This library provides a comprehensive set of global and country-specific tools, guidance, and other resources to support oxygen scale-up and long-term respiratory care planning.
JOURNAL PUBLICATION | Published in Universal Library of Clinical Nursing, this review reports the extent of measurement bias for pulse oximeters, describes its clinical importance, and discusses approaches to eliminating it.
GUIDANCE | The purpose of this document is to present a comprehensive package of technical specifications for medical oxygen system products and components: source, storage and distribution.
JOURNAL PUBLICATION | Published in PLoS Digital Health, this article investigates how digital determinants of health contribute to bias in health technologies and their potential impact on healthcare equity.
JOURNAL PUBLICATION | Published in The Lancet, this study investigated the feasibility of regenerating old zeolite for use in oxygen concentrators.
TOOL | The Global Fund is partnering with UNICEF to source oxygen products. The current product list, including pricing and a link to the technical specifications, can be found in this document.
JOURNAL PUBLICATION | Published in medRxiv, this systematic review found that most research on medical oxygen emerged post-COVID-19, highlighting gaps in empirical studies on its accessibility and use.
GUIDANCE | This document has been compiled to capture definitions, technical requirements, tools and resources related to medical oxygen systems.
REPORT | This NEST360 report outlines a compendium of newborn healthcare technologies, both commercially available and in development, suitable for use in resource-limited settings.
TOOL | This sheet is a living document and is being populated with specifications of oxygen concentrators.
JOURNAL PUBLICATION | Published in Journal of Pharmaceutical Sciences, this review evaluates the updated European Medical Device Regulations and their global impact, emphasizing stricter compliance requirements post-COVID-19.
REPORT | This report describes ways to ensure that the attention that medical oxygen has received can be leveraged to create a broader network – a grid of oxygen resources.
REPORT | This report aims to assess the potential of multimodal pulse oximeters to improve the integrated diagnosis and treatment of illnesses for patients presenting at health facilities in LMICs.
GUIDANCE | This guide highlights evaluation results and provides 12 opportunities of designing oxygen concentrators, humidifier bottles, and flow splitters to address the oxygen gap in healthcare settings in LMICs.
REPOSITORY / TOOLKIT | In order to build capacity for long-term sustainability, PATH developed, translated, and disseminated high-quality, reliable, and ready-reference knowledge products specific to India.
TOOL | The NEST360 qualified technologies are a list of newborn care technologies best suited for use in low-resource setting hospitals, including being effective, affordable, rugged, and simple to use.
JOURNAL PUBLICATION | Published in International Journal of Pharmaceutical Sciences and Research, this study focuses on the devices, including ventilators, which require regulations but still lack the quality check points.
JOURNAL PUBLICATION | Published in Sensors (Basel, Switzerland), this review aims to study the literature that assesses the influence of skin pigmentation on the accuracy of pulse oximeters.
GUIDANCE | The document provides, in detail, the components and functioning of an oxygen concentrator.
JOURNAL PUBLICATION | Published in Sante Publique, this article investigates the functionality of oxygen concentrators in hospitals in North Kivu, DRC, and emphasizes the need for improved maintenance and training.
JOURNAL PUBLICATION | The World Federation of Societies of Anesthesiologists (WFSA) has developed the “WFSA—Minimum Capnometer Specifications 2021”, which are published in Anesthesia & Analgesia.
COURSE / TRAINING VIDEO | These NEST360 training videos demonstrate model-specific equipment setup, use, and maintenance and are used as training aids in clinical and technical training.
PRESENTATION / WEBINAR | This WHO webinar provides as introduction to the oxygen ecosystem, a holistic assessment of oxygen and biomedical equipment, and recommendations for medical device specifications and procurement.
TOOL | This tool from NEST360 provides a technical scenario for a bubble CPAP device.
TOOL | This tool from NEST360 provides a technical scenario for a flow splitter.
TOOL | This tool from NEST360 provides a technical scenario for an oxygen concentrator.
TOOL | This tool from NEST360 provides a technical scenario for a pulse oximeter.
TOOL | This tool from NEST360 provides a technical scenario for a suction pump.
REPORT | This report presents findings of the registration status of tracer MNCH medicines and the functionality of regulatory agencies with respect to legal provisions, organization and resources, and registration processes.
