ELECTRICAL HAZARDS AND THEIR

PREVENTION IN PATIENTS
MONITORING
PRESENTER: FELIX PAUL AMANI
(Mmed. Anesthesiology).

FACILITATOR: DR ALBERT
 OBJECTIVES
• Understand the meaning of electrical hazards and their
sources.
• Discuss effects of electrical hazards to patients and other
staffs in theatres.
• Understand the clinical implications of electrical hazards
in relation to patients’ monitoring
• Explain different preventive measures
 Outline

• Introducion
• Sources of Electrical hazards
• Mechanisms of body injury
• Prevention
• References
 INTRODUCTION
• Electric current refers to the flow of charges (electrons) from one point
to another.

• According to Ohm’s law, the current that travels through a conducting

medium is entirely dependent on the potential difference (volts)
driving the electricity and the resistance (ohms) offered by the
conducting medium.

Current (I)=
 INTRODUCTION CONT…
• Current will be greatest if the voltage is high or the resistance is low.

• Most of the body’s resistance occurs in the outer skin layers, internal
tissues and blood (largely ionic solutions) that make up the body have
very low resistance.

• Dry skin has much higher resistance than wet or punctured skin
 INTRODUCTION CONT..
• Electric hazards: Are the potential dangers (harms) we can succumb
when an electric current flows from electrical equipment through our
bodies.

• In most cases arises due to:

- Equipment faults
- Mishandling of equipment
- Leakage currents
 SOURCES OF ELECTRIC HAZARDS

• The electrical hazards in the operation theatre may happen either from

(1) Normal:
- Static electricity( produced by friction)
- Diathermy
- Sparks from monitors
- Sparks from X-ray machine
- Sparks from switches
 Sources Cont..

(2) Faulty electric currents:

- short circuits in electrical apparatus,
- faulty wires and cables and breaking of bulbs
 HOW DOES ELECTRICITY DAMAGE THE BODY

• When the body receives an electric shock by touching a live wire

with a finger, the current enters through finger and normally exits
to the ground through the feet.

• This in turn may cause:

(i) Electrocution,
(ii) Burns, and
(iii) Ignition of a flammable material, causing a fire or an
explosion.
 ELECTROCUTION
• Is a electric shock, produced on the body (via skin) when
electric current flows through (may be fatal).

• The amount of current provides a rough indication of the likely

level of injury caused by electric shock
 FACTORS AFFECTING

• The effects produced depends on:

(i) The amount of electricity that flows (current)

(ii) Where the current flows (current pathway) its density
(iii) The type of current (direct or alternating)
(iv) Current duration.
 1. Current: Will be greatest if the voltage is high or the resistance is low.

Electric current Voltage required to generate current

(1 sec contact)
Physiological effect High resistance Low resistance
(10000Ω) (1000Ω)

1mA - Threshold of feeling 10V 1V

- Tingling sensation
5mA - Approximately the maximum harmless 500V 10V
current
10-20mA - Current at which person “cannot let go” 1000V 100V
- Sustained muscle contraction
100-300mA - Ventricular fibrillation 100 000V 1000V
6A - Temporary respiratory paralysis 600 000V 6000V
- Burns likely
 Factors cont..
2. Current pathway and density:

• The pathway that current takes through the body will determine which
tissues are damaged.

e.g. current passing through the chest may cause ventricular

fibrillation or asphyxia due to tetany of the respiratory muscles,
whilst a current passing vertically through the body may cause
loss of consciousness and spinal cord damage.
 Factors cont..
3. Type of current; DC vs AC

4. Current duration: The shorter the duration, the higher the current
required before damage is done
 Micro shock (Micro electrocution)
• Unintended flow of small but dangerous currents directly, or within close
proximity, to the heart.

• A substantially smaller current (50μA at 50 Hz) can cause ventricular

fibrillation. The maximum leak allowed is 10 μA.

• The shock received during depolarization of the ventricles puts the heart
at greater risk of being thrown into ventricular.
E.g. intracardiac pacemakers with an external lead, to a lesser extent, a
temperature probe placed in the esophagus immediately behind the left atrium.
Electrocution risk scenario
 BURNS
• When an electric current passes through any substance having electrical
resistance, heat is produced.

• Burning depends on the current density. Skin (especially when dry) has
a high electrical resistance compared with the moist tissues beneath.

• Thus, electrical burns are generally most marked on or near the skin.
 Fire and Explosions
• Sparks caused by switches or plugs being removed from wall sockets can
ignite inflammable vapours.

