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PQ TechWatch

A product of the EPRI Power Quality Knowledge program

Power Quality for


Healthcare Facilities December 2007

Philip Keebler, EPRI


CONTENTS
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .1 EXECUTIVE SUMMARY

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.

This PQ TechWatch will introduce the typical problems found in


healthcare facilities, enlighten the reader on some new issues, and
provide practical guidelines for avoiding those problems.
About the EPRI Power Quality Knowledge Program
The EPRI Power Quality Knowledge program provides a wealth of resources in well-designed,
readable, and accessible formats. Paramount among these resources are documents covering
a wide range of PQ topics, written not only for use by busy PQ professionals, but also to be
shared with important end-use customers and internal utility managers. The program’s
website, www.mypq.net, is the most comprehensive electronic PQ resource available,
providing 24-7 access to proven expertise via the PQ Hotline, hundreds of PQ case studies,
over 200 PQ technical documents, PQ standards references, indexes, conference
presentations, and a wealth of other resources.

For more information, please visit www.mypq.net.

Copyright 2007, EPRI (www.epri.com). All rights reserved. Distribution of PQ TechWatch is


subject to a license agreement with EPRI. No portion of this report may be reproduced or
redistributed in any form, including electronic copies, without prior written consent from
EPRI. Distribution outside the licensed organization is expressly forbidden. Product and
company names mentioned in this document may be trademarks of their respective
companies. Mention of third-party products is for informational purposes only and
constitutes neither a recommendation nor an endorsement. EPRI and the EPRI logo are
trademarks of EPRI.

ii Power Quality for Healthcare Facilities


Healthcare INTRODUCTION problem to cripple the emergency medical
staff. A second CT machine may not be an
providers have Although the electricity provided to a
option, and the nearest machine may be
little time to be healthcare facility or medical location is an
many miles away in another hospital. This
absolute necessity for healthcare providers to
concerned with operate their facilities, it is usually not given
mission-critical imaging system could be
taken off-line by a minor voltage sag to 80%
the quality of a lot of thought. The widespread growth of
of nominal (i.e., a 20% sag), lasting for only
power or to find new and lingering illnesses and diseases, the
three 60-hertz cycles (50 milliseconds). The
call for increasingly critical emergency
a reliable U.S. power quality community has estimated
services, and the pressure to reduce
source of power healthcare costs force healthcare providers to
that $10 billion is lost yearly when
automated control systems in industrial
to operate their keep their minds on their business—caring
plants are upset by voltage sag events. Such
equipment. for their patients, enlisting the best possible
numbers have not been estimated
healthcare professionals, and purchasing and
specifically for healthcare facilities or
installing the best medical equipment that
providers, but one can assume that the cost
money can buy. Turning on a heart-lung
of downtime will also include possibly
bypass machine prior to a six-hour open-
placing one or more patients at risk.
heart surgery where the operating room
lights “are always on” has become as routine
as activating a medical gas supply of oxygen The Healthcare Environment
for a patient and then adjusting the flow rate The healthcare environment in the United
so the patient receives the desired amount of States is in continual transition in efforts to
oxygen. Healthcare providers have little time improve patient care. Aside from the
to be concerned with the quality of power or practice of medicine, nursing, and other
to find a reliable source of power to operate medical-related fields, two areas key to the
their equipment. They need quality power 24 success of these transitions are (1)
hours per day, 365 days per year. Moreover, improvements in the design, construction,
the time spent on power quality concerns is and maintenance of healthcare facilities,
becoming shorter and shorter as bottom-line and (2) the identification, selection,
pressures continue to be applied. installation, and maintenance of medical
equipment. Lessons learned in the area of
In most situations, instead of focusing on power quality for healthcare demonstrate
the power quality, they have learned ways to that efforts made beforehand to incorporate
“work around” malfunctioning and failed power quality into these two areas usually
medical equipment. When one blood- prevent significant interruptions in patient
pressure monitor is broken (possibly from a care services and escalations in the costs of
voltage surge), a nurse or medical medical equipment downtime.
technician goes and finds another monitor.
But, in smaller healthcare facilities where The healthcare environment encompasses
equipment may be limited, providers may everything associated with patient care and
find themselves with fewer pieces of the healthcare facility from the time the
redundant medical equipment and without patient enters the facility to the time the
resources including power to operate the patient leaves the facility. This environment
facility. To healthcare providers, the includes healthcare functions that occur
malfunction or failure of one key piece of outside and inside the facility. Healthcare
medical equipment—a computed facility designers, planners, architects, and
tomography (CT) scanner in an emergency engineers and facility operating engineers
room, for example—would be enough of a and maintenance support personnel should

1 Power Quality for Healthcare Facilities


Healthcare staff focus upon those parts of the environment
Complex Electronic Medical Equipment
that contribute to shaping the quality of
can contribute Used in Patient Care Areas
power and depend upon the quality of the
to improving power in providing patient care. Healthcare
patient care staff, including medical professionals, can
also contribute to improving patient care
and the
and the environment through increasing
environment their level of awareness in recognizing
through equipment malfunctions that may be caused
increasing their by power quality problems.

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.

„ Examples of new medical


electrotechnologies include
diagnostic imaging systems capable of New technologies, such as electronic machines in the
intensive care unit (top) and those used for laparoscopic
resolving more patient detail,
imaging (bottom), are continually being introduced into
computer-based wireless clinical the healthcare environment.
information systems, and advanced
patient diagnostic and therapeutic
equipment. Additionally, much of the
medical equipment is mobile, Today, the public and the government are
requiring reliable, well-regulated making unprecedented demands upon the
electricity on tap throughout a facility. healthcare industry to provide high-quality,
„ Examples of new functional cost-effective patient care. Corporate
technologies include microprocessor- restructuring and mergers are just two
based food preparation equipment examples of how the healthcare industry is
and laundry equipment that use meeting a financial challenge that leaves
adjustable speed drives. little room for equipment malfunction.

