Electrical safety is a global concern

Electrical safety in Group 2 healthcare facilities remains one of the most critical challenges in modern healthcare infrastructure. Even minor electrical faults can have life-threatening consequences in operating theatres, intensive care units, and other high-risk clinical environments.

While international standards such as IEC 60364-7-710 provide a clear framework, effective safety depends on proper implementation, continuous monitoring, and staff awareness. Legislation, enforcement, and thorough commissioning inspections play a vital role in ensuring compliance — not only to protect patients and staff, but also to prevent costly outages and inefficiencies in clinical operations.

Electricity is an invisible hazard, but with modern monitoring systems, training, and preparedness, its risks can be effectively controlled at relatively low cost. The lifecycle of an insulation monitoring system can exceed 30 years, making it both technically robust and economically sustainable.

Country perspectives on Group 2 electrical safety

In this article, we examine the subject from two contrasting perspectives. We first focus on India, where significant efforts have been made to enhance electrical safety in medical environments. This section has been prepared by Mr Gopa Kumar.

We also present a perspective from Ukraine, where hospitals have been required to maintain operations under exceptionally challenging conditions. Together, these examples illustrate both the diversity of operating environments and the shared importance of electrical safety in critical care settings worldwide.

Electrical safety in Group 2 medical locations

Group 2 medical locations are the most critical hospital environments — operating theatres, intensive care units, and other areas where medical devices are directly connected to the heart or other vital organs. Even momentary interruptions in the electricity supply or minor leakage currents can put patients and staff at immediate risk. Currents as low as 10 mA may cause muscular paralysis and respiratory arrest, while slightly higher levels can trigger ventricular fibrillation. Remarkably, even microampere-level currents (10 µA) applied to sensitive regions of the heart can cause heart failure.

Although it is often assumed that advancing technology automatically makes medical devices safer and more compatible, the reality is more complex. Leakage currents can still occur in both new and old equipment, caused by insulation faults, poor connections, or component failures. The rapid pace of development, combined with the increasing number of interconnected systems, can introduce new vulnerabilities. Reliable and proactive monitoring is therefore essential to anticipate and address faults before they compromise patient and staff safety.

Relying solely on residual-current devices (RCDs) is insufficient. They act only after a fault current exceeds the trip threshold, shutting down entire fuse groups without advance warning — an unacceptable risk in environments where continuity of supply is vital.

International standards for Group 2 medical locations

IEC 60364-7-710 is the primary international standard for electrical installations in medical locations. It defines the requirements for Group 2 environments and mandates the use of medical IT systems with insulation monitoring devices (IMDs).

In Europe, the harmonised version EN 60364-7-710 applies, ensuring consistent requirements across EU member states. Insulation monitoring is therefore compulsory in OTs, ICUs, and other Group 2 locations. The medical IT system provides an uninterrupted power supply during the first insulation fault, which is detected by the IMD and signalled through both visual and audible alarms.

The system consists of a medical isolation transformer and the IMD, which must comply with IEC 61557-8. For fault location, IEC 61557-9 defines the requirements for insulation fault location systems (IFLS).

In practice, this means that Group 2 locations must be designed not only for safe operation under normal conditions, but also for resilience against insulation faults, with staff immediately alerted and able to act. National regulations may complement or supplement these international and European standards and must also be respected.

Electrical installations in hospitals — an Indian perspective

In recent years, there has been a significant increase in hospital accidents, especially in high-risk areas such as Neonatal Intensive Care Units (NICUs), ICUs, and OTs, where patient evacuation is challenging. Detailed studies reveal that most of these accidents are due to the non-operation of protective devices during overcurrent or fault conditions. The studies also show that protective measures, such as equipotential bonding, are rarely implemented or maintained in medical settings.

As a leading global destination for medical tourism, India’s healthcare sector must improve the safety of electrical installations and maintain standards comparable to those of Western countries.

• The legal framework for electrical safety

Safety requirements in medical locations were first introduced in the National Electrical Code (NEC) of 1985 (SP 30, Part 3, Section 4). This code included provisions for system earthing (TN-S & IT), disconnection times, touch-voltage limits, continuity of supply, supplementary equipotential bonding, and requirements for oxygen-rich areas. The NEC 2011 elaborated on these requirements with illustrations for clarity, while the NEC 2023 further refined them, classifying locations into Group 1 and Group 2 and aligning the requirements with IEC 60364-7-710.

• Implementation challenges

The implementation of electrical safety in Indian hospitals remains a major challenge. There is no agency to enforce or verify compliance, leading to widespread non-implementation and a depletion of knowledge. Most hospitals are accredited under systems designed to improve patient safety and care, but electrical safety is not included in these frameworks. Instead, practices such as the thermal imaging of panels — not recognised in the NEC — are often emphasised, further diverting attention from critical safety measures.

Earthing practices present another problem. While the NEC recommends TN-S systems for general applications and IT systems for Group 2 locations, unrecognised alternatives are commonly used, causing dangerous failures. Global medical equipment manufacturers often demand separate ‘earth pits’ (dedicated earthing electrodes) with a resistance of ≤ 1 Ω for biomedical equipment — a non-standard practice that conflicts with equipotential bonding and compromises patient and staff safety. Often, guarantees and warranties are tied to this requirement, leading hospital management to refuse to implement supplementary equipotential bonding. As a result, one of the most important protective measures against electric shock in Group 1 and Group 2 locations is routinely neglected.

The use of medical IT systems is still rare, although some are implemented in modular operating theatres or integrated with UPS systems. Monitoring the continuity of PE conductors in such systems is particularly important due to the frequent confusion in protective earthing practices.

