Session IX: Medical Oxygen Handling And Safety REACHING

Session IX: Medical Oxygen Handling And Safety REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Session: Prevention of Fires in Oxygen System, and Hospital Fire Safety REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Introduction - Hospital Fires Do not smoke close to oxygen sources! Fire triangle - the 3 ingredients of fire Main causes of hospital fires CAUTION! Oxygen supports combustion. The addition of concentrated oxygen to a fire increases its intensity greatly and can even support the combustion of materials which normally do not burn. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Introduction - Civilian Injuries And Property Damage In Hospital Fires Data from the US healthcare facilities Leading cause of fire- Cooking equipment Most civilian injuries- Fires from cooking equipment and intentional fires Highest property damage- Fires from electrical equipment REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Introduction - Some of The Worst Hospital Fire Accidents In India Date Place Casualties Description Dec 2011 AMRI Hospital, Kolkata 95 killed Main cause of this mishap was an Electrical Short Circuit and stocking of Combustible Substances in the basement. This was a case of negligence by the management of the hospital. During the Incident, the hospital had around 160 patients and also many staff members. At least 50 patients were there in the intensive ward. Oct 2016 IMS & SUM Hospital, Bhubaneshw ar 22 killed & 120 injured In this case, the hospital staff tried to douse the fire with fire extinguishers and in the process, they lost almost 20 crucial minutes before they called the Fire Department. This shows the lack of preparedness of the hospital staff during emergencies. Oct 2017 Rohini Super 2 killed & 4 Specialty injured Hospital Hanamkonda An electrical short-circuit triggered the fire. 199 patients were admitted to this hospital at the time of the accident. The hospital’s Fire Safety system did not work during this crucial time. Everyone including the doctors and hospital staff were in a state of panic and did not know how to respond. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Oxygen as a Fire Risk

Oxygen As A Fire Risk Oxygen is classified as an ‘oxidizing agent’, reacting with most elements The Fire Triangle Oxygen is highly supportive of combustion (the reaction with oxygen to release heat and light/flame/glow) Oxygen enrichment oxygen content greater than in air Oxygen concentrations higher than 23.5% create greater fire hazards than normal air Image: High Speed Training, 2016 REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Causes Of Fires And Explosions Oxygen enrichment of atmosphere Incorrect design of oxygen systems Leaks from damaged hoses, pipes, and valves Leaks from poor connections Poor ventilation, where oxygen is being used Use of incompatible materials with oxygen Careless operation, misuse and storage of oxygen equipment Oxygen-enriched air in combination with a fuel source and heat source can cause a fire! Oxygen-enriched air increases the risk of fire REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Prevention of Fires in Oxygen Systems

Prevention Of Fires In Oxygen System Information/ Training: Personnel using oxygen equipment or works in the area where oxygen enrichment occur should be informed of the hazards, properties, risks of oxygen and immediate consequences. All maintenance and repair work should be performed by trained personnel only. Design: Equipment that has been specifically designed for oxygen shall be used only. While designing the equipment intended to use for oxygen service, configuration and use of material should be taken into consideration in order to minimize any risk of ignition. Oxygen equipment should only be lubricated with lubricant specific to the application and service. Oxygen system should be designed so that the flow velocity is as low as possible. Oxygen system should be positioned in well-ventilated areas away primary from ignition sources Prevention Of Oxygen Enrichment: Leak testing: Check for leakages using air or nitrogen either by a timed gas pressure drop test, a leak detection test or other suitable methods. Periodic retests should be done to check for leaks. Operation and practice: When work period is over, main oxygen supply valve should be closed to avoid leakage. Filter should be inspected at frequent interval to remove debris. Ventilation: Room in which vessels or cylinders are stored, handled, maintained, used or analyzed should be well- ventilated. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Prevention Of Fires In Oxygen System Vessel Entry/ Blanking Procedure: Prior to entry into any vessel, connected to a gas source, vessel should be emptied and isolated from the source. Isolation Equipment: An isolation valve should be provided outside the building in accessible position for operation in case of event of oxygen release inside the building Disused oxygen line should either be dismantled, or completely severed, and blanked off from the supply system. Oxygen Cleanliness: Ensure all equipments are cleaned before being put into or returned to oxygen service. Oxygen equipment shall be free of solid particles or shall be plurged with oil- free or nitrogen before start up, in case of new equipment. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Protection of Personnel

