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Safety and Risk

Management

Codes and Standards


Definitions
Standard:
A widely recognized and accepted statement of
criteria by which an object (product) or action
(service) may be measured.

Code:
A standard which has been made compulsory by an
act of legislation.

Examples
CODE
Canadian Standards Association (CSA)
C22.1
Part 1 of the Canadian Electrical Code (CEC)
Adopted by legislation in Province of Alberta
Enforced by Safety Standards Branch, Alberta

Department of Labour

Examples
STANDARD

Z32.2 - M89 Electrical Safety in Patient Care Areas


Z32.4 - M86 Essential Electrical Systems for Hospitals
Z32 04 (Sept. 2004) Electrical Safety and Essential
Electrical Systems in Health Care Facilities

Voluntary standard
Most hospitals attempt to conform

Canadian Standards
Association
Non-profit

Organization Chartered in 1919


Accredited by Standards Council of Canada 1973
Standards Writing
Certification Testing & Inspection
CSA standards reflect national consensus
Producers
Users
Regulatory Authorities

Not

Part of Government

Canadian Standards
Association
Certification

indicates that a product, system or


service has been evaluated and complies with
applicable safety and performance standards.

Only

a few production samples are tested by CSA


Incoming safety inspections are still required

Alberta Safety Standards


Branch
Purpose

is to provide safe and uniform


electrical environment to citizens of
Alberta.
Inspects, tests and certifies electrical
equipment not already certified by CSA
Does not certify electromedical equipment
(referred to CSA testing facilities)

All electrical equipment must be approved before


it is used, sold, displayed, advertised, offered for
sale, or distributed in Alberta. (Includes devices
made in-house or any device which is modified.)

Pertinent CSA Standards

Z32-04 Electrical Safety and Essential Electrical Systems in Health


Care Facilities
C22.2 No. 125 - M84 Electromedical Equipment
C22.2 No. 601.1 - M90 Medical Electrical Equipment, Part 1 General
Requirements for Safety
C22.2 No. 601.2.4 - M90 Medical Electrical Equipment, Part 2
Particular Requirements for the Safety of Cardiac Defibrillators and
Cardiac Defibrillator Monitors
C22.2 No. 151 - M86 Laboratory Equipment
C22.2 No. 114 - M90 Diagnostic Imaging and Radiation Therapy
Equipment
C22.2 No. 204 Line Isolation Monitors
Z386 Laser Safety

Z32-04 Electrical Safety and


Essential Electrical Systems in
Health Care Facilities
Describes

elements essential to an
electrical safety program in a healthcare
facility.

Includes the design, installation, operation,

and maintenance of a hospital electrical


system.

Safety Program
Safety
Definition: A state of freedom from injury
or damage.
Concept: A combination of the awareness
of, and actions taken to prevent injury or
damage.

Hazards Present in Hospitals


Mechanical
Chemical
Environmental
Biological
Fire
Radiation
Electrical

Mechanical Hazards
Injuries
Lacerations, contusions, dislocations, fractures

Failure

of mechanical patient support systems

Wheelchairs, ramps, lifts, stretchers, restraints

Absence

of general building safety

Loose railings, wet floors, obstructions, improper

lifting
Rupture

of pressurized cylinders

Chemical Hazards
Injuries
Poisoning, burns, eyes, lungs

Toxic

compounds

Inhalation
Skin contact
Ingestion

WHMIS

(Workplace Hazardous Materials


Information System)

Environmental Hazards
Sources of Pollution
Noise

The threshold of hearing occurs at 0 dB(A)


The threshold of pain occurs at 140 dB(A)
Hospital noise levels typically fall between 50 and 85 dB(A)
Noise levels in infant incubators must be kept to a minimum (less than 60 dB(A))
The current standard for industrial exposure is 90 dB(A) for an 8 hour workday.

Disposables

The average hospital produces 15 pounds of solid waste per day per bed.

Infectious

waste

Incineration is required for all pathological specimens

Radioactive

waste

Fire
Injuries
Burns, smoke inhalation

Fire

requires

Oxygen

Air, O2 and NO2 (Nitrus Oxide)

Flammable substance

Alcohol, solvents, clothing, etc.

Source of ignition

Flame (smoking), sparks (electrical)

Radiation Hazards
Injuries
Radiation sickness, cancer, burns, eyes

Non-ionizing

Sources

Ultraviolet (sterilization)
Microwave (physiotherapy)
Lasers (surgery)

Ionizing

Sources

X-ray (diagnostic imaging)


Cobalt 60 (nuclear medicine)
Radioactive seeds of cesium or radium (nuclear medicine)

Biological Hazards
Threat

to patients and staff


Disinfection
Reduces number of infectious organisms

Sterilization
Destroys all infectious organisms

Electrical Hazards
Explosion

and Fire Ignition


Power Interruption
Electric Shock

Electrical Shock Hazards

Hospital patients are at higher risk


Use of electrodes and fluid-filled catheters
Weak physical condition

Physiological

effects vary with

Path through body


Body resistance
Physical condition of victim
Applied current

Magnitude
Duration
Frequency

Electrical Safety Program


Integrates
Environment
Staff
Administration
Patient.

Involves the establishment of


Policies
Standards & regulations
Safety tests and procedures

Program Parameters
1. Administrative commitment
Personnel, budgets and authority

2. Electrical Safety Training


Clinical and support staff

3. Safety Committee
Determines hazards
Provides advice
Has authority to initiate change

Program Parameters
4. Technical Expertise
External sources (CSA, ECRI, SSB, etc.)
Internal sources (CE)

5. Management and Control


Authority to implement:
Controls of personnel and environment
Safety surveys
Equipment inspection
Specification and testing of all new patient
instrumentation

Priority of Program
Implementation
1. Immediate protection of electrically
sensitive patients (ICUs). (Safety testing
and inspection.)

Priority of Program
Implementation
2. Investigation of current safety practices
Environment (electrical power distribution system)
Equipment acquisition process
Equipment application

Degree of protection required (risk class)


Degree of reliability (maintenance)
Equipment obsolescence
Degree of immunity from consequences of human failure in
operation or maintenance
Consequences of delay
Economic factors

Priority of Program
Implementation
3. Protection for general patients and
personnel in existing facilities as soon as
possible
4. Development of formal PM program
Electrical Safety
Performance Assurance

Program Implementation
Program

specifications must balance

Costs
Benefits
Degree of risk

Involves
Departmental organization and responsibilities
Official policies
Safety and performance testing of equipment and

environment
Test schedules

Clinical Engineering Services


1. Safety testing
Receptacle wiring, tension, and grounding in

patient care areas


Leakage current and grounding of patient-care
equipment

2. Performance Testing

Clinical Engineering Services


3. Repair
Backup system available
24 hour service available

5. Incoming safety and performance inspection


6. Education
Lectures and demonstrations on electrical safety,

operations and care of equipment are provided to


clinical staff

7. Equipment Acquisition