Session IX: Medical Oxygen Handling And - PowerPoint Presentation

1. Session IX: Medical Oxygen Handling And SafetyReaching Impact, Saturation, and Epidemic Control (RISE)

2. Session: Prevention of Fires in Oxygen System, and Hospital Fire SafetyReaching Impact, Saturation, and Epidemic Control (RISE)

3. Introduction - Hospital FiresMain causes of hospital firesFire triangle - the 3 ingredients of fireCAUTION!Oxygen supports combustion. The addition of concentrated oxygen to a fire increases its intensity greatly and can even support the combustion of materials which normally do not burn.Do not smoke close to oxygen sources!Reaching Impact, Saturation, and Epidemic Control (RISE)

4. Introduction - Civilian Injuries And Property Damage In Hospital FiresData from the US healthcare facilitiesLeading cause of fire- Cooking equipmentMost civilian injuries- Fires from cooking equipment and intentional fires Highest property damage- Fires from electrical equipmentReaching Impact, Saturation, and Epidemic Control (RISE)

5. Introduction - Some of The Worst Hospital Fire Accidents In IndiaDatePlaceCasualtiesDescriptionDec 2011AMRI Hospital, Kolkata95 killedMain cause of this mishap was an Electrical Short Circuit and stocking of Combustible Substances in the basement. This was a case of negligence by the management of the hospital. During the Incident, the hospital had around 160 patients and also many staff members. At least 50 patients were there in the intensive ward.Oct 2016IMS & SUM Hospital, Bhubaneshwar22 killed & 120 injuredIn this case, the hospital staff tried to douse the fire with fire extinguishers and in the process, they lost almost 20 crucial minutes before they called the Fire Department. This shows the lack of preparedness of the hospital staff during emergencies.Oct 2017Rohini Super Specialty Hospital Hanamkonda2 killed & 4 injuredAn electrical short-circuit triggered the fire. 199 patients were admitted to this hospital at the time of the accident. The hospital’s Fire Safety system did not work during this crucial time. Everyone including the doctors and hospital staff were in a state of panic and did not know how to respond.Reaching Impact, Saturation, and Epidemic Control (RISE)

6. Oxygen as a Fire Risk

7. Oxygen is classified as an ‘oxidizing agent’, reacting with most elementsOxygen is highly supportive of combustion (the reaction with oxygen to release heat and light/flame/glow)Oxygen enrichment = oxygen content greater than in airOxygen concentrations higher than 23.5% create greater fire hazards than normal airOxygen As A Fire RiskReaching Impact, Saturation, and Epidemic Control (RISE)The Fire TriangleImage: High Speed Training, 2016

8. Reaching Impact, Saturation, and Epidemic Control (RISE)Causes Of Fires And ExplosionsOxygen enrichment of atmosphereIncorrect design of oxygen systemsLeaks from damaged hoses, pipes, and valvesLeaks from poor connectionsPoor ventilation, where oxygen is being usedUse of incompatible materials with oxygenCareless operation, misuse and storage of oxygen equipmentOxygen-enriched air increases the risk of fireOxygen-enriched air in combination with a fuel source and heat source can cause a fire!

9. Prevention of Fires in Oxygen Systems

10. Prevention Of Fires In Oxygen SystemPrevention Of Oxygen Enrichment:Leak testing: Check for leakages using air or nitrogen either by a timed gas pressure drop test, a leak detection test or other suitable methods. Periodic retests should be done to check for leaks.Operation and practice: When work period is over, main oxygen supply valve should be closed to avoid leakage. Filter should be inspected at frequent interval to remove debris.Ventilation: Room in which vessels or cylinders are stored, handled, maintained, used or analyzed should be well- ventilated. Information/ Training: Personnel using oxygen equipment or works in the area where oxygen enrichment occur should be informed of the hazards, properties, risks of oxygen and immediate consequences.All maintenance and repair work should be performed by trained personnel only.Design: Equipment that has been specifically designed for oxygen shall be used only.While designing the equipment intended to use for oxygen service, configuration and use of material should be taken into consideration in order to minimize any risk of ignition.Oxygen equipment should only be lubricated with lubricant specific to the application and service.Oxygen system should be designed so that the flow velocity is as low as possible.Oxygen system should be positioned in well-ventilated areas away primary from ignition sourcesReaching Impact, Saturation, and Epidemic Control (RISE)

