system pressure
Zone Valve located behind
door
Oxygen
Tank on its
side
Questions?