Assessment of Oxygen Supply Management and Utilization in Indian Hospitals during the COVID-19 Pandemic: Insights and Recommendations for Oxygen Stewardship
Authors: Joseph Lallu , Prabhakar Shweta , Agarwal Vijay , Murugesan Malathi , Rajasekar K. , Mehta Sameer , Ebenezer P. Joel 
Published: February 2025

Abstract

Introduction:
Oxygen is essential for various medical applications, including routine care and emergency response. Its critical role in sustaining life, particularly during severe health conditions such as pneumonia, malaria, sepsis, and meningitis, is well-established. Despite its natural abundance, the timely availability of medical oxygen is crucial and can be a matter of life or death for patients. This study aims to investigate the sources, backups, and consumption of oxygen in Indian hospitals during the COVID-19 pandemic and to explore the need for effective oxygen stewardship programs.

Methodology:
Data were collected through convenience sampling using a semi-structured questionnaire designed based on practices from a large tertiary teaching hospital in Vellore. The questionnaire covered demographic details of hospitals, average and peak oxygen consumption, and the management of oxygen supply sources. It was distributed via Google Forms to hospitals across India, resulting in responses from 73 private facilities. Data analysis was performed using MS Excel and pivot table tools. Ethical considerations included ensuring confidentiality, avoiding disruption, and maintaining transparency.

Results:
The study found that all participating hospitals were private, with 14% affiliated with medical colleges. Most hospitals (96%) had either entry-level or full accreditation status, and 84% allocated over 30% of their beds to COVID-19 patients during the second wave. The primary oxygen sources were predominantly liquid medical oxygen (60%), followed by oxygen gas manifolds (32%) and oxygen concentrators (8%). The secondary sources included oxygen gas manifolds (56%) and both oxygen concentrators and liquid oxygen (15% each). Reserve supplies were mostly oxygen gas manifolds (52%), with liquid medical oxygen (12%) and oxygen concentrators (11%). Notably, 25% of hospitals lacked reserve oxygen backup. Most centers (97%) had alarm systems, with 32% using automatic changeover systems and 64% using manual systems. Disaster management protocols were present in 60% of hospitals, and 75% conducted oxygen audit or stewardship training. Peak oxygen consumption occurred in May 2021, with 75% of centers experiencing shortages during the second wave, compared to the first wave.

Discussion:
The findings highlight significant challenges in oxygen management during the second wave of COVID-19. The study underscores the importance of effective oxygen stewardship programs and the need for improved training and infrastructure to handle high-demand situations. Implementing more automated systems, better reserve planning, and comprehensive disaster management protocols can help mitigate future shortages and enhance overall preparedness.

Conclusion:
In summary, while there have been some positive developments in oxygen management, the findings emphasize the need for more robust and automated systems, comprehensive disaster preparedness protocols, and better supply chain resilience.