008 Handbook For Isolation Requrement

Do you wish to provide eIectricaI safety to your patients?...
Provide 'SWITCHTRONICS' make

Provides solated System to prevent shocks / Electrocution of Valued Patient.
Alerting surgeon. about leakage in instrument Under use.
Duel setting available in built.
For coronary operations - alarm at 2mA
As Leakage current above 2.5 mA leakage is considered Hazardous.
for general Surgery - alarm at 4mA
Leakage current as above 5mA leakage is considered Hazardous.

Easy to install.
Manufactured as per standards Laid by "Health Care Facilities NFPA99 &
NEC517 & UL1047. No special standards are provided by S .
Technical Assistance available.
Specially designed low leakage Transformers manufactured as per UL 1047.
Line solation Monitor as per UL1022.
MUST for patient care areas ; such as : OPERATION THEATERS, ICUs,
CCUs, CARDIO, VASCULAR LABS., DIALYSIS UNTS ETC.
ISOLATION PANELS
TMG G AM NPOMT GUMGTTUTE
Medicare Company
HAND BOOK
References:-
"NFPA" (
NATONAL FRE PROTECTON AGENCY), USA. NFPA No. 99
"NEC" (NATONAL ELECTRCAL COMMTTEE), USA. ARTICLE 517
"U L" (UNDER WRTERS LABORATORY),USA. UL 1022, UL 1048.
"HEALTH CARE FACILITIES" (HAND BOOK) BY "BURTON R. KLEIN.
"SQUARE D", USA. HANDBOOK

INFORMATIVE HANDBOOK
FOR
DOCTORS, PARAMEDCS, HOSPTAL MANAGEMENT

AND ENGNEERS
MR. K. J. PHADKE
DIRECTOR, M/S SWITCHTRONCS MEDICARE COMPANY
Medicare Company
HospitaI IsoIated Power Systems
Llectrical Safety for Patients
Contents:
1. HospitaI IsoIated Power System..................................................................................................3
Over view.................................................................................................................................3
..............History......................................................................................................................................3
..............Effect of leakage current..........................................................................................................4
..............Human Body reaction to Electric shock...................................................................................4
..2...EIectricaI Hazards in HospitaI......................................................................................................5
.............General........................................................................................................................... ........ 5
.............Shock Effects............................................................................................................................5
............ Patients ...................................................................................................................................5
.............Leakage Current.......................................................................................................................6
.............Recommendation for Electrical Safety......................................................................................7
.............Procedure for Electrical Safety should include:........................................................................ 7
..3..Standard & Codes .........................................................................................................................8
.............General .................................................................................................................................. .8
.............NFPA 99...................................................................................................................................8
..............Article 517 National Electrical
Codes........................................................................................................9
..............NFPA-70..................................................................................................................................9
..............Give Special consideration on the following potential susceptible.........................................10
4..Why IsoIated Power System?....................................................................................................11
..............General...................................................................................................................................11
..............Grounded System..................................................................................................................11
..............Ungrounded System...............................................................................................................11
5 Grounding (Earthing) .................................................................................................................15
..............General..................................................................................................................................15
............. nstruments Power Cord........................................................................................................15
............ Permanent .............................................................................................................................16
..............Ground Jack..........................................................................................................................16
..6..IsoIation Transformer...................................................................................................................17
7 Design Assistance for IsoIation system.......................................................................... .........18
System ..................................................................................................................................18
System size............................................................................................................................18
Capacity of System................................................................................................................18
Wiring and ............................................................................................................................19
System Design......................................................................................................................19
Operation Theater Layout......................................................................................................19
Field Test and nspection.......................................................................................................20
8 EIectricaI Maintenance................................................................................................................21
solated Power System....................................................................................................... ..21
Adopter and Extensions Cord................................................................................................22
Medical Equipment Maintenance..........................................................................................22
Leakage Current...................................................................................................................23
Testing Program.....................................................................................................................23
9 To Know More about Our Products............................................................................................24
solation Panels.....................................................................................................................24
General.........................................................................................................................24
Location.........................................................................................................................24
Components...................................................................................................................25
Transformer..........................................................................................................25
Circuit breaker........................................................................................................25
Line solation Monitor (LM)...................................................................................25
LEAK GARD (Microprocessor based LM).............................................................26
Operation Theater Panel........................................................................................27
Duel Display Digital Clock Timer............................................................................................27
Surgical Chronometer.............................................................................................................27
Ultra Sonic Cleaners..............................................................................................................28
Patient Safety Remote Switch ................................................................................................28
Patient Safety Nurses Call stem............................................................................................28
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Medicare Company
HospitaI IsoIated Power Systems
Overv|ew
This Handbook has three main purposes.
To explain to the Hospital Management the
importance of need of providing solation System.
To guide the Engineer in the application of
hospital ungrounded (unearthed) systems.
To guide Hospital in having effective system
providing guidance for design and selection of
proper equipment.
"Switchtronics Medicare Co." have developed the
system to cater to this requirement and we are making
this equipment compatible to US standards "HeaIth care
faciIities" and to specifications.
"Switchtronics Medicare Co." manufactures
special solation Transformers having reIiabiIity, Iow
noise IeveI and Iow Ieakage current.
This Hand book is not to advertise our products but to
make you aware of the importance of the system,
explaining in common man's language. This, also
enlightens one about the codes and standards of US,
specially made for patients safety. Unfortunately these
are being ignored in ndia though recommended in NEC
1985.
This information about the codes and standards is
with the latest revision.
Any hospital considering changes in the electrical
system in critical patient care areas should obtain the
services of electrical consulting engineer.
Today's technical complexities of hospital requires all
parties concerned to have a thorough understanding of
hospital's objective. This is the only way in avoiding
purchase of unnecessary equipment.
Time spent for proper and good planning will result in
large dividends, provided following parties are involved.
UL
n the past, surveys done in USA and other
western countries have shown that the number of
explosions in the operation rooms and number of
electrocuted patients had gone up by alarming rate
On investigations the authorities determined that
the major causes of these accidents fell into two
categories, namely:
Man made electricity
static electricity (approximately 75 to 80 % of
recorded cases)
Due to these happenings, a committee was
formed to investigate the causes behind these mishaps.
n the year 1944, NFPA (National Fire Protection
Agency) published standards of 'Safe Practice in
Operating Rooms".
n 1949 NFPA appointed a committee to revise
1944 standards. This committee published new
standard NFPA No.56A, the bases of present
standard.
The National Electrical Code (NEC) of 1959 firmly
establish the need for ungrounded isolated distribution
system. and incorporated the NFPA No.56A. Major
revisions were done in 1970, 1971, 1973, 1978

