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British Journal of Healthcare and Medical Research - Vol. 11, No. 6
Publication Date: December 25, 2024
DOI:10.14738/bjhmr.116.17970.
Altinawi, A., Javed, R., Abdulwahed, A. S., & Alqahtani, M. (2024). Compliance of Hospitals in Saudi Arabia with National and
International Medical Gas Pipeline System Maintenance Guidelines. British Journal of Healthcare and Medical Research, Vol - 11(6).
217-222.
Services for Science and Education – United Kingdom
Compliance of Hospitals in Saudi Arabia with National and
International Medical Gas Pipeline System Maintenance
Guidelines
Amir Altinawi
Department of Biomedical Technology,
College of Applied Medical Sciences,
King Saud University, Riyadh, Saudi Arabia
Ravish Javed
Department of Biomedical Technology,
College of Applied Medical Sciences,
King Saud University, Riyadh, Saudi Arabia
Abdullah Salem Abdulwahed
Department of Biomedical Technology,
College of Applied Medical Sciences,
King Saud University, Riyadh, Saudi Arabia
Mahdi Alqahtani
Department of Biomedical Technology,
College of Applied Medical Sciences,
King Saud University, Riyadh, Saudi Arabia
ABSTRACT
The aim of this study has two folds. Firstly, to investigate the extent to which
hospitals in Saudi Arabia adhere to CBAHI (Saudi Central Board for Accreditation of
Healthcare Institutions) standards regarding maintenance of medical gas pipeline
systems (MGPS). Secondly, to determine if different hospitals implement the MGPS
check-points required by CBAHI in a similar manner with respect to timeframe of
performing the check-points. A cross-sectional survey was conducted during field
visits to 11 hospitals biomedical engineering offices. A paper-based questionnaire
was developed to collect all the relevant information. The study results showed that
99% of the check-points specified by CBAHI are implemented fully by all the 11
hospitals. There was only one hospital that failed-short of checking the system
alarm of the pipeline system, and another hospital that failed-short of checking for
leak-signs in joints of liquid oxygen plant. There were large variations in time- periods of actually performing the required check-points among hospitals. The
study suggests modification on CBAHI standards regarding maintenance and
operation of MGPS that incorporate timeframe for performing each check-point to
guarantee an efficient and safe MGPS.
Keywords: Saudi Arabia, Medical Gas Pipeline Systems, British Department of Health,
CBAHI.
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British Journal of Healthcare and Medical Research (BJHMR) Vol 11, Issue 06, December-2024
Services for Science and Education – United Kingdom
INTRODUCTION
The medical gas pipeline system (MGPS) plays a fundamental and pivotal role in the efficient
delivery of healthcare in hospitals as a reliable supply of medical gases in operating theaters,
intensive care wards, patient rooms and outpatient clinics (1-4). Oxygen, nitrous oxide, medical
air and vacuum are crucial for various medical procedures (5). To ensure patient safety in the
hospital, and a constant dependable supply of medical gases throughout the hospital clinical
spaces, the design and installation of the medical gas pipeline system must comply with strict
design standards and regulations (6-8), whether in relation to the nature of the gases present
in each clinical space, the pressure of the gases in the pipeline system, outlet flow, or even other
design aspects in the gas station.
In addition, the operation and maintenance of the MGPS are also subject to specific standards
and guidelines adopted by regional and international regulatory health authorities with the aim
to unify the mechanism for ensuring the readiness and safety of the medical gas network with
the intention of reducing the risk of cross-contamination, gas leaks and shortage, and other
risks that could compromise patients’ comfort, safety and care (9-11). Moreover, equipping the
MGPS with advanced real-time monitoring systems of gas pressure and levels may reduce
catastrophic health complications (12-16) and ensure that the MGPS functions correctly and
delivers the appropriate gas dose to the patient (17-21).
In Saudi Arabia, the governmental body responsible for setting guidelines and standards for
testing and operating the medical gas pipeline system is the Saudi Central Board for
Accreditation of Healthcare Institutions (CBAHI). The CBAHI has developed detailed standards
for steps and point of checks of the MGPS to ensure its proper and reliable operation with no
scheduled timeframe for performing each check point. All government and private hospitals of
all sizes and specialties are obligated to follow these standards and guidelines. One of the
criteria for these hospitals to obtain CBAHI accreditation is their commitment to these
standards for operating, maintaining and inspecting the MGPS.
The aim of this study has two folds. Firstly, to investigate the extent to which hospitals in
Riyadh, Saudi Arabia, adhere to these CBAHI standards. Secondly, to determine if different
hospitals implement the MGPS check-points required by CBAHI in a similar manner with
respect to timeframe of performing the check-points. To that extent, this study incorporates the
MGPS of British Department of Health (BDH) guidelines considering that it takes into account a
timeframe of performing the required check points.
