ELECTRICAL DISTRIBUTION

SYSTEMS IN HOSPITAL

 Prepared by: Dr. Nur Farahiyah Mohammad, Sept 2017

 This Week

 Hospital Electrical System: Introduction

 General power and lighting system
 Distribution of electrical power system
 Electrical Hazards in Hospital
 Macrocshock
 Microshock
• Leakage current
 Electrical Safety Cord and Standards
 Protection Against Shock
 Isolated Power distribution
 Ground fault circuit interrupters (GFCI)
 Equipment design
 Electrical safety analyzers / Testing electrical systems
 Distribution of Electric
Power: Introduction

• Electric Power is needed in health-care facilities not only for medical devices
but also for any other electrical equipment like lightning, air condition,
telephone, television etc.

• BUT
Medical devices underlie special safety regulations as they might stay in special
contact to and with patients, applicants and third persons
1. Overvoltage protection
2. Special ground

• Example
A lightning causes an overvoltage at the public power supply. The overvoltage is
transferred directly to the patients heart by applied ECG-Electrodes.
=> Over voltage protection
 Distribution of Electrical Power

(230 V)

Simplified electric-power distribution for 115 V circuits. Power frequency is 60 Hz

 Distribution of
Electrical Power

(230 V)

Simplified electric-power distribution for 115 V circuits. Power frequency is 60 Hz

 Distribution of
Electrical Power
 High voltage enters the building via underground cable.
 The secondary stepdown transformer develops 240V.
 This secondary transformer has a grounded centre tap to
provide two 120V circuits between ground and each side of
the secondary winding.
 Heavy duty devices (air conditioner, electric dryers and x-ray
machine) that require 240V are placed across the entire
secondary winding by making connections to the two
ungrounded terminals.
 Ordinary wall receptacles and light operate on 120V obtained
either one from ungrounded hot (black) transformer terminals
and neutral (white) grounded centre tap.
 For healthcare facilities, the National Electrical Code (NEC)
for 1996 requires that all receptacles be “Hospital Grade” and
be grounded by a separate insulated (green) copper conductor
(Article 517-13)
 HOSPITAL ELECTRICAL SYSTEM

• The factors to be considered in the design of an electrical

power system include safety, reliability, adequacy, distribution,
grounding and quality.
• The quality of electrical power is concerned with voltage
viability, frequency, stability and waveform.
• Each of these factors is important but with different priorities
on where in the hospital you are.
• Example: Reliability and quality become equally important in
surgery so that cardiopulmonary bypass machines function
continuously and at constant speed.
 HOSPITAL ELECTRICAL SYSTEM

 The primary source for standards in wiring is the:

 National Electrical Code (NEC) @ NFPA 70 is a regionally
adoptable standard for the safe installation of electrical wiring and
equipment in the United States.
 It is part of the National Fire Codes series published by
the National Fire Protection Association (NFPA), a private trade
association.
 In Malaysia : MS IEC 60364-7-710 (Electrical installations of
buildings - Part 7-710: Requirements for special installations
or locations - Medical locations (IEC 60364-7-710:2002,
IDT)
 HOSPITAL ELECTRICAL SYSTEM

 Should have 2 independents

sources of power fed by
separate distributions networks
and substations.
 To increase the reliability of
the power to the hospital
 Each source must have the
ability to handle the entire load
of hospital.
 Should have an automatic
transfer from one source power
to the other in the event of
failure of the primary source of
Hospital wiring diagram showing
the distribution of electrical power
power.
 HOSPITAL ELECTRICAL SYSTEM

 Must have an emergency generator on the premises (even

though there is 2nd source of power), independent from the
other sources of power to provide uninterrupted partial service
to “essential” areas of the hospital.
 Emergency generator able to restore power to “essential” areas
within 10 s after the interruption of the primary power source.
 HOSPITAL ELECTRICAL SYSTEM

General power and lighting systems

 The majority load in the hospital is supplied by the general
power and lighting system
 This system must be installed in such way that a fault (short
circuit line to line or to ground) or failure in this system will
not interfere the functioning of other electrical systems in the
hospital.
 HOSPITAL ELECTRICAL SYSTEM

 Other electrical systems in the hospital:

 Essential electrical system
• Auxiliary power supply and its associate equipment, such as transfer
switches and feeders.
• This system used during a disruption of the normal power supply
 Essential electrical system
• Auxiliary power supply and its associate equipment, such as transfer
switches and feeders.
• This system used during a disruption of the normal power supply
 Equipment system
• The division of the essential electrical system supplying heating
system, selected elevators, and other devices necessary for hospital
function.
.
 HOSPITAL ELECTRICAL SYSTEM

