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Maintaining a Modern Hospital

Mohammad Akhtar
Introduction
First of all I would prefer to give you a brief outline of the different areas that I’ve had a great deal of experience in. All these areas I am going to mention are critical to any running medical facility. The maintenance of Medical equipment, upgrading of Medical facilities in general, and enhancement of contemporary technology into existing facilities and optimum level of service that can compete with rest of the world cannot be achieved without adequate pre-planning. If I were to give you details on I would end up writing pages after pages so here is just an outline, to give you an idea:
 

Maintaining of various facilities in Medical and their respective Equipment and systems requires ample planning before its implementation, such as Operating Rooms and their equipment, (operating table, operating lights, scrub sink, x-ray, x-ray film processor etc) Central Supplies Services and their equipment (All kinds of sterilizers, ultrasonic cleaner, water distiller, automatic washers etc) and internal communication system such as Nurse call system, intercom system, Medical piped gas supply system etc. 

All of these equipment need to be working in mint condition at all times since each has an important part to play in the treatment which any medical facility provides to their patients.  All this maintenance of all these equipments must be done strategically and systematically since any equipment might be needed at anytime for saving the life of a patient in critical condition. Here are a few things that might need to be looked into for any medical facility having wide-ranging equipment:          

a)       Remedial maintenance of non-critical equipments (such equipment if fails does not obstruct the treatment of a patient.) 

b)       Periodical preventive maintenance of critical equipments (critical equipment such as Anesthesia units and vaporizers, operating table and operating light, electrical supply system etc, if fails it directly poses a threat to patient’s life)    

c)       Overhauling/Re-conditioning of equipments (critical and costly equipment needs to be brought back to its original efficiency over a period of time)

d)       Enhancements & upgrading (coping with contemporary technology with same old equipments) 

Installation of additional equipment in an existing facility is as important as maintenance if not more. Installation of any equipment in areas for example such as in or for Operating Rooms, Central Supplies Services (CSS), Medical Labs, Radiology and Dental Clinic etc requires:

a)       Adequate pre-planning

b)       Development of design

c)       Renovation of area and pre-installation work according to design.

d)       Installation of equipment as per recommended by Manufacturer.         

e)       Initial startup of equipment

f)         Commissioning & handover 

·         New construction of additional Medical facility is also a major responsibility of any Medical Facility Management Unit since the needs are always on a rise and rearrangement and or add up of land for it’s maximum utilization is necessary for productive outcomes of any new or already running Medical Facility. The high level of achievement can be obtained if:-

a)       Pre- planning in distribution of available space.   

b)       Decision making in selecting of appropriate equipment.

c)       Development of design from reputed design agency.

d)       Thorough & clear job explanation to the constructing contractors for bidding.

e)       Supervising construction from barricading of site to its completion.

f)         Development of as built drawings for future reference.

g)       Mechanical completion certificate & handover to Medical professionals are carried to its level required.

 

·         Upgrading of existing Medical Facility   

Upgrading of existing Medical facility needs minimum following activities for adequate planning:-   

a)       Conducting of initial survey with the coordination of end user (Medical professionals).

b)       Developing preliminary scope of work by coordination of Medical professionals

c)       Developing a detailed scope of work by coordination of design agency, site visits and based on pre-installation requirements of the equipment to be installed.

d)       Development of design from design agency based on detailed scope of work.

e)       Job explanation to the proposed constructing contractors for bidding

f)         Supervising the removal & relocating of existing equipment.  

g)       Supervising construction & coordinating with Medical professionals on daily bases for optimum results, safe & minimal disruption to the continuous patient treatment.

h)       Advising & monitoring interim life safety measures and Infection control for patients, workers, visitors and surrounding community.

i)         Development of as built drawings for future reference.

j)         Supervising the installation & commissioning of new equipment.

k)       Coordinating hand over of the facility to Medical professionals.

This is just a brief idea of what kind of different tasks must be carried out for enhancement and expansion in any medical facility.

If anyone needs any assistance or consultation in this field then pls. feel free to contact Webmaster ContactPakistan.com 

Maintaining a Hospital Equipment
Those old days are gone when doctors had no choice except demonstrating their skills as a one man show and diagnosing a disease by observing the rate and rhythm of the pulse, looking into the eyes, nose and throat of a patient or external bruises, cuts and bleeding in order to write up a prescription.

Now a days things have changed for the complete treatment of a patient in depth includes everything from underground utilities of a building , every piece of equipment in the building, the building it self and even its roof top exhaust fans contribute in the well being and treatment of the patient in any modern Hospitals. The new era of contemporary technology and state of the art equipment has made it vital for a doctor to depend on the test result either from Medical Labs, Radiology Department, and Cardiovascular Units and or from Sleep apnea etc. The doctor will write a prescription based on the test results he would be obtaining. The accuracy of these results will play key role in this whole process.  Keeping the level of accuracy of a piece of equipment up to its designed parameters depends upon how equipments are being maintained.

