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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 that motivated the WoundReference team to develop the Go-No-Go Risk 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 a score 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.

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. 


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