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Safety/Technical

Questions pertaining to safety and technical information.

Regarding the Hyperbaric Safety Director for a hospital based hyperbaric department (monoplace chambers)
Published: 04 May 2016

Regarding the Hyperbaric Safety Director for a hospital based hyperbaric department (monoplace chambers)

  1. Does NFPA 99 require the Hyperbaric Safety Director to be on premise when chambers are operating?
  2. Is it ok for them to be available by phone?
  3. If someone is covering for the Hyperbaric Safety Director when they’re unavailable, i.e. on vacation:
    • Does the covering person need to have Hyperbaric Safety Director Training?
    • Would the Hospital Safety Director (not involved in daily hyperbaric operations) be an approved choice?

Thank you for your question. The UHMS hyperbaric oxygen safety committee (SC) can provide information but the ultimate responsibility for these types of questions is with the medical director and safety director of your facility.

Regarding: Hyperbaric Safety Director (HSD) requirement to be on premises when chambers are operating.

It is the responsibility of the administration, medical director and safety director to compile a policy and procedures for the type of chambers, acuity of patients and qualifications of staff.

  1. Language requiring an individual with the responsibilities of hyperbaric safety director (HSD) has been in NFPA 99 since 1970 (56D). NFPA 99, 14.3.1.3.2 requires that each facility designate an on-site hyperbaric safety director (HSD). We are not aware of any requirement in NFPA 99 that specifies that the hyperbaric safety director be on the premises when chambers are in operation.

    There is further information on this topic in the annex of NFPA 99 A14.3.1.3.2. The complexity of hyperbaric medicine is such that one person should be designated as the chamber operator. That person should be knowledgeable and have the training and experience to recognize hazards.

    NFPA 99, 14.3.1.4.8 requires that a chamber operator be physically present and maintain visual and audible contact with the control panel or chamber occupant(s) during hyperbaric oxygen therapy.

    The UHMS facility accreditation probe HBOHR 2.2 looks for a Certified Hyperbaric Nurse or CHT on premises when chamber operations are going on.

  2. It is acceptable for the HSD to be available by phone, and in our experience, this position is most often available 24/7 for calls regarding the hyperbaric facility.
  3. If the HSD is not available, on vacation or other, there needs to be an alternate HSD named to be responsible. It is good practice to bring staffing “up” in the department and have a succession plan in place.
    1. The individual covering for the HSD should have attended a hyperbaric safety director course, have knowledge and experience in hyperbaric medicine and with the equipment used at the facility. This could be the lead chamber operator with the most experience, for example.
    2. Unless the hospital safety director has knowledge and experience with hyperbaric medicine and has attended a hyperbaric safety director course, we would not encourage using this resource to cover the HSD absence. We would encourage working closely with the hospital safety director so that individual has some knowledge of our unique practice.

For references see:

MEDFAQ July 07, 2015 regarding safety director training
NFPA 99, 2015 edition, chapter 14 Hyperbaric Facilities
UHMS Guidelines for Hyperbaric Facility Operations, 2nd edition
UHMS Clinical Hyperbaric Facility Accreditation Manual (Rev1)

DISCLAIMER
Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet. If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility. Information provided on this forum is for general educational purposes only. It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

I have a medicine/safety question. A referral came to our off campus monoplace hospital owned wound care and hyperbaric center with a diagnosis of pyoderma for 20 HBO2 treatments. Aetna has already approved this treatment. They placed a VAC on her perianal deep wound and...
Published: 31 August 2017

I have a medicine/safety question. A referral came to our off campus monoplace hospital owned wound care and hyperbaric center with a diagnosis of pyoderma for 20 HBO2 treatments. Aetna has already approved this treatment. They placed a VAC on her perianal deep wound and...

I have a medicine/safety question. A referral came to our off campus monoplace hospital owned wound care and hyperbaric center with a diagnosis of pyoderma for 20 HBO2 treatments. Aetna has already approved this treatment. They placed a VAC on her perianal deep wound and they have to give her propofol to place the VAC on her. We cannot change or apply the VAC under those conditions here at the center, so the patient will go to the GI office and have the VAC changed twice a week after her HBO2 treatment on Monday and Thursday. Is there any increased danger of toxicity or seizures with this patient with this regime and the consistent use of propofol twice a week for VAC placement?


 There is no safety issue here. We have used such a regimen routinely in some of our hyperbaric patients with large wounds. The effects of low dose propofol disappear after a few minutes.

What types of pillows can be used in the Monoplace chamber? Can we utilize reusable pillows?
Published: 01 March 2019

What types of pillows can be used in the Monoplace chamber? Can we utilize reusable pillows?

Thank you for your question. The UHMS HBO2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

Regarding pillows approved for use in Monoplace chambers: One should be careful not to allow just any pillow into the monoplace chamber. The National Fire Protection Association (NFPA) 99, “Health Care Facilities Code,” 2018 edition contains a section regarding textiles (14.3.1.6.4) that provides guidance on the decision process for textiles, garments and wound care products.

