Public Hospitals: Central oxygen supply elusive

Ensuring uninterrupted oxygen supplies at hospitals appears to have emerged as the latest choke point in the battle against the coronavirus outbreak, which is bearing down on the country.

A ministry letter paints the grim picture as most of the 39 major public hospitals, including those dedicated to coronavirus treatment, still do not have this nonstop essential supply for critical Covid-19 patients.

These hospitals, constructed by the Public Works Department, have medical gas pipeline systems, but most lack the central oxygen supply system supported by liquid tanks.

Instead, they rely on oxygen cylinders. As a result, it is not possible to ensure uninterrupted oxygen supply to the critical coronavirus patients, who suffer badly from respiratory problems, health officials said.

A central oxygen supply means having a dedicated place in a hospital where oxygen is stored and supplied to all patient beds, using lines in the wall.

With the number of infections surging every day and researchers projecting the total number of cases would double by the month-end, providing adequate oxygen support to critical Covid-19 patients remains extremely crucial.

Experts said uninterrupted oxygen supply could save many lives.

Against this backdrop, the health ministry, in a letter on Tuesday, asked the authorities concerned to ensure liquid oxygen tanks at the 39 hospitals, if they don't have it, on an urgent basis to activate an central oxygen supply system.

The ministry sent the letter, signed by Sherajul Islam, additional secretary (Hospital Wing) of Health Service Division, to the National Electro-Medical Equipment Maintenance Workshop and Training Center (NEMEMW and TC), asking it to take steps to expand gas system lines if necessary.

NEMEMW and TC has already started checking whether all hospitals mentioned in the letter are suitable for having central oxygen systems. It, however, would require "some time" to complete all the procedures, said its Chief Technical Manager Aminur Rahman.

He claimed that many of the 39 hospitals have the central oxygen system. He also said a total of 21 public hospitals across the country are equipped with the system.

"We are now making a list of hospitals which have the system and of those which are viable [where the system can be installed]. We will send the list to the ministry tomorrow," Aminur told The Daily Star yesterday.

He said on Wednesday they sent a letter to the ministry seeking permission to install central oxygen supply systems at three hospitals. Upon approval, it would take 15 days to complete the work.

The three hospitals are: Kurmitola General Hospital, Kuwait-Bangladesh Maitree Government Hospital and Shaheed Suhrawardi Medical College Hospital, he said.

Doctors and health officials said government hospitals use gas cylinders, in many cases inter-connected large cylinders, to supply oxygen to patients. Cylinder gas supply system is relatively expensive and requires frequent refilling and constant monitoring by doctors or nurses to ensure that the stock is enough.

The government move to install central oxygen supply system comes at a time when allegations are rife that patients, especially those at dedicated Covid-19 hospitals, were suffering due to insufficient oxygen supplies, which in some cases resulted in deaths.

The health ministry's letter also admitted as most of the 39 hospitals do not have liquid oxygen tanks, Covid-19 patients were being deprived of uninterrupted oxygen supply.

Of the 39 hospitals mentioned in the letter, 18 have medical colleges. Those include Dhaka Medical College Hospital, Sir Salimullah Medical College and Mitford Hospital; 16 are 250-bed hospitals, and five specialised hospitals.

The ministry asked (the NEMEMW and TC) to install liquid oxygen tanks on an emergency basis at hospitals that do not have them, and if necessary, take steps to expand gas system lines.

Among government hospitals in Dhaka, DMCH, Sir Salimullah Medical College, National Institute of Cardiovascular Diseases (NICVD) and National Institute of Neurosciences & Hospital, Dhaka, have central oxygen systems, said Aminur Rahman.

However, a doctor of the DMCH said they have central oxygen systems only at their new building and ICU, operation theatre and post-operative rooms.

WHY CENTRAL OXYGEN SYSTEM IS CRUCIAL?

Infectious diseases specialist Prof Ridwanur Rahman said the main reason behind the death of any Covid-19 patient is the shortage of oxygen.

When the lung gets infected, many patients gasp for oxygen. The urgency of the requirement, however, varies from patient to patient, he said.

Using a cylinder, a patient can be given oxygen at a maximum rate of six litres per minute, he said, adding that many need more oxygen and the central system can provide even 40 litres of oxygen per minute.

"It's possible to save lives of many [Covid-19] patients with the central oxygen system," he told The Daily Star yesterday.

He said the central system should be immediately installed at all the dedicated Covid-19 hospitals.

"We have been asking for the installation for long, but the authorities paid little heed to it," he lamented.

Talking to The Daily Star late last month, at least three doctors at the Kurmitola General Hospital, one of the dedicated Covid-19 facilities, said patients at their wards get between six to 10 litres of oxygen per minute. This means a 2000-litre cylinder lasts between 3.5 and 5.5 hours, depending on the patients.

With increased number of Covid-19 patients, the cylinders were running out fast, they said.

In addition, the hospital staff was divided into three groups. While one group works, the others stay in quarantine. It means the hospital was running with a third of its staff members. So, it was impossible for them to monitor the cylinders of each patient all the time, they said.

Aminur Rahman said a central oxygen system can reserve more than 5,000 litres of oxygen, whereas an oxygen cylinder can contain 38.7 litres. In that case, 20 to 50 such cylinders were made interconnected to supply oxygen to patients.

That's why the cylinders need to be refilled after every two to three days, he said.

Asked why the central oxygen system has not been installed in all the 39 hospitals yet, Aminur said all of them were not viable.

Hospitals having 500 beds or more are usually eligible for the central oxygen supply system, but oxygen demand has increased sharply as Covid-19 patients need more oxygen, he said.

"So, a dedicated Covid-19 hospital with only 150 beds is also viable."

The chief technical manager said only two companies -- one local and one multinational -- can supply and install the central oxygen supply system and it takes around 15 days.

These companies have already brought some liquid oxygen tanks and if the number of hospitals is more than 10, they might have to import tanks. "It may take some more time".