CABMET Study Group – Public Safety in the Healthcare Facility

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Public Safety in theHealthcare Facility

CABMET Study Group

Matt BaretichBaretich Engineering

Fort Collins, Coloradomfb@baretich.com

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Public Safety: 15% of CBET Exam

• Electrical

• Chemical

• Radiation

• Biological

• Fire

• Codes and StandardsSlide 3

ElectricalMicroshock and

Electrical Safety Testing

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Ground Conductor Resistance

Chassis to ground pin of electrical plug

• NFPA 99 (2005) 8.4.1.3.2. Ground Conductor Resistance. Patient-care-related equipment in the patient care vicinity = 0.5 Ω.

• AAMI ES60601-1:2005 8.6.4. Protective Earth Impedance. Medical electrical equipment = 0.3 Ω.

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Chassis Leakage Current

• NFPA 99 (2005) 8.4.1.3.5. Chassis Leakage Current. New patient-care-related equipment = 300 μA. Existing and special patient-care-related equipment = 500 μA.

• AAMI ES60601-1:2005 8.7.3. Touch Current. Medical electrical equipment. Normal Condition = 100 μA. Single Fault Condition = 500 μA.

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AAMI ES60601-1:2005 Test Load

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ESM 2008 Recommendations

• Ground conductor resistance:• A practical limit for identifying ground

conductors problems is 0.5 Ω.

• Chassis leakage current:• A practical limit for identifying chassis

leakage current problems is 500 μA.• Normal polarity, power switch on and

off, ground closed and open.Slide 9

Electrical Safety References

• NFPA 99 (2005) Health Care Facilities Handbook. Chapter 8: Electrical Equipment.

• Medical Electrical Equipment – Part 1: General Requirements for Basic Safety and Essential Performance. AAMI ES60601-1:2005.

• Electrical Safety Q&A. Health Devices(February 2005).

• Electrical Safety Manual 2008. AAMI (Baretich & Shepherd).

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ElectricalPower Systems

Slide 11 Slide 12

Normal Electrical System

• Branch Circuit: The circuit conductors between the final overcurrent device protecting the circuit and the outlet(s).

• Feeder: All circuit conductors between the service equipment, the source of a separately derived system, or other power supply source and the final branch-circuit overcurrent device.

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Special Electrical Systems

• Essential (emergency) electrical system• Generator and transfer switches• Automatic transfer within 10 seconds• Extensive testing requirements• TJC specifies systems to be supplied

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Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07

• Alarm systems*

• Exit Route and exit sign illumination*

• Emergency communication systems*

• Elevators (at least one)

*As required by the Life Safety Code

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Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07

• Critical equipment, including:• Blood, bone, and tissue storage systems• Medical air compressors• Medical and surgical vacuum systems

• Critical areas, including:• Operating and recovery rooms• Obstetrical delivery rooms and nurseries• Urgent care areas

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Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07

• Monthly and annual testing of battery-powered lights required for egress

• Quarterly and annual testing of Stored Emergency Power Supply Systems (SEPSS)

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Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07

• Monthly testing of generators and transfer switches (30 minutes, adequate load)

• Additional testing of generators every 36 months (4 hours, adequate load)

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Special Electrical Systems

• Isolated power system• Isolation transformer• Line isolation monitor (LIM)• Significant testing requirements• For “wet locations” where interruption

of power cannot be tolerated

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Schematic Diagram

From NFPA Health Care Facilities Handbook

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IPS Panel

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Line Isolation Monitor (LIM)

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Decision Tree

From Square-D HospitalIsolated Power Systems

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Special Electrical Systems

• Ground Fault Circuit Interrupter• Trips at 6 mA current to ground• Subject to “nuisance” tripping• For “wet locations” where interruption

of power can be tolerated

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Power Line Color Codes

• 120 VAC Grounded (United States)• Hot = Black• Neutral = White• Ground = Green

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Power Line Color Codes

• 120 VAC Grounded (European)• Hot = Brown• Neutral = Blue• Ground = Green (solid or yellow stripe)

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Power Line Color Codes

• 120 VAC Isolated Power System• Line 1 = Orange (to “neutral” terminal)• Line 2 = Brown (to “hot” terminal)• Ground = Green

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Electrical System References

• Health Care Facilities Handbook:NFPA 99 (2005)

• National Electrical Code Handbook:NFPA 70 (2008)

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OSHAChemical & Biological Hazards

Infection Control

Workplace Safety Pointers

• OSHA: Occupational Safety and Health Administration (www.osha.gov)

• OSHA is exclusively concerned with the safety of employees

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OSHA

Occupational Safety & Health Administration

• Hazard Communication• Material Safety Data Sheets (MSDS)

• Bloodborne Pathogens• Universal Precautions• Personal Protective Equipment (PPE)

• Lock-out Tag-out

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OSHA: Hazard Communication

• Employees have a “Right to Know”• Inventory of hazardous materials• Information and training• Access to MSDS information

• Material Safety Data Sheets• Hazards of using the material• How to use the material safely (including PPE)• What to do if exposed (including First Aid)• How to clean up spills• How to dispose of the material

43www.osha.gov/dsg/hazcom/ 44www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf 45www.osha.gov/OshDoc/data_General_Facts/factsheet‐lockout‐tagout.pdf

Lockout ‐ Tagout

Infection Control Pointers• APIC: Association for

Professionals in Infection Control and Prevention (www.apic.org)

