MUHIMBILI UNIVERSITY OF HEALTH AND

ALLIED SCIENCES

SCHOOL OF MEDICINE
DEPARTMENT OF PHYSIOLOGY
UNIT OF BIOMEDICAL ENGINEERING
FIELD REPORT OF BACHELOR OF BIOMEDICAL ENGINEERING
A CASE STUDY AT AMANA REFERRAL HOSPITAL
NAME: GEORGE ELISHA NYARUGEZI
REG NO: 2020-04-14338
ACCADEMIC YEAR: 2022/2023
 ACKNOWLEDGEMENTS

My grateful thanks go to GOD who enabled me to do this field. Also, my special thanks go to my
parents and my family for their support from the beginning of my studies to where I am.

I would like to thank my supervisor Mr. Tumaini for his support and advice.

Also, the greatest thanks to all biomedical staff at Amana Referral Hospital and hospital management
for their good cooperation and support while conducting my IPT at the hospital. Also greater thanks to
Director of training and research at Amana Referral Hospital for approving my IPT request.

Thanks to my fellow students who in any way or another helped me to share ideas through intensively
collaborations during field practical training at Amana Regional Referral Hospital. I would like to
thank them for their courage, support and preparation of this field practical training report.

2
Contents
ACKNOWLEDGEMENTS................................................................................................................2
CHAPTER ONE..................................................................................................................................4
1.0 INTRODUCTION...............................................................................................................4
1.1 historical background of AMANA REFERRAL HOSPITAL............................................4
1.2 LOCATION OF AMANA REGIONAL REFERRAL HOSPITAL...................................5
1.3 VISION AND MISSION.......................................................................................................6
1.3.1 Vision...................................................................................................................................6
1.3.2 Mission.................................................................................................................................6
1.4 OBJECTIVES OF AMANA REFERRAL HOSPITAL......................................................6
1.5 HEALTH DEPARTMENTS AT AMANA REFERRAL HOSPITAL..................................6
1.6 ORGANIZATION STRUCTURE OF AMANA REGIONAL REFERRAL HOSPITAL.. .8
CHAPTER TWO.................................................................................................................................9
2.1. OXYGEN CONCENTRATOR................................................................................................9
2.2. HOW IT WORKS...................................................................................................................10
2.2.1. TYPICAL DEVICE FLOW............................................................................................10
2.3. MAIN COMPONENTS OF OXYGEN CONCENTRATOR..............................................12
2.4. CARE & MAINTENANCE...................................................................................................17
2.4.1. CARE................................................................................................................................17
2.4.2. PREVENTIVE MAINTANANCE..................................................................................17
2.5. TROUBLESHOOTING FAIRULE AT AMANA HOSPITAL...........................................19
CHAPTER THREE...........................................................................................................................20
3.1. CONCLUSION AND RECOMMENDATION.....................................................................20
3.1.1 CONCLUSION.................................................................................................................20
3.1.2 RECOMMENDATION....................................................................................................20
CHAPTER FOUR.............................................................................................................................21
4.1 REFERENCES........................................................................................................................21

3
 CHAPTER ONE
1.0 INTRODUCTION
1.1 historical background of AMANA REFERRAL HOSPITAL.
ILALA District is one of the five (5) Districts of Dar es Salaam Region. It has an area of 365
km2. It has a population of 1,220,611 as per 2012 census. National Population Census with an
estimated population growth of 4.6% per annum. ILALA district is administratively divided
into three (3) divisions and 27 Wards with 160 streets.
Health-wise the district is served by 110 facilities amongst which 33 are public and 77 are
private (2010). Public facilities include government and private Hospitals, (Amana, Aga
Khan health center) and 30 dispensaries, and 1 maternity wing the round table. Most of the

