Home

MINISTRY OF HEALTH Health Infrastructure Division

1. 117 No 2 Tool Kit Electrician No Qt y Cutter side large Max size wire 2 0mm L 210mm ig I N Screwdriver star insulated blade 4 0mm shaft 100mm Screwdriver mains tester blade 4mm shaft 100mm 100 500V Knife trimming retractable blade Tape measure Steel 3m Screwdriver Phillios chubby No 2x Diam 5 0mm shaft 40mm Screwdriver Pazidriv No 1 75mm Screwdriver Pozidriv No 2 100mm Spanner adjustable medium 205mm 8 jaw 27m tter Stripper Wire Standard 170mm Pen marking waterproof medium Screwdriver flat insulated blade 4 0mm shaft 100mm Screwdriver star insulated blade 2 5mm shaft 75mm Box tool steel big 4 tray cantilever 550 x 220 x 215mm I x w x h 42 Circlip plier set 1 No ES EA a 9 42 118 No 3 Tool Kit Electronics No Description Tool Kit Electronics Cutter side small size L 125 De soldering tool standard Dispenser solder Iron soldering medium general 30W 220V tip diam 6mm Multi meter digital Like fluke 79 series Resol 3 5 digit Pliers long nose 170mm Screwdriver mains tester blade 4mm shaft 100mm 100 500V Stripper wire standard 170mm Tools trimming set Wick de solder File needle set 6pcs 160mm Knife trimming retractable blade Tweezers 130mm tips 1mm Box tool brief case type 500 x 380w x 150h mm File half round second cut 150mm Hacksaw J
2. Fault Possible causes Solution _ _ _ No display on No power The power cord is loose control panel in the socket outlet Check the outlet for power Check the circuit breaker on the power panel In case of tripping reset it 100 2 High temperature alarm flushes 3 Oxidation forming on the interior Surfaces Check that the main power switch on the incubator is turned on Check for any blown fuses Faulty thermostat Check if temperature probe is well connected Check whether the thermostat is able to switch on and off Use of high concentrated detergent Clean the interior surface with soft water 4 Temperature Location effect Check the incubator display is drifting location 5 Inside temperature is NOT equal to the display temperature Temperature NOT controlling at set point 7 Display on but NO temperature rise Temperatures take long to reach the set temperature Verify the calibration procedure Check the location of Needs calibration Location effect the incubator Fault with set Check the set point point Chambers Close the doors for a minimum of 30 40 circulated with minutes cold air Fault on the Check thermostat Thermostat Fault on the Element whether it s okay if not replace Check element if blown replace Check the gasket if damaged replace Faulty door system 101 28 Colorimeter Function A colorimeter is used to measure t
3. ee enone The machine Faulty power out let Check the power socket does NOT socket if faulty replace get power Power cord loosely Fix the power cord connected Blown fuses Replace fuses of the same rating The Blown bulb Replace the bulb of the machine same rating powers but no light The machine Machine is due for Carry out calibration with is NOT calibration a standard medium Zeroing Dust accumulation Clean the filters on the light filter 103 29 Haematology Analyzer Function A Haematology analyzer is an automatic multi parameter blood cell counter for in vitro diagnostic use in clinical laboratories It performs speedy and accurate analysis of parameters in blood and detects the abnormal samples The instrument displays abnormal analysis data with abnormal marks attached on the LCD screen Displayed analysis data allows detecting those samples which are outside the tolerance and need further analysis and consideration Whole blood and pre diluted blood can be analyzed How it works The white blood cell WBC count is measured by the WBC detector block using DC detection method The red blood cell RBC count and platelets are taken by the RBC detector block also using the DC detection method The HGB detector block measures the hemoglobin concentration using the non cyanide hemoglobin method Maintenance Checklist Caring and Clean the transducer TD chamber and diluted Handling sample line
4. Y COUNTRY The Republic of Uganda MINISTRY OF HEALTH FOR Gop m Health Infrastructure Division Operation Manual for Regional Medical Equipment Maintenance Workshops and Medical Equipment Maintenance Guidelines A guide for Regional Workshop and Hospital Technicians December 2013 Forward Acronyms Chapter 1 ee i mhkwhy Chapter 2 2 1 2 2 2 3 2 4 2 5 2 6 Chapter 3 3 1 3 2 Table of Contents introduction A EEA EAE AAE A EAE AAE irren 8 Background Overall Objectives Specific Objectives Stakeholders in Medical Equipment Maintenance Definition of Medical Equipment Maintenance Organization Structure for Medical Equipment Maintenance E E E ee ee ee A 1 3 NACME Health Infrastructure Division HID Regional Medical Equipment Maintenance Workshops RWs National Referral Hospitals Regional Referral Hospitals RRHs District Health Services Function Operation and Role of RWS 18 Central Medical Equipment Maintenance Workshop Regional Medical Equioment Maintenance Workshops Chapter 4 4 4 1 1 4 2 4 2 1 4 2 2 4 2 3 4 2 4 4 3 4 3 1 4 3 2 4 3 3 4 3 4 Chapter 5 5 1 511 5312 5 1 3 5 2 Chapter 6 6 1 Planning Budgeting and Management of Medical Equipment Maintenance A a ee ee 21 Medical Equipment Inventory Update Inventory taking Rules and Procedure Work Plan and Budgeting for Medical Equipment Maintenance Process of Prepara
5. 29 gt Comments and matters arising from the Workshops Managers Report gt Submission of relevant issues from the various participants gt Comment by a representative of ACHS HI gt Issues at Hand and Way Forward Note The meeting should always review the proposed work plan schedule and budget for next quarter year 4 3 4 Internal Workshop Staff Meetings at workplace RWs are manned by a Workshop Manager and other technicians in the RRH To ensure cohesion and coordination in the RW the workshop manager will hold regular internal meetings with other staff The RW Manager will use these meetings to discuss action plans allocate work and review progress and challenges Frequency Internal meetings between the workshop manager and his her staff should take place on a daily weekly basis to ensure clarity on the tasks to be performed on a daily weekly and or monthly basis Discussion points Relevant tasks and timelines should be discussed and agreed upon by all staff members Meeting Minutes and Work Reports The Workshop manager will put in place a mechanism to ensure that action points agreed upon in the internal meeting are documented and followed up 30 Each staff shall prepare a one page report on the tasks he she undertook for the day week and the overall status of the task Minutes of all meetings held shall be prepared and filed for future reference Making of Minutes shall be a shared responsibilit
6. 44 details and maintenance record A reference number should be engraved on each equipment Additional information that should be captured includes 7 7 1 Whether equipment is maintained in house or Maintained by external agency or manufacturer 7 1 Routine Maintenance Procedures and Work Flow Charts 7 7 2 As much as possible PPM activities to be conducted on each equipment shall be laid out in a workflow chart or check list The specific work to be carried out may be based on guidance from the manufacturer s maintenance service manual e Ihe frequency of maintenance shall be based on the manufacturer s recommendation or usage e A heavily used equipment must be cleaned and checked more frequently than one which is used less often Minimum standards must be met to ensure safety and reliability Personnel Maintenance of equipment will be undertaken by a trained biomedical technician Engineer In accordance with the approved MOH structure the following maintenance personnel shall constitute the maintenance team in the RW e Assistant Engineering Officer Engineering Assistant e Engineering Technician Electrical and Mechanical e Biomedical Engineering Technician e Artisan Plumber Mechanic Mechanical Carpentry 9 Future cadre in MOH structure 45 1 1 3 7 7 4 7 7 9 Reminder system A reminder system will be put in place so that staff are prompted to carry out tasks when they are due A card i
7. Blood Pressure BP Machine Function Blood pressure is an indicator of several diseases as well as of general health It is an easy screening test using the BP machine A sohygmomanometer can be used to measure the blood pressure at the high point systolic and low point diastolic of the cardiac pressure cycle Pressure is usually measured using a cuff on the upper arm How it works The cuff on the arm is inflated until blood flow in the artery is blocked As the cuff pressure is decreased slowly the sounds of blood flow starting again can be detected The cuff pressure at this point marks the high systolic pressure of the cycle When flow is unobstructed and returns to normal the sounds of blood flow disappear The cuff oressure at this point marks the low diastolic pressure Pressure can be measured using a meter with dial aneroid type a mercury column or an electronic display The sounds are normally detected using a stethoscope but electronic equipment use an automatic technique with pressure sensors The two methods do not always give the same results and the stethoscope method is generally more accurate for all tyoes of patient 48 Maintenance Checklist Care and Check whether equipment is safely packed Handling If mercury is spilled seal unit and send to the technician Remove all dust and dirt with a damp cloth Visual checks Ensure all parts are present and are tightly fitted Check that the display is zero when th
8. Function An oxygen concentrator draws in room air separates the oxygen from the other gases in the air and delivers the concentrated oxygen to the patient When set at a rate of two litres per minute the gas that is delivered by the concentrator is more than 90 oxygen It is used for situations where bottled gas supply is impractical or expensive and can be used by patients in the hospital or the home How it works Atmospheric air consists of approximately 80 nitrogen and 20 oxygen An oxygen concentrator uses air aS a source of oxygen by separating these two components It utilizes the property of zeolite granules to selectively absorb nitrogen from compressed air Atmospheric air is gathered filtered and raised to a pressure of 20 psi 138kPa by a compressor The compressed air is then introduced into one of the canisters containing zeolite granules where nitrogen is selectively absorbed leaving the residual oxygen available for patient use After about 20 seconds the supply of compressed air is automatically diverted to the second canister where the process is repeated enabling the oe of oxygen to continue uninterrupted While the pressure in the second canister is at 20 psi 138kPa the pressure in the first canister is reduced to zero This allows nitrogen to be released from the zeolite and returned into the atmosphere The zeolite is then regenerated and ready for the next cycle By alternating the pressure between the two canisters
9. a constant Supply of oxygen is produced and the zeolite is continually being regenerated Individual units have an output of up to five litres per minute with an oxygen concentration of up to 95 Oxygen Reservoir gt low Meter gt Oxygen To Patient Maintenance Checklist Care and Remove any dust dirt with a damp cloth and dry off Handling Fill humidifier bottle up to the level marker with clean distilled water Wash filter in warm water and dry Replace if damaged Clean humidifier bottle thoroughly and dry off Visual Check all screws connectors tubes and parts tightly fitted Checks Replace humidifier bottle if covered with limescale Check mains plug cable or socket for any damage and replace if necessary Check oxygen flow before setting up line to a patient Run machine for two min and check that no alarm goes off Check functionality of flow meter Oxygen flow rate should vary with flow control see bubbles Function Checks Troubleshooting Fault Possible causes_ Solution 224 2 Unit NOT 4 Temperature light 7 Service warning Unit NOT No power from operating power mains socket failure alarm Concentrator sounds circuit breaker has been set off Alarm battery operating no dead power failure alarm 3 No oxygen flow Flow not visible Tubes not connected tightly Water or dirt blocking the oxygen tubing Blocked flow meter or humidifier bottle Unit over hea