Protection of Personnel Clothes Analysis Firefighting Equipment Smoking Emergency response and rescue REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Hospital Fire Safety Assessment Checklist

Appendix: Hospital Fire Safety Baseline Assessment Checklist REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Appendix: Hospital Fire Safety Baseline Assessment Checklist S.N Assessment o Fire Safety Points (Prevention Aspect) 24 Availability of underground water reservoir? If yes, mention the number. 25 Availability of overhead water reservoir? If yes, mention the number. 26 Any point or gate identified in the hospital building as emergency exit? 27 Display of fire evacuation plan if it exists? 28 Constituted hospital disaster management committee? Availability of Emergency Response Plan for Fire, Evacuation, etc. 29 Functional public-address system (assigned intercom number)? 30 Availability of emergency hooter? 31 Availability of emergency power backup system? 32 Availability of material safety data sheet of hazardous chemicals in the hospital store? 33 Total number of fire extinguishers installed? Type of extinguisher installed- A, B, C, etc.? Size of extinguishers? 5 kg (if installed, mention the number)? 10 kg (if installed, mention the number)? 4.5 kg (if installed, mention the number)? 500 gram-Foam (if installed, mention the number)? Availability of sand buckets? 34 Availability of smoke detectors in key areas (if yes, mention the department)? ICU SNCU Paediatrics wards Isolation ward Store Kitchen Record room Other Mark Y/N or as desired REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Appendix: Hospital Fire Safety Baseline Assessment Checklist S.N Assessment o 35 Water hydrants (if the building is G 2 and plot area more than 1000 m 2 but less than 1500 m2) No. of hydrants installed (if in compliance with the above criteria)? 36 Availability of automatic sprinkler system as per IS 15105 (if basement area exceeds 200 m 2) Area/department where sprinklers are installed (if in compliance with the above criteria)? 37 Availability of dedicated fire water tank (if basement area is more than 200 m 2)? Availability of diesel fire water pump which can discharge water 1620 litres/minute (if in compliance with the above criteria)? Mark Y/N or as desired Electrical fire water pump which can discharge water 180 litres/minute (if in compliance with the above criteria)? 38 Availability of hose reel (if G 1 construction)? Area where hose reels are installed and no. of hose reels available (if in compliance with the above criteria)? Statutory Compliance 39 NOC of the building from the municipality 40 NOC for fire safety of the building 41 AMC of firefighting equipment Training 42 Training of all the staff to operate firefighting equipment 43 Availability of SOP for fire emergency? 44 Provision for periodic mock drills (if yes, no. of mock drills conducted in a year) 45 Are staff members familiar with their role and responsibility in the event of a fire? Remarks: REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Appendix: Hospital Fire Safety Inspection Report Hospital name, address & contact number: 1 Means of escape Are there any fire exits? Are all exits clear of obstructions? Are exit signs adequate? Are exit routes clear? Comments: Yes/No 2 Fire alarm system Is there a fire alarm system? Is the fire alarm system functional? Is the fire alarm system regularly serviced? Is there any smoke or heat detector? Is the smoke or heat detector functional? Is the smoke or heat detector regularly serviced? Comments: Yes/No 3 Firefighting equipment Is there any fire extinguisher? Is the fire extinguisher functional? Is the fire extinguisher regularly serviced? Is there any hose reel? Is the hose reel functional? Is the hose reel regularly serviced? Comments: Yes/No REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Appendix: Hospital Fire Safety Inspection Report Hospital name, address & contact number: 4 Training Yes/No Is there a staff training program on fire-safety? Are fire evacuation mock drills scheduled and performed regularly? Comments: 5 Fire safety leadership Yes/No Are there any designated personnel for fire-safety management in the facility? Comments: 6 Fire prevention standards (official use only) Name of the Inspecting officer: Date of inspection: Date of next inspection: Comments: REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Fire Suppression

Fire Safety Key Components Key Components Of Fire Safety 1. Prevention 2. Suppression 3. Evacuation 4. Evacuation training drills REACHING IMPACT, SATURATION, AND EPIDEMIC 21CONTROL (RISE)

