6242: HOSPITAL SYSTEMS

MODULE 1
Reshma Babu K

Lecturer in BME

HOSPITAL ORGANIZATION & ARCHITECTURE

What is a hospital?

▪ An institution providing medical and surgical treatment and nursing care for sick or
injured people.

▪ Consists of:

▪ Medical departments

▪ Supporting departments

BIO ENGINEERING

▪ It is a discipline that applies engineering principles of design and analysis to

biological systems

BIOMEDICAL ENGINEERING

▪ Biomedical engineering (BME) is the application of engineering principles and

design concepts to medicine and biology for healthcare purposes.

CLINICAL ENGINEERING

▪ It is a sub branch of Biomedical Engineering responsible primarily for applying and

implementing medical technology to optimise health care delivery.

HOSPITAL ENGINEERING

▪ It involves the maintenance of the complete hospital system including various clinical
and non clinical departments.

▪ These include maintenance of buildings, Air conditioning systems, Electricity,

Hospital Information systems etc.

ROLE OF BIOMEDICAL ENGINEERS IN HOSPITALS

1. Prepare specification and assist the purchase of an equipment;

2. Departmental planning;

3. Maintenance of equipments;
 4. Documentation.

1. SPECIFICATION

It is a detailed description of the design and materials used to make something.

It includes the complete technical details of an equipment which is useful before and after
purchasing.

2. DEPARTMENTAL PLANNING

Design of various departments including Examination rooms, ICU, OP department,

casualty, Radiology and imaging department, operation theatre, laboratories, CSSD etc.

3. MANAGING MEDICAL EQUIPMENTS

This includes continuous participation throughout the lifecycle of medical equipments. The
duties of Biomedical Engineers regarding management of medical equipment include

A. Planning (decision to acquire)

B. Procurement
C. Incoming inspection
D. Inventory and documentation
E. Commissioning and acceptance
F. Monitoring of use and performance
G. Maintenance
H. De-commissioning
A. PLANNING

▪ Biomedical Engineers analyse the Hospital’s need for a particular equipment

▪ They approve and reassure the source of operating budget;

▪ They confirm maintenance services and support;

▪ They ensure the availability of qualified users and adequate environment support.

B. PROCUREMENT

▪ It is the act of getting possession of something.

▪ Here, the need to standardize on models or manufacturers of equipment is

considered.

C. INCOMING INSPECTION

▪ Incoming equipment is carefully checked for:

▪ Possible shipment damages;

▪ Compliance with specifications in the purchase order;

 ▪ Delivery of accessories, spare parts and service manuals.

D. INVENTORY AND DOCUMENTATION

▪ Inventory entries include accessories, spare parts and operating and service manuals.

▪ Copies of manuals are distributed to the users, while the originals of the manuals are
kept at the technical document library for safe keeping.

E. COMMISSIONING AND ACCEPTANCE

▪ Commissioning is carried out by in-house technical staff if they are familiar with that
item of equipment.

▪ If commissioning by the suppliers is needed, the process is monitored by in-house

technical staff so that any technical matters can be noted and recorded on the
Equipment Service History.

F. MONITORING OF USE AND PERFORMANCE

▪ In-house technical staff is the link between the user and the supplier and he always
observes any supplier's technical services.

▪ The use and performance of the accepted equipment is regularly monitored

▪ Warranty services are recorded in the Equipment Service History.

G. MAINTENANCE

▪ Proper maintenance of medical equipment is done to obtain sustained benefits and to

preserve capital investment.

▪ Two extreme approaches to maintenance :

▪ To rely entirely on equipment companies ;

▪ To have in-house technicians and expect them to do the full range of repairs.

Best is to combine in-house with external services.

Types of maintenance

I. Preventive maintenance;
II. Routine maintenance;
III. Emergency maintenance;
IV. Breakdown maintenance.
V. Shut down maintenance;
VI. Calibration
I. PREVENTIVE MAINTENANCE

Predetermined work performed to a schedule with the aim of minimizing the wear and
tear or sudden failure of equipment components.

• Planned preventive maintenance- Regular, repetitive work done to keep equipment in

good working order and to optimize its efficiency and accuracy.

