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Multiplace Delivery System

Monthly Hyperbaric Safety Notice: September 2006

JCAHO National Patient Safety Goal #7

Background

In 2002 the Joint Commission for Hospital Accreditation (JCAHO) approved a list of 6 safety goals and 11 recommendations for improving safe patient care.  One of the 2006 goals is: Reduce risk of health care acquired infections.

How do we comply with hospital and national policy regarding infection control in the chamber?

Safety Issue

Infection control is a concern in the clinical multiplace chamber.  We have policies about hand washing between patients.  Cleaning of patient care items such as stethoscopes and bloodpressure cufs are also considered.  One of the tools for infection control is to use alcohol based antibacterial hand wipes between patients.  I do not have a recommendation for a non-alcohol based antibacterial hand wipe for use in the chamber while at pressure.  Our facility has sinks installed and we are use Germa-Care Lotion skin cleanser (Huntington brand, ECOLAB). Vigorous hand washing for 10-15 seconds is important to allow the soap to work.  The thumbs, backs of hands and beneath the fingernails are the most common places missed. Do not wear any kind of artificial nails for germs to harbor under.  The use of gloves can also be used as a tool. 

"NFPA 99 2005, A.20.3.1.5.2.2 (2) describes a formula for determining allowable quantities of Isopropyl alcohol LEL =2%/VOL (irrespective of chamber pressure)
Vapor density = 2.1 relative to air
Liquid density = 789 g/l
Air density = 0.075 lb/ft3 at STP
The limiting case occurs at the lowest ambient pressure that is 1 atmosphere:

Alcohol vapor density a LEL = 0.02 X 2.1 X 0.0057
  = 0.000315 lb/ft3
  = 1.43 g/ft


The example given in the NFPA implies that 500 ft 3 1.43 X 500 = 715 g alcohol vapor at LEL, using the suggested safety factor of 10 the NPA document concludes that 71.5 g  = 91 ml of alcohol would be allowed in a 500 ft 3 chamber."

There are other factors, static electricity, humidity, maintenance of the chamber, personnel, administration etc that must be considered to allow the use of the formula safely.   The antibacterial hand sanitizers dry quickly and it could be argued that this risk is minimal.  For me the risk is not acceptable and we do not allow alcohol based cleaning products in the chamber while it is pressurized.  There are occasionally some wound care products that are allowed on a case by case basis. The use of alcohol based equipment wipes and hand cleansers are allowed in and around the chamber while it is not pressurized.  There must be constant vigilance to insure that these products are removed and the chamber ventilated before pressurizing.  I would encourage the use of hand washing; if your chamber does not have sinks installed there are portable sinks available that may answer for your situation.

Key Operational Issues

Bottom Line

We have to insure infection control in the chamber while at the same time considering the risks of a confined space, and increased fire hazard.  Use hand washing and gloves between patients during chamber use.  Use standard precautions when the chamber is not pressurized.  If you do not have a sink in the chamber consider how to get one.

Reading Assignment

Contributing Author: James Bell, CHT, EMT

James Bell Jim has over 25 years experience in the operation and maintenance of multiplace hyperbaric chambers. He serves as safety director and lead hyperbaric technologist at Hennepin County Medical Center, in Minneapolis, Minnesota, USA. Jim is a certified hyperbaric technologist, and an Undersea and Hyperbaric Medical Society facility accreditation surveyor.

Full Panel of Safety and Technical Correspondents