Ask a new question
You don't have permission, please login or register

Safety/Technical

Questions pertaining to safety and technical information. Open to the public.

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)

Published Date:   5/2016
Review Date:       5/2019
Due Review:        5/2022


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.

Question; 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?

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.
    • 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.
    • 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, 2018 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.

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.

One of our researchers has a hyperbaric oxygen chamber. We had a question about appropriate paint to use for a HBO chamber. I am having a hard time finding information on where to find paint that is high oxygen rated. Can you help point me in the right direction?
Published: 15 July 2019

One of our researchers has a hyperbaric oxygen chamber. We had a question about appropriate paint to use for a HBO chamber. I am having a hard time finding information on where to find paint that is high oxygen rated. Can you help point me in the right direction?

Date:  7/15/2019

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. If you are a safety officer responsible for this chamber and you have not attended a Hyperbaric Safety Director’s course as described by the National Board of Diving and Hyperbaric Medical Technology (NBDHMT.org), this committee would highly recommend it.

The UHMS Safety Committee cannot specify a specific brand, product, or chemical makeup for paint that would be suitable for a 100% oxygen environment. The action of painting a hyperbaric chamber is not something that should be taken lightly, as mishaps have been recorded in the literature (ref. 1), and failure to address fire safety concerns could result in unsafe conditions. This committee would strongly suggest that you reach out to your chamber manufacturer for further guidance. You should consider the design life of the particular chamber and consider all of the risks prior to an undertaking of this nature. There is guidance from the Department of Defense related to air-filled chambers that may be considered as a reference point, but these documents do not address 100% oxygen environments. (ref. 2, 3)

In general terms, chamber manufacturers will consider a number of safety factors when choosing paint for air-filled chambers, to include:

  • Is the paint low-VOC?
  • Are there residual flammable vapors that haven’t off-gassed?
  • Is it water-based (where fire is concerned)?
  • Is this product eco-friendly or non-toxic?
  • Is the product corrosion-inhibiting?
  • Is there as unpleasant or residual smell?

The safety of this process should be carefully respected and thoroughly planned, ensuring that:

  • The safety of this process should be carefully respected and thoroughly planned, ensuring that:

    • All of the manufacturer’s application instructions are followed
    • Staff applying paint are safe and the area is well ventilated
    • The location of the chamber is suitable to paint on site – If not, consider moving the chamber to a commercial site
    • The paint has had enough time to off-gas potentially harmful vapors. To validate this, it may be necessary to follow the application with high precision gas analysis and contamination scrubbing before the chamber can be used. Follow the chamber manufacturer’s guidance and study the data provided from the product’s SDS. (ref. 2, 3).

    Additionally, we encourage you to reference the following codes and standards for further guidance:

    • Section 14.2.2.5 through 14.2.2.5.3, National Fire Protection Agency (NFPA). (2018). NFPA 99 2018 Edition: Health Care Facilities Code. Quincy, Massachusetts.
    • Fire Hazard Classification, ASTM E-84 (NFPA 255), Class “A” (Class A (or 1) is the lowest flame spread rate)
    • ASTM E-84 (UL 723) provides flame spread ratings/classes: "Test for Surface Burning Characteristics of Building Materials."
    • NFPA 255 (describes the test to provide a comparative measurement of surface flame spread and smoke development of materials under specific fire exposure conditions).
    • “U.S. NAVY GENERAL SPECIFICATION FOR THE DESIGN, CONSTRUCTION, AND REPAIR OF DIVING AND HYPERBARIC EQUIPMENT,” Revision 1, August 23, 2006 https://www.navsea.navy.mil/Portals/103/Documents/SUPSALV/Diving/General%20Specifications%20Hyperbaric%20Equip.pdf?ver=2016-02-10-114010-800
    • U.S. ARMY CORPS OF ENGINEERS, NAVAL FACILITIES ENGINEERING COMMAND (Preparing Activity), AIR FORCE CIVIL ENGINEERING SUPPORT AGENCY, “UNIFIED FACILITIES CRITERIA (UFC), UFC 4-159-01N, DESIGN: HYPERBARIC FACILITIES,” 16 January 2004 https://www.wbdg.org/ffc/dod/unified-facilities-criteria-ufc/ufc-4-159-01n

    Citations:

    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.

 

“Are diapers with synthetic material (infant and adult) allowed in the Monoplace hyperbaric chamber, pressurized with 100% oxygen?”
Published: 13 August 2019

“Are diapers with synthetic material (infant and adult) allowed in the Monoplace hyperbaric chamber, pressurized with 100% oxygen?”

Thank you for your question. The UHMS HBO 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 Hyperbaric Safety Director of your facility.

The UHMS Hyperbaric Safety Committee understands the advantage that absorbent diapers offer to the patient and the caregiver. Regarding the allowance of synthetic materials in Class A or Class B chambers, one must weigh the risks carefully and consider any opportunity for risk mitigation. For guidance concerning risk assessment and mitigation, we refer you to the National Fire Protection Association® (NFPA) 99, Health Care Facilities Code, 2018 Edition, which contains a section regarding textiles (14.3.1.6.4) offering guidance on the decision process for textiles, garments and wound care products.

We suggest that you know the types of materials commonly used to manufacture these products and their potential flammability. Typically, disposable diapers contain several layers of material Consisting of::

  • The inner layer or top sheet rests against the skin of the wearer and can be made from polypropylene material. Some top sheets include a skin-care lotion, which can protect the skin from overhydration and reduce irritation.
  • The absorbent core layer is designed to hold fluids. To enhance absorbency, most disposable diapers include a matrix of fluff material and a chemical compound known as Super Absorbent Polymer (SAP) that holds up to three hundred times its weight. This material forms into a gel as it absorbs fluids, and is known by other names, including hydrogel, sodium polyacrylate, polyacrylate absorbents, or Absorbent Gel Material (AGM).
  • The fluff in the absorbent core is usually made from wood pulp and may include wheat/corn-based materials. It is designed to distribute fluid across the diaper surface, while the SAP is intended to absorb and lock liquids in its core.
  • The waterproof outer shell is most often a petroleum-based plastic or polyethylene-treated material.
  • Bands made of elastic Lycra® or spandex to keep the diaper close to the wearer.
  • Non-woven refastening tape which holds the diaper in place and allows for adjustment.

We suggest the Hyperbaric Safety Director initiate a risk assessment. The risk assessment found in section A.14.3.1.6.4.3 is written for hyperbaric wound dressings, but the process is useful for other items as well. The Hyperbaric Safety Director should consider using this risk assessment when deciding which materials may be allowed in the hyperbaric environment. Furthermore, section 14.3.1.6.4.4 calls for written approval by the (Hyperbaric) 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 diapers.

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

Material Considerations

  • 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 (Hyperbaric) Safety Director based on sound and safe reasoning
  • Avoid static producing materials
  • Closed-cell materials, such as some synthetics may retain oxygen after decompression, presenting an additional risk once the treatment has been concluded. Patients must avoid contact with any naked flames for approximately 30 minutes after therapy.
  • Although most codes regarding textiles are not written for 100% oxygen environments, garments are required to comply with UL requirements and A Guide to the Undited States Apparel and Household Textiles Compliance Requirements; NISTIR 8115, https://nvipubs.nist.gov
  • The Safety Committee is aware of practices that have utilized cotton towels to fashion a cloth diaper as well.

Static Considerations

  • Confirmation of the continuity of ground between the patient and the chamber before each therapy.
  • Consider placing a damp cotton towel over the garment to lessen static capacity.

References

https://www.babygearlab.com/expert-advice/what-is-inside-those-disposable-diapers

https://tapes.averydennison.com/en/home/solutions/personal-care/baby-diaper.html

https://nvlpubs.nist.gov/nistpubs/ir/2016/NIST.IR.8115.pdf

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.

What is the proper management of gastric tubes in the Monoplace HBO chamber?
Published: 21 September 2019

What is the proper management of gastric tubes in the Monoplace HBO chamber?

Date posted:  9/21/2019


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.

For the Monoplace environment, it is reasoned that Gastrostomy tubes (commonly known as G-Tubes) may remain either closed or open during therapy and throughout pressure changes. Your facility’s Hyperbaric Medical Director should make the determination based upon the needs of your program. Here are several considerations that may aid you in determining the best approach for your facility:

  • It is recommended that the disposition of the tube remain static (open or closed) throughout therapy to reduce the potential for air trapping and rapid release of air and fluid (Boyle’s Law).
  • Open G-tube ends may be wrapped with sterile gauze to contain any potential drainage.
  • Closed G-tube ends may also be wrapped, in the event of accidental opening.
  • Closed G-tube ends may reduce the amount of drainage, but require an additional step to complete before and after therapy. You may wish to adjust your pre/post therapy checklists accordingly.
  • After therapy, you may wish to check the tube for patency and proper function prior to departure.

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 there any literature or consensus about treating patients less than 5 days a week on a regular basis? We have a patient who can only come 3 days a week due to his work. Is it only the total number of treatments received that matters or does the time frame in which it is received also important? (not referring to Marx protocol patients).
Published: 21 September 2019

Is there any literature or consensus about treating patients less than 5 days a week on a regular basis? We have a patient who can only come 3 days a week due to his work. Is it only the total number of treatments received that matters or does the time frame in which it is received also important? (not referring to Marx protocol patients).