• Additional safety considerations

Public utilities or distribution companies supply most medical establishments and rely on multiple backup diesel generators. The capacity of these sources varies widely, which in turn influences circuit impedance. Under such conditions, implementing automatic disconnection is difficult. The use of a three-phase UPS without isolation for single-phase loads adds further complexity.

The NEC 2023 introduced requirements for initial and periodic verification. In existing hospitals, conducting such verification is difficult because switching off power is often not feasible.

Nevertheless, several new hospitals have already adopted initial verification, ensuring compliance before commissioning — a significant improvement.

• Changing scenario and mass awareness

Recent fire accidents in medical facilities — many caused by medical electrical equipment — have triggered large-scale discussions on fire safety. In this context, electrical safety is increasingly being recognised as a measure to reduce fire risks.

Following the publication of NEC 2023, large-scale awareness campaigns and training programmes have been launched. These have led to a better understanding of the subject, with some leading hospitals beginning to implement the NEC 2023 recommendations. New hospitals are considering the use of IT systems in accordance with IEC 60364-7-710, which incorporates isolation transformers (IEC 61558-2-15), insulation monitoring devices (IEC 61557-8), and insulation fault location systems (IEC 61557-9). While adoption is still limited, these developments represent progress.

The use of PE conductor monitoring is proving to be a valuable tool for ensuring the reliable operation of medical IT systems. Several new hospitals have also begun implementing initial verification as per the 2023 NEC, ensuring that errors are corrected before installations are placed into service. This represents a positive step, although there is still a long way to go before full compliance and best practice become the norm across the country.

Ukraine — hospitals under extreme pressure

Contributed by Dmitry Horbatchov, CEO, and Tatyana Horbatchov, technical director, LLC PKF Industrial Technologies, Kharkiv. We are grateful for their valuable insights and continued commitment to improving hospital safety under exceptionally difficult circumstances.

In the 2010s, Ukraine had already begun to modernise its hospital infrastructure. Regulatory reforms introduced after 2015 aimed to align national practices with European standards. In new construction and renovation projects, operating theatres were increasingly designed with isolated power supply (IT) systems, isolation transformers and insulation monitoring devices, creating a foundation for safer Group 2 medical environments.

The full-scale invasion in February 2022, however, significantly changed the situation. Before 2022, approximately 720 hospitals were operational in Ukraine. By April 2023, this number had dropped to 450, and the situation has since further deteriorated.

Hospitals have been forced to operate amid prolonged power outages and physical threats. In many cases, operating theatres and intensive care units have been relocated to underground shelters. The continuity of electricity supply is maintained through generators and automatic transfer switches, while temporary solutions are employed to secure vital equipment.

Despite these challenges, progress has not stopped. With international support, new hospitals and facilities continue to be built, applying European standards wherever possible. However, the contrast is striking: alongside modern installations, many hospitals still rely on outdated systems, and the overall level of electrical safety remains uneven.

The Ukrainian experience is a reminder that healthcare infrastructure must be prepared not only for everyday risks but also for exceptional disruptions. Ensuring resilient and modern Group 2 installations is therefore not only a technical requirement but also a safeguard for maintaining critical medical services under extreme conditions.

Case example — why proactive monitoring matters

A modern insulation monitoring system, when combined with PE conductor continuity monitoring, maximises the safety of critical Group 2 premises. While international standards mandate insulation monitoring, continuity monitoring of the PE conductor is not yet a compulsory requirement; it is, however, a recommended practice. Nevertheless, it provides a significant additional safeguard, ensuring that equipment remains grounded correctly in the event of faults or power interruptions. Such cases underline why combining mandatory and recommended monitoring functions is the most effective way to safeguard patients, staff, and critical medical equipment.

Practical case illustrating the importance of this combined approach

In an OT, a fault developed in a socket line with four ceiling outlets. Due to insufficient strain relief, the cables at one outlet shifted and came into contact with each other, resulting in deterioration of the insulation. The IMD detected the fault immediately and triggered both a visual and an audible alarm. Because the system also monitored PE conductor continuity, the technical staff could verify that protective grounding remained intact, even under fault conditions.

Thanks to this early and comprehensive warning, the staff intervened before the fault escalated. There was no risk to patients or clinical personnel, and valuable medical equipment remained protected. Moreover, the incident demonstrated how such systems can also help to prevent dangerous electrical fires.

Summary

The examples presented in this article confirm that progress in electrical safety for Group 2 medical facilities is moving forward worldwide. From India’s systematic improvements to Ukraine’s resilience under extreme conditions, awareness is increasing, and modern solutions are gradually being implemented. Similar insights from colleagues in Europe and Asia further underline that this is a truly global effort.

India demonstrates that progress requires not only regulations but also the active involvement of professionals from different disciplines. Collaboration, regular communication across multiple channels, and continuous research have been crucial in driving change and ensuring that knowledge is widely disseminated within the healthcare sector.

However, the picture is not without challenges. Even in Europe, where strict standards exist, implementation is not always consistent, and gaps remain. Standards provide an essential framework, but they must be accompanied by effective enforcement, adequate investment and ongoing professional development.

The way ahead is clear: we must continue to raise awareness, support research, and strengthen the competence of healthcare engineers and technical staff. Sharing knowledge and best practices across borders is vital. Only then can we ensure that the invisible hazard of electricity is reliably controlled, securing safe and resilient healthcare environments for the future. This requires not only compliance with standards, but also continuous commitment from healthcare organisations and technical professionals.

Acknowledgement

• This article — appearing here in revised and updated form — originally appeared in IFHE Digest 2026.