Upload
dinhcong
View
223
Download
9
Embed Size (px)
Citation preview
CABMET Study Group – Public Safety in the Healthcare Facility
1
Slide 1
Public Safety in theHealthcare Facility
CABMET Study Group
Matt BaretichBaretich Engineering
Fort Collins, [email protected]
Slide 2
Public Safety: 15% of CBET Exam
• Electrical
• Chemical
• Radiation
• Biological
• Fire
• Codes and Standards
Slide 3
Electrical
Microshock andElectrical Safety Testing
CABMET Study Group – Public Safety in the Healthcare Facility
2
Slide 4
Slide 5
Ground Conductor Resistance
Chassis to ground pin of electrical plug
• NFPA 99 (2005) 8.4.1.3.2. Ground Conductor Resistance. Patient-care-related equipment in the patient care vicinity = 0.5 Ω.
• AAMI ES60601-1:2005 8.6.4. Protective Earth Impedance. Medical electrical equipment = 0.3 Ω.
Slide 6
Chassis Leakage Current
• NFPA 99 (2005) 8.4.1.3.5. Chassis Leakage Current. New patient-care-related equipment = 300 μA. Existing and special patient-care-related equipment = 500 μA.
• AAMI ES60601-1:2005 8.7.3. Touch Current. Medical electrical equipment. Normal Condition = 100 μA. Single Fault Condition = 500 μA.
CABMET Study Group – Public Safety in the Healthcare Facility
3
Slide 7
AAMI ES60601-1:2005 Test Load
Slide 8
ESM 2008 Recommendations
• Ground conductor resistance:
• A practical limit for identifying ground conductors problems is 0.5 Ω.
• Chassis leakage current:
• A practical limit for identifying chassis leakage current problems is 500 μA.
• Normal polarity, power switch on and off, ground closed and open.
Slide 9
Electrical Safety References
• NFPA 99 (2005) Health Care Facilities Handbook. Chapter 8: Electrical Equipment.
• Medical Electrical Equipment – Part 1: General Requirements for Basic Safety and Essential Performance. AAMI ES60601-1:2005.
• Electrical Safety Q&A. Health Devices(February 2005).
• Electrical Safety Manual 2008. AAMI (Baretich & Shepherd).
CABMET Study Group – Public Safety in the Healthcare Facility
4
Slide 10
Electrical
Power Systems
Slide 11
Slide 12
Normal Electrical System
• Branch Circuit: The circuit conductors between the final overcurrent device protecting the circuit and the outlet(s).
• Feeder: All circuit conductors between the service equipment, the source of a separately derived system, or other power supply source and the final branch-circuit overcurrent device.
CABMET Study Group – Public Safety in the Healthcare Facility
5
Slide 13
Special Electrical Systems
• Essential (emergency) electrical system
• Generator and transfer switches
• Automatic transfer within 10 seconds
• Extensive testing requirements
• TJC specifies systems to be supplied
14
Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07
• Alarm systems*
• Exit Route and exit sign illumination*
• Emergency communication systems*
• Elevators (at least one)
*As required by the Life Safety Code
15
CABMET Study Group – Public Safety in the Healthcare Facility
6
Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07
• Critical equipment, including:• Blood, bone, and tissue storage systems• Medical air compressors• Medical and surgical vacuum systems
• Critical areas, including:• Operating and recovery rooms• Obstetrical delivery rooms and nurseries• Urgent care areas
16
Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07
• Monthly and annual testing of battery-powered lights required for egress
• Quarterly and annual testing of Stored Emergency Power Supply Systems (SEPSS)
17
Joint Commission: Emergency PowerEC.02.05.03 and EC.02.05.07
• Monthly testing of generators and transfer switches (30 minutes, adequate load)
• Additional testing of generators every 36 months (4 hours, adequate load)
18
CABMET Study Group – Public Safety in the Healthcare Facility
7
Slide 19
Special Electrical Systems
• Isolated power system
• Isolation transformer
• Line isolation monitor (LIM)
• Significant testing requirements
• For “wet locations” where interruption of power cannot be tolerated
Slide 20
Schematic Diagram
From NFPA Health Care Facilities Handbook
Slide 21
IPS Panel
CABMET Study Group – Public Safety in the Healthcare Facility
8
Slide 22
Line Isolation Monitor (LIM)
CABMET Study Group – Public Safety in the Healthcare Facility
9
Decision Tree
