Electrostatic Discharge (ESD): Is it on our radar?

Electrostatic Discharge (ESD): Is it on our radar?

Chris Fish-Huson, PhD, RN, CNE - Sr. Director - Carilion Nursing Research

Healthcare workers use an increasing amount of technology in their practice. In the inpatient environment, some of this technology includes electronic tools such as blood glucose measurement devices, pulse oximetry, and infusion pumps. One might see intracranial pressure monitoring, mechanical ventilators, and ventricular assist devices in specialty areas. When considering preventing adverse events related to medical devices such as these, providers often believe in diligence in following policy and procedure. However, one phenomenon associated with using electronic devices is a potential cause of an adverse event and is often overlooked in policy and procedure. This phenomenon is electrostatic discharge or ESD.

ESD is a transfer of electricity between two objects with differing electronic potentials1. To better relate the concept of ESD, consider a time you walked across a carpet, touched a table lamp or the television, and received a shock you relate to as a static electrical shock. This electrical shock you experience is electrostatic discharge. ESD is not always a noticeable event; it is often unnoticed. To complicate the issue, healthcare workers are often unaware of ESD and how it might impact their care.

The FDA has reported 1,342 ESD-related equipment malfunctions between 2006 and 2016, resulting in 46 incidents of injury and five patient deaths1. The most common device to be reported was a clinical chemistry analyzer (n=769 reports), resulting in inaccurate laboratory measurements1. The second most reported device was infusion pumps (n= 173 reports), leading to errors in date/time display, restarting of the pump, and dose delivery errors1. ESD has also been reported to trigger motor restart of ventricular devices, unexpected shutdown and inaccurate values of mechanical ventilators, time and date change on blood glucose devices, and incorrect readings of intracranial pressures1 .

Factors that impact ESD include humidity levels and activity1,2. Activities such as friction on the floor when transporting a patient, transferring a patient to a stretcher, and repositioning the patient in bed can all lead to ESD3. In these instances, ESD is most often discharged through human touch of a metal part of the device, increasing the occurrence when touching the device while holding a metal object such as an IV pole3. Moisture in the air contributes to the discharge of electricity, with greater room air humidity being found to decrease electrical discharge3. It is recommended that the room humidity level be no lower than 30% to minimize the ESD and the associated adverse events3 .

We can take action to lower the risk of ESD-related adverse events by considering the following:

1. Be aware of those instances when ESD can occur such as during transport and repositioning. 2. Wear grounded/insulated footwear such as rubber-soled shoes, or wear disposable shoe covers.

3. Wear nitrile gloves when touching patients or equipment, including when transporting a patient2 .

4. Be cautious when transferring patients from the bed to a stretcher.

5. Make sure equipment due for a preventative maintenance check is sent to Clinical

Engineering promptly. 6. Submit a Safewatch report if you believe an ESD event has occurred (device restarts inappropriately, errors with display, etc.).

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Practical Applications of Nursing Inquiry

The increasing use of technology in our practice is important to improve efficiency and safety of care, thereby improving patient outcomes. One challenge we must keep in mind is to continue to question if our practice, in this case, related to technology, is the best practice. After all, ensuring the best outcomes of our patients is the reward for exercising best practices.

References

1. Kohani, M., Pecht, M. Malfunctions of medical devices due to electrostatic occurrences; Big data analysis of 10 years of the FDA’s Reports. Institute of Electrical and Electronics Engineers

Access, 2018: 6, 5805-5811. 2. Welker, R. W., Nagarajan, R., Newberg, C. E. Contamination and ESD control in hightechnology manufacturing. John Wiley & Sons; 2006. 3. Kohani, M., et al. Electrostatic charging of a human body caused by activities and material combinations in hospitals. Institute of Electrical and Electronics Engineers Transactions on

Electromagnetic Compatibility, 2020: 62(2), 315-323.

Other resources:

Elliot, W. Gianetti, G “Electrostatic discharge interference in the clinical environment” Biometrical Instrumentation & Technology, 1995.495-499.

ESD Association. “Fundamentals of electrostatic discharge: Part 1-an introduction to ESD” 2020. Retrieved on 6/3/2022 from https://www.esda.org/esd-overview/esd-fundamentals/part-1-an-introduction-to-esd/

Najjar, E., Hallberg Kristensen, A., Thorvaldsen, T., Dalen, M., Ulrich, P., Lund, L. Electrostatic discharge causing pump shutdown in HeartMate3. 2021: 3(3), 459-463.