Routine electrical safety testing remains a given at most hospitals around the country, but that might soon be a thing of the past. The Association for the Advancement of Medical Instrumentation has released a new edition of its electrical codes handbook, the AAMI Electrical Safety Manual, 2015: A Comprehensive Guide to Electrical Safety Standards for Healthcare Facilities. Written by Matt Baretich, PhD, president of Baretich Engineering in Fort Collins, Colo, the volume highlights some important but under-publicized changes to NFPA 99, the safety code governing healthcare facilities.
A hospital consultant who also coauthored the 2004 and 2008 editions, Baretich helps facilities cost effectively manage their compliance in the areas of medical equipment, utility systems, and hazardous materials. He has spent the last year combing through various electrical safety standards and attempting to distill them into a clear, accessible format. A lot has changed from the “pretty scary” days of the 1970s when medical equipment posed a much higher risk to patients, Baretich says, and the updated codes reflect that: no longer do they require hospitals to conduct routine electrical safety testing. 24×7 spoke to him about how these updates could relieve overburdened biomedical departments and what other practical tips, charts, and resources the volume offers readers.
24×7: Given improvements to medical device technology, is electrical safety still as important as it once was?
Baretich: The roots of this book go all the way back to when equipment wasn’t quite so well designed and reliable. In those days, it really was important for hospitals to constantly check that their equipment was meeting appropriate standards for electrical safety. As equipment has gotten better, the core issue has declined substantially in importance. The way everyone has responded is better; the power distribution in hospitals is better, the equipment is better. I think that as a profession, we can declare victory and stop spending so much time doing electrical safety testing. There are still things that need to be done, but they’re not as time-consuming as has been the case in the past.
24×7: What are some of the key changes in the new edition?
Baretich: The 2012 edition of NFPA 99 no longer requires routine electrical safety testing. That’s a big change in the standards, and it’s a change that has not rolled out to many hospitals. The change was based on the fact that it was rare to find anything wrong in routine testing. It was pretty much a waste of effort. Almost all of the problems that are found are connected with some other failure or damage to the equipment. For a long time, I’ve been a proponent of reducing the amount of electrical safety testing. That opinion, which is increasingly shared by others, is reflected in the codes. The old way of doing things has really lost its justification.
While we’ve trimmed back some things in this manual because they just aren’t that important anymore, we’ve added some things related to isolated power systems. They’ve been somewhat controversial over the years. The latest edition of NFPA 99 has made the default decision that you need to install them in areas like operating rooms unless you go through a formal risk assessment process. The requirement for the risk assessment process is new. It’s easy for hospitals to say, “I’m not going to bother with that. I’m just going to install the system.” In what I think is an important addition, the manual outlines how you can do that risk assessment process and points the reader toward references they can use.
24×7: What other codes have you covered in this new edition?
Baretich: There’s NFPA 70, the National Electrical Code, and another NFPA standard, 70E. There are The Joint Commission standards. There’s the AAMI/IEC standard, 60601-1. Facility Guidelines Institute has some guidelines, and the federal Occupational Safety and Health Administration has some rules about electrical safety. Those are the key ones that we pull from. There are a couple others that I pulled little bits of information from. They’re all applicable to hospitals.
24×7: What are you trying to accomplish with this volume?
Baretich: It’s somewhat ironic, because I’ve been arguing against the excessive electrical safety testing for a long time, but here I am the author of the book on how to do it. Rather than people having to buy and read all the different codes and standards, I do all that reading and pull out the relatively small portion that applies to healthcare facilities. What I try to make clear in this book is what electrical safety testing really is, when it really makes sense to do it, and why you would not. It’s intended to be a really practical source for someone who doesn’t want to be a specialist in all these codes—they just want to get the job done, be compliant, and do the right thing for patients. It’s smaller than it used to be; it’s 60 pages long. There’s really no reason to expand it, given its objective. We want this to actually be something some busy engineer or technician in the hospital can read, know what to do, and just move on. I’ve tried to explain what the issues are and some of the nerdy detail, and then say, “Here’s what we recommend as a practical way to deal with all this stuff.”