10. element Always put enough water user train Replace safety switch Replace thermostat Tighten loose nuts and replace missing ones Replace drain valve Reduce on the items train user 22 ECG Electrocardiogram Machine ECG machines are used to monitor the electrical activity of the heart and display it on a small screen or record it on a piece of paper The recordings are used to diagnose the condition of the heart muscle and its nerve system The electrical activity is picked up by means of electrodes placed on the skin The signal is amplified processed if necessary and then ECG tracings displayed and printed Some ECG machines also provide oreliminary interpretation of ECG recordings There are 12 different types of recording displayed depending upon the points from where the recordings are taken Care must be taken to make the electrode sites clean of dirt before applying electrode jelly Most problems occur with the patient cables or electrodes Keyboard Maintenance Checklist Care and Clean the Printing head Handling Clean body of equipment with a damp cloth and dry off Visual Check that battery charge indicator power indicator Checks and patient cable connector indicators are working Check that cables are not bent knotted or damaged Replace any damaged electrical plugs sockets or cables un e Check all knobs switches and indicators are tightly fitted Function Checks a steady Calibrate m
11. 3 Per diem for Engineers Technicians Annex 3 Fuel Operational Cost Past Average Electricity Bill Past Average Water Bill Past Average Stationary oe GE GE Be CHE Past Average RWMC Meeting Past Average User Training Seminar Vehicle Maintenance ss Grand Total 5 Urgent issues to note 1 The maintenance money for the 1st quarter was released late 2 The mobile workshop vehicle has worn out tyres but budget is not adequate to purchase tyres 3 The procurement of spare parts has delayed 4 Solar panels for blood bank refrigerator in HC IV were stolen 5 xxx GH generator starting system circuit board needs replacement Compiled By Name of WS Manager Hoima Regional Workshop Manager 135 Annex 8 Job Card Form JOB CARD Job Card Number Department Room Complaint Form No DE on Equipment Year A B C D E F Fault Detected Extra work to be done Advise to the owner Health Facility Findings Name of Eng Tech Time spenton Contact No maintenance Hrs Name of Eng Tech Time spenton Contact No maintenance Hrs Name of Eng Tech Time spenton Contact No maintenance Hrs Spare Parts Used and Other Expenses Any other expenses Casual Labor etc should be described here Source of Spares HP RWS Trip Contingency Other identify HP RWS Trip Contingency Other identify HP RWS Trip Contingency Other identify HP RWS Trip Contingency Other identify HP RWS Trip Contingency 5 Other iden
12. Lock or lever is jammed No power to electric table No oil in hydraulic table Oil leakage Worn out gasket oil seals Clean wheels remove obstruction Check power to table Replace fuse if blown If problem persists refer to technician Clean jammed part remove rust and dirt lightly oil and replace Check correct switch is used Check power and fuses Refill hydraulic oil if needed Check no leakage occurs Locate leak and block it Clear spillage Refer to technician 4 Electric shocks Wiring fault Refer to technician immediately 75 15 Lamps Function There are many kinds of sources of light used in medicine This section deals with large lights for operating theatres or delivery Suites ultraviolet or infrared phototherapy units ophthalmic slit lamps handheld and head worn lamps for ENT clinics and domestic torches However the principles here will helo in the maintenance of any kind of light source How it works Each type of lamp will have a power source with switch and a bulb Some will also have controls for the brightness or focus of the light while others will also have lenses to direct the light where required Some lights operate off mains electricity while others use batteries instead Some lights have both using the batteries for back up power in case of mains supply failure Electric bulbs and batteries have limited life and will need regular checking A stock of spares shoul
13. _ _ _ _ 1 Wrench adjustable small 200mm _ _ _ _ _ 1 Screwdriver flat long shaft blade 4 0mm shaft 250mm 1 36 Brush cleaning 12mm 260mm 37 38 39 Screwdriver flat blade 6 5mm shaft 100mm 1 1 1 1 1 1 Screwdriver Pozidriv No 0 60mm 1 l 1 Screwdriver Pozidriv Long shaft No 2 250mm 1 l J J 1 i l 33 1 19 O 1 22 23 24 28 26 27 28 29 30 31 32 33 34 35 EES Ee 16 BEE BE BER EA EH 24 EN E26 ra eee BEN BEI IE Er 33 _ 34 EES 36 37 38 _ 1 1 120 No 5 Tool Kit Plumber No Description Tool Kit Plumber O Bit drill concrete set hammer operated 3 5 4 5 5 6mm with handle Level Spirit L 50cm NO Trowel pointing 150mm lron brazing soldering large 300W 220V Tape measure steel 3m Box tool steel big 4 tray cantilever 550 x 220 x 215mm I x wxh N Chisel cold 16mm x 250mm Chisel floorboard Cutter pipe 3 30mm Hacksaw junior 11 12 13 14 15 16 17 18 Shears metal 19 O 21 2 23 24 25 26 27 28 29 30 Hacksaw standard 470mm Lamp soldering paraffin 0 5 litre Mallet bossing 60mm Mallet tinmans 60mm Pliers combinations 203mm 8 Pliers water pump standard 225mm Rule s s 300mm 25mm wide Wrench footprints 220mm Hammer plumbers 500gr Hook shave triangular NO Plumber s bob with line 100 gr Portal
14. and the District and Health Sub District Authorities The main functions of RWs include the following i Maintenance of medical equipment in all health facilities in their catchment area ii Medical equipment inventory update in all health facilities in their region iii Advise hospital managers on medical equipment disposal iv Preparation of quarterly equipment maintenance reports for submission to ACHS HI v Organizing and participating in the Regional Workshop Management Committee RWMC Meetings vi Organizing User Training for equipment Users in proper use handling and first line maintenance 20 Chapter 4 Planning Budgeting and Management of Medical Equipment Maintenance Lack of medical equipment maintenance results in break down and prolonged down time affects the reliability and quality of health care Lack of a maintenance policy can result in poor planning lack of maintenance budgets and thus no spares parts and accessories Many health facilities suffer because the maintenance requirements are not planned for in advance This renders much equipment unusable and many devices lie idle because of lack of spares parts or funds The staff of the RWs and CW are responsible for planning and budgeting for maintenance activities For day to day duties the RW staff are responsible to the Hospital Director and Hospital Administrator At Ministry level they are supervised by the Senior Engineer Medical Equipment
15. both with wheels and on static platforms and can have movements powered by electric motors hydraulics or simply manual effort They can be found in emergency departments operating theatres and delivery suites How it works Where the table has movement this will be enabled by unlocking a catch or brake to allow positioning Wheels have brakes on the rim or axle of the wheel while locks for moving sections will normally be levers on the main table frame Care should be taken that the user knows which lever applies to the movement required as injury to the patient or user may otherwise result The table will be set at the correct height for patient transfer from a trolley then adjusted for best access for the procedure Maintenance Checklist Care Clean dry and disinfect table underneath base and Wipe off any escaped oil or grease from joints Handling Visual Check that all parts are present and tightly fitted Checks Check that no oil is leaking Inspect mattress and table for signs of wear Replace any worn or damaged items 74 Function Checks Check essential movements before use Check wheel brakes function and wheels rotate Ensure all moving parts can move applying grease If needed el Table can NOT Wheels jammed be relocated Table section or body can NOT be moved Oil leakage from hydraulic table Electric motor not operational electrically driven table
16. carried out in good time to inform decision making on equipping gaps disposal and budgeting The following methodology shall be followed when carrying out inventory 22 gt Visit each department and section of the hospital and record available equipment against the users inventory record if available gt Carry out a physical count and inquire whether the quantity is adequate gt Consult the user on operational status i e whether the equipment is operational or not gt Record all required information as detailed in the Medical Equipment Inventory Form See Annex 4 The Workshop Manager in consultation with the hospital staff should identify equipment that is due for decommissioning and disposal 4 2 Work Plan and Budgeting for Medical Equipment Maintenance In order to plan for maintenance activities the Workshop Manager should prepare a work plan and budget The work plan should have an itemized summary of planned activities targets timelines and intended expenditure on a quarterly basis The work plan and budget should indicate the proposed source of funding Adequate time should be allocated for procurement of goods and services including spare parts The standard templates for oreparation of work plans should be used see Annex 5 _ for Template of Work Plan Preparation Currently medical equipment is maintained using resources from the National budget Local Governments through the health facilities and De
17. duty gloves Automated electrical safety analyzer Ultrasound electrical safety transducer leakage current tester Portable oxygen analyzer 2 Drawer work bench with vice No 5 Engraving machine electric heavy duty 13mm chuck reversible variable soeed Drilling machine with hammer function electrical hand held 13mm chuck reversible 2 soeed Portal drilling machine cordless with spare battery and charger Vice No 3 Portable Generator set SKVA minimum Dual DC regulated power supply 3 Phase tester Mega tester Office Furniture Office Chair Chair Desk with lockable drawers Photocopier Filing cabinet 6 Persons conference table Shelves White board 1600cm x 110cm Note The details of the Kits are described in the following pages 116 7 10 11 12 13 N NO No 1 Tool Kit Mechanical No Description Tool Kit Mechanical Qt y No Pi Cutter sidele OOOO BE 4 Screwdriverltester Voltage tester 5_ Box tool steel big A tray cantilever 550 x 220x 218mm Ixwxh 1 1 1 1 1 1 1 7 Hydrometer battery electrolyte tester Oil can 125ml metal with pump Brush steel hand 290mm 37mm 4 rows Hammer ball pein 500g tib 350mm 1 Hammer nylon 280mm diam 32mm_ 1 Key hexagon metric set 9pc 1 5 10mm 77 Machine drilling hand 2 speed mm 1 1 1 16 Screwdriver star No 3x Diam 8mm shaft 150mm 2 3 34 6 37 Tape measure Steel 3m
18. regarding medical equipment At District and Health facility levels the management of medical equipment is the responsibility of the respective Administrative and Technical Departments The District Health Officers DHOs are directly responsible for planning and management of medical equipment in the District Local Governments For medical equioment RWs established under Regional Referral Hospitals RRHs carry out medical equipment maintenance while the HID of the MoH oversees supervision of maintenance activities 2 1 National Advisory Committee on Medical Equipment NACME The main function of NACME is to review the country s medical equipment needs and determine the appropriate policy framework 13 This includes advising on procurement standardization maintenance and rehabilitation of medical equipment bearing in mind cost effectiveness and appropriateness of technology 2 2 Health Infrastructure Division HID The division has two major sections with the mandate to formulate policies and guidelines on health infrastructure develooment and management The sections are 1 Civil Engineering Section 2 Electro Mechanical Engineering Section 1 Civil Engineering Section All building and Civil Engineering in the Sector are coordinated by this section It provides support and Supervision of pre installation works and ensuring that fixed medical equipment is installed safely 2 Electro Mechanical Engineering Se