Prevention Types of fires Fires can be prevented by: Using materials that combustion or burning are resistant Avoiding materials that are highly flammable to Class A Fires that involve ordinary combustible materials such as wood, cloth, paper, rubber, and many plastics. Class B Fires that involve flammable liquids, combustible liquids, petroleum greases, tars, oils, oil-based paints, solvents, lacquers, alcohols, and flammable gases. Class C Fires that involve energized electrical equipment, such as power tools, wiring, fuse boxes, appliances, TVs, computers, and electrical motors. Class D Fires that involve combustible metals such as magnesium, potassium, titanium, zirconium, lithium, and sodium. Class K Fires that involve combustible cooking oils and fats used in commercial cooking equipment. Having a fire-safety or fire-response team Adhering to fire safety practices and laws REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Prevention - Safety Warnings And Warning Signs WARNING SIGNS Safety warnings: “WARNING: Smoking during oxygen therapy is dangerous and is likely to result in facial burns or death. Do not allow smoking within the same room where the oxygen concentrator or any oxygen carrying accessories are located. “No smoking” signs wherever oxygen is used and not to allow an open flame or a cigarette anywhere within 3 m of an oxygen source. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Suppression Fire suppression is critical in order to circumvent/minimize damage or the loss of property and life. The ability to quickly detect and extinguish fires is a key factor in avoiding the worst-case scenario, which is evacuation of the hospital. To enhance safety of the building & to Fire alarms Fire extinguishers minimise damage Smoke (quicker) or heat detectors Triggers light, alarm bell or voice alerts Manual or automatic Use when the fire is small, confined, and not spreading. Ensure that you have an unobstructed escape route at your back Various types REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Suppression - Types Of Fire Extinguishers Important notes: You should know what is burning and that you have the appropriate type of extinguisher to fight the fire You are knowledgeable regarding the use of the extinguisher Make sure that you keep your back to a clear exit and stand 2 to 3 meters (6 to 8 feet) away from the fire. Your safety is paramount; if the fire is out of control, leave the area immediately. Water sprinkler and mist sprinkler systems, water hose reels, and smoke extractors can be installed in a hospital to improve the facility’s resilience to fire hazards. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Suppression - Using Fire Extinguishers - PASS Important notes: Regular training of fire wardens (or health and safety officers) and hospital staff on how to use fire suppression devices Acronym PASS should be memorised by all staff members Use of fire extinguishers should be translated into local language and pasted close to the fire extinguishers in bold and easily readable text REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Evacuation

Evacuation Types Evacuation Immediate of “Emergency move”- evacuate immediately or patients and staff may die; no time to prepare Rapid Evacuate as quickly and safely as possible; limited time to prepare (1 to 2 hours); follow procedures. Gradual No immediate danger; sufficient time for systematic evacuation procedures (many hours to several days). Prepare only Do not move patients but begin to prepare for evacuation. Movement during Evacuation Moving patients Horizontal away from danger but on the same floor Vertical Complete evacuation of a specific floor Shelter in Place Remain in their units and await further instructions. Evacuation could be Complete or Partial Special needs of patients should be considered Clearly identified assembly point and/or discharge site AVOID ELEVATORS DURING FIRE EMERGENCY REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Evacuation - Patient Prioritization And Transport Equipment Patient Prioritization Transport Equipment 1. Blanket s 2. Wheelchairs 3. Beds 4. Stretcher s Sufficient transportation equipment of good quality which is easily accessible at all times should be available for evacuation A minimum of two fire exit routes on every floor, clearly marked and located as far away from each other REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Evacuation – Transporting Patients On Ventilator Support Planning Steps to following during Evacuation: Initiate ICU Evacuation Plan Formation of Hospital and Transport Request Assistance for Evacuation Ensure Adequate Power and Transport agreements with other hospitals Ventilation Equipment Prepare for and Simulate Critical Care Prioritize Critical Care Patients for Evacuation Evacuation and Transport Critical Care Patient Distribution- contact receiving hospitals Prepare the Critical Care Patient for Evacuation Send Critical Care Patient Information with Patient Transport Critical Care Patients to Receiving Hospitals Track critical Care Patients and Equipment Designate a Critical Care Team Leader REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Evacuation – Using Selfcontained Breathing Apparatus (SCBA) A device worn to provide breathable air in environments with oxygen deficiency, smoke, dangerous gases, and other airborne contaminants Essential for modern firefighting and today’s complex fire grounds An SCBA typically consists of Facemask with a hose that connects to an air source worn by the user Air source can be a tank of compressed air, compressed oxygen, or an oxygengenerating chemical They are of two types: Air Breathing Apparatus (Open-circuit): Air inhaled from cylinder and exhaled air goes to the atmosphere Oxygen Breathing Apparatus (Closedcircuit): Air inhaled from cylinder and exhaled air goes to the absorbing canister, and oxygen REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Evacuation - Hospital Incident Command System REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Evacuation Training Drills General training Training drill is sequence of activities in Lifting & moving patients response to a fire alarm Each health facility should have tailored evacuation/response plan and trainings to meet its needs Using fire extinguishers Specific training Based on the role & responsibility of each staff Fire drills Understandin g of fire safety plan & fire protection Confidence to act in the event of a fire Action upon seeing a fire Note: All training simulations and fire drills need to be scheduled and performed regularly, and performance evaluations need to be completed and used to improve subsequent training drills. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Incase Of A Fire - RACE REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Fire Safety Considerations- Dos Dos Prevent leakages: o All equipment and hose connections must be properly fitted o Newly assembled equipment should be leak-checked o Cylinder valves must be turned off, when not in use Perform maintenance and repair only by experienced and fully skilled personnel Protect gas cylinders against being knocked or dropped Ventilate workplaces well Identify all oxygen apparatus and equipment properly with the gas name and safe working pressure Keep fire extinguishers and blankets in good condition Keep all routes clear Make fire safety officer’s designation at the facility level mandatory Conduct periodic trainings and drills on fire safety and their record should be maintained Don’ts Ignore fire alarm Tamper with fire alarm systems Use elevators during evacuation Smoking around oxygen-enriching devices Allow naked flames, sparks, and static electricity Use oils/grease as lubricants on oxygen or enriched-air equipment REACHING IMPACT, SATURATION, AND EPIDEMIC 35CONTROL (RISE)

