ELECTRICAL SAFETY OF MEDICAL EQUIPMENT

Many people have received an electric shock at some stage or other through carelessness or ignorance. We all use electricity every day, both at home & work, so some knowledge & appreciation is useful. It would make sense that everyone, not only people responsible for Electrical Safety, understands electricity & the potential dangers that it presents. It is necessary to respect electricity & its hazards. It would appear that the young & old are more prone to electric shock. In the case of youngsters perhaps this is due to a lack of appreciation of the dangers. And in the case of older people it may be due to over familiarity. Electrocution claims the lives of several hundred people each year, mostly involving domestic electrical equipment. Hospital Safety Electrical equipment is used in Hospitals therefore the same risks are present, but the hazards are greater due to the involvement of sick people. People in hospital are in a weakened physiological state due to their reason for hospitalisation. This means that they are more susceptible to any electrical exposure, that a normal fit, healthy person may withstand. Now days the patient environment contains a large amount of medical equipment providing various functions to aid the care of patients. Many items of medical equipment may be connected to the patient at the same time. Human susceptibility to electric shock varies from individual to to individual & depends on a number of factors:

The patients general state of health The position of any electrodes on the patient The dampness of the patients skin

Safety Standards Modern medical equipment is now manufactured in such a way that the risks of electric shock are minimal.

Physiological effects of electrical current

Electricity travels in closed circuits, normally through a conductor Shock results when the body becomes part of the electrical circuit Current enters the body at one point and leaves at another Current(Amps) 0.001 ( 1mA) 0.005 (5 mA) 0.006-0.025 (6 25 mA) (Women) 0.009-0.030 (9 30 mA) (Men) 0.050-0.150 (50 150 mA) 1 - 4.3 (1 A 4.3 A) 10 Amps Human Reaction Perception level. Just a faint tingle. Slight shock felt; not painful but disturbing. Average individual can let go. Painful shock, muscular control is lost. This is called the freezing current or "letgo" range. Extreme pain, respiratory arrest, severe muscular contractions. Ventricular fibrillation. Cardiac arrest, severe burns and probable death.

How do electrical shocks happen? Without two contact points on the body for current to enter and exit, respectively, there is no hazard of shock. This is why birds can safely rest on high-voltage power lines without getting shocked: they make contact with the circuit at only one point. Many times, one side of a power system will be intentionally connected to earth ground, and so the person touching a single wire is actually making contact between two points in the circuit (the wire and earth ground):

AC

The ground symbol is that set of three horizontal bars of decreasing width located at the lower-left of the circuit shown, and also at the foot of the person being shocked. In real life the power system ground consists of some kind of metallic conductor buried deep in the ground for making maximum contact with the earth. That conductor is electrically connected to an appropriate connection point on the circuit with thick wire. The victims ground connection is through their feet, which are touching the earth. In order to prevent shock hazards, all the current carrying wires are insulated and the metallic equipment body is connected to the ground. But in some cases there may be leakage currents due to insulation break down. In the event of a leakage current flowing in the equipment it will be grounded by the metallic body. Conditions for the electrical hazards potential difference must be present the individual must be a part of the electrical current The current flowing through the body is determined by Ohms Law Current = Voltage/impedance Three phenomena can occur due to electrical shocks:

electric stimulation resistive heating electrochemical burns

Electric stimulation of an excitable tissue is due to low-frequency (< 1kH) current exceeding stimulus threshold Effects of electrical stimulation are:

sensory nerves: pain motor nerves muscle contraction heart: fibrillation skin surface burns at dc- and low-frequency deep tissue burns at rf current

Effects of resistive heating of tissue are

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local effect of heating depends on the tissue, time of exposure, contact area, circulation

Electrochemical burns (electrolysis) and tissue damage occur due to direct current and very high voltages. When high voltage direct current passes through the body positive ions will migrate to negative electrode and negative ions to positive electrode. Electrical susceptibility factors of patients The magnitude of electric current required to produce a certain physiological effect in a person is influenced by many factors. The voltage to cause current flow depends solely on the electrical resistance of the body. The major part of the body resistance is offered by skin. The skin conductance is proportial to the contact area and the skin condition. This resistance can vary from few ohms to several megohms. Depending on the point of contact and the amount of current passing through the body a microshock or a macroshock may result.

Macroshock

current applied on the surface of the body cardiac fibrillation risk depends on the location of the entry points and skin resistance normal condition: 100 A single-fault condition: 500 A

Safety limit to prevent macroshock:

Microshock

current applied directly to the heart (catheterization, open-chest surgery) in dogs: 20 A, in humans: 80-600 A normal condition: 10 A single-fault condition: 50 A

Safety limit to prevent microshock:

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In certain medical procedures a direct contact to the heart may be established as in the following cases. 1. Electrically conductive catheters are inserted through a vein into the heart to apply stimulating signal from a pacemaker. These catheters provide a resistance of only a few ohms. 2. Fluid filled catheters are used in a number of surgical procedures which provide a resistance in the range of 0.1 Megohms to 2 Megohms depending on the size and length of the catheter. In the above situations an accidental current may flow because of an electrical insulation failure in any of the equipment connected to the patient. Leakage currents Major source of potentially lethal currents in any instrument is the leakage current Definition Leakage current is an inherent flow of non-functional current in normal or single-fault condition from the electrical parts of instruments at different potential to an accessible metal parts (usually chassis of the device) due to finite insulation impedance The leakage currents can be the result of stray capacitance and stray resistive current paths created by poor insulation, dust and/or moisture. Types of the leakage currents

Enclosure leakage current due to the current from the enclose of the device through the patient to the ground Ground leakage current due to the current which flows in normal condition to earth from the mains parts of an apparatus via a large capacitance Patient leakage current resulting from the current through the patient from or to the applied part of the patient circuits (electrodes, catheters)

Methods of accident prevention

Grounding A power distribution grounding system using a 3 wire receptacle and very good conducting wires with resistanc less than .15 ohms

Using double insulation for the equipment Using normal insulation between energized conductors and the chassis a secondary insulation between the chassis and outer surface so that in case of ground fault the outer surface can not be energized to hazardous potential Protection by using low voltage equipment

low voltage is always safer than high voltage macroshock can be avoided but not microshock Provide electrical isolation between the patient leads and the pre amplifier so that the isolated preamplifier breaks the ohmic contact between the input leads and output of the amplifier. Since the leakage current flows now mainly through capacitance between the transformer windings and the instrument amplifier, isolation of the amplifier from patient leads will prevent leakage currents.

Equipment design

Installing GROUND-FAULT CIRCUIT INTERRUPTER

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