HYPERBARIC OXYGEN THERAPY (HBOT) DEPARTMENT AND WOUND CARE UNIT AT THE KING HAMAD UNIVERSITY HOSPITAL(KHUH), BAHRAIN
King Hamad University Hospital is committed to provide high quality healthcare and has the only public service Hyperbaric Oxygen Therapy facility in Bahrain. The Department of Hyperbaric Medicine is staffed by physicians and nurses specially trained and qualified in Hyperbaric Oxygen Therapy (HBOT) and advanced wound care. Dr Chaitanya Kodange is the Consultant and is a Hyperbaric Medicine & Wound care specialist with 25 years of baro-medical experience.
This modern HBOT unit comprises of a multiplace chamber (where up to 8 patients can be treated at same time) & 5 Monoplace chambers (in which one patient or a child with attendant can be treated at a time). The HBOT department conducted over 2800 HBOT sessions in 2019.
The HBOT unit was inspected by the South African Undersea & Hyperbaric Medical Association (SAUHMA) for International accreditation. It was a singular honor & achievement that the unit received the highest certification level of exceeding the minimum safety requirements for hyperbaric operations in January 2019. This was the first time any Hyperbaric facility has been awarded this level of certification by SAUHMA.
As part of our constant endeavor to increase our standards and benchmarks, the Hyperbaric & Wound care unit was also inspected by the JCI (Joint Commission International) accreditation team in Jul 2019 and received a special mention in JCI feedback. Full JCIA accreditation was achieved for the hospital in Nov 2019.
The KHUH HBOT and Wound care unit is currently the only one in Western Asia that holds two recognized international accreditation certifications.
What is Hyperbaric Oxygen Therapy (HBOT)? Hyperbaric oxygen Therapy (HBOT) is a medical treatment in which the patient breathes 100% oxygen while being subjected to increased atmospheric pressure in a pressurized chamber.
HBOT exerts its beneficial effects by: -
- Reduction and elimination of tissue obstruction caused by gas bubbles in diving accidents (Decompression sickness or “Bends”)
- Increase of oxygen carrying capacity of blood to injured tissues of the body
- Promotion of new small blood vessel formation
- Promotion of wound healing due to cell activity enhancement
- Supporting infection treatment protocols (improving antibiotic effects) in selected cases
- Reduction of swelling in injured tissues after trauma
Medical Conditions in which HBOT is useful Apart from recompression therapy for treating injured divers, the most common medical & surgical conditions which benefit from HBOT are severe life threatening skin infections, non-healing & infected wounds (especially in persons with diabetes), osteomyelitis (bone infections), radiation injury to bone or soft tissue and carbon monoxide poisoning. This is in line with the internationally accepted indications approved by the Undersea and Hyperbaric Medical Society (UHMS), USA and these include the following: -
- Air or Gas Embolism – Air or gas bubbles inside the blood vessels which affects the blood flow
- Carbon Monoxide Poisoning
- Clostridial Myositis and Myonecrosis – Gas Gangrene
- Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischemia’s.
- Decompression Sickness – Seen in Divers and Compressed air tunnel / Caisson workers
- Arterial Insufficiencies & Selected problem wounds such as Diabetic foot ulcers, Diabetic gangrene, Non healing wounds and ulcers
- Severe Anemia
- Intracranial Abscess
- Necrotizing Soft Tissue Infections
- Osteomyelitis (Refractory) – Chronic bone infection not responding to normal treatment
- Delayed Radiation Injury (Soft Tissue and Bony Necrosis) – Radiation Proctitis, Radiation enteritis, Radiation cystitis, Osteoradionecrosis of jaw bone etc.
- Acute Thermal Burn Injury
- Idiopathic Sudden Sensorineural Hearing Loss
There are other medical and surgical conditions with a sound physiological basis for providing HBOT, but is deemed as currently experimental and not yet included on the UHMS approved HBOT indication list. Benefit to some patients is determined on a case to case basis, after assessment by and on discretion of the Hyperbaric physician. Some of these include Facial palsy, Migraine, Autism, Cerebral Palsy, Acute hypoxic encephalopathy, Acute Intracranial hemorrhage (Stroke) / Chronic Stroke, Multiple sclerosis, Chron’s disease, Ulcerative colitis etc.
HBOT services in KHUH
Patients who are referred for HBOT or seek consultation by themselves, undergo a detailed consultation with the Hyperbaric medicine specialist and are assessed for fitness to undergo HBOT (which usually include tests such as a Chest X-Ray and ECG). Depending on the clinical condition & indication for HBOT, the Hyperbaric physician plans the required HBOT therapy & treatment protocol. HBOT treatment sessions usually last between 1.5 -2 hours and are conducted once or twice a day depending on the clinical condition. The total number of HBOT sessions can vary from 10 to 40 sessions depending on the indication, clinical condition and patient response to therapy. HBOT treatment sessions are carried out by a well-trained, skilled and dedicated nursing team that is focused on patient centered concerns and clinically geared outcomes with continuous evaluation before, during and after HBOT treatment.
The Wound care unit of KHUH
Due to the high prevalence of Diabetes in Bahrain, Diabetic foot wounds and Infections are a major health concern and a large burden of care for this unit. The wound care unit has been incorporated and integrated within the Hyperbaric department to provide an interprofessional setting consisting of wound care physicians, wound care specialist nurses, stoma care nurses and podiatrists who are working together in providing high quality wound care services in this tertiary care setting.
As assessment is key to successful wound outcomes, critical equipment used includes Transcutaneous Oxygen Monitoring machines (TCOM) for TCOM & ABPI assessment; 8 MHz hand held Doppler machine for assessment of vascular supply, Infra-red thermometry, three dimensional wound imaging camera for Wound healing assessment, with Negative Pressure Wound Therapy (NPWT) units available as well. The wound care unit has a wide variety of modern wound dressings available to deal with all types of wounds.
Wound care staff is well trained & have been regularly dealing with the most complex of wounds since 2013. This unit has achieved around 90% healing rates for most wounds, which is comparable to, or even better than, benchmark international standards. The wound care department performed over 10,000 wound care procedures in 2019.
Immediate Future plans for the unit
A dedicated Diabetic Foot Care program with multiple specialists in KHUH will be launched shortly.
A HBOT Wellness program will be started wherein HBOT will be offered for many medical, surgical and cosmetic conditions, as determined on a case to case basis.
The Hyperbaric Department unit is located on the 1st level of the King Hamad University Hospital.
Hours of service: 8 am to 4pm Sunday to Thursday with a 24h on call list available at the Emergency Department for dealing with emergency cases after hours.
For further information regarding Hyperbaric Oxygen Therapy, please call Hyperbaric Oxygen Therapy department or KHUH to book appointments or receive more information.
Tel: 17444255 / 17444250 / 17444414
Dr Chaitanya Kodange, Consultant in Hyperbaric & Diving Medicine & Wound care specialist