Efficiency and safety are essential pillars in the operation of hospitals, 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 neglected.
The sudden increase in the consumption of medical gases, equipment failure due to operation outside of manufacturer recommendations, dynamic resizing of supply systems, and unnecessary or emergency maintenance are just some examples of situations that can generate risks such as:
- Risk to patients' lives;
- Inefficiency and unnecessary expenses;
- Legal proceedings due to lack of supplies or interrupted procedures;
- Lack of operational documentation for inspections, audits, and legal defenses;
- Difficulty in decision-making due to a lack of historical data.
The aim of this article is to highlight the main critical operational failures in hospital infrastructure, emphasizing the most common problems and their potential consequences. By understanding these challenges, healthcare professionals and hospital managers can take proactive steps to minimize risks and ensure the safety and efficiency of hospital operations.
Case Study: Incident at 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 and more critical problems. A maintenance technician was called to perform an operation on the hospital's steam piping network. Due to the complexity and lack of standardization of the old infrastructure, both the steam and medical oxygen piping were painted the same color, green. Convinced that he was working on the correct piping, the technician closed a valve, without realizing that he was actually interrupting the supply of vital medical oxygen to the Intensive Care Unit (ICU).
The problems identified during this incident were numerous and alarming. Firstly, the lack of a clear distinction between steam and oxygen piping led to the initial human error. Secondly, the absence of a monitoring system that could quickly identify the fault and alert those responsible exacerbated 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 appeared to be normal. The complexity of the hospital infrastructure, with piping extending across vast and remote areas, made locating the point of failure even more challenging.
The consequences of this incident were tragic. The interruption of the oxygen supply resulted in the failure of the ventilators in the ICU, immediately endangering the lives of patients. The medical team had to resort to portable oxygen cylinders, manually transporting them to the patients, which took several hours and demanded 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 the human losses, the hospital faced an operational and reputational crisis.
Common Operational Problems in Hospital Infrastructure Management
Hospitals face a number of operational challenges that can compromise the efficiency of services and patient safety. Among the most frequent problems are oversized compressors, electrical failures in gas mixers, and challenges in managing clinical vacuum, in addition to variations in oxygen demand. Each of these problems can lead to significant disruptions in hospital operations, causing delays in treatment and endangering patients' lives. Understanding and mitigating these problems are essential to maintaining a safe and efficient hospital environment. Let's briefly analyze each of these problems.
Oversizing of Compressors
A common operational problem in hospitals is the oversizing of medical gas compressors. When a compressor is sized for a greater capacity than is needed 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 equipment's lifespan. Furthermore, operating in relief mode can result in wasted energy, increasing the hospital's operating costs. Therefore, it is crucial to properly size compressors for the hospital's current and future demand, ensuring efficient and sustainable operation.
Electrical Faults in Gas Mixers
Gas mixers are essential for providing a precise mixture of oxygen and nitrogen, creating synthetic air necessary for various medical applications. However, these devices are vulnerable to electrical faults, such as voltage spikes or power outages. An electrical fault can disable the mixer, interrupting the supply of synthetic air and forcing the hospital to resort to backup cylinders, which may not be sufficient in cases of high demand. Recovery from these faults usually requires manual intervention by technicians, who may take a long time 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 the removal of secretions from patients and the performance of surgical procedures. Any failure in this system can paralyze these operations, resulting in treatment delays and increasing the risk of complications for patients. One of the most common challenges in managing clinical vacuum is filter clogging, which occurs due to the accumulation of particles and liquids aspirated during operations. If not properly monitored and maintained, these filters can become saturated and clogged, reducing system efficiency and potentially causing complete failure. Furthermore, failures in 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 setting, the demand for oxygen can increase suddenly and unexpectedly due to events such as medical emergencies, respiratory disease outbreaks, or accidents that result in a large number of patients requiring ventilatory support. These sudden increases in oxygen demand challenge the capacity of the hospital's supply systems, which may not be prepared to handle such consumption peaks. When demand exceeds supply capacity, there can be a significant drop in pressure in the oxygen distribution systems, compromising patient care and putting lives at risk.
In addition to technical challenges, oxygen supply logistics become critical in situations of high demand. In remote regions or during extreme weather events, such as floods, replenishing oxygen tanks can be severely hampered. Failure to ensure timely replenishment can lead to critical situations where the autonomy of oxygen reserves is reduced to dangerously low levels.
Humidity Problems and Maintenance of Gas Filters
The presence of moisture in hospital gas systems is mainly caused by condensation of water vapor due to temperature variations within the pipes, water infiltration through faulty seals and inadequate connections, and saturation of moisture filters that are not maintained or replaced regularly. Furthermore, 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 supplied air.
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 on the system.
The Impact of Stress on Decision Making
Stress has a significant impact on judgment and decision-making abilities, especially in high-pressure environments such as hospitals. Studies show that in situations of extreme stress, such as medical emergencies, people's cognitive capacity can be reduced by up to 50%. This occurs 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 severe cases, putting patients' lives at risk.
Conclusion
In this article, we explore the critical operational challenges faced by hospitals, especially those related to the management of medical gas systems. Through the study of a serious incident in a São Paulo hospital, we highlight how human error and the absence of an adequate means of diverting the operation can lead to catastrophic consequences.
Problems such as compressor oversizing, electrical failures in gas mixers, and difficulties in managing clinical vacuum were addressed, highlighting 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 addressed the main causes of this moisture, including vapor condensation, leaks, and failures in drying and filtration systems. Furthermore, we highlighted 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 meet these challenges and ensure the safety and efficiency of hospital operations, download our "Intelligent Hospital Infrastructure Management" catalog.
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