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Recent disruption of medical oxygen during the second wave of coronavirus disease 2019 (COVID-19) has caused nationwide panic. This study attempts to objectively analyze the medical oxygen supply chain in India along the principles of value stream mapping (VSM), identify bottlenecks, and recommend systemic improvements.
Process mapping of the medical oxygen supply chain in India was done. Different licenses and approvals, their conditions, compliances, renewals, among others were factored in. All relevant circulars (Government Notices), official orders, amendments, and gazette notifications pertaining to medical oxygen from April 2020 to April 2021 were studied and corroborated with information from Petroleum and Explosives Safety Organization (PESO) official website.
Steps of medical oxygen supply chain right from oxygen manufacture to filling, storage, and transport up to the end users; have regulatory bottlenecks. Consequently, flow of materials is sluggish and very poor information flow has aggravated the inherent inefficiencies of the system. Government of India has been loosening regulatory norms at every stage to alleviate the crisis.
Regulatory bottlenecks have indirectly fueled the informal sector over the years, which is not under Government’s control with difficulty in controlling black-marketing and hoarding. Technology enabled, data-driven regulatory processes with minimum discretionary human interface can make the system more resilient.
In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, New Delhi was expedited at war footing level and converted into a COVID-19 Emergency response Centre (ERC). Engineering works were completed in a speedy manner and various patient care areas were equipped as deemed necessary for providing tertiary care to COVID-19 patients. A highly spirited team comprising of Emergency Medicine Specialists, Anesthesia and Critical Care specialist, Hospital Administrators and Nursing Officers was formed. Effective segregation of patient care areas into clean, contaminated, and intermediate zones was done using physical barriers and air conditioning modifications. The screening area for patients suspected of having COVID-19 was created in addition to a 2-step process i.e., Triage 1 and Triage 2, thereafter, patients requiring admission would be referred to the emergency area. An in-house designed and fabricated sampling booth was created to bring down the use of PPEs and for better infection control. The ERC has a general ward and state of the art intensive care units. Mobilizing resources (machinery, manpower, consumables etc.) during the lockdown required commitment from top leadership, motivated teams, expeditious procurement, coordination with multiple agencies working on site, expediting statutory clearances, coordination with police services, transportation of labor etc.
Coronavirus disease 2019 (COVID-19) has posed formidable challenges, including overwhelming biomedical waste management. Guidelines have been rapidly changing along with the mounting pressure of waste generation.
These challenges were managed by smart re-engineering of structure and processes for the desired outcomes. Dedicated staff, in personal protective equipment with appropriate training, were deployed to collect waste using dedicated trolleys. A dedicated route plan was drawn with a dedicated elevator meant for COVID-19. A new temporary holding area was created. Dedicated trucks with requisite labels were deployed to transport COVID-19 waste to a common biomedical waste treatment facility. Communication challenges were addressed through timely circulars, which were further reinforced and reiterated during various on-going training programs.
Before the onset of COVID-19 pandemic, the amount of biomedical waste generated was 1.93 kg/bed/day; currently, the quantity of COVID-19 biomedical waste generated is 7.76 kg/COVID bed/day. Daily COVID-19 waste generation data are maintained and uploaded in an android application monitored by Central Pollution Control Board, Government of India. To date, none of the workers handling COVID-19 waste has acquired health-care associated COVID-19 infection, which reflects on the soundness of the new system and the infection control practices in the institute.
A responsive leadership harmonizing with a robust communication and training system has augmented timely re-engineering of structure and processes for better outcomes in the war on waste.
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