Source: Chinese Journal of Health
Founded in 1942, the First Affiliated Hospital of Gannan Medical College (hereinafter referred to as the First Affiliated Hospital of Gannan Medical College) is the only provincial tertiary hospital in Ganzhou City, Jiangxi Province, as well as a cooperative unit of the National Respiratory Medicine Center and one of the top 100 hospitals in China. The hospital has two major hospital areas, Jinjin and Zhanggong, with 3,328 beds, a total construction area of 405386 square meters, an annual outpatient and emergency 1.5 million person-times, 130,000 discharges, and 50,000 surgeries.
Sufficient oxygen supply to ensure that "all should be collected and all should be treated"
In December 2022, the prevention and control of the new crown epidemic entered a new stage, and the focus of work shifted from "preventing infection" to "protecting health and preventing severe disease". The surge in the number of patients infected with the new coronavirus has brought great pressure to the medical treatment of public hospitals, and put forward higher requirements, and ensuring the oxygen needs of patients has become the top priority of medical treatment.
Medical oxygen is an important medical resource to fight the epidemic of new coronavirus infection, and an important condition for the treatment of critically ill patients. Severe and critical lung infections are common in patients with severe and critical disease, and dyspnea and hypoxemia are major life-threatening problems. Medical oxygen supply has become one of the most important means to improve blood oxygen status, support life, and win treatment time. From mask oxygen delivery, nebulization therapy, to high-flow oxygen therapy, and ventilator-assisted breathing, a large amount of medical oxygen is consumed. If the oxygen supply is insufficient, it will greatly affect the treatment effect and even endanger the patient's life. The oxygen inhalation of critically ill patients is more than 10 times that of ordinary patients, resulting in the oxygen consumption of hospitals reaching several times the peak daily oxygen consumption. During the peak period of new coronavirus infection, how to upgrade and transform the medical oxygen system to provide stable and reliable medical oxygen and meet the peak supply of oxygen is a serious challenge faced by medical institutions at all levels across the country.
Take multiple measures to ensure the supply of "life-saving oxygen".
Previously, the First Affiliated Hospital of Jiangxi Medical College mainly relied on the central oxygen supply system to transport the oxygen output from the central oxygen production station to the operating room, rescue room, treatment room and the terminal of each ward through the pipeline system to achieve medical oxygen. The supply of medical oxygen mainly relies on molecular sieve oxygen generators (using compressed air as raw materials to produce oxygen using the principles of compression, conversion and adsorption) and medical oxygen cylinders, which can meet the "usual" oxygen demand. After entering the new stage of the epidemic, the demand for oxygen has increased exponentially, and the previous oxygen supply methods are difficult to meet the oxygen needs of patients infected with the new crown.
As a regional medical center based in southern Jiangxi and facing the four provinces of Jiangxi, Guangdong, Fujian and Hunan provinces, the First Affiliated Hospital of Jiangxi Medical College is the "main battlefield" for the treatment of new crown infection patients in southern Jiangxi. In the face of the arduous and arduous task of medical treatment, the hospital has taken multiple measures to solve the problem of oxygen supply, effectively guarantee oxygen supply, and do everything possible to protect the "lifeline" of medical treatment for patients.
The first is to make frequent scheduling and realize the list of oxygen supply responsibilities. Set up a special work class, which is personally promoted by the main leaders of the hospital, commanded from the front, deployed on the front line, held a special scheduling meeting every day, analyzed the oxygen situation, studied and solved the countermeasures, clarified the division of labor, refined the responsibility, and achieved the responsibility layer by layer compaction, pressure layer by layer transmission, and task layer by layer implementation.
The second is to focus on overall planning and promote the refinement of oxygen supply and allocation. The resources of the whole hospital are coordinated by "a game of chess", and the allocation plan is optimized according to the actual clinical situation, and the oxygen supply is dynamically allocated by classification and sub-region, so as to solve the clinical oxygen demand as a whole. With the efforts of the whole hospital, we set up wards for patients with new crown infection, optimized the layout, formulated the "Oxygen Therapy Plan for New Coronary Infected Patients", and scientifically guided the clinical practice to provide patients with "private customized" diagnosis and treatment plans to ensure that the precious medical oxygen is the most sufficient, reasonable and maximized effect.
