Electrical Safety

Cedric Dupont-Eisner M.D.

Principles
Electricity is the flow of electrons
Direct Current-electrons flow in 1 direction Alternating Current-electrons switch directions at regular intervals

Capacitance
The ability of a capacitor to store a charge.

Principles

Principles
Stray Capacitance/Capacitive Coupling
inherent in all electrical equipment. Not designed into the system, but incidental to the equipment construction

Principles

Application: Electrical Shock

If electrical systems are not properly wired, persons can be subjected to electric shock.

Application: Electrical Shock

People become injured and death occurs when voltage pushes electrons through the human body, particularly through the heart.

Application: Electrical Shock

Damage from electrical current is due to disruption of normal electrical function of cells or dissipation of electrical energy into human bodies (increased temp->burn).

Application: Electrical Shock

Macroshock-large amount of current flow that can cause harm or death

Application: Electrical Shock

Microshock-small amounts of current flow. Dangerous only to electrically susceptible patients

Application: Electrical Shock

DC-is less dangerous AC-is more dangerous 3x DC is needed for VFib High frequency current have low tissue penetration and does not excite contractile cells Low frequency current penetrates more

Application: Electrical Shock

What levels of current (mA) is dangerous? Remember 1,10,100 macro/100 micro
<1 mA = imperceptable to touch 10 mA skeletal muscle shock (you can let go) V Fib can be induced by:
100 mA of macroshock 100 A (microamperes)of microshock current

Application: Electrical Shock

THE MAX LEAKAGE ALLOWED IN OR EQUIPMENT IS 10 A (microamperes)

Grounding
Electrical Power Grounding can exist in two forms
GROUNDED UNGROUNDED Easy?

Grounding
Think about your house:
2 prong outlets = no ground 3 prong outlets = grounded

Modern homes have a ground to reduce amount of shock

Grounded Power

Grounded Electrocution

Why is equipment grounded?

Stray Capacitance/Capacitive Coupling:
Remember all equipment leaks a small amount of current All OR equipment has 3 prong plug

Ungrounding
The OR has many perils that make grounding impracticle.
Saline puddles Power cords w/ tears in their insulation (colored part of cord) Numerous electronic devices that risk

Ungrounding
This is where the questions are derived:
OR uses ungrounded power that is derived from Grounded utilities ISOLATION TRANSFORMER is the answer

Isolated and Ungrounded

Ungrounding: Isolated Power

Power source does not have a ground,the equipment is grounded Isolated Power System provides protection from Macroshock. Faulty equipment plugged into an isolated power system does not present a shock hazard.

Ungrounded Safety

LIM (Line Isolation Monitor)

Continuously monitors the potential for current flow from the isolated power supply to ground. Determines the degree of isolation b\w 2 power wires and the ground. Predicts the current flow.

LIM (Line Isolation Monitor)

Alarm is activated if 2mA-5mA of current is detected. Remember Macroshock vs. Microshock?

Line Isolation Monitor

Application: Electrical Shock

What levels of current (mA) is dangerous?
<1 mA = imperceptable to touch Ventricular Fibrillation can be induced by: 100 mA of macroshock 100 A (microamperes)of microshock current

Application: Electrical Shock

SO LIM DOES NOT PROTECT AGAINST MICROSHOCK SINCE IT DETECTS 2mA5mA

LIM (Line Isolation Monitor)

Indicates the existence of a single problem (SINGLE FAULT)
Namely there is a problem with the ungrounded system becoming grounded So we are back to regular home power No chance for shock

LIM (Line Isolation Monitor)

A second problem (TWO FAULTS) are required for SHOCK to occur.
A faulty piece of equipment-very likely at HH Unsafe environment like electric device + pool of normal saline.

Boards
LIM DOES NOT protect from MICROSHOCK, it warns of a POTENTIAL problem If an LIM goes off, remove the last piece of equipment that was plugged in In OR power source is ungrounded and equipment is grounded

Electrocautery

Electrocautery with Poor Contact

QUESTIONS
The isolation monitor (LIM) on the wall of the operating room is to alert one to
a) Faulty drainage of static electricity from equipment to the conductive floor b) The presence of equipment with a broken ground wire connection c) An excessive load on the isolation transformer supplying the room d) An excessive electrical leakage from either side of the power line to ground e) Too low conductance in the floor.

Answer
The isolation monitor (LIM) on the wall of the operating room is to alert one to D - An excessive electrical leakage from either side of the power line to ground

QUESTION
Electrocautery machines do not cause VF because the current they deliver differs from the electric current supplied by wall electrical outlets primarily by being:
a) b) c) d) DC instead of AC Lower in voltage Lower in frequency Higher in frequency

Answer
Electrocautery machines do not cause VF because the current they deliver differs from the electric current supplied by wall electrical outlets primarily by being: D - Higher in frequency

QUESTION
The LIM (line isolation monitor)
a) Measures leakage current flowing from patient to ground b) Measures leakage current flowing from the electrical equipment to the patient c) Sounds an alarm if the leakage current exceeds 50 mA d) Measures the impedance between AC wiring and ground e) Cuts off power to the circuit if a faulty piece of equipment is connected

Answer
D The LIM measures the impedance from the AC wiring of an isolated power system to ground and only sounds an alarm if current in excess of 2-5 mA could flow to ground.

QUESTION
The isolated power supply system used in ORs requires that:
a) The metal portions of the OR table be connected to earth ground b) The patient be insulated from the metal portions of the OR table c) Conductive flooring be used in the OR d) A transformer be connected between electrical equipment in the OR and the electric power supplied by the utility company

Answer
The isolated power supply system used in ORs requires that: D - A transformer be connected between electrical equipment in the OR and the electric power supplied by the utility company

LIM

QUESTION
Microshock hazard is increased in patients:
1. 2. 3. 4. With a temporary pacing wire in place In electrically operated beds Receiving TPN via CVC Who are in rooms with isolation transformers

Answer
B Both 1 and 3 can conduct electricity close to the heart and bypass the high resistance of the skin 100 mA for VF in MACROSHOCK 100 A (microamperes) for VF in MICROSHOCK

QUESTION
Operating rooms use an isolated power supply because:
1. Grounding cannot occur 2. Contact with both wires of the isolation transformer would cause no shock 3. Leakage current is zero 4. It affords protection against high amperage electrocution

Answer
Operating rooms use an isolated power supply because: 4 - It affords protection against high amperage electrocution Remember LIMs detect 2-5 mA (milli Ampres), a small amount of current

QUESTION
A ground fault circuit interrupter:
1. Is almost never used in OR 2. Is foolproof method for preventing serious electrical shock 3. May be used in a grounded electrical system 4. Has both audio and visual alarms to indicate the presence of a ground fault

Answer
B A GFCI prevents current from flowing in a circuit when there is an imbalance in the current flowing in the two sides of the circuit. Not used in OR b\c it would turn off life support equipment

QUESTION
Leakage current:
1. Is harmless 2. Occurs b\c of the magnitude of the inductance b\w electrical conductors supplying equipment 3. Is of the DC type 4. Is unintentional flow of current from the internal wiring of a device

Answer
Leakage current 4 - Is unintentional flow of current from the internal wiring of a device

QUESTION
The current delivered to a pt by an electrocautery device differs from the current supplied by an electrical utility in its
a) b) c) d) e) Capacitance Frequency Amperage Voltage Power

Answer
B USA electricity is 60 Hertz and electrocautery is > 10,00000 Hertz Hertz = frequency-remember bovie uses high frequency to prevent tissue damage