n 1982 NFPA incorporated all these standards
and complied the standard as 'HEALTH CARE
FACILITIES". This standard is NFPANo.99.
The material covered originally by NFPA 56A is
now located in chapter 3 of NFPA No.99.
NFPA No.99 was updated in 1984, 1987, 1990, and
1993
This NFPANo.99 is also incorporated by NEC
(NationaI EIectricaI Code) in USAas NECArticIe 517.
These standards and code ie. NFPA No.99 and
NECArticIe 517 are made compulsory for application in
USand other Western Countries for hospitals.
ncrease in the use of electrical and electronic,
diagnostic and treatment equipments has lead to a
correspondi ng i ncrease i n el ectri cal safety
requirements. This has resulted in use of 'Isolated
Ungrounded System" in the Hospital since 1971.
H|sfory
CHAPTER 1
Consulting engineer,
Chief of surgery,
Chief of anesthesiology,
Cardiologist.
Hospital engineer,
Hospital administrator,
Page no.03
Medicare Company
Fffecf of |eokoge currenf
The current passing through a human body or object
to the earth (ground) is known as leakage current. This
leakage current can lead to electrocution or fire.
With this consideration general purpose electrical
usage is protected by providing RCD (residual current
device) generally known as ELCB (earth leakage circuit
breaker
As per ndian electrical regulations and Sstandards
ELCBs are to be provided to protect system leakage
current by tripping with increase in leakage current.
These are in three categories,
Leakage Purpose
Current
1) 30 mA For use as an additional
protection against direct contact
which a normal human body can
sustain
2) 100 mA for larger installations like hotels,
Shopping complex, etc where
protection against indirect contact
is provided
3) 300 mA for large installations such as
factories as these installations
have combined system leakage
current high.
Ihe humon body's reocf|on fo e|ecfr|c shock
Electrical shock currents, passing through the
human body, confuse the internal nervous system. This
causes the body to react to the passage of current
through it as follows ;
These are
Intensive care units (ICUs),
Coronary care units (CCUs),
Emergency departments,
Special procedure rooms,
Cardiovascular Laboratories,
Dialysis units.
Page no.04
A tingling sensation is felt.
Muscle spasm and
tightening occurs.
The heart may fibrillate;
severe shock is felt. This
could be lethal if
sustained.
Lethal, fibrillation of the
heart occurs.
3mA
10-15mA
25-30mA
>50mA
n ndia "National Electrical Code 1985, in
Medical establishment section recommends
solation system in various departments of Hospital
for patients safety. As this being not Mandatory it is
neglected. Now is the time for us to implement this
to match safety standards to international level, for
benifit of our valued clients, the patients.
Very few of hospitals in ndia, with recommend-
ations of their Consutants, have provided these
systems but only in operation theaters to follw
nternational standards.
A vaIued patient is for a Ionger time in ICU,
ICCU,where he is subjected to various eIectricaI
/eIectronic gadgets, and chances of getting
eIectrocuted are more ,where isoIation system is
more essentiaI.
With increase in the use of Electrical and
electronic equipment in the hospital and other
patient care areas such as Laboratories, Consulting
rooms for diagnostic and therapeutic purposes, now
it is absolutely necessary to have knowledge of this
subject in detail.
Health Care Facilities recommend "Isolated
Ungrounded Power Systems". The purpose is to
alert the surgeon and medical staff to protect their
valued patient from electrical shock.
The NFPA No.99 "HeaIth Care FaciIities" standard
and code recommend "Isolated Ungrounded
Power Systems" to be used where ever the
patient is in vicinity of electrical devices.
Medicare Company
Electrical 'power is blessing to mankind ,like fire.
Various electrical and electronic equipments add
comfort to human life.
Electrical power can be disastrous at times. t can
cause electrical accidents such as,
FIRE BURNS SHOCKS
This article is dedicated to a "SHOCK", which is a
common electrical accident.
t is a general belief that shocks are due to voltage
to which the man is exposed, but it is not true,
Consider a common event. A TV mechanic while
repairing removes a charged condenser. A child
accidently touches both the wires & experiences shock.
Here no voltage is involved, but he experiences shock,
because the charged condenser discharges through his
body and the current is passed. This current is
responsible for the shock experienced..
. The aetiology of shock is the current from the device
which passes through the body
Nowa days ELCB (Earth leakage circuit breaker) is
used to prevent shock from electric equipment which is
leaky.
These ELCBs as per IER (ndian Electricity
Regulations) and IS (ndian Standards) are available in
value of leakage current 30mA, 100mA,& 300mA (mA -
Mili Amps) For a normal human body, a leakage current
upto 30mAis considered to be safe.
The human body acts as a heavy resistor to current
flow. Average adult has a resistance between 1,00,000
(ohms) to 10,00,000 , measured hand to hand on a
multimeter. This resistance depends upon body mass
and moisture content.

The threshold of perspiration for an average adult is
1mA. At this current value, tingling through fingertips is
experienced.
For 10-20 mA current the person may experience
muscle contraction finding it difficult to release his/her
hand from the electrode.
A current of 50 mA passing through body causes
pain, at times a fainting attack & exhaustion. f 100mA
leak is present, it may cause ventricular fibrillation.
FAIlFNI5 5AFFIY;
We have seen the effect of various current leaks
on a healthy average human.
n the hospitals we deal with patients. The level of
leakage current which harm a patient is amazingly low.
Most susceptible patient is one who is exposed to
external conductors, diagnostic catheters and other
electrical devices near the cardiovascular system.
Electrical or electronic devices used during surgical
procedure bypasses the patients body resistance &
exposes the patient to electrical current from
surrounding devices.
The highest risk is to the patients undergoing
cardiothoracic surgery.
The threat of electrocution increases when current
carrying device is used within the circulatory system
;(equipment such as cardiac monitors, dye injectors,
cardiac catheters, etc.) Now a days the use of such
equipments has increased.
Other factors contributing to electrical susceptibility
are hypokalemia, acidosis, elevated catecholamine
levels, hypoxemia &presence of digitalis.
Adult patients with cardiac arrhythmia could be
electrocuted by misuse of pacemakers connected
directly to myocardium
Children are more susceptible to shock because of
lower body resistance due to their smaller body mass
n the USA many articles have been written
regarding current levels which are considered lethal for
catheterized &surgical patients.
EIectricaI Hazards in HospitaI
CHAPTER 2
5hock Fffecfs
Page no.05
Medicare Company
G
BK
R
TRANS.
INSTRUMENT LEAKAGE
POWER CORD
FIG. - 1
UNSHIELDED SHIELDED
LEAKAGE ORIGINATION
FAULTYUSAGE FIG. - 2
FAULTY
POWERCORD
2-WIRE
PLUG
CONVERSIONOF
3-PINTO2-PIN
3 COREWIRE
GROUNDOPEN
Considerable controversy exists about the actual
dangerous level for a patient who is in direct connection
with the device. Minimum dangerous level is 10 A
(Micro Amps) with a maximum of 180 A. Whatever be
the level between 10 & 180 A, it is still fraction of the
level that is dangerous as far as medical attendant
attending the patient.
t is believed that the resistance between the
patient's heart & external body parts is approximately
1000 (ohm).
This information helps one to conclude that patient's
environment is a prime target for electrical accidents. n
no other situation i.e. industrial, residential etc. does one
come across negative factors such as low body
resistance, increased use of life saving electrical devices
& good electrical conductors like blood, urine, saline,
water.
Given this combination it is indeed a challenge to
increase electrical safety for patient areas.
LFAKAGF CJkkFNI5.
The figure 1 below show how leakage current
develops.
Leakage may be due to insulation failure of wires
(main cord) or apparatus.
t is dangerous to use main cord without earth
conductor (Ground Conductor).This is commonly seen
with use of main cord with 2-pin plug, improper use of
receptacles such as 2 wire extension cords & use of
damaged cords &receptacles.
The devices used in the vicinity of the patient, while
operating perfectly, may still be dangerous to the patient.
The reason being, that every piece of electrical
equipment produces leakage current.
Leakage current is any current including capacitively
coupled current, not intended to be applied to the patient,
but which may pass from exposed metal parts of an
appliance to the patient. Normally this current is shunted
around patient via ground conductor in the main cord.
However, as these current increases it can be dangerous
to the patient.
As per US Standards, nowadays 'Hospital
Isolated systems" are commonly used to protect
against electrical shock in many areas such as:
Intensive Care Units (ICUs)
Coronary Care Units (CCUS)
Emergency Departments
Special procedure rooms
Cardiovascular laboratories
Dialysis Units
Fig.2 below illustrates few of these
Page no.06

Medicare Company
Without proper use of grounding, leakage current
may reach 1,000Abefore the problem is perceived.
n this chapter it is evident that, a leakage current of
10-180A can injure a patient by causing ventricular
fibrillation.
There are no perfect electrical system or infallible
equipment to eliminate hospital electrical accidents.
However, careful planning on the part of consulting
engineer, architect, contractor, and hospital personnel
can reduce electrical accidents to nearly zero.
Hospital electrical equipment may receives physical
abuse; therefore it must be properly maintained to
provide electrical safety for patient and staff.
kecommendof|ons for e|ecfr|co| sofefy.
1. Regularly check if all the wall receptacle are proper
and their polarities correct..
2. Verify the grounding of conductive surfaces
(metal surfaces) in all patient areas at regular
intervals.
3. n case electrical devices such as tooth brushes
shavers ext are used for the patient ,they should
be battery operated instead of electrical.

