www.fgks.org   »   [go: up one dir, main page]

WHO / Andrew Quilty
COVID-19 vaccines arrive in Afghanistan via COVAX. On 24 March 2021, a nurse working at Shaidayee Hospital in Herat, Afghanistan, treats a patient with oxygen
© Credits

Oxygen

    Overview

    Medicinal Oxygen 

    Oxygen is a life-saving essential medicine with no substitution. Healthcare professionals use oxygen to treat respiratory illnesses like  COVID-19 and pneumonia. Oxygen is also essential for surgery and trauma. Vulnerable groups like the elderly, pregnant women and newborns need oxygen therapy in regular basis. 

    Despite being an essential medicine, oxygen is a complex product. It needs to be produce by a medical device or Industrial plant. Oxygen also requires a whole system to safely reach patients.

    Due to their complexity, access to oxygen meets many challenges on: availability, quality, affordability, management, supply, human resources capacity and safety. In face of these challenges, the WHO continuously develops resources and tools to overcome them.

    Impact

    Surveys in low- and middle-income countries (LMICs) have found that fewer than half of all health facilities have uninterrupted access to oxygen. It has been reported that lack of access to reliable oxygen supplies contributes to preventable deaths, particularly in LMICs. For example, it has been estimated that up to 122 000 deaths from childhood pneumonia could be prevented annually with the strengthening of oxygen supplies. Numerous studies show that oxygen access is a global problem. For example, a recent study found that among facilities treating respiratory infections in sub-Saharan Africa, only 1 in 5 had oxygen in Mauritania and 1 in 10 in Niger. Surveys by the United States Agency for International Development found similar situations for countries in South America and South Asia. A serious concern at any time, the global medical oxygen problem has been exacerbated by the COVID-19 pandemic. 

    Despite being an essential medicine, producing oxygen that is safe for patient use is a complex process since it requires the devices and systems needed to deliver oxygen to patients, ranging from pulse oximeters to ventilators, and health workers that are trained to use such devices effectively. However daunting, the investment of time and resources required to meet oxygen supply demand is worth it. The support to the urgent scale-up of medicinal oxygen will save lives by improving care for people with COVID-19, severe pneumonia and other conditions needing. oxygen therapy.

    WHO Response

    WHO is continuously updating guidance on clinical use of Oxygen for different diseases and health conditions. 

    WHO efforts include the development of technical specifications. The purpose of technical specifications is to increase access to quality products. It also aims to ensure the supply of oxygen, in low-resource settings. These efforts also aim to support ministries of health by: 1)ensuring oxygen supply is available and 2) highlighting the importance of appropriate selection, procurement, maintenance and use of medical devices.

    When the COVID-19 pandemic erupted more than a year ago, the Access to COVID-19 Tools (ACT) Accelerator was created, with two objectives: the rapid development of vaccines, diagnostics and therapeutics; and equitable access to those tools. Nevertheless, the majority of countries still have trouble accessing sufficient oxygen supply for patients. The ACT accelerator also launched the Oxygen Task to to confront surges in oxygen demand and cut preventable deaths. Identified US$ 90 million in immediate funding needs for medical oxygen in up to 20 low- and middle-income countries.

    Other tools to increase access to oxygen includes:


    Quality and safety of medicinal oxygen

    Different industries, including health systems, use oxygen in regular basis. Oxygen in the market is available for industrial and medicinal use. Medicinal oxygen is very different from industrial oxygen in purity and quality.

    Industrial oxygen is not intended for human use. Medicinal oxygen reaching patients should be tested to meet authorized specifications for identity, purity and co ntent. In addition appropriate practices for production, storage and distribution of medicinal oxygen should be followed.

    Uncertainties regarding the purity and content of industrial oxygen, the possible occurrence of particulate and microbial contamination, and production, storage and distribution processes that may not be appropriately planned, performed and controlled can result in unacceptable risks for patients.

     


    Given their relevance in view of the COVID-19 pandemic, some oxygen related working documents have been pre-discussed with experts. Agreed interim versions of these documents will be submitted to the Committee for possible adoption. For more information please visit the - Health products and policy standards working documents in open consultation- website.

