Medical Gases and their associated equipment are widely used for treating patients in hospitals, at home, and by the emergency services.
Many BCGA member companies are licensed by the Regulatory Authorities to manufacture and distribute the medical gases used within the UK and provide a range of associated equipment and services. Within BCGA, all aspects of medical gases are managed by Technical Sub-Committee (TSC) 7.
All medical gases and some of the associated equipment used are highly regulated by European Directives and UK legislation. The gases are classified as medicinal products for administration to a patient and the associated equipment is classified as a medical device when used to administer the gas.
Although medical gases are very similar to non-medical gases; like other medicinal products they need to have a Marketing Authorisation (product licence) in order to be sold. The Marketing Authorisation defines when a gas can be used and how it should be administered to a patient. Only medical gases with an appropriate licence should be prescribed for the treatment of patients
Note: Medical gases are not to be used for non-medical purposes.
Medical gases are classified as a medicine and, as such, they shall always be managed and controlled by a Pharmacist. When medical gases are delivered to the medical facility where they are to be used they are to be delivered to and be under the management of the site Chief Pharmacist. Each site shall have a suitable storage area with appropriate security provision. All personnel required to handle, move or use medical gases shall have received appropriate information, instruction, training and, as required, be under supervision. The Chief Pharmacist shall provide written policies and Standard Operating Procedures for the management and safe use of all aspects of medical gas supply and administration.
As with all medicines, medical gases have a defined shelf life which is specified within the relevant Marketing Authorisation. Each cylinder will have a label that will show the expiry date as well as the batch number of the medicinal product. Do not use medical gases once this shelf life has expired; upon expiry the cylinder should be returned back to the owner (normally the gas supplier).
Some equipment such as medical gas regulators, demand valves and medical gas flow meters, that are associated with the administration medical gases, are classified as medical devices. European Medical Devices Directives 93/42/EC (as amended) covers the placing on the market and the putting into service of medical devices. Medical devices carry a CE marking that is the manufacturer's declaration that the equipment complies with the Essential Requirements of the relevant Medical Devices Directive.
The Medicines and Healthcare products Regulatory Agency (MHRA) is an Executive Agency of the Department of Health and Social Care. The MHRA protects and promotes public health and patient safety by ensuring that medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness, and are used safely.
Any organisation that wishes to manufacture medical gases must have a Manufacturer's Authorisation issued by the MHRA for the manufacture of medical gases. The organisation is required to comply with the basic principles and practices of Good Manufacturing Practice (GMP) and Good Distribution Practice (GDP) as laid down in the relevant European Guidelines.
For information on GDP refer to BCGA GN 32
Any organisation that does not hold a Manufacturer's Authorisation or wishes to provide and distribute medical gases that they have not manufactured must have a Wholesale Dealer's Authorisation issued by the MHRA. The organisation is required to comply with the basic principles and practices of Good Distribution Practice as laid down in the relevant European Guidelines.
Any organisation that wishes to manufacture medical devices must conform to the requirements laid down in the relevant Medical Device Regulations and must be registered with the MHRA or another European Competent Authority.
All Medical Gas Pipeline Systems (MGPS), which includes vacuum systems, and Dental Air and their Vacuum Systems (DAVS) are to be compliant with the standards required by the Department of Health and Social Care. Compliance is required, for example, with:
a. Health Technical Memorandum (HTM) 02 - Medical Gas Pipeline Systems
b. HTM-2022 Supplements:
- Dental Compressed Air and Vacuum.
- Medical Gas Systems for Ambulances.
- Pressure Systems Safety Regulations.
In a gas cylinder, medical gases are stored under pressure and they should always be handled and used with care, in particular they should not be exposed to fire.
All staff who handle or use gases shall be competent to do so, including being appropriately trained in the safe handling of gas cylinders, the safe use of gases, as well as the safe use of any associated equipment.
Gas cylinders are also frequently stolen, both for the value of the materials they are made from and for their contents. This is particularly true of medical gases.
When not in immediate use gas cylinders should be kept in a secure, well ventilated store, away from any sources of ignition. For more information refer to BCGA CP 44, The storage of gas cylinders.