19. with customized valves either bull nose or pin index type with valve guards which are opened with valve keys A flow meter Is an instrument used to measure the flow rate of a liquid or a gas In healthcare facilities gas flow meters are used to deliver oxygen at a controlled rate either directly to patients or through medical devices Oxygen flow meters are used on oxygen tanks and oxygen concentrators to measure the amount of oxygen reaching the patient or user Sometimes bottles are fitted to humidity the oxygen by bubbling it through water Maintenance Checklist Care and Ensure delivery tubes and masks are sterile Handling If humidifier bottle is used refill with clean water Clean cylinder valve and flow meter with a damp cloth Visual Check that the cylinder is the correct tyoe and marked Checks oxygen Check all parts are fitted tightly and correctly Check for leakage hissing sound or reduction in pressure 64 Function Checks Before use ensure cylinder is filled amp flow is present Close cylinder valve after each use Remove valve dust with brief fast oxygen flow Check flow can be varied using flow control No oxygen Is flowing Leakage from cylinder or Flow meter Leakage can NOT be located Flow meter ball NOT moving yet oxygen Is flowing Pressure gauge does NOT show pressure yet oxygen is flowing EL SU Cylinder is empty Flow meter knob or cylinder valve is closed Fa
20. 00ml disinfectant solution 9 parts tap water amp 1 part 5 25 Sodium hypochlorite household bleach shake vigorously and let settle for 10 minutes Shake again and then rinse twice with water Purge the unit with air Flush the system with disinfectant solution a Turn unit off Empty the water bottle replacing the water with cleaning solution b Remove hand pieces from tubing and hold the hand piece tubing and syringe over a pail c Turn unit on wait a few moments and then operate the flush toggle syringe and foot control unit a continuous stream of solution is running through the system Allow the disinfectant to remain in the unit for at least 10 to 20 minutes and then flush the system again unit all the solution is used up Purge the unit with air a Hold the hand piece tubing and syringe over a pail Turn the unit on with a few moments and then operate flush toggle syringe and foot control unit all solution is purged from the system b Turn unit off Fill with clean water Turned unit off remove the empty disinfectant bottle Replace with clean bottle and water 110 ez CFs solution checks system to be OK Function When the power is on you check Checks e Hand pieces Air compressor Foot switch e Check knobs are operational Hand piece lacks Power Water coolant does NOT shut off when foot switch is released More than one hand piece is operating Insufficient water coolant Water cool
21. A safety feature is incorporated by the use of door switches The switch completes the circuit only when the lid is closed to protect fingers from injuries that can be caused by the fast spinning head of the centrifuge Some larger centrifuges are equipped with an electrical or mechanical braking system for halting rotation Magnetic door locks in conjunction with centrifugal switches ensure that the lid cannot be opened as long as the head is rotating 96 Three Check mountings and replace if necessary monthly Check for loose bolts and tighten checks Check brushes and replace if necessary Check for corrosion and repaint if necessary Clean commutator with smooth sand paper Troubleshooting Noisy vibration e Imbalance by Ensure all buckets missing buckets are in place e Worn out bearings Check and replace Speed variation e Check the variable Clean or replace NOT e Resistor contacts responding 1 Powers up but e Worn out brushes Replace batteries does NOT spin e Dirty commutator Clean with smooth Sand paper and contact spray supply and fuses 97 26 Microscope Function Microscopes are indispensable in medical laboratories They enable the investigation of specimen blood urine etc for the presence of parasites or other abnormalities The microscope is able to achieve this by producing magnified images of specimen examined through it by means of multiple lens arrangement How it works A microscope consi
22. F Ws VR BC IT Chapter 1 Introduction 1 1 Background Medical equipment plays an important role in our Health Care system and there are numerous equipment adapted to Health Care In the health facilities medical equipment will range from injection needles centrifuges stethoscopes blood pressure machines to X Ray Machines MRI etc designed to help medical personnel carry out diagnosis and treatment of patients Optimal performance of medical equipment is required to ensure safety accuracy and expected results To keep medical equioment in good working condition and optimal performance is the function of a medical equipment maintenance unit in a health facility The Ministry of Health set up Regional Medical Equioment Maintenance Workshops to carry out medical equipment maintenance in health facilities In the hospitals there are different engineering personnel deployed to man hospital maintenance units They carry out maintenance and repair on medical equipment This operation manual is intended to support and guide engineering personnel in the RWs and Hospital maintenance units in the maintenance of basic medical equipment It will also guide the equipment users and technicians on the operation and working principles of some commonly used equipment 1 2 Overall Objective The overall objective of preparing this manual is to define the roles of RWs and other stakeholders and provide guidelines on medical equipment mainten
23. READY No events displayed and Status READY scatter parameters distorted Time delay calibration fails Sample tube NOT pressurizing Troubleshooting No sheath pressure Communication failure between computer and instrument No sample in the sampler tube Air bubble in flow cell Incorrect instrument settings Empty sheath reservoir Air in sheath filter Air bubble in the flow cell Fluid mode not in RUN Cracked sample tube Worn Loader seal 108 Check for leaks or cracks in the sheath reservoir Replace it if needed Tighten the sheath cap Verify the vent valve is in forward Turn off the computer and instrument Turn on the instrument then the computer Add sample or install new sample tube Prime the fluidics Press PRIME Rerun BD FACSComp Fill the sheath reservoir Vent air from the sheath filter Prime the fluidics Press RUN Replace the sample tube Replace the seal 31 Dental Unit and Dental Chair Function Dental unit is intended for diagnostic and therapeutic treatment of dental patients by dentists or health care professionals Generally a dental chair refers to the chair for patients while the dental unit consists of the chair treatment hand pieces a doctor s table a light and a cuspidor unit How it works 1 Turn the Master ON OFF toggle to the ON position 2 The hand pieces are automatically activated when removed from their hange
24. See the cone prism through left eyepiece and check whether cone prism is located at the center If not adjust the cone position of vertical and horizontal direction e Slit lamp blades should close without overlapping and open with parallel edges Troubleshooting a ee 7 No illumination Power cable Check and replace dim switch fuse bulb damaged part socket or bulb is damaged Slit light is too Bulb is not correctly Insert bulb correctly inserted or Voltage set Voltage selector to selector setting is the correct position incorrect 95 25 Centrifuge Function Centrifuges are used to fasten the sedimentation of substances in liquids In medical laboratories specimen may be blood urine etc In the centrifuge test tubes containing specimen are placed into buckets which are then rotated at high speeds or RPM rotations per minute for a pre determined time The substances in the test tubes are deposited in the order of weight the heaviest element being the first to settle How it works The brackets holding the buckets are coupled to the shaft of a motor which then rotates the shaft The motor is normally a universal one with a variable soeed mechanism A timer is also incorporated in the circuit which cuts out power to the motor after a pre set time by the user elapses The two parameters being variable make it possible for various time speed combinations to be applied to a varied range of specimen
25. Tripod stand Pipe cutter Wrench adjustable medium 350mm Wrench adjustable small 200mm Wrench socket medium 350mm Wrench socket small 200mm Bit drill auger wood set 5pc 6 25mm 125mm No 2 7 EZ a BER BER ELA 15 16 KA 18 BEN 21 22 23 24 Ea 26 27 28 29 30 Brace bit ratchet 4 jaw 255mm 121 No 6 Tool Kit Refrigeration No ary Pipe bender set 1 2 3 4 1 2 Reamer set o O 24 Reamer set 7 10 11 12 13 14 15 16 17 18 19 20 21 22 23 EA EA 8 ES 10 EI BER EB Ea Ea 16 Ba Sie BEN 20 21 22 23 24 122 Annex 3 Stickers Form Equipment Condition A F CLASSIFICATION OF CONDITION FOR MEDICAL EQUIPMENT BY COLOR CODE GOOD NO AND IN LISE PROBLEM i p USER GOOD TRAINING B7 BUT NOT IN USE I NEEDED gt i i l IN USE l MAINTENANCE C BUT NEEDS REPAIR NEEDED i i i SSS SSeS cS IN LISE i PLAN FOR BUT NEEDS REPLACEMENT pECOMMISSION OLD OR OBSOLETE l I NG DISPOSAL l i OUT OF ORDER MAINTENANCE BUT REPAIRABLE NEEDED i i OUT OF ORDER l l l AND SHOULD BE REPLACED DISPOSE LAN NOT BE REPAIRED I HO SPARE OLD OR OBSOLETE 123 Medical Equipment Inventory Form Annex 4 uawwon UOI IPUOD ojeq AO odAL Swen Juawd nbg U0N99S yONpold by nu wyed qg p vejd q pInoys pue 1 p10 JO NO 4 1UusWeseldsi spasu Ing sn uj q sn u ON Ing pooy g jq
26. achine before use using 1mV pulse Check that the baseline of the ECG recording is e Check the calibration of recordings with ECG a simulator e Check battery power can operate the equipment Troubleshooting Fault Possible causes Solution ECG traces have artifacts grounding or base Patient is tensed line drift up Deep breathing Improper 2 ECG traces have artifacts in one or more traces but NOT in all traces connection with patient or problem Improper electrode with the ECG cable Try with battery power only If the recording improves then problem is with grounding Power the machine from another outlet with proper electrical ground Relax the patient Check the patient cable Replace cable if found faulty Check the electrodes expiration Check patient skin preparation Check limb electrodes and chest electrodes for damage 3 Paper feed Incorrect paper Use instructions to reload paper NOT advancing loading 4 Printing NOT clear or NOT uniform Printing head problem Problem with battery or charging circuit 5 The machine shuts down after a few minutes while on battery power 91 Adjust the printing head temperature or position Clean the printing head with head cleaner If it does not improve replace printing head Check the paper roller and replace if not smooth Recharge the unit overnight If there is no Improvement then replace the battery If there is still
27. actions for sorting 1 Create a chaos free environment 3 Use Red Tags 2 Clean the walls and notice boards How Dispose of unnecessary materials on tables in drawers in cabinets and on the floor Remove unnecessary instructions and posters on the walls and on notice boards Attach Red Tags for undecided items for disposal and determine whether the item may be necessary or is unnecessary Hints for actions Eliminate all unnecessary items from workplace and reduce clutter Go through all tools materials and so forth in the work area Keep only essential items and eliminate what is not required prioritizing things as per requirements and keeping them in easily accessible places Everything else should be stored or discarded LEVELT gR Dispose off unnecessary materials on tables Attach Red Tags for undecided items in drawers in cabinets and on the floor for disposal and determine whether the item may be necessary or is unnecessary BLEN Mua iuas m ee ko ee his paa So A ao ai TE OF Pry hal Good example of chaos free environmentat The walls and notice boards use X Y line Remove unnecessary instructions and the office desk posters on the wall and on the notice boards 127 2S SETTING Material Handling Basic points for setting material handling 1 Zone area clear transport routes 3 Home for each tool 2 Mu
28. alfunctioning parts Incorrect connection Faulty ground connection Poor filtering systems in monitoring device Metal to Metal Sparking Cords and cables are bundled touching or damaged High power setting Equipment activation is causing battery or implant malfunction Check power switch is on Replace fuse Check mains power Try cable on another piece of equipment Note error code and turn unit off Check footswitch and front panel buttons Disconnect all foot pedals Turn on unit again Check connections and plugs on all cables are tight Adjust power check manual Check connection or replace parts Check correct orobe footswitch cord are well connected Check all monitors and power connections Use separate outlets for each device Replace monitoring device Check all connections are tight Remove cable cluttering replace damaged cords Reduce power setting use blend Mode Stop procedure immediately perform emergency care and call implant supplier before restarting procedure Electrical Wiring fault Refer for rewiring by a shocks to user technician 73 14 Tables for Operating Theaters and Delivery Function Tables are required to hold the patient in a position that is comfortable for both the patient and for medical staff during procedures They can include dedicated supports for head arms and legs and often have movable sections to position the patient appropriately They are made