„ Examples of facility equipment


To ensure that the safe operation of medical
include energy management systems,
equipment does not become a casualty of
electronic controls for facility HVAC
this new corporate mentality, the U.S.
systems and equipment, and medical
Congress passed the Safe Medical Device Act
gas systems.
in 1990 (Public Law 101-69), which

2 Power Quality for Healthcare Facilities


For equipment establishes a partnership in safety between Power Quality in Healthcare Facilities
the healthcare industry and manufacturers Although inadequate and faulty wiring and
with low of medical equipment in the United States. grounding systems and equipment
immunity, This act is required to track all implantable interactions can exacerbate power quality
electrical medical devices and life-supporting or life- problems in healthcare facilities, electrical
sustaining devices listed in the act—such as disturbances can damage low immunity
disturbances
pacemakers, pulse generators, and equipment or cause malfunction. In facilities
are a primary automatic defibrillators—that were where wiring and grounding systems are error
cause of distributed outside healthcare facilities after free and equipment immunity is known,
August 29, 1993. electrical disturbances are less likely to cause
damage and
power quality problems. Additional causes of
malfunctions. The electrical environment in U.S. power quality problems include the generation
healthcare facilities is regulated by the of disturbances from the normal operation of
National Electrical Code (NEC). The purpose medical, functional, and facility equipment.
of this code is to provide minimum For example, a contactor that controls power
standards to safeguard life or limb, health, to part of the heating system in a facility can
generate voltage transients that could impact
property, and public welfare by regulating
the operation and reliability of electronic
and controlling the design, construction,
medical equipment powered by the same
installation, quality of materials, location,
panel that powers the heating system. In this
operation, and maintenance or use of
situation, using a contactor that contains a
electrical systems and equipment. This code
snubber to limit the voltage transients and
regulates the design, construction,
powering the heating system from a separate
installation, alteration, repairs, relocation,
feeder circuit than the one powering the
replacement, addition to, use, or
medical equipment will help resolve the
maintenance of electrical systems and
problem.
equipment.

Before the introduction of electronic medical


equipment, common electrical disturbances
Microprocessor-Based Electronic Medical Equipment were inconsequential to healthcare
operations. Today, however, common
electrical disturbances may cause high-tech
medical equipment to malfunction, which is a
problem given the intimate connection
between this equipment and the patients that
hospitals serve (see figure at left). Much of
this equipment incorporates sensitive
electronic power supplies and
microprocessors (see figure on top of
following page)—possibly resulting in
extended patient discomfort, misdiagnoses,
increased equipment downtime and service
costs, and even life-threatening situations.
Moreover, equipment damage and
malfunctions can jeopardize patient safety
and increase the cost of healthcare.

The healthcare environment is a unique one because of the intimate proximity of people
to equipment.

3 Power Quality for Healthcare Facilities


Medical equipment used in the United
Circuit Boards from a Medical Imaging System States, such as diagnostic imaging systems,
that present dynamic loads to the facility
electrical systems can cause power quality
problems internal to the facility. The figure
at lower left is an example of a nonlinear
current waveform captured by a power
quality monitor connected to the input of a
CT scanner during imaging system
operation. From the figure, one can see that
the current is very nonlinear and is
characteristic of a high inrush current when
the system is placed into the scan mode. If
the healthcare facility contains wiring and
ground errors with its earthing system, then
dynamic loads such as those characteristic
Integrated circuits, sensitive to electrical and electromagnetic disturbances, are used in
electronic medical equipment. of diagnostic imaging system operation
cause PQ disturbances that may impact

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.

administrators must also consider the


bottom line. Electrical disturbances can
result in repeated diagnostic tests, wasted RECOGNIZING POWER QUALITY
medical supplies, and expensive service and PROBLEMS
repair calls. These unexpected events are
not covered by any healthcare insurance Symptoms and Their Causes
provider. The increasing use of healthcare Disturbances can enter healthcare
insurance and the increased coverage equipment through any electrical port—the
limitations therefore compel healthcare AC power input, telecommunications, or
facilities to minimize all equipment network—common in the facility’s electrical
malfunctions. environment. Most disturbances will enter
the AC power port and present themselves
Non-linear (Harmonic-Rich) Load Current from a CT System to equipment’s power distribution unit or
power supply. Because most medical
equipment in a healthcare facility is
Current (50 amps/division)

networked to other equipment, variations in


the facility grounding system provide paths
for disturbances to enter the equipment’s
telecommunications and network ports.

The effects of electrical disturbances upon


healthcare equipment can be noticeable or
unnoticeable. Disturbances entering AC
power input, telecommunications, or
Time (10 milliseconds/division) network ports may not cause immediate
damage to electrical and electronic
components or cause equipment to fail
This medical imaging system creates dynamic power quality problems in healthcare
suddenly. Depending upon the type of
facilities with wiring and grounding errors.

4 Power Quality for Healthcare Facilities


The most disturbance—undervoltage or overvoltage, malfunction, including malfunctions not
its duration, and the immunity of the related to microprocessors.
common equipment to that disturbance—gradual or
equipment fast occurring damage to electrical and Distortion of Displayed Medical
malfunctions electronic components may result. A Information
disturbance such as a voltage surge entering
are caused the AC power input of medical equipment
Medical information displayed on cathode ray
tubes (CRTs), liquid crystal displays (LCDs),
by the inputs may not be sufficiently mitigated by internal
printouts, and film may be distorted by
overvoltage and overcurrent protection
and outputs of disturbed DC voltages powering the display, a
devices and may propagate through the
microprocessors power supply to other sensitive electronic
microprocessor malfunction, or faulty data
from memory. For example, a waveform from
erroneously subsystems and components. Voltage sags
an electrocardiogram printout may be
may cause post-sag inrush currents, which
switching on disfigured, film from an X-ray may have a hot
may cause permanent damage to
and off because spot (a white area without any detail), or a
overcurrent protection devices. A series of
video display on a physiological monitor may
of voltage sags, disturbances occurring over the period of a
be distorted. Faulty data from memory or a
few hours or a few months, for example, may
swells, chip away at internal protection devices and
microprocessor may also degrade the quality
or resolution of an image captured by an
transients, electronic components, although damage to
imaging system such as a CT scanner (see
andmomentary equipment may be virtually unnoticeable.
figure below). Caregivers who encounter
Intermittent equipment malfunctions may
power be noticeable until eventual failure occurs.
distorted information often report that they
had to repeat tests or were unable to make
interruptions.
timely, critical decisions because of the
However, the most common equipment
distortion.
malfunctions are caused by the inputs and
outputs of microprocessors switching
Distorted Computed Tomography Image
between an on and off state resulting from
and Digital Readout
voltage sags, voltage swells, voltage
transients, and momentary power
interruptions. For example, a voltage sag
may cause the DC voltage (produced by the
power supply) to the microprocessor of a
blood-pressure monitor to decrease or
suddenly change such that one or more of
the microprocessor inputs or outputs drop
from an on state to an off state. Or, a voltage
transient incident upon the power supply
may cause a change from an off state to an
on state. In either case, data may be lost or
scrambled, or the microprocessor may lock
up or otherwise misoperate. Additionally,
such changes in logical states can alter
stored data, such as the control parameters
of a defibrillator, ventilator, or an imaging
system. Healthcare staffs have also reported
power quality problems that are obviously
not related to the malfunction of a
microprocessor, such as 60-hertz artifacts
on the signal recordings of biomedical
equipment. The following are the most Variations in DC voltages can cause problems with the
common symptoms of medical equipment images and digital readouts from CT scanners.

