Frontline healthcare workers administer critical medical oxygen to their patients every day. But where does the oxygen come from? This question is more pertinent than ever with recent challenges like the COVID-19 pandemic and natural disasters affecting oxygen supply networks. Understanding the basics of the medical oxygen supply chain equips facility managers, respiratory therapists and other healthcare personnel with the knowledge they need to mitigate the risk of a future supply disruption. In this three-part series, we will follow bulk medical oxygen from the plant to the patient.
Part 1: Three Questions Every Healthcare Facility Should Ask About Bulk Medical Oxygen Production and Delivery
When evaluating your medical oxygen supplier’s reliability of supply, here are some questions to consider:
- How close is my primary medical oxygen source to my hospital and are there backup sources nearby?
- What is my medical oxygen supplier’s emergency preparedness plan for customers who experience equipment failure or oxygen surges?
- Does my supplier provide remote monitoring of my bulk system to optimize deliveries and can I easily get access to that data?
Medical Oxygen Production and Distribution
Prior to medical oxygen arriving at a healthcare facility, medical oxygen suppliers take crucial steps in producing, analyzing, and distributing oxygen in compliance with regulatory and industry standards. Medical oxygen suppliers produce oxygen by compressing and separating air into nitrogen, oxygen and argon through a cryogenic distillation and purification process. Messer utilizes its vast supply network of plants and sources to produce medical oxygen throughout the United States. With numerous plants and sources located in contiguous geographies, Messer supports its customers using backup supply sources. Because bulk medical oxygen is classified as a drug under Title 21 of the U.S. Code of Federal Regulations, all medical gas manufacturers are required to register each of their air separation plants annually with the Food and Drug Administration (FDA).
The Compressed Gas Association (CGA) and United States Pharmacopoeia (USP) specify the manufacturing and analysis of USP (medical) oxygen to ensure impurities are removed to a required level and the oxygen is suitable for patient care. It is the responsibility of the medical gas manufacturer to ensure its standard operating procedures (SOP) comply with all federal, state, and local regulations. Bulk medical oxygen storage tanks are sampled daily to verify conformance to specification. This specification requires that the oxygen purity exceed 99.5% purity and is free from foreign odor. Once the medical oxygen is loaded into the trailer, it is then analyzed again to confirm that it meets or exceeds the specification and a Certificate of Analysis (COA) is provided to the hospital with each delivery. The COA should be stored in hospital records for use and reference in future inspections, such as those performed by Joint Commission, a healthcare accreditation organization.
For more information about manufacturing medical oxygen, please refer to the following resources:
- Current Good Manufacturing Processes Practice for Medical Gases
- Standard For The Manufacturer Of Bulk Medical Gases - 4th Edition (CGA M-3 2015)
- FDA Compliance Program Guidance Manual on Compressed Medical Gases
Medical Oxygen Delivery Scheduling
As the COVID-19 pandemic swept across different regions of the U.S., Messer monitored and responded to unprecedented demands in medical oxygen usage. Messer quickly mobilized to increase production of oxygen, re-allocated drivers and bulk delivery trailers to areas where they were most needed, and increased delivery frequency to its healthcare customers to keep pace with the surging demand for oxygen. Messer also deployed portable oxygen trailers to provide supplementary supply to hospitals experiencing increased demand.
Messer provides an optimized supply chain for a healthcare facility’s medical oxygen needs. During the pandemic, hospitals learned that it can be advantageous to have separate bulk and cylinder suppliers to diversify their sources of supply. Because the hospital received oxygen from two different oxygen supply networks, both oxygen suppliers could flex their networks to supply bulk oxygen.
Messer’s Operating and Scheduling Center in Stewartsville, NJ controls and monitors plant operations remotely to consistently produce and deliver medical oxygen for our medical customers. The Operating and Scheduling Center operates 24/7, 365 days per year, and has a Disaster Recovery and Emergency Response Plan that features redundant telecommunications, data connectivity and an additional diesel generator for electrical back-up to ensure uninterrupted service and support for our customers.
Messer monitors medical oxygen usage patterns remotely via telemetry systems to help optimize delivery schedules. Our customers can view their telemetry data and delivery history on our proprietary NSC Online platform. Please reach out to Messer to learn how to access your oxygen usage information.
What Makes a Successful Medical Oxygen Supplier?
Premiere medical oxygen suppliers must have reliability of supply, strict SOPs to ensure patient safety, a strong emergency response plan and a remote monitoring system. A superior supplier presents the lowest risk option while not compromising the quality of the product or the customer’s unique needs.
Continue reading for part two in our three-part series to learn more about bulk medical storage equipment design and piping systems to help you identify potential bottlenecks in your current oxygen delivery system.
We deliver to you, so you can deliver to your patients.
Part 2: Understanding the Major Components of Your Bulk Medical Oxygen System
Once your medical bulk oxygen supplier has delivered oxygen to the healthcare facility, how do healthcare facilities get oxygen to their patients?