29. ance management including maintenance planning budgeting training and disposal of medical equipment 1 3 Specific Objectives The specific objectives of this manual are e To define the role and function of RWs and Central Medical Equipment Maintenance Workshop e To identify and define the roles of various stakeholders e To streamline the operations of RWs and CW e To develop maintenance guidelines for commonly used medical equipment in health care facilities e To prepare equipment specific Maintenance Guidelines to ensure safety proper use care and management of medical equipment 1 4 Stakeholders in Medical Equipment Management The following categories of health care workers and providers play a significant role in the maintenance of medical equipment e Users of medical equipment This category involves doctors nurses and paramedics whose primary function is to use medical equipment for diagnosis and treatment of patients Their main role will be to care for the equipment including reporting equipment failure to the maintenance unit e Medical equipment maintenance personnel This category includes artisans technicians and engineers employed by health facilities to offer maintenance services for equipment Their main role is to identify and isolate the fault and take remedial action to restore full functionality of the medical equipment e Hospital administrative staff This category includes the hospital administ
30. and the different procurement methods Regional workshops will be responsible for planning for spare parts needs i e quantification specifications and budget out sourcing maintenance services on a case by case basis and disposal of Spare parts that are not useful 32 As a User Department the RW will play the following orocurement roles Determine and quantify workshop requirements Propose provide technical specifications for the required Supplies Raise procurement requisitions using the Procurement Form PP 20 iv Participate in the selection of supplies and service providers v Participate in inspection testing and verification of supplies Note 1 RW staff must exercise high moral and ethical conduct while handling procurement of goods and services 2 No supplies should be used before they are taken on charge in the stores and issued out 5 1 1 Determination of Spare Parts Needs Determination of spare parts needs shall be based on demonstrated maintenance needs and requirements for Planned Preventive Maintenance PPM Problem oriented planning and budgeting will be the basis for maintenance planning and scheduling to ensure efficient and cost effective utilization of available resources e Medical equipment inventory for each health facility will be analyzed to determine the maintenance condition of the equipment Repair carried out will always be supported with a Job Card Form see Annex 8 33 e RWs will
31. ant is running from hand piece while in holder Water coolant is running continuously Troubleshooting Check regulator adjustment 80psi Check hand piece pressure adjustment on control block Pinched supply Bad hand piece gasket at connection with tubing Defective hand piece Adjust air pressure to 80psi Water pressure to 40psi Foot control is not exhausting Defective water relay in valve Hand piece is not completely in the hanger Improve adjustment of pilot valve in the hanger Kinked or pinched signal line from the pilot valve Adjust coolant flow valve Water filter may be plugged Plugged hand piece Kinked or pinched tubing Improper adjustment of water relay Water pressure is too high Air pressure is too low Hand piece holder out of adjustment Purge switch is on Water pressure is too high Hand piece holder out of adjustment Improper adjustment of water relay 111 32 Solar Photovoltaic PV System Function solar PV systems generate electricity to operate recommended appliances e g lamps for lighting ultrasound scanner oxygen concentrator suction machine computer etc How it works A solar PV system uses sunlight to generate electricity A solar PV system consists of the following main components Solar panel module t receives sunlight and converts it into electricity to charge the battery Charge controller Regulator t controls battery charging and discharging t prevents o
32. ar instructions and information necessary for safe efficient work Use color coding rules such as for garbage medical waste and linen by type Use a board with X Y axis alignment for sharing medical information a 5 S corner display and a map of work areas for patients Hints for actions if ines fiers AMT Alt Labels should be easy to read and easy to Clear instructions for operation of the fire Numbering rules of medical charts for understand extinguisher proper setting 5S corner display by X Y axis alignment The place for each item should be clearly A map of work areas for patients The place for each item should be clearly labeled or demarcated items should be arranged in a manner that promotes efficient work flow with equipment used most often being the most easily accessible labeled or demarcated 130 3S SHINING Regular maintenance and cleanliness Basic points for Shining 1 Cleanliness 3 Proper maintenance of equipment 2 Waste bin cleaning tool How Designate the responsibility for keeping areas clean to staff members and clean regularly Place waste bins and cleaning tools in the appropriate workplace Inspect and maintain medical Instruments machines and tools regularly Hints for actions Designate responsibility for keeping the area clean to staff members 45 P agius PL a MEERE Discuss the placement of waste bins in areas where they are need
33. based at HID Wabigalo in Kampala The following activities will promote effective maintenance planning and management i Regular medical equipment inventory taking and update ii Prepration of annual quarterly work plans and budgets iii Preparation of maintenance schedules iv Preparation of maintenance reports including quarterly and annual performance reports v Holding regular workshop and regional workshop management committee meetings 21 4 1 Medical Equipment Inventory Update The Workshop manager shall endeavor to keep and update an inventory of all medical equipment in each health facility Proper entry should be made in the inventory database The inventory record should contain the following details i Name of health facility and date of inventory taking li Equipment Name iii Manufacturer with contact details where possible iv Serial No of equipment or allocated identification No v Location of equipment in health facility e g OPD Maternity vi Date Year of Installation purchase vii Current maintenance status Condition A F see Annex 3 Medical inventory taking should be carried out in August of every year Inventory update however should be done when new equipment has been procured or equipment has been transferred from one location to another 4 1 1 Inventory taking Rules and Procedure An accurate inventory is important for proper maintenance planning and scheduling It should be
34. ck door completely or replace door gasket 3 Can NOT Disconnected linkage Connect linkage power up completely Mal functional switch Replace switch Burnout heater Replace heater Blew fuse Replace fuse temperature one uniformity or adjust the air vents Temperature Dirty sensor Clean sensor fluctuated Burnout electronic Repair or replace parts parts Defective circuit board Repair or replace circult board 87 21 Disinfector Boiler Function Disinfection kills and reduces some microorganisms but not the resistant bacterial soores A boiler is used to disinfect medical objects that come in contact with intact skin but not mucous membranes none critical items Examples of these items are suction tubes dishes and some instruments Boilers can be electrically operated or non electric external heat source How it works lt has different parts that helo it perform its work effectively They include chamber cover with handle equipment tray with handles heating elements electrical cable electrical boiler drain tap thermal switch for safety thermostat temperature control and rubber stands ltems to be disinfected first undergo a process of washing cleaning and rinsing Clean items are then immersed into equioment tray dipped in and properly covered under water and closed Heat is introduced and water is left to boil at 100 degrees centigrade for twenty 20 minutes before it is switched off The equioment t
35. cklist Care Clean and sterilize mouthpiece and medicine and chamber Handling Wipe dust from the machine and replace cover after checks Visual Check all parts are present and tightly fitted Checks Check all moving parts move freely all holes are unblocked If mains plug cable or socket are damaged replace them If chamber and tube seals are damaged replace them 60 Check the whole system functions before use Before next use check that there is adequate nebulization Check that the compressor fan is working without excessive noise Function Checks Equipment is NOT working Equipment is on but flow is absent Inadequate nebulizing amount Electrical shocks Troubleshooting No power from mains socket Blown mains fuse Electrical cable fault Filter is blocked Pipe is twisted or nebulizer chamber mouth piece is blocked Output adjustment not correctly set Mouth piece cracked Vibration generator weak Improper earthing grounding of the machine Bare wires touching the body of the machine 6l Check power switch is on Replace fuse with correct current ratings Check mains power Try cable on another piece of equipment Clean filter Connect pipe properly clean chamber mouthpiece Adjust output as directed in the user manual Replace mouthpiece Replace vibration generator Earth the machine appropriately Insulate all live conductors 8 Oxygen Concentrators
36. ction This section encompasses the electrical and mechanical engineering disciplines The electrical and mechanical engineering professionals are responsible for preparing specifications and ensuring that procured equipment conforms to national and international standards and that the equioment is appropriate and maintainable Some of the activities related to medical equipment in this section include 14 i Supervision and monitoring the management of the complete life cycle of medical equipment and furniture in public health facilities ii Acting as the Secretariat to NACME and take care of the executive work for the committee Preparation of the standard equipment lists and update of specifications is handled by the Electrical Mechanical Engineers i Specification and quantification of equipment for orocurement in the health sector ii Organizing training from time to time so as to ensure that technicians and engineers keep abreast with the fast changing trends in Biomedical engineering Department of Clinical Services CS Health Infrastructure Division HID Electro Mechanical Engineering Section Civil Engineering Section 8 Regional Medical Equipment Maintenance Workshops RWs debli fey Fig 1 HID Organogram 15 2 3 Regional Medical Equipment Maintenance Workshops RWs In order to decentralise medical equioment maintenance the MOH established RWs at RRHs to maintain medical equipment in health facili
37. cy sounds The head picks up the sound from a wide area so it sounds loud to the user Care must therefore be taken not to hit or shout into the stethoscope while in use 50 Care and Handling Visual checks Function Checks Maintenance Checklist Check that the equipment is safely packed Remove any visible dirt Remove all dust and dirt with a damp cloth Remove earpieces and clean the inside with warm water Ensure all parts are present and are tightly fitted Remove or replace any cracked rubber parts Replace membrane If broken Tap gently before use to check operation Check tube holder rotates easily within headpiece Check sound can be heard from both sides of headpiece Troubleshooting E R Faint or NO Leakage or Remove all parts and sound heard blockage check for leakage and blockage Tube connector Broken locking Repair to be done by a does NOT stay in mechanism technician headpiece 3 Parts damaged Broken part Replace with part or faulty taken from other units 5I 3 Refrigerator Electric and Solar Function A refrigerator is a hospital plant that keeps health facility vaccines reagents and blood at a required environment e g temperature and humidity How it works An electrical refrigerator can be a compression or absorption tyoe Compression fridges use electrical power as a source of power and it has four major components 1 A compressor 2 A condenser 3 An Expansion valv