11. Prevention Of Fires In Oxygen SystemReaching Impact, Saturation, and Epidemic Control (RISE)Oxygen Cleanliness: Ensure all equipments are cleaned before being put into or returned to oxygen service.Oxygen equipment shall be free of solid particles or shall be plurged with oil- free or nitrogen before start up, in case of new equipment.Vessel Entry/ Blanking Procedure: Prior to entry into any vessel, connected to a gas source, vessel should be emptied and isolated from the source.Isolation Equipment: An isolation valve should be provided outside the building in accessible position for operation in case of event of oxygen release inside the buildingDisused oxygen line should either be dismantled, or completely severed, and blanked off from the supply system.

12. Protection of Personnel

13. Protection of PersonnelReaching Impact, Saturation, and Epidemic Control (RISE)ClothesAnalysisFirefighting EquipmentSmokingEmergency response and rescue

14. Hospital Fire Safety Assessment Checklist

15. Appendix: Hospital Fire Safety Baseline Assessment Checklist Reaching Impact, Saturation, and Epidemic Control (RISE)

16. Appendix: Hospital Fire Safety Baseline Assessment Checklist S.NoAssessmentMark Y/N or as desiredFire Safety Points (Prevention Aspect)24Availability of underground water reservoir? If yes, mention the number. 25Availability of overhead water reservoir? If yes, mention the number. 26Any point or gate identified in the hospital building as emergency exit? 27Display of fire evacuation plan if it exists? 28Constituted hospital disaster management committee? Availability of Emergency Response Plan for Fire, Evacuation, etc..29Functional public-address system (assigned intercom number)? 30Availability of emergency hooter? 31Availability of emergency power backup system? 32Availability of material safety data sheet of hazardous chemicals in the hospital store? 33Total number of fire extinguishers installed?  Type of extinguisher installed- A, B, C, etc..?  Size of extinguishers?  5 kg (if installed, mention the number)?  10 kg (if installed, mention the number)?  4.5 kg (if installed, mention the number)?  500 gram-Foam (if installed, mention the number)?  Availability of sand buckets? 34Availability of smoke detectors in key areas (if yes, mention the department)?  ICU  SNCU  Paediatrics wards  Isolation ward  Store  Kitchen  Record room  Other Reaching Impact, Saturation, and Epidemic Control (RISE)

17. Appendix: Hospital Fire Safety Baseline Assessment Checklist S.NoAssessmentMark Y/N or as desired35Water hydrants (if the building is G+2 and plot area more than 1000 m2 but less than 1500 m2)  No. of hydrants installed (if in compliance with the above criteria)? 36Availability of automatic sprinkler system as per IS 15105 (if basement area exceeds 200 m2)  Area/department where sprinklers are installed (if in compliance with the above criteria)? 37Availability of dedicated fire water tank (if basement area is more than 200 m2)?  Availability of diesel fire water pump which can discharge water 1620 litres/minute (if in compliance with the above criteria)?  Electrical fire water pump which can discharge water 180 litres/minute (if in compliance with the above criteria)? 38Availability of hose reel (if G+1 construction)?  Area where hose reels are installed and no. of hose reels available (if in compliance with the above criteria)? Statutory Compliance39NOC of the building from the municipality 40NOC for fire safety of the building 41AMC of firefighting equipment Training42Training of all the staff to operate firefighting equipment 43Availability of SOP for fire emergency? 44Provision for periodic mock drills (if yes, no. of mock drills conducted in a year) 45Are staff members familiar with their role and responsibility in the event of a fire?  Remarks:Reaching Impact, Saturation, and Epidemic Control (RISE)