Date posted: 9/21/2019


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.

There is significant interest in this question throughout the hyperbaric community as there are a number of occasions where circumstances often prohibit consecutive hyperbaric therapy. The committee refers you to resources such as Pubmed and the Rubicon Foundation. A literature search has revealed the following result:

Rate of delivery of hyperbaric oxygen treatments does not affect response in soft tissue radionecrosis.

Given that this study represented a response rate in soft tissue radionecrosis only, the committee does not propose that this logic be applied universally to all other indications for hyperbaric oxygen therapy.

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.

In the Monoplace chamber, is it always proper to turn off oxygen supply if there is a fire in the chamber? It is very logical to cut off O2 which is fueling fire, however at another class we were told never to turn off O2 because you then lose control of chamber. Which is correct?
Published: 21 September 2019

In the Monoplace chamber, is it always proper to turn off oxygen supply if there is a fire in the chamber? It is very logical to cut off O2 which is fueling fire, however at another class we were told never to turn off O2 because you then lose control of chamber. Which is correct?

Posted: 9/21/2019


 

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.

It is well known that the reduction of pressure is proven to decrease the rate and intensity of an oxygen-enriched fire. It is this committee’s opinion that in the event of a fire in the Monoplace chamber, maximum decompression should not be delayed as the heat of combustion will significantly contribute to increasing pressure in the chamber. As such, rapid evacuation of the patients and staff in the immediate and surrounding areas is critical.

Additionally, it is imperative that each hyperbaric facility contact their chamber manufacturer to understand the behavior of their emergency ventilation controls associated with their particular chamber model and system design. When describing the system to the manufacturer, consider any potential system modifications that may have occurred since installation.

You may also consider:

  • A test of your system with and without gas supply during decompression to understand how the system behaves. Consider the time required to decompress and the impact on facility evacuation and perform fire drills with each of these scenarios in mind.
  • Develop your emergency procedures to reflect the behavior of your particular system. NFPA 99, Annex B.14.3.2 contains guidance in drafting the emergency procedures for fire in a Class B chamber.
  • It is also important to perform a timed test of the emergency ventilation function periodically per the manufacturer’s maintenance recommendations.
  • Once all chambers have been decompressed, it is common for emergency procedures to include the shutdown of oxygen supply at the zone valves prior to evacuation or relocation.

Lastly, the Safety Committee has reached out to two Monoplace chamber manufacturers to address this question. Each of them confirmed that the emergency ventilation function installed on their chambers require a gas supply in order to operate normally. These manufacturers also stated that when the emergency ventilation function is activated, the inflow of oxygen to the chamber ceases.  The gas supplying the actuating valves that keep the exhaust valve open will remain, so that the chamber can fully decompress. Again, it is important to confirm and test the function of your particular chamber, as there are many variations of this design. Your understanding of this design will lead to a procedure that will dictate a series of life saving events. Therefore, this question is one that should be asked and answered by every Hyperbaric Safety Director and Medical Director.

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.

I would like to ask you regarding one of our patient’s device (Ahmed glaucoma valve implant/ glaucoma drainage implant). Is he allowed to enter the hyperbaric chamber with this device without any concern?
Published: 05 February 2020

I would like to ask you regarding one of our patient’s device (Ahmed glaucoma valve implant/ glaucoma drainage implant). Is he allowed to enter the hyperbaric chamber with this device without any concern?

Posted Date:       2/5/2020


MEDFAQ Question: I would like to ask you regarding one of our patient’s device (Ahmed glaucoma valve implant/ glaucoma drainage implant). Is he allowed to enter the hyperbaric chamber with this device without any concern?

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 safety committee understands this item to be surgically attached to the sclera of the eye and free of air. Therefore it is reasonable to consider that pressure would have no effect on the functionality of the device. However, we strongly suggest that a risk assessment be performed by the hyperbaric physician aided by the patient’s ophthalmologist, as there may be the potential for intraocular changes during and after hyperbaric oxygen therapy.

Literature review reveals a handful of studies and commentary on the application of hyperbaric oxygen therapy, intraocular pressure, and glaucoma-related procedures, but there are no known studies specifically related to the Ahmed valve and hyperbaric oxygen therapy.

The following references may assist you in completing the risk assessment and determining the proper course of action for your particular case. Again, we strongly suggest consulting the patient’s ophthalmologist prior to the decision to proceed with hyperbaric oxygen therapy:

Ersanli D, Akin T, “The effect of hyperbaric oxygen on intraocular pressure,”  Vol 33: Journal of the Undersea and Hyperbaric Medical Society, 2006

McMonnies CW, “Hyperbaric oxygen therapy and the possibility of ocular complications or contraindications” Journal of clinical and experimental optometry, 2015, Volume 98, Issue 2, Pages 122-125

Official site: “Ahmed Glaucoma Valve,” New World Medical, 2020

Animation: “How does the Ahmed Valve Work,” New World Medical, 2014

Animation: “(Surgical Placement of the) Ahmed Valve model PC7,” New World Medical, 2010

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 would like to start treatment in the monoplace chamber for a patient that currently has a Denali Vena Cava Filter in place. Called manufacturer, no hyperbaric testing has been done for this device. Does anyone have experience with these devices or know of any contraindications?
Published: 05 February 2020

We would like to start treatment in the monoplace chamber for a patient that currently has a Denali Vena Cava Filter in place. Called manufacturer, no hyperbaric testing has been done for this device. Does anyone have experience with these devices or know of any contraindications?

Posted Date:       2/5/2020


MEDFAQ Question: We would like to start treatment in the monoplace chamber for a patient that currently has a Denali Vena Cava Filter in place. Called manufacturer, no hyperbaric testing has been done for this device. Does anyone have experience with these devices or know of any contraindications?

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.

Several members of the committee have expressed no concerns allowing this type of device. This is mainly due to the fact that the item is solid and contains no air-filled spaces. The UHMS Safety Committee considers this device to be compatible in either the Monoplace or Multiplace hyperbaric environment.

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.

Could any of you experts discuss the effects (if any) of implanted/impregnated radiation seeds/beads radiation emission in a hyperbaric patient being treated and the possible adverse effects on the chamber acrylic windows. Thank you.
Published: 06 February 2020

Could any of you experts discuss the effects (if any) of implanted/impregnated radiation seeds/beads radiation emission in a hyperbaric patient being treated and the possible adverse effects on the chamber acrylic windows. Thank you.

Date Posted:       2/28/2020


MEDFAQ Question: Could any of you experts discuss the effects (if any) of implanted/impregnated radiation seeds/beads radiation emission in a hyperbaric patient being treated and the possible adverse effects on the chamber acrylic windows.


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.

For the sake of clarity, there are two main sources of therapeutic radiation emission that have potential reference here: external beam and brachytherapy.

It is well known that external beam radiation, used for treatments commencing around the 1960’s, had a detrimental effect on acrylic windows, shortening the life span to approximately 3 years (1).

The PVHO limits(2) of radiation exposure to acrylics and described in acrylic testing (1) refer to external beam radiation, which  are exponentially higher than levels seen in brachytherapy.

  • PVHO-1, 2-1.2 Exclusions (f) The exposure to nuclear radiation shall not exceed 4 Mrad.
    • 4 Mrad = 40 kGy (kiloGray)

Brachytherapy is given in two different forms, namely high dose-rate (HDR) and low dose-rate (LDR) brachytherapy.

  • The isotopes used in HDR brachytherapy emit radiation at greater than 12 Gy/hour. This is provided by the insertion of a higher energy isotope into the body in order to provide an intense dose to the tumour or affected area. The isotope is then removed after a short-term exposure (usually about 20 minutes). This form of radiation therapy would not be done inside a chamber. However, it would be safe to treat such a patient in a hyperbaric immediately after each dose.
  • LDR brachytherapy is achieved by inserting or locating isotopes into the tumour or affect area in the form of seeds or beads. There can be up to 100 seeds implanted at a time. These seeds then emit radiation continuously to achieve the required dose. These isotopes are selected based on their emission energy and half-life. It is important to account for this as the radiation intensity is highest right after being inserted, then decays until the half-life has been reached, where-after the intensity falls to below any levels of concern.
  • In order to determine whether an acrylic window could be damaged by the emission of the gamma rays, the dose rate – indicated as Grays (Gy) per unit time, treatment time and number of treatments given in a specific chamber need to be considered. This would enable a computation to be done to determine the likely absorbed dose by the acrylic window.
  • In the case of LDR brachytherapy, the radiation emitted by the isotopes is conservatively quantified as safe to other humans at distance of less than one foot.
  • At this distance, depending on the typical isotopes in use, the total absorbed radiation by any acrylic window, located one foot from the actual isotope and assumed to be given continuously for a full 8-hour day, for every day of the year, would require between 40 and 150 years to achieve the PVHO limit of 4 Mrad. Well beyond any envisaged service life of an acrylic window.

