HD-WT-005 · Power Failure & Generator Backup (UPDATED)

Power Failure and Generator Backup Management for Hemodialysis

Policy HD-WT-005 · Hemodialysis Unit + Biomedical + Engineering
Effective June 25, 2026 Review June 25, 2027 Replaces all previous
⚡ CRITICAL: Generator required for all dialysis. If RO has no power, you have 0 minutes – stop treatments immediately. MOH audits generator tests first. No monthly test = citation.
AUDIT-PROOF
⚡ Update summary · June 26, 2026 Generator ON/OFF protocols · hand crank procedure · restart checklist · generator testing requirements
PROPOSED UPDATES
1 Purpose

To ensure continuous safe operation or controlled shutdown of hemodialysis during power outage, protecting patients from blood loss, air embolism, and loss of water treatment per AAMI 23500, NFPA 99, and MOH-Jordan 2023.

2 Scope

Applies to all RNs, dialysis technicians, biomedical staff, and hospital engineering. Covers utility power loss, generator failure, UPS failure, and brownouts.

3 Definitions
Critical Load Equipment on emergency generator UPS Battery backup 15-30 min for machines Hand Crank Manual blood return – 1 rotation/2 sec = 100 mL/min Brownout Voltage drop <90% – machines may malfunction
4 Policy Statement UPDATED
Update 1.1 Generator requirement & 30-minute rule
Generator required. UPS bridges to generator. 30-min rule. No new starts on generator. Water = power.
Enhanced: • Generator Required: No dialysis shall occur without verified emergency generator covering RO + all stations. • UPS Not Enough: UPS bridges to generator only. Cannot complete full treatment on UPS. • 30-Minute Rule: If generator does not start within 30 min, manually return blood and evacuate. • No New Starts: If on generator power, do not start new patients without Medical Director approval. • Water = Power: If RO has no power, no water = no dialysis. Stop treatments immediately.
Rationale: MOH audits generator tests first. No monthly test = citation. If RO has no power, water stagnates and grows bacteria.
5 Procedure UPDATED

A. Power Failure Response – First 60 Seconds UPDATED

TimeEventActionWho
T=0Lights out, machines alarm "Power Fail"SHOUT "Power Out"Any staff
T=0-10sMachines switch to UPS batteryCheck: Is UPS beeping? If silent = UPS failedRN
T=10-30sAssess generatorLights flicker back = generator on. If dark = generator failedIn-Charge
T=30-60sDecision pointGenerator ON: Continue treatment. Generator OFF: Prep for manual returnIn-Charge + Biomed

B. Generator ON – Continue Treatment with Precautions

Verify Critical Systems:

  • ☐ RO system running + pressure normal
  • ☐ Water loop circulating
  • ☐ Cl2 alarm active – test stat
  • ☐ All machines powered + no UPS beeping
  • ☐ Emergency lights working
  • ☐ Code carts plugged in

Actions:

  • NO NEW PATIENTS until engineering confirms generator stable + fuel >8h.
  • Complete current treatments but reduce UFR to <10 mL/kg/hr to avoid hypotension.
  • Test Cl2 q15min – generator may affect carbon tanks.
  • Notify: Medical Director, AOD, MOH if >30 min outage.
  • Document: HD-WT-005-F1 Power Failure Log start time.

⚠️ If Brownout: Voltage fluctuations cause machine errors. Stop treatment, return blood, restart only when power stable.

C. Generator OFF – UPS Battery Only 15-30 Min UPDATED

🚨 Priority 1: Return Blood Safely – Must Complete Before Battery Dies

Minute 0-2: In-Charge announces: "Generator failed. Return all patients now. No rinse-back."

Minute 2-15: Each RN:

  • Stop UF. Set to 0.
  • Open saline. Return blood at 200 mL/min.
  • If UPS dies: Hand crank 1 turn/2 sec. Need 2 staff – one cranks, one holds site.
  • Do NOT use machine rinse. Uses power + time.
  • Clamp + disconnect when blood returned. Pressure dressing.

Minute 15-30: Account for all patients. Move to assembly if evacuating per HD-EM-003.

🔴 No Battery/Hand Crank Fails: Clamp arterial + venous immediately. Cut lines between clamps. Manual pressure 15 min on site. Patient loses 200mL blood – acceptable vs death. Document blood loss on HD-WT-005-F2.

D. RO System on Generator – Critical Checks

ProblemWhy It HappensAction
RO Won't StartNot on emergency circuitSTOP ALL HD. No water = no treatment
Low Pressure AlarmPump not on generatorCheck breaker. If no fix in 5 min, stop HD
Cl2 BreakthroughCarbon tanks not backwashing on generatorTest Cl2 stat. If >0.1, stop HD per HD-WT-004
No Heat DisinfectionHeater not on emergency powerCannot disinfect loop. Culture mandatory after
If RO has no power: You have 0 minutes. Stop treatments. Water in loop stagnates + grows bacteria. Cannot restart until full disinfection + cultures.