18. Appendix: Hospital Fire Safety Inspection ReportHospital name, address & contact number:1Means of escapeYes/NoAre there any fire exits? Are all exits clear of obstructions? Are exit signs adequate? Are exit routes clear? Comments:2Fire alarm systemYes/NoIs there a fire alarm system? Is the fire alarm system functional? Is the fire alarm system regularly serviced? Is there any smoke or heat detector? Is the smoke or heat detector functional? Is the smoke or heat detector regularly serviced? Comments:3Firefighting equipmentYes/No Is there any fire extinguisher? Is the fire extinguisher functional? Is the fire extinguisher regularly serviced? Is there any hose reel? Is the hose reel functional? Is the hose reel regularly serviced? Comments: Reaching Impact, Saturation, and Epidemic Control (RISE)

19. Appendix: Hospital Fire Safety Inspection ReportHospital name, address & contact number:4TrainingYes/NoIs there a staff training program on fire-safety? Are fire evacuation mock drills scheduled and performed regularly? Comments:5Fire safety leadershipYes/NoAre there any designated personnel for fire-safety management in the facility? Comments:6Fire prevention standards (official use only)Name of the Inspecting officer: Date of inspection: Date of next inspection: Comments:Reaching Impact, Saturation, and Epidemic Control (RISE)

20. Fire Suppression

21. Key Components Of Fire Safety| 21Reaching Impact, Saturation, and Epidemic Control (RISE)

22. Reaching Impact, Saturation, and Epidemic Control (RISE)PreventionFires can be prevented by: Using materials that are resistant to combustion or burning Avoiding materials that are highly flammableHaving a fire-safety or fire-response team Adhering to fire safety practices and lawsTypes of firesClass AFires that involve ordinary combustible materials such as wood, cloth, paper, rubber, and many plastics. Class BFires that involve flammable liquids, combustible liquids, petroleum greases, tars, oils, oil-based paints, solvents, lacquers, alcohols, and flammable gases. Class CFires that involve energized electrical equipment, such as power tools, wiring, fuse boxes, appliances, TVs, computers, and electrical motors. Class DFires that involve combustible metals such as magnesium, potassium, titanium, zirconium, lithium, and sodium. Class KFires that involve combustible cooking oils and fats used in commercial cooking equipment.

23. Reaching Impact, Saturation, and Epidemic Control (RISE)Prevention - Safety Warnings And Warning Signs Safety warnings:• “WARNING: Smoking during oxygen therapy is dangerous and is likely to result in facial burns or death. Do not allow smoking within the same room where the oxygen concentrator or any oxygen carrying accessories are located. • “No smoking” signs wherever oxygen is used and not to allow an open flame or a cigarette anywhere within 3 m of an oxygen source.WARNING SIGNS

24. SuppressionFire suppression is critical in order to circumvent/minimize damage or the loss of property and life. The ability to quickly detect and extinguish fires is a key factor in avoiding the worst-case scenario, which is evacuation of the hospital. Reaching Impact, Saturation, and Epidemic Control (RISE)

25. Reaching Impact, Saturation, and Epidemic Control (RISE)Suppression - Types Of Fire ExtinguishersImportant notes: You should know what is burning and that you have the appropriate type of extinguisher to fight the fireYou are knowledgeable regarding the use of the extinguisherMake sure that you keep your back to a clear exit and stand 2 to 3 meters (6 to 8 feet) away from the fire. Your safety is paramount; if the fire is out of control, leave the area immediately. Water sprinkler and mist sprinkler systems, water hose reels, and smoke extractors can be installed in a hospital to improve the facility’s resilience to fire hazards.