Although considered safe for acrylic windows, any user should always record all events where such patients are treated, together with information from the radiation oncology department as to the isotopes in use and their maximum dose rate, and the total treatment time. This will enable any future decisions on service life to be more accurately determined based on actual, estimated absorbed radiation.

References:

  • Stachiw JD, “Handbook of Acrylics for Submersibles, Hyperbaric Chambers and Aquaria," Best Publishing, 2003
  • American Society of Mechanical Engineers, “Safety Standard for Pressure Vessels for Human Occupancy. ANSI/ASME PVHO-1, 2-1.2 Exclusions,” 2019

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.

It seems that COVID-19 has now reached the shores of Europe in full swing and although the UK has left Europe, Europeans are still plentiful in the UK and UK travellers and visitors are exposed to this new virus. What PPE has been tested to be safe under pressure? What cleaning products would be recommended after treating an infected patient? .
Published: 25 February 2020

It seems that COVID-19 has now reached the shores of Europe in full swing and although the UK has left Europe, Europeans are still plentiful in the UK and UK travellers and visitors are exposed to this new virus. What PPE has been tested to be safe under pressure? What cleaning products would be recommended after treating an infected patient? .

Date Posted: 3/17/2020


 

Thank you for your question. The UHMS HBO2 safety committee (UHMS-SC)  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 Hyperbaric Safety Director (MD & HSD) of your facility.

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.

The CDC has released a list of items as identified by the Environmental Protection Agency (EPA) that can be utilized for disinfection, stating that:

“Products with EPA-approved emerging viral pathogens are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).”

It is important to note that many of the items within the EPA’s list may be unsafe to utilize on acrylic surfaces. It is important to reach out to your specific chamber manufacturer for further guidance. In all cases, it is important to follow the guidance of the product’s manufacturer for application and contact time.

For non-acrylic surfaces, The UHMS-SC advises you follow the guidance of your hospital’s infection prevention and control department to identify a particular product that is known to be effective against COVID-19.

Regarding protocols for cleaning chamber surfaces, hyperbaric facilities should follow the protocols set forth by their institution. Dr. Jim Chimiak, Medical Director at the Divers Alert Network states: “There are no special recommendations that we are aware of for chamber attendants or for disinfection of the hyperbaric chamber and BIBs in light of the COVID-19 pandemic. The usual disinfection protocols are more than sufficient to kill COVID-19, in the unlikely event that it would be present.”

References:

EPA.gov, “List N: Disinfectants for Use Against SARS-CoV-2,” Accessed 3/17/2020

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

Sechrist Industries, “CARE AND DISINFECTION OF THE CHAMBER AND GURNEY,” Accessed 3/17/2020

https://sechristusa.com/wp-content/uploads/2018/09/Approved-Chamber-Disinfectants.pdf

Perry Baromedical, “PERRY GUIDANCE ON COVID-19,” Accessed 3/17/2020

https://perrybaromedical.com/uncategorized/perry-guidance-on-covid-19/

Divers Alert network, “DAN ENCOURAGES DIVERS AND DIVE OPERATORS TO PROPERLY DISINFECT DIVE GEAR,” Accessed 3/17/2020

https://www.diversalertnetwork.org/news/dan-encourages-divers-and-dive-operators-to-properly-disinfect-dive-gear

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.

Lung damage and ARDS in COVID 19 infection has implicated immune modulation as a possible treatment. IL-6 inhibitors are now in trials. From Medscape article: "Interleukin-6 (IL-6) inhibitors may ameliorate severe damage to lung tissue caused by cytokine release in patients with serious COVID-19 infections. This treatment doesn't necessarily alter the course of viral infection but would mitigate long term lung damage to those severely affected by COVID. So HBO doesn't impact IL-6 per se but
Published: 23 March 2020

Lung damage and ARDS in COVID 19 infection has implicated immune modulation as a possible treatment. IL-6 inhibitors are now in trials. From Medscape article: "Interleukin-6 (IL-6) inhibitors may ameliorate severe damage to lung tissue caused by cytokine release in patients with serious COVID-19 infections. This treatment doesn't necessarily alter the course of viral infection but would mitigate long term lung damage to those severely affected by COVID. So HBO doesn't impact IL-6 per se but

Posted: 3-24-2020


Q: Lung damage and ARDS in COVID-19 infection have implicated immune modulation as a possible treatment. Interleukin-6 (IL-6) inhibitors are now in trials. A Medscape article notes: 

"Interleukin-6 (IL-6) inhibitors may ameliorate severe damage to lung tissue caused by cytokine release in patients with serious COVID-19 infections.

This treatment doesn't necessarily alter the course of viral infection but would mitigate long-term lung damage to those severely affected by COVID.  So HBO doesn't impact IL-6 per se but does suppress IL-1 and PGE-2 as well as macrophages.  Additionally, the use of HBO in ARDS would help in oxygenation in these patients.  Difficulties in providing ventilatory support during HBO could be a limitation."


A: Using HBO2 to treat someone with subacute, ongoing hypoxemia (due to any cause) would work in the short term but would be time-limited due to pulmonary oxygen toxicity, which would then cause further deterioration. If adequate blood oxygenation cannot be achieved using supplemental O2 (up to around 50% FiO2) and manipulation of ventilator settings (e.g. I:E ratio, positive end-expiratory pressure/PEEP level), then the only option is extracorporeal membrane oxygenation (ECMO).

.

Richard Moon, MD
Professor of Anesthesiology
Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine
Medical Director, Center for Hyperbaric Medicine & Environmental Physiology


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 work in a clinic setting with wound care on one side of the building and I am alone on my side with HBO2. My boss would like to put a push button code lock on my door and I'm wondering if this is permitted? If there was a fire I'm concerned about the Fire Department not being able to get in. Does anyone have a similar issue? Is it ok to have this type of device on the HBO2 room door? We need some type of Safety policy and procedure for an active gunman in the building and I’m not sure how to go about th
Published: 30 March 2020

I work in a clinic setting with wound care on one side of the building and I am alone on my side with HBO2. My boss would like to put a push button code lock on my door and I'm wondering if this is permitted? If there was a fire I'm concerned about the Fire Department not being able to get in. Does anyone have a similar issue? Is it ok to have this type of device on the HBO2 room door? We need some type of Safety policy and procedure for an active gunman in the building and I’m not sure how to go about th

Published Date:      02/2017
Review Date:         02/2020


Question:  I work in a clinic setting with wound care on one side of the building and I am alone on my side with HBO2. My boss would like to put a push button code lock on my door and I'm wondering if this is permitted? If there was a fire I'm concerned about the Fire Department not being able to get in. Does anyone have a similar issue? Is it ok to have this type of device on the HBO2 room door? We need some type of Safety policy and procedure for an active gunman in the building and I’m not sure how to go about this.


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.

Security is a real concern and we agree that Hyperbaric Facilities need to develop Policy and Procedures to manage active shooter / Code Silver, Bomb threats and other security concerns. We are required by NFPA 99, chapter 14, to have emergency drills on a regular basis. These threats should be added to your emergency response plans.

The SC would refer you to your local Authority Having Jurisdiction (AHJ). There are codes and regulations regarding locked doors. For guidance you can start with NFPA 101 Life Safety Code, 2018 edition, 5-2.1.5 Locks, Latches and Alarm Devices and NFPA 99, 2018 edition, Chapter 13, Security Management. Work with your local AHJ and Safety and Security department, possibly Emergency Management, to complete a threat assessment. These resources will help decide if a key pad is necessary.

In general, we see no issue with a cipher lock on the entrance to the hyperbaric suite. In fact, we are aware of many facilities with ID badge, card access, push button locks and even keyed doors entering the room housing the chamber(s). The Fire Department will be able to gain access in the event of an emergency. Consideration should be given to enabling not only the Fire Department, but other responders such as code teams or security. The chamber room can be considered a restricted area with authorized entry only. The concern is that evacuation in the event of an emergency is not hindered. There must always be an exit path, and the lock mechanism must not impede egress (or ingress of authorized personnel).

We also note that a chamber operator working alone is concerning. NFPA 99, 2018 edition, chapter 14 requires that there be a qualified chamber operator at the control panel with visual and audible communication with the occupants any time the chamber is in use. We would encourage the use of the UHMS Guidelines for Hyperbaric Facility Operations, 2nd edition, Section 3, Staffing Guidelines, to staff the chamber operation. Consider how to ensure the safety and security of the single operator and any patients being treated, as described in this question. Is there a communications link for immediate help? Consider a panic button or regular rounding (closed circuit video feed?) by someone to check on the chamber operator and patients to provide support as needed. During your emergency drills, do you have the help you need to manage the number of patients? 

Is there any contraindications on a patient receiving Etoposide Chemotherapy Drug and HBOT treatments?
Published: 30 April 2020

Is there any contraindications on a patient receiving Etoposide Chemotherapy Drug and HBOT treatments?

Posted: 05-01-2020


Question:  Is there any contraindications on a patient receiving Etoposide Chemotherapy Drug and HBOT treatments?

Answer: 

Etoposide (VP-16) and Hyperbaric Oxygen

Mechanisms: This drug directly interferes with cancer cell duplication directly by interfering with DNA replication and recombination by preventing the uncoiling of DNA. There are no indications that it is an oxygen dependent process.