From Square-D HospitalIsolated Power Systems
Slide 26
Special Electrical Systems
• Ground Fault Circuit Interrupter
• Trips at 6 mA current to ground
• Subject to “nuisance” tripping
• For “wet locations” where interruption of power can be tolerated
Slide 27
CABMET Study Group – Public Safety in the Healthcare Facility
10
Slide 28
Power Line Color Codes
• 120 VAC Grounded (United States)
• Hot = Black
• Neutral = White
• Ground = Green
Slide 29
Power Line Color Codes
• 120 VAC Grounded (European)
• Hot = Brown
• Neutral = Blue
• Ground = Green (solid or yellow stripe)
Slide 30
Power Line Color Codes
• 120 VAC Isolated Power System
• Line 1 = Orange (to “neutral” terminal)
• Line 2 = Brown (to “hot” terminal)
• Ground = Green
CABMET Study Group – Public Safety in the Healthcare Facility
11
Slide 31
Electrical System References
• Health Care Facilities Handbook:NFPA 99 (2005)
• National Electrical Code Handbook:NFPA 70 (2008)
Slide 32
Slide 33
CABMET Study Group – Public Safety in the Healthcare Facility
12
Slide 34
Slide 35
CABMET Study Group – Public Safety in the Healthcare Facility
13
Slide 37
CABMET Study Group – Public Safety in the Healthcare Facility
14
Slide 40
OSHA
Chemical & Biological Hazards
Infection Control
Workplace Safety Pointers
• OSHA: Occupational Safety and Health Administration (www.osha.gov)
• OSHA is exclusively concerned with the safety of employees
41
Slide 42
OSHA
Occupational Safety & Health Administration
• Hazard Communication
• Material Safety Data Sheets (MSDS)
• Bloodborne Pathogens
• Universal Precautions
• Personal Protective Equipment (PPE)
• Lock-out Tag-out
CABMET Study Group – Public Safety in the Healthcare Facility
15
OSHA: Hazard Communication
• Employees have a “Right to Know”• Inventory of hazardous materials• Information and training• Access to MSDS information
• Material Safety Data Sheets• Hazards of using the material• How to use the material safely (including PPE)• What to do if exposed (including First Aid)• How to clean up spills• How to dispose of the material
43www.osha.gov/dsg/hazcom/
44www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf
45www.osha.gov/OshDoc/data_General_Facts/factsheet‐lockout‐tagout.pdf
Lockout ‐ Tagout
CABMET Study Group – Public Safety in the Healthcare Facility
16
Infection Control Pointers• APIC: Association for
Professionals in Infection Control and Prevention (www.apic.org)
• Infection Control Professional vs. Infection Preventionist
• CDC Guidelines: www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf
46
Slide 47
Infection Control
• Airborne Infection Isolation (AII) room:
• Protects people in surrounding areas from airborne pathogens
• Negative pressure; external exhaust
• Protective Environment (PE) room:
• Protects patient from airborne pathogens in surrounding areas.
• Positive pressure; HEPA filtration
48
CABMET Study Group – Public Safety in the Healthcare Facility
17
Slide 49
Radiation Hazards
Laser Safety
Radiation Safety
50www.epa.gov/radiation/understand/ionize_nonionize.htm
51www.safety.vanderbilt.edu /training/topics_laser.htm
CABMET Study Group – Public Safety in the Healthcare Facility
18
Slide 52
Radiation Safety References
Basic facts:
• www.epa.gov/radiation/understand/ionize_nonionize.htm
Laser safety:
• www.safety.vanderbilt.edu/training/topics_laser.htm
• Protective goggles
• Avoid direct and reflected beam
Slide 53
Fire Safety
Classes of Fires & Extinguishers
Slide 54
Fire Triangle
Wikipedia: “Fire Triangle”
CABMET Study Group – Public Safety in the Healthcare Facility
19
Slide 55
Fire Tetrahedron
Slide 56
Fire Types
• Class A: Ordinary combustibles such as wood, paper, cloth, trash plastics.
• Class B: Flammable liquids such as gasoline and paint. Also propane and butane. Not cooking oils and grease.
• Class C: Energized electrical equipment such as motors and appliances. If power is removed, fire becomes another class.
• Class D: Combustible metals such as potassium, sodium, aluminum, and magnesium.
• Class K: Cooking oils and greases.
• www.hanford.gov/files.cfm/ExtBrochure.pdf
Slide 57
Extinguisher Types
• Dry Chemical: Class ABC fires
• Water and Foam: Class A only.
• Carbon Dioxide: Class BC fires.
• Wet Chemical: Class K fires.
• Halogenated or Clean Agent: Class ABC fires.
