Nabl 126
Nabl 126
Nabl 126
10
Amendment Sheet 1
Contents 2
1. General Requirements 3
2. Scope 3
3. Application 3
7. Safety Precautions 6
8. Documentation 6
9. Labeling of Equipment 6
• The purpose of this document is to specify requirements with which a laboratory has to
operate and demonstrate its competency to carry out Calibration of Medical Devices in
accordance with ISO/IEC 17025:2005 or 2017, ISO 13485, IEC 60601, IEC 62353, GHTF,
(Global Harmonization Task Force)
• To achieve uniformity between the laboratories, assessors and assessment process in
terms of maximum permissible error, CMC, measurement uncertainty etc in line with
National/International standards.
• To achieve uniformity in selection of equipment’s, calibration methods, maintaining required
environmental conditions, personnel with relevant qualification and experience.
2. Scope
This specific criterion lays down the requirements for Management system and Technical
requirements for Calibration of Medical devices which:
• Needs to demonstrate its ability to consistently provide medical devices that meet customer
and applicable statutory and regulatory requirements.
• To enhance customer satisfaction through the effective application of the system and
technical requirements, including processes for continual improvement of the system and
the assurance of conformity to customer
3. Application
All requirements of this document are generic and are intended to be applicable to all
organizations, regardless of type, size and product provided.
Where any requirement(s) of this document cannot be applied due to the nature of an organization
and its products, this can be considered for exclusion.
If any requirement(s) of this document is (are) not applicable due to the nature of the medical
device(s) for which the quality management system is applied, the organization does not need to
include such a requirement(s) in its quality management system and appropriate justification shall
be recorded, provided such exclusions do not affect the organization's ability, or responsibility, to
provide product that meets customer and applicable statutory and regulatory requirements.
Management needs to understand the scope, significance, and complexity of the program
4.1.1 Calibration Personnel: Degree in Electrical / Electronics / Biomedical Engineering/
Instrumentation or equivalent or post graduate in the relevant field, with at least one year
experience in the relevant field of calibration or, graduate, Diploma in science with Physics /
Electronics/Instrumentation with experience of 3 years in the relevant field of calibration. The
personnel shall have relevant knowledge of basic principles of testing, evaluation of calibration
results, equipment capabilities and uncertainty of test results & applicable regulations and general
requirements expressed in relevant& associated standards.
4.3.1 Due to various kinds of medical devices and each being used for different purpose, the
authorized calibration engineer should be trained in each of the medical device which he/she is
authorized to handle including the aspects of criticality of results, interpretation of data, correctness
of data, specific operating ranges expected from the medical device, safety during usage,
regulatory requirement to be followed / adhered to etc.
4.3.2 Experience in evaluation of Risk Assessment, Usability Engineering, EMC and Software Life
Cycle Management is mandatorily needed. Knowledge of bio-compatibility and sterilization
techniques and requirement are expected as needed depending on the product. Training on
Emergency Medical preparedness including CPR shall be provided.
i. Permanent laboratory
ii. Onsite Facility
iii. Mobile Facility
5.1.1 Service that intended primarily for working standards, reference standard / reference
equipments which are further used for calibration purposes or high accuracy measurements
which requires high degree of accuracy and better CMC.
5.1.2 Service that intended primarily for calibration and adjustment of test, measurement and
diagnostic equipments to use in such areas as product calibration, manufacturing and
servicing.
5.1.3 Accommodation and environmental conditions adversely affect the results of calibration and
measurement accuracy unless they are controlled and monitored. Hence, they play a very
important role.
5.1.4 The influencing parameters may be one or more of the following i. e. temperature, relative
humidity, atmospheric pressure, vibration, acoustic noise, dust particle, air currents/draft,
National Accreditation Board for Testing and Calibration Laboratories
Doc. No.: NABL 126 Specific criteria for calibration of Medical Devices
Issue No.: 01 Issue Date: 02-Jan-2018 Amend No.: 02 Amend Date: 18-Jul-2020 Page No.: 4 of 29
illumination(wherever applicable), voltage fluctuations, electrical earthing, line harmonic
distortions and direct sunlight etc., depending on the nature of calibration services provided.
The variables described above can play a major factor on calibration results.
5.1.5 The main difference between the permanent laboratory, onsite and mobile calibration
services has to do with environmental conditions only. Since the onsite calibration relies on
where the service is provided, it affects the results of calibration.