Other Fire Safety Considerations Safety is always the primary concern Steps on how to operate fire extinguishers should be translated in local language and pasted close to the fire extinguishers in bold and easily readable text. Full evacuation of a hospital should generally be considered as a last resort. Simplicity is key; the staff will need a simple plan to follow in an emergency. Flexibility is vital because the procedures must be adaptable to a variety of situations. Self-sufficiency at the unit level is important because timely communication from hospital leaders may be difficult or even impossible; employees at every level must know immediately what to do in their area. BMEs should also train health care workers on basic safety when using oxygen equipment. Dedicated assembly points & discharge sites in the vicinity of the facility External patient transporters should generally not be asked to come into the hospital to evacuate patients because of the risks, time delays, and inefficiency associated with this process when large When difficult choices must be made, leaders and staff must focus on the “greatest good for numbers of patients are involved. the greatest number”. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Emergency Plan

Emergency Response And Rescue Emergency response procedure should contain provisions for entry into potentially oxygen- enriched areas. Victim rescue or entry to shut down, the process should not be attempted until the level of oxygenenriched gases determines to be less than 23.5% and is safe to enter. Clothing materials should be flame resistant. Emergency procedures may include the use of water spray to protect potential victims. Provide emergency procedures and readily accessible emergency contact number for fire and medical response. Trained the personnel and conduct mock drills. Source of oxygen rich gases should be cut off. If liquid oxygen rich gases released in an open space, a hazardous concentration exists within the visible fog cloud with the spill or can exist outside the cloud as well. Avoid entering a visible fog cloud or used a portable oxygen analyser before entering the area near a release. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Safety Signs

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Session: Precautions, Safety Consideration, Maintenance for LMO, PSA Plant, MGPS and Other Oxygen Equipment REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Precautions Handling Oxygen Cylinder

General Handling Personal protective equipment should be worn when handling oxygen cylinder All compressed medical oxygen gas cylinder should be secured to racks, walls, work benches or hand trolleys by a strong chain or strap Secure in an upright position Do not drop cylinders or allow sharp impacts on cylinders Cover the top of oxygen cylinder with the cap when not in use or when being transported Set up the cylinder at a safe distance from the patient REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

General Handling Do not place cylinder on a patient’s bed Disconnect the cylinder from regulators or manifolds before moving the cylinder by applying protective valve caps Cylinder should be moved only on a hand truck or other cart designed No more than one cylinder should be handled at a time All medical gas cylinders should be clearly labelled to identify the contents All defective gas cylinders or equipment should be reported immediately to the supplier for correction or replacement REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Storage Physically separate full and empty medical gas cylinders Ambulatory organizations can do using separate racks, physical barriers or by color coding the storage rack Label the cylinder clearly to avoid confusion and delay in selecting the cylinders Store in well- ventilated, clean, dry conditions, not exposed to extreme of heat or cold Do Not use oil or grease on the valve of cylinders or regulators/ gauges Never use a single use and/ or re-use an industrial gas cylinder for refilling medical oxygen REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

