As hospital census for COVID-19 is hitting record numbers and the use of high flow respiratory equipment is being used widely, bulk oxygen shortages are being reported. FHA continues to look for guidance and information to help hospital personnel understand conservation strategies that may help decrease the demand on your oxygen system.
Clinical Application Considerations: Hospitals should consider the following methods to conserve and extend oxygen for respiratory care support:
Use an Oxymizer® or similar reservoir device to conserve oxygen delivered via a nasal cannula.
Use liquid oxygen (LOX) devises which allow for the storage of very large quantities of oxygen in a smaller container.
Consider the use of mobile LOX units which can be connected to a hospital’s secondary O2 system to refill as needed.
Hospitals should look for oxygen leakage from equipment in all care areas on a regular basis.
Facilities Management Recommendations: Many hospitals are reporting best practices and applying lessons learned from other emergency incidents where oxygen systems were stressed. These include:
Adding secondary oxygen supply lines that bypass the existing oxygen delivery systems, allowing more oxygen to flow without freezing the vaporizers. These secondary systems can connect directly to trucks or tanks carrying bulk liquid oxygen.
Deploying improvised warm water sprinkler systems to keep the external vaporizers from freezing.
Outfitting large H cylinders with manifolds to service multiple patients simultaneously.
Using oxygen concentrators as much as possible in place of wall or cylinder oxygen. These draw oxygen from the air and do not need oxygen resupply or flow regulators.
Regularly monitor the tank levels of your bulk oxygen system.
If you are on allocation for bulk oxygen, establish frequent conference calls with your leadership team and oxygen provider to clearly communicate your status and advocate for oxygen delivery as quickly as possible.
The Johns Hopkins Bloomberg School of Public Health, Center for Health Security article Potential Solutions to the COVID-19 Oxygen Crisis published earlier this year provides these useful conservation measures for consideration.
FHA is working with the Florida Healthcare Engineering Association and the American Society for Healthcare Engineers to provide helpful medical air and oxygen capacity tools for facility managers including:
Ventilator capacity for existing medical gas systems - a tool, provided by Kaiser Permanente National Facilities Services, outlining ventilator capacity considerations based on piping sizes to assist in determining how many ventilators can be served by an existing medical gas system in a given patient care area.
A short training video provided by Beacon Medaes called Handling and Connecting Med Gas Cylinders Safely, that hospitals can utilize to guide your team on best practices for handling, connecting and disconnecting cylinders to and from manifolds.