GUIDANCE | ISO’s Action Plan maps out how ISO aims to contribute to improving developing countries’ economic growth and access to world markets and helping to achieve sustainable development.
JOURNAL PUBLICATION | To respond to inflated costs and export restrictions on medical equipment, Mercedes HPP worked with key experts to produce a simple, mechanical noninvasive respiratory device to deliver CPAP.
REPORT | This market report serves as a preliminary guide to available suppliers with capacity to provide equipment for respiratory care and is intended to help conduct an initial supplier landscaping.
GUIDANCE | This document specifies requirements for the basic safety and essential performance of an oxygen concentrator in combination with its accessories.
GUIDANCE | This document describes the medical devices required for the clinical management of COVID-19, selected and prioritized according to the latest available evidence and interim guidelines.
TOOL | This document describes the medical devices required for the clinical management of COVID-19, selected and prioritized according to the latest available evidence and interim guidelines.
REPOSITORY / TOOLKIT | The Ventilator Training Alliance provides a library of training and product resources for medical professionals.
GUIDANCE | This document provides technical specifications for the minimum requirements that a PSA oxygen plant must meet for use for the administration of medical-grade oxygen.
GUIDANCE | These technical specifications describe the minimum requirements that invasive and noninvasive ventilators must comply with to ensure quality, safety, and effectiveness for COVID-19 management.
GUIDANCE | This interagency publication provides harmonized product specifications for a wide range of products for delivering oxygen therapy and guidance on the selection, procurement, use, and maintenance of these products.
GUIDANCE | ISO 80601-2-61:2017 applies to the basic safety and essential performance of pulse oximeter equipment intended for use on humans.
INFORMATION BRIEF | This summary document highlights PATH’s proposed inclusion of oxygen as a medical gas on the WHO Model List of Essential Medicines (for Children) to clarify its importance as a medicine.
GUIDANCE | This guidance document supports the selection, procurement, utilization, and maintenance of oxygen concentrators.
GUIDANCE | This document provides guidance to developers and manufacturers on the key performance requirements and potential design for a reliable, robust, and scalable oxygen concentrator.
JOURNAL PUBLICATION | Published in Anaesthesia, this study evaluates seven models of oxygen concentrators for use in resource-limited countries, identifying key performance issues under high temperature and humidity conditions.
GUIDANCE | The U.S. Food and Drug Administration has developed this guidance document to assist industry in preparing premarket notifications (510(k)s) for pulse oximeters.
TOOL | This handbook provides troubleshooting flowcharts for various medical equipment, including respiratory equipment like oxygen concentrators, pulse oximeters, respiratory monitors, etc.
JOURNAL PUBLICATION | This review presents and compares four different medical oxygen system configurations across a wide range of criteria relevant to low-resource settings.
JOURNAL PUBLICATION | Daily temperature and humidity data were collected at a health center in The Gambia, where a battery system has been installed as back-up power for a medical oxygen system.
GUIDANCE | Published by Acare Technology Co., Ltd., this manual outlines the usage, setup, and safety guidelines for the AH-M1 handheld pulse oximeter, including features like alarms and maintenance procedures.
GUIDANCE | This document is part of a series of reference documents on medical equipment and health technology being developed for use at the country level.
JOURNAL PUBLICATION | Published in Bulletin of the World Health Organization, this study highlights the challenges faced by a Gambian hospital after receiving incompatible oxygen concentrators.
REPOSITORY / TOOLKIT | The Biomedical Equipment Technician (BMET) Library is a free library containing resources for the repair, maintenance and operation of medical equipment.
REPOSITORY / TOOLKIT | This website provides courses and other training materials on clinical engineering.
REPOSITORY / TOOLKIT | This library provides different resources specific to oxygen equipment technicians.
REPOSITORY / TOOLKIT | This oxygen library by the Oxygen Alliance includes videos, comprehensive service manuals, and other information on every oxygen concentrator the Alliance has analyzed in the past.
TOOL | This presentation highlights the Bioforge Oxysaver, which was developed as a more affordable product for LMICs, compared to the Demand Oxygen Delivery Systems (DODS) currently available.
COURSE / TRAINING VIDEO | In this course, biomedical engineers with a strong background in biomedical engineering or electronics will be given a refresher on oxygen concentrators.
REPOSITORY / TOOLKIT | This toolkit provides answers to many questions related to COVID-19. The answers were curated from evidence-based literature and peer-reviewed resources.
