ELECTRICAL SAFETY

By: Yassir Eltayeb Ali Hassan

Electrical safety
Medical procedures usually expose the patient to more hazards than the typical home or workplace, because :1. In medical environments the skin and mucous membranes are frequently penetrated or altered. 2. There are many sources of potentially hazardous substances and energy forms that could injure either the patient or the medical staff. These sources of hazards include: fire, air, earth, water, chemicals, drugs, microorganisms Waste products Sound and electricity Natural and unnatural disasters surroundings, gravity, mechanical stress People responsible for acts of omission and operation

Physiological effects of electricity

psychophysical and physiological effects of For a physiological effect to occur, the electrical current in humans:body must become part of an electric circuit. Current must enter the body at one point and leave at some other point The magnitude of the current is equal to the applied voltage divided by the 70 kg sum of the series impedances of the body tissues and the two interfaces at the entry points Three phenomena can occur when electric current flows through biological tissue: (1) Electric stimulation of excitable tissue (nerve and muscle) (2) Resistive heating of tissue (3) Electrochemical burns and tissue damage for direct current and very high voltages AWG No. 8 copper wires

psychophysical and physiological effects of electrical current in humans:-

Threshold of perception = the minimal current that an individual can detect. This threshold varies considerably among individuals and with the measurement conditions (wet or dry skin) Thresholds for dc current range from 2 to 10 mA, and slight warming of the skin is perceived (realized)

psychophysical and physiological effects of electrical current in humans:Let-go current:Is defined as the maximal current at which the subject can withdraw voluntarily. Involuntary contractions of muscles or reflex withdrawals is occur The minimal threshold for the let-go current is 6 mA Respiratory paralysis, pain, and fatigue: respiratory arrest has been observed at 18 to 22mA Strong involuntary contractions of the muscles and stimulation of the nerves can be painful and cause fatigue if there is long exposure.

Ventricular fibrillation

Ventricular fibrillation:Is a rapid and disorganized cardiac rhythm. If the magnitude of the current is sufficient to excite only part of the heart muscle and disrupted the heart rate The heart rate can rise to 300 beats/min The fibrillation does not stop when the current that triggered it is removed. Ventricular fibrillation is the major cause of death due to electric shock. The threshold for ventricular fibrillation for an average-sized human varies from about 75 to 400 mA Normal rhythmic activity returns only if a brief high-current pulse from a defibrillator is applied to depolarize all the cells of the heart muscle the cells relax together, a normal rhythm usually returns

Threshold and let-go variability

For men:The mean value for the threshold of perception is 1.1 mA. let-go currents of 16 mA For women:the estimated mean is 0.7 mA. The minimal threshold of perception is 500 mA. let-go currents of 10.5 mA

let-go current versus frequency of the current

The minimal let-go currents occur for commercial power-line frequencies of 50 to 60 Hz For frequencies below 10 Hz, let-go currents rise, probably because the muscles can partially relax during part of each cycle At frequencies above several hundred hertz, the let-go currents rise again.

Let-go current versus frequency

Body weight and fibrillation, duration of the current

Several studies using animals of various sizes have shown that the fibrillation threshold increases with body weight Fibrillating current increases from 50 mA rms for 6 kg dogs to 130 mA rms for 24 kg dogs.

Point of entry (macroshock and microshock)

Macroshock:When current is applied at two points on the surface of the body, only a small fraction of the total current flows through the heart (macroshock). The magnitude of current needed to fibrillate the heart is far greater when the current is applied on the surface of the body than it would be if the current were applied directly to the heart Microshock:All the current applied through an intracardiac catheter flows through the heart small currents called microshocks can induce Ventricle fibrillation Current of about 20 A can cause microshock . The widely accepted safety limit to prevent microshocks is 10 mA.