5 Power Quality for Healthcare Facilities


Electrical Incorrect Diagnostic Results unacceptable levels of 60-hertz current), and
Electrical disturbances can alter the control miswired or damaged equipment that forces
disturbances
parameters stored in electronic medical supply current through ground conductors.
can cause equipment and used to diagnose a patient’s Electromagnetic fields from certain electrical
microprocessor condition. For example, the status of a CT distribution equipment, medical equipment,
and facility equipment can also produce stray
-based medical system may be misreported via the digital
readout as illustrated in the figure on the magnetic fields that can cause these artifacts.
equipment to Artifacts in medical data may also be caused by
previous page. Moreover, biomedical
malfunction. equipment such as blood-pressure monitors current flowing in conductors that are not
may display diagnostic data, such as a digital contained in conduits.
readout or level indicator, that disagrees with
the patient’s prevailing condition. Equipment Lockup

Electrical disturbances can cause


Incorrect diagnostic results may also be caused
microprocessor-based equipment to lock up
by 60-hertz noise coupled to the patient or to
and fail to capture data used by caregivers to
the leads of diagnostic equipment such as
make critical medical decisions. Infusion
electrocardiographs (EKGs) (see figure below)
equipment used to administer a patient
and electroencephalographs (EEGs). Such
treatment may fail to regulate or count the
noise is commonly associated with stray
proper dosage. The lockup of a medical
currents caused by faulty grounds (i.e.,
imaging system wastes the valuable time of
miswired ground conductors carrying
patients, imaging technicians, and medical
staff and may extend patient discomfort

Incorrect Diagnostic Results when imaging scans must be repeated.


Moreover, lockups of life-support
equipment such as defibrillators pose life-
threatening risks to patients. Rebooting of
medical equipment may take as long as two
hours and in some cases cannot be
accomplished if equipment software
becomes damaged from electrical and
electromagnetic disturbances.

Procedure Interruptions

Electrical disturbances may lock up


microprocessor-based medical equipment,
resulting in interrupted medical procedures.
The consequences of these interruptions
range from minor inconveniences to patient
jeopardy. For example, if the video system
fails during a routine laparoscopic surgery,
the surgeon may have to incise the patient
An artifact-infested electrocardiograph (top) appears to match a textbook example of to complete the operation, an unplanned
arrhythmia (bottom) (reproduced from Capuano, 1993). The waveform on the top had a procedure that significantly increases the
rate of 300 beats per minute or 5 hertz and was accepted and diagnosed as arrhythmia, patient risk, recovery time, and the cost of
or atrial flutter (but actually was not).
patient care.

6 Power Quality for Healthcare Facilities


An electrical Loss of Stored Data Control or Alarm Malfunctions

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.

Damage to a Power Supply Board Nurse Checking on the Status of a Patient


after Resetting a Medical Device

False alarms or, worse, alarm failures may result from


any instrument malfunction, presenting a possible risk to
patients and increased workload for healthcare
professionals.

A temporary overvoltage permanently damaged this power supply board from a


medical instrument.

7 Power Quality for Healthcare Facilities


Equipment Sources of Electrical Disturbances Faulty Facility Wiring and Grounding

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

8 Power Quality for Healthcare Facilities


The power engineers, facility designers, and
Power-Factor Correction Capacitors at a
maintenance directors are realizing the
supply Substation Near a Healthcare Facility
importance of the integrity of their electrical
equipment systems in shaping the quality of power used
and wiring in for patient care. However, Article 517
focuses on electrical construction and
a healthcare
installation criteria in healthcare facilities to
facility may reduce the risk of electrical shock and fire; it
fully comply does not address power quality in the
with applicable facility. The standard NFPA 99 entitled
Handbook for Healthcare Facilities, also
standards,
commonly used in the United States,
codes, and focuses on the installation and performance
recommended of equipment in a healthcare facility, but
also does not address power quality. The
practices and
equipment and wiring in a healthcare Switching capacitors in and out of service can create
still be facility may fully comply with applicable
transients that impact sensitive instrument.

inadequate standards, codes, and recommended


to prevent practices and still be inadequate to support
sensitive electronic equipment commonly
interruption
found in a healthcare facility.
of sensitive (MRI) systems, CT scanners, and linear
accelerators operate at high line voltages,
electronic Routine Electric Utility Activities
require high steady-state current, and
equipment. To correct the power factor of electricity, present dynamic loading (see figure on
electric utilities routinely switch large following page) to healthcare facility power
capacitors (see figure on top right) onto the systems. During startup, this type of
power lines. These switching activities may equipment draws very high inrush current—
generate transient overvoltages, called as high as 70 times the normal operating
“capacitor-switching transients,” which may current—which can cause voltage sags and
enter a healthcare facility or medical other electrical disturbances on adjacent
location at the service entrance. These types circuits not properly sized for these loads.
of electrical disturbances are more likely to Problems occur when the circuits connected
occur in the morning and evening, when to such disturbance-causing equipment
industrial facilities are powering up and were not carefully planned for high-wattage
down. Other routine activities such as the equipment. Such problems most often arise
operation of reclosures and breakers that after a facility has recently undergone a
occur to maintain and stabilize the power renovation or expansion or has recently
system and reduce the effects of electrical moved existing medical equipment or
disturbances caused by natural events (e.g., installed new medical equipment. Also,
lightning) can result in some residual installing high-wattage electronic
disturbances. equipment without upgrading the existing
facility power system (i.e., switchgear,
High-Wattage Medical Equipment with transformers, and electrical wiring and
Dynamic Load grounding) to accommodate the higher
power consumption may result in overload,
Large medical equipment such as X-ray undervoltage, and even overvoltage
machines, magnetic-resonance imaging conditions.

