Medical Gas & Vacuum Design for Outpatient Surgery Centers

There are some inherent challenges to designing medical gas & vacuum systems for Ambulatory Surgery Centers.

One common misconception is that because ASCs are typically smaller outpatient facilities, they aren’t required to adhere to the same requirements as hospitals.  But this is an outdated concept.  In 2012, NFPA 99 Health Care Facilities Code (i.e., U.S. medical gas code) underwent a major overhaul, where it was restructured from the antiquated approach of an occupancy-based standard to its current form as a risk-based safety code.

What this means is, the size of the facility is irrelevant.  The key factor when designing medical gas & vacuum systems is the risk associated with the types of procedures that will be performed within the facility.

At the onset, the owner should determine the risk category to which the design must adhere.  This is explicitly defined by NFPA 99 (Chapter 4).  The key question to answer is what is the likely impact on patients, staff or visitors should any of the medical gas & vacuum systems fail?  If the answer is major injury or death, the facility must adhere to Category 1 requirements; if minor injury, Category 2; and if discomfort, Category 3.

You can easily see that for various ASCs (orthopedic, plastic, oral, eye, maxillofacial, endoscopy, vascular, ENT, gastrointestinal, urology, et al.), where the types of procedures can vary greatly, this might not always be a simple answer.  But you can also appreciate that many ASCs provide similar procedures as major hospital ORs, so it can be quite unsafe to design them like, for example, a dental office.

One important consideration for determining the risk category is to review the types of anesthesia that will be administered during procedures as defined by NFPA 99 (Chapter 3).  If general anesthesia and/or deep sedation are used, then it must be Category 1; for Category 2, only moderate sedation and/or minimal sedation are permitted; and for Category 3, only minimal sedation and/or no sedation are allowed.  The use of general anesthesia and deep sedation are explicitly prohibited for Categories 2 or 3.    

The factors above should be included among others as part of a full risk assessment for the facility.  Once the risk category is determined, then other considerations include the sizing of the central source equipment and piping, and the general configuration of the system to meet the various code requirements and standards, but also ensure the system will support the specific needs of the facility.  For instance, if you’re using nitrous oxide and/or halogenated anesthetic gases, then a waste anesthetic gas disposal (WAGD) network is required – however, there are several variables affecting this design (that we can discuss in more detail when you’re ready).

One misguided approach is that a Category 2 system will offer significant cost savings over Category 1, when in fact the differences are minimal; in short, Category 2 requirements permit the use of simplex systems for medical air and medical-surgical vacuum (i.e., a single compressor or pump, respectively), as well as a single master alarm panel monitoring the systems.  Often, the savings might be insignificant compared to the added risk of reduced safety or operational reliability.

Based on the above, you can see why it’s vital to engage a qualified medical gas expert during the design phase, so that you can be confident the appropriate system will be specified and installed.  I can cite several examples where an inadequate design resulted in project delays and costly change orders after construction began.

Specialty Oxygen Partners is here to help you navigate all of this – from design to installation to final verification.  We’ll be glad to consult when you’re ready.