4
private facilities being commercial in nature are concentrated in the urban areas whereas the
rural part is served by the public services mostly dispensaries only.
Amana Regional Hospital started as a dispensary in 1972 and was upgraded to health center
in 1980, and operated as a District Hospital in 1985 and later upgraded to regional referral
hospital in the year 2010 to date. It is the regional referral hospital that is serving the Ilala
population and its neighboring districts of Amana to the south and Kinondoni to the north.
Services that are provided include; The OPD department which has a number of services; to
mention a few they include; General OPD, RCH Clinic, Oral Health services, Eye services,
Diabetes Clinic, TB/LEPROSY, Mental Health Unit, VCT services, and ART clinic. Others
are Social Welfare services and NHIF/NSSF services which are currently quite over crowded.
The OPD receives between 1,000 and 1,500 patients a day attending various service delivery
points.
The number of patients attended is too high as compared to the hospital capacity in terms of
human resources, infrastructure, resulting into congestion of patients at different sites of
service provision at the hospital. Technological advancement in medicine and the emerging
of new diseases has necessitated the need for improving the services offered in the Amana
hospital.
To meet this 2-advancement status, the training has enabled us to identify five (5) key
performance areas that need be addressed; Human resource for health, Infrastructure,
Working tools and high-tech equipment, health Management Information system, finance in
health.
These 5 key performance areas have been addressed in the plan document through 5 strategic
Objectives and Goals as follows;
 Increase number of qualified staff.
 Increase number of new and standard buildings and renovation of the existing structure.
 Increase working tools and procure of high-tech equipment.
 Strengthening data collection and management.
 Improve financial availability and management.

1.2 LOCATION OF AMANA REGIONAL REFERRAL HOSPITAL

Amana Regional Referral Hospital is located at Dar es Salaam city in Ilala Municipal

5
 Fig 2: Map of location of Amana regional referral hospital
1.3 VISION AND MISSION
1.3.1 Vision
To be the center of excellent in the provision of quality health care to all Tanzanians.
1.3.2 Mission
To provide quality health services to all clients through use of highly dedicated and trained/
skilled health workers and use available resources effectively and efficiently.
1.4 OBJECTIVES OF AMANA REFERRAL HOSPITAL
In achieving the vision, mission, goal and other hospital interventions, Amana Referral
Hospital have five strategic objectives of performance namely:
 To Increase availability capacity of qualified/skilled HRHs from 40% to 100% by 2025
 To improve infrastructure for health provision and Increase number of buildings.
 Increase modern working tools and high-tech equipment increased from 20% to 60% by
2025
 Improve hospital data management capacity from 40% to 80% by 2020
 Improve hospital revenue collection & financial management capacity from 50% to 90% by
2022

1.5 HEALTH DEPARTMENTS AT AMANA REFERRAL HOSPITAL

Amana Referral hospital have several departments which are:
I. Curative/Clinical Services) Department. Which includes; Outpatient Services (OPD),
Emergency, medicine services, Internal Medicine services, mental health services.

6
II. Surgical Services Department Which includes; General surgery services, orthopedics
and Trauma services, Urology Services, theatre, Anesthesia and Intensive Care Unit
Services.
III. Obstetrics and Gynecology Department Which includes; Delivery services,
reproductive system diseases, Cervical Cancer and Reproductive system diseases.
IV. Pediatric and Child Health Department Which includes; Neonatology/neonates
services, Pediatric and Child health services.
V. Surgical Specialties Services Department Which includes; Ophthalmology services,
Oral Health Services, Ear, Nose and Throat (ENT) Services.
VI. Nursing and Midwifery Department Which includes; Nursing Services, Midwifery
Services, Social Welfare Services, Nutrition Services.
VII. Pharmaceuticals, Medicines and Medical Supplies Department Which includes;
Pharmacy store services, Dispensing services.
VIII. Laboratory and Pathology Department Has units/sections of: Laboratory Services and
Pathology Services.
IX. Radiology and Imaging Department which includes; Radiology Services and Image
(Ultrasound) Services.
X. Planning and Management Department, which includes; Clinical audits, quality
assurance and customer Care, Environment health and Sanitation and Health
Promotion, Medical Engineering, Infrastructure and Transport, Health Management
Information System and Research.
XI. Human Resources Management Department which includes; Administration and
Human Resources, training & Continuous Professional Development.

