How long do we need to keep maintenance logs/records/annual preventative maintenance records? We have kept records since we opened in 1998.

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 answer to your question may be varied, and we suggest that you work closely with your Authority having Jurisdiction (AHJ) and internal resources available in your facility to make this determination. These may include facility administration, Quality Control, Risk Management, Safety, Information Management, compliance and clinical engineering departments. The National Fire Protection Association glossary of terms defines the AHJ as “An organization, office, or individual responsible for enforcing the requirements of a code, or for approving equipment, materials, an installation, or a procedure.” There is more than one AHJ that would have interest in the records kept. Examples of possible AHJs would include: NFPA, ASME (PVHO-1 and PVHO-2), UHMS, FDA, TJC, OSHA, CMS, State specific Department of Health, Local Fire Authority, Interest specific Insurance Carriers/Underwriters, and institutionally imposed standards.

It is important to know that many standards only have the force of law if recognized by a governmental agency with authority in your area. The others are only enforceable if agreed to by the institution, for example insurance carrier/underwriter rules.

There are valid legal reasons for and against maintaining records beyond 7 years. Legal liability for keeping records past a determined time should be discussed with those responsible for the risk management of your facility. The Joint Commission has typically asked for preventive maintenance history and service history up to 3 years, while other regulatory agencies may go back a little further in time. Other areas (such as pediatric, neonatal, labor and delivery, or maternity) expect records to be kept for 21 years. And in some cases, facilities will retain records indefinitely.

The code references listed below reflect several examples of specific regulations regarding record retention:

• ASME PVHO-2-2016, Section 1 General, 1-4 PVHO and PVHO systems documentation, “The owner shall be responsible for maintaining the following documentation for the service life of the PVHO and PVHO systems:
(a) documentation required by ASME PVHO-1, section 1, General Requirements
(b) documentation generated during inspection, maintenance, repairs, and modifications
(c) documentation related to operational procedures and manuals”

• NFPA-25, 2017 ed. 4.3.4 “As-built system installation drawings, hydraulic calculations, original acceptance test records, and device manufacturer's data sheets shall be retained for the life of the system.”

• NFPA-25 2017 ed. 4.3.5 “Subsequent records shall be retained for a period of 1 year after the next inspection, test, or maintenance of that type required by the standard.”

The reference document listed below may be beneficial in determining your needs, and is intended for information purposes only:

ACEC Risk Management Committee and NSPE Professional Liability Committee, “DOCUMENT RETENTION GUIDELINES,” 2016

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, who 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.

When we started our Wound and Hyperbaric Oxygen Unit about 6 years ago, we did this with the help of a consultant. One of the things that they were emphatic about was NOT to ever wax the floor of the hyperbaric unit. Unfortunately the cleaning staff waxed it this past weekend, and there is quite an odor in the unit. We have cancelled the dives for today, but we don't know what we should do next. Should we have the floors stripped and if so, when can we resume dives. Please help us figure out what to

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

Regarding: Waxing the floor of a monoplace suite

You did the right thing in canceling the treatments until the odor dissipated. The odor in and of itself may be a health and safety concern. The issue of waxed floors in the monoplace suite has been a topic in the hyperbaric community for quite some time. We can state with confidence, that there are many monoplace suites over many decades that have waxed floors in the room housing the class B chamber(s).  There have been no reported incidents due to waxing of the floors in the monoplace room. The chamber manufactures have been asked to remove this language from the manuals, but there are still some that include …“no wax or terrazzo flooring, carpeting is not allowed”. This stems from a concern about static electricity building up and becoming a possible ignition source. While carpeting should not be allowed, the no wax or terrazzo flooring prohibition has been shown to be unnecessary. More importantly it is required that both the monoplace chamber and patient are grounded. Neither the NFPA 99, 2018 edition, chapter 14, or the UHMS Hyperbaric Facility Accreditation Program prohibit waxed floors in the monoplace suite.

Normally we would direct you to the chamber manufacturer for guidance. In this case we would encourage you to work with your facility environmental services and care for the flooring as per the hospitals policy and procedure. There are positive aesthetic and infection control reasons to wax the floor. Since we do not know the type of flooring in your facility, the wax may indeed need to be removed. This will depend on the type of flooring your facility has installed. Work with your facility’s engineers and the environmental services and document your findings.

• Caution must be used to insure that none of the flooring product (either the wax or the wax remover) be allowed to get on the acrylic window of the chamber. This may damage or red tag the acrylic. Since you were not engaged in this incident until after the fact, we would encourage a complete, documented, maintenance inspection of the acrylic per ASME PVHO-2 to insure that no damage has occurred. If damage has occurred, you may need to replace the acrylic window.
• Housekeeping must be trained in the hazards of hyperbaric medicine and this training needs to be documented.
• Continued communication with the environmental services so that any maintenance of the flooring be done in a scheduled and coordinated manner.

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?

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:

  • “Atmosphere contamination following repainting of a human hyperbaric chamber complex.” Undersea Biomed Res. 1990 Sep;17(5):437-51., https://www.ncbi.nlm.nih.gov/m/pubmed/2219552/
  • “U.S. NAVY GENERAL SPECIFICATION FOR THE DESIGN, CONSTRUCTION, AND REPAIR OF DIVING AND HYPERBARIC EQUIPMENT,” Revision 1, 1-3.7.7, page 65 (83/246), August 23, 2006 https://www.navsea.navy.mil/Portals/103/Documents/SUPSALV/Diving/General%20Specifications%20Hyperbaric%20Equip.pdf?ver=2016-02-10-114010-800
  • “UNIFIED FACILITIES CRITERIA (UFC), UFC 4-159-01N, DESIGN: HYPERBARIC FACILITIES,” Section 3. INTERIOR APPURTENANCES: 8.PAINTS, 16 January 2004 https://www.wbdg.org/ffc/dod/unified-facilities-criteria-ufc/ufc-4-159-01n

  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.

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.