When And How To Change A Cylinder Gas cylinders should only be transported with their protective metal cap in place, using a cylinder trolley where available. Be sure that the cylinder contains the right gas. The tank valve must be closed and the pressure has to be released completely before disconnecting the regulator. The valve must not be damaged and must be free of dirt, dust, and grease. When the regulator has an O-ring, check if it is correctly in place and not damaged. Do not use Teflon tape on the high pressure side. Use the right spanner key/ spanner to tighten/loosen the pressure regulator. Do not use too much force. Never use a longer lever or a hammer to tighten a regulator. The regulator will tighten itself further under pressure. Open the cylinder valve slowly. Check for leaks around the regulator. Listen to hissing sounds. After closing the cylinder valve, the pressure shown on the pressure gauge should remain stable. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Fire Safety Ensure appropriate fire extinguishers to be kept nearby and regularly inspected Keep oxygen cylinder at least several meters from a heat source, open flames, electrical devices or other possible source of ignition Put a “No Smoking” sign near oxygen sources in the hospital Check for electrical circuit breakers and devices are in safe working condition and free from sparking to prevent a serious fire occurrence. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Precautions During Equipment Handling Handle cylinders carefully, move in trolley Keep cylinders clamped or chained to prevent from falling over Only store as many cylinders as needed; return empties to suppliers Use an adjustable strap wrench to remove over-tight or rusted caps Install valve- protection cap Open valves slowly and in correct order Close valve when not in use Store full and empty containers separately Never insert an object into cap openings Protect cylinder from physical damage Never attempt to lift a cylinder by its cap Use a first-in, first out inventory system REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Decontaminating and Disinfecting Oxygen Supply Devices

All oxygen equipment need exactly same sanitization as given to other machinery in the hospital Guidelines for handling oxygen cylinder Cleaning and disinfection procedure should be performed at the hospital Initial cleaning should be done with soap and hot water (not exceeding 50 degree Celsius) Under no circumstance medical gas cylinder should be immersed in water. Ensure valves and inlets should be covered and closed so that water doesn’t get inside. After initial cleaning, cylinder should be cleaned with isopropyl alcohol or equivalent disinfectant wipes Ensure the residual disinfection agents are removed from the gas cylinder as it can cause a potential fire risk Avoid cleaning agents that contain ammonia, amine or chlorine-based compounds as they can cause corrosion Used cylinder should be kept in an isolated area with a tag clearly mentioning that cylinder is infected REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE) Medical gas cylinder should be quarantined till they are cleaned. Cylinder should be filled only

Precautions Handling LMO

Safety Considerations Hazards associated with liquid oxygen are exposure to cold temperature It Can cause severe burns, over pressurization, oxygen enrichment of the surrounding atmosphere and the possibility of a combustion reaction Personnel should stay in well- ventilated area and avoid any source of ignition until their clothing is free of any excess oxygen Clothing saturated with oxygen is readily ignitable and burn vigorously Smoking or open flames should not be permitted in any areas where liquid oxygen is stored or handled Do not permit liquid oxygen or oxygen enriched air to come in contact with organic material or flammable or combustible substances If liquid oxygen spills, keep sources of ignition away for 30 minutes after all frost or fog disappeared System used in oxygen service must meet stringent cleaning requirements REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Handling Never use oxygen as a substitute for compressed air Never use oxygen jet for any type of cleaning Do not get liquid in eyes, on skin or on clothing Person exposed to high concentration of liquid oxygen should stay in well- ventilated area for 30 min Immediately remove exposed to oxygen clothing Prevent ignition sources such as static electricity to be generated in clothing while walking Wear leather safety gloves shoes when handling cylinder Protect damage Use a cart while moving cylinders (only for micro/dura cylinders) Never insert an object into cap openings Close the container valve after each use; keep closed even when empty cylinder form and physical REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Handling Never apply flame or localized directly to any part of the container High temperature container Cryogenic container must be stored, handled and transported in the upright position Use only transfer lines and equipment designed for use with cryogenic liquids Avoid mechanical and thermal shock Use only oxygen-compatible and lubricants Do not remove or interchange connections. Use only properly assigned connections Some elastomers and metals must be avoided in cryogenic service as they may become brittle at extremely low temperature All vents be piped to the exterior of the building Do not use adapters On gas withdrawal systems, use check valves or other protective apparatus to prevent reverse flow into the container On liquid systems, pressure relief devices REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE) may damage heat the materials

