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The Healthcare Environment . . . . . . . . . . . .1 The healthcare environment is made up of perhaps the most unusual
combination of electronic loads found in any facility. Healthcare
Power Quality in Healthcare Facilities . . . . .3
facilities not only rely upon commercial loads (such as computers,
Recognizing Power Quality Problems . . . . . .4 servers, and lighting system) and industrial loads (such as food
preparation equipment, laundry equipment, medical gas systems,
Symptoms and Their Causes . . . . . . . . . . . .4
but also rely on electronic medical loads (that is, medical equipment)
Sources of Electrical Disturbances . . . . . . .8 to operate the facility and provide patient care services.
Improving Power Quality in the As in other facilities, when an electrical disturbance such as a voltage
sag, voltage transient, or voltage swell reaches the service entrance of
Healthcare Environment . . . . . . . . . . . . . . . .13
the healthcare facility or medical location, computers in the
Meeting the Power Quality Challenges accounting department may shut down, and motor starters and
of the Healthcare Industry . . . . . . . . . . . . .13 contactors providing power to the air-conditioning and ventilation
system may change the environment within the facility. Unlike other
Establishing Partnerships . . . . . . . . . . . . . .13
places, however, a patient’s life could be threatened when an aortic
Creating a Power Quality Checklist for balloon pump trips off-line during a cardiovascular surgery. The
costs associated with downtime can be staggering, but no bounded
Procuring Equipment . . . . . . . . . . . . . . . . .14
cost can be placed on the irreversible result of loosing a patient.
Using Power-Conditioning Devices to
Building, electrical, and healthcare codes in the United States require
Improve Equipment Compatibility . . . . . . .16
that hospitals and other medical clinics have emergency power ready to
Understanding Facility Voltage activate upon the detection of a power quality problem and assume the
Requirements, Grounding, and load within 10 seconds of the detection. However, even though a
generator may be used at a healthcare facility or medical location, it
Dedicated Circuits . . . . . . . . . . . . . . . . . . .17
cannot be on-line to support critical medical equipment with an
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . .24 activated transfer switch in less than about 2 to 3 seconds at best. This
duration of time might as well be forever in terms of the ability of
Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . .24
electronic medical equipment to continue operating. In fact, an
undervoltage as short as ¼ of a cycle (about 4 milliseconds) is often
sufficient to confuse sensitive electronic devices.
level of
New electrotechnologies are continually
awareness in introduced into this complex environment
recognizing (see figure on right), placing new challenges
upon the healthcare and facility staff, the
equipment
quality of power delivered to the facility and
malfunctions to the equipment, and the electricity
that may be demand. These electrotechnologies may also
caused by consume additional floor space and weight
load and place new burdens upon the facility
power quality
infrastructure—electrical and mechanical
problems. systems. These new technologies include
medical, functional, and facility equipment.
The healthcare environment is a unique one because of the intimate proximity of people
to equipment.
Although patient safety is the number one other electronic devices in the hospital or
reason for reducing the potential for even interfere with the operation of the
equipment malfunctions, healthcare dynamic load itself.
Procedure Interruptions
disturbance can An electrical disturbance can damage an The possible results of microprocessor
electronic component or circuit board in malfunction include the loss of equipment
damage an medical equipment causing a loss of data control (see figure below) or the false
electronic stored in memory or rendering the memory sounding of an alarm. For example, the
component or inaccessible. Such losses can occur in data keypad on an infusion pump may not
stored in the memories of biomedical respond to finger touches of medical staff,
circuit board in
equipment and imaging systems, as well as the pump may not remain in the desired
medical billing and patient records stored in programmed state, or the equipment may
equipment computer memory. If previously stored data sound an alarm contrary to the condition of
causing a loss suddenly becomes unavailable as a result of the equipment or patient. Moreover, if an
a disturbance incident upon an electronic unstable patient condition develops and an
of data stored data storage system, then patient tests may equipment alarm does not sound, then the
in memory or need to be repeated, delaying patient patient may be placed in a life-threatening
even destroying treatment. Power supply, mainframe, situation. Some medical devices such as
memory, interface, and other types of circuit infusion pumps have a built-in battery
the memory
boards may suffer damage from backup that provides for internal backup
altogether. disturbances. Permanent damage to a power power in the event of a sag or momentary
supply circuit board, like that shown in the interruption. The use of a backup battery
figure below, may initiate the loss of stored system in a medical device does not protect
data on a circuit board downstream of the the device from malfunctions caused by
power supply board. voltage transients and other disturbances.