 Emergency system
• The emergency system must be in full operation within 10 s after a
fault in general power supply.
• This system serves the life safety branch, the critical branch, and life
support branch
– Life safety branch : supplies power to the equipment necessary for
patient and personal safety such as hallway and stairway lighting, exit
signs and directional signs , smoke detectors, alarm systems.
– Critical branch: Serves the patient care areas as well as areas related
to patient care such as nursing stations and pharmacy. Also supplies
power to isolation transformer in anesthetizing locations.
– Life support branch: Provide power to those areas where electrical
power is essential for patient survival. Such as respirator and heart
lung machines.
 Electrical Hazards in Hospital

 Macroshock hazards
“The undesirable effect of a current greater than 5 mA at 60
cycles applied to the surface of the body”
 Electrical Hazards in Hospital-
Protection Against Macroshock
1. Separate ground wire is used in hospital wiring systems.
 Local codes for home wiring do not require this separate grounding
when metal conduit may serve as the ground return path.
 Hospital require the use of separate ground wire to keep the ground
resistance as low as possible and to prevent breaks in ground path due
to corrosion, which can happen with conduit.

Hospital wiring
Home wiring
Protection Against Macroshock
 Protection Against Macroshock

2. Make sure that all outlets have a “good” ground,

meaning that the ground wire is intact and is a low-
resistance path for the flow of ground current.
3. The grounding on the all electrical equipment is
functional and is not circumvented by the use of two-
wire extension cords or three-prong to two-prong.
 In the event of a short to the case of an electrical device, no
harmful voltage will appear on the chassis or case because of the
ground wire will provide a low-resistance path for the current to
flow and will not allow the chassis voltage to rise to a dangerous
level.
 Protection Against Macroshock

4. Good visual inspection of the physical condition of

the electrical devices.
 A good grounding system will not prevent macroshock
if someone comes in direct contact with an electrically
hot wire.
 This could the case if a person touched an exposed
metal conductor where the insulation was worn or
broken.
 Electrical Hazards in Hospital

MICROSHOCK HAZARDS
“Define as a effect where a low level current (μA)
passes directly through the heart via a needle or
catheter in artery or vein”

Source of the low

level current
Electrical Hazards in Hospital-
Leakage Current
Exists in all power-line-operated equipment and is
usually due to:
 Capacitive coupling – Capacitive leakage current
Resistive coupling – Resistive leakage current
 Under normal circumstances, leakage current is
conducted away by the ground wire.
 Electrical Hazards in
Hospital- Leakage Current
Capacitive leakage current
Is developed any time two conductors that carry current
are separated by a dielectric.
In this case, the dielectric is the insulation on the wire
When an alternating voltage is applied between the
conductors, a current will flow that is given by the
equation for current in capacitor:
 Electrical Hazards in
Hospital- Leakage Current
 For grounded equipment, leakage current is conducted to
ground. Leakage current = 100 μA
 Figure 15.7: Ground resistance = 1 Ω
Chassis voltage = ?

V = IR
= (100 μA) (1Ω)
= 100 μV
 Electrical Hazards in Hospital-
Microshock Hazards
 If a catheterized patient, who is also grounded, comes in
contact on the medical device, the chassis-to-ground voltage
will be applied across the patient.

Schematic of grounded catheterized patient, who

comes in contact with medical device chassis
 Current through the heart of
the patients is:

This level of current is not known to

produce ventricular fibrillation
(a) Schematic of grounded catheterized patient, who comes in contact with medical
device chassis, (b) equivalent-circuit diagram for the grounded catheterized patient,
  If the ground wire is broken, the situation changes.

Microshock

 Now the chassis of the device has become a common node

point connecting the device capacitance in series with the 500
Ω impedance of the patient.
 The current through the patient’s heart is much larger that it
was in the previous case.
 Electrical Hazards in
Hospital- Leakage Current
 Limits on leakage current are instituted and regulated by the
safety codes instituted in part by the National Fire Protection
Association (NFPA), American National Standards Institute
(ANSI), Association for the Advancement of Medical
Instrumentation (AAMI), and Emergency Care Research
Institute (ECRI).
 Microshock via Ground Potentials
Microshocks can also occur if
different devices are not at the Faulty electric polisher
exact same ground potential.
In fact, the microshock can
occur even when a device that
does not connected to the patient
has a ground fault!
A fairly common ground
wire resistance of 0.1Ω can
easily cause a a 500mV
potential difference if
initiated due to a, say
5A of ground fault.