Storage Store where temperature will not exceed 125-degree Fahrenheit Post “No Smoking/ No Open Flames” signs in storage and use areas Secure containers in upright position to keep them from falling Store full and empty containers separately Use a first-in, first out inventory system Store and use liquid container with adequate ventilation Liquid container should not be left open to the atmosphere for extended periods Keep valves and outlets caps closed when not in use REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

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Precautions Handling MGPS

Safety Principles Identity Adequacy Identity is assured using gas-specific connections throughout the pipeline system, including terminal units, connectors etc., adhere to strict testing and commissioning procedures of the system Depends on accurate assessment of demands and the selection of plant appropriate to the clinical/ medical demands on the system Continuity It is achieved by the specification of system that has duplicate components. The provision of alarm systems and connection to the emergency power supply system. Surgical air system are not considered to be life-support system and therefore duplicate components are not normally required, an emergency/ secondary supply is provided Quality of supply It is achieved using gases purchased to the appropriate Ph. Eur. Requirements or produced by plant performing to specific standards, by the maintenance of cleanliness throughout the installation of the system, and by the implementation of the various testing and commissioning procedures. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Fire Safety Fire detection system such as smoke or heat detector heads should be installed in the plantrooms, medical gases manifold rooms and medical gases cylinder stores in hospital An automatic shutdown system, linked to local smoke detector can be installed An automatic emergency supply manifold system is sited well away from the fire risk area and is arranged to come on-line automatically in the event of plant shutdown REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Precaution Handling MGPS Formulating SOPs and maintaining logbooks Preventive maintenance of equipment Leak test of pipeline should be ensured on quarterly basis 24 hrs manning by trained personnel Periodic training of manifold personnel Daily checking of contingency plan Mock drills of pipeline failure, fire and explosion should be regularly conducted REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Precautions Handling PSA

Room should be well- ventilated where oxygen generators are operated. Oxygen vents should be piped outside the building or to a safe area. Warning signs should be posted in oxygen enriched atmosphere. Special precaution should be taken such as installation of analyzers with alarms, ensuring minimum number of air changes per hour, implementing special entry procedures. Recognize the accumulation of oxygen in the areas remote to generator. Use of protective clothing special equipment when working with oxygen. REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Fire Protection Primary fire protection for generator is an ample water supply Adequate number of fire hydrants, chemical type fire extinguishers, hoses or a combination of these should be strategically located close to generator Automatic isolation valves or generator shutdown are used to isolate oxygen sources from feeding a fire REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)

Precautions Handling Oxygen Concentrator

Troubleshooting – Electrical Safety Fault Equipment is not running Possible Cause No power from mains socket Solution Check power switch is on. Replace fuse with correct voltage and current rating if blown. Check mains power is present at socket using equipment known to be working. Contact electrician for rewiring if power not present. Try cable on another piece of equipment. Contact electrician for repair if required. Electrical cable fault Refer to biomedical technician Internal problem Fuse or circuit breaker blows a second time after replacement Coloured or metal wire visible in cable, socket or plug Cracks visible in socket or plug Internal equipment fault Refer to electrician or biomedical technician Insulation damaged Electrical shocks Wiring fault Remove item and refer to electrician for repair. DO NOT cover with tape. Remove item and refer to electrician for repair. DO NOT cover with tape. Refer to electrician Damaged cover REACHING IMPACT, SATURATION, AND EPIDEMIC 65CONTROL (RISE)

Electrical Safety – Weekly Checklist Weekly Checklist Cleaning Clean dust and liquid off with a DRY cloth. Remove tape, oil and dirt from all cables, plugs and sockets. Visual checks Function checks Report any sockets that are loosely fitted or not working. Check for and report and broken fans or lights Remove any cracked connectors or cables from service. Check for and report any damaged room wiring or fittings. Check for and report any signs of burning, melting or sparks. Untangle all cables and store carefully. REACHING IMPACT, SATURATION, AND EPIDEMIC 66CONTROL (RISE)

Thank You! REACHING IMPACT, SATURATION, AND EPIDEMIC CONTROL (RISE)