38. d Establish hand hygiene procedures and hygienic washing facilities Reducing waiting time for patients at an outpatient room a laboratory and a pharmacy Hints for actions Listing basic clinical procedures makes it easy to find necessary standardized care procedures for documentation Labels and signs are needed for clear instruction for procedures Encouraging collection of patients opinion is essential for improving quality of care The protocols of standardized malaria Instructions for procedures for the use of Curtains for protection privacy of persons diagnosis as a flowchart equipment with operations clearly labeled cared Proper hand hygiene procedures and hygienic A suggestion box helps improve the quality Reducing waiting times for patients at washing facilities of care outpatient departments laboratories and pharmacies 132 5S SUSTAIN Teamwork Basic points for sustaining 1 Tool box meeting 3 Work Improvement Team WIT 5S Training 2 Record of accidents and injuries How Hold a brief meeting before beginning work to plan assignments and avoid giving excessive workloads to particular staff members Keep records of medical accidents occupational injuries and diseases for ensuring both patients and workers safety Encourage Work Improvement Team WIT activities and provide adequate participatory 5S and safety health improvement training to all workers Hints for action
39. d be kept of all the correct voltages and wattages ratings of parts Maintenance Checklist Care Unplug clean outside of the lamp r with a damp and cloth and dry off Handling Clean and sterilize the lamp head handle Visual Check that all lamps are functioning Checks Check that there are no cracks in glass covers or liquid spillages Tighten any loose screws and check parts are fitted 76 Function e Check that switches and focus knob operate Checks correctly e Check working condition of moving parts EN ee O No light or No power at Check power switch is on power on mains socket Replace fuse Check mains visible power Dead battery Charge or replace battery Blown bulb Replace bulb with correct voltage and wattage Battery leakage Remove batteries clean battery terminals and replace with new battery Electrical cable Try cable on another piece of fault equipment Internal wiring Refer to an Electrician fault Fuse Fuse or bulb is Replace with correct rating bulb wrong rating keeps Power supply or Refer to an electrician blowing cable fault Light can Dirt on lens or Clean area with dry clean NOT be tube cotton made Poor power Check power line or replace bright supply Batteries enough Check bulb rating is correct Wrong bulb rating Refer to an electrician Control malfunction 4 Electrical Wiring fault Refer to an electrician shocks 71 16 Anesthesia Machine Function The anesthesia mach
40. d cost effectiveness e Equipment down time and response time The response time to emergency calls for repair of life support equipment should not be more than 24hours The PPM schedule 37 should aim at keeping at least 65 of the essential medical equioment in good maintenance condition 1 Frequency of visits The HID will carry out Support Supervision and monitoring of RWs once every quarter A standard monitoring sheet has been designed to assess RWs see Annex 9 for Support Supervision amp Monitoring Sheet 38 Chapter 7 Guidelines for Medical Equipment Maintenance 7 1 Introduction The main objective for any maintenance system is to ensure orolonged use of available equipment to provide safe and rellable healthcare over its design life All RWs shall ensure proper maintenance of medical equipment to sustain the intended healthcare benefits and to preserve capital investments To achieve this medical equipment shall be maintained in working order and periodically calibrated to ensure accurate results To ensure efficient maintenance of equioment RWs will plan and budget for maintenance under two main categories e Planned Preventive Maintenance e Breakdown maintenance 7 2 Planned Preventive Maintenance PPM PPM is usually scheduled at specific intervals and includes specific maintenance activities such as lubrication calibration cleaning of filters or replacement of spare parts that are expected to wear
41. daily Execute shut down Clean the sample rotary valve SRV tray weekly Clean the waste chamber rinse sequence monthly or after every 2500 samples Clean the transducer rinse sequence monthly or after every 2500 samples Clean the sample rotary valve SRV every 3 months or after 7500 samples SAV life time is 5 years Clean the rinse cup as needed Clean the WBC RBC transducer aperture as needed 104 Visual checks Function Checks Check trap chamber level daily and discard if necessary Auto rinse as needed Replace the waste tank as needed Perform a reagent replacement sequence Auto rinse with background check sequence Check settings sub menu for system set up Perform the waste chamber cleaning sequence Perform the transducer cleaning sequence Perform transducer fluid draining sequence for clog removal Check status display 1 Hemoglobin HGB convert real time 2 Pressure and Vacuum real time 3 Unit operation counter Check paper feed optional built in printer _ Troubleshooting ni Alarm sounds and an error message Is displayed Pressure or vacuum is Press HELP key outside range on keyboard to stop the alarm Air bubbles in the system and change over to the HELP Clogging in transducer screen that shows aperture s what actions to take against the error 105 30 CD4 Counter Flow Cytometer Type Function CD4 counter uses flow Cytometry technology tha
42. delivered to the DHO s stores or HCIV by the In charge of the HC for the workshop team to carry out maintenance On a case by case basis the RW team may visit a HCII or HCIIl to repair immovable equipment like a generator solar system 3 1 Central Medical Equipment Maintenance Workshop Wabigalo CW The CW located in Kampala is the RW for Health facilities for the Central region and a referral workshop It is also acts as a training centre for Hospital based technicians Other roles and functions of the CW include the following i Supervision of all RWs through the Electro Mechanical Engineering Section of HID focusing on maintenance and repair activities review of work plans and budgets and quarterly reports ii Identification of suitable service providers and guidance on orocurement of spare parts iii Plan for capacity development activities for all regional workshops This involves human resource develooment mentorship iv Support other RWs to carry out and update medical equipment inventory 19 3 2 Regional Medical Equipment Maintenance Workshops The RWs are based at the RRH and cater for maintenance of medical equipment in health facilities within the catchment area While day to day supervision of the operations of RWs is under the Administration of the RRH each workshop has a RW Management Committee that over sees its operations The RW Management Committee consists of members from all beneficiary hospitals
43. dust cover after checks Clear away any dirt or hair on controls and feet Clean exterior with damp cloth and dry off Clean off then repaint any exposed or rusted metal If bent cracked or damaged send for repair Tighten any loose screws and check parts are fitted tightly Check zero at start of day and before each patient Check reading is accurate using a known weight Send for repair if inaccurate or sticking Replace battery if display shows low battery Troubleshooting Zero point can Scale is not level Set scale on level NOT be set Reading is inaccurate Electronic 2 Movement is Dirt lodged inside Remove any visible dirt Stiff or jerky or foreign body and ground and Retest Zero control broken Repair or change parts or internal part jammed reset Internal blockage Lubricate repair Zero not properly Reset to zero set Calibration error Recalibrate Battery power Replace battery or display is blank failed power supply and retest 57 6 Suction Machines Aspirators Function Suction machines also known as aspirators are used to remove unwanted fluid from body cavities They are found in operating theatres delivery suites ENT and emergency departments Smaller specialized Suction machines are used in dental departments How it works Suction is generated by a pump This is normally an electrically powered motor but manually powered versions are also often found The pump generates a suction that d
44. e ed ing 1 p10 JO1NC J Jiede sp u ing sn uj 9 9SN ul pue poop y Aoy UOI IPUOD 1Ue d JeNGSOH 4H JUS WNASUJ JEOIPOWN IN SINIUWIN EIIPaY AN us wd nb3 jes payy IN OWEN S Jojoodsuj 498 u09 eds SAP OWEN S 10 090dSu 9 eq A10 UdAU Ayloe4 yeH 124 lon Template of Work Plan Preparat Annex 5 000 EZE puelul JOJOSIIG OACI eLIdOH PUe U jornel Je eueyy MH SIUEU Sule WN ewdi nbg Js eueyy MH Je euey MH 1991 0 IsoNn ojq suodsay nog a Bulpun4 SHUNBOW s p 1uswe eueW vO cO Mu Ploy pue esiueblO SAIOH pue sjeqidsoy 19B1E O SIISIA ED ZO soOuUeUd UIeW JoNPUON JeaA 19d sOuleew z jesods p pue 1U8WoeBeUeW gsem aed Yljeau syed aleds JUSWAINDS jeolpew zo DE1IOSSEB aunodold JUsewd nde P909 9S JO souUeUS UIeW pue BuUIIM S Ul SUBIOIUYDS Jo Bulured JonpUuOyD SINdINO JSAI 9q 0 SOIIAHOWY POUUEIA UONPUOO poop ul 1d y ju wdinbo eop aw SIQEIIENE JO 99 SUBIDIUYDS SIBSUIBUZ play sOuneew JO selnuly p urezurew yu wdi nb UO sauljopInd paepdA Jo JOQUINN UONIPUOO HOUEUSLUIEW yu wdinb 3 Ie3IpP N paure OL JO payonpuoo s ssul us pue BHululed GBuvseulbuz jeo peyn old 1e nd nO pouueld SUBIOIUUDO Jo JoquunN s Jo eoIpuj jndjno AVANOY 10 210 D9AOJCUI SOUBUS UIeW yu wdinb4 Ie3IP N uoldl loseg jndjn
45. e capillary tube 4 An Evaporator A compressor has a pump and electrical coil both inside the housing The coil gets electrical power to form an electrical field to drive the pump which then pumps the refrigerant in form of gas with a high pressure to the condenser The condenser receives the refrigerant removes heat and condenses refrigerant into a liquid The liquid refrigerant still at high pressure goes to an expansion valve capillary tube The Expansion valve or capillary tube drops the refrigerant pressure and temperature and this is where cooling starts The Evaporator is the cooling part of the refrigerator which evaporates the liquid refrigerant back into gas form and removes heat from the room 32 Care and Handling Maintenance Checklist Use a damp cloth to clean the solar panel and fridge body Use a damp cloth to clean evaporator after melting ice Never use a sharp object to remove ice Use a brush or dry cloth to clean the condenser Use a brush to clean the compressor Use a brush to clean the charge regulator Visual Check door rubbers if not damaged checks Check thermometer position in the fridge Check room ventilation where the fridge is located Check discharge level on the charge regulator Check ice formation inside the fridge Check dust on solar panels Check if solar panels are not shaded Function Checks Check whether the power source if available Check thermostat position insid
46. e cuff is deflated Remove or replace any cracked rubber parts Function Before use check that the pressure rises and returns to Checks zero Check correct operation of inflation bulb and valves Remove any batteries if not in use for more than one month Inflate to 200 mmHg and check leakage is not faster than 2 mmHg in 10 seconds Troubleshooting ee DT ee E Mercury leakage or Mercury leakage or Correction to be done by a mercury NOT at zero overfilling technician level Pressure does NOT Valve or tube Remove and clean all increase easily or blockage valves and tubes Pressure Increases Reassemble and test after inflation Aneroid instrument Zero setting has Rotate collar on the base does NOT moved until zero setting Is return to zero achieved and tighten Pressure does NOT Leakage of air Isolate leak by closing off remain steady parts of tubing Replace leaking section and retest 49 2 Stethoscope Function A stethoscope is used to listen to sounds within the body These might be sounds generated by breathing coughing blood flow or the stomach The sounds are picked up and transmitted to the ears of the medical staff for diagnosis How it works A membrane on the stethoscope head picks up the vibrations caused by internal sounds and transmits them to the stethoscope tube The sounds pass up the tube through the earpiece to the user The stethoscope head also contains an open bell which is used to pick up lower frequen
