Province begins to breathe more easily

Demand for oxygen in hospitals drops along with number of infections

OXYGEN demand is dropping off at Western Cape hospitals as Covid-19 infections decrease.

Mark van der Heever, spokesperson for the Western Cape Health Department, said at the moment they are using a little more than half of what they have been.

“We are now using approximately 26 tons of oxygen per day, about 52% of our available capacity,” he said.

At Groote Schuur Hospital (GSH), it was a combination of incredible foresight and a very lucky coincidence for head of engineering, Denton Smith – along with the tireless work of his team – which allowed them to provide the hospital with 10 times its usual oxygen supply.

As soon as Smith saw the Covid pandemic hitting countries in Asia and Europe, he knew he would need to plan ahead for when it reached South Africa.

“My life at GSH started off running medical gas. With that insider knowledge, you see things coming,” Smith said.

“When it started hitting Europe and Italy got closed down, I started stocking up. I said to my guys, order the cylinders for portering patients, as much as you possibly can – increase stock tenfold. We had a massive fall-back stock. That helped initially, because in the first three weeks everyone went into a panic because there was no supply.”

The first week of lockdown also saw a massive pay-off for Smith’s foresight, which ended up being a game changer for the hospital’s capability to care for Covid patients.

“Two years ago I started negotiating with Afrox for a much bigger bulk oxygen tank. It arrived in the first week of lockdown,” Smith said. “That was brilliant; an amazing coincidence.”

The new 37-ton tank, added to the old 10-ton one, equipped GSH to treat Covid patients with all the oxygen they needed.

“That is why we were able to handle the extra oxygen demand. It was an absolute lifesaver on many levels.”

With supply secured, Smith and his staff turned their focus to the delicate task of managing the pressures of the oxygen supply that is carried in pipes throughout the hospital, to wall outlets where medical devices such as ventilators can be plugged in.

“Pre-Covid, we were drawing on average about 1 ton per day. At the peak we were drawing 10 tons per day. The Covid pandemic quadrupled our gas costs,” he said.

Groote Schuur was built with small pipes which can only deliver a certain amount of gas at any given time. But thanks to the planning of the engineers who designed the hospital, the pipe network is structured in rings which allow the gas flow to be doubled if needed. It was Smith’s job to carefully juggle the pressures throughout the system to deliver the required amount of gas without pushing it below or above the safety limits.

“It was great fun employing the basics of mechanical engineering to a system which has ultimately saved hundreds of lives,” he said.

It wasn’t the number of patients that caused the demand to soar, but the type of treatment they were receiving. High-flow nasal oxygen was a new therapy doctors were trying out, and when its successes became evident, the number of machines in use went from 10 to 40.

“They came to us and said ‘we need to run a new system of high-flow nasal oxygen at 60 litres per minute to the patient’. The average supply is designed for 30 litres per minute, at a push,” Smith said.

Add this to the patients on ventilators, on standard nasal oxygen and those using oxygen masks, and you have an enormous demand for gas.

“The doctors would just keep plugging in equipment to keep patients alive who were coming in the doors,” he said. “It was because of the change in medical practice that we saw the increase. Because the demand is so much less now, our consumption is dropping accordingly, because we’re using fewer machines.”

Oxygen use at GSH is now down to 3 tons a day, but Smith said his team is prepared if Covid infections spike in the Western Cape again.

“It’s just a matter of time before a second wave hits,” he said. “We are ready to ramp it up. We’ve got everything we possibly need.”

We had a massive fall-back stock that helped initially

Denton Smith HEAD OF ENGINEERS AT GROOTE SCHUUR HOSPITAL