Planned Preventive Maintenance

• It includes regular, routine cleaning, lubricating, testing, calibrating, checking for

wear and tear and eventually replacing components to avoid breakdown
II. ROUTINE MAINTENANCE

• Maintenance done on regular basis by in-house technicians.

• Includes Pre-use check, loading of printing papers, keeping the equipment battery
charged

III. EMERGENCY MAINTENANCE

• Done when a machine is "down" and incapable of doing what it is meant to do when
it is needed.

• Considered during conditions where emergency attention is required.

IV. SHUT DOWN MAINTENANCE

• Any maintenance that is performed when a machine or piece of equipment is turned
off and out of service.
Eg: Operation Theatres and ICUs carry out shutdown maintenance at least once in a
year
V. BREAKDOWN MAINTENANCE
• Mostly used when the equipment failure does not significantly affect the operation or
production or generate any significant loss other than repair cost.
VI. Calibration
• Act of checking the correctness of a measuring instrument by comparing the measures
with another similar instrument that serves as a standard.
• It has a standard and a test equipment
VII. DECOMMISSIONING
• Old equipments can be dismantled to provide spare parts for similar units.
• This process will also provide an opportunity for cultivating technical innovation
using local resources.

4. DOCUMENTATION

• Keeping a record of activities undergone by the department regarding equipment

management.
• Generally, each equipment has an exclusive log book to record the activities
undergone in regard to that machine
• Similarly, each department has a stock book that has the complete inventory of all
the utilities.
• The BME department keeps a Master stock record with all the stock details,
equipment history and their current location/ end users
 6242: HOSPITAL SYSTEMS
MODULE 1

Reshma Babu K

Lecturer in BME

HOSPITAL ORGANIZATION CHART

I. ADMINISTRATION SERVICES

Hospital Administrator manages and oversee the operation of departments

a. oversee budgeting and finance

b. establish hospital policies and procedures

c. perform public relation duties

Generally include: Hospital President, Vice Presidents, Executive Assistants, Department

Heads

II. INFORMATIONAL SERVICES-Documents and process information

A. Admissions- Checks patients into hospital

a. Responsibilities include: obtaining vital information (patient’s full name, address,

phone number, admitting doctor, admitting diagnosis, social security number, date of birth,
all insurance information)
 b. Frequently, admissions will assign in-house patients their hospital room

B. Billing and Collection Departments - responsible for billing patients for services
rendered

C. Medical Records - responsible for maintaining copies of all patient records

D. Information Systems - responsible for computers and hospital network

E. Health Education - responsible for staff and patient health-related education

F. Human Resources - responsible for recruiting/ hiring employees and employee benefits

III. THERAPEUTIC SERVICES

Includes the following departments:

1. Physical Therapy (PT)

a. provide treatment to improve large-muscle mobility and prevent or limit permanent

disability

b. treatments may include: exercise, massage, hydrotherapy, ultrasound, electrical

stimulation, heat application

2. Occupational Therapy (OT)

a. Goal of treatment is to help patient regain fine motor skills so that they can function
independently at home and work

b. Treatments might include: arts and crafts that help with hand-eye coordination, games and
recreation to help patients develop balance and coordination, social activities to assist
patient’s with emotional health

3. Speech/Language Pathology

a. Identify, evaluate, and treat patients with speech and language disorders

b. Also help patients cope with problems created by speech impairments

4. Respiratory Therapy (RT)

a. Treat patients with heart and lung diseases

b. Treatment might include: oxygen, medications, breathing exercises

5. Medical Psychology

a. Concerned with mental well-being of patients

b. Treatments might include: talk therapy, behaviour modification, muscle relaxation,

medications, group therapy, recreational therapies (art, music, dance)
6. Social Services

a. Aid patients by referring them to community resources for living assistance (housing,
medical, mental, financial)

b. Social worker specialties include: child welfare, geriatrics, family, correctional (jail)

7. Pharmacy

a. Dispense medications per written orders of physician, dentists, etc.

b. Provide information on drugs and correct ways to use them c. ensure drug
compatibility

8. Dietary - responsible for helping patients maintain nutritionally sound diets

9. Sports Medicine

a. provide rehabilitative services to athletes

b. teaches proper nutrition

c. prescribe exercises to increase strength and flexibility or correct weaknesses

d. apply tape or padding to protect body parts e. administer first aid for sports injuries