Tumors Treated: Germ cell tumors, lung cancers, lymphomas including Hodgkin’s disease, gastric cancer, breast and ovarian cancer

Routes of Administration: Oral and IV

Common Toxicities: Bone marrow suppression with decreased blood counts (mostly white cells and platelets), nausea and vomiting, loss of appetite, hair loss, mucositis including lower GI tract leading to diarrhea, allergic reactions including chills, fever, bronchospasm, shortness of breath, tachycardia, swelling of face and tongue and low blood pressure (less than 2% of patients have these reactions, local inflammatory reactions, risk of secondary malignancies

 Metabolism: Metabolized primarily by the liver. Serum half life is up to 30 hours.

Recommendations with HBO2:

  • There is no published experience of HBO2 with Etoposide.
  • Based on mechanisms of action and common complications, it is unlikely that there are frequent or severe harmful interactions.
  • Because it is cleared from the serum to about 3% of peak concentrations in 5 half lives (i.e. 5X30 hours), one could postulate that an interval of about 6 days would be prudent before initiating or re-starting HBO2 after a dose of Etoposide.
  • Without published experience, of course the decision is the decision to treat or not treat concurrently with HBO2 and Etoposide is the purview of the managing physician and the UHMS cannot make a firm recommendation to treat or not to treat.

John J. Feldmeier, D.O., FACRO, FUHM

 

What is the risk of airborne droplet transmission from the exhaust of a Monoplace chamber? What elements of risk mitigation (i.e. filters, distance, exhaust location) should be considered?
Published: 05 May 2020

What is the risk of airborne droplet transmission from the exhaust of a Monoplace chamber? What elements of risk mitigation (i.e. filters, distance, exhaust location) should be considered?

Date:       5/5/2020


 

Question: What is the risk of airborne droplet transmission from the exhaust of a Monoplace chamber? What elements of risk mitigation (i.e. filters, distance, exhaust location) should be considered?

Answer:  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.

It must first be known that the UHMS Safety Committee cannot definitively answer your specific question of risk without knowing a myriad of factors surrounding the construction of your facility’s exhaust system. Other factors such as the height of the exhaust, wind, temperature, humidity, and variations in ventilation rate may impact the ability of the droplets to travel the length of the exhaust. Even with these factors, we assume there may remain an element of uncertainty, as serial cultures and viral concentration measurements in several locations would be necessary to validate any mitigation measures. In any case, we would encourage you to work with your chamber manufacturer, infection prevention specialists and facilities management teams to determine the best course of action.

We encourage you to review these additional comments from the committee that may assist you in the risk assessment (1) and decision-making process:

  • There is speculation that the droplets will likely salt out on the inside of the exhaust pipe.
  • The exhaust point is typically found on the rooftop of a building, and should not be considered a serious concern, as the location is usually a great distance from the general population.
  • Monoplace chambers have moisture and particulate filtration on the supply side to protect pneumatic gauges, regulators and valves (PVHO-1, 4-4.3). On the exhaust side, PVHO-1 requires a screen to prevent exhaust blockage, and NFPA 99, 14 14.2.11.2.4 calls for the installation of a 0.3cm2 screen to protect the exhaust endpoint. Neither of these items would serve as filters in the infection control sense.
  • If the user were to add exhaust-side filters of the same materials used in the N95 respirator, there would be a risk to the chamber’s ability to ventilate and decompress capably. Any attempt to modify the existing exhaust system should be done only with approval of the chamber manufacturer. Alterations like these would also require testing of the decompression capability and documentation describing the testing measures used, along with approval from the manufacturer. The measure is possible, but may be seen as excessive, as this measure is not a current requirement concerning the delivery of Hyperbaric Oxygen to patients with other highly infectious diseases.
  • It is noted that sea-level negative pressure rooms within hospitals require the point of exhaust, without HEPA filtration, to be 25 feet away from potentially contacting the general population (Ventilation of Healthcare Facilities - ASHRAE Standard 170).
  • Other factors include particulate size. The Diver’s Alert Network has investigated this to understand the effectiveness of face masks and the output of compressed breathing air filter systems. The particles range from 4µm down to 0.5µm. From the research found on virus particles (not specifically SARS CoV2), 42% of particles were smaller than 1µm. Here is one source. To quote: “RNA was detected in coughs from 38 (81%) of the 47 subjects who had flu. The RNA was found in 35% of particles larger than 4 microns in diameter, 23% of particles 1 to 4 microns in diameter, and 42% in particles smaller than 1 micron.” Compressed air filters don’t really remove particles smaller than 1µm. However, the N95 respirator can remove up to 95% of particles as small as 0.3 µm. 99.5% for particles down to 0.75µm.
  • Transmission of droplets: there would need to be some studies, but firstly the air/oxygen leaving the chamber is going to be cooler due to the pressure drop from chamber pressure to the 1 psi regulated outlet pressure (adiabatic cooling from the pressure change and some Joule-Thompson cooling from orifices in the flow path). We have actually seen this when decompressing a monoplace chamber rapidly – ice forming at the exhaust screen. This will/should cause droplets to fall out faster and rest on the piping (and associated pressure controls in the exhaust system). Secondly, the longer they travel, the more of them are going to fall out – friction on the piping, temperature, impact at the bends and so on; however, some particles will likely make it to the exhaust outlet. Lastly, this argument is with respect to droplets and does not address airborne transmission. Droplets, which have greater mass, will be more likely to settle at some stage due to the gravitational effects.
  • Exhaust outlet concerns: Physical distancing of at least 6 feet is generally accepted; however this may be insufficient as some claim these droplets can exist in the air for up to 30 minutes before dropping. Additionally, temperature and turbulence will affect these results as will the exit speed of the droplets and wind effects which may carry them further. A higher temperature at the exit will also serve to keep them from coalescing.
  • It is perceived that a safe distance from the exhaust point could be 30 feet. This is based upon comments from infectious disease specialists including Dr. Anthony Fauci, who stated that in extreme cases, sneezing in patients with significant viral loading can project particles into the air up to 27 feet. A typical monoplace chamber exhaust ranges from 85 to 400 lpm, and human exhalation may deliver 6 – 25 lpm (rest to active). In the chamber you’d expect a dilution of 6/85 at the minimum flow rates. Ventilating the chamber at 250 lpm may provide a dilution of approximately 3%. This in combination with the adiabatic and Joule-Thompson cooling, and the length of the exhaust piping (which if it has any metallic section is going to cause the droplet to stick to the wall more easily), would make it highly unlikely for someone to be significantly exposed.
  • It is likely that the exhaust from a monoplace chamber is akin to hospital HVAC exhaust due to its general location (rooftops in most instances). Because of this, there should be minimal exposure to patients, staff or the public at large. If the facility and the safety director have done their due diligence and ensured that NFPA-99 guidelines have been followed for installation of the chamber exhaust, then there should be minimal risk due to this distancing. While the intent of NFPA-99 regarding exhaust requirements was for fire safety, they also serve to help mitigate infection control risks.

14.2.11.2* Exhaust from all classes of chambers shall be piped outside of the building.

14.2.11.2.1 Each Class B chamber shall have an independent exhaust line.

14.2.11.2.2 The point of exhaust shall not create a hazard.

14.2.11.2.3 The point of exhaust shall not allow reentry of gases into the building.

References

Burman, F. (2019). Risk Assessment Guide for Installation and Operation of Clinical Hyperbaric Facilities. San Antonio, TX: International ATMO, Inc.

The American Society of Mechanical Engineers. (2019). ASME PVHO-1-2019: Safety Standard for Pressure Vessels for Human Occupancy. Two Park Avenue, New York, NY

National Fire Protection Agency (NFPA). (2018). NFPA 99 2018 Edition: Health Care Facilities Code. Quincy, Massachusetts.

N Engl J Med (2020). “Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1,” April 16, 2020, 382:1564-1567, DOI: 10.1056/NEJMc2004973

Bourouiba, L. (2020), “Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19,” Published online March 26, 2020, Journal of the American Medical Association, doi:10.1001/jama.2020.4756

Lindsley, W. (2010). “Measurements of Airborne Influenza Virus in Aerosol Particles from Human Coughs,” November 30, 2010, PLOS One, https://doi.org/10.1371/journal.pone.0015100

American Society of Heating, Refrigeration, and Air-Conditioning Engineers (2017), “Ventilation of Healthcare Facilities - ASHRAE Standard 170 -2017,” American Society of Heating, Refrigeration, and Air-Conditioning Engineers, www.ashrae.org

 

 

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.

 

 

I was wondering where UHMS stands on patients that take herbal supplements doing hyperbaric therapy. Also estriol vaginal cream and progesterone gel. Can the patient use it 20 hours before HBO therapy?
Published: 13 May 2020

I was wondering where UHMS stands on patients that take herbal supplements doing hyperbaric therapy. Also estriol vaginal cream and progesterone gel. Can the patient use it 20 hours before HBO therapy?

Posted: 5/20/2020


Question:I was wondering where UHMS stands on patients that take herbal supplements doing hyperbaric therapy. Also estriol vaginal cream and progesterone gel. Can the patient use it 20 hours before HBO therapy?

