Until 2010 provision of medical oxygen to medical institutions (hereinafter – MPI) of Zaporizhzhya City was carried out in the standard oxygen cylinders (weight with gas – 90 kg, capacity – 40 L, pressure – 150 bar or 15 MPa) connected to the ramp. Annual demand for oxygen in one health facility was around 120-150 cylinders, and in all 12 health facilities of urban governance on health, which use medical oxygen, annually it was used about 10 thousand cylinders.
What are the difficulties and dangers in this “cylinder” system of oxygen supply?
Ideally, a health institution interested in only the oxygen, but in order to ensure its delivery, it was necessary to have a sufficient number of its own tanks, care for their maintenance in good repair and provide technical examination. It was also necessary to prepare the vehicle for the carriage of dangerous goods, it regularly inspection and permission to route this traffic. For heavy loading / unloading manually, there were at least two workers. Relatively small volume of each cylinder driven by the need for the daily operations of their connection / disconnection and internal displacement ramp, and constantly adjust the oxygen supply to maintain the pressure in the network at a given level. And above all the above types of work prevailed potential explosion hazard due to the high pressure of oxygen gas in the tank (150 bar or 15 MPa), as well as its powerful oxidant properties.
What would result from non-compliance with the existing rules for handling oxygen cylinders is well known for example, the explosion of cylinders in Lugansk city hospital № 7 in January 2010, when 16 people died. Occupational health service professionals and other management services for the health of the city council, chief physicians of medical institutions of Zaporozhye, using medical oxygen, carefully studied all the existing options for the latter, compare, compare. It was necessary to find the most safe, comfortable and advanced process flow supply medical oxygen. Read the letter Gosgorpromnadzora to strengthen monitoring of the safety in hospitals, the adoption of measures for safe use of oxygen tanks, adoption of safety technologies supply of oxygen. No time for advice in terupravleniya Gosgorpromnadzora in Zaporizhia region. Joint efforts were found the optimal solution to this problem. In addition to the above flowsheet oxygen supply “of the bottle,” there are two “of the gasifier” and “from the hub.” But the last of these flow charts prohibited DSTU. Thus, determining the direction of the search – supply of medical oxygen in the technological scheme “from the gasifier.” Next it was necessary to examine in detail the list of companies working in this field, and the range of services they offer.
As a result of this work Zaporozhian physicians chose the firm “Kriogenservis” (Kiev), which has extensive experience of delivery and the safe use of oxygen in medical institutions of Ukraine. To do this, it uses the so-called kriotsilindry. Each kriotsilindr – is a cryogenic vessel made of stainless steel, which is filled with liquid oxygen. Its diameter – 505 mm, height – 1530 mm. He was placed in a steel container obreshechenny on wheels, which greatly facilitates the movement of the floor space кислороднораспределительной station (hereinafter – the cattle). This self-contained unit is equipped with a cryogenic vacuum-screen insulation and equipped zapornoreguliruyuschey valves, level, economizer control devices, control system and maintain the pressure. Pressure relief valve, which is equipped with kriotsilindr, is designed to protect the vessel against excess pressure above the set (triggered at 16 bar or 1.6 MPa). The second device – bursting disc which open at 25 atm (2.5 MPa) when in an emergency situation, for some reason does not work safety valve. With built-in hardware liquid oxygen passes into the gaseous state at a given operating pressure of 14 atm (1.4 MPa). On gas volume one brand kriotsilindr DPL450 175 equivalent twenty-two 40-liter oxygen cylinder.
The firm “Cryogenservice” provided to LPU 26 Cryocylinders in Zaporozhye (22 of them – free of charge under the contract for their custody and maintenance) in containers and charging hose. Kriotsilindry installed in the premises of cattle. But unlike the cylinders, they do not need to carry a gas station, because they manage to refuel directly on the ramp from the station of a special vehicle of the firm. In addition, “Kriogenservis” provides the full range of services for the creation of medical gas supply systems, such as the provision of modern equipment, maintenance systems, life support systems engineering, commissioning and repair, free development of operational documentation, complete installation of centralized medical gas and free training personnel on safety when working with kriotsilindrami. Thus, starting in October 2010, the firm provides twelve LPU Zaporozhye medical oxygen in the technological scheme “from kriotsilindrov.”
According to experts of occupational health services management on health Zaporizhzhya City Council, the transition of 12 health facilities at that flow chart will provide a substantial increase in the level of security of supply medical oxygen better through:
- avoid manual operations of loading / unloading of oxygen cylinders and transportation motor vehicle;
- a 22-fold reduction in the number of transactions and the time the connection / disconnection of vessels to / from network kislorodoobespecheniya for cattle;
- more than 10-fold reduction in the initial pressure of oxygen in the blood vessels;
- reduce the area occupied by the ramp-filled and empty vessels (kriotsilindr is about 15 times less than 20 bottles);
- having safety valves, bursting discs and reducing devices on each kriotsilindre;
- presence Bole perfect system to ensure stability of oxygen pressure in the network;
- kriotsilindrov greater stability, eliminating the need to take action against them tipping.
In addition, there are institutional and economic factors that also favor the technological scheme LPU medical oxygen supply “of kriotsilindrov.” There is no need to prepare a special vehicle for the transport of dangerous goods in the regular conduct of its inspection, the permit for the route of the carriage. Reducing labor costs for manual loading / unloading operations and adjusting it possible to optimize the number of workers. The complexity of operating vessels decreased by 20 times. More than 7-10 times the cost of decreased oxygen delivery. For example, it is estimated maternity hospital № 3 the cost of 1 kg of medical oxygen decreased by more than 2 UAH., And the total cost for the year related to its delivery in a medical institution, decreased by more than 55 thousand UAH.
Therefore, make your experience on the safety and feasibility of low-gasifier – kriotsilindrami, leadership, management specialists on health Zaporizhzhya City Council, as well as its chief physicians of hospitals and maternity homes are confident that they will receive in 2013 the necessary financial support for their initiatives related to new technological scheme of health facilities providing medical oxygen “from kriotsilindrov.” And they are deeply convinced that we should introduce this technological scheme and other medical institutions of Ukraine.
Oleg Moiseenko, correspondent of “HSE” , www.ohoronapraci.kiev.ua
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