26. Suppression - Using Fire Extinguishers - PASSImportant notes: Regular training of fire wardens (or health and safety officers) and hospital staff on how to use fire suppression devicesAcronym PASS should be memorised by all staff membersUse of fire extinguishers should be translated into local language and pasted close to the fire extinguishers in bold and easily readable textReaching Impact, Saturation, and Epidemic Control (RISE)

27. Evacuation

28. Evacuation Types of Evacuation Movement during Evacuation Evacuation could be Complete or PartialSpecial needs of patients should be consideredClearly identified assembly point and/or discharge site AVOID ELEVATORS DURING FIRE EMERGENCYReaching Impact, Saturation, and Epidemic Control (RISE)

29. Evacuation - Patient Prioritization And Transport Equipment Sufficient transportation equipment of good quality which is easily accessible at all times should be available for evacuationA minimum of two fire exit routes on every floor, clearly marked and located as far away from each other Patient Prioritization Transport Equipment1. Blankets2. Wheelchairs3. Beds4. StretchersReaching Impact, Saturation, and Epidemic Control (RISE)

30. Evacuation – Transporting Patients On Ventilator SupportPlanningDesignate a Critical Care Team LeaderFormation of Hospital and Transport agreements with other hospitalsPrepare for and Simulate Critical Care Evacuation and TransportSteps to following during Evacuation:Initiate ICU Evacuation PlanRequest Assistance for EvacuationEnsure Adequate Power and Transport Ventilation EquipmentPrioritize Critical Care Patients for EvacuationCritical Care Patient Distribution- contact receiving hospitalsPrepare the Critical Care Patient for EvacuationSend Critical Care Patient Information with PatientTransport Critical Care Patients to Receiving HospitalsTrack critical Care Patients and EquipmentReaching Impact, Saturation, and Epidemic Control (RISE)

31. Reaching Impact, Saturation, and Epidemic Control (RISE)Evacuation – Using Self-contained Breathing Apparatus (SCBA)A device worn to provide breathable air in environments with oxygen deficiency, smoke, dangerous gases, and other airborne contaminantsEssential for modern firefighting and today’s complex fire groundsAn SCBA typically consists ofFacemask with a hose that connects to an air source worn by the userAir source can be a tank of compressed air, compressed oxygen, or an oxygen-generating chemicalThey are of two types:Air Breathing Apparatus (Open-circuit): Air inhaled from cylinder and exhaled air goes to the atmosphereOxygen Breathing Apparatus (Closed-circuit): Air inhaled from cylinder and exhaled air goes to the absorbing canister, and oxygen is re-supplied through breathing bag. This mechanism enables for long time use.

32. Evacuation - Hospital Incident Command SystemReaching Impact, Saturation, and Epidemic Control (RISE)

33. Reaching Impact, Saturation, and Epidemic Control (RISE)Evacuation Training DrillsTraining drill is sequence of activities in response to a fire alarmEach health facility should have tailored evacuation/response plan and trainings to meet its needsNote: All training simulations and fire drills need to be scheduled and performed regularly, and performance evaluations need to be completed and used to improve subsequent training drills.

34. Incase Of A Fire - RACE Reaching Impact, Saturation, and Epidemic Control (RISE)

35. DosPrevent leakages:All equipment and hose connections must be properly fittedNewly assembled equipment should be leak-checkedCylinder valves must be turned off, when not in usePerform maintenance and repair only by experienced and fully skilled personnelProtect gas cylinders against being knocked or droppedVentilate workplaces wellIdentify all oxygen apparatus and equipment properly with the gas name and safe working pressureKeep fire extinguishers and blankets in good conditionKeep all routes clearMake fire safety officer’s designation at the facility level mandatoryConduct periodic trainings and drills on fire safety and their record should be maintainedBe aware of your facility’s fire safety protocolFire Safety Considerations- Dos| 35Don’tsIgnore fire alarmTamper with fire alarm systemsUse elevators during evacuationSmoking around oxygen-enriching devicesAllow naked flames, sparks, and static electricityUse oils/grease as lubricants on oxygen or enriched-air equipmentReaching Impact, Saturation, and Epidemic Control (RISE)

