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HAZARDS COMMONLY ENCOUNTERED IN THE USE OF MEDICAL INSTRUMENTS COME UNDER TWO CATEGORIES


I. Hazards on account of Electric Shocks

II. Dangers due to malfunctioning of instruments


I. ELECTRIC SHOCKS

There are two situations that account for hazards from electric shocks, viz. (i) gross shock and (ii) micro-current shock. The gross or macro shock is the high value current passing through the body due to faulty plug, socket , power chord etc. This can happen to all and can be easily identified. The other type is shock due to micro currents. This happens due to leakage currents inside the instruments caused by the leakage current  generated within the instrument  due to parametric changes  within the components, low quality of  materials used, poorly insulated windings and incorrect designs etc. The effects of these currents on the patient’s body result in life-threatening situations like ventricular fibrillation. It is the most common cause of death by electrocution in hospitals. Patients in coronary care units are very vulnerable. To make the point more clear, let us imagine a situation where a patient lies in a poorly grounded electrically powered bed in the ICCU. He has an external pacemaker attached to him. Touching the bed, the doctor adjusts a control on the pacemaker. The doctor may not feel anything but the patient dies. This is due to the micro-shock induced by the minute quantity of leakage currents present in the instrument that have no effect in the healthy human body whereas for the patient it proves fatal.


II. MALFUNCTIONING OF INSTRUMENTS

Malfunction is usually caused by a breakdown of the control systems in a machine or equipment. It may be due to failures of electronic sub assemblies/ software changes which potentially may cause injury to operators or patients. Hazardous malfunctions can be prevented and controlled by proper functional analysis.

The malfunctioning of the biomedical instruments or parametric changes of components may cause variations/ fluctuations in the micro-current, leading to the fatal consequences.  


Even inbuilt Alarms provided in biomedical instruments for warning of potential dangers may cause adverse events.  The Possibility of the attending staff getting complacent towards the fore warning of the machine and feeling indifferent to the urgent action called for, cannot also be ruled out.  It needs to be ensured each alarm is promptly attended to, each alarm should be distinctly recognizable that the medical attendant is alerted appropriately even from a distance.

The life saving radiation therapy can also cause very serious consequences. Unnecessary radiation exposure is caused by an irrational approach in determining radiation dose admissible to patients undergoing repeated CT scan. The procedural formalities and the internationally accepted norms are to be strictly insisted up on in matters like this. It has to be ensured always that the radiation doses are as low as possible while maintaining image quality also. In order to ensure this it is quite unavoidable that such scanners are calibrated with in every six months.

Infusion pump and syringe pump made use in critical care units needs constant vigil. The medical personal attending the patients need to have very good awareness about the dose admissible and whether it exceeds the limits in any manner  the system is usually provided with an inbuilt alert mechanism to detect the error before it occurs. But how ever hard the medical attendant tries or is aware of the mechanism involved, unless and until the perfect functioning of this instruments are ensured, fatal consequences may follow.

Endoscopy is currently a much sought after diagnostic device. But the possibility of cross contamination caused by improper cleaning and disinfection techniques of the flexible endoscope is a matter of severe consequences. Here also it has to be ensured that the hardware and software changes are regularly monitored to ward off any possibility of cross contamination or potential problems associated with electronic circuits.

Surgical fire hazards do occur sometimes, even though such incidents are avoidable. The surgical team may be aware of all the precautions that have to be ensured, but the chances of a surgical fire depends on the flawless performance of the Percentage Oxygen Monitor.


CHOKING TO DEATH

Anesthesia unit place a decisive role in the successful completion of any surgical procedure.

The flaws in the Anesthesia ventilator ,misconnected breathing circuits, undetected leaks in the ventilator, absence of sufficient gas in the cylinder, imperfect functioning of the Roto Meter etc are certain to cause complications which are definitely avoidable if the protocols are strictly observed.  

Faulty Ventilators in hospitals, instead of saving the patients, at times suffocate them to death Instead of providing the required volume of air with proper rhythmic movement, these instruments may pump in air with high speed and the patients become victims in no time. Nobody knows what happened after putting them in the ventilators. There won't be any survivors to tell the ordeals they went through during those harrowing moments. At times the quantum of the input of air is so low, the patient struggles to breathe due to insufficiency of air.


DOCTOR AS MUTE SPECTATOR

Defibrillator is a life saving device put to operation in very critical cardiac arrest. If the machine does not deliver the desired energy to the patient for the revival of the heart, at the very first instants itself, there is no possibility of a second chance. Quite often fatality is caused due to the failure of the machine to operate properly in time. The energy discharged may be either lower or higher than the set value, and in both cases it is fatal to the patients. This may be some times caused by a defective capacitor or a faulty battery without proper charge.  Defibrillator has to be kept ready to function faultlessly with in an instant without any lapse. If equipment is not maintained in such perfection, it is bound to cause fatal consequences to the patients.  Defibrillators require daily functional checkup in addition to calibration once in every six months. In case any repair or maintenance is done it must invariably be followed by a calibration to ensure its efficiency.

Defibrillators are used in every ICCU to save persons from death due to myocardial fibrillation. Imagine a situation where the Defibrillator is not functioning properly. Instead of giving sufficient energy to revive the heart, say 200 J, set by the doctor in the instrument, if only 100 J is delivered due to its malfunctioning, this cannot save the patient in time from fibrillation and the patient dies in front of the helpless doctor. This death could have been easily averted, had the Defibrillator been tested periodically for its proper functioning.


BABY BLUES

In Incubators for the new-born, the story is not different. Instead of giving the optimum warmth required for the survival of the premature babies, the incubators often scald and singe the bodies of these hapless beings due to failure of their Temperature control mechanisms. No one will care for these things unless the persons concerned are made aware of such possibilities.

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