4. Sealed and totally insulated remote controls for
. use in patient bed are advisable.
5. We recommend the use of bed rails made of
Plastic or covered by insulating sleeve.
Frocedure for e|ecfr|co| sofefy shou|d |nc|ude:
Page no.07
Medicare Company
Standards and Code
CHAPTER 3
n ndia NEC 1985 elaborates in Medical
Establishment section recommendation of solated un-
Grounded system for various departments in Hospital
for electrical safety for patient.
The standards presently available and accepted in
European countries &worldwide are as available in USA,
& are mandatory almost all western countries as well as
Middle east
The code and standard which are referred over here
are of USAas they are elaborated the same.
We recommend Consulting Engineers and Hospital
Management to keep these for their reference.
We are summarizing few of the important points of
the code & standards applicable to 'Hospital Isolated
Ungrounded Distribution system".
Detailed study of these code & standards is required
for effective design of the Hospital project.
NFFA No..
Introduction -
(1) This code is included as a reference in
NationaI EIectricaI Code ArticIe 517 in USA.
(2) NFPA No. 99 addresses Fire, Explosion &
Electrical safety in Hospitals.
t Consolidates 12 NFPA different
documents or standard into one document
Anesthetizing Location Classifications.
The first type of location is that which is flammable
because explosive anesthetic agents used. The location
must be designed to comply to the NationaI EIectricaI
code ArticIe 501.
There are many other requirements for the
flammable anesthetizing location; they are discussed in
Chapter 12 of NFPA No. 99. Explosive anesthesia is
now virtually non-existent in the United States.
Therefore, this Handbook does not cover the flammable
location in any detail.
APatient care area that is normally subject to wet
condition while patient is present. This includes
standing fluids on the floor or drenching of the work
area, either of which condition is intimate to the
patient or staff. Routine housekeeping procedures
and incidental spillage of liquids do not define a wet
location.
The governing body of the Hospital will make the
determination of a '"Wet Iocation", using the following
definition.
Non-fI ammabI e anestheti zi ng I ocati on
requirements are also covered in Chapter 12 of NFPA
No.99. A permanent sign must be displayed at the
entrance to all nonflammable locations. t must state that
only non flammable anesthetics can be used in the
room.
Non-fIammabIe anesthetizing Iocations can be
further divided into locations that are subject to
becoming 'wet' and those that are 'not wet'. The
location requires special protection against electrical
shock. The allowable protection is as follows:
Ground-fault circuit interrupter if first-fault
conditions are to be allowed to interrupt power.
solated power systems (PS) if first-fault
conditions are not to be allowed to interrupt
Power.
NFPA No.99 defines the items in an anesthetizing
location which must be powered from the isolated
ungrounded system. Since these section is subject to
individual interpretation by local code authorities, it is
essential to work closely with these authorities before
selecting the equipment to be powered from standard
grounded systems. This is especially important when
ordering permanent installed equipment to be powered
from standard grounded systems such as X-ray
apparatus. NFPANo. 99 and the NECArticIe 517 allow
the grounded circuit providing power to an isolated
system to enter the non-hazardous area of an
anesthetizing location. However, ungrounded wiring and
grounded service wiring cannot occupy the same
conduit or raceway.
Page no.08

Medicare Company
The primary and secondary solation transformer
cannot exceed 600 V (volts) in any isoIation system
supplying an anesthetizing area or other critical care
patient area. The secondary circuit conductors must be
provided with an approved over current protective
device in both conductors of each branch circuit.
Paragraph 3-4.3.2 of NFPA No.99 sets the limits of
impedance to ground of the isolated system and the
instructions for testing to determine compliance with the
standards. The size of the isolation transformer should
be limited to 10 KVA or less
Even in the most sophisticated operating rooms, the
equipments load rarely exceed 5 KVA. When writing
specifications, we suggest that choosing an isolated
transformer rated at 5KVA, having a continuous
overload capability of 25% to 50%.(ie 7.5 KVA) The
transformer will thus be designed to operate at a
relatively cool normal temperature, but will still be able to
handle future demands which exceed today's norm.

Paragraph 3-3.4 of NFPA No. 99 'Line Isolation
Monitor" (Ground detector) is require to monitor the
isolated system. The limitation of total system Hazard
current is set at 5 mA
Conductors for the isolated ungrounded systems
must be color-coded::orange for conductor # 1, brown for
conductor #2, and green for the grounding (earthing)
conductor. Where three phase isolated systems are
used, the third color, or that for conductor # 3, must be
yellow. (As per S these colors should be Red and Black
for single phase & Red Yellow Blue for three phase
supplies.
The grounding system is specified in paragraph 3-
3.5 of NFPA No. 99, Another chapter deals with this
subject in detail.(See chapter-6)
Arf|c|e 517, Nof|ono| F|ecfr|co| Code
NFFA No. 70.
ArticIe 517 defines three types of patient care
G C as eneral are Are : i ed roo
(Pat ent b ms,
i oo l cs,
examin ng rooms, treatment r ms, C ini
d mi s an si lar area .)
In these areas ,the patient may come in contact with
ordinary appliances, such as nurse call systems,
electrical beds, examining lamps, telephones and
entertainment devices. Patient may also be connected
to electro medical devices such as heating pads, EKGs,
drainage pumps, monitors, otoscopes, opthalmoscopes
and IVlines.
Critical care areas: (Special care units,
intensive care units, coronary care units
angi ography l aborat ori es, and cardi ac
catheterization laboratories, delivery rooms and
similar areas). In these areas patients are
subj ected to i nvasi ve procedures and
connected to line operated electro-medical
devices.
Wet locations: Patient care areas normally
subject to wet conditions while patients are
present. This includes spilled fluids on floor
or drenching of the work area, either of which
condition is intimate to the patient or staff.
Routine house keeping procedures and
accidental spillage do not define wet
location. Critical care and general; care areas can
also be considered as wet areas. The governing
body of hospital determines whether
a location is to be considered "Wet".
As with NFPA No. 99, anesthetizing locations
are classified as:
Hazardous locations which use flammable
anaesthetics. These locations must meet
Class 1 division requirements and must have
isolated power systems.
Other than hazardous locations, allowing
the use of grounded systems.
Both types of anaesthetizing locations must be
further classified as "wet" or "not wet" areas. f
designated as wet location ,extra electrical protection is
required. The acceptable protection is the same as that
defined for NFPANo. 99.
Page no.09
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The designation of all of above mentioned areas in
the 'Health Care Facility" is the responsibility of
facility's governing body. Before a designer can chose
the proper electrical distribution system for a hospital,
the governing body of hospital must inform the designer
about the location. t requires close coordination with
medical staff of the faculty, to ensure that the designer
understands current medical procedures as well as
future procedures.
The National Electrical Code recognizes that
hospital patients are more susceptible to electric shock
than normal healthy individuals. Consequently, patients
must be protected through use of special procedures.
The special procedures and equipments required,
become more complicated with the degree of electrical
susceptibility of the patient.
The hospitaI administration and designer are
responsible for determining the degree of patient
susceptibility and selecting the correct equipment. This
selection procedure requires close communication
between the hospitaI administration, medicaI staff
and the consuIting engineer.
t is generally accepted that any time the normal body
resistance of patient is by passed, the body becomes
electrically susceptible. Degree of susceptibility varies
for electrical probe or catheter connected to the heart
muscle, to the electrode attached to the outer skin after
conductive paste is applied. Patients who are
anesthetized, or demobilized through illness, restraints,
or drug therapy, also have a higher degree of electrical
susceptibility than normal individuals. Such patients can
not avoid or disconnect themselves from an electrical
hazard that would be relatively harmless to a normal
person
For example a patient who has impaired nerve
sensitivity can not detect heat. A cup of very hot coffee
would not be a hazard for a normal person, however, it is
a potential disaster for the nerve impaired individual.
Certain medical conditions may render a patient
particularly vulnerable to electric shock. These patients
may require special protection even though their
normal body resistance has not been intentionally by
passed.
G|ve spec|o| cons|derof|on fo fhe
fo||ow|ng pofenf|o| suscepf|b|e pof|enf
Acute care beds,
Angiographic labs.,
Cardiac catheterization labs.,
Coronary care units
Delivery rooms,
Dialysis units,
Emergency room, treatment areas,
Human physiology labs.,
Intensive care units,
Operating theaters,
Post operative recovery rooms.
Page no.10

