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Assessment of Harmonics at a Medical Facility

David Ramirez-Castro Efiain O'Neill-Camllo Julio Santiago-P&ez
Electrical and Computer Engineering Department
University of Puerto Rico-Mayagiiez
Ma- PR

Abstract A high quality of power is required in healthcare Mli- Events such as voltage transients may cause a micro-
ties due to increased use of microprocessor-based equipment. processar to read voltage levels incorrectly, resulting in in-
However, the ability to diminish power quality concems depends correct data processing (ones being read like zeros) or al-
on the limitations imposed by the system under study, especially tered stored data/settings. Table l presents malfunctions in
infi.sstructute c " * ts. This paper describes a power quality medical equipment caused by power quality events 121.
audit amducted at a medical facility. Voltage and current meas-
These examples illustrate the importance of taking care of
ured at various points were used to assess the quality of the service
power quality issues at a medical facility. The effkcts range
h m the utility as well as the condition of the hospital's electrical
system. The main power quality problem bund was hannonic fiom being as simple wasted supplies or repeated procedures
distortion. Measurements of the total harmonic distortion (TIID) to serious situations at intensive care or operating areas.
were used to locate harmonic sources. Potential problem areas Source of power quality problems at hospitals include:
were identified within the facility. A correlation was made be- 0 Utility side events (e.g., capacitor switching)
tween portable, medical equipment and power quality concerns. 0 Accidents and nature phenomena (e.g., lighting)
Recommendations are presented based on the results of the audit. 0 Inadequate Wiring and grounding
This study will serve as a guide for installations of new equipment
and futm expiinsions in the hospital. 0 High-wattage equipment
Testing of emergency generators
Keywords: Power quality, harmonic distortion, voltage distur- Physical plant renovations
bances, transient phenomena The first two are related to events outside the hospital elec-
trical system, and a m the quality of the power delivered to
L INTRODUCTION the facility [3]. The last four depend on the characteristics of
the medical facility's system. An increase in the number of
The advent of the microprocessor has dramatically sensitive, nonlinear loads at hospitals should go in-hand
changed the healthcare industry. Magnetic resonance im- with improvements in the facilities' electrical systems.
aging (MRI), monitoring devices and portable x-ray ma- However, many buildings were exempt of complying with
chines are common equipment in any hospital. figher new or revised regulations. Compounding the problem is the
quality of power is required at all healthcare facilities due to fkct that many codes or regulations deal with safety issues,
the sensitive nature of microprocessor-based equipment. but they do not address power quality concerns [2]. Fre-
Nowadays, medical devices are smaller and faster, but they quently, largedemand equipment such as x-ray machines is
are also more susceptible to electrical disturbancesthan they installed at fkcilities without a complete power quality sur-
were twenty years ago. Electrical transients that were once vey. Power quality problems are also cumulative; therefore,
normal, are now intolerable due to these machines. Many of small power quality events can lead to loss-of-life and even-
these devices are not only sensitive to, but also generate tually equipment failure.
power quality problems as part of their normal operation, Changes in the quality of power have been observed at
e.g., radiology equipment. ofiice equipment also has a sig- the Bella Vista Hospital in Mayagiiez, PR An increase of
nificant impact on the quality of the electric service at a sensitive medical equipment, recent problems with an expen-
medical facility. Therefore, it is not only important to sive catheterization equipment and the installation of mil-
monitor the quality of the power supplied by the utility, but liondollar equipment, motivated the Hospital's Engineering
also monitor the power quality impact among loads within
the medical facility [ 11.

Problem Possible Cause

*
Distortion of displays Distorted voltage, altered
data
Incorrect diagnostic results EM, grounding
Equipment lockup Voltage surges or sags
r
Control/alarm malfimction Microprocessor malfunction