     

    Depending on the source and production method the medical oxygen has the following percentages: 

    1. For oxygen produced by the air-liquefaction process, the International Pharmacopoeia, defines the requirements of medical-use oxygen. Currently, oxygen must contains not less than 99.5% v/v of O2.
    2. For Pressure Swing Adsorption (PSA) plants, the WHO interim guidance technical specifications for PSA plants, published in June 2020, specifies: "pressure swing adsorption technology to produce medical oxygen 93%±3 from ambient air"
    3. For oxygen concentrators, the WHO-UNICEF technical specifications and guidance for oxygen therapy devices, published in 2019, as one of the sources of oxygen. “The concentrator should delivery of low-flow, continuous, clean and concentrated oxygen (> 82%) from room air (21%). “ This same statement was published in WHO interim guidance of WHO list of Priority Medical devices for COVID-19 and its associated technical specifications, published November 2020.  


     

     

     

    Use of oxygen across the health system

    Many levels of the health systems need medical oxygen. The units in the health system that use oxygen include:

    • Primary health care
    • General wards
    • Emergency transport
    • Delivery rooms
    • Surgical rooms
    • Intensive care units (ICU)
    • Specialized hospitals
    • Outpatient units
    • Hyperbaric chambers

    Some patients need oxygen in homecare and other special settings like airplanes.

    This diagram illustrates examples of medical units that use oxygen. All levels in the health system require oxygen and pulse oximeters (to monitor oxygen saturation in patients). These different levels and scenarios meet different needs of oxygen systems.

     

     

    Oxygen in the health systems

     

    Source:  WHO-UNICEF technical specifications and guidance for oxygen therapy devices. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2019 (WHO medical device technical series).

     

    oxygen complex system
    Source:   WHO-UNICEF technical specifications and guidance for oxygen therapy devices. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2019 (WHO medical device technical series).
     

    Despite being an essential medicine, oxygen is a complex product. It needs to be produce by a medical device or Industrial plant. Oxygen also requires a whole system to safely reach patients. Oxygen systems consist of oxygen:

    • Sources
    • Distribution
    • Regulation and conditioning
    • Delivery
    • Patient monitoring

    Oxygen systems need regular power supplies and maintenance to function adequately. The following diagram illustrates all the components of an oxygen system. 

    Oxygen and COVID-19

    Oxygen therapy and COVID-19 patients

    In many contexts during the COVID-19 pandemic, health services are delivered at community level and in the home by a variety of formal and informal community-based providers, including caregivers. “Caregivers” refers to parents, spouses and other family members or friends providing informal care as opposed to the care provided by formal health-care providers.

    It is therefore critical to ensure that caregivers have appropriate training and guidance on how to care for patients as well as how to minimize the risk of infection. The decision as to whether to isolate and care for an infected person at home depends on the following three factors:

    1) clinical evaluation of the COVID-19 patient

    2) evaluation of the home setting

    3) the ability to monitor the clinical evolution of a person with COVID-19 at home

    The decision to isolate and monitor a COVID-19 patient at home should be made on a case-by-case basis. Please refer to the guidance below to get further information on how to care for a COVID-19 patient at home.

    In respect to oxygen, home pulse oximetry is a safe, non-invasive way to assess oxygen saturation in the blood and can support the early identification of low oxygen levels in patients with initially mild or moderate COVID-19 or silent hypoxia, when a patient does not appear to be short of breath but his or her oxygen levels are lower than expected. Home pulse oximetry can identify individuals in need of medical evaluation, oxygen therapy or hospitalization, even before they show clinical danger signs or worsening symptoms.

    Questions and Answers

    Summary: Medical oxygen is an essential medicine in the treatment of COVID-19. How is it used? Why is there a shortage in some countries and what are WHO, partners and Governments doing about it? WHO’s Dr Janet Diaz explains in Science in 5.

     

    Summary: If you have COVID-19 and are caring for someone or yourself at home, what is the treatment protocol? What is WHO’s guidance on Remdesivir and convalescent plasma therapy? How to monitor oxygen at home and what are the red flags when you should call the doctor? WHO’s Dr Janet Diaz explains in Science in 5.

     

    Therapeutics and COVID-19: living guideline

    This publication has been superseded by a new version, dated 13 January 2023.Version dated 13 January 2023The WHO Therapeutics and COVID-19: living guideline...

    Guidance on COVID-19 for the care of older people and people living in long-term care facilities, other non-acute care facilities and home care

    In response to the COVID-19 outbreak, this guidance provides information on infection and prevention control (‎IPC)‎, community preparedness, selfcare...

