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.
How do we know which wound dressings, devices and objects are prohibited, restricted or allowed inside a hyperbaric chamber during a hyperbaric oxygen therapy (HBOT) treatment?
The NFPA 99, chapter 14 Hyperbaric Facilities – provides our 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.” So…the question that frequently arises…
“If the item, device or product is prohibited then why is it allowed into the chamber?”
That is a great question! To avoid boring you with a long winded response we will get right to the point:
Since we cannot disregard the language used by the NFPA, it is important to use language that provides clarity to clinicians when establishing policies, operational procedures or “Go -No Go" lists. We utilize three categories for items that require specific authorization when introduced or restricted for use into the hyperbaric chamber in 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
In addition to this list, it is important to keep documentation on file explaining the risk assessment for each item. This will prevent future duplication of effort. It also serves as evidence that due diligence was used.
It was this statement above that motivated the WoundReference team to develop the Go-No-Go Assessment Tool. The Go-No-Go Risk Assessment Tool is an interactive tool that facilitates the decision-making and documentation process. The Tool enables HBOT clinicians to assess the risk for each area of concern (production of heat, static, flash point, fuel load, adverse effect, mechanical), quantify each risk with the Burman scoring system, and more confidently determine the risk level of each item. Upon completion of the risk assessment process, HBOT clinicians can print or email the document and upload documentation to the electronic medical record. The Tool allows each facility to have a digital, customized "Go-No Go" list, that can be accessed by the entire team. For an overview of the Tool, watch the webinar "Performing Risk Assessments With The Go/No-Go Tool And The Burman Scoring System", and refer to topic "How to Assess HBOT Prohibited Items: The Go/No-Go Risk Assessment Tool And The Burman Scoring System". For challenges and solutions related to prohibited items risk assessment, see topic "Prohibited Item Risk Assessment".
The take – away points 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.
Resources
About the Authors
Jeff Mize, RRT, CHT, UHMSADS
With over four decades of healthcare experience, Jeff currently holds the position of Principal Partner at Midwest Hyperbaric LLC and the Co-founder and Chief Clinical Officer of Wound Reference.
Jeff has excelled in critical care throughout his career, devoting almost a decade as a Flight Respiratory Therapist/Paramedic for the Spirit of Kansas City Life Flight. In 1993, Jeff transitioned into the field of Hyperbaric Medicine and Wound Care, where he committed 21 years of his career to serving as the Program Director for a 24/7 Level 1 UHMS Accredited facility with Distinction. In this role, he continued to provide patient care while overseeing all administrative, clinical, and daily operations within the Wound Care and Hyperbaric Facility.
Jeff is a Registered Respiratory Therapist and a Certified Hyperbaric Technologist (CHT). He has also undergone training as a UHMS Safety Director and a UHMS Facility Accreditation Surveyor.
Jeff currently serves as a member of the UHMS Accreditation Council, the UHMS Accreditation Forum Expert Panel, and the UHMS Safety Committee. Additionally, he is an esteemed member of the NFPA 99 Hyperbaric and Hypobaric Facilities Technical Standards Committee.
Jeff's dedication to the field has earned him numerous prestigious awards. In 2010, he received the Gurnee Award, which honored his outstanding contributions to undersea and hyperbaric medicine. Three years later, in 2013, he was awarded the Paul C. Baker Award for his commitment to Hyperbaric Oxygen Safety Excellence. Most recently, in 2020, Jeff was honored with "The Associates Distinguished Service Award (UHMSADS)," a recognition reserved for exceptional Associate members of the Society who have demonstrated exceptional professionalism and contributions deserving of the highest accolades.
Tiffany Hamm, BSN, RN, CWS, ACHRN, UHMSADS
An Advanced Certified Hyperbaric Registered Nurse and Certified Wound Specialist with expertise in billing, coding and reimbursement specific to hyperbaric medicine and wound care services. UHMS Accreditation Surveyor and Safety Director. Principal partner of Midwest Hyperbaric LLC, a hyperbaric and wound consultative service. Tiffany received her primary and advanced hyperbaric training through National Baromedical Services in Columbia South Carolina. In 2021, Tiffany received the UHMS Associate Distinguished Service Award. "This award is presented to individual Associate member of the Society whose professional activities and standing are deemed to be exceptional and deserving of the highest recognition we can bestow upon them . . . who have demonstrated devotion and significant time and effort to the administrative, clinical, mechanical, physiological, safety, technical practice, and/or advancement of the hyperbaric community while achieving the highest level of expertise in their respective field. . . demonstrating the professionalism and ethical standards embodied in this recognition and in the UHMS mission.”