C- 7303-6439-5/00/$1C. 00 2050 I EEE

- 620 -
Department to conduct a power quality audit. The main
objectives of this work were to assess the quality of service
received &om the utility and to identify areas within the hos-
pital where power quality problems currently exist or may
develop in the near future. This information will be used for
better planning when instailing sensitive equipment and in
future expansions. Other objectives were the study of the
impact of portable medical equipment upon other sensitive
devices and to evaluate the condition of the hospital's elec-
trical system.
IL DESCRlPTION OF THE SYSTEM
The peak load at Bella Vista Hospital (BVH)is 1 MVA,
as measured by the local utility. The load is distributed
among thirty-seven circuits, using two 1 MVA dry-type
transformers. Fig. 1 shows the main circuits of the system.
Service fim the Puerto Rico Electric Power Authority
(F'REPA) comes fim a 4.16 kV feeder. The hospital is lo-
cated in a residential area over the top of a hill.
BVH has an alternate power supply consisting of two
generators. The first one has a capacity of 625 kVA, and
can supply emergency power in only 5 seconds, as required
by regulations [4]. The second is a backup in case of mal-
function of the main gene". It has a capacity of 487
kVA. The emergency energy is supplied trough fifteen
transfer switches. Individual l d can be selectively turned
omon with this configuration. However, the topology in-
creases significantly the number of components in the sys-
tems that can have troubles.
4.16 KV
YA
Fig 1. Pictorial for the hospital's electrical system
The physical facilities at Bella Vista Hospital range
fiom 25 to 45 years old. Although the electrical system of
the five-story building has undergone many renovations, it
may not be suited to support power qualily conditions related
to the operation of a large number of sensitivq microproces-
sor-based devices. The neutral wires were not designed to
support nonlinear loads and harmonic flow. There is a pos-
sibility of grounding problems caused by corroded wiring.
Rooms that had one or two medical devices in the past, now
house complex medical systems and/or numerous portable
devices.
The interaction between loads is also a concern at BVH.
OiEce equipment and medical devices with high distortion
can affect the operation of miaoprocxssor-based equipment
even if the latter has built-in power cunditimm. Imaging
systems cause sags that may generate some of the problems
shown in Table 1.
Recently, there have been problems with a catheterism
equipment. This is an image processing equipment known
as C-Arm, used for fluoroscopy studies. This study is similar
in concept to an x-ray image, but it continuously projects the
image in a monitor instead of a film. The device's power
drivers and its emission tube had to be replaced. A surge
was blamed for the failures, even though the f i e ' s surge
protection was in g d condition and showed no evidence of
operation. Other power quality issues may be a better expla-
nation to these even?.
The conditions described above and the installation of
another milliondollar machine (a new MRI) made it clear
that a power quality audit was needed at BVH.
IIL METEODOLOGY
The first step of the power quality audit was an inspec-
tion of the hospital's electrical system. Even though numer-
ous renovations had been made in the last fifteen years, a
one-line diagram of the electrical system was not available at
BMI. There were only original drawings of the facilities
and separate drawings for major improvements without
documentation of the changes made in the system. During
the inspection of the system, information was gathered to
develop a complete, current schematic of the system. The
hospital has 37 major circuits available in the two switchgear
at the substation, and more than 50 panelboards distributed
through the building. The single line diagram was indispen-
sable for the power quality audit.
A portable, stand-alone, single-phase power quality
analyzer was used to record the measurements [5]. One 500
A clamp-on CT and a 2000 A flexible clamp-on CT were
also used. The final analysis was perfinmed using sofhvare
provided with the equipment by the manubturer as well as
commercially available mathematical sofhvare. The tools
used were relatively inexpensive equipment when one thinks
about the capabilities they ofFer and the many tasks that can
be paformedwith them.
 ,621 -

