NHS WALES Estates and Facilities Alert

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WG EFA 2011 007 NHS WALES Estates and Facilities Alert Date: 19 December 2011 Cathays Park, Cardiff CF10 3NQ Parc Cathays, Caerdydd CF10 3NQ Electrolux (Dometic) absorption pharmacy / drug

information is given in the Alert Estates and Facilities Alerts are agreed by NHS representatives and issued throughout the United Kingdom The Alert is endorsed by the Welsh Government as being

1 WG EFA NHS WALES Estates and Facilities Alert Date: 19 December 2011 Cathays Park, Cardiff CF10 3NQ Parc Cathays, Caerdydd CF10 3NQ Electrolux (Dometic) absorption pharmacy / drug refrigerators, all models To: Chief Executives, LHBs Chief Executives, NHS Trusts NHS Wales Shared Services Partnership - Contractor Services A list of people who need to have early sight of this information is given in the Alert Estates and Facilities Alerts are agreed by NHS representatives and issued throughout the United Kingdom The Alert is endorsed by the Welsh Government as being relevant to NHS Wales and is issued by: Neil Davies, Assistant Director, NHS Wales Shared Services Partnership Facilities Services Contact point in Wales: For advice see details on the alert Nigel Porter Principal Engineer NHS Wales Shared Services Partnership Facilities Services P. O. Box 182, Bevan House Lambourne Crescent Cardiff CF14 5GS Tel: nigel.porter@wales.nhs.uk Alerts are available in full text at:

Estates and Facilities Alert Action Ref: EFA/2011/007 Issued: 16 December 2011 19 December in Wales Device Electrolux (Dometic) absorption pharmacy / drug refrigerators, all models Problem Risk of

or inspected at regular intervals o displaying signs of impact damage, corrosion or ammonia leakage o displaying signs of failure to cool o beyond their recommended service life Ammonia gas is toxic

2 Estates and Facilities Alert Action Ref: EFA/2011/007 Issued: 16 December December in Wales Device Electrolux (Dometic) absorption pharmacy / drug refrigerators, all models Problem Risk of ammonia gas leakage from Electrolux (Dometic) absorption pharmacy / drug refrigerators that are: o not installed correctly o not used in line with manufacturer guidelines o not adequately maintained or inspected at regular intervals o displaying signs of impact damage, corrosion or ammonia leakage o displaying signs of failure to cool o beyond their recommended service life Ammonia gas is toxic and exposure / inhalation can cause harm. Action Absorption refrigerators should be installed and used in line with Dometic guidelines (see Appendix) and covered by a preventative maintenance programme which includes visual inspection. Any displaying signs of impact damage, corrosion or ammonia leakage should be removed from use before contacting Dometic. Any that have ceased to function correctly (i.e. maintain drugs at correct temperature) should be removed from use while awaiting repair. Any aged 8 to 10 years should be considered for replacement. Risk assessments should be carried out on the use of absorption refrigerators in all areas, particularly those occupied by vulnerable patients. Action by Managers responsible for departments which have this equipment in use. Managers and staff responsible for the procurement, supply, maintenance and asset management of pharmacy / drug fridges. Contact Dometic Technical Support technical@dometic.co.uk Telephone: Template version 5: 14 October 2011 Page 1 of 3