• Dry Powder: Class D fires only.
• Water Mist: Primarily Class A fires.
CABMET Study Group – Public Safety in the Healthcare Facility
20
Slide 58
Fire Safety
Principles of Life Safety
Fire safety concepts
• Patients “incapable of self-preservation”
• “Defend in place” versus evacuation
• Building “compartments”
59
Building compartments
• Patient room
• Smoke compartment
• Floor assembly
• Building separation
• Exits and methods of egress
60
CABMET Study Group – Public Safety in the Healthcare Facility
21
61
62
63
CABMET Study Group – Public Safety in the Healthcare Facility
22
Fire Safety Pointers
• Life Safety Code Handbook NFPA 101
• Current edition: 2012
• CMS (and TJC): 2000
64
Slide 65
Codes & Standards
Joint Commission
Slide 66
Joint Commission Management Plans
2008 2009Safety
Safety & SecuritySecurity
Hazmat & Waste Hazmat & Waste
Emergency [Note 1]
Life Safety Fire Safety [Note 2]
Medical Equipment Medical Equipment
Utility Systems Utility Systems
[Note 1] All moved to new EM chapter. Emergency Operations Plan
[Note 2] ILSM and SOC standards moved to new chapter.
CABMET Study Group – Public Safety in the Healthcare Facility
23
Slide 67
Medical Equipment Management
• Management plan
• Selection and acquisition of equipment
• Equipment inventory
• Inspection and maintenance strategies
• Inspection and maintenance schedule
• Hazard notices and recalls
• FDA Medical Device Reporting
• Emergency procedures
Slide 68
Performance Monitoring & Improvement
• Performance monitoring
• Annual evaluation:
• Scope
• Objectives
• Performance
• Effectiveness
• Performance improvement
Slide 69
Joint Commission References
• Comprehensive Accreditation Manualfor Hospitals (Joint Commission)
• Environment of Care Essentials for Health Care (Joint Commission)
• The Performance Improvement Cycle (Baretich Engineering)
CABMET Study Group – Public Safety in the Healthcare Facility
24
Slide 70
Codes & Standards
NFPA
Slide 71
NFPA Codes and Standards
• NFPA 101: Life Safety Code
• NFPA 70: National Electrical Code
• NFPA 99: Healthcare Facilities
• Electrical Equipment
• Medical Gas Systems
Joint Commission: Medical Gas SystemsEC.02.05.09
• Inspect, test, maintain critical components (time frames defined by the hospital)• Master signal panels• Area alarms• Automatic pressure switches• Shutoff valves• Flexible connectors• Outlets
72
CABMET Study Group – Public Safety in the Healthcare Facility
25
Joint Commission: Medical Gas SystemsEC.02.05.09
• Test for …• Purity• Correct gas• Proper pressure
• Whenever systems are …• Installed• Modified• Repaired
73
Slide 74
Storage and Handling of Gas Cylinders
• Compressed GasAssociation poster
• Air Products Safetygram #10
Slide 75
Medical Gas Color Codes
Air Yellow
Carbon Dioxide Gray
Helium Brown
Nitrogen Black
Nitrous Oxide Blue
Oxygen Green
www.sciencecases.org/gas_cylinders/handout3.asp
CABMET Study Group – Public Safety in the Healthcare Facility
26
Slide 76
Codes & Standards
FDA
Slide 77
FDA Medical Device Reporting
• Safe Medical Devices Act: Requires medical device reporting by Device User Facilities.
• Referenced by the Joint Commission (EC.02.04.01 EP5).
• FDA: www.fda.gov/cdrh/mdr
Slide 78
FDA Medical Device Reporting
• Report to the manufacturer and FDAwhen the facility has information that reasonably suggests a device has or may have caused or contributed to a patient’s death.
• File FDA Form 3500A within 10 work days.
CABMET Study Group – Public Safety in the Healthcare Facility
27
Slide 79
FDA Medical Device Reporting
• Report to the manufacturer when the facility has information that reasonably suggests that a device has or may have caused or contributed to patient’s serious injury (requiring medical or surgical intervention).
• File FDA Form 3500A within 10 work days.
Slide 80
Codes & Standards
Other
Slide 81
• AABB: American Association of Blood Banks
• ACR: American College of Radiology
• ANSI: American National Standards Institute
• FCC: Federal Communications Commission
• IEC: International Electrotechnical Commission
• CMS: Centers for Medicaid and Medicare Services
• Joint Commission
• American Osteopathic Association (AOA)
• DNV Healthcare