    This document is an update of the guidance published on 17 March 2020 entitled “Home care for patients with COVID-19 presenting with mild symptoms...

     

     

    Medicinal oxygen global supply and COVID-19

    Since the start of the pandemic, affordable and sustainable access to oxygen has been a growing challenge globally. COVID-19 has put huge pressure on health systems, with hospitals especially in LMICs running out of oxygen, resulting in preventable deaths and families of hospitalized patients paying a premium for scarce oxygen supplies.

    In response to the many challenges of the pandemic, WHO created the Access to COVID-19 Tools (ACT) Accelerator.  The ACT Accelerator is a groundbreaking global collaboration to accelerate development, production, and equitable access to COVID-19 tests, therapeutics, and vaccines. The ACT-Accelerator is organized into four pillars of work: diagnostics, therapeutics, vaccines and health system strengthening. The therapeutic pillar is especially relevant for medicinal oxygen supply. The therapeutics pillar (co-led by Unitaid and Wellcome), is taking a new role to coordinate and advocate for increased supply of oxygen, and, in partnership with a WHO-led consortium launched a COVID-19 Oxygen Emergency Taskforce.

    • More than half a million COVID-19 patients in LMICs estimated to need oxygen treatment every day.
    • New assessments show US$90 million immediate funding required to meet urgent need in up to 20 low- and middle-income countries (LMICs). Unitaid and Wellcome will make an immediate contribution of up to US$20 million in total for the emergency response.
    • COVID-19 Oxygen Emergency Taskforce brings together key organisations working on oxygen access under ACT-Accelerator Therapeutics pillar, as COVID-19 surges and preventable deaths occur
    • Taskforce partners will work together to measure oxygen demand, work with financing partners, and secure oxygen supplies and technical support for worst-affected countries

    Read more

     

    Note: Report updated on 15 Sept 2021 with removal of reference to the average price of antigen RDTs on page 3, removal of reference to price reductions...

    This 'How it works' document gives an overview of the ACT Accelerator's structure, detailing which organizations co-lead each of the pillars: vaccines...

    The COVID 19 pandemic is exposing an important weakness in health systems: medical oxygen production and delivery.Tatum Anderson reports. 

     

    Medical equipment related to oxygen therapy

    As part of the COVID-19 response WHO developed a series of training videos for medical equipment related to oxygen therapy and is available in OpenWHO. The videos include the the different steps during equipment lifecycle.

    Medical devices lifecycle

    The training videos include the following equipment:

    • Pulse oximeter
    • Mechanical ventilator
    • CPAP/ BiPAP
    • Patient monitor
    • Oxygen concentrator
    • High flow nasal cannula (HFNC)
    • Oxygen cylinder

    Oxygen Initiatives

    Oxygen Access Scale Up

    Only a strong and collaborative action can scale up access and availability to oxygen quickly. That is why WHO, together with other global entities, have joined efforts to find context appropriate, sustainable solutions.
    Learn more

    Publications

    All
    Therapeutics and COVID-19: living guideline

    This publication has been superseded by a new version, dated 13 January 2023.Version dated 13 January 2023The WHO Therapeutics and COVID-19: living guideline...

    In the face of rapid increases in the number of hospitalizations due to COVID-19 in Latin America and the Caribbean, coupled with shortages of human and...

    Priority medical devices list for the COVID-19 response and associated technical specifications

    This document describes the medical devices required for the clinical management of COVID-19, selected and prioritized according to the...

    Technical specifications for Pressure Swing Adsorption(PSA) Oxygen Plants

    Oxygen is an essential medicine required at all levels of the health care system; only high quality, medical-grade oxygen should be given to patients. ...

    Oxygen sources and distribution for COVID-19 treatment centres

    This interim guidance on oxygen sources and distribution strategies for COVID-19 treatment has been adapted from WHO and UNICEF’s technical specifications...

    WHO-UNICEF Technical specifications and guidance for oxygen therapy devices

    The purpose of this interagency publication is to provide harmonized product specifications for a wide range of products for delivering basic oxygen therapy,...

    Oxygen therapy for children

    Hypoxaemia is a major contributor to child deaths that occur worldwide each year; for a child with pneumonia hypoxaemia increases the risk of death by...

    WHO technical specifications for oxygen concentrators

    The purpose of this guidance document is for the appropriate selection, procurement, utilization and maintenance of oxygen concentrators. This document...