malfunctions The most common causes of electrical In a fair number of cases, the cause of a
disturbances that lead to power quality power quality problem in healthcare
can be avoided facilities and medical clinics is simply a
problems in healthcare facilities and
if the level of medical clinics are loose or corroded power or ground
power quality connection. Many medical equipment
low and unknown equipment malfunctions attributed to poor power
is known and
immunity; quality are caused by inadequate electrical
equipment wiring and grounding. Such problems
faulty facility wiring and grounding;
selected or frequently arise when
facility and equipment
installed to be
modifications; new electronic medical or office
immune. equipment is connected to existing
high-wattage equipment;
facility wiring;
routine electric utility activities;
permanently installed medical
accidents, weather, and animals; and
equipment is moved from one
a transfer to an emergency generator location to another; or
or alternate feeder.
underlying non-PQ-related
equipment malfunctions are not
Low and Unknown Equipment Immunity resolved and changes to wiring and
grounding are made in efforts to
The immunity of most electronic medical
“enhance” the quality of power to the
equipment to electrical disturbances is low,
equipment.
unknown, or both. This is evidenced by the
number of cases of medical equipment
malfunction and damage that are caused by Wiring and grounding errors also enhance
power quality problems. Many power quality the negative effects of neutral-to-ground
problems can be avoided if the quality of transients, which disrupt electronic medical
power is known at the point of use within equipment. Reversal of neutral and ground
the healthcare facility and if equipment conductors; poor, missing, or redundant
immunity is known and high enough to neutral-to-ground bonds; and poor, missing,
avoid equipment malfunction. When or redundant equipment grounds are a few
immunity is unknown, healthcare providers examples of faulty wiring and grounding
cannot determine if disturbances are likely that can lead to medical equipment
to cause equipment malfunction and malfunctions.
damage. As a result, healthcare providers
cannot provide the utility with the data they Many facility engineers and electricians in
need to warrant improvements to the power healthcare facilities in the United States
system and cannot determine the degree of used to mistakenly believe that if electrical
mitigation that can be provided by systems are wired and grounded according
improving the operation of facility electrical to Article 517 of the NEC (National Fire
systems (that is, identifying wiring and Protection Association [NFPA] 70), there
grounding errors and resolving them) and by should be no problems with the equipment.
utilizing power quality mitigation By increasing the level of awareness of the
equipment. impacts of power quality and compatibility
on healthcare facilities and medical
equipment through EPRI research, facility
This distorted current waveform was captured with a power quality monitor during a PQ
field investigation at a healthcare facility.
Voltage sags originating from outside a This toppled power pole caused a power outage at the
In healthcare facilities where power quality installation and maintenance of these the facility. These devices are designed to
problems occur frequently, healthcare systems, even when new large medical operate on internal batteries, and thus
providers may be eager to purchase and equipment is specified and purchased. Large continuous operation of this equipment is
install power quality mitigation equipment to medical equipment such as diagnostic possible during a voltage sag or momentary
protect both small and large loads from imaging systems can be fitted with a UPS at interruption. One should note, however, that
electrical disturbances. In situations where the installation site, but the barriers in doing so electronic medical equipment with an onboard
small loads such as biomedical equipment do are significant. Imaging suites are tight on battery recharger and an internal rechargeable
not contain internal battery backup systems, floor space, and the electrical system provided battery may also malfunction during an electrical
installing an appropriately sized uninterruptible for these spaces was not designed to disturbance as the charger could be rendered
power supply (UPS) will increase the accommodate the installation of power inoperable as a result of a deep voltage sag;
immunity of these loads to common mitigation equipment. Moreover, imaging hence the need for characterizing this equipment
disturbances such as sags and momentary system operators do not have time to routinely for immunity to sags and interruptions.
interruptions. UPSs for large medical loads test a UPS or maintain the UPS’s batteries.
