One simple thought that needs to be understood and applied by every person involved in creating a Medical Infrastructure Installation – (it could be a multi-speciality tertiary level hospital or a basic Primary Health Centre) is that the facility is to be designed to be fully functional 24/7 and 365 days of the year.
This fact is most often compromised in the urge to get the facility operational and results in huge damages when the unit starts to come on stream.
In addition to this is the other important aspect that the people who are using these facilities are involved in a much more critical task of saving human lives and therefore the infrastructure has to function flawlessly and also address extreme conditions for its designed life time. The need is a seamless integration with the lifesaving activities that are being carried out. There cannot be any short cuts or compromises in this basic understanding.
The issue of poor wiring standards in hospitals has only been aggravated during the current pandemic. The recurrent phenomenon of hospitals fires has been ongoing for more than a decade since monitoring has started. Surveys have shown that during the design and construction of a hospital, the extent of electrical load is not envisaged in detail and only basic loads are considered. Over a period, equipment is added in piece meal. Non airconditioned rooms get converted to airconditioned with a view to increase the comfort level and revenue. While this could a valid reason from the hospital authority, what does not get upgraded is the existing wiring.
A simple factor like conducting an electrical audit by a qualified professional is never done. Such an audit could reveal the following short falls in the electrical design:
- Condition of the insulation of the existing wiring
- Load on the system (how much is the deviation from its original design)
- RCCB protection and every floor or wing
- Independent isolated power supply for critical areas like Operation Theatres/MICU/ICU’s
- Where central air conditioning is not available, inspect the standalone units for its wiring (these units are not meant for continuous operation and hence are more prone to fire accidents due to heat and poor insulation
A review of 33 major fires reported in hospitals across the country between January 2010 to December 2019 and published in the International Journal of Community Medicine and Public Health (September 2020) pointed out that the most common cause of fires in hospitals was electrical short circuit with air conditioners being the most common source. In ten cases, fires originated at or near intensive care units.
Even in the current pandemic, the need for Oxygen cylinders at bed side was a major requirement across all hospitals. According to NFPA regulations, ambient Oxygen levels should not exceed 23.5 per cent. But imagine an environment where multiple bed side oxygen cylinders have been provided making the entire closed area rich in Oxygen. A tiny spark from any of the electrical equipment or over heated wiring could turn it into a furnace in no time.
Fire accidents in hospitals result in more fatalities since the victims are patients whose movements are limited or non-existent. Smoke is the major killer here and studies have shown that patients have died on their beds without even knowing what has affected them in the absence of timely help. Even in cases where help has arrived, the increasing toxic smoke levels and poor visibility makes it impossible to find a safe exit.
The use of low smoke zero halogen insulated wires and cables should be made mandatory in every hospital as the nation moves forward in creating better medical infrastructure facilities. This is the first step in creating a circle of safety and then the requisite health care.