Hyperbaric Chamber Therapy Unit: excerpts from IHF guidelines, 2025

Disclaimer: This post is for academic purposes only. Please read the original document if you intend to use them for clinical purposes.

This document summarises the key planning, design, and operational guidelines for a Hyperbaric Chamber Therapy Unit, a facility for delivering Hyperbaric Medicine as per International Health Facility Guidelines (IHFG), 2025. The core treatment, Hyperbaric Oxygen Therapy (HBOT), involves patients breathing 100% oxygen in a pressurized chamber at 2-3 times normal atmospheric pressure. It is primarily used for conditions like decompression sickness, carbon monoxide poisoning, gas gangrene, and hard-to-heal wounds. The guidelines mandate the use of rigid, not flexible, hyperbaric chambers and recommend single-patient (monoplace) units over multi-patient (multiplace) ones. Facilities may be stand-alone or integrated into a hospital at a Role Delineation Level (RDL) of 3 or higher, with critical functional links to the Emergency Unit, In-patient Unit, and ICU. Design is governed by stringent safety standards, requiring specialized finishes like seamless, anti-static flooring in treatment rooms, robust building services, and strict infection control protocols. Minimum staffing is mandated to ensure patient safety, including at least two personnel present outside the chamber during operation and specific operator-to-chamber ratios.

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1. Introduction:

A Hyperbaric Unit is a specialized facility dedicated to the discipline of Hyperbaric Medicine. This field involves an ambulatory mode of treatment where patients are placed in a pressure vessel, known as a hyperbaric chamber, to receive treatment at an ambient pressure greater than sea level atmospheric pressure.

The treatments performed in a Hyperbaric Unit primarily fall into two categories:

• HBOT: This treatment involves the patient breathing pure oxygen within a pressurized environment where the air pressure is increased to two to three times higher than normal.
• Therapeutic Recompression: This is a treatment for decompression illness which involves administering 100% oxygen for several hours in a sealed chamber at pressures higher than one atmosphere. The primary goal is to reduce the size of systemic gas bubbles in the body, such as in the bloodstream, and improve conditions for their elimination.

Initially developed to treat diving disorders like decompression sickness and gas embolism, the applications of hyperbaric medicine have since expanded significantly. Such facilities and treatments may be provided by hospitals, diving organizations, and naval institutions.

2. Applications/Indications:

Hyperbaric Oxygen Therapy is utilized for a diverse range of conditions and treatments. In addition to its original application for diving-related disorders, HBOT is indicated for numerous medical uses.

Primary Applications:

• Decompression sickness
• Air or Gas embolism
• Gas gangrene (Clostridial Myositis and Myonecrosis)
• Carbon Monoxide poisoning (including cases complicated by cyanide poisoning)
• Severe infections
• Wounds that are difficult to heal due to conditions like diabetes or radiation injury

Other Approved Medical Indications:

• Central retinal artery occlusion
• Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias
• Enhancement of healing in selected problem wounds
• Diabetically derived illnesses (e.g., short-term relief for diabetic foot, retinopathy, nephropathy)
• Exceptional blood loss (anemia)
• Idiopathic sudden sensorineural hearing loss
• Intracranial abscess
• Mucormycosis (especially Rhinocerebral disease in diabetic patients)
• Necrotizing soft tissue infections (necrotizing fasciitis)
• Osteomyelitis (refractory)
• Delayed radiation injury (soft tissue and bony necrosis)
• Compromised skin grafts and flaps
• Thermal burns
• Possible treatment for Cerebral Palsy and Multiple Sclerosis

3. Planning and Operations:

Planning Models and Integration:

A Hyperbaric Unit can be developed as a stand-alone facility or as an integrated department within a larger health facility, such as an outpatient clinic or a hospital. The unit is permissible at facilities with a RDL of 3 or higher. When integrated, its planning closely resembles that of an Outpatient and Ambulatory Unit, and it can share support facilities with adjacent departments like the Emergency or Outpatient units.

Functional Relationships:

Effective planning requires consideration of the unit’s relationships with other critical hospital services.

Functional Zones:

A comprehensive Hyperbaric Unit is organized into several distinct functional zones. Many non-treatment facilities can be shared if the unit is part of a larger hospital.

• Entry/Reception: Waiting areas, interview room, public amenities, and patient holding/recovery bays.
• Outpatient/Diagnostic Facilities: Consultation and examination rooms.
• Treatment Facilities: The core operational area, including the HBOT treatment room, patient changing rooms, compressor room, and gas cylinder storage room.
• Support Areas: Clean and dirty utility rooms, and storage for clinical and non-clinical supplies.
• Staff Areas: Administrative offices, workstations, change rooms with showers, and a staff room.

Hours of Operation:

The unit may operate at any time, day or night, depending on operator preference and patient urgency. However, the most typical operational hours align with other ambulatory and outpatient facilities. Regardless of the schedule, all required clinical and technical staff must be available on the premises at all times during operation for safe patient monitoring and equipment management.

