Assigning room names could impact your medical gas design. For example, what would you expect to find in a room called “Special Care Nursery?” Would you think it was a NICU, or just a general care room? 

We, as medical gas designers, need to pay close attention to room names. We also need to work with architects and healthcare planners to determine how to handle them. 

In addition to scope, budget, utility information and code issues, some of the less obvious considerations you can ask the architect or owner to address when beginning your information-gathering process include, risk assessment, sedation levels, type of procedure, if the city requires a special inspection for medical gas systems, and if the facility has an inspector/verifier that they wish to use.

Risk Assessment

Here are a few sections on risk assessment from 2012 NFPA 99 for reference:

4.2* Risk Assessment. Categories shall be determined by following and documenting a defined risk assessment procedure. A.4.2 Risk assessment should follow procedures such as those outlined in ISO/IEC 31010, Risk Management — Risk Assessment Techniques, NFPA 551, Guide for the Evaluation of Fire Risk Assessments, Guide for the Evaluation of Fire Risk Assessments, SEMI S100307E, Safety Guideline for Risk Assessment and Risk Evaluation Process, or other formal process. The results of the assessment procedure should be documented and records retained.

5.1.14.2.2.3 Inspection Procedures. The facility shall be permitted to use any inspection procedure(s) or testing methods established through its own risk assessment.

6.3.2.2.8.4* Operating rooms shall be considered to be a wet procedure location, unless a risk assessment conducted by the health care governing body determines otherwise.

A.6.3.2.2.8.4 In conducting a risk assessment, the health care governing body should consult with all relevant parties, including, but not limited to, clinicians, biomedical engineering staff and facility safety engineering staff. When it comes to hyperbaric chambers, there are additional risk assessments required beginning at A.14.3.1.5.4.3.

Sedation levels

Sedation levels apply to several departments, including the emergency department, procedure rooms, dental departments, MRI, and CAT scans. The relevant 2012 NFPA 99 sections are listed here for reference:

3.3.63* General Anesthesia and Levels of Sedation/Analgesia.

3.3.63.1 Deep Sedation/Analgesia. A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. 

3.3.63.2 General Anesthesia. A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. 3.3.63.3 Minimal Sedation (Anxiolysis). A drug-induced state during which patients respond normally to verbal commands. 

3.3.63.4 Moderate Sedation/Analgesia (Conscious Sedation). A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. 

Procedures

The above mentioned levels of sedation will help guide you in determining which category to apply to an area or room. For example, an OR would fall under an anesthesia category. This classification comes into play when placing zone valves and area alarm transducers. If the room is an ICU or Pre-OP / PACU, it would be considered a critical care location, which affects where you place the transducers for the area alarm. 

The following provides further explanation:

5.1.9.3* Area Alarms. Area alarm panels shall be provided to monitor all medical gas, medical–surgical vacuum, and piped WAGD systems supplying the following:

Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered

*Critical care areas

5.1.9.3.4 Alarm sensors for area alarms shall be located as follows:

*Critical care areas shall have the alarm sensors installed on the patient or use side of each individual zone valve box assemblies.

*Anesthetizing locations where moderate sedation, deep sedation, or general anesthesia is administered shall have the sensors installed either on the source side of any of the individual room zone valve box assemblies or on the patient or use side of each of the individual zone valve box assemblies.

As you can see, communication with the architect, planner and/or owner is essential. Without this detailed information, you can only make guesses about what is needed. 

Medical gas inspections and verification process

When you’re putting together your specifications, you may want to begin a dialogue with the company that the facility has been using for medical gas inspections and verification so you are all on the same page before the project goes out for bid. This will help in reducing RFI questions and future change orders. 

However, you still should state how you want everything installed; which tests you would like witnessed; and how many visits you require to witness tests and installation being performed at varying points during construction. You ultimately have to sign off on the installation, as well as the inspectors’ and verifiers’ reports. 

I prefer to have one person/company perform both the inspections and verification process on smaller projects. However, on larger projects, I prefer to have one person/company perform inspections and a different company perform the verification. The reason for splitting the work up between two companies on larger projects is to catch mistakes before the walls are closed up. Otherwise, there could be expensive delays on the project.

As a sidenote, you also have the authority to be the inspector for the medical gas system as the registered design professional in responsible charge or of record. 

Now for the answer to the question at the beginning of this article: it’s a general care room based on the risk assessment performed and recorded by the facility. 

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. John’s unique skills are an asset to every team in which he is involved. He can be reached at john.gregory@hdrinc.com.