GUIDANCE | This webpage highlights World Health Organization guidance and resources on the use of medical oxygen.
REPOSITORY / TOOLKIT | Medevis is an open access WHO electronic database on appropriate medical devices according to the levels of care, setting and intended health intervention.
PRESENTATION / WEBINAR | The Oxygen Talk is where the Oxygen Alliance invites experts to come and speak about an oxygen-related topic.
GUIDANCE | This guidance outlines the definition, production, testing, and storage requirements and allowed impurities for oxygen 93 percent, as laid out in the U.S. Pharmacopoeia.
JOURNAL PUBLICATION | Published in British Journal of Anesthesia, this study hypothesized that color bias in pulse oximetry results from the optical properties of two LED sources typically used in commercial pulse oximeters.
JOURNAL PUBLICATION | Published in The Lancet Global Health, this paper urges WHO, governments, ministries of health, and funders to implement these 5 recommendations to strengthen the biomedical engineering profession.
JOURNAL PUBLICATION | The Lancet Global Health Commission on medical oxygen security aimed to synthesize available evidence and produce actionable recommendations. This article highlights the results of the Commission’s work.
JOURNAL PUBLICATION | Published in Sensors, this study sought to further investigate the root causes of overestimation of arterial oxygen saturation (SpO2) in individuals with darker skin.
ARTICLE | The U.S. Food and Drug Administration published new draft guidance aimed at helping improve the accuracy and performance of pulse oximeters across the range of skin pigmentation.
JOURNAL PUBLICATION | Published in Journal of Perinatology, this study assessed if a novel CPAP system is associated with improvement in premature infants in a low-resource setting and if blended oxygen reduced FiO2.
JOURNAL PUBLICATION | Published in IEEE, this study investigates the impact of melanin concentration on the accuracy of oxygen saturation (SpO2) estimation using reflective photoplethysmography (PPG) measurements.
JOURNAL PUBLICATION | This paper proposes a conceptualization of a particular delivery model that takes a broader approach than the traditional oxygen procurement and delivery – ‘Outsourced Oxygen-to-the-Bedside’ (O2B).
JOURNAL PUBLICATION | Published in Annals of the American Thoracic Society, this paper describes how this rule recognizes that pulse oximeters are less reliable on dark skin pigmentation and needs to be addressed.
JOURNAL PUBLICATION | Published in World Journal of Clinical Pediatrics, this study evaluates the advantages, limitations, and challenges of pulse oximetry in clinical practice, as well as proposes recommendations to optimize its use.
REPORT | This report summarizes the results of an analysis conducted on PSA plant failures, and opportunities for improved management.
GUIDANCE | This technical resource document for ensuring the quality of medical oxygen, whether produced on-site or outsourced, aims to serve as a reference and includes tools for practical application.
TOOL | This publication was developed in response to the need for a reference list of priority medical devices required for management of noncommunicable diseases (NCDs), focusing on cardiovascular diseases and diabetes.
JOURNAL PUBLICATION | Published in Journal of Chemical Education, this study highlights the role of knowledge transfer in the development of oxygen concentrators during the COVID-19 pandemic.
ARTICLE | To address recruitment challenges in Nigeria and improve medical oxygen supplies, CHAI collaborated with the Biomedical Engineering Training Institute to conduct a national TOT for biomedical engineers.
ARTICLE | Published in Respiratory Care, this editorial responds to findings from a recent publication and offers mitigation strategies so the use of pulse oximetry is safe for all patients.
GUIDANCE | The U.S. Food and Drug Administration (FDA) is informing patients and healthcare providers that pulse oximeters have limitations and a risk of inaccuracy under certain circumstances.
JOURNAL PUBLICATION | In this article published in Nature, two groups of researchers analyze skin pigmentation’s impact on pulse oximetry readings and its effects on people with dark skin.
JOURNAL PUBLICATION | Published in BMC Medicine, this study systematically reviewed the effects of skin pigmentation on the SpO2 accuracy by pulse oximetry compared with the gold standard SaO2 measured by CO-oximetry.
JOURNAL PUBLICATION | Published in Medicine, Conflict and Survival, this study aimed to assess the effectiveness of solar powered oxygen at Hanano General Hospital in Dusamareb, Galmudug State, Somalia, in a conflict-affected region.