• This is prevented by the use of spark proof switches and electric socket
outlets which prevent the plug from being withdrawn whilst the switch is
turned on.
 PREVENTIVE MEASURES
• Methods of reducing the risk of risk electrocution can be broadly
classified as:
(i) general measures
(ii) equipment design
(iii) equipotentiality
(iv) isolated circuits
(v) circuit breakers.
 PREVENTIVE MEASURES CONT..

1. General Measures: These include;

- Adequate maintenance and regular testing of electrical equipment

- Ensuring the patient is not in contact with earthed objects

- Wearing of antistatic shoes ( high impedance will reduce any current

flowing through the body)
- Use of battery-powered equipment completely.(Have low voltages)
 PREVENTIVE MEASURES CONT..
2. Equipment Design:

- According to their means of protection.

(i). Class I-Full earthed.(melting fuse)
(ii). Class II- Double insulated
(iii). Class III- Low voltages (SELV is defined as a voltage not >
25 V AC or 60 V for DC)
Class I
 2. Equipment design Cont..
- According to the degree of protection (the maximum permissible
leakage currents)
(i) Type B (Class I, II or III) with the maximum leakage current not
exceed 100 μA. It is therefore not suitable for direct connection to the heart.

(ii) Type BF; As for type B, but uses an isolated (or floating) circuit

(iii) Type CF; These provide the highest degree of protection, using isolated
circuits and having a maximum leakage current of < 10μA. Suitable for
direct cardiac connection,
e.g. ECG leads, pressure transducers and thermodilution computers.
 Leakage Current Classification Standard
Leakage Technical information Comments
Classification
Type B - Max leak 100mA - Risk of micro-shock
- can be Class I, II or III
Type BF - Max leak 100mA - Not suitable for
- Circuits are isolated from connection to the heart
other parts of equipment
Type CF - Max leak 10mA - Suitable for medical
connection with the heart
Floating System
 Preventive measures Cont..
3. Equipotentiality: Connecting the terminals of each piece of equipment
that are at different potentials (relative to earth) to each other bringing
them all to the same potential.

- This avoids a connection current flowing from the higher to lower

potential via the user.
 Preventive measures Cont..
4. Isolated or floating circuits: Provides a circuit whereby a
connection between the electrical source and earth does not allow current
to flow.

- Created by the use of an isolating transformer which consists of 2 coils

electrically insulated from each other.

- These floating circuits can be used to isolate an entire operating theatre.

Floating circuit
 Preventive Measures Cont..
5. Current-operated earth leakage circuit breakers (COELCB): Also
called residual current circuit breakers
- Consist of a live and neutral wire with the same number of windings
around the core of a transformer.
- If the current in the live and neutral conductors is the same, the
magnetic fluxes cancel themselves out.

- If they are different (due to excessive current leakage) there is a

resultant magnetic field. This induces a current in the third winding
causing the relay to break the circuit.
 SURGICAL DIATHERMY.
• Surgical diathermy equipment uses the heating effects of high
frequency (kHz–MHz) electrical current to coagulate and cut tissues.

• There are two basic types:

- Monopolar
- Bipolar.
 Diathermy Cont..
• Monopolar (Unipolar): Generates electrical energy at 200 kHz to 6
MHz applied between two electrodes (neutral and active).

• The neutral electrode has a large conductive surface area producing a

low current density with no measurable heating effect.

• The active electrode has a very small contact area resulting in a very high
current density..
 Monopolar Diathermy
• Unipolar diathermy with adequate contact surface area.
 Bipolar Diathermy
• Bipolar diathermy operates with a much lower power output.

• The output is applied between the points of a pair of specially designed

forceps producing high local current density.

• No current passes throughout the rest of the body.

Bipolar Diathermy
Good and bad electrical practice
 Summary
• Electricity can damage the body by electrocution, burns or ignition of a
flammable material. Damage is dependent upon the density, type and
duration of current.
• Current as small as 50 micro A can cause ventricular fibrillation (micro-
shock). Patients must never be in contact with earth.

• Dry skin has a relatively high resistance, minimizing the risk of serious
injury through electrocution in many circumstances.
• Proper designing of electrical equipment and their frequent checkups
minimizes the electrical hazards to patients and staffs in theatre.
 REFERENCES
• Physics in Anaesthesia, 2012: Ben Middleton, Justin Philips, Rik
Thomas and Simon Stacey.
• Electrical Safety in the Operating Theatres –CEACCP 2003