Undersea & Hyperbaric Medical Society
Guidelines for infection control, patient treatment, and staff safety considerations related to Hyperbaric Oxygen Therapy (HBO2) in monoplace and multiplace hyperbaric chambers during the novel coronavirus disease (COVID-19) outbreak
Created: March 2020
PDF COPY of guidelines
This document is provided with the intended purpose to enhance infection prevention practices, address patient selection, and offer solutions for safe patient care practices for monoplace and multiplace hyperbaric facilities during the novel coronavirus disease (COVID-19) outbreak. The following guidelines are not intended to replace the infection prevention policies and procedures that have been established by hospitals, healthcare centers and manufacturers, but to provide some confidence in the safety measures you already use and to provide some additional input to optimally reduce infection risk.
Due to the shared space and presence of multiple bodies within a confined area, the greatest infection risk exists within the multiplace chamber. As a result of this, the bulk of this document is aimed at infection prevention measures in that environment.
The proposed guidelines are an amalgamation of recommendations from our Safety Committee, Oxygen Committee, and the generous contributions of our colleagues in the European Committee for Hyperbaric Medicine (ECHM) and the Canadian Undersea and Hyperbaric Medical Association (CUHMA).
The UHMS recommends that all medical facilities independently evaluate and review their infection prevention procedures, to include, but not limited to: patient screening upon arrival, patient selection, patient and staff interactions, physical spacing/distancing, how to limit patient access throughout the clinic/department, use and cleaning of changing rooms, patient spacing/seating within the chamber, and co-morbidities as a measure of morbidity/mortality risk.
The Centers for Disease Control (CDC), as well as local and state governments, provide a continually changing landscape of recommendations related to population measures aimed at infection control. Within the clinical setting, thoughtful, and often difficult decisions are required to balance infection risk against the benefits of HBO2 therapy.
In highly affected populations, consider the need to limit HBO2 to selected cases only and to the minimum number of sessions necessary to reach a pre-defined clinical goal or endpoint. The intention is to avoid unnecessary exposures for medical personnel and patients, as well as saving limited resources (masks, disinfectants etc.).
Multiplace Chamber Guidelines
Safety of Inside Attendants
Options may include:
All personal breathing equipment to include masks, BIBS, and hoods are either discarded or properly and thoroughly disinfected after every use.
All chamber surfaces require thorough disinfection procedures with use of approved solutions and materials. Disinfection solutions must be effective against bacteria and viruses. If available, the chamber atmosphere should be appropriately cleaned with closed UV systems (avoiding direct exposure on PVC windows) after each treatment.
Multiplace Guidelines for Urgent/Emergent Indications for Patients with Suspected COVID-19 Infection
All of the recommendations stated above regarding general infection control recommendations still apply.
A thoughtful approach that balances the risk of disease transmission to staff and other patients versus the anticipated benefit to the patient is an imperative part of whether treatment is provided and which procedures/safety measures are used.
Optimize isolation of the infected person through standard droplet precautions (the World Health Organization (WHO) is considering a recommendation for airborne precautions) with a surgical mask, or if necessary and based on the clinical scenario, intubation. If the patient is intubated, a HEPA filter may be placed between the endotracheal tube and the bag or ventilator. However, it is important to consider the risk of inadequate ventilation and increased CO2 within the breathing circuit if the patient requires high minute ventilations and high PEEP.
Monoplace Chamber Guidelines
Statement Regarding use of HBO2 as Treatment of Severe COVID-19 Infection
There is a cohort of patients who suffer severe hypoxia associated with COVID-19, and there are some reports related to the experimental use of HBO2 to minimize these effects. Based on the current evidence, logistics of care, temporary effect of treatment, and the availability of other treatment options, HBO2 is not recommended for the treatment of COVID-19 associated hypoxia. Recommended treatment options include ventilator support or extracorporeal membrane oxygenation (ECMO).
The Undersea and Hyperbaric Medical Society's Board of Directors has made the difficult but necessary decision to cancel the 2020 Annual Scientific Meeting in San Diego, California. After considering all of the ongoing challenges and factors related to COVID-19 (SARS-CoV-2), the Board believes this is the right decision to protect our ASM participants, attendees and faculty.
The UHMS will be providing a focused version of the 2020 ASM as enduring materials as a way to provide our membership with important content and highlight the great work and efforts of our community.
For those who have already pre-registered for the ASM 2020, your funds can be moved to the 2021 meeting, refunded or be placed toward the virtual/online fees (with any difference in the fees refunded).
Our goal is to move the San Diego ASM to 2023.
Any questions or concerns can be addressed to email@example.com.
Nicholas Bird, MD
John Peters, FACHE
The Undersea and Hyperbaric Medical Society (UHMS) is providing the following information about the status of UHMS live course programming as it relates to COVID-19. The UHMS is assessing potential risks to attendees of UHMS live programming on a real-time basis based on community outbreak levels and the CDC recommendations for community events, including meetings at https://www.cdc.gov/coronavirus/2019-ncov/community/mass-gatherings-ready-for-covid-19.html.
The UHMS position on the continuation, delay or cancelation of meetings and courses, will be commensurate with the published CDC level of community outbreak.
At this time, all UHMS meetings and courses are continuing as planned.
John S. Peters
The UHMS-SC directs all hyperbaric practices to follow the guidance of the Centers for Disease Control (CDC) along with guidance from the Hyperbaric Chamber Manufacturer, State and local health agencies, and your hospital infection prevention and control group. All of these sources will impact the decision for your practice. Your choice should be a decision made between the MD & HSD of your program. The UHMS-SC can provide guidance based upon existing literature available to the public, but does not endorse a particular product or procedure. CLICK HERE FOR THE FULL ARTICLE
Hyperbaric centers across the country are struggling with how to provide healthcare in the setting of COVID-19. The UHMS has been given permission to publish a recent publication by the European Committee for Hyperbaric Medicine, which provides thoughtful guidelines. This rapidly evolving pandemic has prompted rapid changes in infection control measures, and alterations in established workflows. ECHM position on Hyperbaric Oxygen Therapy (HBOT) in multiplace hyperbaric chambers during coronavirus disease (COVID-19) outbreak
The Undersea and Hyperbaric Medical Society (UHMS) is an international non-profit organization serving members from more than 35 countries. The UHMS is the primary source of scientific information for diving and hyperbaric medicine physiology worldwide.
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