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Centre asks states to maintain supply of oxygen in hospitals

LiveMint logoLiveMint 05-09-2017 Neetu Chandra Sharma

New Delhi: The Union health and family welfare ministry has written to all states that it is mandatory for hospitals to maintain a regular supply of life-saving gas in the operation theatres, Intensive Care Units (ICUs) and wards. The move follows two separate instances of a large number of new born deaths occurring within days of each other, allegedly due to lack of oxygen, at two hospitals in Uttar Pradesh.

Forty-nine infants died in the neonatal critical care unit and the delivery room of a state-run hospital in Farrukhabad district between 20 July and 21 August. Last month, a hospital in Gorakhpur recorded several infant deaths. A disruption in oxygen supply was reported in both cases.

A team of experts from the centre that visited Gorakhpur to investigate deaths of children said that the neonatal (aged up to 28 days) deaths occurred due to prematurity, asphyxia and sepsis, mostly occurring within 48 hours of admission. The team has submitted its report to the Union health ministry.

Medical oxygen comes under the National List of Essential Medicines (NLEM) of India, one of the key instruments in a balanced healthcare delivery system.

“No ICU or hospital for that matter can run without a smooth supply of oxygen as medical oxygen comes under essential medical list. This is very disappointing that such reports from the hospitals from Uttar Pradesh are coming that these hospitals are not maintaining the supply of medical oxygen and children are dying due to it. The centre had given funds for over 10 ICUs to Uttar Pradesh. We have written to the state government to take special care of this aspect,” said Dr. Jagdish Prasad, director general of health services (DGHS) in the Union health ministry.

Medical oxygen is also on the World Health Organization’s (WHO) list of essential medicines.

According to WHO, oxygen therapy remains an inaccessible luxury for a large proportion of severely ill children admitted to hospitals in developing countries. This is particularly true of patients in small district hospitals, where, even if some facility for delivering oxygen is available, supplies are often unreliable and the benefits of treatment may be diminished by poorly maintained, inappropriate equipment or poorly trained staff with inadequate guidelines.

“It is criminal on the part of hospitals to not keep medical oxygen in regular supply. In private hospitals such items including other medicines are at a special focus because hospitals can’t run without these essential medicines,” said Dr. Rajesh Pande, director and senior consultant in critical care medicine department at BLK Super Speciality Hospital, New Delhi.

Both in Gorakhpur and Farrukhabad, the majority of the newborn babies who died were in need of medical oxygen as many of them were suffering from hypoxaemia (insufficient oxygen in the blood).

According to WHO, worldwide every year over 5.9 million children die, mostly from preventable or easily treatable diseases, and more than 95% of those deaths occur in developing countries.

Pneumonia is the leading cause of death in children under 5 years of age, being responsible for at least 18% of all deaths in this age category. Hypoxaemia is a major potentially fatal complication of pneumonia. Oxygen therapy is essential to counter hypoxaemia.

“Oxygen therapy must be more widely available; in many remote settings, this can be achieved by use of oxygen concentrators, which can run on regular or alternative sources of power. Several conditions must be met for hypoxaemic children to receive appropriate, uninterrupted oxygen therapy for as long as is necessary to save their lives,” a WHO handbook for oxygen therapy recommends.

“First, a child must be recognized as hypoxaemic, either by a trained health care provider on the basis of clinical signs or with a pulse oximeter. Then, the child recognized as hypoxaemic must receive adequate, uninterrupted oxygen therapy for an adequate duration,” it says.

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