47. e most important for safety and also is the most likely to have problems relating to power supply The power supply converts the voltage to a lower stable value to make the equioment work and also protects the patient from the mains voltage Any damage to the power supply or any liquid spilled into the equipment could result in very serious consequences The maintenance checklist therefore majors on checking the cables fuses and power connectors If a device uses low voltage batteries It is safer to use In this case the user should take care that the batteries are removed if the equipment will not be used for longer than one month as chemical spillage can occur Rechargeable batteries must be kept topped up with charge power switch power supply N power mains plug 66 General item of electrical equioment one with internal power supply the other with external Care and Handling Visual Checks Function Checks Maintenance Checklist Wipe dust off exterior and cover equipment when not in use Remove any tape paper or foreign body from equipment Unplug clean outside of the equipment with a damp cloth and dry off Clean any filters or covers as directed by in the user manual Check all fittings and accessories are mounted correctly Check there are no cracks in covers or liquid spillages Tighten any loose screws and check that all parts are fitted tightly Check mains plug screws are tight Check tha
48. e of Os pressure Er Machines give m various alarms to Gas delivery system alert operators Patient Patient breathing system 78 Maintenance Checklist Care and e Remove water and waste matter from inside If any leak is audible check with soapy solution Check all seals connectors adapters and parts are tight Check all moving parts move freely all holes are unblocked Check connections for leakage with soap solution amp dry off Check all fittings for proper assembly Replace soda lime if it has turned blue Replace any deteriorated hoses and tubing If seal plug cable or socket are damaged replace Function After use depressurize system and replace all caps covers Checks Before use check pressure gauges rise and there are no leaks Troubleshooting We a a Ten Equioment No power at mains Check power switch is on NOT socket Replace fuse Check mains running Electric cable fault power Is present at socket using equioment Known to be working Rewiring if power not present No Oo pressure in Restore gas supply or replace cylinder gas supply gas cylinders Check pressure gauges Replace Os cylinder and or N20 4 bar or 4 kg cm2 cylinder in case of low pressure Oo failure Alarm battery is low Check alarm setting range alarm Alarm device is not alarm on off alarm lamp blow NOT working out working connections flow Refit cylinders in yokes and valves and O2 N20 retest If leaks remain repair by
49. e out internal cable damage Close different tubes by bending When pressure gauge changes leakage point has been passed Replaced damaged tube or Seal Clean outlet valve Operate control valve through full range Send for repair if it is stuck Refer to a technician Disconnect each tube one at a time When air flow is stopped blockage has been passed Replace filter or unblock tube Floating valve Change filter clean or broken replace floating valve Wiring fault Refer to an electrician Internal slider stuck Refer to a technician for greasing 7 Ultrasonic Nebulizers Function Is a device used to administer medication in the form of a mist inhaled into the lungs Nebulizers are commonly used for treatment of asthma and other respiratory diseases The reason for using a nebulizer for medicine to be administered directly to the lungs is that small aerosol droplets can penetrate into the narrow branches of the lower airways Large droplets would be absorbed by the mouth cavity where the clinical effect would be low How it works Ultrasonic Nebulizers use ultrasonic power as means to break up medical solutions or Suspensions into small droplets these small droplets are passed for direct inhalation either through the mouthpiece of the device or a hose set An Ultrasonic Nebulizer uses a small crystal to generate vibrations in the solution that cause droplets to break off AU Wifi a ATT i Maintenance Che
50. e the fridge Check thermometer reading from the fridge Check fridge stability on the ground Troubleshooting Compressor NOT running 2 Compressor running but NOT cooling Fridge over freezing Too much ice formation inside fridge No power supply Burnt compressor Gas leakage Weak compressor pump Chocked drier Faulty thermostat Wrong Thermostat setting Evaporator fan not running 53 Check power supply Replace the compressor Braze pipe charge the fridge Replace compressor Replace filter drier Replace thermostat Set thermostat properly Replace evaporator fan 4 Refrigerator Gas and Kerosene Function The function of a refrigerator is to bring down the room temperature to the required one How it works The absorption system is different from the compression system It uses heat energy instead of mechanical energy to make a change in the conditions necessary to complete a refrigeration cycle The system may use butane kerosene steam or electrical heating element as a source of heat and ammonia solution as a refrigerant The system has few moving parts small systems have moving parts only in the heat source valves and controls which are used Larger systems also use circulating pumps and fans as moving parts Absorption systems also have 4 major components 1 Generator 2 Condenser 3 Absorber Receiver and 4 Evaporator In this case the compressor is r
51. each health care worker at elbow level or Slightly below it Allow workers to alternate standing and sitting as much as possible and provide good adjustable chairs with good backrests Hints for actions Items should be arranged in a manner that promotes efficient work flow with equipment used most often being the most easily accessible Workers should not have to bend repeatedly to access materials Each tool part Supply or piece of equipment should be kept close to where it will be used in other words straightening the flow path I a a ml u Kun ee a i on a ie KL H sj os re er E Place frequently used tools and Adjust the working height for each Provide good adjustable chairs materials within easy reach of health care worker at elbow level with good backrests workers or slightly below it Ai t l pa pr s a a j I C x a 5 ei Place frequently used tools within Adjust the working height for each Set necessary equipment nearby easy reach health care worker at elbow level worksite for easy to reach or slightly below it to reach 129 2S SETTING Labels signs color coding Basic points for setting labels signs color cording 1 Labeling 3 Color coding numbering 2 Safety signs 4 Signboards mapping How Make labels colors and signs easy to see easy to read and easy to understand Provide cle
52. ear heat or draught near a fan Fan or air duct Unblock air duct if problem obstructed Incubator Heating element If accessible replace NOT heating problem heating element even when the heater lamp is on 81 18 Infant Warmer Function An infant warmer system provides a controlled source of radiant heat for infants and pediatric patients How it works The heater assembly consists of a radiant heater controlled by electronic circuits A probe is used to monitor the patients skin temperature The patients skin temperature is continuously displayed Alarms activate to alert the operator of a low or high patient temperature a skin temperature probe failure a power failure equioment failure or a check patient prompt Maintenance Checklist Care and Clean the warmer at least once a week or after each Handling patient The mattress X ray tray bed and side panels may be cleaned without immersing by using a disinfecting agent safe for use on the materials Visual For units with casters check that all casters are In Checks firm contact with the floor and that the warmer is stable and moves freely Examine the unit for objects placed on top of the heater assembly Function Check that all accessories are mounted securely and Checks that the load limits are not exceeded Connect the warmer to power source and verify the operation of the control panel Check operation of phototherapy warning light 82 Bei Alarm s
53. eck the bulb Replace if blown bulb NOT lighting stage e Intensity knob Check the knob and stuck on minimum rod assembly and clean e Check the light Replace if blown circuit fuses of the transformer and rack tighten the rack Check bearings Clean and lubricate between the stage and limb 99 27 Laboratory Incubator Function Incubator is a device used to grow and maintain microbiological cultures or cell cultures The incubator maintains optimal temperature humidity and other conditions such as the carbon dioxide COs and oxygen content of the atmosphere inside The scope of usage of Incubators may vary but the basic requirement of incubator is to provide a controlled temperature environment How it works Laboratory incubators consist of a chamber heat source a resettable thermostat and a thermometer Heat generated is controlled by the thermostat to a desired temperature that is set by the user The thermometer displays the temperature in the chamber Maintenance Checklist Care and Use a smooth cloth soaked in water to clean the Handling Surface of the equipment Disinfect the machine with an appropriate disinfection solution e g Hypochlorite JIK Visual Make sure the equipment shows no error messages checks on the controls Check whether the door locks properly Function Check whether the whole system functions before Checks use e g temperature control and display power supply Troubleshooting
54. ed at your workplace Regular maintenance keeps your medical equipment productive and safe Check all machine parts carefully In particular special care is needed for rotating parts detachable guards and electrical wires etc If you find an inexpensive machine you should check its safety aspects even more carefully When accidents occur costs can be enormous Develop a long term maintenance plan For instance you may check the machine thoroughly every weekend i WM fa OM TS Place waste bins and cleaning tools in the Inspect and maintain medical instruments appropriate workplace location machines and tools regularly za sar EN ur ER He i i ON PS Cleaning regularly supports daily work tasks Place waste bins at every point where HWs Discuss establishing a standard of undertake procedures cleanliness with staff members 131 4S STANDARIZE Improving quality of care Basic points for standardizing 1 Standardized care procedures 4 Establishing hand hygiene 2 Procedures of the equipment 5 Reducing patients waiting time 3 Ensuring patients privacy How Establish the protocols of standardized care procedures about each cure and care such as maternity vaccination medical health checkup Display procedures of the equipment and label clearly what operation is meant Use partitions curtains and other arrangement for protection privacy of persons care
55. eded Check for leaks during operation Check for operation of pressure gauges temp gauges LED displays LCD and indicator lamps Leakage current meets the safety standards Earth lead is tightly secured to equipment Troubleshooting en a Equioment NOT heating Pressure rises above the marked level Steam is constantly escaping No power at mains Check power switch is on Replace socket fuse Check mains power socket Is Electric cable fault working Rewiring if power not present Damaged heating Try cable on another piece of element equipment Replace if broken Blocked valve Clean the pressure regulating valve Safety valve Pressure vessel may be over filled Retest autoclave under pressure with water only Poor seal Clean leaky valve and hole replace if defective Clean leaking seal or gasket replace if broken 4 Electric Wiring fault Rewiring repair by electrician shocks immediately 85 20 Hot Air Oven Function Hot Air Ovens have several functions depending on the set temperature In the Laboratory they can incubate specimens as well as drying slides if set at low temperatures Sterilization of water sensitive items like powders Vaseline glassware as well as metallic instruments is possible at higher temperatures How it works Ovens are basically insulated enclosures in a metal box They are electrically heated with an air circulating fan A Thermostat up to 300 centigrade is fitted A
