In recent years, the importance of accessible, reliable medical oxygen has come into sharp focus, particularly with the global rise of respiratory conditions like COVID-19.
However, having medical oxygen available is not enough—health workers must be adequately trained to use, manage, and monitor oxygen use appropriately. Within health facilities, the proper use of medical oxygen is a critical element of patient care, as it translates availability to access.
In Malawian health facilities, the introduction of comprehensive medical oxygen and respiratory care training programs has significantly improved both the quality of care and patient outcomes.
Before the integration of specialized training in medical oxygen and respiratory care, most health workers lacked sufficient training in the proper use of oxygen therapy and respiratory care techniques. This was demonstrated by the participants’ average score of 20% below the passing mark on the pretest performed throughout the trainings.
Additionally, many health workers confessed to having done different procedures wrongly as far as medical oxygen administration was concerned. This often led to underutilization or misuse of oxygen—contributing to adverse outcomes in respiratory care.
“We have been having these Venturi masks in our wards but never knew how to use them such that we ended up disposing [of] them.”— Anonymous, nurse midwife
Mismanagement of oxygen delivery systems, from concentrators to cylinders, was another common issue. “In our ward, if a concentrator is continuously beeping, we just turn it off and then on again and the alarm disappears,” said one health worker, who was unaware that this is a sign that the device needs the attention of a biomedical engineer. Clearly, this resulted in the patient receiving insufficient treatment.
There has also been a lack of standard protocols for oxygen therapy, making it difficult for health professionals to implement consistent, evidence-based practices. Another health professional said, “In a case where the clinician prescribes oxygen for a patient, they commonly write it as ‘start O2 therapy.’ This then requires the one performing the intervention to guess the devices that [are] to be used, the source of oxygen, and what flow rate needs to be given [to] the patient.”
A biomedical engineer teaching lecturers from Nkhoma College of Nursing and Midwifery together with in-service health workers from Nkhoma Mission Hospital on how to safely use an oxygen cylinder and its accessories. Photo: PATH/Happy Banda.
In response to these challenges, PATH, together with the Ministry of Health, has been implementing targeted training programs focusing on the safe use, monitoring, and management of medical oxygen for both in-service health workers and lecturers in their training institutions. Thus far, there have been 329 health workers trained, whose improved capacity will impact 26 health facilities and 11 training institutions.
The training modules were designed to:
- Provide a thorough understanding of medical oxygen, its production, and its role in the management of various conditions.
- Teach the correct usage of different oxygen delivery systems, such as nasal cannulas, face masks, nonrebreather masks, and high-flow nasal oxygen devices.
- Ensure proficiency in monitoring patients using pulse oximetry and blood gas analysis to adjust oxygen therapy based on clinical need.
- Emphasize the importance of equipment maintenance and calibration to reduce malfunctions and extend the lifespan of oxygen equipment.
The impact of these trainings has been evident: health workers now have a much clearer understanding of the dos and don’ts of oxygen therapy—as demonstrated by the improved scores in the posttests of the trainings.
They are now more confident in identifying when to initiate oxygen therapy and how to escalate it to meet patient needs. This will help to significantly reduce the incidence of both hypoxia and hyperoxia, contributing to better overall patient safety.
With better knowledge of how to manage oxygen delivery systems, oxygen wastage will be reduced through the use of appropriate oxygen flows for the delivery devices being used.
The training content on regular maintenance schedules and equipment handling will help to reduce breakdowns, ensuring that oxygen delivery devices are always functional when needed.
A snapshot of how the participants performed in the pre- and posttests for one session of the medical oxygen and respiratory care trainings.
“I found the knowledge on the different oxygen delivery devices needing different oxygen flows particularly useful as I was not aware.”— Anonymous, nurse midwife
A practical session on oxygen monitoring devices with staff from Trinity College of Health Sciences and Trinity Hospital. Photo: PATH/Happy Banda.
While the knowledge change is clear from how the trainings were done, there is still room for growth. To sustain and build upon these gains, health workers and biomedical engineers should continue to take ongoing training and refresher courses. This is essential to keep them updated on the latest advancements in respiratory care. Offering refresher courses and integrating new technologies into the curriculum will ensure that skills remain sharp.
PATH, the Ministry of Health, the Nurses and Midwives Council of Malawi, and the World Continuing Education Alliance (WCEA) have made strides in this area by offering the Medical Oxygen and Respiratory Care training on the WCEA CPD platform, which is accessible to all cadres of health workers.
“I took oxygen administration as a light task, and this training has been an eye-opener on how it should be done correctly.”— Anonymous
Equipping Malawi’s health professionals with the skills and knowledge they need has not only enhanced patient safety, but also fostered a culture of continuous learning and improvement. Moving forward, Malawi remains committed to optimizing respiratory care—ensuring that every patient who walks through the doors of its health facilities receives the highest standard of care.