9 Power Quality for Healthcare Facilities


facilities and medical clinics may find that
Harmonic-Rich Current from an MRI System
equipment malfunctions are more prevalent
on windy days when tree limbs may contact
power lines. Voltage sags and interruptions
Current (20 amps/division)

may also be caused by lightning strikes,


animals climbing atop the electrodes of a
transformer or other utility equipment, and
power-line conductor and insulator failures.

Downed Power Pole Adjacent to a


Healthcare Facility

Time (25 milliseconds/division)

This distorted current waveform was captured with a power quality monitor during a PQ
field investigation at a healthcare facility.

Voltage sags Mechanical equipment containing loads


that are inductive (e.g., motors) and
originating
resistive (e.g., heating elements)—such as
from outside a heating, ventilation, air-conditioning,
facility can be transportation, refrigeration, and pump
equipment, which are controlled by starters
caused by
and contactors—may also create electrical
downed, disturbances. The startup, normal
crossed, and operation, and shutdown of this equipment
contacted can cause voltage sags, transient
overvoltages, and electrical noise.
power lines.

Accidents, Weather, and Animals

Voltage sags originating from outside a This toppled power pole caused a power outage at the

facility—which may account for more healthcare facility nearby.

increased patient risk than any other single


type of disturbance—can be caused by Facility electrical modifications
downed (like that shown in the figure on the Renovating and annexing healthcare
right), crossed, and contacted power lines facilities and medical clinics are common in
and are most likely to occur during the global modern healthcare industry, as
inclement weather conditions and peak are the addition of transformers, subpanels,
demand times. Cars crashing into utility and circuits to an electrical system and the
poles and ice-laden, wind-blown, or use of temporary circuits to power existing
overgrown limbs touching and landing on equipment. The rerouting of feeder and
power lines may create a path from the branch circuits can result in the
power line to ground, creating electrical commingling of loads (powering sensitive
disturbances and power interruptions for electronic medical equipment from the
some and voltage sags for many. Healthcare same bus as disturbance-generating loads).

10 Power Quality for Healthcare Facilities


To provide power to some construction manual transfer switch. (Ideally, in facility
equipment, temporary electrical circuits electrical designs where provisions for a
may be connected to the wiring of existing second utility feed are included, the second
structures, or construction equipment may feed should come from a different
be connected to the output of motor- substation, but this is not always possible.)
generator sets. The operation of If the transfer switch is not properly
construction equipment such as arc welders installed, adjusted, and maintained to
(see figure below) and line-powered ensure a smooth transfer of power, the
motorized rotary equipment on the center’s transfer may produce electrical disturbances
wiring system may introduce electrical that are severe enough to cause malfunction
disturbances into branch circuits powering of electronic medical equipment. Inspection
sensitive electronic medical equipment. of generator wiring (see figure below) will
reveal important wiring and grounding
characteristics that are vital to the
Construction of a Shielded Room for an MRI Suite Using an emergency power system. Engineers in
Arc Welder
healthcare facilities and medical clinics may
also find that malfunction and damage to
medical equipment may occur during
routine generator testing (if generator
testing is required by local, state, and
international codes and laws). Most master
generator control centers include an
adjustable time delay to ensure that the
generators are placed online or offline
without creating electrical disturbances.

Searching for a Neutral-to-Ground Bond


in the Emergency Generator at a
Healthcare Facility
Arc welders can introduce electrical disturbances into the branch circuits on which
medical equipment are operating.

Transfer to and from Emergency


Generator or Alternate Feeder

To ensure that power is always provided to


feeder circuits that power subpanels and
branch circuits connected to critical-care
equipment, some electrical codes require
that healthcare facilities have ready access
to emergency power. Whether the source of
emergency power is an on-site generator or
a second utility feed, transferring from the
Generator wiring should be inspected and maintained to
normal power source to the emergency avoid producing electrical disturbances during a power
source is accomplished with an automatic or transfer.

11 Power Quality for Healthcare Facilities


So You Think You Need Uninterruptible Power Supplies?

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.

12 Power Quality for Healthcare Facilities


Power quality IMPROVING POWER QUALITY disturbances and that generates
IN THE HEALTHCARE fewer electrical disturbances,
in the ENVIRONMENT
„ effectively use power-conditioning
healthcare
Power quality in the healthcare environment technologies for existing medical
environment can be improved through enhancing the equipment in accordance with
can be level of awareness among the stakeholders: standards and recommended

improved utilities, healthcare facility and medical practices,


staff, healthcare facility designers, and
through „ carefully plan new construction or
medical equipment manufacturers. Power
renovation of existing healthcare
enhancing the quality problems in this mission-critical
facilities with regard to power quality
level of environment present a series of challenges
concerns,
among stakeholders. Meeting these
awareness „ maintain existing wiring and medical
challenges helps to prevent these problems
among utilities, before they become monumental to equipment in healthcare facilities,

healthcare healthcare providers. and

facility „ learn from past power quality


problems.
designers, and Meeting the Power Quality
Challenges of the Healthcare Industry
medical
Although healthcare staffs rely upon Establishing Partnerships
equipment advanced medical procedures using
Preventing or resolving power quality
manufacturers. advanced medical equipment to provide
problems should be a cooperative effort
immediate patient care, they must
between healthcare facilities, equipment
sometimes plug equipment into antiquated
vendors, equipment manufacturers, and
and unreliable electrical systems. Moreover,
electric supply companies. Electric supply
some equipment manufacturers design
companies have always offered assistance to
equipment without fully considering and
customers in emergencies and have
understanding the electrical environment of
sometimes promoted new energy-efficient
a healthcare facility. Because of its
technologies to improve productivity and
obligation to human care, the healthcare
reliability as well. As problems associated
industry must demand high standards of
with new technologies were revealed, many
performance from facility designers,
electric supply companies established power
equipment manufacturers, equipment
quality programs that invested in power
service companies, facility and equipment
quality research to assist utility customers
support staff, and electric supply
and manufacturers with equipment-
companies. To meet the challenges of the
compatibility problems.
healthcare industry, these people must meet
on common ground to
Electric supply companies especially
recognize the necessity of identifying or
„ establish new partnerships to
providing power quality engineering
improve power quality in the
services to their healthcare customers.
healthcare environment,
These services enable healthcare staff to
„ improve the procurement process for learn how to identify wiring and grounding
new medical equipment, problems that exacerbate power quality
„ encourage equipment manufacturers problems, select the proper power-
to design medical equipment that is conditioning equipment to mitigate these
more immune to electrical problems, develop specifications (that