56. endeavor to print serialized Job Cards and enforce the preparation of Equipment breakdown Report Forms HMIS Form 11 by health facilities e A list of fast moving spare parts will be prepared and used to determine quarterly requirements Where possible a list of fast moving spare parts for each equipment will be developed from time to time 5 1 2 Procedure for Purchasing Spare Parts Procurement of spare parts and tools shall be in accordance with the PPDA guidelines The RW will identify and quantify the spare parts requirements and raise the Procurement requisition to start the procurement process through the PDU While the RW would allow the PDU to manage the procurement process it is advisable for the RW manager to assist the PDU to identify possible suppliers and appropriate procurement method This is important because of the specialized nature of medical equipment Spare parts e Some spare parts are manufacturer specific and direct procurement would be the most efficient and cost effective procurement method e Also prequalification of suppliers would help reduce the time needed to identify and place orders Framework contracts could be entered into with prequalified suppliers 34 9 1 3 9 2 Whatever procurement method is used it is important that the process is transparent fair efficient and cost effective Stores Management by RWs RWs have stores and must maintain inventory records Management of all stor
57. eng Director General Health Services Acronyms List of Acronyms Five steps of Sort Set Shine Standardize and Sustain Alternating Current ACHS HI Assistant Commissioner Health Infrastructure Division Clinical Services Department 5 A AEO Assistant Engineering Officer C C C C a an Dioxide SSS Central Medical Equipment Maintenance DHOs A Disposal Public Asset G Ear Nose and Throat E D O W C P C Health Centre HGB HID Electrocardiogram Health Infrastructure Division HIV Human Immunodeficiency Virus HMIS Health Management Information System JICA Japan International Cooperation Agency T D L Liquid Crystal Display L Hemoglobin Light Emitting Diode Medical Equipment MoFPED Ministry of Finance Planning and Economic Development Ministry of Health S C D D EC EN H C E M D E HI_TWG Health Infrastructure Technical Working Group H MO MA Magnetic Resonance Imaging Nitrous Oxide NACME National Advisory Committee on Medical lll r O OPD Out Patient Department 0 PDU Procurement and Disposal Unit PMT Photo Multiplier Tube O PPDA Public Procurement and Disposal of Public POA asset auhonty ee RRHs Regional Medical Equipment Maintenance ne atamenManerane Pulse Oximeter Oxygen Saturation White Blood Cell Work Improvement Team p p R R R PPM ve Mai Aa RBC Red Blood Cel RE RPM RRHs 2 T DU MT BC
58. eplaced by a heater and Generator Absorption system uses a generator charged with water and ammonia a heat source usually kerosene flame heats this solution in the generator the ammonia becomes vaporized and is driven off to the condenser and the condenser at the top of the system condenses the ammonia vapor into liquid The liquid flows by gravity into the liquid receiver and then into the evaporator During the generating cycle little or no refrigerating effect is taking place As the system cools pressure drops causing the liquid ammonia in the evaporator to boil cooling and absorb heat from the room the cycle is complete when vaporized ammonia is absorbed back to the generator 54 Maintenance Checklist Cleaning Use a damp cloth to clean the fridge body Use a brush to clean the condenser Use a brush to clean the generator Use a damp cloth to clean the inside of the fridge when it is off and ice is melting Visual Check if gas cylinder is open and there is no checks leakage Check if spirit level is in a better position leveling Check if thermostat probe is in a better position Function Check if the burner or nozzles are clean and okay Checks Check if gas cylinder is open and has gas Check if thermostat is functioning well Check the level of ice formation on evaporator Troubleshooting NOT cooling e Nozzles e Clean nozzles well blocked e Carry out manual Too much ice defrosting formation 2 Over coo
59. equipment breakdown is passed to all staff during shift change and the head of the institution All equipment breakdown occurring in the wards should be recorded on the Complaint Form mentioned above 40 7 4 Maintenance Policy The choice of implementing Preventive or Corrective Maintenance depends on the complexity of equipment availability of After Sales service and cost Maintenance of medical equipment by the RWs will be based on PPM for all essential medical equipment that can be handled by RWs and a mix of PPM and Corrective maintenance for medical equioment that need outsourcing the maintenance services Equipment maintenance shall be carried out by both In House trained technicians and Manufacturer s representatives or Vendor For specialized and advanced equipment the RWs will on a case by case basis outsource maintenance services through a combination of on call services and a maintenance contract negotiated at the time of equipment purchase 7 5 Levels of Maintenance For purposes of this Manual three levels of maintenance will be observed Level 1 First line by the Equipment User This refers to maintenance activities that can be carried out by the user or health facility based technician This will include dusting equipment cleaning filters checking fuses and checking power supply source without opening the unit and without moving It away from the point of use Other first line maintenance activities could
60. es i e tools and spare parts Shall be in accordance with standard stores management practices The RW shall secure and maintain stores Stock cards Stores Requisition Forms and Stores Issue Forms stock cards shall be maintained weekly while monthly stock taking will be carried out for all inventories No spare part shall be issued out without clearly identifying it i e name part number and model Disposal of Un necessary Items Disposal is part of the procurement process and must be planned for The life cycle of any equipment ends with disposal but it is often difficult for users to decide when to decommission and how to dispose of equipment The reasons for decommissioning and disposal of equipment will include VVVVV Y Wear beyond economic repair Damage beyond economic repair Unreliability Safety Clinical or technical obsolescence Unavailability of spare parts 35 gt Availability of more cost effective equipment or clinical orocedure or technology Once items for disposal are identified the PPDA guidelines and procedure should be followed The disposal process would include Note Identification of items to dispose of Submission of list of items for approval by the Accounting Officer i e Hospital Director and or Hospital Board Establishment of a Board of Survey team to approve list of items for disposal Initiation of disposal process through preparation and Submission of d
61. eturn current passing through the handpiece whereas monopolar electrosurgery returns the current through a plate normally a eee under the patient Electrosurgery is commonly ee used in dermatological gynaecological cardiac plastic ocular spine ENT orthopedic urological neuro and general Surgical procedures as well as certain dental procedures Maintenance Checklist Visual Check that all fittings and cables are properly connected Checks Check there are no signs of spilled liquids or cable damage Inspect filters clean or replace if needed If any plug cable or socket is damaged replace Function e Check foot probe switch smooth operation Checks e Check returns plate cable disconnection alarm before use 72 Check proper operation of all controls indicators and visual displays on the unit If not recently used check operation on wet soap 1 Equipment is NOT running 2 Equipment is on but shows 3 Equipment is on but output is absent weak or intermittent 5 Monitor interference occurs only when electrosurgery is activated Pacemaker or internal cardiac defibrillator interference 4 Continuous interference with monitors Troubleshooting No power from mains socket Electric cable fault Footswitch pedal may have been depressed as unit is turned on or front panel buttons may be stuck Probe patient cable or plate malfunction Power setting is too low M
62. f number of each type of cell Filters are used to direct the light emitted by the fluorochromes to the colour detectors The fluorochromes attached to the cells absorb light and then emit a specific colour of light depending 106 on the type of fluorochrome The colour detectors PMT s collect the different colours of light emitted by the fluorochromes The electronics in the cytometer amplify and process the resulting data They convert analogue data to digital data which is stored in the computer This data from the light detector and the colour detectors iS analysed from the computer and plotted on histograms Maintenance Checklist Care and Unplug clean external surfaces with a damp cloth Handling with cleaning solution containing alcohol for example 70 ethanol Delonized water and wipe surfaces with a clean dry cloth Visual Check that all parts are there and correctly fitted checks Check that the mains cable has no damage and if damaged replace Check that the air filter is free of dust and if clogged wash clean with water dry and reinstall or replace Check the level of sheath fluid in the reservoir Check the level of waste in waste reservoir dispose of if necessary Function Check photo multiplier tube PMT voltage Checks adjustment Check time delay calibration Check fluorescence compensation adjustment Carry out sensitivity testing 107 a Flow cell NOT filling No events displayed and Status
63. he concentration of a substance in the patient s sample by comparing the amount of light it absorbs with that absorbed by a standard sample that contains a known amount of the substance being tested A coloured solution of the substance being measured or a coloured derivative of it is produced Coloured solutions absorb light at given wavelengths in the visible spectrum How it works The essential parts of a colorimeter are a light source an adjustable aperture colored filters a cuvette holder a detector and a data display Colored filters are used to select the required wavelength The usual wavelength range is from 400 to 700 nanometers nm A cuvette which obtains light path of 10 mm size is recommended The data display indicates the results as transmittance a linear scale from 0 100 or as absorbance a logarithmic scale from Zero to infinity To prolong the life of the lamp switch off the device after use and disconnect from the mains socket at the end of each day Maintenance Checklist Care and Clean the equipment with a soft cloth soaked in a Handling mild disinfection reagent Clean the cuvette holder Visual Check the functionality of the bulbs checks Check that there is no mechanical damage Check that the cuvette is free of scratches and finger marks Function Switch ON OFF and change the filters smoothly Checks Check that the correct type of cuvette Is in use Check that the display is functional when switched ON
64. include the following 41 Equipment decontamination and sterilization Functional checks Calibration checks Safety checks VV VV Note First line maintenance may be carried out by Hospital based Technicians too Level 2 By Technician This refers to maintenance carried out by a technician when first line maintenance cannot rectify a fault or when a regular scheduled check and calibration is due Level 3 Specialized Maintenance by Technician Engineer from Manufacturer s representative Vendor This refers to maintenance activities that need higher level technical expertise troubleshooting techniques and tools Equipment such as X Ray machine CT Scanners Ultrasound scanner Endoscope Automatic Laboratory Analyzer etc need specialized engineers and technicians who have been trained to maintain this specific equipment Additionally specialized tool equipment may be required for testing and calibration of such equipment This caliber of Technicians Engineers is normally employed by third party companies or vendors representing the manufacturer of the equipment This manual focuses on level 1 user or first line maintenance and level 2 technicians level maintenance For purposes of this manual level 2 maintenance shall be largely provided by the RW technicians except for cases where Maintenance Contracts exist 42 7 6 Range of Medical Equipment that can be maintained by WS or Outsourcing The example medical equip