If the patient resistance is less

then 50kΩ, this would cause an
above safe current of 10μA
Microshock via Ground
Potentials
 Microshock Hazards Conductive
Path to the Heart

• Ventricular fibrillation and pump failure thresholds vs. electrode area

Threshold of ventricular
fibrillation and pump failure
versus catheter area in dogs.
From O.Z. Roy, J.R.Scott, and
G.C. Park, “Ventricular
Fibrillation and Pump Failure
Threshold Versus Electrode
Area,” IEEE Transaction of
Biomedical
Engineering,1976,23,45-48.)
 Electrical Safety Codes &
Standards
Code – document that contains only mandatory
documents
Standard –also a document that contain mandatory
requirement, but compliance tends to be voluntary,
and more detailed notes and explanations are given.
Manual or guide- is a document that is informative
and tutorial but does not contain requirements.
 Electrical Safety Codes &
Standards
History:
The process of development, adoption and use of
standards and codes for electrical safety in health-care
facilities began following tragic explosion and fire
resulting from electric ignition of flammable
anaesthetics such as ether.
Lead to adoption of National Fire Protection
Association NFPA 99-1894 and ANSI/AAMI ESI \-
1985 standards.
 Electrical Safety Codes &
Standards
 NFPA 99-Standard for Health Care Facilities – 1996 has
evolved from 12 NFPA documents that were combined in a984
and revosed every 3 years.
 Current edition: 2015
 In addition to electric equipment, this standard also described
gas, vacuum, and environmental systems and materials.
 The primary document that describes the requirements for
patient-care-related electric appliances used for diagnostic,
therapeutic, or monitoring purposes in a patient-care area.
 Electrical Safety Codes &
Standards
 The Association for the Advancement of Medical
Instrumentation (AAMI) developed an American National
Standard on “Safe Current Limits for Electromedical
Apparatus,” ANSI/AAMI ESI -1993.
 This standard concern limits on chassis and patient-lead
leakage currents, which are fixed from dc to 1 kHz and
increase from 1kHz to 100 kHz.
 Protection
against shock
1. Method Protection 1 : Power Distribution
• Grounding System
• Isolated Power distribution
• Ground fault circuit interrupters (GFCI)
2. Method Protection 2: Equipment design
3. Electrical-Safety Analyzers
 Basic Approaches to
Shock Protection

 There are two major ways to protect patients from shocks:

 Completely isolate and insulate patient from all sources of electric
current
 Keep all conductive surfaces within reach of the patient at the
same voltage

 Neither can be fully achieved  some combination of these

two
 Grounding system
 Isolated power-distribution system
 Ground-fault circuit interrupters (GFCI)
 Grounding Systems
Low resistance (0.15 Ω) ground that can carry
currents up to the circuit-breaker ratings protects
patients by keeping all conductive surfaces and
receptacle grounds at the same potential.
Protects patients from
• Macroshocks
• Microshocks
• Ground faults elsewhere (!)
The difference between the receptacle grounds
and other surface should be no more then 40 mV)

All the receptacle grounds and conductive surfaces

in the vicinity of the patient are connected to the
patient-equipment grounding point. Each patient-
equipment grounding point is connected to the
reference grounding point that makes a single
connection to the building ground.
 Isolated Power-Distribution
Systems
 A good equipotential grounding system cannot eliminate large
current that may result from major ground-faults (which are
rather rare).
 Isolated power systems can protect against such major (single)
ground faults
 Provide considerable protection against macroshocks, particularly
around wet conditions
 However, they are expensive !
 Used only at locations where flammable anesthetics are used.
Additional minor protection against microshocks does not justify
the high cost of these systems to be used everywhere in the clinical
environment
 Isolated Power Distribution

Not grounded !

• Normally, when there is a ground-fault from hot wire to ground, a large current is drawn causing a
potential hazard, as the device will stop functioning when the circuit breakers open !
• This can be prevented by using the isolated system, which separates ground from neutral, making
neutral and hot electrically identical. A single ground-fault will not cause large currents, as long as
both hot conductors are initially isolated from ground!
 Isolated Power Distribution

Not grounded !

• In fact, in such an isolated system, if a single ground-fault occurs, the system simply reverts back to
the normal ground-referenced system.
•A line isolation monitor is used with such system that continuously monitors for the first ground
fault, during which case it simply informs the operators to fix the problem. The single ground fault
does NOT constitute a hazard!
 Ground – Fault
Circuit Interrupters (GFCI)
 Disconnects source of electric current when a ground fault greater than about 6 mA occurs!