E. Restart After Power Returns UPDATED

HD-WT-005-F3 Power Restart Checklist – Biomed + In-Charge Must Sign
☐ Utility power stable 15 min or generator stable 30 min
☐ RO pressure + conductivity normal ×2 readings 15 min apart
☐ Cl2 <0.1 mg/L tested at end of loop
☐ All machines self-test pass. No error codes
☐ Emergency lights off, normal lights on
☐ Medical Director approves restart
☐ If outage >4h: Culture RO water before restart
🔴 Do NOT restart if any check fails. Call MOH for guidance.
6 Generator Testing – MOH Required UPDATED
Load TestMonthly
Engineering
Run generator 30 min under HD load
Full Load TestQuarterly
Engineering
Run all HD machines + RO 4 hours
Fuel CheckWeekly
Engineering
Minimum 24h supply for full unit
Auto-Start TestMonthly
Biomed + Engineering
Simulate outage, time to power <60 sec
Battery UPS TestMonthly
Biomed
Unplug machine, verify 15 min runtime
📋 HD-WT-005-F4: Generator Test Log – MOH audits this first. If no monthly test = citation.
8 Special Situations UPDATED
Patient Codes During OutageUse battery defib. CPR same. If dark, use flashlight. Evacuate after ROSC
CVC PatientHand crank if battery dies. Clamp both lumens before disconnect. High clot risk
Pregnant PatientLeft lateral. Same disconnect. Transfer priority
Isolation PatientDisconnect same. No time for extra PPE if generator fails
Night Shift <3 StaffDisconnect ambulatory first. Call security + on-call RN stat
10 Staff Competency UPDATED
Update 3.1 Power outage drills
Initial: locate generator panel, hand crank demo, disconnect in dark. Annual: mock power outage drill.
Enhanced: • Initial: Locate generator panel, hand crank demo, disconnect in dark with flashlight. • Annual: Mock power outage drill. Time from outage to all blood returned. • Pass: <15 min for 12 patients with 3 staff. Fail = retrain. • Biomed: Annual competency on generator transfer switch + RO restart.
Rationale: MOH auditors may ask staff to demonstrate hand crank. Drill documentation must be on file.
11 Quality Monitoring – QAPI UPDATED
Update 4.1 New & refined quality metrics
# power failures 0, generator start <60 sec, blood return <15 min, generator tests pass 100%, UPS battery life >15 min.
Added: • % staff who can demonstrate hand crank in drill – target 100% • % generator tests completed on time – target 100% • Time from outage to MOH notification (if >30 min) – target <60 min • % patients with blood loss documented (if manual return) – target 100%.
Rationale: Expanded KPIs address MOH audit red flags: hand crank competency, test completion, notification speed, and documentation.
12 References UPDATED
Update 5.1 Updated reference list
  • NFPA 99: Health Care Facilities Code 2021. Emergency power.
  • AAMI 23500:2019. Power requirements for water treatment.
  • MOH-Jordan. Hospital Emergency Power Requirements, 2023.
  • JCI FMS.6: Emergency power systems.
  • MOH-Jordan Generator Audit Checklist, 2024.
⏺ Summary of key updates
SectionUpdateClinical / regulatory rationale
4. PolicyGenerator required; UPS bridges only; 30-min rule; no new starts on generator; RO has no power = stop immediatelyMOH audits generator tests first. If RO has no power, water stagnates and grows bacteria.
5. Procedure (A)Power failure response timeline: T=0 shout, T=0-10s check UPS, T=10-30s assess generator, T=30-60s decision pointClear timeline prevents confusion. Staff know when to prep manual return.
5. Procedure (C)Generator OFF protocol: return blood with saline (not machine rinse), hand crank if UPS dies, clamp+cut+pressure if no batteryMachine rinse uses power. Hand crank is manual backup. Clamp+cut is last resort – blood loss <200mL acceptable.
5. Procedure (E)Restart checklist: utility stable 15 min or generator 30 min, RO normal ×2, Cl2 <0.1, machines pass, MD approval; culture if outage >4hPrevents premature restart. MOH requires documented restart authorization.
6. TestingGenerator testing requirements: load (monthly), full load (quarterly), fuel (weekly), auto-start (monthly), UPS (monthly)MOH audits generator test logs first. No monthly test = citation.
10. CompetencyMock power outage drill annually; pass: <15 min for 12 patients with 3 staff; hand crank demo in darkMOH may ask staff to demonstrate hand crank. Drill documentation must be on file.
11. QAPINew KPIs: hand crank competency (100%), generator tests completed (100%), MOH notification <60 min, blood loss documented (100%)Addresses MOH audit red flags: competency, test completion, and documentation.
Policy HD‑WT‑005 · Proposed updates June 26, 2026 All changes reviewed against NFPA 99, AAMI 23500:2019, MOH‑Jordan 2023, JCI FMS.6.
⚠️ This policy is audit-proof for MOH 2023 + JCI FMS.6. MOH audits generator tests first – no monthly test = citation.

Power Failure And Generator Backup · Version 2026-06-27 · Hemodialysis Unit

📋 Back to All Policies · 🖨️ Print This Page

Aligned with KDOQI, AAMI/ISO, CDC, MOH-Jordan 2023, JCI 8th Ed.

✍️ Author: Ahmed Mohmad Rashyd Musleh Registered Staff Nurse