Clostridium difficile (C. Diff) and Hyperbaric Chambers

20140428-070954.jpg
Clostridium difficile or C-Diff for short is one tough bug and is one that is difficult to eliminate with current approved acrylic disinfectants. Using a disinfectant that the chamber manufacturer does not recommend could cause you to void the chambers warranty but not addressing C-Diff in the chamber is a patient safety issue. I have several links that discuss c-diff and hyperbaric chambers below. Hopefully these links are helpful.

“How do you care for the C-diff contaminated patient in the chamber?”.

Acrylic Suitable Disinfectants for Hyperbaric Chambers.

“That is not in MY Chamber” Infection Control and Chamber Cleanliness.

Real HBO2 vs. Soft HBO – When will this end?

Image

Let me paint a picture for you.  A patient comes into a hospital based HBO unit with a re-attached finger (re-attachment was a week ago), the finger is black and the patient says hyperbaric oxygen therapy did not help the finger – in fact it made it worse and why am I here?  I ask the patient, what kind of hyperbaric chamber did you go into?  The response (although not shocking) was, a portable soft, blue and white chamber, we went to 1.3 atmospheres for many hours a day for a whole week and the finger is worse, it was pink after surgery and now its grayish black.  There were a couple of responses that came to mind (all of them were negative), but instead of adding to a patient’s anxiety level, I decided to focus on what we can do now – I got the doctor to do the HBO consult, got all the paperwork done, and immediately treated the patient twice a day for two days, over the weekend, and by today (8 treatments in) the finger was completely black and the physician had to give the patient a realistic assessment that the index finger is no longer salvageable and may have to be amputated.

QUESTION 1: Do you think this patients finger could have been saved if the patient went to a hospital based or a free standing non-soft chamber facility and got the appropriate HBO treatment?

QUESTION 2: Do you think the soft-chamber facility is liable for this patient losing their finger because they “assumed” they can actually treat a post surgical reattachment of a finger at 1.3 ATA in a soft chamber and actually expect a good outcome?

QUESTION 3: Do you think this soft chamber facility will get shut down by the District Attorney and the Feds? I will answer that one for you – YES, and in fact the owners may face jail time & a lifetime of fines to boot.

So why do these places continue to parade around as if they can actually treat such indications?  Don’t get me wrong, I am sure there are certain “none life & limb threatening” indications that these soft chambers are magically indicated for & there probably is a place for them…somewhere.

Do I sound bitter?  Yes I am bitter! This is not the first time I have seen this happen and it will not be the last.  This time it was different.  This time it was a little girl who will grow up without a right index finger for the rest of her life because “someone” thought that their soft chamber could do exactly what a hard chamber can do.  Was it for money?  Was it to say that their chamber can treat basically every indication a hard chamber can treat? Or was it medical malpractice?  I believe it was all of the above and that it was wrong.

The hyperbaric community needs to send a strong message to those soft chamber facilities in their communities that treating indications requiring at least 2 Atmospheres for 90 to 120 minutes on 100% oxygen inside of a soft chamber at 1.3 ATA on AIR IS WRONG! Otherwise more and more patients will fall victim to this type of tragedy. Here is a hint: Send these patients to an appropriate facility and save yourself a lawsuit!

The FDA is now aware of this situation and so is the local FBI office – so here is a WARNING to those with soft chambers that think they can get away with treating medicare approved indications in their chambers at 1.3 ATA, it is only a matter of time before you make this type of mistake and go down for it – do not risk short term income for a long term jail sentence, it isn’t worth the risk or the lawsuit!

Last QUESTION: How would you feel if this was your child?

Comments welcome & so is hate mail so bring it!

Arrest Made In Lauderdale-By-The-Sea Hyperbaric Chamber Explosion

Mr Lance Bark, DMT, CHT was arrested for manslaughter today

Dr. George Daviglus was charged with manslaughter today

LAUDERDALE-BY-THE-SEA, Fla. –

Broward Sheriff’s Office detectives have arrested one man and are waiting for a second to turn himself in three years after a deadly explosion at a Lauderdale-By-The-Sea hyperbaric treatment facility.

Lance Bark, 51, a medical technician, is under arrest on charges of manslaughter and aggravated manslaughter. George Daviglus, , 82, a doctor, is facing the same charges and is expected to turn himself in later this week.

It was May 1, 2009, when a fiery blast inside a hyperbaric chamber injured a 4-year-old Italian boy who was being treated for cerebral palsy and killed his 62-year-old grandmother, Vicenza Pesce. The boy, Francesco Martinisi, died several weeks after the incident.

The explosion made international news. An Italian television station had earlier aired a story showing Martinisi’s father climbing into a chamber with him, saying he hoped oxygen therapy would help his boy’s condition.