When there is no fault, Ihot=Ineutral. The GFCI detects the difference between these two
currents. If the difference is above a threshold, that means the rest of the current must be
flowing through elsewhere, either the chassis or the patient !!!.
The detection is done through the monitoring the voltage induced by the two coils (hot and
neutral) in the differential transformer!
 GFCI

The National Electric Code (NEC - 1996) requires that all

circuits serving bathrooms, garages, outdoor receptacles,
swimming pools and construction sites be fitted with GFCI.
Note that GFCI protect against major ground faults only, not
against microshocks.
Patient care areas are typically not fitted with GFCI, since the
loss of power to life support equipment can also be equally
deadly!
 Protection through
Equipment Design

 Strain-relief devices for cords, where cord enters the

equipment and between the cord and plug
 Reduction of leakage current through proper layout and
insulation to minimize the capacitance between all hot
conductors and the chassis
 Double insulation to prevent the contact of the patient with the
chassis or any other conducting surface (outer case being
insulating material, plastic knobs, etc.)
 Operation at low voltages; solid state devices operating at
<10V are far less likely to cause macroshocks
 Electrical isolation in circuit design
 Electrical Isolation
Isolation
barrier
CM ISO RF
Error Error
CMRR IMRR*
~ ~ -
-
SIG ~
+
ISO
+
Isolation
Capacitance
and resistance
CM ~

~
Input common CM ISO
ISO Output
common
o = SIG ± ± Gain
CMRR IMRR
(a)
*IMRR in v/v

• Main features of an isolation amplifier:

• High ohmic isolation between input and output (>10MΩ)
• High isolation mode voltage (>1000V)
• High common mode rejection ration (>100 dB)
 Transformer Isolation
Amplifiers

FB
AD202
Signal
In - - Demod Hi
In + Mod
+ ±
5V ±5V
SIG F.S. o
F.S. Lo
In com
+ISO Power
Out Rect and
+ 7.5 V filter Oscillator + 15 V DC
-ISO
Out - 7.5 V 25 kHz
25 kHz Power
return
(b)
 Optical Isolation Amplifier

Isolation barrier

CR3 CR1 CR2 RK = 1M W

i i2
i
1 2
+V
+o
RG

- -
AI i2 AII
+ i1 + i3 + +
~ i o
-
-V -
Input
RK Output
control o = i
RG control
(c)
 Electrical Safety Analyzers
Wiring / Receptacle Testing

 Three LED receptacle tester:

 Simple device used to test common wiring problems (can detect
only 8 of possible 64 states)
 Will not detect ground/neutral reversal, or when ground/neutral
are hot and hot is grounded (GFCI would detect the latter)
 Electrical Safety Analyzers
Testing Electrical Appliances

 Ground-pin-to-chassis resistance: Should be <0.15Ω during

the life of the appliance

Ground-pin-to-chassis resistance test

 Electrical Safety Analyzers
Testing Electrical Appliances
 Chassis leakage current: The leakage current should not exceed 500μA with single fault for
devices not intended for patient contact, and not exceed 300 μA for those that are intended for
patient contact. Appliance power switch
(use both OFF and ON positions)
Open switch Grounding-contact Polarity- reversing
for appliances switch (use in switch (use both
not intended to OPEN position) positions) Appliance
contact a patient
H (black)
H To exposed conductive

Circuitry
Internal
surface or if none, then 10 by
120 V N 20 cm metal foil in contact
N (white) with the exposed surface
G

G (green) Insulating surface

I

Building Current meter H = hot

ground N = neutral (grounded)
G = grounding conductor
Test circuit
This connection
is at service I < 500 μA for facility Ðowned housekeeping and maintenance appliances
entrance or on I > 300 μA for appliances intended for use in the patient vicinity
supply side of
separately derived
system
 Electrical Safety Analyzers
Testing Electrical Appliances

 Leakage current in patient leads:

 Potentially most damaging leakage is the one with patient leads,
since they typically have low impedance patient contacts
 Current should be restricted to 50μA for non-isolated leads and to
10 μA for isolated leads (used with catheters / electrodes that make
connection to the heart)
 Leakage current between any pair of leads, or between a single
lead and other patient connections should also be controlled
 Leakage in case of line voltage appearing on the patient should
also be restricted.
 Leakage current Testers
Test for leakage current from
patient leads to ground
 Leakage Current testers
Test for leakage current
between patient leads
 Leakage Current Testers

Test for ac isolation current

Isolation current is the current
that passes through patient
leads to ground if and when
line voltage appears on the
patient. This should also be
limited to 50μA
And this concludes…