36. Safety is always the primary concernSteps on how to operate fire extinguishers should be translated in local language and pasted close to the fire extinguishers in bold and easily readable text.Full evacuation of a hospital should generally be considered as a last resort.Simplicity is key; the staff will need a simple plan to follow in an emergency. Flexibility is vital because the procedures must be adaptable to a variety of situations. Self-sufficiency at the unit level is important because timely communication from hospital leaders may be difficult or even impossible; employees at every level must know immediately what to do in their area. BMEs should also train health care workers on basic safety when using oxygen equipment.Dedicated assembly points & discharge sites in the vicinity of the facilityExternal patient transporters should generally not be asked to come into the hospital to evacuate patients because of the risks, time delays, and inefficiency associated with this process when large numbers of patients are involved. Other Fire Safety Considerations When difficult choices must be made, leaders and staff must focus on the “greatest good for the greatest number”.Reaching Impact, Saturation, and Epidemic Control (RISE)

37. Emergency Plan

38. Emergency Response And Rescue Emergency response procedure should contain provisions for entry into potentially oxygen- enriched areas.Victim rescue or entry to shut down, the process should not be attempted until the level of oxygen- enriched gases determines to be less than 23.5% and is safe to enter.Clothing materials should be flame resistant.Emergency procedures may include the use of water spray to protect potential victims.Provide emergency procedures and readily accessible emergency contact number for fire and medical response.Trained the personnel and conduct mock drills.Source of oxygen rich gases should be cut off. If liquid oxygen rich gases released in an open space, a hazardous concentration exists within the visible fog cloud with the spill or can exist outside the cloud as well.Avoid entering a visible fog cloud or used a portable oxygen analyser before entering the area near a release.Reaching Impact, Saturation, and Epidemic Control (RISE)

39. Safety Signs

40. Reaching Impact, Saturation, and Epidemic Control (RISE)

41. Session: Precautions, Safety Consideration, Maintenance for LMO, PSA Plant, MGPS and Other Oxygen EquipmentReaching Impact, Saturation, and Epidemic Control (RISE)

42. Precautions Handling Oxygen Cylinder

43. General HandlingPersonal protective equipment should be worn when handling oxygen cylinderAll compressed medical oxygen gas cylinder should be secured to racks, walls, work benches or hand trolleys by a strong chain or strapSecure in an upright positionDo not drop cylinders or allow sharp impacts on cylindersCover the top of oxygen cylinder with the cap when not in use or when being transportedSet up the cylinder at a safe distance from the patientReaching Impact, Saturation, and Epidemic Control (RISE)

44. General HandlingDo not place cylinder on a patient’s bedDisconnect the cylinder from regulators or manifolds before moving the cylinder by applying protective valve capsCylinder should be moved only on a hand truck or other cart designedNo more than one cylinder should be handled at a timeAll medical gas cylinders should be clearly labelled to identify the contentsAll defective gas cylinders or equipment should be reported immediately to the supplier for correction or replacementReaching Impact, Saturation, and Epidemic Control (RISE)

45. StoragePhysically separate full and empty medical gas cylindersAmbulatory organizations can do using separate racks, physical barriers or by color coding the storage rackLabel the cylinder clearly to avoid confusion and delay in selecting the cylindersStore in well- ventilated, clean, dry conditions, not exposed to extreme of heat or coldDo Not use oil or grease on the valve of cylinders or regulators/ gaugesNever use a single use and/ or re-use an industrial gas cylinder for refilling medical oxygenReaching Impact, Saturation, and Epidemic Control (RISE)

46. When And How To Change A CylinderGas cylinders should only be transported with their protective metal cap in place, using a cylinder trolley where available.Be sure that the cylinder contains the right gas.The tank valve must be closed and the pressure has to be released completely before disconnecting the regulator.The valve must not be damaged and must be free of dirt, dust, and grease.When the regulator has an O-ring, check if it is correctly in place and not damaged.Do not use Teflon tape on the high pressure side.Use the right spanner key/ spanner to tighten/loosen the pressure regulator.Do not use too much force. Never use a longer lever or a hammer to tighten a regulator. The regulator will tighten itself further under pressure.Open the cylinder valve slowly.Check for leaks around the regulator. Listen to hissing sounds. After closing the cylinder valve, the pressure shown on the pressure gauge should remain stable.Reaching Impact, Saturation, and Epidemic Control (RISE)