On Wednesday, police said negligence instead killed him.

BSO Detective Frank Ilarraza said an investigation showed that Martinisi was not properly grounded and that static electricity started the fire. He also said the machines were not properly maintained.

“The chamber was dusty inside, and that started a fire inside a chamber,” Ilarraza said.

Bark was supposed to be in charge of safety. BSO said he and Daviglus failed.

Official Sheriff’s Hyperbaric Explosion Report

CASE CLOSED?????

Below is the official Marion County Sheriff’s Report of the incident.  Included in the report is the cause of death (blunt force and thermal injuries).  The manner of death was accidental explosion.

Interesting enough, a comment made in the official report by another “tech” at a similar facility nearby states “THAT THERE REALLY IS NO CERTIFICATION TO ENABLE SOMEONE TO RUN SUCH A CHAMBER” (Whoa!!!!, wrong!  The NBDHMT has a certification for that; CLICK HERE TO SEE IT).

The 2nd statement was:  BRENDA MCDUFFEE RUNS THE CHAMBER AT THIS FACILITY AND EXPLAINED THAT SHE HAD BEEN TRAINED IN TEXAS.   SHE STATED THAT THE TRAINING INVOLVED IS NOT SO MUCH AS TO HOW TO RUN THE CHAMBER, BUT MORE OF THE EFFECTS OF THE CHAMBER ON THE HORSES. WHEN QUESTIONED AS TO STANDARD PROTOCOLS REFERENCE THE CHAMBER, SHE TOLD WRITER THAT THERE ARE NONE; HOWEVER AT THE FACILITY WHERE SHE WORKS THEY HAVE INITIATED THEIR OWN PROTOCOL THAT LISTS MEASURES TO ENSURE THE SAFETY OF THE HORSE AS WELL AS THE OPERATOR.

There are no standard protocols? Hmmm. I know that there are some NFPA requirements for Class C chambers.  Time will tell I am sure.

UPDATE:  In a press interview McDuffee stated: “The hyperbaric community is relatively small, we’re all very well connected and everyone keeps up on all the safety protocols,” said McDuffee of The Sanctuary. “This is probably the most safety minded piece of equipment that anyone running these type of chambers does. The protocol books are huge.”  Here is that press interview.

MY QUESTION IS: Are there protocols or not????

MARION COUNTY SHERIFF’S OFFICIAL FULL REPORT ON HYPERBARIC EXPLOSION

A Bomb Technicians View: Possible Methane Contribution to Hyperbaric Explosion

Below is an excerpt from a highly skilled and FBI trained bomb technician & Instructor who has been investigating fires and explosions for 22 years.  Thank you very much RED DIVER1 for the quick response.

FROM RED DIVER 1 Depending on the volume and pressure of each gas present at the time of the explosion, it MAYBE possible that a spark could produce an ignition of the gases to sustain a rapid deflagration or explosion causing the chamber to rupture as the direct result of gas overpressure.

Several factors must be present to support this theory. First off, the Lower Explosive Limit or LEL must be known. Wikipedia defines the LEL as the lowest concentration (percentage) of a gas or a vapor in air capable of producing a flash of fire in presence of an ignition source (arc, flame, heat). At a concentration in air below the LEL there is not enough fuel to continue an explosion. Concentrations lower than the LEL are “too lean” to explode but may still deflagrate (burn or rapidly combust).

The Upper Explosive Limit or UEL is the highest concentration or percentage of a gas or a vapor in air capable of producing a open flash of fire in the presence of an ignition source. In this case the possibility of a spark resulting from a metal horse coming into contact with another metal surface inside the chamber, could be sufficient to cause a rapid deflagration. The resulting gas overpressure would cause the chamber to violently rupture causing heat, fragmentation and a blast pressure wave in the immediate area.

Oxygen enriched atmospheres lower the LEL and increase the UEL. An atmosphere devoid of an oxidizer is neither flammable or explosive regardless of the fuel gas concentration. Increasing the fraction of inert gases in an air mixture raises the LEL and decreases the UEL (keep in mind the fire triangle).

Methane gas has a LEL of 4.4% (at 138 degrees C) by volume, meaning 4.4% of the total volume of the air consists of methane. At 20 degrees C the LEL is 5.1 % by volume. If the atmosphere has less than 5.1% methane, an explosion cannot occur even if a source of ignition is present. When methane (CH4) concentration reaches 5.1% an explosion can occur if there is an ignition source. LEL concentrations vary greatly between combustible gases.

To prove this theory, the volume, temperatures and partial pressures of the affected gases would have to be known values to identify the upper and lower flammability/explosive limits.

In summation, it would be possible for a rapid deflagration or explosion to occur if the explosive limits are within range.

BY,

RED DIVER 1

Bomb Tech Extraordinaire