Answer: This MEDFAQ asks whether the UHMS has a blanket policy on herbal supplements during HBO2 treatment and more specifically whether it is an issue for a patient to use a vaginal estriol cream and/or progesterone gel concurrently or even up to 20 hours before HBO2 treatment.

The UHMS has no across the board policy on herbal supplements. There are hundreds if not thousands of these. Each of them would have to be looked at individually. For the most part, they actually are likely to make little or no difference. On-line resources or one of several paperback references can provide the specific potential side effects or the putative beneficial effects of these supplements. For cancer patients, some of whom are receiving hormonal suppressive therapy as part of their cancer treatment, it is important to determine whether these supplements might be increasing levels of the very hormones the oncologist has set out to suppress. Studies have shown that there is not much systemic absorption of vaginal estrogens typically used to decrease dyspareunia by supporting the vaginal epithelium in postmenopausal women or women receiving anti-estrogen treatment. Progesterone is a frequently used appetite stimulant in cancer patients. In wound healing, it is possible that it might actually have a benefit in supporting nutrition for asthenic patients and by providing an anabolic effect.

Our recommendation is that herbal products and various nutritional supplements be considered like other medications the patient may be taking and considered individually for any negative interaction with hyperbaric oxygen. Because there are so many different products with many different ingredients, no general recommendation can be made. 

I have a patient referred by Urology to provide HBO therapy for radiation cystitis. The patient qualifies but has a bladder stimulator in place. The company states that these devices have been tested to only 2.0ATA, and our not safe beyond this pressure. This device has a battery, but is implanted in the body. Is it safe to provide HBO therapy with the bladder stimulator in place. Thanks.
Published: 05 August 2020

I have a patient referred by Urology to provide HBO therapy for radiation cystitis. The patient qualifies but has a bladder stimulator in place. The company states that these devices have been tested to only 2.0ATA, and our not safe beyond this pressure. This device has a battery, but is implanted in the body. Is it safe to provide HBO therapy with the bladder stimulator in place. Thanks.

Date: 8/24/2020
From: UHMS HBO2 Safety Committee


Q:
I have a patient referred by Urology to provide HBO therapy for radiation cystitis. The patient qualifies but has a bladder stimulator in place. The company states that these devices have been tested to only 2.0ATA, and our not safe beyond this pressure. This device has a battery, but is implanted in the body. Is it safe to provide HBO therapy with the bladder stimulator in place?

A:
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.

While the hyperbaric safety director has the responsibility to assess the performance and safety risks of the device, assessing the medical risk to the patient is the responsibility of the medical director of the hyperbaric clinic. In all cases, a risk assessment weighing the benefit of hyperbaric medicine versus the possible malfunction or damage to the stimulator should be completed. We would not recommend exposing the device to pressures that exceed the manufacturer’s recommendations.

Following this assessment, it is important that the patient is fully aware of any risks discovered and informed consent is obtained. Consider as well the possibility of the device to be turned down or off for the treatment. If this occurs, we recommend that the patients’ medical team outside of the hyperbaric practice be involved in this process.

Obtaining testing documentation from the manufacturer pertaining to the model’s exposure to increased atmospheric pressure is vital to the risk assessment. We advise that this documentation be kept within the patient’s medical record. We would encourage you to contact the manufacturer each time you encounter a patient with this type of device, as it is necessary to access the most up to date recommendation. We may also wish to retain the decision process documents for reference, in the event that the same device is encountered in the future.

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.

I’m looking for care for my mom. I’d like to find a doctor that can come to our house. I purchased a hyperbaric chamber for treatments. My mom suffered from a stroke a year ago and I’d like to get some treatments for her to speed up her recovery.
Published: 25 August 2020

I’m looking for care for my mom. I’d like to find a doctor that can come to our house. I purchased a hyperbaric chamber for treatments. My mom suffered from a stroke a year ago and I’d like to get some treatments for her to speed up her recovery.

Date: 8/25/2020
From: UHMS HBO2 Safety Committee


 Q:
I’m looking for care for my mom. I’d like to find a doctor that can come to our house. I purchased a hyperbaric chamber for treatments. My mom suffered from a stroke a year ago and I’d like to get some treatments for her to speed up her recovery.

A:
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 would normally reside with a medical director and safety director of a hospital or clinic-based hyperbaric facility.

 
Firstly, we would like to extend our sincerest hopes for your mother and her successful recovery. We understand the deep desire to provide expedited care for your mother and to support her recovery. It is important to note that Hyperbaric Oxygen Therapy for stroke-related condition is a yet unproven remedy. Therefore we encourage you to seek other medical cares that have been vetted (peer-reviewed) and proven to be effective (evidence-based) for her condition.
 
Furthermore, the UHMS Hyperbaric Oxygen Safety Committee is in agreement with existing position statements formed by trusted professional hyperbaric entities against the practice of providing hyperbaric oxygen therapy outside of a clinical or hospital-based setting. It is important to recognize that hyperbaric facilities must comply with mandatory federal, state and local codes governing the design, construction, installation and operation of hyperbaric chambers. These continuously evolving safety standards are established to protect patients, staff, and medical facilities. It should be noted that any facility that has been accredited by the Undersea and Hyperbaric Medical Society must meet these requirements. 
 
We would encourage you to review the following position statements from the UHMS, the National Board for Diving and Hyperbaric Medical Technology (NBDHMT), Health Canada, the Food and Drug Administration (FDA) and other pertinent articles referenced below. You will also find references describing the dangers of soft-sided chambers, but please be aware that all hyperbaric chambers are engineered medical devices that may incur serious risk to everyone involved regardless of the type of chamber used. We have also included a link that will assist you in finding a UHMS-Accredited facility.
 
We are happy to provide you with these educational resources, and we implore you to reconsider your approach to providing hyperbaric therapy outside of a UHMS-accredited hospital or clinic-based facility.
 
 
Respectfully,
 
The UHMS Safety Committee
 

References:

 


 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.
 
 

 

A patient has a Loop Recorder implanted 15-20+ years ago, after researching all of his documents and physicians we do not have a manufacturer or serial number to look up. Do you have any information that could help with the pressure testing of Loop Recorders?
Published: 24 August 2020

A patient has a Loop Recorder implanted 15-20+ years ago, after researching all of his documents and physicians we do not have a manufacturer or serial number to look up. Do you have any information that could help with the pressure testing of Loop Recorders?

Posted: 8/26/2020


Q: 
A patient has a Loop Recorder implanted 15-20+ years ago, after researching all of his documents and physicians we do not have a manufacturer or serial number to look up. Do you have any information that could help with the pressure testing of Loop Recorders?

A:
Thank you for your inquiry regarding the loop recorder that you have encountered. My name is Andrew Melnyczenko, chair of the UHMS Safety Committee. Your question was recently forwarded to me by the executive director of the UHMS.

The committee would be glad to assist you in answering your question, but please realize that the ultimate responsibility for these types of questions rests with the medical director and safety director of your facility.

In cases of undocumented medical devices where little is known of the device, we cannot unequivocally recommend it’s allowance in the chamber. Without knowing the manufacturer, make or model of the device, testing the device does not seem feasible. A proper risk assessment of the device would also be difficult to accomplish. You may wish to discuss removal of the device with the patient if there is an urgent/emergent need for Hyperbaric Oxygen Therapy or the benefit of therapy is deemed to be prodigious.

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. 

Does anyone have experience with an Aircast boot in a monoplace chamber?
Published: 26 August 2020

Does anyone have experience with an Aircast boot in a monoplace chamber?

Posted: 8/26/2020


Q:
Does anyone have experience with an Aircast boot in a monoplace chamber?

A:
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.

It is our understanding that these types of boots are designed to assist patients with mobility (i.e. “walking boot”) and are not a necessity during monoplace hyperbaric therapy. Therefore, these should be removed just prior to therapy once the patient is safety positioned on the sliding stretcher.

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.
 
I visited a gym in Illinois that offered hyperbaric chamber services to their members. I would like to possibly add hyperbaric treatment options to my business as well. Where can I go to find out what I would need to do so in Minnesota?
Published: 26 August 2020

I visited a gym in Illinois that offered hyperbaric chamber services to their members. I would like to possibly add hyperbaric treatment options to my business as well. Where can I go to find out what I would need to do so in Minnesota?

Posted 8/25/2020


 Q:
I visited a gym in Illinois that offered hyperbaric chamber services to their members. I would like to possibly add hyperbaric treatment options to my business as well. Where can I go to find out what I would need to do so in Minnesota?

A:

Thank you for your inquiry regarding your interest in hyperbaric oxygen therapy. My name is Andrew Melnyczenko, chair of the UHMS Safety Committee, and your question was recently forwarded to me by the executive director of the UHMS.

Members of the UHMS Hyperbaric Oxygen Safety Committee are in agreement with existing position statements formed by trusted professional hyperbaric entities against the practice of providing hyperbaric oxygen therapy outside of a clinical or hospital-based setting. It is important to recognize that hyperbaric facilities must comply with mandatory federal, state and local codes governing the design, construction, installation and operation of hyperbaric chambers. These continuously evolving safety standards are established to protect patients, staff, and medical facilities. It should be noted that any facility that has been accredited by the Undersea and Hyperbaric Medical Society must meet these requirements.

