Electrical safety in patient care areas Ray Cislo, PEng, BSc; Bhubendra Rasaiah, MD, FRCPC
In December 1989 the Canadian Standards Association (CSA) published standard Z32.2 regarding electrical safety in patient care areas;' the standard describes the safety requirements for the management of medical electrical equipment, nonmedical electrical equipment and patient-owned electrical devices used in patient care areas. It also covers inspection, testing and maintenance standards. Although compliance is voluntary medical practitioners are strongly encouraged to follow the recommended practices. The standard is aimed primarily at hospitals. However, it also applies to other areas, such as private physicians' offices and medical clinics, where patients are brought into contact with electrical equipment for diagnosis and treatment. The highlights of the standard that are considered most relevant to medical practitioners are as follows. * An electrical safety program is necessary to protect patients and staff from potential electrical hazards. The program should include the education of the entire health care team, the proper design of the building's electrical system and the appropriate maintenance of all electrical equipment. * Patient procedures can be categorized according to the type of contact between the patient and the medical electrical equipment used: (a) cardiac contact (greatest hazard) - intentional contact directly with the heart, (b) body contact (moderate hazard) - intentional contact externally or internally but not directly with the heart and (c) casual contact - voluntary contact with an electrical device not intended to be connected to a patient. * Different areas of a practitioner's office or clinic must reflect the nature of the care provided and the degree of electrical contact (e.g., basic, intermediate and critical). For example, the electrical safety requirements of a surgical suite may differ significantly from those in an area used for diagnosis or recovery because of the procedures performed, the equipment used and the electrical installation necessary. * All medical electrical equipment (e.g., elec-
trocardiographs, patient monitors and equipment for anesthesia) should bear either the CSA monogram or the label of a provincial electrical inspection authority. If neither mark is present there is no assurance that the equipment is safe for use, and its operation in Canada is illegal. When buying equipment insist on the CSA certification mark as part of the purchase agreement. In the past, insurance companies have refused to insure practitioners until their equipment has been approved, a process that incurs considerable time and money. * There should be a preventive maintenance program for all medical electrical equipment in accordance with the manufacturer's recommendations. Regular maintenance and checking of power outlets is mandatory to prevent or minimize current leakage, electrical failure and instrument malfunction. Inappropriate use and lack of maintenance can cause the very best equipment to deteriorate to a point at which safety can no longer be guaranteed. Practitioners may use the manufacturer's maintenance services, shared regional services (e.g., those of local hospitals or clinics) or shared private services of biomedical engineering companies. * Extension cords and wall adapters must not be employed in patient care areas. There have been incidents involving extension cords that were inadequately maintained, of poor quality or of inappropriate design and configuration (i.e., two-pin rather than grounded three-pin cords). * If power bars are located in patient care areas they must be CSA certified as "hospital grade". (Refer to the CSA standard for further information regarding their use.) * Although only mandatory for specific patient care areas in hospitals, electrical outlets in patient care areas of a physician's office or a clinic should be hospital grade (i.e., marked with a green dot and the words "hospital grade"). These outlets are more robust than the regular ones and help to ensure good
equipment grounding. * Electrical outlets should be periodically inspected to ensure that they are not broken or charred and that the attachment plugs placed in them fit
Mr. Cislo is standards administrator at the Canadian Standards Association (CSA), and Dr. Rasaiah is director of laboratories, General Hospital, Sault Ste. Marie, Ont., and the CMA representative to the CSA Steering Committee on Health Care Technology.
Reprint requests to: Mr. Ray Cislo, Standards Division, Health Care Technology Program, Canadian Standards Association, 178 Rexdale Blvd., Rexdale, Ont. M9W IR3 CAN MED ASSOC J 1990; 143 (9)
873
snugly and securely. If outlets are damaged or attachment plugs not firmly retained the cause should be investigated and the outlets replaced with ones that are hospital grade. 0 When patient care areas, especially surgical suites, undergo new construction they should be designed according to section 24 of the Canadian Electrical Code, part 1 .2,3 Although this section applies specifically to hospitals its requirements provide an additional level of safety for patients in other settings at only a small cost. If the standards of section 24 are met, likely the installation testing requirements of CSA standard Z32.2 will also be satisfied. This article emphasizes some of the more important aspects of the CSA standard. However, practitioners should obtain a copy of the standard to ensure that their office or clinic meets all the applicable requirements for electrical safety. For further information on CSA standard Z32.2
contact the first author at the reprint requests address or at (416) 747-4377. Copies of the standard can be ordered through the CSA's regional offices: Richmond, BC (604) 273-4581; Edmonton (403) 450-2111; Winnipeg (204) 632-6633; Toronto (416) 747-4044; Pointe-Claire, PQ (514) 694-81 10; and Moncton, NB (506) 858-9300. CSA standard Z32.2 has been approved as a national standard of Canada by the Standards Council of Canada. The publication of this manuscript was supported by the CMA Council on Health Care.
References 1. Canadian Standards Association: CAN/CSA-Z32.2-M89. Electrical Safety in Patient Care Areas, CSA, Rexdale, Ont, 1989 2. Idem: Canadian Electrical Code, Part 1, CSA, Rexdale, Ont, 1990: sect 24 3. Idem: CE Code Handbook: an Explanation of the Rules of the CE Code, Part 1, CSA, Rexdale, Ont, 1990
-~ ~ ~ ~ ~ .~
of professionalism~
....