3 Issued: 16 December 2011 Ref: EFA/2011/007 Problem 1. An adverse incident has been reported to Health Facilities Scotland involving an Electrolux (now Dometic) pharmacy / drug absorption refrigerator which leaked ammonia gas from the cooling system into a high dependency patient care area. As a result some patients and staff required emergency medical treatment. 2. The leakage was due to a sudden de-pressuring of the cooling system. This could have been caused by a corrosion related blockage in the cooling system leading to pressure increase followed by sudden de-pressuration through a leak or pipe work rupture. 3. The refrigerator was over 10 years old. Current models are DS301H, DS601H; older models include DS300H, DS600H, RA122H, MR60 and EAxxx (where x indicates a number) 4. Dometic state that failures of this nature are nearly always indicated in the preceding days or week with a loss of cooling. Any such indications were not noticed or acted upon in this case. 5. This alert supersedes earlier advice on the risk of ammonia leak from Electrolux drug refrigerators. For specific (superseded) alerts / notices, please see Additional Information for the relevant administration. Action 6. This notice should be brought to the attention of all appropriate managers, staff and users. 7. Ensure Dometic absorption refrigerators are installed and used in line with Technical Guidelines for Dometic Pharmacy Refrigerators (see Appendix) and the manufacturer s manuals. 8. Ensure Dometic absorption refrigerators are put into a regular preventative maintenance programme which includes visual inspection of pipe work for signs of impact damage, corrosion or ammonia leakage. Dometic recommend absorption refrigerators 1 to 6 years old should be inspected annually and those over 6 years old should be inspected every 6 months. 9. Any displaying signs of impact damage, corrosion, or ammonia leakage should be disconnected from electrical mains supply and removed from use before contacting Dometic. 10. Where a Dometic absorption refrigerator has ceased to function correctly (i.e. maintain drugs at the correct temperature) it should be disconnected from electrical supply and removed from use pending repair. 11. Dometic recommend absorption refrigerators 8 to 10 years old should be considered for replacement as they will start to exhibit loss of performance. They advise that it is not economical to replace the cooling system of absorption refrigerators over 10 years old. Fridge age is identified by serial no. (e.g. 614xxxxx manufactured week 14 of 2006). Replacement plans for these refrigerators (with budget considerations) should be implemented. 12. Risk assessments should be conducted on the use of absorption refrigerators in all areas but particularly in patient occupied areas. Consideration should be given to the manufacturer s installation requirements, the risks from exposure to ammonia, the type / mobility of patients and local evacuation procedures. Page 2 of 3

4 Issued: 16 December 2011 Ref: EFA/2011/007 Suggested Onward Distribution Accident & Emergency Accommodation Services Anaesthetics Blood Transfusion Coronary Care Units Contacts Day Surgery Dental Dental Hospitals Estates/Facilities General Dental Practitioners General Medical Practitioners Health & Safety Hospices Intensive Therapy Units Neonatal Nursing Occupational Health Operating Departments Pharmacy Risk Management Special Care Baby Units Stores Wards Dometic Technical Support, Dometic UK Ltd, The Brewery, Blandford St Mary, Dorset DT11 9LS Telephone: Additional information for Wales The above sections of this Alert were compiled by Health Facilities Scotland and distributed nationally without modification. Enquiries should quote reference number WG EFA/2011/007 and be addressed to: Nigel Porter Prif Beirianydd Principal Engineer Partneriaeth Cydwasanaethau GIG Cymru Gwasanaethau Cyfleusterau N H S Wales Shared Services Partnership Facilities Services Ffon/Phone e-bost/ Nigel.Porter@Wales.nhs.uk Estates and Facilities Alerts are available in full text on the Public Health Wales website at Crown Copyright 2011 Addressees may take copies for distribution within their own organisations Page 3 of 3

5 Models: DS301HFS and DS601HFS Technical Guidelines for Dometic Pharmacy Refrigerators

Contents: Why Dometic are No. 1...2 DS 301HFS and DS 601HFS Features...2 Dometic Pharmacy Fridges.

..4 Maintenance...5 Older Units...5 Ammonia Leakage...5 Technical Data...6 Why Dometic are No.

Lowest energy consumption for absorption products Intelligent thermostatic control Fuzzy Logic Compact size

Equipped with thermal cut-out device Production recognised to ISO 9001 standards Environmental policy based

Interior Drawer Fronts Silent Operation New Thermostatic Control Digital Thermometer Lockable Manual

6 Contents: Why Dometic are No DS 301HFS and DS 601HFS Features...2 Dometic Pharmacy Fridges...3 Absorption Refrigeration...3 Installation Requirements...3 Day to Day Use...3 Defrosting...4 Warranty...4 Maintenance...5 Older Units...5 Ammonia Leakage...5 Technical Data...6 Why Dometic are No years experience in production Silent in operation Best cooling performance among absorption products Lowest energy consumption for absorption products Intelligent thermostatic control Fuzzy Logic Compact size and design makes them adaptable to any environment Perfect solution for temperature sensitive medication Equipped with thermal cut-out device Production recognised to ISO 9001 standards Environmental policy based on ISO standards DS 301HFS DS 601HFS DS 301HFS and DS 601HFS Features Internal Fan & Door Alarm Interior Drawer Fronts Silent Operation New Thermostatic Control Digital Thermometer Lockable Manual Defrost Optional Wall Bracket DS 301HFS 28 litre capacity H 58.0 x W 42.2 x D 39.3mm DS 601HFS 53 litre capacity H 59.2 x W 48.6 x D 49.4 mm 2.