7
1.6 ORGANIZATION STRUCTURE OF AMANA REGIONAL REFERRAL
HOSPITAL.
Permanent secretary

Hospital Director

Administration and HR Hospital Services Management,

Department Planning & Budgeting
Department

Finance and Accounting Procurement Management

Unit Unit

Internal Audit Unit

Quality Improvement Unit
Communication/ Public
Relations and ICT Units

Emerge Medical
ncy
Surgical Obstetri Pediatri Surgical Nursing Phamaceut
Services services ical Radiolog
Medical cs and c and Speciali and
Departm Departm Services y and
Departm Gynecol Child st Midwife
en en Departmen Imaging
ent ogy Health Departm
t t Services
t entent

Triangle OPD Obste Neucat

General Ophth
Services trics ology
Surgery amolo Nursing
Phar Radi
gy Services
macy olog
Treatment store y
& Internal Orthopedi
Rescuncita Medicine c Gynec
tion ology Pediatri Midwife
Oral Services
c Imag
Mass Urology Health Dispen
ing
Casualit sing
y Mental
Health Social
Services
Theatre, Welfare
Anesthesia
and ICU Nutrition

8
 CHAPTER TWO
2.1. OXYGEN CONCENTRATOR
Oxygen concentrators are used in multiple hospital settings. In newborn care units, oxygen
concentrators are used as standalone or partner devices to deliver oxygen therapy.
Concentrators may be used to share oxygen between multiple patients using a flow splitter or
used with other treatment devices such as continuous positive airway pressure (CPAP)
devices. Supplemental oxygen is indicated for sick children, especially those with low blood
oxygen saturation levels.
Oxygen concentrators (2.1) provide a source of oxygen with typical maximum cumulative
output flow rates of 5, 8, 10 or 20 L/min. Both maximum and minimum flow capacity depend
on device model
Oxygen concentrators are one of the most commonly used sources of oxygen therapy,
concentrating 85-95.5% oxygen from ambient air using two sieve beds containing a
substance that adsorbs nitrogen at high pressures.

Figure 2.1. Typical oxygen concentrator

Oxygen concentrators may have one or two oxygen output ports that may be used to supply
oxygen directly to one or two patients or to multiple patients at low flows using a flow
splitter. Each output port has a flowmeter that can be adjusted to regulate flow from that port.
Oxygen can be delivered using both ports simultaneously.

9
 2.2. HOW IT WORKS
An oxygen concentrator operates on the principle of Pressure Swing Adsorption (PSA) using
a microporous granulated molecular sieve material called zeolite. Zeolite has the property of
selectively adsorbing (trapping) nitrogen from air at high pressure and desorbing (releasing)
nitrogen at low pressure hence the name pressure swing (swinging between low and high).
For the purposes of an oxygen concentrator, the zeolite is contained in two cylindrical
canisters called molecular sieve beds
Air at atmospheric pressure of 14.7 psi (101 kPa, 1.01 bar) is filtered and drawn into the
concentrator by the cabinet fan and compressor. The compressor raises the air pressure to
about 30 psi (206 kPa, 2.1 bar) and feeds it into one of the molecular sieve beds (controlled
by the feed & waste valves). Nitrogen is adsorbed by the zeolite granules while oxygen is
allowed to pass. The residual oxygen is collected at the molecular sieve bed outlet port into
the product tank. After 10 to 15 seconds the zeolite will be saturated with nitrogen. At this
point, it can no longer adsorb further and the supply of compressed air is automatically
switched to the second molecular sieve bed where it undergoes the same sieving process
Concurrently, the pressure in the first molecular sieve bed is reduced to atmospheric pressure
by venting it back to the atmosphere. This allows the trapped nitrogen to be released from the
zeolite back to the atmosphere. By releasing nitrogen, the zeolite becomes regenerated and
ready for the next cycle. By having two sieve beds a continuous supply of oxygen is ensured.
There is no lag in production as the molecular sieve beds alternate between oxygen
production and zeolite regeneration.