JOURNAL PUBLICATION | Published in BMJ Open, this study assesses the clinical impact and cost-effectiveness of expanding the FREO2 Oxygen System to 20 hospitals and health facilities in Western Uganda.
GUIDANCE | This outlines the proposed update to the definition of medical oxygen, particularly the specifics of 93% and 99.5% purity of medical oxygen, as of May 2022.
JOURNAL PUBLICATION | Published in JAMA Network, this journal article investigated whether there is differential inaccuracy of pulse oximetry by race or ethnicity among patients with COVID-19.
GUIDANCE | This outlines the update to the definition of medical oxygen, particularly the specifics of 93% and 99.5% purity of medical oxygen, as of May 2022.
JOURNAL PUBLICATION | Published in Journal of Global Health, this study assessed pulse oximetry performance of different types of assessors in inpatient settings after an update to the existing IMCI package in Bangladesh.
TOOL | UNICEF, in collaboration with NEST360 and the Oxygen CoLab, is driving the development of a fit-for-purpose Resilient Oxygen Concentrator for low-resource settings.
JOURNAL PUBLICATION | Published in Indian Journal of Critical Care Medicine, this article highlights the problems with donated medical equipment.
TOOL | This pocket reference provides a quick reference on respiratory care, including oxygen sources and delivery devices, respiratory mechanics, volume and pressure control, etc.
JOURNAL PUBLICATION | This article proposes five priority areas for the research community and actionable changes to current regulations that will help improve oximeter accuracy and help reduce bias in pulse oximeter performance.
TOOL | This clinical job aid from NEST360 provides an overview of an Acare suction pump, including assessment and preparation as well as repair and maintenance of the device.
TOOL | This clinical job aid from NEST360 provides an overview of an AirSep oxygen concentrator, including assessment and preparation as well as repair and maintenance of the device.
TOOL | This clinical job aid from NEST360 provides an overview of an Aspeed suction pump, including assessment and preparation as well as repair and maintenance of the device.
TOOL | This clinical job aid from NEST360 provides an overview of a Bistos pulse oximeter, including assessment and preparation as well as repair and maintenance of the device.
TOOL | This clinical job aid from NEST360 provides an overview of a bubble CPAP device.
TOOL | This clinical job aid from NEST360 provides an overview of a Canta oxygen concentrator, including assessment and preparation as well as repair and maintenance of the device.
TOOL | This clinical job aid from NEST360 provides an overview of a flow splitter, including assessment and preparation as well as repair and maintenance of the device.
TOOL | This clinical job aid from NEST360 provides an overview of a LifeBox pulse oximeter, including assessment and preparation as well as repair and maintenance of the device.
INFORMATION BRIEF | This supply intelligence brief series is intended to be a concise primer to understand the solutions available to meet a health system’s need for medical oxygen and its delivery.
TOOL | This document, featuring common noninvasive oxygen delivery devices, is part of a set of tools that can be locally modified to train health providers in respiratory care.
TOOL | This document, featuring how-to information on oxygen concentrators, is part of a set of tools that can be locally modified to train health providers in respiratory care.
GUIDANCE | The NEST-ED Technical Modules help technical staff and students understand the basics of when and how to use equipment essential to newborn care, such as a bubble CPAP device.
GUIDANCE | The NEST-ED Technical Modules help technical staff and students understand the basics of when and how to use equipment essential to newborn care, such as flow splitters.
GUIDANCE | The NEST-ED Technical Modules help technical staff and students understand the basics of when and how to use equipment essential to newborn care, such as oxygen concentrators.
GUIDANCE | The NEST-ED Technical Modules help technical staff and students understand the basics of when and how to use equipment essential to newborn care, such as oxygen cylinders.
GUIDANCE | The NEST-ED Technical Modules help technical staff and students understand the basics of when and how to use equipment essential to newborn care, such as pulse oximeters.
GUIDANCE | The NEST-ED Technical Modules help technical staff and students understand the basics of when and how to use equipment essential to newborn care, such as suction pumps.
TOOL | This tool from NEST360 provides a clinical scenario for continuous positive airway pressure (CPAP).
TOOL | This tool from NEST360 provides a clinical scenario for oxygen concentrator and flow splitter.
TOOL | This tool from NEST360 provides a clinical scenario for suction pumps.