13 Power Quality for Healthcare Facilities


Building strong include power quality specifications) for and clinics where significant and
purchasing medical equipment problems, costly power quality problems have
relationships
establish correct installation guidelines, and occurred find it cost-effective to
between plan center renovations or the construction purchase a monitor and learn to use
healthcare of new healthcare facilities and medical it. Consider tapping the expertise of
clinics to help avoid problems. your local utility company or
facilities,
independent consultants. Determine
equipment Building strong relationships between the characteristics of your facility’s
vendors, healthcare facilities, equipment vendors, electrical system: Can it tightly
equipment equipment manufacturers, and electric regulate equipment voltage? Is
supply companies offers many benefits. voltage to equipment continuous?
manufacturers,
These benefits include learning how to avoid Does high-wattage equipment create
and electric wiring and grounding errors, reducing or electrical disturbances in the facility
supply eliminating controllable electrical wiring? Your local utility company
disturbances, managing common may also provide site-specific
companies
uncontrollable electrical disturbances, characteristics such as expected
offers many encouraging equipment manufacturers to voltage regulation and statistical
benefits. design and build robust equipment immune analysis of electrical disturbances.
to most electrical disturbances, significantly
„ Evaluate the immunity performance
reducing the potential for lawsuits by
requirements of existing equipment.
healthcare patients involved in events
How susceptible is each type of
possibly initiated by equipment
medical equipment to common
malfunctions, and avoiding citations and
electrical disturbances such as
penalties from international regulatory
voltage sags and transient
agencies.
overvoltages?

„ Set your expectations for the


Creating a Power Quality Checklist for performance of new equipment, and
Procuring Equipment
then ask your utility company for
Healthcare facilities and medical clinics help in specifying design features
routinely procure and install medical, that enhance compatibility between
functional, and facility equipment. To the equipment and its intended
reduce power-quality-related problems electrical environment.
between equipment and the intended
„ Identify and repair all wiring and
electrical environment, equipment-
grounding problems.
procurement procedures should include the
following steps. „ Identify all areas where critical
electronic medical equipment may
be used and the special power
Planning for Additional Equipment
requirements of such equipment.
„ Begin a sound in-house power
„ With assistance from your local
quality program with the purchase of
utility company or independent
a PQ monitor to conduct an on-site
consultants, identify appropriate
survey to identify potential power
power-conditioning devices for
quality problems and diagnose
critical electronic equipment.
problems with sensitive electronic
medical equipment. Some facilities

14 Power Quality for Healthcare Facilities


Purchasing Additional Equipment Installing Additional Equipment

„ Disclose to equipment suppliers the „ Use high-performance wiring and


power quality characteristics of the proper grounding techniques
electricity and wiring where the new specified in the International
equipment will be installed. Electrical Code (IEC), the Institute of
Electrical and Electronics Engineers
„ Ask the manufacturer’s representative
(IEEE) Standard 602-1996 (White
about known power quality problems
Book; Recommended Practice for
with the equipment and if the
Electric Systems in Healthcare
equipment has been tested for
Facilities), and the IEEE Standard
compatibility with the utility power
1100-1992 (Emerald Book; Powering
system. If there is reason to believe
and Grounding Sensitive Electronic
that compatibility may be an issue, ask
Equipment).
to see the power quality test report.
„ For circuits connected to sensitive
„ For all new equipment, specify the
electronic equipment, use single-
voltage range (required voltage
point grounding, locate equipment
regulation), frequency, and voltage
as electrically close to the source as
sag immunity (i.e., ride-through)
possible, and make sure that the
performance.
sizing of phase, neutral, and ground
„ Purchase equipment with an input conductors follow international and
voltage rating matched to the voltage local codes and manufacturer
at the installation site when possible. installation requirements.
Purchase high-quality matching
„ When adding grounding conductors
transformers with new equipment
to an existing facility, run the
when the voltage ratings of the
grounding conductors parallel to the
equipment do not match the available
existing power conductors to reduce
voltage at the installation site.
stray electromagnetic fields.
„ If a power-conditioning device is
„ When installing high-wattage
needed, make sure that it is designed
medical equipment in an existing
for compatibility with electronic
facility, monitor the input voltage at
medical equipment. Medical
the proposed installation site for
equipment such as imaging systems
electrical disturbances for at least a
with dynamic load behavior may not
30-day period before completing the
function properly when connected to
installation.
some power conditioners.

„ Make sure that all medical and


power-conditioning equipment Maintaining Equipment
complies with applicable „ Regularly review equipment
international codes, standards, and performance and continue the
recommended practices. relationship between healthcare
„ To reduce susceptibility to common facility staff, utility company
electrical disturbances, select the representatives, equipment vendors,
highest input voltage rating for equipment manufacturers, and
equipment known to be sensitive to medical equipment service
common electrical disturbances. companies.

15 Power Quality for Healthcare Facilities


„ Document all facility power outages, Using Power-Conditioning Devices to
noticeable disturbances (i.e., light Improve Equipment Compatibility
flicker), and equipment problems. Some power quality problems in healthcare
Include patient schedules, the facilities and medical clinics can be solved
location of equipment, the with appropriate power-conditioning
symptoms, suspected causes, time devices. Some of these technologies are
and date of occurrence, and any listed in the table on the left and include
other related events. Checking isolation transformers, surge-protective
disturbance logs against utility devices, voltage regulators, and UPSs.
company records and facility
activities can help reveal the source However, power-conditioning devices are
of electrical disturbances. These logs not always the answer to a power quality
can also be used to specify future problem. In some cases, installing power
equipment purchases and determine
quality mitigation equipment can worsen a
correct installation methods.
medical equipment malfunction, especially
in cases where medical equipment loads are
General Summary of Available Power-Conditioning very dynamic in nature, like that of
Technologies diagnostic medical imaging equipment. In
addition, low-kilovolt-ampere power-
conditioning devices and “ice-cube” relays,
power supplies, and contactors routinely
used in industrial facilities can be used in
the physical plants (i.e., where HVAC, steam,
air, vacuum, and other mechanical systems
are located) but cannot be used with
medical equipment to solve power quality
problems.

