Coronavirus: Hospitals warned problems with oxygen supply will be worse than first wave

Hospitals across England could see oxygen supplies at worse levels this winter than at the peak of the first coronavirus wave – when some sites were forced to close to new admissions.

An alert to NHS hospitals this week warned that because of the rise in admissions of Covid-19 patients, there is a risk of oxygen shortages.

Trusts have been ordered to carry out daily checks on the amount of oxygen in the air on wards to reduce the risk of catastrophic fires or explosions.

The problem is not because of a lack of oxygen but because pipes delivering the gas to wards will not be able to deliver the volume of gas needed by all patients.

This can trigger a cut-off in supply and a catastrophic drop in pressure, meaning patients would be denied the oxygen they need to breathe.

NHS England is spending £15m to urgently upgrade dozens of hospitals’ oxygen supplies.

Earlier this month, Scunthorpe Hospital declared a major incident when demands on its oxygen supply led to patients being diverted to different hospitals and extra staff called in to help care for patients and reconfigure wards.

In April, Watford General Hospital was forced to close its accident and emergency department after a collapse in oxygen supply there.

Hospitals have been told to urgently carry out any possible improvements on their pipework before 18 December and to monitor oxygen use on wards daily.

After a series of fires in hospitals in Europe, the alert also warned of risks to UK hospitals.

NHS trusts were told to check that the levels of oxygen in areas including intensive care and operating theatres did not go above 23 per cent – the threshold for a potential fire.

The warning to all NHS hospitals said: “As hospitals come under increased pressure from acute respiratory admissions due to Covid-19 and winter viruses, oxygen estates may also come under pressure due to admitting large numbers of Covid-19 patients in addition to their usual workload of elective, urgent and emergency care.”

It said the creation of new areas to care for Covid patients especially in older hospitals was increasing the risk of oxygen supplies cutting out.

One new factor, different to the first wave of the pandemic is that fewer patients are being ventilated after doctors have learned less invasive treatment is better. This has meant more patients using what is known as continuous positive airway pressure (CPAP) and non-invasive ventilation as well as high flow oxygen.

The alert added: “Demand for oxygen this winter is also likely to be higher than in spring because there are more general and acute patients in hospital than in the spring, many of whom require some oxygen; and there is proportionately greater use of high flow oxygen and CPAP in patients with Covid-19 and in general, these devices use more oxygen than critical care ventilators.”

If hospitals place too much demand on their oxygen supplies it can cause the vacuum insulated evaporator (VIE) tank, which stores the gas, to cut off supply or reduce pressure rapidly, which can prevent oxygen reaching the wards. The VIE could also be rapidly depleted.

The alert warned: “Both of these situations present a potentially significant risk to multiple patients simultaneously.”

They have also been told to ensure oxygen is being used appropriately, monitor oxygen use every hour and make sure plans are in place if it exceeds 75 per cent of the maximum available.

Hospitals must also review fire risk assessments and ensure evacuation plans are up to date as well as carry out drills.

The use of extra oxygen cylinders on wards, which can explode in the event of a fire, should be limited to emergencies and when transporting patients.

An NHS England spokesperson said: “The NHS is investing a further £15m to upgrade medical oxygen supply in hospitals, with 25 projects already completed and a further 52 in train.”