Medicare Company
Why IsoIated Power System ?
CHAPTER 4
Red Wire
BIack Wire
Iron
Fig.- 8
Red Wire
BIack Wire
Green Wire
Iron
Fig.- 7
n viewof such important subject discussed in earlier
chapters. We now give the brief technical information
about Ungrounded, Grounded &IsoIated systems.
Reason - The body of iron is connected to Ground
potential so Resistance is 0 or negligible.
This short circuits person's body resistance say
approximately 1,00,000 (ohm). So person's body
(Resistance) is shunted by green wire hence the current
passes through the wire &not through human body.
The term isoIated system may apply to many
systems in hospital such as management of patients
having contiguous (communicable) disease. However in
this chapter we discuss Electrical solated systems.
IsoIated systems explained here is 'Isolated
Ungrounded Electrical System".
When SpeciaIized ConsuIting Engineers &
HospitaI system Engineers advise & establish the
system knowing the importance and requirements they
find it difficult to pass on this knowledge to lay man who
will be operating &maintaining of the system.
Consider most simple and experienced example as
explained below:
Grounded system.
The system used at residence is with 230 Volts
grounded supply which has 3 insulated wires -
Red -Phase or 230 V potential
Black - Neutral or 0 V potential
Green - Earth or Ground.
Normally wires are called : Red LVE, Black
NEUTRAL&Green EARTH.
Fig-8 With 2 pin supply -The iron body is not
connected to ground and the current will flow through
person's body & he will feel a shock. ntensity of shock is
how much leakage current passes & this may be fatal &
may electrocute the person.
n case Red wire and Black wire
gets connected (Short-circuited)
Or
Red wire touches Green wire or
ground (earth)
Fuse will
blow
Or
MCB will
trip
Connect Red wire to Live point &
other wire to Black or Green
point.
Bulb will
glow.
Fig. 3
Fig.4
Fig
5 & 6
Consider a case of leaky iron or equipment,
nsulation between Red wire/element & body is
damaged.
Fig-7 f 3 pin cord is used touching iron body though
leaky will not give the shock to person using the
Red Wire
BIack Wire
Green Wire
BIown Fuse
Fig - 3 Fig - 4
Red Wire
BIack Wire
Green Wire
BIown Fuse
Red Wire
BIack Wire
Green Wire
Lamp
Red Wire
BIack Wire
Green Wire
Lamp
Fig -5 Fig.- 6
Page no.11
Medicare Company
The grounded supply is given to one coil known as
primary. Other coil is electrically isolated (nsulated)
and ungrounded which will work as supply for
instruments.
TRANSFORMERCONSTRUCTION Fig.-9
PR.
WDG.
WDG.
SEC.
RECEPTACLE
BIack Wire
Red Wire
ISOLATING
TRANSFORMER
CORE STEEL
This is because the primary coil induces the current
in secondary coil by electro magnetic induction.
There is no direct electrical connection between
primary &secondary coils.
t is possible to convert grounded system to
ungrounded system. There are many ways to achieve
this. Most common & economical among them is by use
of an "solating Transformer.
lso|ofed 5ysfem
Refer the Fig - 9 below.
Jngrounded 5ysfem
nsulated wires enclosed in grounded metal conduit.
Electrical components within permanently installed
electrical equipment.
Electrical components within portable devices
housed in grounded enclosures (commonly
referred to as the capacitance of the system).
5Y5IFM COMFAkl5ON.
Take case of Fig-7 & 8 as the ground is not
connected to secondary winding no current will flow
through the persons body handling leaky iron
(instrument). Also the Fig-3 &5 are still applicable as the
fuse will blow&bulb will glowrespectively.
While Fig -4 & 6 are not applicable due to
ungrounded system as ground is not connected to
secondary coil.
Imperfect Isolation
n the above paragraphs we have seen advantages
of IsoIated Ungrounded system.
n practice this can not be achieved.
Consider a transformer is connected to several
receptacles, various equipment are connected through
Because an isolated system can easily become
grounded without giving warning or any indication to the
user, there must be a way to monitor the integrity of the
isolation in the system. With this monitoring, there must
be some warning when the system becomes grounded.
When the system becomes partially grounded, the
warning is still necessary, but a limit must be set for the
warning to be sounded. Limits are established by codes
and standards, specially the National Electrical Code
of USA.
See the codes and standards given in "Chapter 3
for additional information. Codes and standards state
that an alarm must sound and display (it must be
audible and visible). The alarm must activate when the
integrity of an isolated ungrounded system degrades to
the extent that 5mA of current will flow from either
secondary conductor to ground through a zero
impedance fault.
For the instrument information to achieve this
requirement see chapter 5.
magine one of the equipment is leaky, this means
the phase is connected to the ground partially or fully
depending on leakage current .
Due to this the whole system is connected to ground
by the leakage current & hence the system becomes
partially grounded or fully grounded.
Keep in mind that there are no perfect insulations.
What we commonly call "insulators such as rubber or
plastic coverings on wire, are actually just poor
conductors. All materials conduct electricity to some
degree. Thus, everything attached to the secondary
conductor of an isolating transformer will partially ground
the system. Examples of items that partially ground the
system, without making direct connection to ground, are:
Different receptacle.
Page no.12

Medicare Company
Line IsoIation Monitor ( LIM )
CHAPTER 5
Code & standards not only specify the limits within
which an isolated ungrounded system must operate, but
also the method for checking system integrity. A Iine
isoIation monitor(LIM) is required to continuously
check the resistance (impedance) of the total isoIated
ungrounded system to ground. t must respond audibly
and visibly when the impedance of the system degrades
to the extent that five milliamperes of current will flow
through either conductor of the system to ground in a
zero impedance fault.
Several types of line isolation monitors are
available. Reviewing them not only help determining
requirements for a system, but also helps to identify the
equipment currently used in the hospital.
There are several points to consider
The alarm condition does not necessarily mean
that there is imminent danger to the patient or any
one else. The alarm simply indicates that the
system has reverted to grounded or partially
grounded system, which is the same system
present in the rest of the hospital. Correction of the
problem as soon as possible is essential; but it is
not necessary to interrupt the procedures that are
being conducted when the alarm had gone on.
The LIM does not interrupt electrical service.
Loss of integrity in the ungrounded system does
not affect the operation of life support devices.
An activated alarm does not mean that there is
hazardous current flowing. The LIM is a
predictive device; by sounding an alarm, it
predicts that 5mA of current could flow from one
conductor of the isolated system to ground if a
path for that current is provided. This represent
that a second fault or electrical failure must be
present in the system before a true hazardous
Condition exists.
The LIM is equipped with a meter (also required by
code) that gives continuous indication of the system's
condition. The meter is calibrated in milliamperes (mA) of
current; its pointer indicates howmuch current could flow
from either conductor of the isolated system to ground if a
path was provided.
Note : Keep in mind that this meter merely predicts
the possibility of the condition; it does not indicate that
current is actually flowing.
Iypes of LlMs
Ground Detector.
The first unit is not actually a LIM, but rather the
original "ground detector": which is essentially a
balanced bridge device. Ground detectors were
standard equipment until about1970, so there are many
of these units still in use. nexpensive to built and reliable
because of its simplicity, the ground detector is
unaffected by and does not create any radio frequency
(RF) interference. However, it only recognizes
unbalanced resistive or capacitive faults. t cannot
recognize a partially grounded system. This inability to
sound an alarm (to recognized balanced fault systems)
is the main reason why codes and standards no longer
allowits use.
Systems in the field have been observed to allow as
much as 30mA(300,000 A) to flow from line to ground
without sounding an alarm. This hazardous condition
can cause an electrical hazard to the patient or medical
staff.
Ground detectors if installed before 1971 are
permitted to be use. Though not compulsory., hospitals
should consider to modernize these with current
standard equipment.
Dynamic Ground Detector. The first dynamic
ground detectors, now called line isolation monitors,
were developed in Canada. They are called dynamic
ground detectors, as opposed to static ground detectors,
because the measuring circuit continually switches
between the two isolated conductors and ground. n this
way, it overcomes the greatest inadequacy of static
ground detectors the inability to recognize and sound an
alarm at the occurrence of an excessive balanced fault
condition.
This type of LIMconnects to grounds through a high
resistance so that it can measure the impedance of the
total system, thus grounding it. With nothing connected
to the system except the LIM, 1000 A could flow from
either line of the isolated system to ground. The LIM is
calibrated to sound an alarm when 2000A flow from
either line to ground approximately one half of capacity of
total system is dedicated to LIM.
Page no.13
Medicare Company
Present generation of Line IsoIation monitors is
where the internal leakage current dedicated to LM is to
the tune of 100 A This is due to higher impedance
connection to ground. Rather than using half the system
capacity of LM the units contribution is less than 10% of
system capacity. Switchtronics Iine IsoIation Monitor
LIM "981" is based on above system.
Line Insulation Monitors (LIMs) are
Now recommended in ndia by various Hospital
Electrical Consultants. Switchtronics Medicare
Company are supplying these along with specially
designed lowleakage ISOLATIONTRANSFORMERS.
The equipment is called "ISOLATION PANELS
FORHOSPITALS"
You are requested to contact them. Their addresses
is as under:
SWITCHTRONICSMedicare Company ;
A1, JEEVANSONA, LNKNG ROAD,
SANTACRUZ (WEST),
MUMBA-400054..(NDA).0
PHONES; 91 22 2661 6633,
MOBLE: 91 632 411 6633
Switching between isolated conductor & ground
system which is used in LIM 981 causes interference on
isolated system.
Page no.14