In other cases, installing such equipment is


not necessary and can have no effect on the
problem. For example, power-conditioning
devices will not protect equipment against
radiated emissions or electrostatic
discharge, which has been reported as one
of the electromagnetic-related causes of
equipment malfunction. In some cases, the
potential for this problem can be virtually
eliminated by maintaining correct humidity
levels or installing building materials that
reduce the buildup of static charge.

In other cases where wiring and grounding


problems exacerbate equipment
malfunctions caused by voltage transients,
installation of a UPS can provide enhanced
immunity to voltage sags and momentary
interruptions and some mitigation of
transients. However, if equipment damage is

16 Power Quality for Healthcare Facilities


Good caused by a wiring and grounding problem „ medical equipment such as imaging
and voltage transients developed at the and radiology equipment and
grounding is medical air pumps, and
point of use (where the equipment is
essential for connected to the center electrical system), „ mechanical equipment such as
good power then installing an upstream UPS will not adjustable speed drives, chillers,
resolve the problem. Consult the equipment
quality and fans, pumps, and HVAC equipment.
manufacturer and local utility company to
safety at any determine whether a power-conditioning
Other support equipment, such as
healthcare device can be used effectively.
biomedical and laboratory equipment and
facility. low-power kitchen and laundry equipment,
Understanding Facility Voltage are powered at 120 volts.
Requirements, Grounding, and
Dedicated Circuits
However, effective January 1, 2008, the
The voltage level provided to the service tolerance levels for the electric supply
entrance of a healthcare facility will impact voltage with a range of ±10% will again be
the voltage that is provided to all loads in unified for European healthcare facilities
the facility, especially the medical and medical clinics. Thus, European
equipment loads. Because the healthcare manufacturers of medical equipment used
provider must provide healthcare services to in the United States, who have integrated
patients in real-world power quality design changes into their equipment to help
environments, grounding the facility ensure reliable operation in Europe, may
infrastructure, the secondary of the utility find that United States users file fewer
company’s transformer at the service complaints regarding medical equipment
entrance, within the switchgear, throughout malfunctions. Healthcare facilities and
the facility electrical system, and at the end- medical clinics in the United States may
use level where the equipment is connected experience fewer malfunctions caused by
and used is also critical. Moreover, many long-term steady-state undervoltage
end-use loads in healthcare facilities require conditions and possibly minor voltage sags.
the use of a dedicated feeder or branch In areas such as medical laboratories where
circuit, which helps to maintain voltage and microscopes are used and surgical suites
current quality to critical equipment. where eye surgery and other surgical
procedures are performed, high power
The voltage levels selected for new quality lighting that is immune to more
equipment will depend upon the available types of voltage fluctuations and other
utility voltage, the size of the healthcare electrical disturbances may operate with
facility or medical location, voltage levels less flicker to lamps, thus improving light-
used within, type of equipment, building assisted and light-dependent medical
layout, voltage regulation requirements, and procedures.
cost. Typically, power to a healthcare facility
or medical location is supplied by the utility
Voltage Matching
company at a medium voltage level for large
facilities and clinics and at 480 volts (with a Once the nominal voltages of equipment
±5% range), three-phase. These voltages have been selected, the voltage source for all
may be used to power: medical equipment to be installed in the
facility should be carefully checked to assure
proper voltage levels. New equipment

17 Power Quality for Healthcare Facilities


should be ordered to match one of the However, the focus of the discussion in this
planned voltage sources. Otherwise consider section of this report is not on patient
using buck/boost transformers, safety, but on wiring and grounding (i.e.,
autotransformers, or standard two-winding earthing systems) as they relate to power
isolation transformers to match the voltage quality in U.S. healthcare facilities and
requirement of the equipment to the voltage medical clinics. Moreover, the compatibility
source. Variacs should never be used to between medical equipment and the
match a source voltage to an equipment electrical environment in these facilities and
voltage. clinics is dependent upon the type of
earthing system that powers and grounds
the medical equipment.
Regardless of Equipment from International
Manufacturers
the earthing Equipment purchased from international
Regardless of the earthing system used,
system used, sources originally designed to operate in
providing a solid low-impedance ground to
sensitive equipment—which is required by
providing a countries with different nominal voltage
the NFPA NEC and healthcare facility codes
levels requires careful consideration of the
solid low- and recommended by the IEEE Emerald,
design of the facility distribution system so
impedance that the correct voltage can be supplied to
Green, and White Books—will help minimize
power quality problems. Because patients
ground to the equipment. Equipment designed for
are often moved from one location in the
sensitive nonstandard U.S. voltages may require
healthcare facility to another, grounded
matching transformers. The addition of a
equipment will transformer may make equipment more
receptacles should be available at all
help minimize sensitive to common electrical disturbances.
possible equipment locations. Power cords
should never be modified to accommodate
power quality Also, equipment designed for 60-hertz
an ungrounded receptacle by removing the
operation must be able to operate properly
problems. grounding connector. Nor should grounding
at 60 hertz. The voltage tolerance of
adapters be used on equipment requiring a
overseas equipment may also be a concern
ground. In some older healthcare facilities,
and should be checked. Equipment
grounding conductors may be present but
purchased from European manufacturers
may not be running parallel to the power
not recognizing the standard U.S. nominal
conductors. In the course of enhancing the
voltage may require a special transformer to
grounding system in these facilities, the
be powered from U.S. voltage sources.
grounding conductors should be run parallel
to the circuit’s neutral and power
Ensuring Proper Grounding and Wiring conductors, which will minimize stray
Power quality investigations carried out in electromagnetic fields due to the presence
the United States are revealing that the of any unwanted ground currents.
integrity of wiring and grounding systems in
healthcare facilities and medical clinics has Similar to the requirements of electrical
an even greater impact on the immunity of systems for providing quality voltage and
medical equipment to common electrical current to large loads such as chillers and
disturbances. Since the term leakage current printing presses found in commercial and
was coined for the medical equipment industrial facilities, large loads in healthcare
industry, much of the focus on the integrity facilities must be circuited such that their
of grounding systems in healthcare facilities operation does not affect other loads.
has been on patient safety. Powering disturbance-generating loads such
as HVAC equipment (e.g., motor contactors,