Common practices recommend that three-phase meas-

urements be taken for seven days to register the fluctuations
and the most critical scenarios possible [l]. There were a
total of 75 points to be measured in the system, firom the sub-
station transformers, to the output of each circuit breaker,
then at the input of each distribution panel, and finally
through the individual loads. Spending a week in each point
was not a feasible alternativeto log the required data. A fav
tests w e performed to determine if less time could be spent
making the measurements at each point, using a single-
phase instead of a three-phase instrument.
The first circuit measured was the office area, it is a 130
A load. The reason for this selection was that in a medical
facility the office area is the most unpredictable load. Each
phase was measured during 05ce hours (8 hours a day) at
normal load. The first day, measures for voltage and current
were logged. The next day, power and power factor were
logged. After taking the first voltage and current measure-
ments, it was evident that harmonics were the main problem
in the facility. Therefore, the THD was also measured on the
third day. The procedure was repeated for the remaining
two phases. The voltage and current measurements were
repeated on a different day of week fix each phase. There
were no major differences between the first set of measure-
ments and the second. The peak load occurred between
10:30 am and 11:30 am for both sets of measurements.
To reduce the time required for data acquisition, a total
of sixteen measurements were taken, two minutes apart fiom
each other in the office area. There were 254 samples per
measurement in an interval of 4 cycles or 67 ms. The sam-
pling time was 2.6(10") ms. The three phases were evalu-
ated in only 1 % hour. The values for power and THD were
calculated f?om the digitized wavefoxms stored in the com-
puter. The results were compared with the previous meas-
urements. The error was less than five percent, which was
small compared to the savings in time. Furthermore, in most
cases the connected load was known, and any variation could
be predicted. The exception was measuring at the trans-
formers. At that point the measurements were taken at 15-
minute intervals for 24 hours in each phase. This was done
because the whole hospital can be monitored at those points,
and load behavior can not be predicted with a reasonable
precision.
Temperature readings were also taken to study the ef-
fects of the harmonics and other power quality problems in
the system. A formal infiared study was recommended and
performed in the main circuits and critical services in the Site vrms Inns TI-Q
facility. This study revealed some hot points in circuits (one Main Transformer # 1 123.56 995.64 3.91%
as high as 349" F), which gave evidence of the deterioration Main Transformer # 2 119.28 1230.42 5.26%
L
of the contacts. Harmonics were present at some of these office Loads 120.34 84.65 14.29%
hotpoints. Portable X-Ray 119.63 13.88 23.61%
M e r the tests to validate the method, voltage and cur-
Surgery Suits 121.81 18.78 29.17%
rent measurements were taken at various points in the sys-
tem. A method based on the current-source model was used surgery suits (EM) 122.65 74.35 21.76%
to locate harmonics [6]. One can trace a harmonic source CathLab Idle 277.40 20.80 47.1oyo
kom multiple measurements of THD in the system. The 1CathLabON 1272.44 140.40 134.00% I
- 622 -
For the surgery suits there are two main circuits. One
has general equipment amneded to it, including the surgery
luminaries. These luminaries were experiencing fiequent
bum out. M e r they were moved to a circuit with less har-
monic distortion, the luminaries' life was increased. The
other circuit has the isolation monitors for the suits and the
anesthesia machine. It is interesting that the ground refer-
ence at this point is precisely the interface between the oldest
and newest part of the Hospital. Grounding problems seem
to be the cause of harmonic levels at this point. Further
analysis is required at this point.
In Fig. 2 a high degree of distortion is observed for the
current, but the voltage presents only minimum distortion.
The same distortion is observed in both sides of the wave-
form (positive and negative). It is a typical magnetic distor-
tion with some switching component. At this point the cur-
rent draw was around 20 A. The load was the in-line volt-
age regulator and the C-Arm equipment (described in sec-
tion II) in idle mode.
Fig. 3 showsthe harmonics present in the current for the
catheterism machine. There is a high degree of third har-
monic present in this case, typical of magnetic devices. The
system is not affected by this distortion because as it can be
seen in Fig. 1, there is a transformer in a wyedelta configu-
ration. This configuration effectively isolates the triplens
harmonic fiom the rest of the system. The only problem is
in the transformer itselt where this harmonic heats up the
windings. This transformer presents some damage in its
windings and is under schedule to be replaced. The equip-
ment harmonic distortion seems to be the cause.
___---__-___-___________________________-------------------------.
.iwm
Cat L a b fwe A - Yo Load
a.?
Fig 2. Catheterism equipment idle (phase A)
rm onar
30
80 ....
m .................................. -....................................... .,
60
..
~
-. .................................................................. . .-. . . .
1 3
I5 m7 9 1 1 1 3 1 5 1 7 1 9 2 l 2 3 2 5
.................................................................
Cat L a b Lase A - Bo Load
HdNunba
Fig. 3. Harmonic strength for equipment idle (phase A)
In Fig. 4, the catheterism machine is operating. The current
distortion looks like a step square wave. The steps follow a
sinusoidal wave. This behavior agree with the way this ma-
chine operates, as explained in section 11, were amtinuos
"shoots" of x-ray draw high current in steps. As with idle
operation, there is minimal voltage distortion. The total
current is almost double in this case, but the distortion is
very different. Fig. 5 is the corresponding frequency spee
trum for the device's current. In thii case the fifth harmonic
is the largest, typical for switching devices. The current
magnitude of the third harmonic is slightly reduced as com-
pared to idle operation, and its percentage in the spectnrm is
significantly reduced since the total current magnitude is
double.
Besides the harmonic distortion, the audit identified the
monthly emergency test on generators as a recurrent power
quality monitor as in [l] and [2]. The emergency generator
must be tested monthly. The purpose of the test is to ensure
that in case of real power fiilure the generators will start
normally within the required parameters and that it can
manage the emergency load. This requirement is known as
30/50[4]. This means that the generator should run with
30% of the nameplate or 50% of its actual connected emer-
gency load. The larger of these two quantities should be
used. The standards also require that the generator should
be supplying energy to the load in 8 seconds or less. This
t : . : . _ , . .
,a, ~
(ina
90
- . _ _ _ ~ ---___
m
8 ) - ____
5.I.z
U)
30
zo I
10
0
1 3 5 7 9 1 1 1 3 1 5 1 7 1 9 Z l D 2 5
HaaatNunbs
_____________________.____________._____-----------------------
C- W Tu. b 6- Load -
Fig. 5. Harmonic strength for equipment operating (phase A)

