Implementation and 8-year follow-up of an uninterrupted oxygen supply system in a hospital in The Gambia

Abstract

SUMMARYSETTING: A 42-bed hospital operated by the Medical Research Council (MRC) Unit in The Gambia.OBJECTIVE: To devise, test and evaluate a cost-efficient uninterrupted oxygen system in the MRC Hospital.DESIGN: Oxygen cylinders were replaced with oxygen concentrators as the primary source of oxygen. An uninterruptable power supply (UPS) ensured continuity of power. Hospital staff were trained on the use of the new system. Eight years post-installation, an analysis of concentrator maintenance needs and costs was conducted and user feedback obtained to assess the success of the system.RESULTS: The new system saved at least 51% of oxygen supply costs compared to cylinders, with savings likely to have been far greater due to cylinder leakages. Users indicated that the system is easier to use and more reliable, although technical support and staff training are still needed.CONCLUSION: Oxygen concentrators offer long-term cost savings and an improved user experience compared to cylinders; however, some technical support and maintenance are needed to upkeep the system. A UPS dedicated to oxygen concentrators is an appropriate solution for settings where power interruptions are frequent but short in duration. This approach can be a model for health systems in settings with similar infrastructure.

Providing oxygen to children in hospitals: a realist review

“…Where pulse oximeters were used, they were valued as both a diagnostic aid (determining which children require oxygen therapy) and therapeutic aid (giving staff and patients confidence in oxygen therapy; Gray et al) 3 , 49 , 52 , 56 . Limited data suggested that the introduction of pulse oximetry can improve oxygen use and reduce pneumonia case fatality rates, even with suboptimal oxygen access 3 , 56 …”

“…less than daily) and brief (e.g. less than 20 minutes), but not if power failures are frequent or prolonged 49 . Solar power with battery storage is feasible, but requires experienced technicians and quality products 26 , 30 , 31 …”

“…The Gambia provided a positive case study involving: well-trained biomedical engineers; a schedule for preventive maintenance; spare parts; electronic work orders (facilitating access to engineers); and a maintenance protocol for users 48 , 49 . They reported excellent long-term equipment function: 21/27 (78%) of oxygen concentrators working at 8-year follow-up; and minimal equipment down-time (5.2% of total cumulative hours in service) 48 .…”

“…However, while the overall use of oxygen increased, it was usually lower than expected based on admission and case-mix data, suggesting underuse of oxygen (Gray et al) 35 , 37 , 40 . The highest mean concentrator use (around 15–18 hours/day) was reported by two hospitals with high caseloads and close supervision by project doctors; 24 , 28 other projects reported a mean use of less than 6 hours per day (Morpeth et al) 19 , 25 , 34 , 36 , 37 , 48 , 49 , 53 …”

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

“…They also require technical maintenance including regular filter changes. Not all models of oxygen concentrators are technically suitable for sustained use in a tropical environment [75]. Centralized, piped oxygen systems typically deliver pressurized oxygen through wall outlets to bed spaces in the ICU.…”