5.1.6 The laboratories are advised to follow the requirement of accommodation and environment
depending on the types of services provided as recommended:
• By the manufacturers of the reference equipment
• By the manufacturers of the Unit under calibration
• As specified in the National/ International Standards or guidelines followed for the
calibration.
5.1.7 The environmental monitoring equipments used should also meet the requirement of
manufacturers’ recommendations and specifications as per the relevant standards followed.
If, accommodation and environmental conditions are not specified either by manufacturer or
by National/International standards / guidelines, the laboratory shall follow the below
recommendations.
• The calibration area shall be adequately free from vibrations generated by central air-
conditioning plants, vehicular traffic and other sources to ensure consistent and uniform
operational conditions. The laboratory shall take all special/ protective precautions like
mounting of sensitive apparatus on vibration free tables and pillars etc., isolated from the
floor, if necessary.
• The acoustic noise for the calibrations area shall be < 60dB
• The Illumination level of calibration area shall be 250 Lux to 500 Lux
The environmental conditions for the activity of the laboratory shall be such as not to adversely
affect the required accuracy of measurement. Facilities shall be provided whenever necessary for
recording temperature, pressure and humidity values prevailing during calibration. The
atmospheric conditions maintained in the laboratory during calibration shall be reported.
a. The calibration laboratory shall make arrangements for regulated and uninterrupted
power supply of proper rating. The recommended voltage regulation level is ± 2% or
better, and Frequency variation ± 1 Hz or better on the calibration bench.
b. The reference standards shall be maintained at temperatures specified for their
maintenance on order to ensure their conformance to the required level of operation. The
laboratory shall take adequate measures against dust and external air pressure.
c. As far as possible, only the staff engaged in calibration activity shall be permitted entry
inside the calibration area.
d. The calibration Laboratory shall ensure adequate space for calibration activity without
adversely affecting the results with the free movement of personnel.
7.1 Relevant fire extinguishing equipment for possible fire hazards shall be available in the
corridors or convenient places in the laboratory. Adequate safety measures against electrical,
chemical fire hazards (fumes/gases), Power backups must be available at the work place.
Laboratory rooms/ areas where highly inflammable materials are used/ stored shall be
identified. Access to the relevant fire equipment shall be assured near these rooms/ areas.
7.2 Chemical storage area should be highly protected with biosafety cabinets or fume hoods or
with fire protection and should be isolated from workplace.
7.3 According to Regulation (EC) No. 1907/2006) a Material safety data sheet (MSDS) should be
maintained with any hazardous chemical. Safety data sheets (SDSs) provide useful information
on chemicals, describing the hazards the chemical presents, and giving information on
handling, storage and emergency measures in case of an accident.
7.4 Proper eye wash and shower facility need to be provided in chemical hazarders handling
areas.
7.5 Specification SP 31- 1986, a special publication in the form of a wall chart, giving the method of
treatment in case of electric shock, should be followed. The chart shall be placed near the
power supply switchgear and at other prominent places as prescribed under Indian Electricity
Rules 1956.
7.6 Effective mains earthing shall be provided in accordance with relevant specification IS: 3043.
This shall be periodically checked to ensure proper contact with earth rod.
7.7 First aid facility shall be provided in all the work places.
8. Documentation
There must be two copies of the instructions manual and a service manual with the equipment.
Instructions manual should be with the equipment, and the other filed with the person responsible
in department of the health unit. Service Manual must be obtained for each equipment, in order to
provide technical information needed by the clinical engineer for maintenance. This should be a
mandatory item in the technical specifications during procurement of equipment as well. IEC
60601-1 determines that all equipment must be accompanied by a description of technique,
supplied by the manufacturer.
9. Labeling of Equipment
a) The labeling of equipment must be part of the program implemented by the in-
house/outsourced clinical engineering group. Use of series of labels and color code for medical
equipment, serving as guide for the development of a system for each health unit may be
practiced.
b) Green label (Upto 100 µA) – Safe for use in all areas. In devices that have leads which connect
to low impedance, direct wire electrical connection to the conductive system of the heart, lead
leakage must be 20 uA or less, and chassis leakage must be 100 uA or less.
d) Out-of-Service tag. White Tag (red lettering) – Remove from service. If a piece of equipment
does not work properly, disconnect it and attach a white tag. This label and applied in any
equipment classified as unsafe for reasons determined by the clinical engineer, and calls the
attention of medical or nursing staff so that the equipment is not used. When equipment is
classified, the supervisor of the unit must be immediately notified and corrective action should
be initiated. Examples of these tags are the following data:
• Technician:
• Date: _ _ _ _ _ _ _ _ _ _ _ _ _
• Technician:
9.1 The utilization of tags and a nice visual feature to determine whether the equipment has been
inspected. Its not uncommon for vendors, nurses or even get a medical equipment for the
health unit without the knowledge of the clinical engineering group, and therefore without your
safety inspection. However, while a device is in the health unit, this will be liable if it is used in a
patient, and bring any damage to the same.
