Huong T. Chu, Senior Project Officer, Coordination & Knowledge
Rachel S. Coley, Technical Advisor & Project Manager, EpiC Vietnam
When the COVID-19 Delta variant arrived in Vietnam last summer, more than 18 months of successful measures to reduce transmission, including mask use and social distancing, failed to contain it. Hospitals quickly became overwhelmed with critical and severe patients, and medical oxygen systems could no longer keep up with demand.
In response, the United States Agency for International Development (USAID) asked the Meeting Targets and Maintaining Epidemic Control (EpiC) project in Vietnam to conduct a rapid assessment of sites that would benefit from significant investments in medical oxygen infrastructure. The project worked with the Ministry of Health, provincial departments of health, and facilities to scope and install new systems for thirteen sites, 12 of which were Delta hot spots.
Why is medical oxygen so important?
For many patients, including those with COVID-19, medical oxygen is an essential medicine. When oxygen is stored at very low temperatures (-183 degrees Celsius), it takes a liquid form, allowing large amounts to be stored efficiently. A liquid oxygen system with piping to patient bedsides provides a safer alternative to cylinder-based gaseous oxygen located within hospital wards — the common stopgap measure used during COVID’s peak in Vietnam. In addition to being safer, liquid oxygen is the most cost-effective solution, as high-volume tanks with condensed oxygen reduce transportation costs and waste.
Vietnam has dozens of suppliers providing medical grade liquid oxygen (≥ 99.5% purity), but during the peak of the epidemic, most local health facilities did not have any way to safely store liquid oxygen, convert it to gas, and deliver it to patients. Across the country, provincial general hospitals were the primary facilities with liquid oxygen ecosystems, and demands on those systems were high due to the inordinate number of severe COVID patients.
To address this gap, EpiC is installing liquid oxygen systems at 13 high-demand facilities. EpiC worked with a qualified vendor to determine the needs of each supported site. The overall size of the facility, number of beds dedicated to priority groups for medical oxygen, and proximity to other sites with liquid oxygen infrastructure were used to determine tank size, number of beds with bedside piping, and required accessories. Each system included a cryogenic liquid oxygen storage tank of five to 20 cubic meters, an appropriately sized vaporizer, safety regulators, and a piping system linked to between 20 and 80 beds.
Providing this equipment alone does not ensure its successful use. It is critical that administrators, technicians, and clinicians understand how to calculate oxygen needs, safely use and maintain the equipment, and accurately prescribe the use of medical oxygen for patients.
To help health facilities determine the volume of oxygen they need, EpiC Vietnam and the USAID-supported STAR–UCSF OpenCriticalCare.org Project translated the Open Critical Care medical oxygen calculators to Vietnamese and hosted the calculators on a public website. EpiC also created a five-minute instructional video that describes key functions and features of the tool.
EpiC provides a safety training and introduction to medical oxygen at each supported site concurrent with the system’s inspection and official launch. The project is also developing a more comprehensive course that will complement onsite trainings with offline content that covers safety, regulations, clinical care using medical oxygen, and sustainable financing for the maintenance of equipment and ongoing purchasing of oxygen for the system.
Less than two months after receiving necessary approvals from USAID and the Ministry of Health, EpiC completed two of the thirteen planned systems. The remaining systems will be completed by August 2022. EpiC will continue to provide support for the management of the equipment, clinical use of medical oxygen, and sustainable financing to support ongoing purchases of tank refills. The warrantied systems, which have a decades-long lifespan, will continue to improve care to patients at supported facilities for at least a generation.
Featured Image: With EpiC’s support, the first USAID-funded liquid oxygen system is inaugurated at the Tan Bien District Health Center in Vietnam (Photo Credit: EpiC Vietnam).