Distribution of electric power

Safe distribution of power in health-care Electric power is needed in health-care facilities:facilities for :1. The operation of medical High voltage (4800 V) instruments enters the building 2. Lighting, maintenance appliances usually via underground cables 3. Patient conveniences (such as television, hair curlers, and electric toothbrushes) 4. Clocks, nurse call buttons, and an endless list of other electric devices So the first step on providing electrical safety is to control the availability of electric power and the grounds in the patients environment

Patients electrical environment

A shock hazard exists between the two conductors supplying either a 240 V or a 120 V appliance. Because the neutral wire on a 120 V circuit is connected to ground, a connection between the hot conductor and any grounded object poses a shock hazard. Microshocks can occur if sufficient potentials exist between exposed conductive surfaces in the patients environment THE maximal potentials permitted between any two exposed conductive surfaces in the vicinity of the patient are specified by the 2006 NEC, Article 517-15: 1. General-care areas, 500 mV under normal operation 2. Critical-care areas, 40 mV under normal operation Things must be done:1. All exposed conductive surfaces in the vicinity of the patient must be grounded at a single patient grounding point. 2. Periodic testing for continuity between the patient ground and all grounded surfaces is required 3. Each patient-bed location in generalcare areas must have at least four single or two duplex receptacles ,the receptacle must be grounded 4. At least two branch circuits with separate automatic overcurrent devices must supply the location of each patient bed. 5. For critical-care areas at least six single or three duplex receptacles are required for each location of a patient bed

Isolated-power systems
Any ground faults can posses hazard . A ground fault :Is a short circuit between the hot conductor and ground that injects large currents into the grounding system. Isolation of both conductors from ground is commonly achieved with an isolation transformer + line isolation monitor isolation transformer

Measures the total possible resistive and capacitive leakage current (total hazard current) that would flow through a low impedance if it were connected between either isolated conductor and ground. When the total hazard current exceeds 3.7 to 5.0 mA for normal line voltage, a red light and an audible alarm are activated Checking the lines by the LIM can interfere with (ECG,EEG ,ect.) ,or it can trigger synchronized defibrillators

Isolated-power systems
Isolated-power systems were originally introduced to prevent sparks from coming into contact with flammable anesthetics such as ether. The NEC requires isolated-power systems only in those operating rooms and other locations where flammable anesthetics are used or stored.

EMERGENCY-POWER SYSTEMS
Article 517 of the 2006 National Electrical Code specifies the emergency electric system required for heath-care facilities. An emergency system is required that automatically restores power to specified areas within 10 s after interruption of the normal source. The emergency system may consist of two: The life-safety branch (illumination, alarm, and alerting equipment) The critical branch (lighting and receptacles in critical patientcare areas)

Skin and body resistance

The resistance of the skin varies widely with the amount of water and natural oil present. It is inversely proportional to the area of contact. Most of the resistance of the skin is in the outer (epidermis). For 1 cm2 of electric contact with dry, intact skin, resistance may range from 15 K to almost 1 M, depending on the part of the body and the moisture or sweat present. If skin is wet resistance drops to as low as 1% of the value for dry skin. The internal resistance of the body is about 200 for each limb and about 100 for the trunk(Thus internal body resistance between any two limbs is about 500 .

Electric faults in equipment

Many devices have a metal chassis and cabinet that medical personnel and patients may touch If the chassis and cabinet are not grounded, If a person touches the chassis and any grounded object, a macroshock results

Electric faults in equipment

ungrounded cases ungrounded cases

Macroshock due to a ground fault from hot line to equipment cases

Microshock hazards
Leakage currents:Small currents (usually on A) that flow between any adjacent insulated conductors that are at different potentials The leakage current in line operated equipment flows through: 1. The stray capacitance between the two conductors. 2. Resistive leakage current flows through insulation, dust, and moisture.

If the ground wire is broken, then the chassis potential rises above ground, and a patient who touches the chassis and has a grounded electric connection to the heart may receive a micro shock

Conductive paths to the heart

A patient is in danger of microshock only when there is some electric connection to the heart. The following clinical devices make patients susceptible to microshock:-

1.
2.

3.