The third is to strengthen the supply to ensure the efficiency of oxygen supply capacity. On the one hand, the hospital urgently purchased more than 300 ventilators and high-flow humidified oxygen therapy systems to alleviate the problem of insufficient treatment equipment. On the other hand, we adhere to the principle of "only gas can wait for tanks, not tanks for gas", actively contact the oxygen supply company that maintains the supply relationship, arrange special car pick-up, increase the frequency of transportation, and change from once a day to twice a day, so as to effectively ensure that patients receive oxygen treatment.
Fourth, expand the capacity and broaden the diversification of oxygen supply channels. The oxygen supply system of liquid oxygen storage tank is composed of cryogenic liquid storage tank, vaporizer, pressure reducer, transportation pipeline, etc. When oxygen is used, the liquid oxygen flows out of the liquid oxygen storage tank and is vaporized by the carburetor, and then the pressure is regulated by the pressure reducing device, and transported to each medical unit through the oxygen supply pipeline. The hospital gave full play to the advantages of the construction of provincial epidemic prevention and control bases, and urgently built one new liquid oxygen station in each of the two hospitals, increased the supply of liquid oxygen, doubled the oxygen supply capacity, and provided strong support for the treatment of new crown infection. It took only 10 days from the start of construction to the putting into use of the liquid oxygen station, with 8 5 cubic meters of liquid oxygen storage tanks (1 cubic meter of liquid oxygen can be gasified into 800 cubic meters of gaseous oxygen), and 40 cubic meters of liquid oxygen can be supplied every day during peak periods, which can effectively meet the clinical oxygen needs of the whole hospital, save a lot of money, and fundamentally solve the problem of oxygen supply. In the next step, the hospital will continue to use liquid oxygen as the main gas source to supply oxygen, strive to ensure the safe, stable and continuous supply of medical oxygen, and escort the protection of people's health and life safety.
"Combination of peacetime and wartime" strengthens oxygen supply guarantees
High-level propulsion is fundamental to ensure adequate oxygen supply. The problem of medical oxygen supply involves a wide range, there are many related departments, it is difficult to co-ordinate, and the situation is urgent, so it is necessary for the main leaders to participate in the planning and deployment in order to promote the next game of chess, the whole hospital is one heart, the integration and coordination of all kinds of resources, the overall coordination of all departments to cooperate closely, gather a strong work force, and provide a solid and powerful guarantee for ensuring oxygen supply.
Diversification of pathways is the key to ensure adequate oxygen supply. At present, due to the site, funds, approvals and other reasons, the vast majority of public hospitals have a single source of oxygen supply, and the oxygen supply capacity is limited, which can only meet the daily oxygen demand in "peacetime", which is also the key to restricting the "wartime" oxygen supply guarantee. During the major epidemic test, the demand for oxygen has increased exponentially, and the existing oxygen supply is a drop in the bucket. Public hospitals with conditions can quickly solve the "wartime" oxygen supply demand by building or expanding liquid oxygen stations, expanding oxygen supply channels and oxygen supply capacity, and "increasing the number of oxygen filling".
Optimal management is the key to ensuring adequate oxygen supply. The oxygen needs of patients with different diseases are different, and the oxygen requirements of ordinary patients infected with the new coronavirus and critically ill patients are also different, which requires hospitals to optimize the setting of wards, reasonably place patients, and deploy high-flow oxygen equipment as needed to treat more patients with the minimum amount of oxygen to ensure that the benefits of medical oxygen use are maximized.
The construction of the base is the foundation to ensure sufficient oxygen supply. In the national "14th Five-Year Plan", comprehensive guidance has been given to the construction of infectious disease wards in medical institutions, emphasizing the further improvement of the top-level design of the medical service system for infectious diseases, optimizing the regional distribution of medical resources for infectious diseases, improving the ability to respond to major epidemics, and helping to achieve regional separation. In recent years, based on the advantages of the provincial epidemic prevention and control treatment base, the hospital has accelerated the construction of the epidemic prevention building in accordance with the principle of "peacetime and wartime", and reasonably divided the functional layout. The epidemic prevention and control treatment base provides a solid foundation for effectively ensuring the treatment work in "wartime", including oxygen supply.
Text: He Chunming, Deputy Secretary of the Party Committee and President of the First Affiliated Hospital of Gannan Medical College