Furthermore, the provision of hyperbaric treatment without the administration of oxygen has shown no beneficial health effects. Medical grade oxygen meeting the purity standards for human use as defined by the United States Pharmacopoeia (USP) must be prescribed by a licensed medical practitioner, and in this case one with specific training in the combination of oxygen used under hyperbaric conditions.

I encourage you to review the following position statements from the UHMS, the National Board for Diving and Hyperbaric Medical Technology (NBDHMT), Health Canada, the Food and Drug Administration (FDA) and other pertinent articles referenced below. You will also find references describing the dangers of soft-sided chambers, but please be aware that all hyperbaric chambers are engineered medical devices that may incur serious risk to everyone involved regardless of the type of chamber used.

I am obliged to provide you with these educational resources as a warning, and I implore you to reconsider any plans to offer hyperbaric therapy outside of a UHMS-accredited hospital or clinic-based facility. If you have any additional questions, I would be happy to discuss this further. Thank you once again for reaching out to the UHMS – this indicates to me that you are seeking to understand the dangers associated with non-compliance and the serious risks associated with hyperbaric oxygen therapy.

 

Sincerely,

Andrew R. Melnyczenko
Safety Committee Chair


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 work in a multiple facility and a patient posed a questions to one of my techs that I was not here to help discuss. The question was "why do we not use an alcohol swab when we check blood sugar levels toward the end of the treatment?" History, we do an in chamber post treatment blood sugar check on a with about 8ish minutes remaining at pressure. We use a standard 2x2 cotton swab to wipe the figure of the patient prior to the lancet. I know an alcohol swab has a low flash point, and in my prior 2 years
Published: 28 September 2020

I work in a multiple facility and a patient posed a questions to one of my techs that I was not here to help discuss. The question was "why do we not use an alcohol swab when we check blood sugar levels toward the end of the treatment?" History, we do an in chamber post treatment blood sugar check on a with about 8ish minutes remaining at pressure. We use a standard 2x2 cotton swab to wipe the figure of the patient prior to the lancet. I know an alcohol swab has a low flash point, and in my prior 2 years

Date:       9/28/2020
From:      UHMS HBO2 Safety Committee



Q:

I work in a multiple facility and a patient posed a questions to one of my techs that I was not here to help discuss. The question was "why do we not use an alcohol swab when we check blood sugar levels toward the end of the treatment?" History, we do an in chamber post treatment blood sugar check on a with about 8ish minutes remaining at pressure. We use a standard 2x2 cotton swab to wipe the figure of the patient prior to the lancet. I know an alcohol swab has a low flash point, and in my prior 2 years of operating in a monoplace facility, I did not use alcohol swab pre or post treatment. Just a 2x2 swab. I am curious where y'all stand on the use of alcohol swabs for an in chamber blood sugar? Any thoughts will be appreciated.


A:

Thank you for your question. The UHMS HBO2 Safety Committee can provide information to assist you in answering your question, but the ultimate decision and responsibility for these types of questions rests with the Medical Director and Safety Director of your facility.

          The UHMS HBO2 Safety Committee can provide guidance but cannot endorse a specific product for use in the multiplace hyperbaric environment to cleanse the skin before a capillary finger stick procedure for glucose scanning. The decision to allow items containing alcohol that could increase the probability of fire within the hyperbaric environment should be carefully made by the Hyperbaric Safety Director and Hyperbaric Medical Director of your particular facility. Swabs containing 70% isopropyl alcohol do emit vapors that are easily ignitable within the multiplace hyperbaric environment if in close proximity to an ignition source. However, it is plausible to consider limited and controlled amounts of this material after careful consideration of the risks and benefits involved.

  • We recommend before choosing a product that a proper risk assessment is performed by the Hyperbaric Safety Director and Hyperbaric Medical Director; with careful consideration given to the flammability, NFPA 704 rating of the material, amount, potential vapors released, chamber volume, and the fuel load added to the environment.
    • For more information related to this topic, please refer to NFPA 99 section 14.3.1.6.2 – Flammable Gases and Liquids (2018).
    • You may wish to seek an alcohol–free option like Benzalkonium Chloride wipes. It is important to work with the laboratory and infection control practices within your institution to determine the best option for your practice.
    • We strongly encourage that all hyperbaric facilities own a copy of the NFPA 99 in their library. You can find read only, free access to all the NFPA codes at http://www.nfpa.org/. You may also wish to consider the NFPA-99 Health Care Facilities Handbook, a valuable resource containing an expansive explanation of the NFPA-99.
  • We would also encourage you to share your methods with the laboratory or infection control teams within your institution who are responsible for setting the policies related to this procedure and educate them on the unique nature of the hyperbaric environment. We would advise you to work with these teams to develop a specific procedure related to glucose scanning within the hyperbaric environment of the multiplace chamber to ensure that you are in compliance with local guidelines.

Respectfully,

The UHMS HBO2 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.

I work at ***** and am often a single chamber operator (Monoplace). Our manager is trying to come up with a safety measure for if the chamber operator would go down. They have talked about placing some sort of emergency button inside chamber as a way for the security office to be notified if I were to go down. In the past, our manager would call on the telephone to check on us or security will round by the clinic. Security officers have not been able to do that due to staffing issues. Our chamber is down
Published: 13 October 2020

I work at ***** and am often a single chamber operator (Monoplace). Our manager is trying to come up with a safety measure for if the chamber operator would go down. They have talked about placing some sort of emergency button inside chamber as a way for the security office to be notified if I were to go down. In the past, our manager would call on the telephone to check on us or security will round by the clinic. Security officers have not been able to do that due to staffing issues. Our chamber is down

Posted: 10/12/2020


Q:
I work at ***** and am often a single chamber operator (Monoplace). Our manager is trying to come up with a safety measure for if the chamber operator would go down. They have talked about placing some sort of emergency button inside chamber as a way for the security office to be notified if I were to go down. In the past, our manager would call on the telephone to check on us or security will round by the clinic. Security officers have not been able to do that due to staffing issues. Our chamber is down in the basement of the main hospital and literally off the path of heavy traffic by others. I have stressed the importance of staffing but at this time extra staffing is not an option. Have you ever heard of an in chamber notification system that could be looked into? Any advice would be appreciated.


A:

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 agrees that this scenario is a legitimate concern for monoplace facilities with limited staffing. Several committee members have either encountered this question in their own experience, or have seen several worthy solutions while performing site surveys as a UHMS surveyor. The committee has previously addressed this subject in brief while answering other questions (See references below). However, we will provide a more direct and detailed answer here for your benefit.

The committee will list several options for your consideration below. Before implementing any of these solutions, it is important to note that the staffing, education, and training of personnel responsible to the monoplace hyperbaric facility are paramount to any signaling device, security system, or policy. These measures will only be successful if properly implemented into your program.

Alarm Systems:

  • The committee is aware of a facility that has utilized an emergency push button installed at the chamber operator's desk.  When pushed, an alarm would sound at the nearby nursing station and nursing staff would immediately respond. This solution could be helpful to alert staff to a variety of urgent or emergent needs.
  • While the creation of a non-electrical, pneumatically-controlled alert switch located inside the monoplace chamber is technically possible, the committee would caution you from placing the responsibility of monitoring the chamber operator in the patient’s hands. Any modification of the chamber or the creation of a switch of this nature must be either endorsed by or created and installed by the manufacturer. This committee does not endorse the use of electrically-powered, wired or wireless technology for this purpose in a monoplace hyperbaric chamber. Electrical components to include speakers (used for entertainment and communication) and physiological leads within the monoplace hyperbaric setting are intended to be designed and installed by the manufacturer, as the NFPA 99 prohibits the use of electrical components for anything other than patient physiological leads and communication functions (NFPA 99, 14.2.9.6 -  14.2.9.6.3 and annex material A.14.2.9.6.1.1)
  • For monoplace applications, this committee does not recommend the use of an automated decompression or signaling switch, which are sometimes used in multiplace systems and is usually located outside of the chamber. In this instance, the alarm is initiated and decompression begins if the timer is not reset periodically by the operator (this is commonly referred to as a “dead man’s switch”). In the monoplace setting, this could place the patient at risk for suffocation if response is delayed, as the chamber door could remain sealed at the surface without gas flowing.

Staffing Considerations:

Section 3, Staffing Guidelines (pg.15):

       “One (1) chamber operator should not operate and/or monitor more than two (2) monoplace chambers simultaneously during patient treatments”

       “At least one (1) additional hyperbaric-trained staff member should be immediately available to assist, if needed, during any patient treatment.”

Section 3, Staffing Guidelines – I. Physician/NPP Staffing Guidelines (pg.15-16):

       “Physician staffing should provide coverage of the following clinical safety provision(s): Coverage of patients for consultation and treatment supervision during published working hours in strictly outpatient facilities.”

       “Physician staffing should provide coverage of the following clinical safety provision(s): Physician or non-physician provider supervision and be readily available during treatments.”

