I'm still a little lost on the subject of Oxygen for Patient Use In Healthcare within the USA.

The FDA is the ruling order for Healthcare right ?

They have guidelines and regulations (i.e. maybe laws) for Oxygen use in Healthcare for Human Consummation right ?

Well NFPA 99, is only a Document for Installation, Testing and Maintenance of Medical Gases and Vacuum Systems right ?

It a guideline on how to preform those listed items, if the items are approved by the FDA right ?

In my opinion, and with just a few hours of review. I can only find that the FDA has only approval the use of Oxygen Concentrators 93 USP, during times of government emergency use only. 

I do believe in Oxygen Concentrators 93 USP and its healthcare efficacy.

But should we not be quoting FDA documents numbers and not NFPA 99 ? 

NFPA 99 does not approved anything.

I would love to debate on how and when USP 93 Oxygen is approved for Standard Healthcare Facilities in the USA. Just think the Federal Government via CMS is only working from NFPA 99 the 2012 Edition. Oxygen Concentrators (i.e. USP 93 Oxygen ) has only been listed within NFPA 99 for the 2018 Edition.

This and other fun topics in Las Vegas NV / at the Annual MGPHO meeting / Sept 30 - Oct 3. / Sign Up Today:

Please direct me or list the documents per the FDA - for the area, section, paragraph and verse. That specifically addresses Oxygen use on human in daily healthcare for standard hospital use, in regards to Oxygen USP 93. Then we can start the debate in Las Vegas. 

Editting is required: 

The FDA enforces and NFPA recommends is my understanding, correct me if I am wrong.

To my current knowledge FDA has approved 93% oxygen centralized concentrator supply for:

1. NEMA emergency hospitals erected during and for a Federally declared emergency.

2. US Active Duty Military Hospitals.

Any other suggested use has not been approved by FDA as an acceptable method of centralized oxygen supply.

There are sound clinical reasons why the FDA has taken this stance at this point in time.

There are many things MGPHO could do as far as advocating for it's membership. 

Since MGPHO is not a clinical based/oriented organization I suggest we stay out of this one.

But, that said we certainly need to stay current on the trending of this topic and I will look up the CFR again ruling this FDA enforcement and see if anything has changed regarding the exceptions.

A hospital based somewhere in the world where cryogenic liquid and gaseous oxygen supply is neither practical nor dependable leading to frequent outages should be reviewed and considered a federally declared emergency.

BUT, keeping a studied eye on which diagnosies are allowed admission for prolonged care to these hospitals shall be a prerequisite to any change in the current CFR exception for 93% oxygen central supply concentrators. A list of diagnosies where only accute care shall be allowed needs to be addressed by the clinical professional organizaitons. 

If this does not get addressed from a clinical perspective first the original CFR for 99% oxygen could go in the direction of the Oxygen Bar in the Flamingo Hotel & Casino regarding the FDA enforcement.

In the words of G. D. McA. " I shall return" on this subject with CFR language in hand. The spin stops there.

Forgive my lack of intimate knowledge Mark but if I understand you the transition to 96% and 93% Oxygen is transitioning using the community standard model approach and not a scientific method for this transition.

Again, I lack any knowledge of any periodicals addressing this change from Europe or the Germans

As I stated it makes sense in some areas of the world to have the lower oxygen concentration if conventional supply is not a dependable source.

I can see it is rather easy to mix a lower concentration with air and nitrous oxide until you get into some high risk pathophysiologies requiring very high concentrations (FiO2) of oxygen for treatment. These would be limited to most teaching facilities where heart transplants and heart/lung transplants are performed.

I have not had time to research this subject intimately and I am motivated to "ping" my curious mode. Nice kitty.

I am not for or against anything here except a clear and logical transition period for the clinical community in a facility currently using the 99% USP Oxygen. This transition should be based upon  documented risk management case studies determined by clinicians in conjunction with the other disciplines already engaged in the code changes addressing the concentrator technology.

The times are a changing where a community standard is the process over the historically reliable scientific standard has been the practice in the past. That said neither method is totally infallible. These two methods do compliment each other during the period of change.

I take it there is no study documented from a clinical perspective?

Nice hairball!