Medicare Company
ECGMonitor
Possible
Broken
Ground
Attendant contacting
bed to pacemaker
catheter terminal
CHAPTER 6
Grounding (Earthing)
Electrical standards & rules applicable in entire
nations including "Indian Electricity Rules" regards
Grounding , commonly known as earthing, to be the
most important factor in safeguarding human life for
shocks, fires etc.
The green wire in the cord prevents static potential
because of 0the static charge from reaching dangerous
values on non current carrying parts such as instrument
body. (t may be present evenon insulated material,
generally known as shock proof equipment.)
Rigid standards are laid, that one has to maintain
minimum possible resistance in normal ground and earth
station. This is known as permanent earthing
(grounding) system.
None of the electrical equipments are 100% leak-
proof.f the grounding system is proper the leakage
current goes directly to ground , this enables the ELCB
to operate and trip at rating chosen for tripping i.e. 30mA,
100mA Or 300mA, when leakage current exceeds
respective value (Read Chapter 1 to understand in more
details.)
n "HeaIth Care FaciIities" code & standards of
NFPA and NEC, Grounding is considered with utmost
importance, particularly in IsoIated Systems.
Grounding should be done very properly following
rigid specifications & should be checked periodically.
This aspect is an important safeguard against shock &
eIectrocution as well as fire in most susceptible areas
i.e. Patient care &anaesthetizing areas.
Proper earthing, as per specifications dissipates
static electrical charges and shunts normal leakage
current as well as fault current away from patient &
attendants.
One is aware of the fact , that if a person
experiences shock and if any other person touches him
the other person experiences shock as well. This is
because the leakage current passes from the first
person to the second person as the leakage current
increases because the two body resistance are in
parallel which reduces the actual resistance.
lnsfrumenfs Fower Cords Ground|ng :
n Chapter 1 it has been brought to your notice why it
is important to have 3 wire cord and not 2 wire cord for
instruments in use. The Green or Ground conductor of 3
wire cord is necessarily to be connected to earth i.e.
Ground.
Static charge have tendency to accumulate & the
charge may reach to large value to discharge
automatically as a electric static spark.
This charge could prove fatal or hazardous
particularly to the patients if it discharges as shock and
also to the attendant if it ignites some flammable gas or
material. The ground conductor provides a path for
leakage current which could be conducted to electrical
appliance case. Leakage current value will be
dependent on appliance characteristic & insulation.
Leakage current will make potential difference between
pieces of equipment and could flow through vital organs
of patient provided patient current path is established.
For e.g, during cardiac catheterization, small
amounts of current could cause ventricular fibrillation.
Fig., from Square D Hand book,. Show how this leakage
current path is established
Connecting earthing or Ground wire to earth does
not serve the purpose. t is important to select right
section of copper wire conductor. As the areas of wire
decreases the resistance per meter of wire increases
and the resistance of wire plays important role.
Example :1.0 Sq. Mm. wire have 0.0e21 /meter,
while 1.5 Sq. mm wire have 0.014 /meter
Page no.15
Medicare Company
'Health Care Facilities" code &Standards requires,
that in critical areas no more than 40 mV millivolts, exist
between reference point i.e. Ground Bus , and the
exposed conductor surfaces i.e. Body of instrument in
patients vicinity.
So equipment cord of 3 meters and conductor1.0 Sq.
mm. will not develop fault current.635 mA fault current
without exceeding the 40 mV potential difference
required
The fault could developed through poor cord
insulations on the leakages of the components. t is not
easy to prevent these faults but what you can achieve is
to keep the magnitude of these faults well within limits by
use of isoIation power system.
The initial line to ground fault can be kept as low as
5mA if the system is in safe conditions. The power cord
ground wire can easily sustain 5mA fault & stay well
within the requirements of NFPA No.99 & NationaI
EIectricaI Code .ArticIe 517
FFkMANFNI FAkIHlNG :
As per standards laid down, all the electrical devises
should be connected to ground system properly. This
provides equipotential ground plan for patient.
Health care facilities codes & standard emphasizes
that all conductive surfaces within patient's vicinity must
be properly grounded.
Grounding system permits intermingling of electrical
appliances located near or applied to the patient without
hazard of leakage current to the patient.
By inter connecting all metal surfaces within the
patient area, potential difference between metal surfaces
can be kept to minimum..
Since all the metal surfaces are at same potential
level to reference ground no circulation of current is
possible , because for current to pass, potential
difference is required.
Check up equipotential Grounding laid down by
'Health Care facilities" code & standards NFPANo.99
& NEC .These grounding conditions differ fromgeneral
grounding standards.
The resistance of conductor for grounding should
be less than 0.1 Ohm.
The potential difference between exposed
conductive surface & reference point should be checked
& should not be more than 20mV across 1000 Ohms
resistor under normal operation.
t is not feasible to connect every expanded metal
surface in patients vicinity to ground bus on permanent
basis. Hence specially designed Ground Jacks are
recommended for this purpose.
GkOJND JACK5:
t is recommended to have 5/8 jacks available per
Operation Theater.
Since the potential difference is required to produce a
current flow, entire ground plane can rise above ground zero
as long as all metal components are at the same potential.
even though person contacts two of them ,both at say 15 V,
no current path can develop.
Page no.16
Medicare Company
TRANSFORMER CONSTRUCTION
TRANS.
X2
X1
H2
H1
SW
X
TRANSFORMER
TRANS.
H1
H2
SW
X1
X
X2
TRANSFORMER
Fig. 10. Fig. 11
NormaI (unshieIded) ShieIded
IsoIation Transformers
CHAPTER CHAPTER CHAPTER 7
Switchtronics Hospital solating Panels eliminate
the difficulty in coordinating an effective isolating
distribution system for hospital anesthetizing locations
and electrically susceptible patient areas.
The components are factory engineered, wired, and
thoroughly tested to provide the ultimate in protection,
reliability, and ease of installation.
The heart of the system is the Switchtronics
isoIation transformer. Since a silent operation is
important in hospital applications., Switchtronics
follows a rigid design criteria to provide a transformer
core/coil unit that is virtually inaudible. Sound ratings of
35-40 dBor less are guaranteed on units
Iso|ot|on Irons|ormer.
The transformer uses the finest Class H rated
insulating material available. This insulating system
allows, by NEMA-ANSI standards, a temperature rise of
150C above a 40C ambient. Switchtronics however,
limits the temperature rise of the isolation transformer to
below55C, further ensuring system reliability..
solating the operating room system from normal
building service is important. Take all possible
safeguards to guarantee the transformer's isolating
properties. To accomplish this Switchtronics provides
an electrostatic shield between the primary and
secondary windings as standard equipment in all
transformers used in hospital isolated systems.
There has been much discussion whether an
electrostatic shield is necessary in a transformer used in
a hospitaI isoIating system. Although the shield makes
the electrical design of the coil more difficult, these two
features make it desirable:
The shield establishes a ground plan between the
primary and secondary. n an unshielded
transformer, a potentially hazardous conditions
exists if the insulation between the primary and
secondary fails for any reason. When this happens ,a
low resistance path would electrically connect one
turn of the primary winding with one turn of
secondary winding. The transformer would function
electrically with no indication of this failure. Only a
line isolation monitor connected to the secondary
would indicate the problem.
n Figure 10, this failure occurred at "X. This in
effect,.grounds the secondary through the primary. The
secondary line-to-ground potential depends upon the
portion of the primary winding between the ground and
the fault, plus or minus the portion of the secondary
winding. t could be from 1 V to approximately 460 V in a
230 / 230 V transformer. ndividuals coming in contact
with a secondary lead and ground would complete the
circuit and current would flowthrough their bodies.
The same failure occurring in a shielded
transformer, as in Figure 11, causes a high current flow
in the primary. This causes the primary circuit breaker to
open, removing the unit from service.
Because secondary windings of isolating
transformers are ungrounded, a primary secondary
failure may not trip the circuit breaker. The result is a
dangerously high secondary voltage (primary +
secondary) due to auto transformer action.