10. Nursing- Provide care for patients as directed by physicians

Many nursing specialties include: nurse practitioner, labor and delivery nurse, neonatal
nurse, emergency room nurse, nurse midwife, surgical nurse, nurse anaesthetist

IV. DIAGNOSTIC SERVICES -Determines cause(s) of illness or injury

Includes the following departments:

1. Medical Laboratory (MT) - studies body tissues to determine abnormalities

2. Imaging - includes Diagnostic Radiology, MRI, CT, Ultra Sound

3. Emergency Medicine - provides emergency diagnoses and treatment

V. SUPPORT SERVICES - Provides support to entire hospital

Includes the following departments:

1. Central Supply

a. in charge of ordering, receiving, stocking and distributing all equipment and

supplies used by healthcare facility

b. sterilize instruments or supplies

 c. clean and maintain hospital linen and patient gowns

2. Biomedical Technology

3. Housekeeping and Maintenance

a. Maintain safe clean environment

b. Cleaners, electricians, carpenters, gardeners

 6242: HOSPITAL SYSTEMS
MODULE 1
Reshma Babu K

Lecturer in BME

DESIGN OF VARIOUS WARDS & ICUs

FLOW CHART OF OUTPATIENT DEPARTMEN

FLOW CHART OF EMERGENCY DEPARTMENT/CASUALTY
ICU DESIGN

DESIGN OF A HOSPITAL WARD

 6242: HOSPITAL SYSTEMS
MODULE 1

Reshma Babu K

Lecturer in BME

ELECTRICAL POWER SUPPLY IN A HOSPITAL

In health care systems, human body is in direct contact with the equipment and thus it
requires

o Extensive grounding even for an electrical socket.

o Maximise the physical and electromagnetic protection of wiring by metal
wiring method
o Minimize electrical hazards by reducing the voltage potential between the
patient and the equipment

ESSENTIAL ELECTRICAL SYSTEMS(EES) FOR HOSPITALS

• It ensures the continuity of electrical power to specific functions and areas of a

healthcare facility.

• EES consists of two separated systems which must be kept separated from all other
wiring and equipment.

• The two systems are:

o Emergency system

o Equipment system

Emergency system: Limitted to circuits essential for life saving and critical patient care

Eg: Operation theatres and ICUs

Equipment system: Suppllies major electrical equipment essential for basic patient care and
hospital function

Eg: Wards, reception, Canteen etc

CRITERIA FOR HOSPITAL ELECTRICAL WIRING

 The number of transfer switches to be used should be based on design and load
consideration.

 Each branch of the EES shall be served by one or more transfer switches
  With special permission, facilities with a maximum demand on the essential
electrical system of 150 kVA will be permitted to have one transfer switch serving the
emergency branches.

 Loads served by the generating equipment shall be given their own transfer switches
such that these loads shall not be transferred if the transfer overloads the generating
equipment, and shall be automatically shed upon overloading

GENERAL CARE AREAS

● At least two branch circuits-one from the emergency system and one from the normal
system-must supply each patient bed location.

● All branch circuits from the normal system must originate in the same panelboard.

● Each "patient bed location" must have a minimum of four hospital grade electrical
socket.

SEPARATION FROM OTHER CIRCUITS

 The life safety branch and critical branch of the emergency system shall be kept
entirely independent of all other wiring and equipment and shall not enter the same
raceways, boxes, or cabinets with each other or other wiring.

 Exception: Service switchboard and transfer switch equipment.

Mechanical Protection of the Emergency System

 The wiring of the emergency system of a hospital shall be mechanically protected by

installation in non-flexible metal raceways, or shall be wired with Type MI cable.

 Where installed as branch circuit conductors serving patient care areas, the
installation shall comply with the requirements.

 Exception: Flexible power cords of appliances, or other utilization equipment,

connected to the emergency

Capacity of Systems

 The essential electrical system shall have adequate capacity to meet the demand for
the operation of all functions and equipment to be served by each system and branch.