ranging from 10 kVA to a few hundred kilovolt- Even though electric utilities try to provide as
amperes, which can cost as much as $1 million, Unlike industrial and manufacturing facility many nines of reliable power to a healthcare
may be installed on an individual medical environments where industrial process facility as possible, healthcare providers must
imaging system, can support multiple systems systems can be made much more robust to realize that their facilities are also fed from
in a medical imaging department, or can be voltage sag phenomenon with proper typical power distribution networks. Utilities
used for a group of critical equipment such as electrical and software design techniques, will make every effort to ensure that a direct
ventilators in an intensive care unit (ICU). most medical equipment is not designed to service feed (service entrance) to a hospital is
offer this option. Medical equipment is properly maintained and that second feeds are
In many situations where large UPSs are designed for individual use in an array of provided from a second substation whenever
thought to be needed (and some are needed), equipment and for compact use. For example, possible. However, redesigning distribution
healthcare providers discover that common the ten different types of medical equipment systems or making other investments in the
disturbances are exacerbated by typical wiring used in an ICU are not linked together with utility’s power delivery infrastructure may also
and grounding errors within the healthcare one downstream system depending upon the be prohibitively costly. Given that the cost of
facility’s electrical system. Prior to the results from an upstream system. Instead, the events and facility-level solutions can be
decision to purchase and install a large UPS, a each piece of medical equipment is designed very expensive, electric utilities and their
well-developed power quality investigation to carry out a specific task such as monitoring healthcare customers search for ways to ease
should be done within the facility to determine blood pressure, monitoring blood oxygen the financial burden of increasing the immunity
the extent to which wiring and grounding level, and providing breathing assistance to a of their healthcare customers to common
errors contribute to the root cause of patient. However, the typical solutions that electrical disturbances such as voltage sags,
malfunctions with small and large medical can be applied in manufacturing environments momentary interruptions, and surges.
loads. In almost all situations, typical wiring to solve power quality problems with
and grounding errors internal to the facility can industrial equipment can also be applied to a Healthcare providers are not willing to install a
be linked to the severity of common healthcare facility. power mitigation device on each piece of
disturbances entering the facility from medical equipment. However, they can be
everyday electrical events occurring on the The types of portable electronic medical persuaded to have their maintenance staff sift
utility power system and from events equipment that can be fitted with a low- to through the details of a facility’s power
generated by the operation of large loads in mid-power UPS are limited (to some less than distribution system through learning how to
neighboring customer facilities and/or 10 kVA machines. Because of the need to conduct power quality investigations.
generated by the operation of large loads provide safe patient environments, most Moreover, healthcare providers may also be
within the healthcare facility. typical power quality solutions, such as persuaded to improve their medical
constant voltage transformers and sag- equipment procurement process by learning
Purchasing and installing large UPS systems reducing technologies, cannot be how to specify an acceptable level of
to protect individual imaging systems or implemented on medical equipment in the immunity to voltage sags and momentary
several systems in a medical imaging suite patient environment. Most medical interruptions and voltage surges that is
can present additional problems for the equipment are designed to be portable and suitable to most healthcare facility electrical
healthcare provider. Healthcare facility are placed on high-quality equipment carts environments. But, before this concept can be
designers do not make accommodations for without space provided for a UPS. Some widely applied, medical equipment
such large pieces of power mitigation devices such as blood-pressure monitors and manufacturers must succumb to determining
equipment. Healthcare providers, operating on infusion pumps must have power maintained the full immunity capability of their equipment
extremely tight budgets, do not budget for the to them as the patient is moved throughout to these common disturbances.
The bulk of the electrical safety In the EU, electronic medical equipment is
requirements detailed in IEC 60601-1-2 are subject to the Medical Device Directives 93-
based on IEC 950, Safety of Information 42-EEC, which was implemented on January
Technology Equipment Including Electrical 1, 1995. These “New Approach” Directives
Business Equipment. However, an IEC 950 gave a three-year transitional period (up to
(EN 60950) approved power supply would January 1, 1998) until CE marking (mandatory
need to pass the additional test and marking to indicate conformity with the
inspection requirements of EN60601-1 for health and safety requirements set out in the
separation, leakage current, dielectric European Directives) was required.
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