• Infection Control Professional vs. Infection Preventionist

• CDC Guidelines: www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf

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Infection Control

• Airborne Infection Isolation (AII) room:• Protects people in surrounding areas

from airborne pathogens• Negative pressure; external exhaust

• Protective Environment (PE) room:• Protects patient from airborne

pathogens in surrounding areas.• Positive pressure; HEPA filtration

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Radiation Hazards

Laser Safety

Radiation Safety

50www.epa.gov/radiation/understand/ionize_nonionize.htm 51www.safety.vanderbilt.edu /training/topics_laser.htm

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Radiation Safety References

Basic facts:• www.epa.gov/radiation

/understand/ionize_nonionize.htm

Laser safety:• www.safety.vanderbilt.edu

/training/topics_laser.htm• Protective goggles• Avoid direct and reflected beam

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Fire SafetyClasses of Fires & Extinguishers

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Fire Triangle

Wikipedia: “Fire Triangle”

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Fire Tetrahedron

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Fire Types

• Class A: Ordinary combustibles such as wood, paper, cloth, trash plastics.

• Class B: Flammable liquids such as gasoline and paint. Also propane and butane. Not cooking oils and grease.

• Class C: Energized electrical equipment such as motors and appliances. If power is removed, fire becomes another class.

• Class D: Combustible metals such as potassium, sodium, aluminum, and magnesium.

• Class K: Cooking oils and greases.

• www.hanford.gov/files.cfm/ExtBrochure.pdf

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Extinguisher Types

• Dry Chemical: Class ABC fires

• Water and Foam: Class A only.

• Carbon Dioxide: Class BC fires.

• Wet Chemical: Class K fires.

• Halogenated or Clean Agent: Class ABC fires.

• Dry Powder: Class D fires only.

• Water Mist: Primarily Class A fires.

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Fire SafetyPrinciples of Life Safety

Fire safety concepts

• Patients “incapable of self-preservation”

• “Defend in place” versus evacuation

• Building “compartments”

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Building compartments

• Patient room

• Smoke compartment

• Floor assembly

• Building separation

• Exits and methods of egress

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Fire Safety Pointers

• Life Safety Code Handbook NFPA 101

• Current edition: 2012

• CMS (and TJC): 2000

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Codes & StandardsJoint Commission

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Joint Commission Management Plans

2008 2009Safety

Safety & SecuritySecurityHazmat & Waste Hazmat & WasteEmergency [Note 1]

Life Safety Fire Safety [Note 2]

Medical Equipment Medical EquipmentUtility Systems Utility Systems

[Note 1] All moved to new EM chapter. Emergency Operations Plan

[Note 2] ILSM and SOC standards moved to new chapter.

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Medical Equipment Management

• Management plan

• Selection and acquisition of equipment

• Equipment inventory

• Inspection and maintenance strategies

• Inspection and maintenance schedule

• Hazard notices and recalls

• FDA Medical Device Reporting

• Emergency proceduresSlide 68

Performance Monitoring & Improvement

• Performance monitoring

• Annual evaluation:• Scope• Objectives• Performance• Effectiveness

• Performance improvementSlide 69

Joint Commission References

• Comprehensive Accreditation Manualfor Hospitals (Joint Commission)

• Environment of Care Essentials for Health Care (Joint Commission)

• The Performance Improvement Cycle (Baretich Engineering)

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Codes & StandardsNFPA

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NFPA Codes and Standards

• NFPA 101: Life Safety Code

• NFPA 70: National Electrical Code

• NFPA 99: Healthcare Facilities

• Electrical Equipment

• Medical Gas Systems

Joint Commission: Medical Gas SystemsEC.02.05.09

• Inspect, test, maintain critical components (time frames defined by the hospital)• Master signal panels• Area alarms• Automatic pressure switches• Shutoff valves• Flexible connectors• Outlets

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Joint Commission: Medical Gas SystemsEC.02.05.09

• Test for …• Purity• Correct gas• Proper pressure

• Whenever systems are …• Installed• Modified• Repaired

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Storage and Handling of Gas Cylinders

• Compressed GasAssociation poster

• Air Products Safetygram #10

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Medical Gas Color Codes

Air Yellow

Carbon Dioxide Gray

Helium Brown

Nitrogen Black

Nitrous Oxide Blue

Oxygen Green

www.sciencecases.org/gas_cylinders/handout3.asp

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Codes & StandardsFDA

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FDA Medical Device Reporting

• Safe Medical Devices Act: Requires medical device reporting by Device User Facilities.

• Referenced by the Joint Commission (EC.02.04.01 EP5).

• FDA: www.fda.gov/cdrh/mdr

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FDA Medical Device Reporting

• Report to the manufacturer and FDAwhen the facility has information that reasonably suggests a device has or may have caused or contributed to a patient’s death.

• File FDA Form 3500A within 10 work days.

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FDA Medical Device Reporting

• Report to the manufacturer when the facility has information that reasonably suggests that a device has or may have caused or contributed to patient’s serious injury (requiring medical or surgical intervention).

• File FDA Form 3500A within 10 work days.

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Codes & StandardsOther

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• AABB: American Association of Blood Banks

• ACR: American College of Radiology

• ANSI: American National Standards Institute

• FCC: Federal Communications Commission

• IEC: International Electrotechnical Commission

• CMS: Centers for Medicaid and Medicare Services

• Joint Commission

• American Osteopathic Association (AOA)

• DNV Healthcare