Failure in the primary, which normally cause a
dangerous secondary voltage condition, are shorted
through the shield, thus activating the primary
protective device.
The shield attenuates high frequency harmonics
picked up by the conductors which act as antennae, or
disturbances that are frequently generated by
equipment used in other locations such as diathermy
and x-ray.
The shield's attenuating characteristics prevent
most of the signal from feeding into the distribution
system and through it into other treatment or monitoring
equipment.
Page no.17
Medicare Company
To make system introduction superior , there must
be proper communication between all concerned, else it
would leads to poor planning. This subsequent turns out
to be very costly and time consuming requiring
modification after being installed.
ConsuIting EIectricaI Engineer should be the heart
of the team that makes decision. However every
member of the team contributes vital information to the
system design.
Every piece of wire & equipment including parts of
solation system such as LM transformer, circuit
breakers, secondary wiring & any peripheral
equipments, contribute to leakage. The hazard index of
system should be as lowas possible. To achieve this, it is
recommended to provide as much small capacity
system as possible to keep total leakage current low.
HeaIth Care faciIities Code & Standards NFPA
states that the unloaded system with the LM
disconnected must have a minimum line to ground
impedance of 400 k ohms which corresponds 600 A
when measured through milliammeter connected
between phase &ground.
For considering system size, we must include all
wiring between the circuit breakers in solation Panel
and their power points (sockets). Hence it is required to
minimize length of wire. This makes it necessary to
place the solation panel as close as possible to the
point of usage.
Page no18
SystemS|ze
Design Assistance for isoIation System
CHAPTER 8
SystemApp||cot|on
Ateam approach benefits all members of the hospital
team, for example:
The architect can make the proper provisions for
mounting the equipment; this results in superior
aesthetic quality. As a part of the team, the hospital
administrator can make informed decisions while
ordering the equipment for the operating room,
specifying maximum leakages, and correct cords and
connectors The proper accessories are often available at
no extra cost.
The chief staff surgeon can specify a traffic flow
within the operating room, allowing the engineer. to
provide proper receptacle placement .f included in the
team, the hospital maintenance. engineer will
understand the isolated system better. This enables the
engineer to perform .maintenance more conveniently
and efficiently.
. n view of the above mentioned fact centrally
located solated system for several operating rooms or
CCUs is not practical except in rare circumstances. This
is practicable only in case two rooms are adjacent to
each other allowing a common place to install the
solation panel.
n selecting the capacity of an isolating
transformer, remember that the isolated areas
generally present an intermittent load condition and
load diversity. Agiven area may contain equipment that
requires power greater than the isolated system
provides; but the hospital does not use every piece of
equipment at the same time.
The isolated power requirement of the operating
room is almost always under 7.5 kVA. However, the
Switchtronics 7.5 kVA isolation panel incorporates a
transformer built with a Class H insulation, suitable for
150C rise. The full load design temperature, however,
is limited to a 55C rise. Therefore, the transformer can
easily provide power for loads up to 125% of its rating.
This is an important feature in an isolating transformer
since it provides for intermittent heavy loads, like those
presented by hypothermia equipment. n critical care
areas, where one transformer serves one bed, a 3kVA
transformer is recommended.
Copoc|ty o| the system
Since the amount of wire is often proportional to
the number of breakers, keep the number of breakers
to a minimum. This can be done by connecting two or
four receptacles to one breaker. n most cases, an
operating room panel with eight or ten secondary
breakers is sufficient. f additional receptacle are
required, up to15 secondary breakers can be used.
solation panels serving a single bed in a critical care
area require only eight secondary breakers.
Medicare Company
Page no.19 Page no.19
Page no.19
solation panels serving a single bed in critical care area
require only eight secondary breakers.
The selection of a proper conductor is one of the
most important design criteria of an isolated power
system. f improper conductor insulation is chosen, the
result is the same as if the capacitive leakage is raised. A
good commercially available wire insulation for this
application is having a mineral filler instead of a carbon
black filler. A minimum wall thickness of 1.0 mm should
be demanded for use in 208V and 240 V applications. t
is also important to specify wire with a dielectric constant
of 3.5 or Iess, as recommended by the NEC and NFPA
No. 99.
Standard THHN wire is definitely unsuitable. t can,
however, be used for the ground conductor. The code
demands that the #1 conductor in the system be color-
coded orange (red), the #2 conductor color-coded brown
(black or blue), and the ground conductor color-coded
green. n three phase systems, conductors shall be
color-coded red, yellow, blue
Switchtronics is often asked to specify
manufacturers and wire catalog numbers for the low
leakage conductor. This is extremely difficult to do since
information of wires asked to reputed manufacturers is
denied. We therefore, recommend to get this
information in writing from manufacturer before the
hospitals decide to place bulk order with the supplier for
their requirements.
The code no longer allows wire pulling compound to
be used in conduits for isolated power systems. This
compound is usually unnecessary, since most of runs on
an isolated system are short. Occasionally, difficulty
occurs in X-ray circuits since these conductors are
somewhat larger. These difficult runs can be anticipated
and provided for using oversized conduits to ease the
situation.
Obviously, conduits must be dry or the leakage
characteristics designed into the system will suffer.
During construction, keep conduits ends capped so they
will remain free from moisture. The specifications should
state that, if moisture accidentally enters the conduits,
they must be swabbed and thoroughly dried before
conductors are pulled. Use minimum fill for conduits; this
results in a better random lay of the conductors within
the conduit, which further reduces the capacitive
coupling.
W|r|ng And Condu|t.
.
From data available from American company "The
Rome Cable Corporationthe approximate expected
hazard current per foot of power conductor, using the
various wiring schemes described in the preceding
paragraphs. The consulting engineer can use this table
to estimate the system hazard current at the design
stages. Values given are approximate; variations in
humidity, conduit moisture content, conduit fill, and wire
insulation will give difference results.
Hazard Current Leakage Contributed By
Wiring.
MateriaI Used ResuIt
TWwire, metal conduit. 3 A per ft of wire
Wire pulling compound
XLP wire, metal conduit 1 A per ft of wire
No wire pulling compound
With ground conductor.
.SystemDes|gn
Before the electrical design of an operating room
begins, some important information should be acquired
from hospital personnel. Most hospital operating rooms
have a set traffic pattern and positioning for the
operating room table. This is usually restricted to the
location of the overhead operating room light. However,
since the position of the head of the operating room
table can be varied, the hospital personnel should
advise the electrical engineer of the table's standard
The traffic pattern, along with the positioning of the
surgeon and support team, should also be verified. The
positioning of the electrical equipment in the operating
room has a direct relationship to this information. n the
following examples, we will use a configuration shown
in Figure 9 on the next page.
The panel is located behind the support team,
near the head of the operating room table. The location
of this panel is important; correct placement will keep
electrical and ground cords out of the traffic area.
Operot|on Iheoter |oyout
Medicare Company
Page no.20 Page no.20 Page no.20
Page no.20
Secondary Circuit Breaker ScheduIe
Number of
Breakers Load
6 12 Receptacles in all proper
locations to cater loads of
anesthetists surgeon requirements
(2 per Breaker)
1 Surgical Light.
1 film illuminator, clock etc.
A 7.5 kVA isolation panel is recommended for
operating room use. Be sure to determine the load of
secondary equipment being used; very few cases will
require higher rating than 7.5 kVA transformer.
Switchtronics's 7.5 kVA isolation transformer is capable
of a 125% continuous load within its maximum designed
temperature.
Eight secondary circuit breakers are recommended
for the panel in this example. Each circuit breaker should
supply two power receptacles; there are 12 receptacles
in this illustration. Following table shows the
recommended breaker to load schedule.
Two additional breakers should be used for the