test represents a power quality problem since it is responsible
for contactors in transfer switches to operate for the single
purpose of testing, this reduce its useful life and increase the
contact resistance which produce a cumulative effect that
increase power quality problems. In this case sags and
swells may be the most common problems associated with
the recurrent operation of the generator.
Another important outcome of the power quality audit is
in regard to the condition of the electrical system. Installa-
tion of new equipment did not go in-hand with infrastructure
improvements (at least they were not made hst enough). As
in most facilities changes occur at a fast pace, new equip-
ment is added almost daily, from office equipment, diagnosis
equipment, and patient treatment equipment. When in the
past a single receptacle per bed in patient rooms was more
than enough, today two or three are insufficient. Unfortu-
nately, services are added most of the time without improv-
ing feeders, panelboard capacity, circuit protection and infia-
structure in general. Therefore, a system that was once stiff
is now operating near its limits. This change in operating
point has already cawed malhctions in equipment such as
patient’s IV pumps (used to administer serum and other
medicines to patients).
Maybe one of the major fkdings in this audit is related
to standards compliance. For example IEEE 519 refers to a
5% TH4, at the point of common coupling. The intend of
this standard is to avoid that the distortion caused by one
user to be a problem to other users. Quality of the service
from the local utility was acceptable. Therefore, the hospital
has minimal power quality impact on neighboriig loads.
Nevertheless, some people interpret this compliance with
IEEE 519 as if there are no power quality problems inside
their facility. This is not necessarily true. Individuai circuits
may present problems at various points in the facility, ,as
shown in the preceding discussion. At the hospital under
study, there were also continuous motor failures that were
caused by harmonics. A better guide to problems inside
medical facilities can be found in [9] and [IO].
The main recommendation of this study is to establish a
routine or periodic power quality assessment at the hospital.
The study described in this paper should be repeated to en-
sure compliance to codes/regulations and also as a preventive
measure. The cost of such measure is low compared to the
benefits that will be obtained. Overall system &ciency may
be improved, resulting on less repairs, reduced loss-of-life
and better maintenance records. This kind of study would
give an ability to identify and prevent power quality events.
This study will serve as a guide far installations of new
equipment and future expansions in the hospital.
Further analytical investigation of harmonic propagation
and unbalance conditions is required. At this point, the use
of tuned filters and other expensive solutions is not recom-
mended to mitigate the problems encountered. As a first
step, we recommend the improvement of the grounding
bonding in the fkilities. A detailed study of the hospital
grounding is required to implement this recammendation.
- 623 -
V. CONCLUSIONSAND FUTUREWORK
This paper presented a description of a power quality
audit carried out at the Bella Vista Hospital. The method is
simple; the measuring equipment is relatively inexpensive.
However, the information obtained from such a study is in-
valuable to conduct preventive maintenance or to trace
sources of power quality problems. Harmonic distortion was
the main problem found in this audit. Measurements of
THD were used to identify the harmonic sou~ces. The prin-
cipal power quality offenders were high-wattage medical
equipment in surgery units and office areas. Areas that are
sensitive to power disturbances were also identified. Poten-
tial problem areas were identified within the facility.
The study revealed conflicting point of views between
standard compliandinterpretation and actual power quality
problems found inside installations. A detailed study of
harmonic propagation is required. Evaluation of grounding
connections throughout the facility is underway. Finally, a
periodic power audit should be performed at the facility to
prevent hture power quality problems.
VIL ACKNOWIXDGMENTS
The authors wish to acknowledge the support f?om the
Bella Vista Hospital. Mr. Luis J. Rodriguez, biomedical and
communications technician, his help was invaluable in the
data collection process. Mr. Wilfiedo Perez biomedical
technologist, who supplied detailed information on the op-
eration of the biomedical and medical image processing
equipment. Also Mr. Fred Medina electrician who supplied
information neceSSary for the single line diagram. Finally
Mrs. Olga Babilonia, Vicepresident and responsible for the
acquisition of the measurement equipment.
REFJZRENCES
D. Stymiest, W.Henry, “Power Prognosis: Swgery Required!,’’ Con-
sulting4pecifjtingEngineer, no. 3, September 1998,pp. 71-76.
Power Qual@ for Healthcare, Industrial and Agricultural Business
Area, Electric Power Research Institute, Palo Alto, 1997.
P. Hall, B. Bailey, E. Camm, “Power Quality Evaluation at Medical
Center,” Proceedings of the 1999 Tronsmission and Distribution Con-
ference, vol. 2,pp. 560-565.
Hospitol Accreditotion Standards, Joint Commission on Accreditationof
HealthcareOrganizations,Oakbrook Terrace, Illinois, 1999.
Power QirolityAnolyzer-Applicotions Guide, Rev. 2, Fluke Corporation,
Evere*, WA,June 1998.
G.T.Hey&, Electric Power Quality, 2“ ed., Stars in a Circle Publica-
tiom, Scottsdale, 1991.
S. Lugo, D. Ramirez,G. Rivera, E. Vekques, Idennificotion and Cor-
rection ofHormonics in an Indusrria~Focility, Elec~ricaland Computer
Engineering Department, University of Puerto Rico-hhyaglleq May
1999.
Recommended Practices and Requirements for harmonic Control in
Electrical Power Systems, IEEE Standard 519,N Y , 1992.
Recommended Practice for E1ecm.c Systems in Healthcare Facilities,
IEEE Standard 602 (White Book), NY, 1996.
“Electrical Systems for Healthcare,” &fiv“zement ond Compliance
Series, American Society of Hospital Engineers, vol. 7,1992,pp. 65-76.
- 624 -
BIOGRAPElES
David Rnmfrez4hh-a is h m Aguadiua, Puerto Rico. He holds a BSEE
h m the university of Puerto Rico-Maya&uez(UPRM). Mr.Ramfrez is the
Diredor oftbe Eagiwering Department at the Bella Vista Hospital in haay-
agaez, Puerto Rico. He also has mdushial expnicnCe with local amdting
firms, and various g o v e r n " agencies Mr. Ramirez is Currently working
towards 811 MSEE at UPRM.

