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The most likely cause of interference on a video monitor while using an Electrosurgical Unit (ESU) is related to faulty ground connections. Electrosurgical Units generate high-frequency electrical currents during surgical procedures, which can produce electromagnetic interference. A proper grounding system is crucial for minimizing this interference, as it ensures that excess electrical energy is safely dissipated. If the ground connections are faulty or inadequate, the high-frequency currents generated by the ESU can couple into the video monitor's circuitry, leading to interference such as noise or flickering on the screen.

Effective grounding not only enhances equipment performance but also protects patients and staff from potential electrical hazards. Therefore, ensuring that all grounding connections are secure and functioning correctly is vital for preventing such interference in clinical environments.

In contrast, while metal-to-metal sparking may cause other issues, it is less directly related to monitor interference. A malfunctioning monitor could present problems independently of the ESU operation. Additionally, high settings used for fulguration could cause issues, but they would likely result in operational problems of the ESU itself rather than specifically causing interference on a video monitor.