Epicardial or endocardial electrodes of externalized temporary cardiac pacemakers Electrodes for intracardiac electrogram measuring and stimulation devices Liquid-filled catheters placed in the heart

Microshock via ground potential differences

A patient in the intensive-care unit (ICU) who is connected to an ECG monitor that grounds the right-leg electrode to reduce 60 Hz interference. In addition, the patients left-ventricular blood pressure is being monitored by an intracardiac saline-filled catheter connected to a metallic pressure sensor that is also grounded. Assume that these two monitors are connected to grounded three-wire wall receptacles on separate circuits that can come from a central power-distribution panel many meters away. A microshock can occur when any device with a ground fault that does not open the circuit breaker is operated on either circuits

Electrical-safety codes and standards

A code is a document that contains only mandatory requirements. A standard also contains only mandatory requirements, but compliance tends to be voluntary, and more detailed notes and explanations are given. Standards are designed for voluntary use and do not impose any regulations. However, laws and regulations may refer to certain standards and make compliance with them compulsory. A manual or guide is a document that is informative and tutorial but does not contain requirements

Limits on Leakage Current

Limits on Leakage Current for Electric Appliances

one fault is applied to the equipment to see what happens

Basic approaches to protection against shock

There are two fundamental methods of protecting patients against shock:1. The patient should be completely isolated and insulated from all grounded objects. 2. All sources of electric current and all conductive surfaces within reach of the patient can be maintained at the same potential, which is not necessarily ground potential In practical neither of these approaches can be fully achieved so we used : Grounding system Isolated power-distribution system Ground-fault circuit interrupters (GFCI) Reliable grounding for equipment Reduction of leakage current Double-insulated equipment Operation at low voltages Electrical isolation Isolated heart connections

For the power distribution For the equipment

Protection: power distribution

Grounding system:-

A grounding system protects patients by keeping all conductive surfaces and receptacle grounds in the patients environment at the same potential

The grounding system has 1. a patient-equipment grounding point 2. a reference grounding point 3. and connections

Protection: power distribution

The patient equipment grounding point is connected individually to all :receptacle grounds Metal beds Metal door and window frames Water pipes Any other conductive surface. These connections should not exceed resistance of 0.15

The difference in potential between receptacle grounds and conductive surfaces should not exceed 40 mV

Ground-fault circuit interrupters (GFCI)

GFCI disconnect the source of electric power when a ground fault greater than about 6 mA occurs In electric equipment that has negligible leakage current, the current in the hot conductor is equal to the current in the neutral conductor. The GFCI senses the difference between these two currents and interrupts power when this difference exceeds the fixed rating GFCI are not sensitive enough to interrupt microshock levels of leakage current, so they are primarily macroshock protection devices

Protection( equipment design)

Strain-relief devices are recommended both where the cord enters the equipment and at the connection between cord and plug. A convenient cord-storage compartment or device reduces cord damage are recommended . Equipment grounds are often intentionally interrupted by improper use of the common three-prong-to-two-prong adapter (cheater adapter).

Reduction of leakage current

Reduction of leakage current in the chassis of equipment and in patient leads is an important goal for designers of all line-powered instruments Special low leakage power cords are available (<1.0 mA/m).

Protection( equipment design)

Leakage current inside the chassis can be reduced by :1. Using layouts and insulating materials that minimize the capacitance between all hot conductors and the chassis 2. Maximizing the impedance from patient leads to hot conductors 3. Maximizing the impedance from patient leads to chassis ground

Double-insulated equipment
Primary insulation is the normal functional insulation between energized conductors and the chassis. A separate secondary layer of insulation between the chassis and the outer case protects personnel even if a ground fault to the chassis occurs. The outer case, if it is made of insulating material, may serve as the secondary insulation both layers of insulation should remain effective, even when conductive fluid is spilled. Double insulation protects against both macroshock and microshock.
Reinforced insulation is defined in standards as being a single layer of insulation offering the same degree of protection against electric shock as double insulation Supplementary Insulation: independent insulation applied in addition to basic insulation in order to provide protection against electric shock in the event of a failure of basic insulation.

