Monoplace Delivery System

Monthly Hyperbaric Safety Notice: August 2006

Active TB Patients and The Hyperbaric Chamber

Background

Tuberculosis (TB) is a bacterial disease that commonly involves the lungs. This disease remains a clinically significant problem and can be fatal, particularly in view of the recent emergence of drug resistant strains. The primary means of transmission is through breathing aerosolized ‘droplet formation’ bacteria. Transmisson usually occurs as a consequence of patients with active TB (organisms concentrated in sputum) expectorating the organism while coughing, sneezing, etc.

The Issue

Patients suffering from active TB, i.e. are expectorating the bacteria, are considered infectious and require some form of respiratory isolation. Clearly, these patients represent a significant challenge in regards to hyperbaric oxygen therapy. Cross-contamination of the chamber, hyperbaric personnel, and other patients is a real concern. The ability to utilize an appropriate filtration mask is limited by the potential fire hazard, inability to provide adequate air breaks, and the possibility of hypercapnea leading to an increased risk of oxygen toxicity. To date, there are no available disinfectants approved for use on acrylic chambers that are effective against mycobacteria (e.g. Tor-HB).

Bottom Line

No suitable method has been developed to manage active tuberculosis patients in the hyperbaric chamber. As a result, “Active TB” should be considered a relative contraindication for hyperbaric oxygen therapy. Ideally, hyperbaric oxygen treatments should be held until an appropriate anti-tuberculous drug regimen has been administered rendering their sputum non-infectious. Emergent life/CNS threatening conditions present a particular challenge. In these cases it will be left to the clinical team to weigh the potential benefits and considerable hazards before deciding to treat. One might also consider referral to a multiplace chamber, if one is in reasonable close proximity. These chamber types represent a better environment for decontamination and isolation (including the patient hood).

Contributing Author: Dick Clarke, CHT

Dick Clarke Dick is President of National Baromedical Services, which he founded in 1986. His previous background included service in the British Royal Navy, diving instructor and underwater photographer, assistant director of the seabed habitat 'HydroLab' and several years in the offshore commercial diving industry. Dick heads the Baromedical Research Foundation where he serves as Principal Investigator for several international clinical trials. He is course director for 'Primary Training in Hyperbaric Medicine' and the 'HBO 2000' series of advanced hyperbaric symposia. Dick has been a NOAA Diving Medical Officer Training Course faculty member since 1983. He pioneered the Certification in Hyperbaric Technology (CHT) program, is a past president of the National Board of Diving and Hyperbaric Medical Technology and remains active at the committee level within the Undersea and Hyperbaric Medical Society.

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