Praxair Healthcare Services
55 Old Ridgebury Road
Danbury, CT 06810
Tel (800) 431-2460
Fax (914) 666-9103
Planning and testing the plan for an oxygen shut-down should be part of a healthcare facility’s program for maintaining the system. The following briefly describes the type and scope of planned shut-downs, and provides useful information for facilities personnel engaged in updating their plans or who contemplate a system shutdown in the near term.
Planned facility shutdowns
Planning a facility shutdown of the oxygen supply system requires careful planning to assure patient safety. The results will go unnoticed by the patient. It sounds simple enough: provide a plan, execute, perform the system modifications and certify the system to confirm the system is compliant for routine operation.
There are many types of shutdowns from small to large scale. The importance of planning is the same for all but the complexity and potential impact changes dramatically relative to the areas potentially affected.
For example, smaller shutdowns may include the securing of a zone valve to provide the installation of some pipeline components. A small shutdown may appear to be the least complex to plan for but this not necessarily the case. A small shutdown can directly impact all of the patients on an affected zone. This type of shutdown requires multiple personnel types including but not limited to nursing, respiratory, facilities, medical gas vendor, certifier, installer and administrative staff. Once the scope of work is defined, it is typically the facility personnel’s responsibility to develop a plan to isolate the section of the system to conduct the work. The facilities personnel will contact administration staff who will contact nursing and respiratory staff to meet and discuss the shutdown plan. A direct impact plan typically requires any patient who needs oxygen to be supplied with an alternate means during the shutdown period. Portable oxygen cylinders need to be provided and administered by the respiratory staff. This switchover from the piped medical gas outlets to the cylinders requires safe placement of the cylinders in the patient room, equipment to regulate the pressure safe for patient use, and the delivery system to the patient. Continuous monitoring of the contents of all of the cylinders is required by the respiratory staff during the shutdown period. An inventory of cylinders must be on hand to replace any depleted cylinders. The quantity of cylinders must be determined by respiratory staff and the vendor to assure that sufficient cylinders are on hand not just for the amount of time determined requisite, but an additional inventory should any unforeseen events occur as well.
Larger shutdowns often include work affecting the source distribution system feeding oxygen to zones within a hospital. The same personnel are necessary to plan for the affected areas but the scope of the shutdown is typically much larger. For example, in a large facility where multiple oxygen risers exist, performing work on one of the risers may include several different potential shutdown plans to safely manage the temporary distribution of oxygen to the patients. A choice is made to either provide portable oxygen to individual patients or back feed independent zones. Back feeding zones may be a viable choice where the impact to patients and the ability to maintain individual patients is not sustainable by facilities staff. Back feeding a patient zone usually includes attaching larger high pressure oxygen cylinders with high flow regulators and relief valves to patient oxygen outlets. The flow capabilities of the type and manufacturer of the outlet affect the performance of the back feeding flow. There are pre-packaged systems currently provided by the manufacturer to back feed directly through the patient side of a zone valve. This method of back feeding a zone is a safer and more controlled method of distributing oxygen for patient use during a shutdown. It does not put cylinders in a patient room and is less burdensome to the staff tasked with replacing the cylinders.
The largest potential oxygen impact occurs when it is necessary to take the primary oxygen system off line for planned maintenance, replacement or repair. Typically, planned maintenance is less than a days work and usually much less than half a days work. There are multiple courses of action that may be taken to provide oxygen during a planned shutdown of the entire system. Some provide direct impact to patients and some provide no impact and are seamless to the pipeline distribution system.
NFPA 99 requires an emergency oxygen supply connection (EOSC) for distributing an alternate oxygen supply source in the event that an unplanned disruption occurs to the primary oxygen system. The EOSC is designed to be properly sized to manage the amount of flow required by the facility. The oxygen vendor typically provides a “Courtesy Port” at the oxygen pad to connect an alternate source of supply as well. Either one of these connection points will facilitate a planned shutdown of the oxygen system.
A system that is capable of managing the demand of the facility is typically provided by the vendor and includes proper planning, coordination and certification to facilitate this need. The system is typically identified by the vendor as a “Portable”. The “Portable” is an NFPA 99 compliant system including an alternating bulk system with the required alarm points to connect to the facility master alarms and is on a tractor trailer. The “Portable” system must be transported “dry” (no liquid oxygen), set up in a secure location large enough to accommodate a tractor trailer, and then filled by an additional tractor trailer designed to transport liquid oxygen. The system must be certified by a credentialed verifier prior to use since the system had to be filled on site. Oxygen vendors do not maintain a large inventory of portables due to the expense, therefore they must be scheduled well in advance of any necessary shutdowns.
An alternate system is provided by the manufacturer that is capable of maintaining facility demands as well. It is designed for high flow applications sustaining maintained flow rates of 3500 ft^3/hr (2.5 million ft^3/month) or less. Most facilities use less than 1000 ft^3/hr (750,000 ft^3/month). The system meets NFPA 99 requirements as a medical gas manifold delivery system and the system is portable. The manifold alternates between two banks of liquid oxygen dewars with a high pressure cylinder bank as a reserve. The system may not need certification since the dewars and cylinders are verified by the vendor prior to shipment. These systems may be owned by the facility and are readily available.
Praxair maintains several of these types of systems varying in flow capacity. As an example, we were recently contacted by a large 1200 bed facility in the northeastern United States which had no record of ever having tested the EOSC. Many personnel identified that the EOSC had been used, but were concerned the event(s) were undocumented. The facility requested our assistance with testing the connection. The duration of the test was to be approximately one hour which would consume less than the contents of one portable dewar. On the day of the test, the system was rolled into place and running within minutes. The impact to the patients and staff was seamless. the cost associated was negligable for the confidence and documentation that they received. The report they received now forms part of the hospital’s emergency preparedness compliance documentation, required in Chapter 12 of NFPA 99 2012.
The manufacturer maintains a system that is for emergency uses as well. The emergency systems are designed for un planned emergencies to be ready and deployed in minutes should the primary oxygen system fail. They are pre certified package systems that require maintaining high pressure gas cylinders on site with relief associated with the delivery of liquid oxygen dewars. The systems are designed and tested to supply 1200 ft^3/hr continuous and 2000 ft^3 intermittently. They are designed as a first response solution to a potentially large scale emergency to be deployed in a moments notice.