4. Equipment specifications:

Chamber Types:

The primary equipment for HBOT is the hyperbaric chamber, a rigid pressure vessel. The guidelines establish specific requirements for the types of chambers permitted.

Key Chamber Components:

Hyperbaric chambers are precision medical equipment that must include a range of safety and operational features:

• A pressure vessel with acrylic viewports or windows.
• Patient access hatches, appropriately sized for trolleys if needed.
• An airlock (for multiplace units) to allow entry/exit without depressurizing the main chamber.
• A control panel for external operation of valves and gas flow.
• An intercom system for two-way communication.
• Observation systems like viewports or closed-circuit television (CCTV).
• A built-in breathing system (BIBS) to supply and exhaust treatment gas.
• A fire suppression system.
• An over-pressure relief valve.
• Optional: A carbon dioxide scrubber system.

All equipment must be installed, operated, and regularly maintained according to manufacturer specifications, with careful records kept.

5. Design and Environmental Considerations:

HBOT Treatment Room Design:

The design of the HBOT treatment room must adhere to strict safety standards from bodies such as the National Fire Protection Association (NFPA) and the Undersea & Hyperbaric Medical Society (UHMS).

• Location: Hyperbaric units may only be provided as stand-alone facilities or within other health facilities; they are not permitted in residential buildings, malls, or industrial areas. Multiplace chambers must be on the ground floor with direct outside access.
• Structural Integrity: The floor must be able to support the significant weight of the chamber and its ancillary equipment.
• Space: The room must be large enough to accommodate the chamber, patient loading activities, support equipment, and staff functions.
• Finishes: The floor must be seamless and anti-static. The ceiling must also be seamless (e.g., set gypsum plasterboard), and drop-in tiled ceilings are to be avoided.

Safety and Emergency Preparedness:

The unit must be equipped to handle medical emergencies. The following must be available and in perfect working order within or very near the treatment area:

• Oxygen resuscitation equipment capable of supplying 100% oxygen.
• An intubation kit.
• Apparatus for performing pleurocentesis.
• An emergency call system with an uninterruptible path to a doctor who can respond within five minutes.
• Gas analysis system.
• Emergency drugs and supplies.

Patient Environment and Accessibility:

• Acoustics: Acoustic treatment is required for consult rooms, treatment areas, and staff rooms to minimize sound transmission, reduce staff error, and ensure patient privacy and safety.
• Natural Light: Maximizing natural light is desirable in waiting areas and staff rooms. However, direct penetration of natural light into the HBOT chambers is undesirable, and provisions for shielding must be made.
• Privacy: Design must ensure patient privacy through discreet discussion spaces, privacy screening for all patient bays and between chambers, and careful placement of doors.
• Accessibility: The unit requires a weatherproof drop-off zone and must be fully accessible for patients in wheelchairs, with provisions for bariatric patients as determined by the service plan.

Infection Control:

A high level of infection control is essential.

• Handwashing: Handbasins are mandatory and must be provided at a ratio of 1 per 4 hyperbaric chambers (if in the same room), at any staff station, and near any patient holding/examination bay.
• Antiseptic Hand Rubs: These should be readily available at points of care but are considered a supplement to, not a replacement for, handwashing facilities.

6. Staffing requirements:

Safe operation of a Hyperbaric Unit depends on a qualified, multi-disciplinary team and strict adherence to staffing protocols.

Team Composition and Leadership:

• A nominated Director/Chair of HBOT services must be in place.
• The multi-disciplinary team must include licensed:
  • HBOT Physicians
  • HBOT Technicians (Chamber Operators)
  • Registered Nurses (Chamber Attendants)
• One licensed healthcare professional must also be designated as the facility’s safety officer and fire marshal.

Qualifications and Fitness:

• All staff must be certified, experienced, and meet all licensing requirements.
• All personnel must complete equipment-specific training.
• All staff must undergo an annual medical check-up at a third-party facility to confirm their fitness for involvement in HBOT.

Minimum Staffing Ratios:

To ensure patient safety during treatment, the following minimum staffing levels are mandatory:

• At all times while a patient is under pressure, a minimum of 2 persons must be present outside the chamber and within the hyperbaric facility.
• For a multi-place chamber, there must be a minimum of two chamber operators or one chamber operator and one chamber supervisor.
• For mono-place chambers, there must be a minimum of one chamber operator for every two chambers.

7. Schedule of Accommodation (SOA):

The guidelines provide a sample SOA to serve as a template for designing a stand-alone Hyperbaric Unit at RDL 3-6. The SOA details the required rooms, quantities, and minimum areas, organized by functional zone. The actual size and room quantities for any specific project must be determined by a Clinical Services Plan.

The provided examples are for facilities with monoplace chambers:

Key spaces in the SOA include Reception/Waiting, Consult Rooms, the Hyperbaric Chamber Room itself (60 m² for 2 chambers, 105 m² for 4), Patient Holding Bays (one per chamber), and essential support rooms like Clean/Dirty Utility, Gas Cylinder Storage, and a Compressor Room.

_{Citation: Hyperbaric Chamber Therapy Unit. IHFG – International Health Facility Guidelines. 2025}