Two weeks ago, due to a breakdown in the dryers on the medical air compressor, water condensate passed through our piped medical gas system into a ventilator. Just as we were moving hospitals too. Exciting times. Have any other hospitals experienced this and what action did you take to protect your patients and make sure the vents were safe to use in the long term?

We also had a problem with our driers a couple of weeks ago. We replaced all the inlet filters on our Siemens 300 vents due to moisture ingress. We also checked all other areas on that pipeline.

It coincided with a cold snap, so condensation was suspected. Medaes were very quick coming in (a couple of hours). (They replaced the drying crystals.)

Hi Guy's, probably sounds a silly question but did you guys involve a pharmacist for a QC check ?

Ffloyd is right amongst the many jargonesc documents that control the work we all deal with are HTM 2022 and a pharmacy document "whos name i cannot rememember at this point" which stipulate what medical pipeline supplies are given to users and what quality they have to pass.
Any authorised person worth their salt would have had a QC test done on the gas supply after any repair, I assume this is so. Otherwise you could end up in a situation that we had many moons ago when driers failed on MA4 supply. Several months later mixers in vents started to fail at an alarming rate. Id suggest you keep a close eye on your gas analysers and if the vents are using the air as a drive gas eg Erica / Elvira via an EDV get in and check theres no crud got past the line filters.

We didn't involve the pharmacist, Where does it say we should?
The equipment is on a comprehensive agreement with our service supplier. Surely they carry out all relevent tests??

I doubt whether a contractor is able to perform quality tests that would normally be carried out by a Quality Pharmacists. One of the things that they check is gas purity, I very much doubt if a visiting engineer would even have the instruments to perform such a test. Making sure the air is dry is one thing, ensuring that it contains nothing else is another (which is what the Pharmacist primarily checks for). John I suggest you speak to your Pharmacy department. The document HTM 2022 referred earlier should be available in your Esatates dept, a quick search on HTM 2022 mentions QC checks by Quality Pharmacists.

Sorry forgot to mention, when I worked for another Trust a few years ago we also had problems with water in our medical air piped supply. Estates, Pharmacy and infection control all worked together to ensure the the problem was rectified. Even though the compressor got fixed relatively quickly it was weeks before the supply was restored. Infection Control and Pharmacy insisted that all the pipes were throughly dried as the moisture represented an infection risk, once they were convinced it was dry purity checks were performed. Some areas I believe failed which meant that some sections of piping had to be flushed through and retested, this was repeated until pharmacy and infection control was happy. The whole saga lasted about a month with some very unhappy ward staff and porters (the poor chaps had to lug G sized cylinders all over the place), although I believe BOC and mobile compressor suppliers benefited quite well out of it. Therefore completing repairs to the piped gas system is only the tip of the iceberg, QC checks should not ne ignored as it can uncover infection issues.

John, I am somewhat confused here, who is your hospital “Authorized Person” [AP], I attended the “Competent Persons” course in Eastwood Park, this is a internationally recognized standard, even out here in the gulf, and my manual stipulates that any “OPEN WORK” done on “Any” medical gas pipeline system must have a QC on completion of the work and before use. Obviously under AP supervision. John, you can call eastwood park for more details,

Regards

Ffloyd

Sorry chaps, you can go on as many courses as you like.
The facts are that the type of work mentioned should be under the supervision of an AP that is working with the interesrs of the trust in mind.
Once again I would say any AP worth their salt would be aware of exactly what they need to do and would cover their backs if nothing else, certainly the ones ive come into contact with would hit the roof if they new people where messing about with MGPS without permits etc.

Hi Karl

I agree that any work to the medical gas piped system should be only be undertaken under a permit to work. The point being debated is the QC after the necessary repair work has been performed. An authorised person generally hasn't got the skill or the knowledge to perform purity checks hence why they are performed by quality pharmacists in conjunction with people like AP's.

Tone,
I will speak to our estates manager when I get back on Monday to find out whether any further pharmacy inspections were carried out. (I am assuming everything was done in accordance with HTM2020.)

Do you want to put money on that ?

I've spoken to Estates staff who think that air is piped round the hospital just to drive tools ! They seem to think that if it isn't Oxygen, then it isn't given to a patient !

Thanks you all. Our Pharmacist is principally responsible for medical gases and has been involved and is very helpful. We immediately started to run our vents off bottled Air and there was much lugging of G size cylinders. We added an extra HME filter to the inspiratory limb of the patient circuit and Microbiology took samples of the fluid coming through the air lines. (They didn't grow anything). Our AP-authorised person- was around commissioning the new site and was able to offer plenty of advice about the gas system. After the compressor was repaired, they flushed the system for some time to get the humidity down. However, the clinicians are still nervous about what may be left inside the vents and the risk to already compromised ICU patients. The Public Health labs at Colindale have recommended a strip down and we await the manufacturers price with interest. In the meantime we are still running those vents with extra HME filters (a fairly cheap precaution). Of course the Medical Gas system is provided and run by our PFI partner and there may be some contractual argy bargy. I will keep you up to date with the outcome.

You have to replaced filter dryer imeadiately otherwise all ventilator will be defective the pressure sensor its self.
for the anasthesia machine will disturb the flow sensor measurement and alarm will sound everytime or will defect the flow sensor who's using thermal platinum wire such as Drager flow sensor ( spirolog nor spirolife sensor ).

And here we all are ... still waiting, John.