2.2.1. TYPICAL DEVICE FLOW

10
Figure 2.2. flow chart of oxygen concentrator

11
 2.3. MAIN COMPONENTS OF OXYGEN CONCENTRATOR

Standard external and internal device components are annotated below

Figure 2.3. External components (front view)

Figure 2.4. Internal components (front view)

12
Figure 2.5. Internal components (back and side view).

13
Compressor
Compressor Pressurizes ambient air by reducing its volume. As the ambient air pressurizes,
heat is produced. A typical compressor assembly is displayed in 2.6. Compressor output
refers to how much compressed air the compressor can produce. This depends upon the
model of the compressor, stroke size, bore size and cup seal condition. Some compressors
may have a pressure relief valve (an automatic, typically spring-loaded mechanism that opens
when the compressor experiences increased pressure to discharge the excess air into the
atmosphere)

Figure 2.6. a typical compressor

Starting capacitor
Starting capacitor Starts and runs the compressor and keeps the auxiliary compressor motor
coil running.
Heat exchanger
Reduces the temperature of the compressed air which has heated during the compression
process.
Thermal switch
Cuts power to the compressor once the compressor running temperature exceeds maximum
heat threshold.

14
Control PCB
Controls the opening and closing of the solenoid valves. It also controls all electronic and
electrical components of the unit including alarms, pressure transducers and oxygen monitor
circuits.
Molecular sieve beds
Canisters that contain zeolite (typically aluminum silicate), which adsorbs nitrogen from air
at high pressures. Compressed air enters the sieve beds from the compressor at high pressure
which allows the zeolite to adsorb the nitrogen in air, leaving 85-95.5% oxygen-enriched gas.
Solenoid valves
Solenoid valves are electrically controlled valves with two main components: a solenoid (an
electric coil with a movable electromagnetic plunger) and a valve. Solenoid valves remain at
their “normal” position (open or closed) until an electric current creates a magnetic field to
force the plunger up and open or close the valve. In oxygen concentrators, solenoid valves are
used to control feed and waste processes through the molecular sieve beds. Feed valves direct
and regulate the flow of ambient air from the compressor to the sieve beds, while waste
valves direct and regulate the exhaustion of nitrogen out of the sieve beds

Equalization valve
The equalization valve plays two critical roles in the Pressure Swing Adsorption process:
1. It facilitates pressurization and nitrogen purging of the sieve under depressurizing cycle.
2. It directs some of the oxygen produced in one sieve to the other thus reducing energy
requirements and increasing efficiency. The equalization valve may be a solenoid or
mechanical valve

Cabinet fan
The cabinet fan pulls ambient air into the unit and circulates air throughout insides of
concentrator, cooling internal components. This component typically has its own PCB that
controls power and rate information to the fan

Pressure regulator
Controls the oxygen pressure as it leaves the product tank. This is typically set by the
manufacturer to 20 psi

Intake muffler
Minimizes noise from compressor suction as air enters compressor

15
Exhaust muffler
Minimizes noise of nitrogen-rich air exhaust and discharges this air from concentrator.

Product tank
Reservoir where oxygen is kept before proceeding to the outlet ports. This tank stores a small
amount of oxygen that is released when the device is turned off or power is lost.

Fine particle intake filter

Internal to the machine, either composed of filter paper or thick white felt filter. Filters
particles from air to protect the compressor.

Gross particle intake filter

External to the machine, very porous and only intended to filter out large particles.

Flowmeter and regulator knobs

Controls and displays the oxygen delivery rate to the patient(s) in L/min

16
2.4. CARE & MAINTENANCE
At AMANA hospital we did a lot of maintenance on different tools and equipments but in
case of oxygen concentrator the following were done to keep machine in a good condition
2.4.1. CARE

POWER SOURCE
Oxygen concentrators may be powered via mains or grid power with a voltage protector in
line, or a rechargeable battery, depending on the model.
WARD LOCATION
At AMANA hospital oxygen concentrator were located in a clean, dry, well-ventillated
space. Also, the back of concentrator was 30-35 cm away from the nearest wall to ensure that
air can freely flow to the concentrator.
DEVICE CALIBRATION
Manufacturers do not recommend calibration for any oxygen concentrator components.