47. Fire SafetyEnsure appropriate fire extinguishers to be kept nearby and regularly inspectedKeep oxygen cylinder at least several meters from a heat source, open flames, electrical devices or other possible source of ignitionPut a “No Smoking” sign near oxygen sources in the hospitalCheck for electrical circuit breakers and devices are in safe working condition and free from sparking to prevent a serious fire occurrence.Reaching Impact, Saturation, and Epidemic Control (RISE)

48. Precautions During Equipment HandlingHandle cylinders carefully, move in trolleyKeep cylinders clamped or chained to prevent from falling overOnly store as many cylinders as needed; return empties to suppliersOpen valves slowly and in correct orderClose valve when not in useNever insert an object into cap openingsUse an adjustable strap wrench to remove over-tight or rusted capsInstall valve- protection capStore full and empty containers separatelyProtect cylinder from physical damageNever attempt to lift a cylinder by its capUse a first-in, first out inventory systemReaching Impact, Saturation, and Epidemic Control (RISE)

49. Decontaminating and Disinfecting Oxygen Supply Devices

50. All oxygen equipment need exactly same sanitization as given to other machinery in the hospitalGuidelines for handling oxygen cylinderCleaning and disinfection procedure should be performed at the hospitalInitial cleaning should be done with soap and hot water (not exceeding 50 degree Celsius)Under no circumstance medical gas cylinder should be immersed in water. Ensure valves and inlets should be covered and closed so that water doesn’t get inside.After initial cleaning, cylinder should be cleaned with isopropyl alcohol or equivalent disinfectant wipesEnsure the residual disinfection agents are removed from the gas cylinder as it can cause a potential fire riskAvoid cleaning agents that contain ammonia, amine or chlorine-based compounds as they can cause corrosionUsed cylinder should be kept in an isolated area with a tag clearly mentioning that cylinder is infectedMedical gas cylinder should be quarantined till they are cleaned. Cylinder should be filled only after cleaningPersonnel involved in filling, storing, handling and transportation should be wearing protective gears at all timesObsolete cylinders must be disposed of based on local regulationsReaching Impact, Saturation, and Epidemic Control (RISE)

51. Precautions Handling LMO

52. Hazards associated with liquid oxygen are exposure to cold temperature It Can cause severe burns, over pressurization, oxygen enrichment of the surrounding atmosphere and the possibility of a combustion reactionPersonnel should stay in well- ventilated area and avoid any source of ignition until their clothing is free of any excess oxygenClothing saturated with oxygen is readily ignitable and burn vigorouslySmoking or open flames should not be permitted in any areas where liquid oxygen is stored or handledDo not permit liquid oxygen or oxygen enriched air to come in contact with organic material or flammable or combustible substancesIf liquid oxygen spills, keep sources of ignition away for 30 minutes after all frost or fog disappearedSystem used in oxygen service must meet stringent cleaning requirementsSafety ConsiderationsReaching Impact, Saturation, and Epidemic Control (RISE)

53. HandlingNever use oxygen as a substitute for compressed airNever use oxygen jet for any type of cleaningDo not get liquid in eyes, on skin or on clothingPerson exposed to high concentration of liquid oxygen should stay in well- ventilated area for 30 minImmediately remove clothing exposed to oxygenPrevent ignition sources such as static electricity to be generated in clothing while walkingWear leather safety gloves and shoes when handling cylinderProtect cylinder form physical damageUse a cart while moving cylinders (only for micro/dura cylinders)Never insert an object into cap openingsClose the container valve after each use; keep closed even when emptyReaching Impact, Saturation, and Epidemic Control (RISE)

54. HandlingNever apply flame or localized heat directly to any part of the containerHigh temperature may damage the containerCryogenic container must be stored, handled and transported in the upright positionAvoid mechanical and thermal shockUse only oxygen-compatible materials and lubricantsDo not remove or interchange connections. Use only properly assigned connectionsDo not use adaptersUse only transfer lines and equipment designed for use with cryogenic liquidsSome elastomers and metals must be avoided in cryogenic service as they may become brittle at extremely low temperature All vents be piped to the exterior of the buildingOn gas withdrawal systems, use check valves or other protective apparatus to prevent reverse flow into the containerOn liquid systems, pressure relief devices must be used in lines where there is a potential to trap liquid between valvesReaching Impact, Saturation, and Epidemic Control (RISE)