18 Power Quality for Healthcare Facilities


To avoid motor starters, chillers, heating systems, The IEEE Standard 602 (White Book), and
etc.) from the same voltage bus that powers IEEE Standard 1100 (Emerald Book) are also
equipment
critical medical loads (e.g., X-ray equipment both excellent technical resources that
malfunctions and medical imaging systems) is a address power quality in healthcare facilities
during prescription for incompatibility problems and medical clinics and offer guidance on
between building and facility loads, and powering and grounding sensitive electronic
renovation or
critical medical loads. Large diagnostic equipment during facility construction.
new medical imaging systems, such as MRI
construction, systems, CT scanners, and various X-ray
Medical Equipment Power Supplies
healthcare machines require dedicated power, neutral,
In healthcare facilities and medical clinics,
and ground conductors also, because they
facility the failure of the facility power may pose
usually draw fluctuating dynamic currents.
engineers Providing dedicated conductors for power,
life-threatening consequences to patients.
Examples of these concerns are the failure of
should neutral, and ground is not only concerned
a power supply in a ventilator, a lighting
with individual circuits (i.e., the fact that the
coordinate with system in an operating room, and the
circuits are separate runs from switchgear
construction and electrical panels) but also the size (i.e.,
branch circuit to a life support system in an

foremen before ICU. The restoration time for medical power


wire gauge) of the conductors with respect
supplies to restore power to the medical
the electrical to the required length and the allowable
equipment is not specified in the United
voltage drop from the supply to the load.
system is States for medical microprocessor-based
Many power quality investigations result in
modified. findings that identify dedicated circuits to
equipment. Designers of medical power
supplies must be conscious of the amount of
X-ray equipment and imaging systems that
leakage current they allow to flow out of the
are sized too small in wire gauge. The size of
supply under certain conditions, and the
the grounding conductor is also important
allowed levels are governed by the
and should be specified according to the
Association for the Advancement of Medical
requirements of the X-ray or medical
Instrumentation (AAMI). Lower leakage
imaging system manufacturer. When this
currents equate to higher levels of
equipment is installed, the facility
conducted emissions, thus increasing the
electrician should also determine what other
likelihood of a medical device creating an
sensitive or disturbance-causing equipment
electromagnetic interference (EMI)
may be powered by the common source. In
problem. Careful balance between EMI filter
some cases, the solution may require
design and leakage current helps to ensure
providing a dedicated circuit to certain
success in both areas. However, as medical
sensitive medical equipment to isolate it
devices become more digital in the next 20
from other disturbance-causing equipment.
years, this balance will become more
difficult to achieve.
To avoid equipment malfunctions during
renovation or new construction, healthcare
facility engineers should talk to the Standards
designated construction contact before the The healthcare and medical equipment
electrical system is modified. This industries are heavily regulated to protect
precaution will help ensure that good power patients. Both the United States and Europe
quality is maintained on circuits deemed have developed and published standards,
essential to patient safety, critical care, and recommended practices, and guidelines
other equipment necessary for the effective related to power quality and
operation of the healthcare facility during electromagnetic compatibility in the areas
the construction and renovation process.

19 Power Quality for Healthcare Facilities


of healthcare facility design, medical „ EN 61000-3-X: Emissions, limits
equipment design (i.e., product standards),
„ EN 61000-4-X: Emissions,
and emergency preparedness. Standards, measurement techniques
recommended practices, and guidelines
„ EN 61000-5-X: Immunity, testing
have also been developed that define
techniques
disturbances and test methods for power
quality and electromagnetic compatibility. „ EN 61000-6-X: Installation and
The United States has made significant mitigation guidelines
contributions in power quality standards
and healthcare facility design standards. Other healthcare codes, standards, and
Europe has made significant contributions recommended practices are promulgated by
in the area of immunity standards (i.e., the NFPA, the IEEE, the American National
emissions and immunity) regarding product Standards Institute (ANSI), the Federal
design and safety. Communications Commission (FCC), the
IEC, and the International Special
The top table on the following page presents Committee on Radio Frequency (CISPR).
a summary of power-line and
electromagnetic disturbances, power
Healthcare Facility Standards
electronics technologies, emissions and
immunity standards, and equipment Standards, recommended practices, and
performance standards relating to electronic guidelines have also been developed in
medical equipment. Medical equipment several areas related to the design of
designers and manufacturers in the United healthcare facilities and medical clinics. The
States have become more cognizant of these NFPA 99 (Standard for Healthcare Facilities),
standards. The emissions and immunity the facility code standard developed and
standards listed in the bottom table on the used in the United States; the NFPA
following page are the Basic Standard 70 (The National Electric Code),
Electromagnetic Compatibility (EMC) the electrical code standard developed in
standards prepared by the European-based the United States; and the IEEE Standard
International Electrotechnical Committee 602-1996, White Book (Recommended
(IEC). In the past few years, they have been Practice for Electric Systems in Healthcare
referred to as IEC 61000-X-X standards. After Facilities), the electrical system design
the European Union (EU) recently adopted practice developed and used in the United
them as European Norms (EN) standards, States, provide guidance to designers of
they were referred to as EN 61000-X-X healthcare facilities and medical clinics.
standards. The requirements listed in these Facility designers in the United States also
standards serve as the basis for all present commonly refer to the well-known IEEE
and future power quality and EMC Standard 1100-2006, Emerald Book (Powering
requirements for all products traded and Grounding Sensitive Electronic
internationally, including electronic medical Equipment), for guidance on powering and
equipment. The Basic EMC standards grounding electronic medical equipment.
consist of the following six parts:

„ EN 61000-1-X: General EMC


standards

„ EN 61000-2-X: Compatibility levels of


environments
Continued on page 22

20 Power Quality for Healthcare Facilities


Effects of Electromagnetic Disturbances on Power Electronics Technologies Used in Electronic Medical Equipment

(Refer to table below)

Cross-Reference of European Standards Applicable to Electromagnetic Compatibility of Electronic Medical Equipment