9.2 Another benefit in the system of tags, and that the medical or nursing staff using the
equipment feels safer if it has been inspected. Also, the medical staff or nursing can give return
to the people of clinical engineering, if you notice that certain equipment is with your date of
inspection due, or not have been inspected. It is important to instill in people the only procedure
using labeled equipment, and bring inspection date updated.
10.2 Site Calibration Facility: Calibration performed by staff of a laboratory or entity at the
customer premises or location outside of a permanent laboratory.
10.3 Mobile Facility: Fully equipped, self-contained, transportable calibration facility capable of
performing tests/ calibrations under controlled environmental conditions.
8. ECG Unit
9. Trans illuminator light source
10. Ventilator
11. Nebulizer (Electric)
12. Syringe Pump
13. Infusion Pump
14. Radiant Warmer
15. Phototherapy
16. Pulse Oxymeter
17. Weighing scales (baby)
18. EEG
19. Electro Surgical Unit/ Diathermy
Machine/ Cautry Machine.
20. Patient Monitors
21. Apnea Monitors
22. External Pace Maker
23. Fetal Monitor
24. Feat Doppler
25. Infant Incubator
26. Electronic Tourniquet
27. Therapeutic Ultra sound Machine
28. Boyles Apparatus
29. Dialysis Machine
30. Heart Lung Machine
31. Patient Warmer
32. OT Table
33. OT Light
34. Electronic /Mechanical Patient Bed
35. CPM Machine
36. Therapeutic Stimulator
37. Enteral Feeding Pump
38. CPAP
39. BiPAP
Note: This list is indicative & non exhaustive
• Airflow
• Sound
• Humidity
• Air and surface
temperature in 6
independent points
18. Semi- Auto 1.IEC 60601-1 1. General requirements for Electrical Safety
analyser 2. IEC 60601-1-2 basic safety and essential Analyzer
3.IEC 61010-2- performance
081: Safety 2. Basic safety and essential
requirements for performance with regard to
electrical electromagnetic disturbances
equipment for and for electromagnetic
measurement, emissions
control and 3. Particular requirements for
laboratory use - automatic and semi-automatic
Part 2-081 laboratory equipment
4.IEC 61010-2- 4. Particular requirements for in
101 vitro diagnostic (IVD) medical
equipment
19. Self inflating 1. ISO 10651- 1. Specifies requirements for
reservoir bag 4:2002 2. IS operator-powered resuscitators
6194(1971) intended for use with all age
groups and which are portable
and intended to provide lung
ventilation
20. Electrosurgical 1.IEC 60601-1: 1. General requirements for Electrical Safety
Unit 2. IEC 60601-1-2 basic safety and essential Analyzer&
performance Electrosurgical
3.IEC 60601-2-2: 2. Basic safety and essential Analyzer/Cautery
Medical electrical performance with regard to Analyzer.
equipment - Part electromagnetic disturbances
2-2: Particular and for electromagnetic
requirements for emissions
the basic safety 3. Medical electrical equipment -
22. Pulse Qximeter 1.IEC 60601-1 1. General requirements for Electrical Safety
2.IEC 60601-1-2 basic safety and essential Analyser & Pulse
3.ISO 80601-2- performance Oximeter
61:2011 or ISO 2. Basic safety and essential Simulator
9919:2005Medica performance with regard to
l electrical electromagnetic disturbances
equipment -- Part and for electromagnetic
2-61 emissions
3. Particular requirements for
basic safety and essential
performance of pulse oximeter
equipment
46. Sterile IS 10258 (Part 3) Test for testing auto disable *Apparatus for
hypodermic ISO 7886-3 feature testing auto
syringes for disable feature
single use –
Part 3: Auto-
disable syringes
for fixed dose
immunization
47. Sterile ISO 7886-4 Test for testing for testing re-use *Apparatus for
hypodermic prevention feature for RUP testing re-use
syringes for syringes prevention
single use – feature
Part 4: Syringe
with re-use
prevention
feature
48. Sterile single IS 12227 Test for bond between hub and *Apparatus for
use syringes, ISO 8537 needle tube measuring bond
with or without between hub and
needle for needle tube
insulin
The elaborate test protocols for each equipment proposed in this work are described in 4 distinct
steps which are described below (Additional steps may be proposed if desired by the
manufacturer/ client.
