How Haryana became oxygen surplus

The middle two weeks in the month of April saw a striking rise in the COVID cases resulting in the stress on health infrastructure and shortage of oxygen. While many states were reluctant in transparent audit of health infrastructure, Haryana state became the first state to engage an independent auditor to examine the situation and offer suggestions to optimize the use of oxygen and augment the delivery of healthcare services to its citizens. The case in point for this scientific endeavour was PGI Rohtak at first and later all government medical colleges in the state of Haryana were examined along with several large hospitals. IIM Rohtak’s team led by their Director Prof Dheeraj Sharma offered the following recommendations arising from audit based on site visit, process mapping, primary, and secondary data collection activity. The report was also shared with the central government’s empowered committee on COVID.

1) Pertinent use of oxygen low flow therapy vs high flow therapy may results in significant savings to the tune of approximately 20% of the used oxygen. The government immediately acted on this and worked with medical fraternity to implement this recommendation. It was found that this segregation of low flow therapy vs high flow therapy resulted is significant optimization of oxygen usage with savings to the tune of 20%.

2) Reduction in use of cylinder oxygen. Hospitals use cylinder where piped supply is not available. However, fixing additional flexible piping from manifold with multiple outlets can help provide oxygen in areas where there is no pipeline right now. Particularly, in COVID wards that have been recently created this additional piping can bring about large amounts of savings. A typical oxygen cylinder can result in wastage of approximately 30% oxygen. The government immediately directed hospitals need to have SoP on when and how cylinders can be used. Also, district administration became active in the real time monitoring of the oxygen.

3) Appointment of oxygen supervisors and proper training of hospital staff can result in savings of approximately 16-18% of the oxygen. A patient spends nearly 4 hours without oxygen mask (eating, tea break, restroom breaks, diagnostics etc.) during which oxygen keeps running. The patients too need to be sensitized so they can turn-off oxygen when not using it. The government again worked with the hospital administrators to sensitize the staff as well as the patients in availing these oxygen related efficiencies. The government is actively assisting hospital in procurement of oxygen concentrators and creation of oxygen concentrator banks. Further, the use of auto-cut devices, AI based solutions, and sensor-based technologies are being envisaged at the hospital level to achieve additional savings. Overall, the timely actions of the government resulted in the containment of this crisis in a very period of time. 

It must be recognized that while crisis created by COVID situation in last two weeks of April was addressed and dealt by allowing for a transparent audit of the healthcare facilities and prompt action on the auditor’s comments. Haryana also saw the stress on its health infrastructure due to movement of patients from the National Capital Region to Haryana for availing treatment, beds, and medicines. Also, the oxygen supply to Haryana was at that point coming from Rourkela which was significant challenge. Overall, it may inferred that better supply chain management, optimization of usage, and process streamlining has allowed the state of Haryana to draw more from its available resources. I hope that the aforementioned steps will allow Haryana to possibly navigate any other COVID wave in much effective manner.



Views expressed above are the author’s own.



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