Security Cameras and Monitors (video and in-person):

  • Perhaps a more practical solution to your concern is a closed-circuit monitoring system (CCTV) with someone positioned elsewhere (front desk or security personnel) keeping an eye on the chamber room. It is possible that motion sensor technology could also be used to ensure that the operator is present. Additionally, an alarm could be triggered if there is no movement after a period of time.
  • More than one Safety Committee member has seen CCTV used at UHMS-accredited facilities while serving as an accreditation surveyor and recommends this solution.
  • Considering the location of your chamber facility and the staffing situation you describe, we encourage you to revisit and enforce your “working alone” policy requiring your supervisors to establish a consistent means of communication with the operator. We encourage your Medical and Safety Directors to be active participants in the enforcement of these policies for the safety of every patient and chamber operator.

Respectfully,

The UHMS HBO2 Safety Committee

REFERENCES:

UHMS HBO2 Safety Committee response to MEDFAQ, Accessed 9/28/2020, Originally published 2/23/2017.

Workman, W. T. (2015). Guidelines for Hyperbaric Facility Operations (2nd ed.). North Palm Beach, FL: Undersea and Hyperbaric Medical Society, Inc.

National Fire Protection Agency (NFPA). (2018). NFPA 99 2018 Edition: Health Care Facilities Code. Quincy, Massachusetts.

Undersea and Hyperbaric Medical Society. (2018). Clinical Hyperbaric Facility Accreditation Manual (4th ed.). North Palm Beach, FL: Undersea and Hyperbaric Medical Society, Inc.


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 am asking this question because the 2018 FGI Guidelines for Design and Construction of Hospitals references the UHMS in Section A2.2-3.13.1.2 as a contact for additional information. I am an architect, and we are currently in the schematic design phase for a Wound Care Center that will house 3 Monoplace Chambers. 
Published: 14 October 2020

I am asking this question because the 2018 FGI Guidelines for Design and Construction of Hospitals references the UHMS in Section A2.2-3.13.1.2 as a contact for additional information. I am an architect, and we are currently in the schematic design phase for a Wound Care Center that will house 3 Monoplace Chambers. 

Posted: 10/14/2020


Your question was reviewed by the Hyperbaric Oxygen Safety Committee of the Undersea and Hyperbaric Medical Society (UHMS). Our committee can provide you with additional information to assist your decision-making, but please keep in mind that your local Authority Having Jurisdiction (AHJ) is ultimately responsible for interpreting the facilities’ classification. Neither the UHMS nor the HBO2 Safety Committee assume any responsibility in this regard as we are not a governing body. The HBO2 Safety Committee’s responses are listed below in red.

Good Morning,

Q: I am asking this question because the 2018 FGI Guidelines for Design and Construction of Hospitals references the UHMS in Section A2.2-3.13.1.2 as a contact for additional information. 

I am an architect, and we are currently in the schematic design phase for a Wound Care Center  that will house 3 Monoplace Chambers. 
A: NFPA 101 invokes the occupancy requirement of Ambulatory Healthcare whenever 4 or more patients are rendered incapable by the procedure. Although ambulatory when they arrive at the facility, hyperbaric patients in the monoplace chamber are rendered incapable of taking actions for self-preservation for the duration of the time they are in the chamber. If there is potential that the facility could expand in the future to 4 or more chambers, the facility should consider building to Ambulatory Healthcare during the initial buildout.  CMS Memo S&C-11-05-LSC has been interpreted by some AHJ’s as requiring Ambulatory Healthcare regardless of the number of monoplace chambers installed. This is the case in the state of Colorado and has led to general best practice recommendations that facilities consider Ambulatory Healthcare regardless of the number of chambers.

Although this strictly Outpatient facility will be located in a Medical Office Building (not a Hospital setting) with standard office hours of 8 a.m. – 6:00 p.m, it will be operating under the hospital umbrella as far as licensure goes.  The point to that statement is, although Hyperbaric chambers are provided for, under the above noted FGI, there are no requirements under the FGI Guidelines for the Design and Construction of Outpatient Facilities.

When designing under the “Hospital” Guidelines, the below are required. 

  • A generator with at least 24 hours of fuel, unless it’s in an area which could have extended outages. In that case, the minimum would be 96 hours.  
    A: A generator is not required unless the hyperbaric facility will treat emergent hyperbaric indications and use ancillary medical devices. The monoplace chamber is run by gas pressure versus electrical power. An exception to this rule of thumb exists in the state of Colorado. In recent years Colorado has required hyperbaric facilities to have a backup generator or a suitably sized battery UPS to provide emergency power for pneumatically operated chambers.
  • A separate electrical room for transfer switches and emergency switchgear
  • All  panelboards would need to be in rooms rather than in corridors
  • Increased receptacle counts in all patient care areas 
    A: The standard receptacle count for business occupancy should generally meet the needs for patient care areas.  Outfitting of the patient care area with computers, monitors, podiatry chairs, procedure lamps, and etc. should be taken into consideration when determining outlet count and locations.
  • HVAC equipment would likely need to be on emergency power  
    A: See response to bullet #1. The internal temperature of the monoplace chamber is primarily regulated by ambient room temperature and chamber ventilation settings. Thus, if treating emergent indications, the HVAC should be tied to the emergency power, should there be a loss of power.

REFERENCES:

Centers for Medicare and Medicaid Services (CMS). (12/17/2010 REVISED 02/18/2011). “S & C-11-05-LSC: Hospital and Critical Access Hospital (CAH) Facility Life Safety Code (LSC) Occupancy Classification Update”. Baltimore, Maryland. DEPARTMENT OF HEALTH & HUMAN SERVICES (Accessed 10/13/2020)

National Fire Protection Agency (NFPA). (2018). “NFPA 99 2018 Edition: Health Care Facilities Code, “Chapter 14 – Hyperbaric Facilities”. Quincy, Massachusetts.

National Fire Protection Agency. (2018). NFPA 101: Life Safety Code, “ 3.3.190.1, 6.1.6, A6.1.6.1”. Quincy, Massachusetts.

Undersea and Hyperbaric Medical Society. (2018). Clinical Hyperbaric Facility Accreditation Manual (4th ed.), “HBOC 1.0 – HBOC 4.0: Facility Construction”. North Palm Beach, FL: Undersea and Hyperbaric Medical Society, Inc.

Thank you for reaching out to the UHMS and please contact us if you have any further questions.

Sincerely,

The UHMS HBO2 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 have a simple question regarding dressings in the hyperbaric oxygen chamber. Can we safely use Mepitel (silicone-based dressing), Steri-Strips and Amnioexcel (skin substitute product) in the HBO chamber? Can you please have the safety team weigh in on the use of these 3 products in the chamber?
Published: 23 October 2020

We have a simple question regarding dressings in the hyperbaric oxygen chamber. Can we safely use Mepitel (silicone-based dressing), Steri-Strips and Amnioexcel (skin substitute product) in the HBO chamber? Can you please have the safety team weigh in on the use of these 3 products in the chamber?

Posted: 10/23/2020


Q:
We have a simple question regarding dressings in the hyperbaric oxygen chamber. Can we safely use Mepitel (silicone-based dressing), Steri-Strips and Amnioexcel (skin substitute product) in the HBO chamber? Can you please have the safety team weigh in on the use of these 3 products in the chamber?


A:

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.

Within NFPA 99 (2021), Chapter 14, the authority to approve an item (creams, materials, and devices) for use within a hyperbaric chamber is delegated to the Physician-in-Charge (Medical Director) with the concurrence of the (hyperbaric) Safety Director; meaning you need two people to agree when allowing an item.

The authority to restrict or remove any potentially hazardous supply or equipment items from the chamber is delegated to the (hyperbaric) Safety Director.

With regards to compatibility of various wound care creams and products, the Hyperbaric Facility should institute an evaluation process to determine if an item is acceptable for use within its chamber.

The testing of products conducted by the UHMS Materials Testing Advisory Committee shows us that any source of heat or energy release are our most significant concerns when it comes to ignition of any flammable material. Therefore, the elimination of heat above the NFPA limits (185°F for a multiplace and 140°F for a monoplace chamber) or static discharge sources are essential to every hyperbaric program.

It is important to understand the ingredients of the cream (ointment or gel) to know if the product has the potential to off-gas flammable vapors. Should this be the case, you would consider prohibiting that medication product from going inside the chamber.

As for a product (or device), it is also important to consider the effect pressure will have, as well as the medical necessity of the item. Simply put, remove it if it is not necessary.

With any item you are evaluating, you should obtain the input of your Medical Director, as there are medical as well as technical considerations when considering an item for use in your chamber.

Regarding absolute contraindications, we refer you back to NFPA 99 for a list of prohibited items. Also, we recommend you take the approach of continually evaluating any item you allow or prohibited, as each patient (and treatment) presents with variables to consider; for example, what you prohibit in the Class B chamber may be acceptable a Class A chamber. Also, a large surface area or amount of a cream/oil/gel may be concerning, but the same cream/oil/gel may be acceptable in smaller quantities.