21 Power Quality for Healthcare Facilities


Healthcare Continued from page 20 strength, and isolation transformer
Healthcare facility standards address every construction to enable its use in electronic
facility
aspect of the electrical system in a medical equipment. The “Y” capacitors
standards healthcare facility from planning; voltage required in the input filter of a standard
address selection; loading (e.g., historical load switch-mode power supply for information
technology equipment would almost
important densities and profiles, demands, and
factors); harmonics; disturbances; certainly cause the power supply to fail on
aspects of the the grounds of excessive leakage current.
mitigation techniques; emergency power
electrical systems; renovation; telecommunications; Briefly, the more-stringent requirements
system in a and lighting. Guidance is given on how to that are of particular relevance to power
avoid overloading, undervoltaging, supplies used in electronic medical
healthcare
overvoltaging, and equipment damage and equipment are (1) service entrance to
facility from shutdown caused by power problems. secondary creepage and clearance distances
planning, for double or reinforced insulation for
equipment operating from 250 volts AC
voltage Medical Equipment Safety Standards
maximum must be 8 and 5 millimeters,
selection, In the EU, technical safety problems of respectively; (2) primary to secondary
loading, electronic medical equipment are addressed dielectric withstand test must be 4,000 volts
by the EN 60601 series of standards which
harmonics, AC; (3) earth leakage current maximum is
follow IEC 601 (now referred to as IEC 0.5 milliamp for normal operation and 1
disturbances, 60601-1-2), Medical Electrical Equipment. In milliamp maximum for a single fault
mitigation the United States, UL 544, Medical and condition. These values are for type B, type
techniques, Dental Equipment, covers medical and BF, and type CF equipment categories:
dental equipment, but in 1994 UL 2601-1,
emergency Medical Electrical Equipment—Part 1: „ Type B—Non-patient-connected
power systems, General Requirements for Safety, came into equipment, or equipment with
renovation, effect. This standard is harmonized with IEC grounded patient connection.
60601-1-2, to be used at present in parallel
telecommunica „ Type BF—Equipment with a floating
with UL 544, Medical Equipment, and the
tions, and patient connection.
U.S. safety standard for medical equipment,
lighting. „ Type CF—Equipment with a floating
but it became the sole mandatory standard
connection for direct cardiac application.
in 2004. In Canada, CSA 22.2-601.1, Medical
Electrical Equipment—Part 1: General
Requirements for Safety, has been in use Patient leakage current for the above
since 1990, again, alongside the existing categories is 0.1 milliamp (0.5 milliamp for a
standard CSA 22.2-125, Electromedical single fault condition) for type B and BF and
Equipment, and it became the sole 0.01 milliamp (0.05 milliamp for a single
applicable standard in the year 2000. fault condition) for type CF.

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.

22 Power Quality for Healthcare Facilities


Two New Approach Directives, 90/385/EEC „ IEC 801-4, Electric Fast Transients:
Active Implantable Medical Devices (AIMD) 1 kV at service entrance plug, 2 kV for
and 93/42/EEC Medical Devices Directive hardwired service entrance, 0.5 kV
(MDD) exempt those specific product on connecting leads greater than
categories from the EMC Directive. They 3 m long
contain their own specific EMC requirements.
„ IEC 801-5, Service Entrance Surges:
Probably only the MDD will be of interest to
1 kV differential, 2 kV common mode
power supply designers and users. The EMC
standards cited are IEC60061-1-2, adopted by
European Committee for Electrotechnical After June 14, 2000, electronic medical
Standardization (CENELEC) and published as equipment was allowed to be sold within the
EN60601-1-2. Emission standards required EU as compliant with either the EMC or MD
follow CISPR 11 (EN55011), Limits and Directives.
Methods of Measurement of Electromagnetic
An important point to note for all products
Disturbance Characteristics of Industrial,
subject to the AIMD, and many products
Scientific, and Medical (ISM) Radio Frequency
under the MDD (except class I), is that they
Equipment, normally class B, with a 12-dB
cannot be self-certified. Approvals must be
relaxation for radiated emissions in X-ray
carried out by Notified Test Organizations.
rooms, for example.
Class I equipment is defined as equipment
Immunity standards again rely heavily on for which electric shock protection is
IEC 801 as follows: achieved by basic insulation and protective
earth. All conductive parts that could
„ IEC 801-2, Electrostatic Discharge:
assume hazardous voltages in the event of
3 kV contact, 8 kV air failure of basic insulation must be connected
„ IEC 801-3, Radiated Radio-Frequency to a valid protective earth conductor. The
Interference (RFI): 3 V/m from 26 to table below lists some additional medical
1000 MHz, 80% amplitude equipment performance standards.
modulation, 1 V/m in X-ray rooms

U.S. and European


Electromagnetic
Compatibility
Standards Applicable
to Healthcare
Facilities and
Electronic Medical
Equipment

23 Power Quality for Healthcare Facilities


CONCLUSION power quality problems. The information
provided in the PQ TechWatch “Hardening
Important information has been provided
Manufacturing Processes Against Voltage
here about how healthcare facilities and
Sags” (EPRI, 200) can also be applied to the
medical clinics view power quality problems,
physical plant of healthcare facilities and
how such problems can be recognized by
medical clinics in efforts to harden
facility and medical staffs, definitions of the
mechanical equipment against voltage sags
sources of electrical disturbances that can
and momentary interruptions. Most voltage
impact healthcare facilities and medical
sag-sensitive components typically found in
clinics, and how power quality challenges
a healthcare facility or medical location
might be met in a complex environment
cannot be placed on a power conditioner at
where patient safety must prevail above
the patient level. Diagnostic medical imaging
power quality. Recognizing and correcting
systems are ultrasensitive to voltage
wiring and grounding errors and the
disturbances, and many times these systems
commingling of loads are paramount in
are not compatible with a UPS or cannot be
resolving power quality problems in
placed on a power conditioner due to cost
healthcare facilities and medical clinics, and
and space limitations in imaging suites. The
establishing partnerships between electric
cost of resolving underlying wiring and
supply companies, facility designers,
grounding errors and separating
medical equipment manufacturers, and the
disturbance-causing loads from sensitive
facility and medical staffs is also critical.
medical equipment is typically much less
This approach is based on common practices
than the cost of placing an entire
employed in U.S. healthcare facilities to
department or facility on conditioned power.
understand, identify, solve, and prevent

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24 Power Quality for Healthcare Facilities