Operation at low voltages

Most solid-state electronic diagnostic equipment can be powered by low voltage batteries (<10 V) or low-voltage isolation transformers. Some facts: Macroshock is avoided if the voltage is low enough to be safe even when the device is applied directly to wet skin. Low-voltage ac-powered equipment can still cause microshock if the current is applied directly to the heart. However, low-voltage ac equipment is generally safer than high-voltage ac equipment..

Isolated heart connections

The best way to minimize the hazards of microshock is to isolate or eliminate electric connections to the heart. Examples:1. Modern blood-pressure sensors are designed with triple insulation between the column of liquid, the sensor case, and the electric connections 2. Catheters with conductive walls have been developed that provide electric contact all along that part of the catheter that is inside the patient, so that microshock current is distributed throughout the body, not concentrated at the heart. 3. Catheters that contain sensors in the tip for measuring blood pressure and flow should have Low leakage currents.

Electrical-safety analyzers
Electrical-safety analyzers are useful for testing both medical-facility power systems and medical appliances These analyzers range in complexity from simple conversion boxes used with any voltohm meter to computerized automatic measurement systems with bar code readers that generate written reports of test results Analyzers features to consider are :1. Accuracy 2. Ease of use 3. Testing time 4. Cost.

Testing the electric system

When we test systems of electric distribution and line-powered equipment, we must consider the safety of both the patients and the personnel conducting the tests Tests of receptacles:Receptacles should be tested for Proper wiring Adequate line voltage Low ground resistance Receptacles tester (wiring ) Mechanical tension

Tests of the Grounding System in patient-care areas

The voltage between a reference grounding point and exposed conductive surfaces should not exceed:1. 20 mV for new construction. 2. For existing construction the limit is : 500 mV for general-care areas. 40 mV for critical-care areas. The impedance between the reference grounding point and receptacle grounding contacts must be :1. less than 0.1 for new construction . 2. less than 0.2 for existing construction.

Tests of electric appliances

Ground-pin-to-chassis resistance:The resistance between the ground pin of the plug and the equipment chassis and exposed metal objects should not exceed 0.15 during the life of the appliance During the measurement of resistance, the power cord must be: Flexed at its connection to the attachment plug Strain relief where it enters the appliance.

Ground-pin-to-chassis resistance test

Chassis leakage current

Chassis leakage current:Leakage current emanating from the chassis should not exceed :500 mA for appliances with single fault not intended to contact patients . 300 mA for appliances that are intended for use in the patient care vicinity. These are limits on rms current for sinusoids from dc to 1 kHz, and they should be obtained with a current-measuring device of 1000 or less

Chassis leakage-current test

The limits on leakage current apply whether the polarity of the power line is correct or reversed

whether the power switch of the appliance is in the on or the off position, and whether or not all the control switches happen to be in the most disadvantageous position at the time of testing

When several appliances are mounted together in one rack or cart, and all the appliances are supplied by one power cord, the complete rack or cart must be tested as one appliance

Leakage current in patient leads

Limits on leakage current in patient leads should be 50 A. Isolated patient leads must have leakage current that is less than 10 A. leakage current between any pair of leads or between any single lead and all the other patient leads should be measured.

Test for leakage current from patient leads to ground

Test for leakage current between patient leads

leakage current between any pair of leads or between any single lead and all the other patient leads should be measured

Test for leakage current between patient leads

Test for ac isolation current

The leakage current that would flow through patient leads to ground if line voltage were to appear on the patient should be tested This leakage current is called isolation current or risk current.

stressed

[1] John G. Webester, Medical Instrumentation application and

design, John Wiley & Sons Ltd, 1997. [2] IEC 60601-1, THIRD EDITION, 2002 CLASS I: passage 3.12 page 19 , CLASS II: passage 3.13 page 20 [3] http://www.seaward-groupusa.com/products/biomedicalsafety-testing/electrical-safety/biomedical-electrical-safetyanalyzer [4] http://www.itc.gov.hk/en/quality/scl/lf/lf25.htm