INTRODUCTION

Overview

This topic provides clarification on frequently asked questions regarding items that are prohibited, restricted or allowed inside chambers during a hyperbaric oxygen therapy (HBOT) treatment. For lists, checklists and authorization form, see topic "Go-No-Go Lists / Prohibited Items". For decision support on which items are prohibited, restricted or allowed see "Go-no-go Tool". Readers are invited to submit us additional questions through Curbside Consult. 

Background

Wound dressings are commonly used inside hyperbaric chambers. They play an important role in infection control and patient outcome. However, wound dressings, devices and other objects that go in the hyperbaric chamber with the patient may raise important safety concerns, including production of heat, production of static electricity, production of flammable vapor, ignition temperature, and total fuel load. It is critical that clinicians understand which dressings, devices and objects are prohibited, restricted or allowed inside a hyperbaric chamber during a hyperbaric oxygen therapy (HBOT) treatment. 

GO-NO GO - FREQUENTLY ASKED QUESTIONS

Question 1. “If the item, device or product is prohibited then why is it allowed into the chamber?” 

Answer:

The NFPA 99, chapter 14 Hyperbaric Facilities – provides guidance for safety and operational issues. According to the NFPA 99 - Chapter 14, “Physician and safety director approval to use prohibited items shall be stated in writing for all prohibited materials employed”. The Cambridge Dictionary defines prohibited as - "to officially refuse to allow something.”  As a result, the question that frequently arises is:  “If the item, device or product is prohibited then why is it allowed into the chamber?”  

Since we cannot disregard the language used by the NFPA, it is reasonable, when establishing policies, operational procedures or “GO-NO GO" lists, to use language that provides clarity for clinicians. We utilize three categories for items that require specific authorization when introduced or restricted for use into the hyperbaric chamber, our “GO – NO GO" lists.  For the sole purpose of clarity we use the following:

• GO – Items approved for use in a Monoplace Hyperbaric Chamber
• RESTRICTED – Items that may be used with CAUTION in a Monoplace Hyperbaric Chamber.
• STOP – DO NOT USE in a Monoplace hyperbaric chamber

Thus, the main take-aways are:

• Understand the intent of the NFPA 99 guidelines and avoid getting caught up in the verbiage. 
• Establish a process for determining what can or can not go in the chamber and without exception adhere to that process. 

Question 2. “Can petroleum based dressings be used on patients undergoing HBOT?” 

Answer: 

The NFPA 99, chapter 14 Hyperbaric Facilities – provides our guidance for safety and operational issues.  It also provides specific guidance on the process for effectively managing patients wound care dressing(s) and/ or product(s) during hyperbaric oxygen therapy.

Dressing types vary, the choice of which will depend on both the nature of the wound and the physicians’ preference. Petroleum based products (e.g  Xeroform Petrolatum Gauze Dressing)  are used to cover certain wounds, and are frequently employed with freshly applied skin grafts. Enzymatic debrider (e.g. Collagenase SANTYL* Ointment ) is another example of petroleum based products, commonly used for the purpose of enzymatic debridement.

Petroleum based dressings and all hydrocarbon-producing products must be evaluated on a case-by-case basis in accordance with the established NFPA 99 2012 Hyperbaric Safety Guidelines. Such items initially may be identified as prohibited items, however Petroleum based dressings may be introduced into the hyperbaric chamber, with due care and attention with strict adherence to chamber cleanliness which is an integral aspect of hyperbaric fire safety. All internal surfaces must be kept free of lint, dust, and other particulate matter.