Given medical oxygen is critical for life-support, bulk medical oxygen systems are designed and installed with redundancies, alarms and monitoring to respond to maintenance issues and maintain consistent supply. The systems should be installed and operated in accordance with the code specifications of National Fire Protection Association (NFPA) 99, the Health Care Facilities Code, and NFPA 55, Compressed Gases and Cryogenic Fluids Field Code.
Bulk Medical Oxygen System Components
A typical Messer medical bulk oxygen station at a hospital features a main and reserve bulk oxygen tank, main and reserve vaporizers, a regulating manifold, and a local alarm panel installed on a specified foundation.
The Main Tank
Given the Covid-19 pandemic, more care needs to be taken with regards to choosing the size of the oxygen tank. High flow oxygen treatments rates along with clarification of the number of possible simultaneous treatments sets the daily maximum. While NFPA 99 does not specify main tank sizing, many suppliers suggest the tank be sized with at least a two-week supply of medical oxygen. This allows the healthcare facilities to maintain adequate medical oxygen inventory and suppliers to optimize deliveries. The main tank size may increase depending on specific hospital needs and risk tolerances for such emergencies as pandemics and natural disasters.
The Reserve Tank
If the supply from the main tank is interrupted for any reason, the reserve tank is designed to automatically engage as a back-up tank.
- NFPA 99 2021 requires that the reserve tank hold at least a 24-hour supply and this should be based on maximum flow rates.
- It’s highly recommended to have a minimum of 48-hour supply, based on a hospital’s oxygen demand. When the demand is unknown, your supplier may be able to make a recommendation on size and quantity.
If a healthcare facility’s oxygen usage is minimal, reserve oxygen cylinders may be used in place of a reserve bulk oxygen tank. Per NFPA, both cylinders and bulk tanks are acceptable reserve supply systems.
Vaporizers receive liquid oxygen from the bulk oxygen tanks and convert it into gas to feed the healthcare facility’s oxygen pipeline system. Many suppliers suggest the installation of vaporizers with separate circuits for the main and reserve tanks in order to provide redundancy. Vaporizers are usually atmospheric heat exchangers; they use ambient air to convert the oxygen from a liquid to a gas. Steam, water bath and electric vaporizers provide alternative means of vaporization in situations where the healthcare facility might require a custom solution. In these cases, ambient reserve vaporizers should be utilized to maintain continuity of oxygen supply in the event of a power failure or other issue.
Excessive frost can accumulate on vaporizers during surging demand or cold weather conditions. Heavy icing can reduce vaporizer performance; report heavy icing to your medical oxygen supplier so they can help with de-icing the vaporizer. Please refer to the blog entry on identifying heavy icing for more information.
Pressure Regulator Manifold
The manifold regulates oxygen pressure for use inside the healthcare facility for patient care. For example, respiratory treatments usually require 50-55 psi oxygen while hyperbaric therapies often require 70-90 psi.
- NFPA 99 2021 (NFPA 99 2021: 22.214.171.124.5.1) requires dual final line regulators on the manifold to allow for redundancy if one regulator needs repair.
- Your supplier can provide a separate manifold for each pressure requirement within your facility.
NFPA 99 requires an alarm scheme to monitor bulk oxygen system operations and to notify the facility of potential supply issues. In a key provision, NFPA 99 2021: 126.96.36.199.1 requires two master alarm panels inside the hospital (details to follow in Part 3 of this blog series). Messer supplies a local alarm panel on the regulating manifold to provide another location for the facility to review the bulk oxygen alarms.
There are four alarm signals originating from the medical bulk oxygen system:
If you receive an alarm, call your bulk oxygen supplier. If Messer is your supplier, call Messer’s emergency line at 1-800-232-4726, open 24/7, 365 days a year.
If Messer is your supplier, we work proactively to maintain a consistent supply. As mentioned in the first part of this medical oxygen blog, we monitor medical oxygen remotely via telemetry systems to help optimize delivery schedules. You can view your telemetry data on our proprietary NSC online platform. Reach out to us; we’ll show you how to access your oxygen usage information.
Bulk System Pad
Due to the inherent safety risks with liquid oxygen (check out our oxygen safety video for more information), NFPA 55 requires specific safety distances between bulk oxygen tanks and other safety hazards like combustible materials and powerlines. The code also requires a 12 foot x 12 foot non-combustible surface for oxygen delivery (a spill pad). For the main pad, code specifies 3-foot distances between each piece of equipment, fencing with a second means of egress inside the bulk system enclosure. Work with your industrial gas supplier to confirm that it is accessible and meets code requirements.
What to Look out for When Monitoring Your Bulk Oxygen System:
While the alarm systems are designed to maintain continual supply, healthcare facility personnel also have a role to keep everything running smoothly. Regular inspection of your medical bulk oxygen system is key.
Messer recommends these four inspections daily:
Messer recommends these activities annually:
Make sure you understand your medical bulk oxygen system. Ask your supplier for training, and to walk you through the components of the system. Messer provides in-service training at the commissioning of a new medical bulk oxygen system and as part of its annual preventative maintenance services. If you have questions or concerns, contact us for a review of your system.
Coming soon, the final entry of our three-part blog series covers piping systems and alarms inside the healthcare facility, to help you identify and remove potential bottlenecks from your oxygen delivery system.