Efficiency and safety are essential pillars in hospital operations, where any failure can have serious consequences for patients' lives. The complexity of hospital systems, especially those related to the supply of medical gases, can lead to catastrophic failures if they are neglected.
The sudden increase in the consumption of medicinal gases, the breakdown of equipment due to operations outside the manufacturer's recommendations, the dynamic resizing of supply systems and unnecessary or emergency maintenance are just a few examples of situations that can generate risks such as:
- Risk to patients’ lives;
- Inefficiency and unnecessary expenses;
- Legal proceedings due to lack of inputs or interrupted medical procedures;
- Lack of operation documentation for inspections, audits and legal defenses;
- Difficulty in decision-making due to the lack of historical data.
The objective of this article is to warn about the main critical operational failures in hospital infrastructure, highlighting the most common problems and their possible consequences. By understanding these challenges, healthcare professionals and hospital managers can take proactive measures to minimize risks and ensure the safety and efficiency of hospital operations.
Case Study: Incident in a Hospital in São Paulo
In the heart of São Paulo, a serious incident at a hospital highlighted how a relatively simple maintenance need can lead to a sequence of larger, critical problems. A maintenance technician was called to carry out an operation on the hospital's steam piping network. Due to the complexity and lack of standardization of old infrastructures, both the steam and medical oxygen piping were painted the same color, green. Convinced he was operating on the correct piping, the technician closed a valve, not realizing he was actually cutting off the supply of vital medical oxygen to the Intensive Care Unit (ICU).
The issues identified during this incident were numerous and alarming. Firstly, the lack of clear distinction between the steam and oxygen pipes led to the initial human error. Secondly, the absence of a monitoring system that could quickly identify the failure and alert those responsible worsened the situation. When alarms began to sound due to a lack of oxygen, the clinical engineering team faced difficulties in identifying the source of the problem, as the main and reserve tanks were apparently normal. The complexity of the hospital infrastructure, with pipes stretching across vast and remote areas, made locating the point of failure even more challenging.
The consequences of this incident were tragic. The interruption of oxygen supply resulted in the stoppage of lung ventilators in the ICU, putting patients' lives at immediate risk. The medical team had to use portable oxygen cylinders, manually transporting them to the patients, which took several hours and required significant physical and logistical effort. Unfortunately, this delay resulted in the death of one patient and injuries to others who did not receive oxygen in time. In addition to human losses, the hospital faced an operational and reputational crisis.
Common Operational Problems in Hospital Infrastructure Management
Hospitals face a series of operational challenges that can compromise the efficiency of services and patient safety. Among the most frequent problems are the oversizing of compressors, electrical failures in gas mixers and challenges in clinical vacuum management, in addition to variations in oxygen demand. Each of these issues can lead to significant disruptions to hospital operations, causing delays in treatments and putting patients' lives at risk. Understanding and mitigating these issues is essential to maintaining a safe and efficient hospital environment. Let's quickly look at each of these issues.
Compressor Oversizing
A common operational problem in hospitals is the oversizing of medical gas compressors. When a compressor is sized for a capacity greater than that required for the hospital's current demand, it tends to operate in relief mode for long periods and in load mode for short periods. This inadequate operating cycle can cause premature wear of compressor components, leading to frequent failures and reducing the useful life of the equipment. Furthermore, operation in relief mode can result in wasted energy, increasing the hospital's operating costs. Therefore, it is crucial to size the compressors appropriately for the hospital's current and future demand, ensuring efficient and sustainable operation.
Electrical Failures in Gas Mixers
Gas mixers are essential for providing a precise mixture of oxygen and nitrogen, creating synthetic air needed for various medical applications. However, these devices are vulnerable to electrical failures such as voltage spikes or power outages. An electrical failure can disable the mixer, interrupting the supply of synthetic air and forcing the hospital to rely on reserve cylinders, which may not be sufficient in cases of high demand. Recovering from these failures often requires manual intervention by technicians, who can be slow to arrive, especially if the hospital is located in a remote area.
Problems in Clinical Vacuum Management
The clinical vacuum system is vital for various hospital operations, including removing secretions from patients and performing surgical procedures. Any failure in this system can paralyze these operations, resulting in delays in treatments and increasing the risk of complications for patients. One of the most common challenges in clinical vacuum management is filter clogging, which occurs due to the accumulation of particles and liquids aspirated during operations. If not monitored and maintained properly, these filters can become saturated and clog, reducing system efficiency and potentially causing complete failure. Furthermore, failures in the vacuum compressors, which are responsible for maintaining the necessary negative pressure, can occur due to mechanical or electrical problems.
Increased Oxygen Demand and Logistical Challenges
In a hospital environment, the demand for oxygen can increase suddenly and unexpectedly due to events such as medical emergencies, outbreaks of respiratory diseases or accidents that result in a large number of patients requiring ventilatory support. These sudden increases in oxygen demand challenge the capacity of hospital supply systems, which may not be prepared to handle such consumption spikes. When demand exceeds supply capacity, there can be a significant drop in pressure in oxygen distribution systems, compromising patient care and putting lives at risk.
In addition to the technical challenges, oxygen supply logistics become critical in high demand situations. In remote regions or during extreme weather events such as floods, refilling oxygen tanks can be severely hampered. Failure to ensure timely refueling can lead to critical situations where oxygen reserve autonomy is reduced to dangerously low levels.
Humidity Problems and Maintenance of Gas Filters
The presence of humidity in the hospital gas network is mainly caused by the condensation of water vapor due to temperature variations within the pipes, water infiltration through failed seals and inadequate connections, and by the saturation of humidity filters that are not maintained. or replaced regularly. Additionally, failures in air dryers, which are essential for removing moisture from compressed air, can allow moisture to remain in the system, compromising the quality of the air supplied.
Another critical factor is the quality of the air entering the compression system. If the incoming air is too humid, it can overload the drying and filtration systems, allowing moisture to enter the distribution network. Extreme environmental conditions, such as high relative humidity in tropical regions or during periods of humid weather, can also increase the moisture load in the system.
Impact of Stress on Decision Making
Stress has a significant impact on judgment and decision-making, especially in high-pressure environments such as hospitals. Studies show that in extreme stress situations, such as medical emergencies, people's cognitive ability can be reduced by up to 50%. This is because intense stress triggers a “fight or flight” response in the body, prioritizing instinctive actions over logical and critical thinking. In a hospital, this can result in hasty or incorrect decisions, delays in responding to crises and, in serious cases, put patients' lives at risk.
Conclusion
In this article, we explore the critical operational challenges faced by hospitals, especially related to the management of medical gas systems. Through the study of a serious incident in a hospital in São Paulo, we highlight how human error and the absence of an adequate means of diverting the operation can lead to catastrophic consequences.
Problems such as oversizing of compressors, electrical failures in gas mixers and difficulties in managing clinical vacuum were addressed, showing the need for constant attention to mitigate these risks. Moisture in the gas network, with its potential to damage equipment and cause microbiological contamination, is also a significant challenge. We address the main causes of this humidity, including vapor condensation, infiltrations and failures in drying and filtration systems. Furthermore, we highlight how stress negatively impacts the decision-making capacity of healthcare professionals.
With so many risks, how can we avoid these events?
To learn more about how to face these challenges and ensure the safety and efficiency of hospital operations, download our “Intelligent Management of Hospital Infrastructure” catalog.
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