Protocol & Guidelines for

Oxygen Concentrator Use

July 20, 2021

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 Protocol for Oxygen Concentrator Use When Supplied by WBG

Background

An oxygen concentrator is used to provide concentrated oxygen to persons in case their oxygen
saturation (SpO2) in blood falls below the normal level.

Indication & Eligibility

As COVID-19 cases rise and the demand for oxygen supply increases, there might be a short
supply of oxygen in the market. If any WBG staff or their registered dependents fall ill and would
require oxygen for home treatment or during hospital stay staff can request the oxygen
concentrators procured by the World Bank Group if oxygen is not available in the market.
• Oxygen concentrators may be available for request by WBG staff for themselves or
their eligible dependents.
• Oxygen concentrators may only be used under a doctor’s order or prescription.
Prescription for oxygen may come from a local UN doctor or other physician familiar
with the treatment protocols for COVID-19. The patient should be under the care of a
local physician. Use of an oxygen concentrator without a prescription can lead to
serious health problems, such as oxygen toxicity caused by receiving too much
oxygen.
• A patient using an oxygen concentrator also must have access to a pulse oximeter to
check oxygen levels. If no home pulse oximeter is available, one should be provided
by the office as part of the oxygen concentrator package.

Request Process and Usage

XX [number] oxygen concentrators are stored at WBG offices under the control and supervision
of XXX [name of individuals, role – a primary and alternate point of contact should be provided]
and the CMT.

A request for an oxygen concentrator must be made to XXX [name of individuals, role] and with
notification to the head of office/CMT. WBG staff making such a request should complete and
sign this Consent to Participate Form with their point of contact.

Confirmation of a doctor’s prescription must be given before the staff member can pick up the
concentrator. Family members can come and collect it on behalf of the staff. However, please
inform CMT and XXX [name of individual, role] before sending a family member. Alternately,
arrangements for delivery of the concentrator may be made by the local team if this allows a safer
alternative from an infection control point of view (i.e. if the person picking up the unit would have
to take public transportation or a taxi).

Staff will sign out the unit (model and inventory number to be recorded) and CMU will maintain a
log of sign out date and time. A signed note of receipt is to be collected by XXX [name of
individuals, role], including a picture of the recipient with the oxygen concentrator.

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During the sign out, XXX [name of individuals, role] will demonstrate how the oxygen concentrator
is used.

Staff member assigned the unit will be supplied with an unopened set of oxygen tubing (nasal
cannula or mask) and provided with an instruction sheet on operating the concentrator.

Use of the oxygen concentrator must follow the instruction manual for the specific unit, as they
are different for different concentrators.

The patient may use the oxygen concentrator as long as it is prescribed by the treating physician.
Check in on continued need will be done every 5 days by the COVID-19 Focal Point and/or the
staff member managing the oxygen concentrator inventory until oxygen support is no longer
needed or until hospitalization is available.

Any damage to the unit is the responsibility of the staff member borrowing the unit. Damage must
be reported to XXX [name of individuals, role] to ensure that the next person requiring an oxygen
concentrator will receive a well-functioning unit.

Return of the Oxygen Concentrator

Staff who have signed out the unit will inform XXX [name of individuals, role] and arrange to
return the unit once use is no longer needed.

Prior to returning the unit, the staff member must wipe down the exterior of unit with a disinfecting
wipe or a damp cloth/sponge using a mild detergent (or otherwise specified by the instruction
manual). The cabinet filter and air filter of the unit must also be cleaned as instructed in the
manual.

On the return of the equipment, XXX [name of individuals, role] will clean/sterilize the oxygen
concentrators and the other non-consumable equipment (e.g. cabinet filter, humidifier bottle) as
per the instructions of the manufacturer (using appropriate PPE – gloves, mask, as needed) and
document the date and time that the unit was cleaned.

XXX [name of individual, role] will test the unit to ensure proper functioning upon return of the unit
(without using tubing).

Ensure that when distributing oxygen concentrators, that all of the concentrators are rotated for
use (i.e. a first in last out model of distribution) to ensure that unused equipment is used first, and
adequate time passes between the use of each equipment.

The person in charge of maintaining the unit must follow manufacturer’s instructions for regular
servicing and maintenance, finding a local vendor who can do so if possible.

The use of oxygen concentrators should be tracked by the person in charge, to maintain data on
how many of the concentrators are used and for how long they are required per individual use.