 The generator sets shall have sufficient capacity and proper rating to meet the demand
produced by the load of the essential electrical systems at any one time

UNINTERRUPTED POWER SUPPLY/SOURCE(UPS)

 An uninterruptible power supply or uninterruptible power source (UPS) is an

electrical apparatus that provides emergency power to a load when the input power
source or mains power fails.
  The on-battery run-time of most uninterruptible power sources is relatively short
(only a few minutes) but sufficient to start a standby power source or properly shut
down the protected equipment.

 It is a type of continual power system.

 It is mainly used in areas where an unexpected power disruption could cause injuries,
fatalities, serious business disruption or data loss.

COMMON UTILITY POWER FAILURES

The UPS systems normally address the following utility issues in a hospital.

 Voltage spike sustain over voltage

 Momentary or sustained reduction in input voltage

 Overload, Short circuit

 Noise, usually injected into the line by nearby equipment

 Instability of the mains frequency

 Harmonic distortion, defined as a departure from the ideal sinusoidal waveform

expected on the line

 ON-LINE UPS

 An on-line UPS uses a "double conversion" method of accepting AC

input, rectifying to DC for passing through the rechargeable battery (or battery
strings), then inverting back to 230 V AC for powering the protected equipment.
i/p

230 v,

50 Hz
AC

OFFLINE UPS/ STANDBY UPS

 The protected equipment is normally connected directly to incoming utility power.

 When the incoming voltage falls below or rises above a predetermined level the UPS
turns on its internal DC-AC inverter circuitry, which is powered from an internal
storage battery.

 The UPS then mechanically switches the connected equipment on to its DC-AC
inverter output.
VOLTAGE STABILIZERS

 A voltage stabilizer is needed for the smooth and constant functioning of devices and
keeps voltage intact.

 The main purpose of a voltage stabilizer is to provide constant voltage to a load even
during voltage fluctuations.

 Efficiency under adverse conditions

 Protecting the equipment from permanent damage due to voltage fluctuations

 6242: HOSPITAL SYSTEMS
MODULE 1

Reshma Babu K

Lecturer in BME

PHYSIOLOGICAL EFFECTS OF ELECTRIC CURRENT

Threshold of perception:

At this level, a tingling sensation is felt by the person when there is contact with an electrified
object through intact skin.

Let Go Current

As the magnitude of alternating current is increased, the tingling sensation gives way to the
contraction of muscles. The muscular contraction increases and finally the volume of current
reach at which the subject cannot release its grip on the current carrying conductor.

The maximum current at which the subject is still capable of releasing a conductor is called
Let Go current.

Physical injury and pain

At the current level higher than the let go current, the subject losses its ability to control its
own muscle action and it will be very painful and hard to bear.

This type of accident is called the hold on type and may result in physical injury because of
the powerful contraction of the skeletal muscles.

Ventricular fibrillation

In this condition the rhythmic action of the heart fails, pumping action stops and the pulse
disappears
Sustained myocardial contraction

The entire heart muscle contracts and this condition can lead to respiratory paralysis

Burns and physical injury

Resistive heating causes burns on the surface of the skin.

Voltage than 230 volt can puncture the brain and nervous system losses all the functionality.

GROSS SHOCK

 Gross shock is experienced by the person by an accidental contact with the electrical
wiring at any point on the surface of the body.

MACRO SHOCK

 Macro shock hazards are usually caused by electrical wiring failures.

 Passage of current from one part of the body to another, especially from arm to arm
and therefore heart

 Current is the most important factor

 Current value ranges from 10 mA to 100 mA

 It is less concentrated

 Severity of macro shock leads to death due to ventricular fibrillation.

 High skin resistance and proper design of equipment prevents macro shock effects
MICRO SHOCK

• Current falls through the myocardium

• Safe limit is 10 µA
• When electrode or catheter is situated near or in the heart and the leakage current
flows through the patient, micro shock occurs
• Direct connection with an internal organ, like spacing lead, electrodes for intra
cardiac measuring devices makes the patient more prone to mico shock
• There is connection from chassis to patient heart and anywhere in the body, there is a
chance for micro shock

RULES FOR MED. EQUIPMENT ELECTRICAL SAFETY

 Equipment connected to a patient to be powered from one socket, or a block of

sockets having the same protective grounding point.