We suggest that a proper risk assessment be initiated by the Safety Director of the hyperbaric program. The risk assessment found in section A14.3.1.6.4.3 is written for hyperbaric wound dressings, but the process is useful for other items as well. The Safety Director should consider using this risk assessment when making decisions about pillows to be used in the hyperbaric environment. Furthermore, section 14.3.1.6.4.4 calls for written approval by the Safety Director and Medical Director for prohibitive items to be allowed. The Safety Committee suggests that this code applies to the acceptance or disapproval of pillows.

You may wish to review these safety factors that may impact your decision:

  • The increased oxygen atmosphere in the chamber and the need to limit combustibles
  • Silk, wool and synthetic textiles are prohibited, unless approved by the medical director and safety director and based on sound and safe reasoning
  • Static producing materials should be avoided
  • Closed cell materials, such as some synthetics may retain oxygen after decompression, presenting an additional risk once the treatment has been concluded.
  • Infection prevention: Non-synthetic cotton or down pillows are relatively safe to be used in some chambers but are challenging when it comes to disinfection. Wipe-able covers are available and may need to be considered for those types of pillows.
  • The pillows need to be able to vent with the change of pressure in the chamber to avoid the pillow expanding on decompression.

It may be beneficial to inquire of your chamber manufacturer when seeking options for pillows. The UHMS website below contains links to many chamber vendors that may offer pillows. However, the Hyperbaric Oxygen Safety Committee suggests that your own risk assessment be performed regardless of the pillow manufacturer.

https://www.uhms.org/resources/links/11-chamber-equipment-manufacturers.html

Please let us know if we can provide any additional guidance or information.

Respectfully,

The UHMS Safety Committee

 

DISCLAIMER

Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

We recently stated using maggots in wound care. Have you guys used these? I looked into the product and I wondered your thoughts of the Dacron screen that holds them in place? We do not currently have any HBO patients using this therapy but trying to get prepared if it comes up.
Published: 25 March 2019

We recently stated using maggots in wound care. Have you guys used these? I looked into the product and I wondered your thoughts of the Dacron screen that holds them in place? We do not currently have any HBO patients using this therapy but trying to get prepared if it comes up.

Thank you for your question. The UHMS HBO2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

The UHMS HBO2 Safety Committee is well aware that maggot therapy is a viable and common practice in wound care. We have evaluated the Dacron screen utilized for this therapy and can find no evidence that this item poses a significant risk in the hyperbaric environment. We must reiterate that the decision to allow foreign materials into the chamber rests upon the safety director and medical director of your facility.

It was observed by members of our committee that several articles regarding maggot therapy are available for your review and may contribute to the decision-making process for your facility.

https://www.ncbi.nlm.nih.gov/m/pubmed/24224280/

http://dx.doi.org/10.1155/2014/592419

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233395/

Respectfully,

The UHMS Safety Committee

 

DISCLAIMER

Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.

Is it safe to treat a patient in hyperbaric oxygen therapy when they have an indwelling peritoneal dialysis catheter that has a minicap that has a iodine impregnated sponge and titanium adapter? The minicap is not able to be substituted at all per manufacturer guidelines.
Published: 23 April 2019

Is it safe to treat a patient in hyperbaric oxygen therapy when they have an indwelling peritoneal dialysis catheter that has a minicap that has a iodine impregnated sponge and titanium adapter? The minicap is not able to be substituted at all per manufacturer guidelines.

Thank you for your question. The UHMS HBO2 safety committee can provide information to assist you in answering your question, but the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

The iodine within the minicap of this type of catheter does not pose an increased risk of fire. Since no flammable materials are otherwise identified, the remaining concern is the titanium adapter. For more information regarding this material, please refer to previously answered questions regarding titanium and peritoneal dialysis catheters.

Respectfully,

The UHMS Safety Committee

REFERENCES:

Material Safety Data Sheet – Iodine (Ratings listed are for the 1ATA environment)

http://dept.harpercollege.edu/chemistry/msds/Iodine%20Fisher.pdf  

________________________________________

MEDFAQ Published: 03 May 2016

Can patients be safely treated with an existing peritoneal dialysis catheter? Are there any precautions that need to be taken prior to therapy?

https://www.uhms.org/resources/medfaqs-frequently-asked-questions-faq/53-safety-technical.html

________________________________________

MEDFAQ Published: 20 June 2016

Can safety committee provide and update on titanium in HBO. Dr. Weaver answered a question about this at the Winter Symposium in SLC.

https://www.uhms.org/resources/medfaqs-frequently-asked-questions-faq/53-safety-technical.html

 


DISCLAIMER

Neither the Undersea and Hyperbaric Medical Society (UHMS) staff nor its members are able to provide medical diagnosis or recommend equipment over the internet.  If you have medical concerns about hyperbaric medicine you need to be evaluated by a doctor licensed to practice medicine in your locale, which can provide you professional recommendations for hyperbaric medicine based upon your condition. The responsibility of approving the use of equipment resides with the physician and safety director of the facility.  Information provided on this forum is for general educational purposes only.  It is not intended to replace the advice of your own health care practitioner and you should not rely upon it as though it were specific medical advice given to you personally.