There are several types of equipments from various manufacturers in the recognized Hospitals, from highly sophisticated to moderate, medium and low. In order to maintain them adequately they all need to be classified for level of maintainability, keeping a track of maintenance history and their physical track for readily available accessibility. 

Classification 

First of all each equipment of Medical facility need to be broadly classified under two heading such as fixed equipment and moveable equipment. Fixed equipment includes items that are permanently affixed to the building or permanently connected to a service distribution system. Where as moveable equipment includes items that require floor space or electrical and/or mechanical connections but are portable, such as wheeled items, portable items which can be carried from place to place.

Group all equipment into further two categories and assign their maintenance responsibilities under their respective Supervisors. The life saving, diagnostic and test equipment that are directly related to the patient treatment such as for example Defibrillators, Ventilators, Infusions pumps, Lithotripter, Magnetic Resonance Imaginer (MRI) and other Radiology and medical Lab equipment , should all fall under Clinical Engineering.

The building services equipment and the rest of the other equipment which are not directly related to the patient’s treatment and diagnostic process(But are critical in the treatment process, safety, security and controlling & monitoring of environmental condition ) for example include Sterilizers, Reverse Osmosis (RO), Water distillers,  Silver recovery Units, Internal Communication Systems, Horizontal & Vertical Transportation Systems, Heating Ventilation & Air Conditioning Systems (HVAC), Electrical Distribution Systems, Medical Gases Distribution Systems, Fire Protection & Fire Detection Systems should all fall under Equipment & Building Engineering.

Each piece of equipment should be marked with permanently fixed identification tags indicating its classification and category. For example a fixed equipment belong to Clinical Engineering should carry a tag number with pre-fix of CP such as CP-12345 where C stands for Clinical Engineering, P for Plant (fixed equipment) and the number indicates its identification. Similarly tag should read CM- xxxxx where C stands for Clinical Engineering, M stands for moveable equipment and number gives its identification.

Keep full description in a computer such as manufacturer’s name, address, model & serial number of each equipment and specify if it needs to be further categorized as critical high-risk, medium-risk and low-risk or non critical under their respective tag number. 

Critical Equipment
Critical equipment are those which at any given time fail for some reason or do not perform to their optimum requirements may put the life of a patient at risk. Equipment in the critical category may include for example defibrillators, ventilators, sterilizers, Medical labs equipment, Radiology equipment, Endoscopies equipment, HVAC feeding to operating rooms, Vacuum pumps, Medical Air compressors and/or Medical gases distribution piped system etc.
 

Preventive Maintenance of Critical equipment
Critical equipments require pro-active approach in their maintenance. They must be organized for periodical Preventive Maintenance (PM). For preventive maintenance tasks (PM tasks) their interval plays a key role in the performance of equipment. PM task should be written and practiced based on:-

 

·         Manufacturer’s recommendation.

·         Location of the equipment installed including environmental condition

·         Water chemistry if water in use (raw water or sweet water)

·         Lubricants. (recommended by manufacturer)

·         Frequency of use.

·         Past experience if available. 

Note: The criticality level of the equipment would be the base for deciding its interval for PM.  

Non-critical equipment

Non critical equipment such as low value equipment that does not directly affect the patient may be maintained on reactive approach bases (remedial maintenance). Repair of such equipment can be carried out as the need arises by receiving a call from the end user.

Replacement of burnt out lights bulbs, florescent tube and routine cleaning of Air Conditioning diffusers etc can be included in House Keeping contract. 

Maintenance History

In order for future planning for replacement of equipment or upgrading, maintenance history is as important as maintaining a piece of equipment. Every maintenance visit either PM or remedial to the piece of equipment whether at site or in shop shall be recorded for:- 

·         Labor cost.

·         Materials cost.

·         Down time

·         Frequency of break down.

·         Repetitive breakage of same nature.

·         Operational fault etc. 

This data must be kept against each piece of equipment and maintained by accurate computer software which should be able to do periodical evaluations. This evaluation will lead to decide and justify the future planning for the upgrading or replacement of equipment. 

Training, appropriate tools, test & calibration instruments
Adequate training to technical staff and continuous enhancement to their knowledge is a pay back process if carefully managed. This must launch and brought in practice for high quality out put.

Proper tools, test & calibration instruments have critical role in maintenance task. These must also be maintained and used according to the instruction of respective manufacturer of the equipment.  

As in any complex organization responsibilities must be organized in a way so each task is completed with maximum output & minimum time. Proper classification and distinction between tasks is as essential as having the right people assigned to the respective tasks. I hope the above information gave you a brief idea on how Medical equipment can be classified and how its maintenance can be organized. If any body needs in-depth information about any of the above mentioned pls. feel free to contact Webmaster ContactPakistan.com 
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