JOURNAL PUBLICATION | Published in PLoS One, this study reports the technical results of a field trial of the FREO2 low-pressure oxygen storage system, consisting of improvements to a standard concentrator, in Uganda.
PRESENTATION / WEBINAR | This video presentation features a panel of pulse oximetry experts sharing essential information on how pulse oximetry works, including that Masimo SET® pulse oximetry is not limited by skin pigmentation.
JOURNAL PUBLICATION | Published in Tropical Doctor, this study explored the views of rural health workers in Papua New Guinea on the impact of a program to improve their oxygen delivery systems.
JOURNAL PUBLICATION | This study analyzed paired pulse oximetry measures of oxygen saturation and measures of arterial oxygen saturation and compared the results to patients who identified themselves as White or Black.
JOURNAL PUBLICATION | Published in the Journal of Global Health, this study describes the development and field testing of two oxygen supply solutions suitable for the realities of health facilities in LMICs.
GUIDANCE | This document is intended to provide guidance on using anesthesia ventilators safely and effectively as ICU ventilators.
GUIDANCE | This document provides guidelines for cleaning externally contaminated medical gas cylinders/containers.
GUIDANCE | This SOP outlines how to convert industrial oxygen cylinders and other gas cylinders to ensure uninterrupted supply of oxygen to hospital and other healthcare facilities.
GUIDANCE | This guidance outlines the definition, production, testing, and storage requirements and allowed impurities for oxygen 93 percent, as laid out in the 9th edition of the European Pharmacopoeia.
GUIDANCE | This guide was created in response to insufficient knowledge about decommissioning medical device and is part of the WHO medical device technical series.
GUIDANCE | This publication provides a comparison between the specifications and the test methods defined for medicinal gases in each of the regional pharmacopoeia compendiums – European, U.S., and Japanese.
GUIDANCE | This publication explains the fire hazards resulting from handling oxygen and the relevant protective measures that should be taken.
JOURNAL PUBLICATION | Published in Trials, this study protocol outlines a trial designed to improve oxygen therapy for children and neonates in Nigerian hospitals through better equipment and healthcare training.
REPOSITORY / TOOLKIT | This toolkit is intended to help with quantifying commodity needs, developing effective procurement plans, and writing specifications for national tenders.
JOURNAL PUBLICATION | Published in the World Journal of Surgery, the study reviewed the surgical capacity in Haiti, identifying significant deficiencies in infrastructure and resources, and recommending task-sharing to improve surgical care.
JOURNAL PUBLICATION | Published in Paediatrics International Child Health, this article examines a quality improvement project in rural Papua New Guinea hospitals to enhance pediatric and neonatal care, including oxygen therapy.
JOURNAL PUBLICATION | This paper in the Annals of Tropical Pediatrics is a practical and up-to-date guide for all involved in purchasing, using, and maintaining oxygen concentrators in developing countries.
JOURNAL PUBLICATION | Published in Respiratory Care, this article emphasizes that contracted vendors can deliver oxygen to alternate care facilities in disaster areas, in the form of concentrators, gas cylinders, or liquid oxygen.
JOURNAL PUBLICATION | As highlighted in this article in the International Journal of Tuberculosis and Lung Disease, the cost-effectiveness of an oxygen systems strategy compares favorably with other higher profile child survival interventions.
JOURNAL PUBLICATION | Published in Canadian Journal of Anesthesia, this study compared inspired oxygen settings of the ventilator/anesthetic machine and actual circuit oxygen levels when using oxygen 99 and 93.
JOURNAL PUBLICATION | Published in Bulletin of the World Health Organization, this study compares oxygen supply options for health facilities in The Gambia and presents a decision-making algorithm for oxygen systems.
JOURNAL PUBLICATION | This study in Anesthesia and Analgesia looks at the relationship between skin pigment and oximeter accuracy in 36 subjects (19 males, 17 females) of a range of skin tones.
JOURNAL PUBLICATION | The study in the journal Anesthesiology showed that the three tested pulse oximeters overestimated arterial oxygen saturation during hypoxia in dark-skinned individuals.
JOURNAL PUBLICATION | Published in the Canadian Journal of Anesthesia, this article reviews ten years experience with oxygen concentrators (OCs) in Canada used as a primary hospital oxygen supply.
TOOL | Published by the Pan American Health Organization, this document discusses the role of health technology assessment in improving healthcare efficiency, safety, and cost-effectiveness in developing countries.