55. StorageStore where temperature will not exceed 125-degree FahrenheitPost “No Smoking/ No Open Flames” signs in storage and use areasSecure containers in upright position to keep them from fallingStore full and empty containers separatelyUse a first-in, first out inventory systemStore and use liquid container with adequate ventilationLiquid container should not be left open to the atmosphere for extended periodsKeep valves and outlets caps closed when not in useReaching Impact, Saturation, and Epidemic Control (RISE)

56. Reaching Impact, Saturation, and Epidemic Control (RISE)

57. Precautions Handling MGPS

58. Safety PrinciplesReaching Impact, Saturation, and Epidemic Control (RISE)

59. Fire SafetyFire detection system such as smoke or heat detector heads should be installed in the plantrooms, medical gases manifold rooms and medical gases cylinder stores in hospitalAn automatic shutdown system, linked to local smoke detector can be installedAn automatic emergency supply manifold system is sited well away from the fire risk area and is arranged to come on-line automatically in the event of plant shutdownReaching Impact, Saturation, and Epidemic Control (RISE)

60. Reaching Impact, Saturation, and Epidemic Control (RISE)Precaution Handling MGPSFormulating SOPs and maintaining logbooksPreventive maintenance of equipmentLeak test of pipeline should be ensured on quarterly basis24 hrs manning by trained personnelPeriodic training of manifold personnelDaily checking of contingency planMock drills of pipeline failure, fire and explosion should be regularly conducted

61. Precautions Handling PSA

62. Room should be well- ventilated where oxygen generators are operated.Oxygen vents should be piped outside the building or to a safe area.Warning signs should be posted in oxygen enriched atmosphere.Special precaution should be taken such as installation of analyzers with alarms, ensuring minimum number of air changes per hour, implementing special entry procedures.Recognize the accumulation of oxygen in the areas remote to generator.Use of protective clothing special equipment when working with oxygen.Reaching Impact, Saturation, and Epidemic Control (RISE)

63. Fire ProtectionPrimary fire protection for generator is an ample water supplyAdequate number of fire hydrants, chemical type fire extinguishers, hoses or a combination of these should be strategically located close to generatorAutomatic isolation valves or generator shutdown are used to isolate oxygen sources from feeding a fireReaching Impact, Saturation, and Epidemic Control (RISE)

64. Precautions Handling Oxygen Concentrator

65. | 65FaultPossible CauseSolutionEquipment is not runningNo power from mains socket       Electrical cable fault  Internal problemCheck power switch is on. Replace fuse with correct voltage and current rating if blown. Check mains power is present at socket using equipment known to be working. Contact electrician for rewiring if power not present. Try cable on another piece of equipment. Contact electrician for repair if required. Refer to biomedical technicianFuse or circuit breaker blows a second time after replacementInternal equipment faultRefer to electrician or biomedical technicianColoured or metal wire visible in cable, socket or plugInsulation damagedRemove item and refer to electrician for repair. DO NOT cover with tape.Cracks visible in socket or plugDamaged coverRemove item and refer to electrician for repair. DO NOT cover with tape.Electrical shocksWiring faultRefer to electricianTroubleshooting – Electrical SafetyReaching Impact, Saturation, and Epidemic Control (RISE)

66. | 66Weekly ChecklistCleaningClean dust and liquid off with a DRY cloth.Remove tape, oil and dirt from all cables, plugs and sockets.Visual checksRemove any cracked connectors or cables from service.Check for and report any damaged room wiring or fittings. Check for and report any signs of burning, melting or sparks.Untangle all cables and store carefully.Function checksReport any sockets that are loosely fitted or not working.Check for and report and broken fans or lightsElectrical Safety – Weekly ChecklistReaching Impact, Saturation, and Epidemic Control (RISE)

67. Thank You!Reaching Impact, Saturation, and Epidemic Control (RISE)