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 Guidelines for Using an Oxygen Concentrator

Those using the oxygen concentrator must have access to the instruction manual for the specific
unit they are using and must follow the manual for specific guidance on usage, cleaning,
maintenance, and alarms. The following guidance is intended as a generic guide: nothing that
follows should be considered to override the specific instructions on the unit or any instructions
or direction provided by the prescribing physician.

An oxygen concentrator requires a continuous power supply. If power is expected to be

intermittent, a back-up power system should be used (such as a UPS unit). An oxygen
concentrator should meet the local power supply specifications (110v or 220v) and should
not be used with a voltage converter, nor should it be altered in any way to meet local
power voltage specifications as this is a fire hazard. A voltage stabilizer and surge protector
should be used with every oxygen concentrator.

Oxygen concentrators operate optimally under specific environmental conditions (temperature,

humidity, barometric pressure, altitude). These will be specified in the user manual of the unit.
Please be aware that not all oxygen concentrators can operate optimally in high altitude
conditions. If the oxygen concentrator you have is outside the optimal operating range, it will
function less effectively and may not provide the specified level of oxygen support.

Safety Considerations for Oxygen Concentrators

• Oxygen concentrators are for personal support but are not equivalent to medical
oxygen supplies in the amount of oxygen that can be provided.
• All manufacturers operating and safety instructions must be followed.
• Oxygen is a flammable gas and oxygen concentrators must be kept away from sources
of heat such as fires, stoves, heaters, etc. and should NOT be used around someone
who is smoking. Concentrators should be kept away from any flammable items or
sources of combustion. Keep water, oils, and any petroleum-based products away
from the concentrator. Concentrators can become hot while in use.
• When in use, the oxygen concentrator should be placed in a location where there is
good ventilation and at least 30 - 60 cm (1 – 2 feet) away from walls, furniture or other
items that could block air intake. It should be placed on a hard, flat surface.
• Nothing should be placed on top of the oxygen concentrator.
• A reliable/steady source of power is needed to operate the concentrator. When used
in a location with frequent power outages, the life of the unit may be affected.

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 How to Use an Oxygen Concentrator

Graphics from WikiHow: https://www.wikihow.com/Use-an-Oxygen-Concentrator

Step 1
Plug the machine into a grounded electrical
outlet. If your outlet is not grounded, you will
have to use a plug adaptor. Do not use an
extension cord and do not plug any other
items into the same outlet.

Keep the concentrator 30-60 cm (1-2 feet)

away from walls and furniture.

Start the machine 15-20 minutes (or

according to the manufacturer’s instructions)
before use to allow it to begin cycling the
correct concentration of oxygen.

Step 2
Fill and attach the humidifier bottle with
distilled water or sterilized water (you can boil
water for 3 minutes and let it cool). This will
prevent the oxygen from drying out the
nose/mouth of the user.

Attach the tubing to the humidifier bottle.

Please note: a humidifier bottle is typically

meant as a single use item. If the
manufacturer’s instructions indicate that it can
be reused, it shall be thoroughly cleaned with
mild detergent and warm water after each
user and completely dried.

It is NOT essential to use a humidifier bottle if

it cannot be done in a manner that prevents
infection between users.

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 Step 3
Adjust the flow of oxygen according to the
doctor’s prescription. Most oxygen
concentrators have a maximum flow of 5
liters per minute.

Step 4
Place the mask or nasal cannula on the patient
and check to be sure they have air flow.

If using a mask, the concentrator must be

running on a flow of 5 LPM (liters per minute) to
receive benefit from the oxygen.

Please note: a fresh set of oxygen tubing and

nasal cannula or face mask must be provided for
each individual user.

https://www.wikihow.com/Wear-an-Oxygen-Mask

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 Step 5
The patient must use a pulse oximeter to check
their oxygen level. Place the pulse oximeter on
the finger and wait a few second to get a
reading.

When using a pulse oximeter, make sure the

patient is not wearing any nail polish and that
their fingers are warm.

The oxygen level should be 95% or above. If

not, or if oxygen levels are dropping, let the
patient’s doctor know.

https://www.wikihow.com/Measure-Oxygen-Saturation-Using-Pulse-Oximeter

Step 6

Continue to check the machine periodically

during use and note any alarm that may
sound.

An alarm will sound when the machine turns

on. An alarm may also signal one of the
following situations (see the user’s manual
for specific alarms on your unit):

• Power failure
• Low or high pressure
• Low oxygen concentration (<82%)
• Low or no flow
• low battery
• high temperature