Dometic Pharmacy Fridges Production Dates from/to Current Models DS301H 2009 DS601H 2009 Older Models DS300H 2004 DS600H 2004 RAxxx 1996 MR60 1994 EAxxx 1996 - - 2009 2009 2004 2005 2010/2011

Instead they use a heat input to create a vapour cycle within a closed loop. This makes them totally silent in operation which is a unique benefit in areas where people are resting or sleeping.

manner of use. However, if the simple guidelines given below are adhered to, your Dometic fridges will give many years of satisfactory use.

from the interior as well as dissipating the heat input to the process itself.

Thought should also be give to the heat input from incident sunlight or spotlighting. 2) Levelling The cooling circuit is finely balanced and gravity assisted.

7 Dometic Pharmacy Fridges Production Dates from/to Current Models DS301H 2009 DS601H 2009 Older Models DS300H 2004 DS600H 2004 RAxxx 1996 MR EAxxx /2011 Absorption Refrigeration DS601HFS Absorption refrigerators primarily differ from normal domestic appliances in that they do not utilise a compressor. Instead they use a heat input to create a vapour cycle within a closed loop. This makes them totally silent in operation which is a unique benefit in areas where people are resting or sleeping. As with any technology, there is a trade off of benefits against limitations and in operation absorption refrigerators are slightly more sensitive than compressor fridges to their environment and manner of use. However, if the simple guidelines given below are adhered to, your Dometic fridges will give many years of satisfactory use. Installation Requirements As with any fridge, whether absorption or compression, the two key points are: Condenser Boiler (insulated) Heating Element 1) Ventilation Refrigerators have to remove heat from the interior as well as dissipating the heat input to the process itself. This is done through the unit s condenser (see diagram) and so it is vital that this area of the fridge has sufficient space (see manual) and is not adjacent to any heat sources e.g. radiators. Thought should also be give to the heat input from incident sunlight or spotlighting. 2) Levelling The cooling circuit is finely balanced and gravity assisted. Operating the fridge outside of 3 degrees of level will impair performance and reduce the life of the unit. Operating the unit within 1-3 degrees of level will provide normal operation but may still impact on the working lifespan. If at all possible, the unit should be operated within 1 degree of level at all times (this is not difficult to achieve, most hospital floors will be within this and the unit will stand perfectly flat when unobstructed). Day to Day Use Absorption fridges are relatively lightweight and easily moved as operational requirements dictate. Care should be taken when moving units that they are not subjected to sudden impacts. Also, the new location must meet the ventilation and levelling requirements described above. If the unit is laid on its side or front (never on its back!) during moving, then it must be stored in the upright position for 24 hours before being returned to service. 3.

Defrosting Frost will gradually form on the cooling surfaces and it must not be allowed to become too thick since it acts as an insulator and interferes with the cooling.

8 Defrosting Frost will gradually form on the cooling surfaces and it must not be allowed to become too thick since it acts as an insulator and interferes with the cooling. To prevent unplanned increases in temperature, the defrost is a manual operation. We recommend that the appliance is defrosted every 3 weeks, or depending on the ice quantity on the cooling fins. While defrosting, the appliance should be switched off by disconnecting the refrigerator from the electricity supply and leave the cabinet door open. The frost will melt and the defrost water will run through the drain tube from the drip channel into an evaporating vessel located at the bottom rear of the refrigerator (see diagram). After defrosting the cabinet interior should be wiped out with a clean, damp cloth. Warranty All Dometic products sold after January 1st 2010 are offered with a 2 year warranty which begins on the date of sale to the enduser. Any faults that develop within this period will be dealt with by providing a temporary replacement while the unit is repaired at Dometic s works. The procedure for the Service Exchange Plus (S/X+) scheme is as follows, User reports Problem to Dometic UK If problem cannot be resolved over the phone, details taken for S/X+ scheme Returns form ed/faxed to user Faulty unit repaired and tested Temporary unit despatched, faulty unit collected (user informed of delivery times) User returns completed form by fax/ Original unit returned, temporary item collected (user informed of delivery times) Temporary unit tested and returned to SX+ stock Figure 1 Service Exchange Plus (S/X+) The S/X+ scheme aims to minimise the time the user is without a fridge in the unlikely event a fault should occur. In order for us to provide this high level of service, it is vital that the following points are noted and adhered to, 1) Please complete the returns form as fully and as quickly as possible. 2) Please ensure that there is a single person dealing with this issue or that details of the issue are passed from one shift to the next where appropriate. 3) Please provide a specific ward address or, if being delivered to a general receiving area, ensure that someone is aware of the imminent deliveries. 4) Please use the packaging provided (i.e. the box in which the temporary replacement arrives) to return the failed unit. The courier will not carry an unpackaged item. 5) We will provide contact details (including ) to keep you informed of the expected delivery times. Please ensure that the contact details provided are correct and relevant! 6) Please remember that the temporary unit is provided as a courtesy and should NOT be mistreated or returned broken or otherwise damaged. Because we test and if necessary repair all returned temporary units before re-use, excessive repairs are time consuming and impair the overall service. 7) If possible, hand the issue to a member of the maintenance/service team from the first point of initial failure and we will deal with them directly. 4.

