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 neglected.
A sudden increase in the consumption of medical gases, equipment breakdown due to operation outside of the manufacturer's 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 inputs or interrupted procedures;
- Lack of operational 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 raise awareness of the main critical operational failures in hospital infrastructure, highlighting the most common problems and their potential 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 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 cascade of larger, 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 aging infrastructure, both the steam and medical oxygen piping were painted the same color—green. Convinced he was working on the correct piping, the technician closed a valve, unaware that he was, in fact, interrupting the supply of vital medical oxygen to the Intensive Care Unit (ICU).
The problems identified during this incident were numerous and alarming. First, the lack of a clear distinction between the steam and oxygen pipelines led to initial human error. Second, the lack of a monitoring system that could quickly identify the failure and alert those responsible worsened the situation. When alarms began sounding due to the lack of oxygen, the clinical engineering team struggled to identify the source of the problem, as the main and reserve tanks appeared to be normal. The complexity of the hospital infrastructure, with pipelines extending across vast and remote areas, made locating the point of failure even more challenging.
The consequences of this incident were tragic. The interruption in the oxygen supply resulted in the cessation of ventilators in the ICU, putting patients' lives at immediate risk. The medical team had to resort to 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 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 service efficiency and patient safety. Among the most common issues are oversized compressors, electrical failures in gas blenders, and challenges managing clinical vacuum, as well as fluctuations in oxygen demand. Each of these issues can lead to significant disruptions to hospital operations, causing treatment delays and putting patients' lives at risk. Understanding and mitigating these issues is essential to maintaining a safe and efficient hospital environment. Let's quickly review 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 higher capacity than required for the hospital's current demand, it tends to operate in off-peak mode for long periods and in on-peak mode for short periods. This inadequate operating cycle can cause premature wear on compressor components, leading to frequent failures and shortening the equipment's lifespan. Furthermore, operating in off-peak 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 to ensure efficient and sustainable operations.
Electrical Failures in Gas Mixers
Gas blenders are essential for providing a precise mixture of oxygen and nitrogen, creating the 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 blender, interrupting the synthetic air supply and forcing the hospital to rely on backup cylinders, which may not be sufficient in cases of high demand. Recovering from these failures often requires manual intervention by technicians, who can 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 to several hospital operations, including removing patient secretions and performing 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 clinical vacuum management 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 issues.
Increased Oxygen Demand and Logistical Challenges
In a hospital setting, oxygen demand 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 hospital supply systems, which may not be prepared to handle such peaks in consumption. 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 situations of high demand. In remote regions or during extreme weather events such as floods, refilling oxygen tanks can be severely hampered. Failure to ensure timely refilling can lead to critical situations, where oxygen reserves are reduced to dangerously low levels.
Humidity Problems and Maintenance of Gas Filters
The presence of moisture in the hospital gas network is primarily caused by water vapor condensation due to temperature variations within the pipes, water infiltration through sealing failures and inadequate connections, and saturation of moisture filters that are not maintained or replaced regularly. Furthermore, faulty 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 incoming air to 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.
Impact of Stress on Decision Making
Stress has a significant impact on judgment and decision-making, especially in high-pressure environments like hospitals. Studies show that in situations of extreme stress, such as medical emergencies, people's cognitive ability 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, delayed crisis response, and, in severe cases, put patients' lives at risk.
Conclusion
In this article, we explore the critical operational challenges faced by hospitals, particularly related to the management of medical gas systems. Through the study of a serious incident at a São Paulo hospital, we highlight how human error and the lack of adequate means of operational diversion can lead to catastrophic consequences.
Issues such as compressor oversizing, electrical failures in gas mixers, and difficulties in clinical vacuum management 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 address the main causes of this moisture, including vapor condensation, infiltration, and failures in drying and filtration systems. Furthermore, we highlight how stress negatively impacts healthcare professionals' decision-making ability.
With so many risks, how can we avoid these events?
To learn more about how to address these challenges and ensure the safety and efficiency of hospital operations, download our “Intelligent Hospital Infrastructure Management” brochure.
This comprehensive resource offers insights and practical strategies to help maintain a safe and efficient hospital environment. Don't miss the opportunity to transform your hospital's infrastructure management.
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