2.4.2. PREVENTIVE MAINTANANCE

At AMANA hospital the following was done in certain period of time to ensure long lasting
of the machine
2.4.2.1. tools used

Digital multimeter
Phillips, star & flathead screwdrivers
Allen keys
Adjustable wrench
Needle nose pliers
Wire strippers
Phase tester
Oxygen analyzer
Compressed air blower
Oscilloscope
Permanent marker
Pressure gauge

17
After Each Use
Turning off and unplug the oxygen concentrator. Use gauze and 70% alcohol or diluted
chlorine to thoroughly wipe the oxygen flowmeter controls, control panel and power button
Weekly
Visually assessing and cleaning the external gross particle intake filter.
Visually assessing the internal fine particle intake filter. Clean or replace if needed.
Turning on and allow the oxygen concentrator to run for 15 minutes. Confirm that no alarms
are audibly or visually activated.
Documenting cumulative hours run and preventive maintenance actions taken

Monthly
Performing Weekly preventive maintenance steps
Testing the power loss alarm: while the oxygen concentrator is plugged in and turned on, turn
off the power at the wall socket. An alarm should sound
Testing the oxygen concentration output at both the minimum and maximum flow range of
the oxygen consent

18
 2.5. TROUBLESHOOTING FAIRULE AT AMANA HOSPITAL

The following problems encountered during IPT at AMANA hospital

1. The oxygen concentrator is not turning on.
The machine encountered such problem was found to have power supply faulty, the
part was replaced and machine functioned well

2. Flow meter air ball stuck in the tube

The flow meter was opened and cleaned well and ball also, the system was restored
again and the machine function well

19
 CHAPTER THREE
3.1. CONCLUSION AND RECOMMENDATION
3.1.1 CONCLUSION

This report contains a summary of several biomedical tools which was conducted at
Amana Regional Referral Hospital. During practical training several biomedical tools was
learned on how to use, operate, as well as maintenance of several biomedical tools
including Suction Machine, Blood Pressure Machine, Dental Unit Chair, Autoclave
machine, Examination lamp, microscope, and anesthesia machine. Those biomedical tools
were learned in details as I was shown on logbook. Several maintenances, and how to
operate those machines were one and learning in details about those biomedical tools.
During practical training I learned how to troubleshoot and repair different problem in
many equipment that training at Amana Regional Referral Hospital.

3.1.2 RECOMMENDATION
I recommend the following for the implementations to Amana Regional Referral
Hospital and to Muhimbili university of health and applied science (MUHAS);

• MUHAS Should extend time to conduct field practical training so as to learn more
as well as to gain some professional skills and knowledge as well as experience

20
 CHAPTER FOUR
4.1 REFERENCES

Ã, J. N., Przybylowski, T., Zielinski, J., & Chazan, R. (2008). Comparing supplementary oxygen
benefits from a portable anaesthesia machine and a liquid oxygen portable device
during a walk test in COPD patients on long-term oxygen therapy. 1021–1025.
https://doi.org/10.1016/j.rmed.2008.02.005

Ambikile, J. S., & Iseselo, M. K. (2017). health care at Amana hospital in Dar es Salaam,
Tanzania. 1–13. https://doi.org/10.1186/s12888-017-1271-9

Concentrator, O., & Support, R. (2020). Target Product Profile. March.

Design, P. (2018). DESIGN AND IMPLEMENTATION OF AN ANAESTHESIA MACHINE

WITH GPRS-BASED FAULT TRANSFER SYSTEM. January.
https://doi.org/10.1142/S0219519412005071

Subramaniam, V., Cheema, T., Carlin, B., & Rrt, R. M. (2008). EVALUATION OF PORTABLE
ANAESTHESIA MACHINES DURING EXERCISE. CHEST, 134(4),
p100002-a, p100002-b. https://doi.org/10.1378/chest.134.4

21