Step 1- Relevant qualitative and quantitative tests should include the following:-
• Curent consumption
• Insulation Resistance
• Leakage current to the ground
• Leakage current through the Cabinet
• Leakage current through the patient
• Auxiliary current through the patient
The above measures include all tests that can be performed on electro medical equipment as
prescribed by the general rule, and that meet the criteria established for this step and the previous
one.
The results of the tests mentioned above represent characteristics common to all electro medical
equipment. Additionally, each equipment must observe compliance with their particular standard.
The nature of the tests varies greatly according to the equipment to be tested; e.g., the tests
applied in electrosurgical units are completely distinct from those applied in infusion pumps.
Through this methodology, test protocols developed for electrocardiographs, infusion pumps,
syringe pumps, defibrillators and electrosurgical units are attached as suggestive tests. The tests
applied in these equipments are listed below:
• Insulation resistance
• Leakage current to the ground
• Leakage current through the Cabinet
• Leakage current through the patient
• Auxiliary current through the patient
Electrosurgical Units
The following tests should be applied:-
• Insulation resistance
• Leakage current to the ground
• Leakage current through the Cabinet
• Leakage current through the patient
• Auxiliary current through the patient
• Accuracy of the power outlet
• RF leakage current
Defibrillators
The following tests should be applied:-
• Insulation resistance
• Leakage current to the ground
• Leakage current through the Cabinet
• Leakage current through the patient
• Auxiliary current through the patient
• Energy delivered
• Isolation of the high voltage parts
National Accreditation Board for Testing and Calibration Laboratories
Doc. No.: NABL 126 Specific criteria for calibration of Medical Devices
Issue No.: 01 Issue Date: 02-Jan-2018 Amend No.: 02 Amend Date: 18-Jul-2020 Page No.: 21 of 29
• Energy loss rate
• Battery capacity
• Insulation resistance
• Leakage current to the ground
• Leakage current through the Cabinet
• Leakage current through the patient
• Accuracy of the intermediary and minimum rate infusion without return pressure
• Accuracy of infusion rate
The above tests are only suggestive. The service provider may add new tests.
Similarly the tests for all the equipment intended to be tested under the Scope should be
developed.
However the procedures for doing each test needs to be elaborated in the Procedures Manual.
Note: Prior to the calibration of the above said DUC, electrical safety parameters such as Ground Wire
Resistance, Chassis Leakage, Patient Leakage Current, Patient Lead Leakage Current, Isolation Test (
mains on applied part), Insulation (Optional) 500 V etc. shall be verified as per IEC-60601/62353 and found
within limits.
References
Equipment details:
*Defibrillator performance for ‘Verify units on battery’ is verified for its operational integrity.
Note: Prior to the calibration of this DUC electrical safety parameters such as Ground Wire Resistance,
Chassis Leakage, Patient Leakage Current, Patient Lead Leakage Current: Isolation Test ( mains on applied
part), Insulation (Optional) 500 V etc. verified as per IEC-60601/62353 and found within limits.
Equipment details:
PATIENTMONITORCALIBRATION PARAMETERS
S. Quantity Measured/ Range/Frequency CMC(±) Remarks
No.
Heart Rate Accuracy ±5%
*Patient Monitor performance for ‘Verify units operate on battery’ & ECG Simulation - (Test for minimum 3
Arythmia’s) all leads is verified for its operational integrity.
Note: Prior to the calibration of this DUC electrical safety parameters such as Ground Wire Resistance,
Chassis Leakage, Patient Leakage Current, Patient Lead Leakage Current: Isolation Test ( mains on applied
part), Insulation (Optional) 500 V etc. verified as per IEC-60601/62353 and found within limits.
Equipment details:
Defibrillator Analyzer
<500µASFC
Patient Leakge <100µABandB
Current F
<10µACF
Equipment details:
Defibrillator Analyzer
<500µASFC
<10µACF
I. Discharge Equipment/Devices
IV. Imaging/Plotters
S. No. Equipment/Device
01 Trans illuminator light source
02 EEG
03 Fetal Doppler
04 ECG
05 X-Ray Diagnostic Equipment