Efinh 0'NcWC.rrillo (S '91, M '99)is 6um Rio piedras, Pueato Rico. He

Ii01d-s the BSEE 5om the UniveSity of Puerto h M a y a @ e z (1994), and the
MSEE from pllrdueUniversity (1 995). He aaaincda PhD. degree m Electrical

-
Engkming hul Ariurna state univasity (1999). Dr. meillcanill0 is
currentlyan Assistant F % o hofElearical Engimering at the University of
Puerto Rico-Mayaagllez He has idwbial eq"e wah CPI del C a r i i
Dorado, Pu- Rico, and TOR Engbaeering,P u Arizona h.O'NeiIl-
crurillo's rrsearch intaeras iuclude computer applications in power systems
powaquality, power ekcmmiq systeas mnlioauenalysis and
chaos
Jalio Santbgo-Phz is &om Agoada, hato Rico. He holds the BSEE from
the univasity of hem RiakMayagaezand the WEE hRasselaa Poly-
tshnic Lmbitatc. He is wrcntly a Proitsor of Flectrical Engineering at the
university of Puerto Rico-Mayagaez. He also has exteusive iudmaid e x p i -
ence with the Puerto Rico Uectric Power Authority. Prof Saatiago's research
and- iutemts includecomputmapplicatiansm power systws, distri-
bution syskms, atmoqhericsardies.