This can be achieved by an integrated pressure gauge, individual signaling or separate group signaling (for bottles stored together). In the past, some accreditation bodies have recommended separation or signage to meet the requirement « promptly ». Section 11.6.5.2 of NFPA 99 requires that empty and full cylinders be separated when stored in the same housing. First, a new FAQ in Chapter EC deals with the storage of oxygen cylinders. Undoubtedly, this FAQ is surprising because it changes several years of TJC`s consistent direction to oxygen cylinder storage. Indoor enclosures equivalent to 3,000 cubic feet of gas storage shall be ventilated with natural or mechanical exhaust gases in accordance with section 5.1.3.3.3 of NFPA 99. When using the natural ventilation option, section 9.3.7.5.2 of NFPA 99 requires that there be two non-resealable fin openings, each with 24 square inches of opening, for every 1,000 cubic feet of gas to be stored in the enclosure. Other considerations. Other general requirements of NFPA 99 when handling oxygen cylinders include: the use of cylinders in the order in which they were received; and protection of cylinders from contact with oil or grease or dirt/dust contamination and according to the requirements of the Compressed Gas Association (CGA) G-4, oxygen.

If oxygen cylinders are stored outside, the tank shall be made of non-combustible or partially non-combustible materials with at least two inlets/outlets. If cylinders are stored indoors, the housing must be equipped with a one-hour fire protection course, including 60-minute opening protection devices (e.g., doors, shutters or other penetrations). But this FAQ reverses that orthodoxy. The guidelines now state: « Vials defined as empty by the organization should be separated from all other cylinders intended for patient use. Full and partially full bottles can be stored together. In the past, TJC has asked hospitals to store full oxygen cylinders separately from those that were not full. In this case, the less-than-full cylinders included both partial and empty cylinders. See EC News December 2012 and EC News February 2014. Enclosures shall be designed in such a way that handcarts or trolleys provide access to bottles and equipment in and out of space and that access to the space (e.g. doors, gates or other methods) is secure. Cylinders can be stored outdoors in a housing or in an enclosed interior in a non-flammable or limited fuel construction with doors to be attached. When storing oxygen cylinders outdoors, NFPA 99 Section 11.6.5.4 requires weather protection, including water, snow and ice accumulation, to prevent rust and extreme temperatures.

A cover/roof for the outer enclosure, as well as some separation between the floor and cylinders, are often useful to meet these requirements. Similarly, section 11.3.3.4 addresses cylinders that are made available to patients for immediate use in patient care areas (e.g., a single cylinder in a patient room) that are secured to prevent tipping or damage, and that are also considered to be in use. CMS confirmed this position in a memorandum (S&C-07-10) in January 2007. Other oxygen cylinders that do not fit any of the descriptions described above are considered warehouses. Although not considered a combustible gas, oxygen is an oxidizing agent, which means that it accelerates a fire when introduced to a higher content than in air (the normal oxygen content in air is 21%). However, shelves and signs need to be adapted to meet the new requirements of the Joint Commission (JCT). New strategies and staff retraining may also be needed. Although NFPA 99 does not specifically address partial cylinders, the Joint Commission (JCC) provides some guidance in this area. They allow an organization to perform a risk assessment that results in a policy that specifies how the organization identifies and stores partial cylinders. If the organization deems it appropriate to store solid and partial bottles together in the same case, TJC will allow this as long as it is specified in hospital policy. If heat is needed for the room, indirect means are needed (for example, steam or hot water). The housing must be equipped with racks, chains and/or other fasteners to protect all cylinders from falling.

All shelving, shelves or housing supports must be made of non-flammable materials or only to a limited extent. Temperature control is required as described above in enclosures of less than 3,000 cubic feet. Regulations for oxygen cylinders are based on the volume of gas present (expressed in cubic feet in the United States). As expected, the more gas, the more requirements apply. Protective fabric, which is sometimes intended to protect cylinders during transport, must be removed if it is considered flammable. Cylinders must also not be stored with flammable gases, liquids or vapour. In addition, healthcare facilities often store and use many other non-flammable, oxidizing and flammable gases that require special attention. While an increase in the storage volume of oxygen cylinders comes with increased requirements, adding other medical gases in the same housing is often also involved. Other general cylinder safety precautions described in NFPA 99 also apply, including rollover or damage protection. Section 11.3.4.2 of NFPA 99 also requires precautionary signage indicating the presence of oxidizing gases that can be read at a distance of 5 feet on each door of the enclosure. Additional signalling may be required for other medical gases that may be present in the enclosure.