Maintenance Dometic recommends that hospitals have some form of inspection/maintenance/service arrangement in place for when the warranty period expires.

There are no routine maintenance procedures necessary on a Dometic pharmacy fridge other than inspection.

9 Maintenance Dometic recommends that hospitals have some form of inspection/maintenance/service arrangement in place for when the warranty period expires. This could be hospital maintenance staff, a third party maintenance company or the local Dometic Approved Network (DAN) engineer (visit for details of local DAN engineers). There are no routine maintenance procedures necessary on a Dometic pharmacy fridge other than inspection. Attention should be paid to ventilation and levelling as well as a visual inspection of the rear of the fridge to look for impact or corrosion damage. There may be breakages or failure of components e.g. the circulation fan and these parts are readily available and simple to change. Inspection routine: Yrs 1-6: Annual Yrs 6- : 6 monthly Training can be provided to maintenance staff or Estates managers please contact Dometic UK for further details. Older Units The average lifespan of a Dometic pharmacy fridge s cooling system is around 8-10 years and after this time will start to exhibit loss of performance. This lifespan can be adversely affected by any number of operational factors and so it is not uncommon for units to fail at 6 years onwards. Parts are available for the majority of units, even those older than 10 years. However, it is never economical to change the cooling units if they have failed and we recommend a new unit in this case. We recommend that the inspection routine is increased from once to twice a year when the units have been in service for 6 years. We would also recommend that units are considered for replacement once they have been in service for 8-10 years. Older units did not benefit from the same sophisticated software that is utilised as standard in modern units and can suffer from rupture of the cooling system due to overheating. The overheating is invariably the result of a corrosion-related blockage in the cooling circuit and whereas a modern unit would sense the heat imbalance and shut down, an older unit will continue to work as it tries to refrigerate. Failures of this nature are nearly always indicated in the preceding weeks/days with a loss of cooling. Switching the unit off/on, turning the unit upside down or shaking it may restore performance but this will only be a temporary solution (if it works at all) and will leave the fridge in a potentially unsafe state. Units that are exhibiting a loss of performance should be switched off immediately, put out of service and Dometic informed. Ammonia Leakage See also NHSE HN (2003) 04 & SAN(SC)98/09 The cooling unit of a Dometic Pharmacy Fridge contains approximately 100g of ammonia along with 150g of water and some corrosion inhibitor. There are 2 methods of failure of the cooling unit, as described below, 1) Rupture Older units suffering from internal corrosion leading to blockage have the potential to overheat leading to a rupture, inevitably in the immediate vicinity of the heating element (see diagram on p.3). The mineral insulation around the boiler will absorb the major part of the rupture although it is likely to burst which can disperse the insulation around the area. Hard impact damage could also potentially cause a rupture although this is unlikely unless it is of considerable force. 2) Micro-leakage Internal corrosion may cause weakening of welds leading to microscopic cracks. Ammonia will be smelt but it might not be immediately obvious to staff that the fridge is the source. The leak may be so small that the fridge does not exhibit loss of performance for days. Impact damage may also cause a micro-leak although this is very unlikely. Should there be a leakage of ammonia at any time, follow standard NHS procedure to ensure the safety of any staff or patients in the vicinity. Switch off and unplug the affected unit and contact Dometic UK. 5.

10 Technical data DS301 H DS601 H Gross/net volume 27/23 53/51 Outer dimension 580x422x x486x494 Power input (W) Energy consumption (kw/24hr) ,05 Weight 16kg 20kg Cabinet temperature 2 C - 8 C Defrosting Manual DS301HFS DS601HFS For further information and a full list of distributors, please contact: Jon Race or Leigh Palmer: retail@dometic.co.uk Technical Support: technical@dometic.co.uk

Estates and Facilities Alert

Estates and Facilities Alert Action Ref: EFA/2010/007 Issued: 8 July 2010 Device Window blinds with looped cords or chains. All types. Problem Action Looped cords and chains on window blinds can present