The study, by three professors and three doctoral students, also suggests that better management of high-flow and low-flow oxygen, separating oxygen lines for ICUs and wards and ensuring hospitals have the right distribution channel for administering medical oxygen to patients would optimize oxygen needs.
Through April and May, the state government scrambled to provide oxygen to hospitals and filling centers as oxygen needs shot up because of the massive surge in Covid cases. Hospitals spent weeks on tenterhooks as they ran on limited oxygen stocks and SOS were sent out every day. The lessons learned from the second wave have made oxygen management a critical aspect of covid care infrastructure.
The study was conducted in two phases. A senior government official said their recommendations in the first phase helped bring down oxygen demand by 5 metric tonnes. The study’s findings have been sent by the state as an input document to the empowered group for planning.
The first leg of the study was based on a primary survey conducted at PGIMS Rohtak. “We are thankful to the IIM-Rohtak director, who offered to conduct an oxygen audit. With the implementation of these recommendations, we were able to bring down the demand from 18 MT to around 12-13 MT. The chief minister also pushed for it as we need to save oxygen and use it efficiently,” said V Umashankar, principal secretary to the CM.
The second leg of the study involved hospitals in Gurgaon, Nuh, Karnal, Rohtak, Sonipat, Khanpur, Panchkula and Ambala. The final report was submitted in the first week of June. “The second wave of Covid-19 brought medical oxygen use into focus. It became the new water but there weren’t enough studies on optimal usage of oxygen, especially during exponential demand,” IIM Rohtak director Prof Dheeraj Sharma, who headed the research team, told TOI.
“So, we decided to focus our study on this aspect and come up with recommendations for planning purposes. My team was out on the field on April 20. Within five days, we reviewed the status of PGIMS Rohtak and submitted the first draft that helped rationalize oxygen usage,” he added.
Sharma and his colleagues tested positive for Covid after the first leg of the research. “The way the Haryana government responded was encouraging. I approached the CM’s principal secretary with our proposal and we got a swift reply. They not only backed our proposal but also ensured we were allowed to collect information in a transparent way,” the IIM-Rohtak director said.
Among the study’s main observations is the lack of standard operating procedures in hospitals for optimum use of medical oxygen. The researchers found that a majority of hospitals were indiscriminately using the D-type cylinder instead of an oxygen plant setup that supports piped supply.
“After discussions, physical inspections and data analysis, we found there is wastage of around 30% oxygen in D-type cylinders due to pressure difference. Oxygen at the bottom of the cylinder remains unused because it is very low pressure. Besides, there is wastage during initial discharge and delivery. Therefore, hospitals must aim to install oxygen plants with adequate capacity to minimize oxygen losses,” said Prof Ashwani Kumar, one of the researchers.
The researchers said they also found segregated oxygen flow by splitting the supply line into ICU and non-ICU would help bring down wastage. “The health department recommends low-flow oxygen in non-ICU wards and high-flow in ICU wards. Hence, separation of the two can help in achieving efficient use of oxygen. Separation can be done by using auto-cut devices and sensor-based technologies,” said Professor Rima Mondal, another member of the research team.
The IIM team said lack of supervision of staffers handling oxygen supply in non-ICU wards led to losses of around 18%. “A patient spends nearly four hours without an oxygen mask (eating, tea breaks, restroom breaks, diagnostics, etc) but the oxygen line keeps running. The patients too need to be sensitised so that they can turn off oxygen when not using it. Hospitals must also appoint supervisors to monitor the usage of oxygen to minimize such losses,” said Prof Sharma.