Hospitals must have a reliable supply of medical gases, and with such a high risk of harm to those who use medical gas systems, commissioning of these systems can help to ensure their safety. According to Chapter 9 of the Los Alamos National Laboratory Sustainable Design Guide, “Commissioning is a process — a systematic process of ensuring that a building performs in accordance with the design intent, contract documents, and the owner’s operational needs.” 

The National Fire Protection Association’s NFPA 99, Health Care Facilities Code, provides minimum standards for safe hospital operations. According to Chapter 5 of NFPA 99-2012, hospitals must perform inspection, testing and maintenance for piped medical gases, waste anesthetic gas disposal and vacuum systems in time frames dictated by the organization. This chapter also defines how medical gas systems should be designed and used.

Best practices call for commissioning of new systems and possibly even after large construction projects during which a system was modified. Recertification of a medical gas system is required to test the system for correct gas, purity and pressure after modifications have occurred. Commissioning, on the other hand, would ensure that the entire system is functioning properly and that other critical components are code compliant. Some of the critical items surveyed by regulatory bodies include verifying that gas shutoff valve boxes are unobstructed and correctly labeled.

Failure of building systems can fall into one of four categories, depending on the severity of injury caused to a patient or health care worker. Medical gas systems fall into the highest level, Category 1, which means there is a high likelihood of severe injury due to poorly installed equipment. Proper installation and safety of a medical gas system can only be guaranteed through the proven process of commissioning.

Brian Wade CHSP, HEM, CHEP, director of emergency management, environment of care and security, Temple University Health System.