With over 30 years of inspecting operating rooms throughout the lower 48 states we have noticed a disturbing trend. Many hospitals and surgery centers are either not providing or maintaining adequate electrical safety protection in their operating rooms and the agencies tasked with certifying safety compliance are not always holding them to the codes.

The national codes regarding electrical safety requiring compliance to maintain accreditation are contained in NFPA 99, Health Care Facilities Code and NFPA 70, National Electric Code. The NFPA 99 code requires at least annual testing of the electric system in ORs. The special electric panels used in operating rooms are called Isolated Power Systems. These panels have been in use for over 50 years. A simple explanation of these special power panels and how they differ from any other electric panel is that a special transformer is installed in the panel to keep a short on a piece of equipment from shocking the patient or medical staff. This transformer also allows for the equipment with the short to continue to function normally so as to not interrupt the surgical procedure. Since a patient is cut open a minor shock is extremely dangerous due to a direct path to the heart by way of exposed veins.

MainPro can ensure your operating room isolated power systems and line isolation monitors are safe and in compliance with NFPA 99.

One of the main national agencies that has the responsibility of certifying all facilities that perform surgical procedures, whether in hospitals or privately owned surgery centers, is called Joint Commission on Accreditation of Healthcare Organizations. This organization is commonly referred to as Joint Commission or JACHO. The mere mention of “Joint Commission” strikes fear in the heart of healthcare facility management. The Joint Commission determines whether a facility is accredited or not. If a medical facility fails to maintain accreditation, it leads to major negative financial implications and possible closure.

According to NFPA 99 ~ 6.3.2.3.4 “Operating rooms shall be considered to be a wet procedure location unless a risk assessment conducted by the health care governing body determines otherwise”. Both NFPA 99 & NFPA 70 require wet procedure locations to have special protection against electrical shock:

NFPA 70 ~ 517.20 “Wet Procedure Locations”

(A) Wet procedure locations shall be provided with special protection against electric shock by one of the following means:

(1) Power distribution system that inherently limits the possible ground-fault current due to a first fault to a low value, without interrupting the power supply.

(2) Power distribution system in which the power supply is interrupted if the ground-fault current does, in fact, exceed a value of 6 mA.

NFPA 99 ~ 6.3.2.3 “Wet Procedure Locations”

6.3.2.3.1 Wet procedure locations shall be provided with special protection against electrical shock.

6.3.2.3.2 This special protection shall be provided as follows:

(1) Power distribution system that inherently limits the possible ground-fault current due to a first fault to a low value, without interrupting the power supply.

(2) Power distribution system in which the power supply is interrupted if the ground-fault current does, in fact, exceed the trip value of a Class A GFCI.

The only power supply system that meets requirement (1) above is an Isolated Power System. It should be noted that the protection from a GFCI (Ground Fault Circuit Interrupter) is less than an Isolated Power System. An isolated system will alarm and protect the patient and medical staff from a 5 mA short, a GFCI has a 6 mA trip point. The GFCI will also interrupt the power and therefore the surgical procedure while the isolated system will continue to allow the electrical equipment to be used to finish the procedure.

According to the definition of what constitutes a “Wet Procedure Location” NFPA 99 ~ 3.3.183 states “The area in a patient care space where a procedure is performed that is normally subject to wet conditions while patients are present, including standing fluids on the floor or drenching of the work area, either of which condition is intimate to the patient or staff.” While a debate over the definition of what constitutes “normally subject to wet conditions”, I think the question should be is it abnormal to have prep solution, water, urine, vomit, or blood on the floor during a procedure? Many operating rooms have 5 or more cases a day. If it happens one time out of 10 and you have 10 operating rooms that means it happens every day.

According to NFPA 99 ~ 6.3.2.3.4 “Operating rooms shall be considered to be a wet procedure location unless a risk assessment conducted by the health care governing body determines otherwise”. The second part of this code has been used by many medical facility governing bodies to eliminate some or, in some cases, all Isolated Power Systems in their facilities.

NFPA 99 ~ 4.2 “Risk Assessment”

4.2.1.1 The governing body shall conduct risk assessments and shall determine risk categories based on the character of the processes and operations conducted in the health care facility.

There are 4 categories to be determined. All operating rooms and procedure rooms fall into the first category. NFPA 99 ~ 3.3.136.1 defines Category 1 spaces as “Space in which failure of equipment or a system is likely to cause major injury or death of patients, staff, or visitors.” NFPA 99 ~ 3.3.158.1 defines Category 1 activities as “Activities, systems, or equipment whose failure is likely to cause major injury or death of patients, staff, or visitors.”

After reviewing the above codes addressing electrical power supply systems and risk categories the question becomes, how is it possible for open heart surgery ORs, C-Section ORs, or any operating room where an anesthesia machine is utilized not to have an Isolated Power Supply? If a C-Section operating room is not a wet location, then what is?

When reviewing these sections in conjunction, it becomes apparent that an Isolated Power System is the only electrical system that meets Category 1 requirements in any operating room or procedure room to avoid electrical shock or interruption of power due to a short and prevent major injury or death as a result.

Joint Commission is responsible to assess the facilities compliance with all safety codes, however in facilities where Isolated Power Systems are not installed or maintained, they are apparently not. If a facility says they do not have Wet Procedure Locations, Joint Commission should be reviewing and challenging the risk assessment as to how the facility can accept the interruption of power or avoid any possible standing fluids. If the facility has Isolated Power Systems installed, Joint Commission should be reviewing the documentation showing compliance with the annual testing requirements.

Are your operating rooms equipped with an Isolated Power System. If not keep in mind that studies report that 1-2 in 1000 patients under anesthesia gain consciousness. If a patient is being shocked, they may not be able to move or communicate this and could receive lasting injury as a result.

Contact us today to discuss your isolated power needs and how we can help you maintain compliance with the NFPA requirements.