Respectfully,

The UHMS HBO2 Safety Committee

We encourage you to resource the following references, which may assist you in your decision making:

  • National Fire Protection Agency (NFPA). (2018). “NFPA 99 2018 Edition: Health Care Facilities Code, “Chapter 14 – Hyperbaric Facilities”. Quincy, Massachusetts.
  • Workman, W. T., & Wood, J. S. (2020). Hyperbaric Facility Safety: A Practical Guide (2nd ed.). Best Publishing Company.
  • Burman, F. (2019). Risk Assessment Guide for Installation and Operation of Clinical Hyperbaric Facilities (6th ed.). San Antonio, TX: International ATMO, Inc.
  • Chimiak, J. (2010). Evaluating Equipment and Materials for Use in a Hyperbaric Oxygen Environment: Clinical Hyperbaric Evaluation and Testing (CHET) Program. (3rd ed.). Best Publishing Company.

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 are looking at letting our patient stay on their inpatient telemetry box during their HBO treatment. Box Model is GE, Apex Pro FH (FH = Frequency Hopping). Also attached to the outside of the tele box is a in-hospital tracker which contains a SONY CR2032 3 volt lithium battery. What are your thought about allowing device this into a multiplace hyperbaric chamber?
Published: 22 September 2020

We are looking at letting our patient stay on their inpatient telemetry box during their HBO treatment. Box Model is GE, Apex Pro FH (FH = Frequency Hopping). Also attached to the outside of the tele box is a in-hospital tracker which contains a SONY CR2032 3 volt lithium battery. What are your thought about allowing device this into a multiplace hyperbaric chamber?

Date Posted: 11/20/2020


Q: We are looking at letting our patient stay on their inpatient telemetry box during their HBO treatment. Box Model is GE, Apex Pro FH (FH = Frequency Hopping). Also attached to the outside of the tele box is a in-hospital tracker which contains a SONY CR2032 3 volt lithium battery. What are your thought about allowing device this into a multiplace hyperbaric chamber?


A:  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 Hyperbaric Medical Director (HMD) and Hyperbaric Safety Director (HSD) of your facility.

The UHMS HBO2 Safety Committee cannot endorse a specific device for use in the chamber. That said, we do not endorse the use of this device in a monoplace (Class B) chamber. We can provide you with specific resources that may assist you in your evaluation process for the multiplace (Class A) in an air-filled environment. We invite you to explore the instances of previous evaluations and key concerns as it may guide your own process. Again, this is not an endorsement by the UHMS HBO2 Safety Committee for the use of this device in the Multiplace Hyperbaric Environment. Rather, we hope that you will consider these suggestions in your individual approach:

Key factors to consider when evaluating telemetry (or other) equipment for the hyperbaric (multiplace – air) environment:

  1. We strongly encourage a formal risk assessment of the device, with assistance from your hospital biomedical engineering group and perhaps your hospital safety or legal teams. There are many useful examples of published risk assessment strategies applied to medical devices in the literature. Here are a few:
    1. A Zigbee-Based wireless system for monitoring vital signs in hyperbaric chambers: Technical Report.
    2. Decision process to assess medical equipment for hyperbaric use.
    3. Safety of a continuous glucose monitoring device during hyperbaric exposure.
    4. An approach to treating a patient with a HeartMate II left ventricular assist device in a multiplace hyperbaric chamber: a case report
    5. Medical Equipment for Multiplace Hyperbaric Chambers Part I: Devices for Monitoring and Cardiac Support.
    6. The Hyperbaric Protective Tube: A housing for a left ventricular assist device (LVAD) in a multiplace hyperbaric chamber
  2. If you discover that the device has been tested previously under hyperbaric conditions, we suggest that this may be utilized as validation of your final assessment, but we do not recommend that this is the entirety of device approval. Simply put, we recommend a formal risk assessment regardless of testing methods. (Exception: Modern ICD’s and Pacemakers are commonly tested by the manufacturer for function under pressure. Therefore, use under increased atmospheric conditions does not constitute an off-label use of those devices.)
  3. Consider reaching out to the manufacturer to learn more about the device, especially if there are limited performance details/specifications in the OEM.
    1. Try to gain an understanding of what types of stress the device was subjected to during the manufacturing and testing phase.
    2. You may wish to make them aware of your intentions or you may remain anonymous.
    3. Regardless of the manufacturer’s response, there may be good reason for you to proceed with the evaluation, as telemetry systems offer uninterrupted monitoring of the patient and may be vital to the continuum of care to the patient.
    4. It should be noted that any modifications to the device or use other than as recommended by the manufacturer risks voiding any warranty on the product.
    5. Using the device in an increased atmospheric environment is not in concert with the manufacturer’s environmental specifications (GE Apex pro Service Manual, Pg. A-4, Operating Environment Specifications).
  4. If evaluating a medical device, it is understood that few are intended to be used in the Multiplace hyperbaric environment. Therefore, consider that such use will likely fall into the FDA category of "Off-Label" and Investigational Use Of Marketed Drugs, Biologics, and Medical Devices.“  You may also wish to review FDA.gov: Frequently Asked Questions about Medical Devices for more information.
  5. At least one major academic tertiary referral institution’s legal team with experience in medical device modification across its entire complex and constantly changing needs of subspecialty patient care including hyperbaric medicine interprets current FDA regulations in the following fashion. The program (modification and testing of medical devices for safe use in the hyperbaric environment) is not subject to FDA regulation. FDA regulates manufacturers and not the practice of medicine. Physicians are able to use FDA approved products other than under the labeled indications as long as the physician meets certain criteria. FDA’s statement on this off-label use is as follows:
    • “Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product's use and effects. Use of a marketed product in this manner when the intent is the "practice of medicine" does not require the submission of an Investigational New Drug Application (IND), Investigational Device Exemption (IDE) or review by an Institutional Review Board (IRB).”
  6. The National Fire Protection Association 99 Health Care Facilities Code, 2021 edition, chapter 14, lists the temperature, electrical limits, and responsibilities of the HSD regarding equipment used in Class A and B chambers. You should have this reference in your library.
  7. Considering the power source, we suggest ensuring that the battery remains secure within the housing and performing routine inspections. Consider involving a Biomedical Engineering representative for this process. The voltage and intended power draw for this particular device is in accordance with NFPA specifications (GE Apex pro Service Manual, Appendix A, Technical specifications). Addressing the risk of the potential to generate heat, you should confirm that the telemetry device contains a low-power, non-rechargeable lithium battery. (Disposable alkaline or silver oxide batteries are safe but are not always an option). Disposable lithium batteries are safer than rechargeable lithium battery types such as lithium-ion or lithium polymer, both of which can suffer runaway fires due to the electrolyte used in these products. Again, it is wise to involve a Biomedical Engineering representative in your risk assessment process.
  8. Pay attention to any sealed compartments within the housing that could be affected by Boyle’s Law. Ventilation of the housing may be necessary. For tracking purposes, you might consider labeling each device so that the care of those devices can be tightly controlled.

References:

Bliss, C., Huang, E., & Savaser, D. (2020). Safety of a continuous glucose monitoring device during hyperbaric exposure. Undersea & hyperbaric medicine: journal of the Undersea and Hyperbaric Medical Society, Inc, 47(1), 13-19.

Burman, F. (2019). Risk Assessment Guide for Installation and Operation of Clinical Hyperbaric Facilities (6th ed.). San Antonio, TX: International ATMO, Inc.

Burman F, Sheffield R, Posey K. Decision process to assess medical equipment for hyperbaric use. Undersea Hyperb Med. 2009;36:137–44. PMID: 19462753.

Carmona, C., Alorda, B., Gracia, L., Perez-Vidal, C., & Salinas, A. (2017). A ZigBee-based wireless system for monitoring vital signs in hyperbaric chambers: Technical report. Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc, 44(3), 243-256.

Kot, J., Siondalski, P., & Lenkiewicz, E. (2019). The Hyperbaric Protective Tube: A housing for a left ventricular assist device (LVAD) in a multiplace hyperbaric chamber. Diving and hyperbaric medicine, 49(2), 137-140.

Kot J. Medical devices and procedures in the hyperbaric chamber. Diving and Hyperbaric Medicine. 2014 Dec;44(4):223-227.

Kot, J. (2005). Medical equipment for multiplace hyperbaric chambers. part i: Devices for monitoring and cardiac support. Eur J Underwater Hyperb Med, 6, 115-20.

Orwig D, Logue C, Hendriksen S, Westgard B, Walter J, Pullis M, et al. An approach to treating a patient with a HeartMate II left ventricular assist device in a multiplace hyperbaric chamber: a case report. Undersea Hyperb Med. 2018;45:89–93. PMID: 29571237.

National Fire Protection Agency (NFPA). (2021). NFPA 99 2021 Edition: Health Care Facilities Code. Quincy, Massachusetts. https://www.nfpa.org/

General Electric Company, (2008). GE ApexPro [R] FH. Service Manual, Boston, Massachusetts. https://www.gehealthcare.com/

Workman, W. T., & Wood, J. S. (2020). Hyperbaric Facility Safety: A Practical Guide (2nd ed.). Best Publishing Company.

 

Respectfully,

The UHMS HBO2 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.