overhead operati ng room l i ght, the surgi cal
chronometer, and film illuminator. f the optional remote
power and ground module is used, the four receptacles
in the optional module should be served by one circuit
breaker, and the four receptacles in the surgeon's
module by another breaker.
When laying out the operating room electrical
system, the location of power and ground receptacle is
significant. Power and ground cords can be dangerous
to circulating personnel; so, whenever possible, locate
receptacles so cords do not lie within the major traffic
area. Since the operating room support team uses most
of the electrical outlets, the majority of the services
should be placed behind them, near the head of the
table.
There is little traffic between the support team and
the anesthetist. Locate a power and ground module at
the head of the table so the anesthetist can easily
connect equipment.
t is convenient to have separate physical points
of grounding connected to one electrical point. To do
this, designate a central reference ground point, most
often located in the isolation panel. For all practical
purposes, all ground points in the room are at the same
electrical potential. The ground modules in the
operating room contain a highly conductive bus bar
equipped with a suitable number of lugs to be used for
permanent terminations.
Because of the complexity of isolated power and
the ground system, the hospital engineer should field
test the system before use. This is the only way to insure
that the system is properly installed. The services of a
f act or y t echni ci an wi l l be avai l abl e f r om
"Switchtronics" at a nominal cost. The factory
technician performs the following on-site testing:
Testing grounding
Testing performance of LM
Check nsulation levels as per NFPANo.99
Explain howto maintain Log Book
Proper location of the receptacles on these two
panels, plus receptacles in the isolation panel, should
eliminate tripping hazards in the traffic flowarea.
There are distinct advantages to integrating power
ground receptacles into one enclosure, rather than in
individual power receptacles scattered around the
room. The single enclosure places the receptacles at
the point of usage and provides a lower resistance
ground path between electrical appliances.
Aclock and elapsed-time indicator are required for
most operating rooms, thereby enabling the surgeon
and anesthetist to see clock time and elapsed time. t
also gives the support team easy access to the controls.
Mount the control panel for the timer at the five foot level
with the timer mounted at the seven foot level. Some
teams prefer to place the control panel within reach of
the anesthetist.
Conductive flooring is still required by code in all
flammable and mixed facilities. Conductive flooring is
not required for rooms that are designed as
nonflammable anesthetizing areas.
Locate an additional module behind the surgeon,
near the head of the table. This gives the surgeon easy
access to power for surgical equipment..
F|e|d Iest And Inspect|on
Medicare Company
EIectricaI Maintenance
CHAPTER 9
..... A periodic maintenance program is essential for the
safety of the hospital patients and personnel. The
services of a factory technician are available from us at a
nominal cost. Following a rigid maintenance program
can reduce electrical hazards significantly.
..... Because of the size of a hospital electrical systems,
it is difficult to establish and follow a maintenance
program that includes the entire hospital; however, it is
recommended that anesthetizing and critical care areas
be checked more frequently than general patient areas.
.....
lso|ofed Fower 5ysfem
..... Before using an isolated power system, certain tests
should be conducted to verify proper installation of the
equipment and wiring. To conduct these test, disconnect
all secondary equipment from the secondary circuits.
Conduct these test before the patient occupies this..
Followthe test procedures listed below:
1....Energize the isolation panel by closing the primary
circuit breaker. Leave the secondary circuit
breakers in the off position. Verify that LIM is
operating. You should observe a slight meter
deflection, indicating the monitor hazard current
plus the hazard current for the isolation panel.
Record the hazard current reading for the LM with
only the primary circuit breaker closed. Then close
one secondary circuit breaker at a time, recording
the hazard current reading for that circuit only. Close
only one circuit breaker at a time; otherwise, the
reading cannot be attributed to a specific circuit. f
only circuit shows an unusually high hazard current
compared to other circuits, nvestigate it
immediately.
Determine the line-to-ground impedance between
each of the power conductors and grounds.
Conduct this test at any of the receptacles; be
sure that all the secondary breakers are in the "on
position. Disconnect the LIM from the circuit during
this test. To conduct this test, place a 0-1
milliammeter between either line to ground and
measure the current. The value of current divided
into the system voltage determines the system
impedance. This impedance must be greater than 1
M (mega ohm) for either line to ground. For a 230
V system, this compares to 230 A. Conduct this
system impedance test without any secondary
equipment connected to the circuits. f the
mpedance is less than that required by NFPA No.
99, investigate the system and correct the
problem.
Test the LIM to ensure the proper alarm trip point.
To perform this test, place a value of resistance
between one line and ground to act as the fault
impedance. The fault impedance should be
inserted directly into the LIM with all secondary
wiring disconnected. Use the following equation
For fault impedance.
E...=...System Voltage. (230 V)
R...=...Fault mpedance in K (Kiloohms).
....=...Alarm Trip Current-Monitor Hazard current
At .Trip Point in mA(milliAmperes).
R =...
E
HAZARDOUS VOLTAGE.
DANGER
3
4
5
Use extreme caution, some of the foIIowing
procedures are performed when circuits are
energized.
OnIy trained personneI shouId perform
these procedures.
Use eIectricaIIy insuIated tooIs.
FaiIure to observe this precaution wiII cause
Shock or Burn resuIting in severe personaI injury
2....Press the push-to-test button on the LIM to ensure
its test capability. Also check for audible and visible
alarms attached to the LIM. The alarms should
operate in the safe condition and in the alarm
condition. Ensure that the alarm will become
silence when the silence button is pressed.
Page no21
Medicare Company
The LM should signal an alarm for an impedance of
10% of this value; if it does not signal an alarm, contact
the manufacturer.
NFPA No.99 recommends that the following
formula be used to fault 5 mAfor LIM:
R = 200 X System Voltage (kilo ohms)
E.g., f a system measures 230 V, the fault
mpedance would be:
R = 200 X230
= 46 K ohms.
For proper continuity, test the ground system
associated with the isolated power system before its
initial use. To perform the test, conduct 20 amperes
between the ground bus in the isolation panel and the
grounded points on receptacles and ground jacks. The
potential difference measured between these two points
should not exceed 1 V. f it does exceed 1 V, inspect the
ground for proper connection and properly sized wire.
The 20 ampere ground test can also verify that all metal
within the room is properly grounded. To perform this
test, attach probes between metal surfaces and the
room ground bus; verify the ground connection. This test
can al so be conducted wi th an 0-0.1 ohm
meter..Switchtronics has developed an instrument for
ground continuity testing known as "Ground Detector
Monitor" Type GDM
The use of extension cords in patient area and
anesthetizing location often presents an electrical
hazard. Although extension cords offer flexibility, they
are often abused. These cords may lie in traffic areas
where people step on them and roll equipment over
them. They may also lie in pools of fluid. t is safer to
instal a sufficient number of accessible receptacles than
to use extension cords.
Med|co| Equ|pment Mo|ntenonce.
The increased use of biomedical instruments
presents another maintenance responsibility. Hospitals
should establish routine programs to test and maintain
such equipment.
The maintenance program should apply to all
patient care areas; but it is of greatest importance for
special care units where the most serious patients and
the most complex equipment co-exist. The amount of
equipment present varies for every hospital, affecting
the complexity of the program. However, the following
items should be found in every medical equipment
testing program:
An established procedure ensuring that intended;
that it is safe, reliable, and the best
choice for its purpose.
Specifications that must be adhered to by
Manufacturers before lease/purchase of
equipment.
Adequate customer support from the
manufacturer, ensuring technical assistance,
repair, and consultation is needed.
Periodic inspections, calibrations, and
preventive maintenance.
mmediate, thorough inspections when
equipment malfunction or shock is considered
a possibility
Close monitoring of services provided by
outside vendor.
A logging/reporting system that provides
effective control and record keeping.
For a capacitive fault, use the following equation:

