Healthcare facilities have various levels of gases and vacuum systems. These systems are regulated by NFPA 99, also called code, the latest edition being 2005. As a member of the Technical Committee on medical gas and vacuum piping of the National Fire Protection Association (NFPA), please understand these discussions are my own and do not represent the opinions, position or interpretations of any other individual committee member, the committee as a whole or NFPA. Please refer to the actual text of the referenced standards for the exact wording.
Medical Gas And Vacuum System Levels
The term “level” represents a listing of specific systems based on the comparative degree of risk to patients and the facility in which they are installed. The levels are intended to define standards of purity, safety and reliability. They indicate intended system uses and the potential risk to a patient if this system shall fail or malfunction, and they are indicated as one to three, with one being the most critical. Alarms, gas quality monitoring and piping arrangements are outside the scope of this article.
The Level 1 vacuum system serves any station inlets installed in critical-care areas, including waste anesthesia gas disposal, and provides medical/surgical support for the patient population undergoing or recovering from invasive diagnostic, treatment or surgical procedures. This level includes the alarms, operating controls, gauges, etc. High-pressure compressed gases over 160 psig used to serve pneumatic devices that are used for invasive procedures are Level 1, which also includes instrument (support) air that is used as a replacement for nitrogen. The supply and alarms must be redundant.
This will serve any patient who is dependent upon the piped medical gas and vacuum system for well-being, and for recovery from invasive diagnostic, treatment or surgical procedures, where a bottled gas could be substituted quickly for the failed service. This includes support air. The source supply, equipment and alarms can be simplex. They must not be connected to Level 1 central systems and are not permitted to be used in hospitals. The occupancy to be served and the function of that occupancy where Level 2 is installed is different from other occupancies in a hospital.
The vacuum system can be either wet or dry and is used predominately for removal of liquids from any treatment area, and from the oral cavity. Alarms and supplies need not be redundant. The systems installed must not supply more than two adjoining treatment facilities.
Compressed Air
Air is divided into the following categories (levels):
Nitrogen
Nitrogen is used primarily to power pneumatic devices in surgical and medical suites. When used to power pneumatic tools, nitrogen is centrally distributed at pressures between 20 and 250 psig (140 and 1725 kPa), depending on the specific tools used. Although mostly distributed at 160 psig or higher, the system must conform to standard CGA NF.Nitrogen is also used for inhalation therapy where mixed gases closely matching natural air proportions are desired. It is not unusual to have two separate pressure systems in some facilities. Often, a dedicated nitrogen cylinder (or bank of cylinders) is installed at each location with the required controls and regulator. Nitrogen is considered a Level 1 gas.
Vacuum Systems
Vacuum is a system that uses air below atmospheric pressure. There is no requirement that any level of vacuum service be a dedicated one. Where there is only one vacuum source for a facility, the vacuum system for a laboratory must connect directly into the receiver tank separate from the medical/surgical system through its own isolation valve and fluid trap located at the receiver.
Definition Of Healthcare Facilities
Healthcare facilities include hospitals, nursing homes, medical and dental offices, and clinics. These facilities fall into two general categories: short-term (acute care) and long-term care. Short-term is considered the typical acute care surgical/medical-type hospital, as well as clinics and outpatient treatment care facilities not requiring overnight stays, such as podiatry and plastic surgery.
1. Medical/surgical compressed gases and vacuum systems for direct patient care, pneumatic devices or supplying mechanical or assisted mechanical ventilation equipment shall conform to Level 1.
2. Waste anesthesia gas disposal (WAGD) systems shall conform to Level 1 requirements and may be produced by either a dedicated system or connection to the medical/surgical vacuum system.
3. High-pressure support gases (nitrogen or instrument air) for pneumatic devices, tools, etc., shall be Level 1, and also may be used for laboratory purposes if appropriate. They shall not be used for respiration.
4. Level 2 systems are not permitted.
5. A Level 3 gas (nitrous oxide and oxygen only) and vacuum system for dentistry shall be permitted if not connected to the hospital’s Level 1 central system source. The gas systems shall not be used for patient or staff ingestion. Existing systems are permitted to be used, providing that they do not constitute a hazard to life as determined by the local authorities.
1. Medical gas and vacuum systems, if provided for patients with mechanical or assisted mechanical ventilation considered critical life support, shall conform to Level 1, as well as any gas connected to Level 1 sources or distribution piping.
2. Where patients are not dependent on medical gas or vacuum systems at any time for critical life support, they shall conform to Level 2, if provided.
3. All other systems, if provided, shall conform to Level 3.
1. Where patients are provided mechanical or assisted mechanical ventilation, gas and vacuum systems, these systems shall conform to Level 1.
2. They shall meet Level 2 if they do not meet all of the above conditions.
1. Medical compressed gases and vacuum systems supplying mechanical or assisted mechanical ventilation equipment and a WAGD system shall conform to Level 1. If general anesthesia is given, Level 1 systems are required.
2. Where patients are not dependent on medical gas or vacuum systems at any time for critical life support, they shall conform to Level 2, if provided.
3. All other systems, if provided, shall conform to Level 3.