Anesthesia Safety: Medical Gas Distribution in
Anesthetizing Locations
It's hardly unexpected that among the diverse areas
dedicated to care within a healthcare facility, the surgical suite stands out
as one of the most important. It is not only vital because of the critical
life-saving procedures that occur within the surgical suite but also because of
its impact on the organization's overall financial health.
It is paramount that the operating rooms' medical gas
systems are designed and installed correctly. The individuals working within
the department need to be aware of their functions and responsibilities in an
emergency.
At CHT, we understand you want your medical gas systems to
be compliant, pass inspections, and be safe for your facility. In this article,
we discuss the different levels of anesthesia, the importance of its safety,
and the distribution of your medical gas systems for areas designated for the
administration of general anesthesia.
Different Levels of Anesthesia in Healthcare Facility
It is essential to understand the different levels of
sedation that may be administered. Although it is considered a sliding scale in
most hospital ORs, there are four distinct levels of anesthesia, based upon the
patient’s physical response to the drug-induced state.
1. General Anesthesia
A loss of consciousness in which the patient is not
arousable, even with painful stimulation
2. Deep Sedation/Analgesia
A depression of consciousness in which the patient cannot be
easily aroused, but will respond to repeated or painful stimulation
3. Moderate Sedation/Analgesia or Conscious Sedation
Depression of consciousness in which the patient responds to
verbal commands, either alone or with light tactile stimulation
4. Minimal Sedation or Anxiolysis
A state in which the patient responds typically to verbal
commands, but cognitive function or coordination may be impaired.
According to NFPA 99-2012, anesthetizing location is defined
as:
"Any area of a facility that has been designated to be
used for the administration of general anesthesia."
In the 2018 edition of NFPA 99, this definition is no longer
included, but as it relates to the design requirements of zone valves and area
alarm panels, anesthetizing locations for moderate or deep sedation or general
anesthesia are grouped into the same category.
Yet, it is important to note that NFPA 99 is a risk-based
document, and the determination of an anesthetizing location is up to the
facility, as stated in NFPA 99:
“It shall be the responsibility of the health care
facility’s governing body to designate anesthetizing locations.”
Anesthesia Safety: Requirements for Zone Valves and Area
Alarm Locations
Now that the anesthetizing location has adequately been
determined, the appropriate codes and regulations can be applied. The Joint
Commission Hospital Accreditation Standards, EC.02.05.01, EP 25 lists the
requirements for zone valves and area alarm locations for accredited
facilities.
These requirements closely mirror those found in NFPA 99.
Specifically, for areas designated for the administration of general
anesthesia, the following shall apply:
Zone valves shall be located outside each anesthetizing
location.
The zone valves shall be readily accessible.
Shutting off one zone valve shall not affect others.
Area alarm panels shall monitor all gas systems and provide
surveillance of pressure variations of +/- 20% from normal operating pressure
and vacuum decreases of 12in HgV.
The sensor locations for the area alarm panels may be
installed on either the source side of individual room zone valve box
assemblies or the patient side of each of the individual zone valve box
assemblies.
In addition to the installation requirements for the valves
and alarms, all assets must be labeled properly. It can be critical in the
event of providing safe and effective shutdowns or modifications to existing
systems.
Again, the requirements of both NFPA 99 and TJC are in
unison. From a Joint Commission perspective, Standard EC.02.05.09, EP 11
indicates that all valves are accessible and identify what the valve's control,
both in terms of gas content and area of control. Additionally, all piping
shall be identified by the name or chemical symbol of the gas system at
intervals of no more than 20 feet.
For area alarm panels, NFPA 99 requires labeling, indicating
the name or chemical symbol of the system being monitored and the area(s)
monitored by the alarm panel. Furthermore, it is recommended that emergency
labeling also be applied to area alarm panels to ensure staff is trained and
aware of the proper protocols to respond to an alarm condition within the
anesthetizing location.
While not a requirement of NFPA 99...
EC.03.01.01, EP1 requires that staff responsible for the
maintenance, inspection, testing, and use of medical equipment, utility systems
and equipment, fire safety systems and equipment, and safe handling of
hazardous materials and waste are competent and receive continuing education
and training.
EC.03.01.01, EP2 requires that staff and licensed
independent practitioners can describe or demonstrate actions to take in the
event of an environment of care incident. A simple label indicating what
actions staff are to take in the event of a medical gas emergency would be the
best practice for facilities to incorporate into their medical gas management
plan.
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