E = System Voltage
R = Fault mpedance as Calculated Above in
Kilo Ohms.
C..=..Capacitance inmicro Farads.

C..=..
1
0.314R
Perform testing periodically, according to this
schedule:
Test the push-to-test button monthly. Check the
associated alarms and silence functions.
Calculate an external fault impedance once every
six months. At this time, take LM readings with all
breakers closed and with all breakers open. This
provides a running history for the permanently installed
wired system. f these values significantly increase
inspect the system. and take corrective action.
Adopters And Extens|on Cords.
Page no.22

Medicare Company
n-service training to ensure safe, effective use of
medical equipment.
Testing Personnel: Hospitals may choose to employ
their own medical engineering personnel, or to share
this personnel with other hospitals, or to sign a contract
with an outside vendor to service medical equipment.
Each hospital must choose the best option for its
purposes.
The size of the hospital, presence of other hospitals
in the area, and regional demographics will help each
hospital make the appropriate decisions about testing
personnel.
All portable equipment has the potential for leakage
current. Periodically test these pieces of equipment and
tag the equipment, showing leakage current reading.
Equipment that connects directly to patient should have
its patient leads checked for leakage current. Each
hospital should maintain the necessary testing
equipment to conduct these testing procedures.
Planning and implementing a medical equipment
control program should include the following factors:
The hospital should obtain competent, objective
biomedical engineering assistants when
planning and developing the program.
There must be a committee that meets for the
sole purpose of medical equipment control.
All medical equipment must be defined and
inventoried.
The hospital should appraise several options for
its equipment control, rather then choose the
easiest or most available program.
The appropriate medical engineering services
must be obtained.
The necessary test equipment must be
purchased, and be kept on site.
The hospital must develop procedures,
specifications, and additional components to
Meets its needs.
Leokoge Current:
Iesf|ng Frogroms:
Page no.23
Medicare Company
This section covers the individual components
that comprise a complete solated power
distribution system for operating coronary care,
delivery and intensive care rooms. The topics
included are:
* operating theater panel
* coronary care and intensive care panels
* digital clock/timer
* digital surgical chronometer.
Components of the Operating theater, coronary
care and intensive care panels are covered by
individual specifications include:
* isolation transformer
* circuit breakers for use in panels
* line isolation monitors (LM) and metering
cabinet
For lLM 98 and LM 99 models
GeneraI:
The panel(s) shall be factory wired and tested
and include a shielded low leakage isolating
transformer, primary and secondary circuit
breakers, and line isolation Monitor (LM). And
metering cabinet
The operating room panels shall be located as
indicated on the drawings. The LM used in these
units shall indicated alarm when the total hazard
current exceeds 5mA. The remote indicator alarm
unit shall be located in the operating room and
connected to the panel supplying power to the
circuits in that room. The panel shall be placed so
its bottom edge is 61 inches above the finished
operating room floor if the room is rated for
flammable anesthetics. Location within the
operating room is as indicated on the drawings.
Second indicator alarm unit shall be built into
an annunciator containing indicator alarm units for
all line isolation monitors in the operating suite.
This console will be located at the operating room
(OR) supervisor's station.
Compone nt s
The following components shall be provided
by the manufacturer of the operating room, CU,
CCU, or panel as one integral unit.
Transformers
The transformer shall be wound with an
electrostatic shield between the primary and
secondary windings. The shield shall be
grounded to the enclosure. The electrostatic
shield will be designed to prevent direct shorting
of the primary winding to the secondary winding,
and to reduce the coupling of harmonic
distortions between the primary circuit and
secondary circuits.
. The total leakage current to ground from the
transformer secondary winding shall not exceed the
values shown in Table 29.2 of UL 1047.
Regulation to be certified not to exceed 6% at
.8 power factor (PF) at 40 C above the full load
continuous operating temperature in accordance
with NEMA- ANS standards.
The transformer is to be single phase, 50 Hz
with primary and secondary voltages as listed in
the drawings and/or schedule.
Class H rated insulation shall be used in the
manufacture of the transformer and the temperature
rise will be limited to 55 Cabove ambient under full load
conditions, when tested in accordance with
NEMA - ANS standards. Transformer must have a
220 C,S recognized insulation system.
The core shall be of stacked design and
securely clamped and bolted. The core and coil
shall be internally isolated from the enclosure by
means of a suitable vibration dampening
system, varnish impregnated, and shall have a
final wrap of insulating material to prevent
exposure of bare conductors.
Location:
Page no.24
CHAPTER 10
To Know More About produts for HospitaIs
Medicare Company
The design sound level of the completed units
shall not exceed 35-40 dBs for 3 through 25 kVA
units.
Circuit Breakers:
All circuit breakers must be 2 pole with a
minimum interrupting capacity of 10,000
amperes. Panels shall have a minimum capacity
of 15 secondary circuit breakers, though 8 circuit
breakers are standard Refer to the panel board
schedule for quantity and sizes of breakers. All
circuit breakers shall be thermal-magnetic type.
Line IsoIation Monitor:
Switchtronics Medicare Company provides
Line isolation monitors type "LeakGard A.. Line
isolation monitor "LeakGard A is a model having
switching between lines incorporated.
LM is solid state design t continuously
monitors system leakage current of line 1 and line
2 of isolated system in case of "LeakGard A
because of switching system, while "LeakGard D
Under development will continuously monitors
system leakage conditions of isolated system. t is
capable of measuring both capacitive and
resistive faults including balance and unbalance
or hybrid faults
"LeakGard A and "LeakGard D will not
contribute more than 50 A to total Hazard
current.
Specifications:
LIM unit:
Supply : 230 V 10 % , 50 HZ
Accuracy : less than 10 %
Alarm level : 2 mA or 5 mA selectable
Corse band : 2.0 to 2.5 mA or
5.0 to 6.0 mA
Hazard level: 2.5 to 5,0 mA or
5.0 to 10.0 mA as selected
Alarm Hysterisis: 100 A
Mode : Single phase
Monitor Hazard current : less than 100 A
2 mA and 5 mA range selector switch
Digital Display
LIM consists:
Leakage current detector
Control transformer with or without switching
Circuit
Mother board with relays etc.
LM monitoring card
Facia with termination
This unit has:
Selected scale indicator
Tiny buzzer
SAFE green indicting LED
Hazard red indicting LED
TEST push button
MUTE push button
A switch for muted condition with
ndicating LED
Swithtronics Medicare Company is now
introducing microprocessor based model .
Details are given in description of Leak Gard D)
"LEAK-GAkD" L|ne Iso|ot|on Mon|tor.
The "LEAK-GARDD" Line solation Monitor
(LM) is a distinct latest generation line isolation
monitor .t uses microprocessor technology that
improves the performance, versatility, and
reliability of this unit over any previous LIMs
Page no.25
Medicare Company
This monitor will be included as a special
component of Switchtronics Medicare
Company hospital isolation panels. At extra cost
The ""LeakGard D" LIM can also be supplied
separately and installed as a replacement for any
outdated line isolation monitor.
The "LeakGard D LIM has the following
capabilities:
* Operating voltages of 200 through 265 VAC
* Hazard current alarm level of 2.0 or 5.0 mA.
* Operation at either 50 or 60 Hz.
* Operation either as a single or three phase
The line isolation monitor shall be the
Switchtronics Medicare Company "LeakGard
D.The LM shall use microprocessor-based
digital signal processing to continually monitor
the impedance from all secondary conductors of
the isolated power systems to ground. The LM
shall be capable of measuring all combinations of
capacitive and resistive faults including
balanced, unbalanced and hybrid faults. LMs
which internally switch between either line and
ground will not be accepted. The LM shall not
contribute more than 50 A to the total hazard
current of the system being monitored.
The L M shal l have t he f ol l owi ng
specifications:
Operating voltage 85 to 265 V AC
Accuracy 5% or better
Alarm level 2 or 5mA (selectable)
Alarm bandwidth Zero (0)
Alarm hysteresis (on/off) 5 A
Mode Single or three phase
Monitor hazard current 50 A
Operating frequency 50 or 60 Hz.
The LM shall incorporate a momentary test
switch. When pressed, it shall check and re
calibrate the unit. Additionally, the test switch
shall perform a complete test of all indicating
lamps and meters on the face of the LM and at
any remote indicating station.
The LM shall have a green safe light and
red hazard light on the front panel. The red
hazard light shall remain illuminated for the
duration when the isolated power system hazard
current is above the selected alarm level of the
LM. An audible alarm shall be incorporated in to
the unit and shall activate in conjunction with the
red hazard light. The audible alarm shall have
high, low and off settings. A silence button shall
be provided on the face of the unit to silence the
audible alarm during fault condition. Upon
silencing the audible alarm, a yellow indicating
light shall illuminated to indicate the audible
alarm has been silenced.
The "LeakGard D LIM exhibits a 50 A
monitor hazard current and an alarm band width
of zero enabling the unit to sound an alarm at 4.0
mA of hazard current. This is significantly better
than the other brands on the market which sound
between 4.75 and 5.0 mA. The "LeakGard D
LIMalso self tests and self calibrates once every
65 minutes eliminating the need to manually test
the unit periodically.
The " LeakGar d D LI M wi t h i t s
microprocessor-based technology, is impervious
to all types of electrical noise interference found
in hospital operating rooms. At the same time, the
"LeakGard D LI M uses an advance
methodology to monitor hazard current without
interfering with other sensitive patient monitoring
equipment.
Because the "LeakGard D LIM use digital
signal processing technology, serial port is
provided inside the unit. Users can collect
periodic performance data from the "LeakGard
DLIM and send it directly to their PC-based
maintenance records without the need for
manual record keeping.
Page no.26

Medicare Company
Today's modern surgical techniques
requires the most up-to-date support equipment.
This equipment includes elapsed time indicators
for the operating room. Doctors commonly
require simultaneous timing of surgical
procedures; the Switchtronics Medicare
Company Surgical Chronometer fills this need.
This unit has three elapsed-time indicators and
one clock integrated into a single, compact
enclosure. The remote control panel can be
mounted in a location selected for accessibility.
The elapsed timer shall be capable of
holding and then resuming a count at the
discretion of the operator. The solid state design
shall allow the elapsed timer to instantly reset.
The clock/timer shall have an extra set of
connections which, when shorted, will actuate
the elapsed time indicator.
The clock shall be field adjustable to display
either 12-hour or 24-hour time.
The single display clock and elapsed time indicator
shall be as manufactured by Switchtronics. .The unit
shall have two sets of digital displays; the top display
will be a time-of-day clock, and the lower display will be
an elapsed time indicator.

Duo| D|sp|oy D|g|to| C|ockJI|mer
The unit has an extra set of normally opened
and closed dry contacts for use with other
external alarm systems. The Switchtronics
Medicare Company remote alarms for the
"LeakGard D LIM operate at 12VAC and do not
add any additional hazard current to the isolated
power system being monitored. The LM shall use
digital signal processing to determine the hazard
current of the system being monitored. The
algorithms used to determine the system hazard
current shall be programmed into the LM's
microprocessor. At least every 65 minutes, the
unit shall recheck its calibration and re calibrate
the system to original performance specifications.
Additionally, by pressing the LM's momentary
test switch, an immediate check and re
calibration of the LM shall be performed.
All panels, components, and accessories shall be
manufactured in accordance with the applicable UL,
NEMAand NFPAstandards including, but not limited to:
NFPA No. 99
NEC-ARTCLE 517
UL-1047
UL-1022
The light displays shall be bright light
emitting diodes LED 12mm tall, and plainly
visible at 20 ft. The controls to operate the
elapsed timer and to set the clock time shall be
on the face of the unit. These controls shall
operated in parallel with an optional remote
control panel.
Surg|co| Chronometer
Operation theater paneI
Office : A1, Jeevan Sona, Linking Road, Santacruz (West), Mumbai - 400 054.
Tel. : 91 22 26616633 Mobile: 91 932 411 6633
E Mail : switchtronicsmedicare@gmail.com

Medicare Company

008 Handbook For Isolation Requrement

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Do you wish to provide eIectricaI safety to your patients?...

Provide 'SWITCHTRONICS' make

"NEC" (NATONAL ELECTRCAL COMMTTEE), USA. ARTICLE 517

"U L" (UNDER WRTERS LABORATORY),USA. UL 1022, UL 1048.

"HEALTH CARE FACILITIES" (HAND BOOK) BY "BURTON R. KLEIN.

"SQUARE D", USA. HANDBOOK

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