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In order to ensure the that equipment functions well, both equipment users and the equipment maintenance and repair team must be trained. Users must be trained in basic care and maintenance of equipment, and the equipment team must be trained to undertake repairs and more complex maintenance tasks.
The primary responsibility for the care and maintenance of equipment rests with the user. Users should understand how their equipment works, what its limitations are, and what it can and cannot do. All of these are usually well described in the user manual that is supplied by the equipment manufacturer or supplier. It is important that users read and understand the user manual and keep it in a safe place.
In situations where surgeons or clinicians work under extreme time pressure, they may not be able to pay sufficient attention to the care and maintenance of the equipment they use. In this case, nursing staff and patient attendants can be trained in basic preventative maintenance and care. However, surgeons and clinicians must still be trained to use equipment properly and safely; they are also responsible for reporting faults and should be included in discussions about maintenance and repair.
Users should be trained to do the following preventative maintenance tasks on a regular basis (check the manufacturer's guide or user manual for details):
All users, including clinicians, are responsible for the safety of their equipment. Users should be trained and encouraged to do the following:
The person responsible for equipment in the eye unit (the ‘equipment person’) should periodically remind staff about the proper care and use of equipment, using the user manual as a guide to discussion.
Since new makes and models of equipment are constantly becoming available, the equipment maintenance and repair team needs to update its skills continually. Training should cover:
The equipment team also needs other skills common to equipment users, such as:
Training is not an activity that only happens once. Training is required at various times throughout an employee's career:
After training, the team can be expected to do the following:
TIP: If an item of equipment is used far away from the location of the manufacturer or supplier and service personnel are not available, an effort must be made to obtain the service manual. This manual contains more detailed information than the user manual and is usually reserved for the use of contracted service personnel. Reading and understanding the service manual will give in-house maintainers the information they need. Keeping it safe is essential.
In general, hospitals with fewer than a hundred beds are more likely to save money and maintain quality by outsourcing equipment maintenance as opposed to having an in-house maintenance department. Most small health organisations simply cannot provide the needed resources, such as salaries for qualified technicians, to operate a good quality in-house workshop. However, larger hospitals may find it helpful to have their own workshop. The main benefits are:
You can find out whether an in-house equipment workshop will save costs: compare the money spent on maintenance performed by outside vendors to the anticipated initial investment and recurring expenses needed to establish and operate an in-house workshop. It is important to note that, even with an in-house workshop, there will always be a need for outsourced maintenance services, for example when the equipment is too complex for the in-house technicians or when repairs require special tools, test equipment, and service manuals. Most medium-sized health organisations will therefore have a mix of in-house and outsourced maintenance services.
In smaller hospitals, the role of medical equipment maintenance may be incorporated into the facilities maintenance department. Smaller hospitals that are part of a larger hospital system may also receive their medical equipment maintenance services from the medical equipment maintenance department of the central tertiary hospital of the system.
What do you need?
The workshop should be staffed by maintenance personnel of varying skill levels (artisans, technicians, and engineers) according to the amount and complexity of equipment in the health unit. As a rule of thumb, for every 100 beds at a district hospital there should be two medical equipment maintenance technicians.
You will also need a budget to pay the setup and ongoing costs. The setup costs include the cost of tools, equipment, parts, materials, and the physical space for the workshop, as well as the costs of recruiting and training staff. The ongoing costs are salaries, consumables, spare parts, replacement tools, and ongoing training.
It is important to have an equipment workshop management plan that includes department policies, procedures, standards, and guidelines.
The workspace must be big enough to accommodate the equipment technicians and their physical resources. Maintenance work on eye equipment, in particular, requires a separate workspace that can be kept clean to avoid damage to lenses, etc. You will also need:
You should have enough spare parts in stock, which may need to be pre-ordered from the manufacturer or distributor. Useful spare parts to have include specialised light bulbs, gaskets, air filters, and other equipment-specific parts that wear out frequently.
Most of the other maintenance materials you need can be found in local markets, such as oil, grease, electric cables, washers, screws, fuses, generic light bulbs, cleaning agents, disinfectant solutions, brushes, and cloths.
Sam Powdrill, Assistant Professor, University of Kentucky College of Health Sciences, I Division of Physician Assistant Studies, 900 S Limestone Street, Lexington, KY 40536, USA.
Ismael Cordero, Senior Clinical Engineer, ORBIS International, 520 8th Ave, llth Floor, | New York, NY 10018, USA.
V Srinivasan, Aravind Eye Care System, Madurai, India. Email: firstname.lastname@example.org.