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In the current third wave, there has been a significant increase in the demand for medical oxygen by hospitals. In the first wave last spring, hospitals generally only ordered oxygen supplies, but there was basically no significant increase in the amount of medical oxygen actually used compared to normal conditions: Zsolt Bohner, Managing Director of Messer Hungarogáz Kft. He provided guidance to Index.
Then the epidemic gained new momentum, and in November of last year, in the second wave, the consumption of liquid oxygen had already doubled; the demand for bottled oxygen has also increased exponentially, up to about three times the normal situation.
In March of this year, last week, the demand for liquid oxygen increased two and a half times and the demand for bottled oxygen increased nine times compared to normal conditions.
By default, approximately 6,500 messenger bottles are circulating in the health sector, but in the current situation there are already 12,000 pieces. As a result of the explosive increase in demand, the company can now (with special official permission) fill medical cylinders into industrial bottles (subject, of course, to proper quality assurance procedures).
As one of the most important suppliers of medicinal gases, Messer Hungarogáz supplies more than 140 health institutions, including several institutions designated as primary and secondary epidemiological hospitals, to which it supplies medical oxygen in cylindrical or liquid form for the treatment of patients with coronavirus. Messer plants are still producing at full capacity, supplying medical oxygen to about 40 percent of healthcare institutions across the country.
There is no surplus
Before the third wave, we still supplied medical oxygen to Serbia under supply agreements between subsidiaries of the Messer Group, as long as domestic demand allowed.
– says Zsolt Bohner, adding that since the satisfaction of Hungarian needs has become a priority, in the third wave they will concentrate all their resources exclusively on the care of Hungarian hospitals. By the way, hospitals issue a public tender for the supply of medical oxygen, which also implies an obligation to supply the contracted hospitals. The company operates three air separation plants in Hungary (Budapest, Tiszaújváros and Kazincbarcika), two of which are licensed to produce medicinal oxygen.
Others also produce medical oxygen.
The competition in Hungary has almost two players. The other major supplier, Linde Gáz Magyarország Zrt., Decided in January this year to expand its capabilities. The government approved the development of HUF 4 billion of the air separation plant in Kazincbarcika with a non-reimbursable subsidy of HUF 1.9 billion.
Air oxygen
The raw material of production itself is oxygen extracted from the ambient air. Air is made up of 21 percent oxygen, 78 percent nitrogen, then 1 percent argon, and traces of additional noble gases. On an industrial scale, based on the difference in the boiling point of gases, the so-called cryogenic separation of air, air is decomposed into its main components: nitrogen and oxygen.
Medical oxygen used for ventilation, which enters the human body, qualifies as a drug or active ingredient, so OGYÉI periodically checks its quality.
The filling of medicinal oxygen into a cylinder is done in filling systems completely separate from the filling of other industrial and food gases, and samples taken from the manufactured batches are tested in a laboratory. Hospitals generally require oxygen in two forms: in a liquid state with tank supply and compressed oxygen in cylinders.
Liquid oxygen reaches hospitals with a central gas distribution network by tanker truck, and after transfer, it is transferred to the hospital’s central storage tank. The evaporator, installed next to the outdoor tank, converts the oxygen into a gaseous state, which enters the central oxygen distribution network of the hospital and from there to the wards, operating rooms and treatment rooms. The network of wiring built into the walls of the hospital extends to patient beds, where volume regulators can also be connected to “oxygen taps”. From here, oxygen can be delivered through a plastic tube to a cannula placed directly in front of the patient’s nose or to a mask placed on the face, but the ventilator is also connected to this conduit system.
Liquid transport is advantageous for two reasons. On the one hand, from 1 liter of liquefied gas, about 800 liters of gaseous oxygen useful for patients can be produced. On the other hand, large amounts of gas are also much easier to transport and store in small volumes.
Many hospitals also require large amounts of bottled oxygen, either because there is no central oxygen distribution network or to transport patients.
In response to extraordinary demands, even during the first wave, regulatory approvals allowed manufacturers to refill industrial oxygen cylinders with medical oxygen.
In addition to its three air separation plants, Messer also has four cylinder filling plants (in Budapest, Győr, Dunaföldvár and Nyíregyháza), which means one of the largest oxygen production capacities in the country. However, at the same time, steps had to be taken to meet the extraordinary needs.
The performance of air separation plants has been changed from nitrogen production to oxygen production to supply liquid oxygen, and oxygen tanks and evaporators in hospitals and healthcare facilities have been replaced by larger ones.
Where there was no scope for further expansion of liquefying capacity, the supply of bottles meets the increased demand, but this is a more expensive solution and a much higher logistical burden for the hospitals and the gas supplier as well.
Currently, the biggest challenge is collecting empty bottles from hospitals. The head of the company considers it very important that empty cylinders are not scattered in hospital patios, because disinfection and refilling also take time, and oxygen cylinders must be placed as soon as possible next to the patients’ beds.
Medical oxygen cylinders fill and disinfect in 0-24 hours. It has not yet been necessary to limit the oxygen demand of industrial users, but if necessary, we will also take this step, stressed Zsolt Bohner, CEO of Messer Hungarogáz.
(Cover image: Messer Hungarogáz)
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