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Global Health Technologies

Undergraduate Lightning Talks

Securing Access, Accountability and Sustainability of Medical Oxygen Production in The Gambia: A Failure Modes Analysis of PSA Oxygen Supply Systems Serving the Edward Francis Small Teaching Hospital.

Saturday, October 26, 2024
12:45 PM – 12:50 PM EST
Location: Room 342

Introduction:  I. Introduction
Healthcare systems in low- and middle-income countries (LMIC) are characterized by persistently insecure medical oxygen supply. According to the Lancet Global Health Commission, “Medical oxygen insecurity [was] a defining inequity of the COVID-19 pandemic.” Additionally, the unmet need for medical oxygen in LMICs continues to be substantial, threatening lives across various medical conditions beyond COVID-19. The Global Oxygen Alliance (GO2AL) was launched to:

1. Drive investment in to maximize impact.
2. Strengthen innovative supply chain and market shaping.
3. Support country planning and implementation.
4. Advocate and generate demand [for oxygen production].
5. Measure performance and drive accountability.

Thanks to the collective efforts of stakeholders participating in the Global Oxygen Alliance, significant progress has been made. Several medical oxygen production systems have been purchased and deployed in LMICs. While many of these systems are not yet operational, the strides made so far are a cause for encouragement.

The objective of this failure modes effects analysis of three Pressure Swing Absorption (PSA) medical oxygen generation systems located at the Edward Francis Small Teaching Hospital (EFSTH) in the Gambia is to understand multiple stakeholder perspectives on the failure modes and their associated effects of improper installation of the PSA systems. The insights gleaned from this study will be used to provide recommendations to EFSTH administrators on how to properly manage the retro-installation of the existing PSA systems and practical guidelines for future implementations of additional medical oxygen production systems.

Materials and

Methods:  II. Materials & methods

Research Design
We used a prospective cohort study design employing the structured FMEA approach to identify multiple perspectives on the failure modes and their associated effects resulting from improper PSA oxygen supply systems installation. We interviewed six focus groups, five directly involved in clinical care and one group of biomedical engineering technicians. Focus group interviews were audio recorded for transcription. Audio files will be destroyed after the final analysis is complete.

Data collection
Clinical care stakeholders
Data collection was meticulously performed by a team of JHU engineers conducting structured group surveys in EFSTH. Survey participants identified specific failure modes in the oxygen systems, and each failure mode was rigorously rated on a scale of 1-10 based on frequency, severity, and detectability, ensuring a comprehensive understanding of the issues.

Biomedical engineering technicians
A team of JHU engineers collected data in multiple unstructured group interviews with biomedical engineering technicians employed by EFSTH. Both teams of engineers toured the PSA installation sites, reviewed installation logs, and chronicled a narrative description of various operation failures and adverse safety events attributable to improper installation.

Ethical Consideration
Ethical clearance will be obtained from the ethical committee of Edward Francis Small Teaching Hospital. The principles of consent, maintenance of anonymity, and confidentiality were maintained throughout the study. Consent was obtained prior to recruiting participants.

Results, Conclusions, and Discussions: III. Results
Clinical care stakeholders
The structured group prompted participants to identify various failure modes and to rate their related severity, frequency, and detectability. A total of twenty failure modes impacting clinical care were identified. Overall = 7.77; = 5.85; = 2.60 (scale of 1 to 10). The results are presented in table 1.0

Biomedical engineering technicians
The unstructured interviews provided a wide range of failure modes, each with its own unique impact. The effects of these failure modes ranged from damage to hospital infrastructure to two life-threatening safety events. The results are summarized in table 2.0.

IV. Discussion
A root cause analysis of both the structured and unstructured interviews established three primary root causes of the failure to properly install the three PSA oxygen generation plants.

Access
Both hospital administrators and hospital biomedical engineering technicians did not receive adequate expert attention during the installation process. The PSA oxygen generation systems were installed by third-party contractors who were not adequately trained in quality control methods.

Accountability
Hospital administrators needed to establish or adapt standard operating procedures (SOPs) for the safe and effective generation and distribution of medical oxygen.

Sustainability
The failure to establish SOPs contributed to the inability to develop and validate a sustainable business model for operating medical oxygen production.

V. Conclusions
Our engineering team has made the following recommendations:

(1) The Gambian Ministry of Health should form a Medical Oxygen Working Group (MOWG)
(2) The MOWG should establish national-level SOPs for producing medical oxygen.
(3) The MOWG should establish a national-level sustainability plan for medical oxygen supply. This plan should address who can produce medical oxygen and who will manage the capital flows related to it
(4) The MOWG should establish a training program for biomedical engineering technicians to run, maintain, and service medical oxygen generation systems
(5) Administers in the EFSTH should adopt quality control and quality assurance procedures to comply with MOWG directives

Acknowledgements (Optional):