Sofía Córdova, Regional Program Manager, PSI Centro América
Andrea Surette, Knowledge Management Technical Advisor, FHI 360
Emily Headrick, MSN, FNP, Clinical Technical Advisor, FHI 360

Medical oxygen is a vital therapy for treating patients with COVID-19 and other respiratory illnesses, surgical and maternity patients, and children with pneumonia. As with any essential medicine, safety is an important consideration when it comes to storage, handling, and administration. Safe delivery of oxygen therapy relies not only on the availability of trained clinicians and equipment at the bedside, but also the availability of trained technical and maintenance personnel who handle oxygen during its production, transportation, and distribution to health care facilities, and who manage the maintenance of oxygen-related infrastructure.

The USAID-supported EpiC project initiated its work to strengthen the oxygen ecosystem in Panama with a rapid assessment of the medical oxygen ecosystem in 18 national hospitals across several different regions. The rapid assessment determined that the primary source of medical oxygen in hospitals across Panama is liquid oxygen (LOX). Many hospitals have LOX tanks, while others are dependent on oxygen cylinders that are filled at a central location and delivered to facilities. Liquid oxygen is distributed to all hospitals, as there are no oxygen-producing pressure swing adsorption (PSA) plants in any hospital. The oxygen ecosystem assessment found that while oxygen production and distribution is sufficient to meet the needs of the population, only one person among all oxygen cylinder transportation, delivery and maintenance personnel had received any dedicated training on medical oxygen equipment infrastructure and safety. Recognizing the vital role that this cadre of health facility personnel plays in safely maintaining the oxygen ecosystem, EpiC addressed this gap by developing and implementing a dedicated medical oxygen training for nonclinical health facility staff in Panama.

EpiC Panama—led by PSI—worked with a well-recognized Panamanian biomedical engineer, Miguel Vergara, to design and deliver the trainings. Mr. Vergara is internationally certified on medical gases, including oxygen, and has worked on the installation of oxygen systems in several national hospitals across Panama. The comprehensive curriculum covered the basic principles of medical oxygen starting with what oxygen is, why it is an essential medicine, how it is delivered, how tanks and cylinders work, how to calculate oxygen availability at different oxygen flow rates, how to read manometers (which regulate the flow of oxygen from the cylinder to the patient), and the do’s and don’ts of oxygen management. The training continuously emphasized the importance of safety and security as a core principle of oxygen ecosystem management. Medical gases and the associated equipment can be dangerous and lead to life-threatening injuries to both patients and staff if not maintained, stored, or handled properly. This training represented one of the first (and for some participants, the only) trainings to focus on safety and security of oxygen infrastructure.

A total of 68 personnel from national hospitals in Panama City and the surrounding areas participated in the training. Participants included oxygen system maintenance personnel, as well as paramedics and ambulance staff who provide oxygen to patients via cylinders. Participants were selected because they oversee oxygen systems (including tanks and cylinders), manipulate oxygen and related equipment directly, and transport oxygen cylinders and related equipment around a facility to the wards and bedsides of patients who need this essential medicine.

The training event was well-received by participants and leaders alike. Training participants reported deep appreciation for the detailed explanations on the importance of safety and security. They found the content on oxygen calculations particularly valuable. Because they didn´t know how to calculate how much oxygen remained in a cylinder and they were afraid that a patient would be left without oxygen, participants reported that it was common practice to change cylinders when they estimated there was approximately 25% remaining, ultimately resulting in wasted oxygen. With this training, participants learned simple yet crucial calculations that make oxygen consumption safer and more cost-effective. Participants also learned the importance of correctly using personal protective equipment, and not only how to take good care of oxygen cylinders and related equipment, but why it matters for the safety of patients, staff, and the stability of the oxygen ecosystem as a whole.

When the training concluded, participants reported that not only had they improved their own practices, but they also worked with nurses and other clinical personnel to share what they had learned, communicate their improved awareness of risks, and promote the importance of fostering a culture of safety and best practice when it comes to the oxygen ecosystem in Panama.

Featured image: Biomedical Engineer and trainer Miguel Vergara explains valve systems on oxygen cylinders. Photo by Sofía Córdova, PSI Centro América.