METHOD
A cross-sectional survey was conducted during in-person visits to the biomedical engineering
office at Riyadh hospitals, Kingdom of Saudi Arabia. A check-list type paper-based
questionnaire was developed to collect all the information relevant, with the aim of
determining hospitals' level of adherence to MGPS operation and maintenance standards set by
Saudi CBAHI and guidelines set by the BDH. The questionnaire, which includes the purpose and
instructions was handled to the engineering officer responsible in the biomedical engineering
department at the respected hospital. The study covers eleven hospitals in the Riyadh area
three of them are teaching hospitals. As shown in Table 1, the questionnaire contains a check
list of all items required to be checked by the operation and maintenance engineer according to
the Saudi CBAHI standard as well as with the BDH guidelines.
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Altinawi, A., Javed, R., Abdulwahed, A. S., & Alqahtani, M. (2024). Compliance of Hospitals in Saudi Arabia with National and International Medical
Gas Pipeline System Maintenance Guidelines. British Journal of Healthcare and Medical Research, Vol - 11(6). 217-222.
URL: http://dx.doi.org/10.14738/bjhmr.116.17970.
Table 1: The study questionnaire contains a check list of all items required to be
checked according to the Saudi CBAHI standard and with the BDH guidelines.
Checked? Who is
Responsible?
How Often?
Remarks
Yes No
Biomedical
Unit
Contractor
Daily
Weekly
Annually
Other
Pipeline System
(General Tasks)
System Pressure
Pipeline Labeling
Outlet Labeling
System Leaks
System Alarms
Pressure Gauges
Shutoff and Main
Valves
Cylinders’ Leakage
Vacuum Plant Pump Alarms
Plant Panel Alarms
Pump Leakage
Compressed Air Plant Plant Panel Alarms
Compressor Leaks
Dryer Status/Alarms
Purity and Humidity
of Compressed Air
Liquid Oxygen Plant
(if Applicable)
Sings of Leaks in Joints
Vessel Pressure
Plant Output Pressure
Is the Gas Station in a
safe and Secure Place? Yes ☐ No ☐
RESULTS
The questionnaire was filled out by the engineers responsible for MGPS operation and
maintenance in 11 hospitals in the Riyadh region during field visits to these hospitals. Figure 2
shows all the questionnaire data for the 11 visited hospitals. The table shows all the check- points that are required to be implemented according to the Saudi CBAHI standard. The
numbers shown in Table 2 represent number of hospitals that implement each check-point in
the periodic time-period shown.
Table 2: Distribution of the 11 studied hospitals over the actual time-periods at which
the respected MGPS check-point was performed (gray shaded cells). The listed check- points are those required by Saudi CBAHI standard; a standard that does not specify a
time-period for performing each check-point. The bold-bordered cells denote the time- period specified by the BDH guidelines for performing each check-point.
Time-periods of actually performing the
required check-points
Not Checked
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British Journal of Healthcare and Medical Research (BJHMR) Vol 11, Issue 06, December-2024
Services for Science and Education – United Kingdom Daily Weekly Monthly Every 3 Months Every 6 Months Annually
On Delivery
On Modification
On Installation
Randomly
Pipeline System
(General Tasks)
System Pressure 9 1 1
Pipeline Labeling 1 1 4 1 4
Outlet Labeling 2 1 1 3 1 1 2
System Leaks 6 3 1 1
System Alarms 6 3 1 1
Pressure Gauges 6 2 2 1
Shutoff and Main
Valves
4 2 2 2 1
Cylinders’ Leakage 6 5
Vacuum Plant Pump Alarms 7 2 1 1
Plant Panel Alarms 6 1 3 1
Pump Leakage 8 2 1
Compressed Air
Plant
Plant Panel Alarms 7 3 1
Compressor Leaks 9 2
Dryer Status/Alarms 9 2
Purity and Humidity of
Compressed Air
5 1 1
Liquid Oxygen
Plant
Sings of Leaks in Joints 9 1 1
Vessel Pressure 9 1 1
Plant Output Pressure 9 1 1
As for the engineering office responsible for implementing or supervising the implementation
of check-points, the questionnaire showed that 62.1% of the hospitals had assigned these tasks
to the technical engineering staff in the hospital’s biomedical engineering office, while 37.9%
of hospitals had assigned the tasks to an external technical contractor and supervised by the
biomedical engineering office. There was complete consensus in all hospitals that the location
designated for the medical gas station is located, as required by CBAHI, in a safe and secure
place. Regarding the compliance with the CBAHI standards in terms of specific check-points and
the necessity of their implementation; even though CBAHI do not mention specific time-periods
for their implementation, the results of the questionnaire (Table 2) showed that 99% of the
check-points specified by CBAHI are implemented fully by all the 11 hospitals. There was only
one hospital that failed-short of checking the system alarm of the pipeline system, and another
hospital that failed-short of checking for leak-signs in joints of liquid oxygen plant (shown in
rightmost column of Table 2). As for the time-periods at which check-points are implemented,
the questionnaire showed large differences between hospitals, and between hospitals and the
time-periods set by the BDH guidelines. The cells with bold borders in figure 2 show the time- period recommended by the BDH guidelines for implementing each check-point. From the data
shown in Table 2, it appears that only 17.3% of the check-points are implemented according to
the BDH guidelines, while the majority of check-points (82.7%) are implemented at very