The importance of onsite generation to supplement liquid oxygen as a norm for hospitals

 The demand for medical oxygen has shot up by as much as seven times since pre-Covid days. Last month, the country had witnessed a peak demand of nearly 9,000 tonnes of medical oxygen in a day. Among existing technology options PSA technology emerges as the most practicable and indeed a front-ranking option for hospitals and healthcare facilities. This oxygen can be easily piped within the hospital premises or nearby facilities and can even be transported in cylinders supplying to smaller hospitals in the area.

Although the ravaging second wave seems to be ebbing now and the need for medical oxygen, something which was reckoned a desperately lifesaving resource just weeks back, has receded, it is time to consider long-term measures. The tragic sight of hospitals across the country abruptly running out of oxygen and patients losing their precious lives – all of which was avoidable – is still fresh in our memories. As such, one of those measures in the long run which could to a great extent rule out a repeat of such tragedies is equipping hospitals with technologies and associated infrastructure enabling generation of medical oxygen onsite itself. And among existing technology options, pressure swing adsorption (PSA) technology emerges as the most practicable and indeed a front-ranking option for hospitals and healthcare facilities. This onsite generation of Oxygen could also serve as a substantive supplement to the currently prevalent liquid oxygen supplies, compressed gas cylinders, concentrators etc.

Onsite generation no longer a matter of choice but a compulsion

For decades, our hospitals and healthcare facilities have relied on oxygen supplies from outside of their precincts, a proposition which was always fraught with risks. In view of the somewhat inadequate transport and logistics systems in the country, the persistent need for dedicated and specialized tankers, the need for constant refilling, the risk of liquid oxygen evaporating and even worse, the danger of a large volume of oxygen escaping into the air and causing a conflagration and other resultant damages, there is a raft of reasons why the authorities must consider alternatives such as onsite generation of medical oxygen. Consider these against the fact that India only has 1,224 tankers with a capacity of 16,732 MT to carry medical oxygen. Moreover, these tankers have a turnaround time of nearly 6 to 7 days with estimates that only 200 tankers are in transit at a given time.

Admittedly, there never has been as much need for medical oxygen in the country as in recent times on account of Covid. According to reports, the demand for medical oxygen has shot up by as much as seven times since pre-Covid days. Only last month, the country had witnessed a peak demand of nearly 9,000 tonnes of medical oxygen in a day. Several industries which produce and use oxygen in their production processes had to be directed to divert their resource towards Covid-driven medical emergency purposes. And even as demand might seem to be moderating in recent days, there is no full-proof guarantee as to what really lies ahead in terms of the dreadful virus and its public health implications, notwithstanding the accelerated vaccine campaigns. With talks of an incoming third wave, potentially more devastating than the second wave, we can’t yet drop our guard in any way.

Difference between Availability and Timely Disbursal to the Needy

At the same time, that there is a clear difference between the availability of a life-saving resource and its timely supply to the needy patients must be recognized. In the third week of April, the government had submitted in Supreme Court that India had 3 times more liquid oxygen available than the aggregate demand from 12 states with high Covid caseload. Yet, in the days and weeks that followed, several states had continued to report shortages of medical oxygen. Surely, the problem is less of availability and more of not being able to make timely supplies to the needy patients. Therefore, one potent way to address this problem is to make the lifesaving resource available at the hospital itself. What better than generating oxygen onsite itself which would not only obviate the need for long-distance transportation and other logistical requirements but would also completely eliminate the chances of those heartrending tragedies that we have all witnessed recently.

How PSA works

The PSA technology involves passing the ambient air from the atmosphere through a high pressure internal filtration system making use of microporous molecular sieves or zeolites as adsorbers. The large surface area of the molecular sieve allows the separation or adsorption of nitrogen from the air leaving concentrated oxygen behind. This way Oxygen of medical grade purity can be generated and continuously supplied to patients through the hospitals existing gas pipeline.

A practicable solution by all means

This oxygen can be easily piped within the hospital premises or nearby facilities and can even be transported in cylinders supplying to smaller hospitals in the area. We could start with every district hospital in the country having one oxygen generator plant and serve as a hub for further distribution to other healthcare facilities. Or if resource crunch doesn’t permit as brought out by Centre-state wrangling, we could start with one onsite plant for two adjacent districts. The idea is to make a start and to do so as soon as possible.

The advantages of PSA technology

Compared to a cryogenic technology plant, a PSA onsite generator plant is modestly capital-intensive. And even if the initial capital for the set-up might seem large apparently, that cost can be recovered through the savings on monthly oxygen bills in a matter of months that the hospitals have to pay. Moreover, it is not only easier for PSA plants to be assembled, but it also takes only a few weeks to get a PSA plant up and running. Importantly, because they do away with the need for long-distance transportation and therefore rule out noxious emissions, they are also environment-friendly. By WHO’s technical specifications, all medical PSA oxygen generator plants are sources of oxygen that can produce medical-grade oxygen, at scale, 24 hours a day, 7 days a week, implying the intrinsic reliability of this technology. To be sure, PSA oxygen generator plants require trained staff as well as constant maintenance. But those are prerequisites for any technology. Another major advantage of PSA technology is its ability to start producing medical grade oxygen within minutes from standby.

Exceptionally high degree of purity not required

Significantly enough, for oxygen to be used for medical purposes, there is no compulsion to achieve exceptionally high purity of 99% concentration of oxygen. United States Pharmacopeia (USP), European Pharmacopeia (Ph. Eur.) and Indian Pharmacopeia allow 93% purity of medical oxygen (± 3%). Although liquid oxygen offers more purity, given the supply and delivery side bottlenecks in our country, it is better to have some oxygen at all time without fail at our hospitals than to have highest quality oxygen, but only for some time, and unreliably so.

In sum, the urgency to install onsite oxygen generator plants at our hospitals to supplement liquid oxygen cannot be overstated. The government’s announcement of setting up of 551 PSA plants in addition to the 162 announced earlier at public health facilities in the country must be welcomed. However, words need to be followed up with quick action. In fact, the government needs to go even further. It must by law make it mandatory for large hospitals to have onsite oxygen generator plants at their facilities. Remember Covid-19 has not gone away.

By Siddharth Rastogi, Executive Director, MVS Engineering Pvt. Ltd.

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