24×7: What are some of the practical measures that you suggest?
Baretich: For example, there have been issues with RPTs, or relocatable power taps. For normal people, that means a multiple outlet strip that you can plug different devices into. There has been a lot of back and forth about what kind you can use where, under what circumstances, and what kind of maintenance programs you need to have. There’s still a lot of confusion out there. In the book, I try to boil it down: here’s the background, here are where the references are, and here’s our recommendation for how to be compliant and not expend effort you don’t need to expend. Basically, in certain parts of the hospital like patient care areas, RPTs should meet a certain standard, and it’s going to be embossed on that RPT. And then you’re ok. Back in the appendices, there are one-page charts summarizing everything on one topic. If you’re writing a policy for your hospital, there are one- or two-page outlines with the core features that should be in the policy.
24×7: How has your consulting background given you context for writing this volume?
Baretich: A big part of my consulting business is working with hospitals to make sure they’re compliant without wasting time, effort, and money. I’ve seen how hospitals may be using old ideas about what they’re supposed to do. And so it’s important for them to get up to the latest standards. I find that some people are not really comfortable with the underlying codes and standards. They can follow the instructions in the manual for testing but may not be aware of the underlying principles. By helping to explain that, I can also help them devise ways to be more economical in their programs. For example, I tell them, “You know, nobody is actually requiring you to do all that electrical safety testing on a routine basis. So, maybe you want to use your resources to do something else.”
24×7: How big an impact does unnecessary electrical safety testing have on hospitals in terms of time and money spent?
Baretich: Each time you do a test, it takes a few minutes to set it up, do the test, and record the results. The number of times varies by the equipment, but it might be once or twice a year as a typical schedule. You can add that up over thousands of pieces of equipment in the inventory. I think the potential is to reduce a lot of effort.
24×7: How widespread is the issue?
Baretich: I know very few places that have actually cut back routine electrical safety testing to a major extent. Most hospitals are doing routine electrical safety testing, and they don’t really have to. But the change in the code is quite new, and I suspect it will take a while for work practices to change. It’s going to be interesting to watch over the next few years. When I lecture, I say, “We spend a significant amount of time doing this, and nobody is requiring us to do it. So why are we doing it—and what are we going to do instead?” And right now, the reactions I get are, “I don’t know yet how we’re going to handle this.” But people are becoming aware of the issue, so I think we’ll see changes, particularly if we continue seeing pressure on maintenance programs to save money. So many hospitals feel that they’re understaffed in medical equipment maintenance. This may be a way that they can streamline operations and get back that edge they need to bring the workload down to match staffing levels.
Jenny Lower is the managing editor of 24×7. Contact her at [email protected].
I agree with Matt’s take on electrical safety but now CMS is saying that we have to do it on a regular schedule for RPTs instead of letting them run to fail. I think this is a step backwards. What does Matt think?
CMS should not have the authority to create regulations in areas of clinical safety or medical device compliance. As it is, there are too many agencies and entities that overlap in various areas of healthcare regulatory compliance. Consolidating and reducing the number of them involved and/or limiting their authorities to certain areas could help a great deal to reduce confusion and the cost of effort to comply. It could help reduce federal agency expenditures as well.
CMS says we need to inspect certain RPTs on a regular basis. I think a visual inspection would be adequate.
CMS (Center for Medicare and Medicaid Services) has regulations intended to make sure that healthcare facilities receiving Medicare and Medicaid funds meet appropriate standards.
I inquired about this during one of our surveys and the surveyor’s response was, “We are not using the 2012 NFPA 99 standards, so you must still perform them until we start utilizing the 2012 standards.” So as biomeds our hands are still bound by the JCAHO and DNV agencies.