Look for the blue badg 874
CAN MED ASSOC J 1990; 143 (9)
..
In December 1989 the Canadian Standards Association (CSA) published standard Z32.2 regarding electrical safety in patient care areas;' the standard describes the safety requirements for the management of medical electrical equipment, nonmedical electrical equipment and patient-owned electrical devices used in patient care areas. It also covers inspection, testing and maintenance standards. Although compliance is voluntary medical practitioners are strongly encouraged to follow the recommended practices. The standard is aimed primarily at hospitals. However, it also applies to other areas, such as private physicians' offices and medical clinics, where patients are brought into contact with electrical equipment for diagnosis and treatment. The highlights of the standard that are considered most relevant to medical practitioners are as follows. * An electrical safety program is necessary to protect patients and staff from potential electrical hazards. The program should include the education of the entire health care team, the proper design of the building's electrical system and the appropriate maintenance of all electrical equipment. * Patient procedures can be categorized according to the type of contact between the patient and the medical electrical equipment used: (a) cardiac contact (greatest hazard) - intentional contact directly with the heart, (b) body contact (moderate hazard) - intentional contact externally or internally but not directly with the heart and (c) casual contact - voluntary contact with an electrical device not intended to be connected to a patient. * Different areas of a practitioner's office or clinic must reflect the nature of the care provided and the degree of electrical contact (e.g., basic, intermediate and critical). For example, the electrical safety requirements of a surgical suite may differ significantly from those in an area used for diagnosis or recovery because of the procedures performed, the equipment used and the electrical installation necessary. * All medical electrical equipment (e.g., elec-
trocardiographs, patient monitors and equipment for anesthesia) should bear either the CSA monogram or the label of a provincial electrical inspection authority. If neither mark is present there is no assurance that the equipment is safe for use, and its operation in Canada is illegal. When buying equipment insist on the CSA certification mark as part of the purchase agreement. In the past, insurance companies have refused to insure practitioners until their equipment has been approved, a process that incurs considerable time and money. * There should be a preventive maintenance program for all medical electrical equipment in accordance with the manufacturer's recommendations. Regular maintenance and checking of power outlets is mandatory to prevent or minimize current leakage, electrical failure and instrument malfunction. Inappropriate use and lack of maintenance can cause the very best equipment to deteriorate to a point at which safety can no longer be guaranteed. Practitioners may use the manufacturer's maintenance services, shared regional services (e.g., those of local hospitals or clinics) or shared private services of biomedical engineering companies. * Extension cords and wall adapters must not be employed in patient care areas. There have been incidents involving extension cords that were inadequately maintained, of poor quality or of inappropriate design and configuration (i.e., two-pin rather than grounded three-pin cords). * If power bars are located in patient care areas they must be CSA certified as "hospital grade". (Refer to the CSA standard for further information regarding their use.) * Although only mandatory for specific patient care areas in hospitals, electrical outlets in patient care areas of a physician's office or a clinic should be hospital grade (i.e., marked with a green dot and the words "hospital grade"). These outlets are more robust than the regular ones and help to ensure good
equipment grounding. * Electrical outlets should be periodically inspected to ensure that they are not broken or charred and that the attachment plugs placed in them fit
Mr. Cislo is standards administrator at the Canadian Standards Association (CSA), and Dr. Rasaiah is director of laboratories, General Hospital, Sault Ste. Marie, Ont., and the CMA representative to the CSA Steering Committee on Health Care Technology.
Reprint requests to: Mr. Ray Cislo, Standards Division, Health Care Technology Program, Canadian Standards Association, 178 Rexdale Blvd., Rexdale, Ont. M9W IR3 CAN MED ASSOC J 1990; 143 (9)
873
snugly and securely. If outlets are damaged or attachment plugs not firmly retained the cause should be investigated and the outlets replaced with ones that are hospital grade. 0 When patient care areas, especially surgical suites, undergo new construction they should be designed according to section 24 of the Canadian Electrical Code, part 1 .2,3 Although this section applies specifically to hospitals its requirements provide an additional level of safety for patients in other settings at only a small cost. If the standards of section 24 are met, likely the installation testing requirements of CSA standard Z32.2 will also be satisfied. This article emphasizes some of the more important aspects of the CSA standard. However, practitioners should obtain a copy of the standard to ensure that their office or clinic meets all the applicable requirements for electrical safety. For further information on CSA standard Z32.2
contact the first author at the reprint requests address or at (416) 747-4377. Copies of the standard can be ordered through the CSA's regional offices: Richmond, BC (604) 273-4581; Edmonton (403) 450-2111; Winnipeg (204) 632-6633; Toronto (416) 747-4044; Pointe-Claire, PQ (514) 694-81 10; and Moncton, NB (506) 858-9300. CSA standard Z32.2 has been approved as a national standard of Canada by the Standards Council of Canada. The publication of this manuscript was supported by the CMA Council on Health Care.
References 1. Canadian Standards Association: CAN/CSA-Z32.2-M89. Electrical Safety in Patient Care Areas, CSA, Rexdale, Ont, 1989 2. Idem: Canadian Electrical Code, Part 1, CSA, Rexdale, Ont, 1990: sect 24 3. Idem: CE Code Handbook: an Explanation of the Rules of the CE Code, Part 1, CSA, Rexdale, Ont, 1990
-~ ~ ~ ~ ~ .~
of professionalism~
....
Look for the blue badg 874
CAN MED ASSOC J 1990; 143 (9)
..