The primary objective of BCGA TSC7 is to safeguard patients by ensuring that all products provided by BCGA member companies are safe to use and fit for their intended purpose. This is achieved by promoting safety, producing best practice guidance, liaising with the MHRA and other government departments and participating in relevant standard work.
One particular concern continues to be the safe use of medical oxygen, especially when used in the domiciliary environment.
WARNING: The careless use of medical oxygen, especially in a confined space, can result in oxygen enrichment of that space, leading to an increased risk of fire. Do not smoke or use naked flames close to oxygen. The BCGA also advise against the use of electronic cigarettes, or other electronic devices such as mobile phones, whilst undergoing oxygen therapy as they are a potential source of ignition.
BCGA members interested in medical gases and their associated equipment should consult the webpage for TSC7 located in the member's area. The following documents are available within the publications section and are free to download:
- BCGA CP 44 - The storage of gas cylinders.
- BCGA GN 26 - Medical gases. Selection and maintenance of seals used on high pressure cylinders.
- BCGA GN 29 - Medical gases. The management of medical oxygen in domiciliary use.
- BCGA GN 31 - Medical gases. The use of valves incorporating residual pressure devices.
- BCGA GN 32 - Medical gases. Good distribution practice.
- BCGA GN 37 - Medical gases. Data integrity
- BCGA GN 39 - Medical Gases. Responsible person
- BCGA GN 40 - Medical gases. Quality management systems. Corrective and preventative actions
- BCGA L 7 - The dangers of industrial gas abuse.
- BCGA L 13 - Medical gases. Medical oxygen in a vehicle.
- BCGA L 16 - The safe use of electronic cigarettes and other electronic devices used near medical oxygen.
- BCGA TIS 6 - Gas cylinder identification. Label and colour coding requirements.
- BCGA TIS 20 - Medical gases. BCGA policy on colour coding.
- BCGA TIS 21 - Medical gases. BCGA policy on valve outlets.
- BCGA TIS 36 - Medical gases. The safe handling and use of gas cylinders fitted with valves with integrated pressure regulators.
- BCGA TIS 37 - Medical gases. Gas cylinder cleanliness standards.
- BCGA TIS 39 - Medical gases. Quality control and QP batch certification of bulk medical liquid oxygen.
- BCGA TIS 42 - Medical gases. Data integrity policy
EIGA held an oxygen safety workshop in January 2012. The following presentations may be of interest:
Medical gas service providers
Many BCGA member companies can provide services related to medical gases. See full list here.
- The Human Medicines Regulations 2012 (SI 2012:1916)
- Medicines & Healthcare Products Regulatory Agency (MHRA)
- MHRA - Good Manufacturing Practice (GMP) & Good Distribution Practice (GDP), - Good Manufacturing Practice - Data integrity definitions and guidance, - Medical Devices regulation and safety, - Good Pharmacovigilance Practice for Medicines (GPvP)
- European Medicines Agency (EMA) - Good Pharmacovigilance practices (GVP)
- EMA - Good Manufacturing Practice (GMP) & Good Distribution Practice (GDP)
- European Commission - EU Legislation - Eudralex, European Commission & Eudralex -GMP Guidelines
- European Commission - Good Distribution Practice Guidelines, Questions & Answers, Medicinal Products for human use, Medical Devices, Medical Devices - Guidance
- Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme (PIC/S)
- PIC/S - Inspection of Medicinal Gases Facilities
- USA - Food and Drug Administration (FDA) - Drugs, Medical devices, About the FDA and Medical gases
- World Health Organisation (WHO) - Medicines and health products, Training Modules.
- The International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH)
- The International Medical Device Regulators Forum (IMDRF)
- IMDRF - Quality systems - Corrective action and preventative action (CAPA)
- The Health Products Regulatory Authority (HPRA)
- HPRA - Guidance documents, Reporting of quality defects in medicinal products.
- NHS Protect - Guidance on the security and storage of medical gas cylinders
- The Association for Anaesthetic and Respiratory Device Suppliers - (Barema)
- The Association of Anaesthetists of Great Britain and Ireland - (AAGBI)