 All metal subjects in the vicinity of the patient to be grounded one at a time with the
same protective ground point.

 Patient to be connected to the common ground through only one grounding pole.

 Isolation amplifiers to be used for measurements if possible.

 If possible, avoid using material which can be charged electro-statically .

 Deal carefully with electric wires and sockets and let it be checked periodically. Do
not use extension cables. Do not use faulty cables / plugs and ask for replacement.

 If an equipment has a failure, which can cause electric shock, it has to be taken out of
service immediately. Reversing the plug (this “advice” is heard often) , which might
lead to eliminate the shock, is a wrong action / behavior.
 If, by touching the metallic surface of an equipment, you sensed an electric prickle
(even a light one), then plug off the equipment immediately and ask for check. This
equipment is either badly earthed or not earthed at all.

 Do not use any medical equipment you do not know the basics of its operation and did
not read its instruction manual carefully.

CIRCUIT BREAKERS

 A circuit breaker is an automatically operated electrical switch designed to protect

an electrical circuit from damage caused by excess current from an overload or short
circuit.

 Its basic function is to interrupt current flow after a fault is detected.

 Unlike a fuse, which operates once and then must be replaced, a circuit breaker can be
reset (either manually or automatically) to resume normal operation.

 The circuit Breaker consists of a fixed contact and sliding contact and a moving
contact.

 The moving contact moves into the sliding contact which is shown in the figure.

 A handle is attached to a moving contact, which can be manually operated or it can be

operated automatically with the help of a mechanism which has a trip coil energized
by the secondary current of the current transformer (C.T) which is shown in the
figure.
PROTECTIVE RELAY

 A protective relay is a relay device designed to trip a circuit breaker when a fault is
detected.

 The relay must come into action whenever there is a fault and must not operate if
there is no fault.

 Some relays are used for the protection of the power system.

 Some of them are primary relay meaning that they are the first line of defence.

 Such relays sense the fault and send a signal to the proper circuit breaker to trip and
clear the fault.

 The fault can only be reduced if the protective relay is reliable, maintainable and
sensitive enough to distinguish between normal and abnormal condition.

SURGE PROTECTOR

 When a sudden increase in voltage occurs, such as from a lightning strike or damage
to a power line, a surge protector detects the excess current and safely diverts it
through the house's grounding path.

 When voltage reaches a certain point, surge protectors simply re-route that extra
energy with the help a pressure-sensitive valve.

 With the correct voltage, current flows through as normal, but with a spike or surge,
the device kicks-in immediately and redirects the excess.
 Commonly used devices for managing this pressure in surge protectors include metal
oxide varistors (MOV) and gas discharge arrestors, which allow electrical devices to
continue operation while diverting excess energy to grounding wires.

EMI FILTERS

 Electromagnetic interference (EMI) occurs when unwanted electric currents interrupt

the intended currents an electronic device is supposed to receive.

 These disruptive currents — often called "noise" or "electromagnetic noise" — can

come from an external source or get created by other components inside the device.

 When EMI occurs, it disrupts the functioning of the device and can cause unintended
operations to occur.

 EMI filters, also called EMI suppression filters, are an effective way to protect against
the harmful impacts of electromagnetic interference.

 When attached to devices or circuits, EMI filters can suppress electromagnetic noise
transmitted through conduction.

 These filters extract any unwanted current conducted through wiring or cables, while
allowing desirable currents to flow freely.

 EMI filters that suppress noise from grid power are also called EMI power line filters.

 Most electromagnetic noise is in a higher frequency range, so EMI filters are often
low-pass filters that sift out high frequencies while letting lower frequencies pass
through.

 Low-pass filter is formed by installing a capacitor parallel to the load.

 Capacitor impedance by nature decreases as the frequency increases.

 This means that, the higher the frequency, the lower the voltage on the load.

 This is because, as shown in the figure, the noise current is bypassed by the capacitor
and no longer flows to the load.
 Different EMI line filters suppress specific frequencies of noise, while allowing others
to flow unimpeded.

 After the filtering process, electromagnetic noise gets diverted away from the device
and to the ground. Some EMI filters may also route unwanted currents back to the
noise source or absorb them