On March 23, 2010, the Obama Administration’s Affordable Care Act was introduced to the masses. From 2Q 2014 to 2Q 2015, growth in patient volumes improved, which in turn increased many healthcare facilities’ profits.  Some facility administrators chose to renovate or remodel with this additional profit, while others began to update their buildings’ infrastructure to keep pace with the growth they saw or anticipated. 

One such project that I was heavily involved with was a medical gas upgrade. A six-year project, it required a great deal of collaboration between the HDR team I was part of and the client. 

First, we met with the client’s facility director to discuss what they envisioned their facilities would look like in the next five to 10 years. 

The project

The director of the facility wanted to relocate the building’s current departments in preparation for a few areas to be demolished and a new four- to six-story patient tower to go in its place. From here they would build a two-story conference center and another four- to six-story patient tower. 

We had a lot to consider going forward for this project, so we gathered all of the information we could, including as-built documents, and we analyzed it over the next couple of months. During this time, we also performed a hand-over-hand evaluation of the piping to verify the size and location on the as-built documents. We evaluated all of the medical gas equipment and bulk oxygen tank farm sizes as well. 

From there we developed a plan, including anticipated costs to clean up the facilities’ medical gas piping systems. The proposed plan also addressed their oxygen reserve tank, which was undersized based on their usage records. The plan had a six-year time frame and eight phases in which two-thirds of the budget would come from renovation projects.  

We evaluated their potential cost savings by doing this work now instead of five years down the road. This was difficult since copper was experiencing weekly price fluctuations. Depending on the week, our estimate differed by as much as $20,000.

In order to accomplish all of the work that this project required, we put the medical gas mains and the early phased work out to bid to the top three medical gas contractors in the area. From here, the winning contractor installed most of the new mains throughout the facility. At the same time the new mains were installed, renovations and department relocations occurred.

Next, we brought all of the mains into alignment with what the future of this building would become. This upgrade would allow the facility to expand and renovate as they choose, with little to no impact to their medical gas systems going forward. 

Once the new mains were in place, the connections prepared, and the renovations completed, we were ready for the final tie-ins to occur. We placed this last phase of the work out to the same three contractors. This phase involved all of the connections that had to be made, which proved to be the trickiest and most time-consuming part of the project.

The process

During all of the projects’ phases, we worked closely with the facility, contractor, medical gas inspector and verifier that would be on board during the entire phased construction. 

The team worked together weekly to prepare for the final phase, and we worked out many concerns and how to proceed along the way. This was a very detailed and precise plan of how we were going to move forward with each task. We walked the site together to determine the impact to patients and patient safety. We then settled on a game plan, which would be performed over the course of two months in preparation for the final connections.

We determined that we would make the connections by completing one gas system at a time. This consisted of replacing the existing oxygen reserve tank with an upsized tank and the vaporizers with updated versions that are now automated to switch over for de-icing. 

Due to the upsizing of the day tank and an upsized main from the tanks to the building, we were required to shut down the oxygen to the facility. This required communication with the liquid oxygen vendor at the early stages of the project since the vendor was required to come out and verify that the pad and emergency oxygen connection (EOSC) were adequate. We also recommended that a set of signal wires be installed from the master alarm panel to the EOSC so they could be monitored by the master alarm panel in the facility. If we did not provide those signals to the master alarm panel, an employee would have to be at the tanker 24/7 to monitor it and its alarms.

From here, we made the switch-out and connections to the medical gas main house valve inside the building. 

We were a go for switching over the existing oxygen system to the new mains. In order to achieve more than 20 connections throughout the facility, we chose to use Lokring fittings so we didn’t braze each connection (which would have been too time-consuming to accomplish in two nights). All of this work went off without a hitch, so we prepared for the next week.

The same routine was applied for each system: nitrous oxide, nitrogen, high-pressure oxygen, vacuum and medical air.

The vacuum system and medical air piping were actually installed from the central utility plant (CUP) out onto the low roof around the patient tower, and then back inside the building midway on the patient tower. The vacuum piping on the roof also branched off to serve areas below the roof that would be demolished in the future. To accomplish this important switch-over, we had to bring in a portable vacuum system and generators to provide a temporary vacuum. Even though we provided a temporary backup source, we still prepared for the worst by providing several smaller portable units in the ICU.

The test

The week prior to the shutdown, we again verified that everything was ready. As part of this task, we required a test of the system to determine that it would provide adequate suction. The first test failed to provide the required suction, so we determined that we needed to upsize the temporary connection tubing size from a one-and-a-half-inch flex hose to two-inch rigid tubing. After the corrections were made, we performed another test, and the system worked perfectly for a 12-hour time frame during the height of the work day. Next, we had to braze several locations since the pipe sizes were too large for Lokring fittings. Nonetheless, this task also went off without a hitch.

Now we were down to our last system — the medical air. We had a new upsized main to the equipment source valve, so, we collaborated onsite and came up with a decision. We brought in several medical air “H” cylinders for back-up, with more in reserve if needed. The idea was to bypass the medical air source valve, which we had to upsize. We used the port on the source side of the valve and at the transducer to connect the five-eighths-inch medical air tubing to the ports, allowing us to bypass the valve and section of piping where we needed to make the new connection. All we needed to do was maintain flow and pressure for the duration of the connection. 

Once again, we performed a pretest to confirm that the solution would function the way we had anticipated. Again, the test was performed at the height of the work day in order to have full usage on the system over a one-hour timeframe. It worked like a charm; no issues were found anywhere in the facility. The team proceeded to the next step and performed the connections without a hitch. The following weekend, all of the other tie-ins were completed to the new main.

The lessons learned

It's important to remember that design collaboration can occur among the client, engineer, contractor, inspector and verifier on all medical gas-related design/build projects. I firmly believe that opening up a dialogue among everyone sitting at the same table can solve any problem. 

John Gregory, mechanical coordinator in HDR’s Phoenix architecture studio, has 28 years of experience in medical gas systems design and inspections, process piping, plumbing and fire protection systems design for multiple business classes. He coordinates projects with HDR’s clients, and he supervises team members on plumbing, process piping, fire protection and medical gas systems. John is a certified medical gas inspector NITC 6020. He serves on the NFPA 99 Technical Committee for piping and installation, and he is a co-chair of the P.I.P.E. Medical Gas Committee in Arizona. He can be reached at john.gregory@hdrinc.com.