65. ine is used to support the administration of anaesthesia The most common type of anesthesia machine is the continuous flow type which is designed to provide an accurate and continuous supply of medical gases such as oxygen and nitrous oxide mixed with an accurate concentration of unaesthetic vapour such as halothane or isoflurane and deliver this to the patient at a safe pressure and flow Modern machines incorporate ventilator suction unit and patient monitoring devices How it works Oxygen O nitrous oxide N O and sometimes air sources are connected to the machine Through gas flowmeters or rotameters a controlled mixture of these gases along with anaesthetic vapour passes through a vaporizer and is delivered to the patient Sometimes a ventilator is also connected with the machine for rebreathing thus making it a closed circuit With ventilators or a re breathing patient circuit soda lime canisters are used to absorb the exhaled carbon dioxide and fresh gases are added to the circuit for reuse Pressure gauges are installed on the anaesthesia machine to monitor gas oressure Generally 25 or 21 oxygen is always kept in the circuit delivered to patient as a safety feature The device which ensures this minimum oxygen in the circuit is called a hypoxic guard Some basic machines do not have this feature Ventilator but have a nitrous Waste gas lock which Stops scavenging system the delivery of NoO in absenc
66. is Materials are placed inside the unit for a carefully specified length of time Autoclaves achieve better sterilization than boiling water sterilizers Heat is delivered to water either by electricity or flame This generates high temperature within the chamber The autoclave also contains high pressure when in use hence the need for pressure control valves and safety valves Users must be careful to check how long items need to be kept at the temperature reached r Te CONITOI vuIve 3 bes k m _ Safety valve weight operated Pr Pressure gauge a p ai Wing nut __ 3 Pressure vessel Outer housing Water level Heating elements 84 Care and Handling Visual Checks Function Checks Maintenance Checklist Remove water and waste matter from inside Clean outside of equipment and power cord Drain water reservoir and clean inside of reservoir using vinegar solution Check all screws connectors amp parts are tightly fitted Check all moving parts move freely Check internal heating element connections are tight Replace heating element if covered with lime scale If plug cable or socket are damaged replace Take care not to damage heater and sensors Inspect for defects e g cracks severe pits in the chamber kinks on tubes All wires Clean and inspect water level sensor door gasket Test amp inspect all valves e g fill vent air repair or replace as ne
67. is manual helos to streamline the operations of the Regional Medical Equipment Maintenance Workshops Additionally the Maintenance guidelines will facilitate first line Maintenance to be undertaken by both the Users of the equipment and technicians in a well structured and safe manner This manual is an essential reference book for the Regional Medical Workshops to plan manage and execute basic maintenance using the prepared guidelines and ensure adequate and proper maintenance of most common essential Medical Equipment am pleased to write the foreword to this first ever operational workshop manual for RWs in Uganda also recommend the use of this manual to our health workers to carry out User Training and first line maintenance in Health Facilities would like to acknowledge and thank JICA for supporting the preparation of this manual and Eng D M K Katesigwa for providing technical guidance during its drafting Special recognition goes to Mr Naoki Mimuro Mr Shigetaka Tojo and Eng Sitra Mulepo C S for their dedication and Technical input to produce this manual Lastly would like to extend my appreciation to the staff of the Health Infrastructure Division Members of NACME and HI_TWG for their oversight and editorial role during the preparation of this manual have no doubt that this manual will facilitate better maintenance of medical equipment by the RWs in our Health Facilities FTA ial Dr Jane Ruth Ac
68. isposal requisition DPA Form 120 to the PDU to start the disposal process The role of the RW will be advisory as the Accounting Officer PDU has the mandate to dispose of assets stores 36 Chapter 6 Support Supervision Monitoring and Evaluation of RWs The Quality Assurance Department of MOH is responsible for monitoring and evaluation of healthcare services This is done though the Area Teams which assess and monitor implementation of various policy guidelines planned activities and performance against Sector indicators The Evaluation and Monitoring assessment form for Area Teams includes Health Infrastructure and RW staffs need to provide the information on medical equipment maintenance and its impact on healthcare delivery 6 1 Support Supervision Policy for RWs For the RWs specific Support supervision will be conducted by the HID Clinical Service Department and focus will be put on the following e Maintenance planning and budgeting Evidence based planning and budgeting should be the basis for budget allocation e Availability of adequate spare parts Stock planning and control should ensure that essential medical equipment is well maintained at all times e Efficiency and cost effectiveness Operational costs should be optimized to a minimum level but with high outputs and outcomes e Prudent financial management and planning Maintenance scheduling and resource allocations should be optimized to ensure efficiency an
69. it to its original operational condition 11 The choice of approach for preventive and corrective maintenance depends on the complexity of equipment equipment usage and or cost benefit analysis by the in house trained technician The majority of equipment in our health care system is basic in nature and can be handled in house by any technician or artisan at RW level For specialized and advanced equipment the vendor should provide maintenance services through a combination of on call services and a maintenance contract negotiated at the time of purchase Maintenance contracting should be reserved for medical equipment for which there is no in house capacity to maintain or when specialized equipment and technical expertise is needed to be economically viable to develop this capacity in house 12 Chapter 2 Organization Structure for Medical Equipment Maintenance There is a wide range of medical equipment at different levels of the health care delivery system The staffs in these Health Facilities are responsible for ensuring that it is used and stored properly and faulty equipment is reported to departments responsible for maintenance At the central level the Unit directly responsible for the management of medical equipment is the Health Infrastructure Division HID under the Clinical Services Department The National Advisory Committee on Medical Equipment is mandated to give appropriate clinical and technical advice to MOH
70. k is Check safety locks all switches machine NOT on exposing Exposure switch Check for any loose connection even when cable problem power is on Internal error Refer to distributor s technician 3 Poor X Ray X Ray tube Refer to distributor s technician image quality problem 4 The table Table motor or Check all cable connections does NOT cable problem move Safety switch or Check relevant fuse or switch fuse problem Control circuit Refer to biomedical technician problem 5 Electrical Wiring fault Refer to distributor s technician shocks immediately 69 12 Ultrasound Scanner Function Diagnostic ultrasound machines are used to give images of structures within the body Other kinds of machines e g therapeutic and lithotripsy are not dealt with herein The diagnostic machine probes which produce the ultrasound come in a variety of sizes and styles each type being produced for a particular special use Some require a large trolley for all the parts of the unit while the smallest come in a small box with only an audio loudspeaker for output They may be found in cardiology maternity outpatients and radiology departments and will often have a printer attached for recording images Unlike X rays ultrasound poses no danger to the human body How it works The ultrasound probe contains a crystal that sends out bursts of high frequency vibrations that pass through gel and then through the body soft tissue and bo
71. lanned activities and status of implementation gt Summary of medical equipment maintained at each health facility gt Expenditure during the quarter clearly separating expenditure on spare parts per diem workshop operational costs i e electricity water communication as necessary labour and vehicle maintenance Planned activities and expenditure for the next quarter Challenges met Conclusion Recommendations VV VV A proposed format for preparing quarterly reports is attached at Annex 7 for Quarterly Report General Form All Joo Cards for work carried out in the standard format should be attached See Annex 8 27 4 3 2 4 3 3 Workshop Managers Meetings The Managers of RWs will always meet to discuss issues relating to Medical Eauipment Maintenance and Management of RWs Purpose of meeting The Workshop Managers Meeting will be a forum where all the Workshop managers meet and share experiences challenges and chart a way forward to improve maintenance of medical equipment in their regions Frequency The ACHS HI through the CW shall organize a Workshop Managers meeting at least twice a year at the CW or any other RW agreed upon by the members Participants The Workshop Managers meeting will include all RWs Managers senior staff of CW and the HID responsible for medical equipment management and other stakeholders as shall be deemed fit from time to time e g manufacturers representatives equip
72. ling Thermostat not Replace the cutting off gas thermostat or heating element Burning Gas Ammonia Braze the pipe and available but leakage charge the system NOT cooling Generator Bubble Turn the system heating okay formation in the horizontal for at No leakage but system least two days no cooling 55 5 Weighing Scales Function Measuring patient weight is an important part of monitoring health as well as calculating drug and radiation doses It is therefore vital that scales continue to operate accurately They can be used for all ages of patient and therefore vary in the range of weights that are measured They can be arranged for patients to stand on or can be set up for weighing wheelchair bound patients For infants the patient can be Suspended in a sling below the scale or placed in a weighing cot on top of the scale How it works Mechanical scales have a spring deflected by patient weight The soring pushes a pointer along a display or rotates a disc to indicate weight Electronic scales have a sensor pressure sensor that bends under patient weight and the circuitry converts this to displayed digits This pressure sensor under strain induces an electric potential which is directly proportional to the applied force weight Baby weighing scale dial type Baby weighing scale spring type 56 Care and Handling Visual checks Function Checks Maintenance Checklist Wipe off dust and replace
73. lti level shelves and containers How Secure transport routes without obstacles that are even and not slippery Provide multi level shelves or storage racks near the work area for medical charts and drugs Provide a home for medical equipment and work items and mark their position clearly Use carts hand trucks and other wheeled devices when moving materials Hints for actions Organize everything needed in proper order for ease of operation There should be a place for everything and everything should be in its place The place for each item should be clearly labeled or demarcated Items should be arranged in a manner that promotes efficient work flow with equioment used most often being the most easily accessible fee dade KERLE Bade ee Clear transport routes with clear mark Provide multi level shelves or storage Provide a home for each piece of racks near the work area for medical medical equipment drugs 4 EN Wee Use carts hand trucks and other wheeled Secure transport routes without obstacles Provide multi level shelves for medical devices when moving materials that are even and not slippery charts in the record unit 128 2S SETTING Workstation changes Basic points for setting workstation changes 1 Easy reach 3 Comfortable chairs 2 Elbow height How Place frequently used tools controls and materials within easy reach of workers Adjust the working height for
74. ment is shown below ATEGORY EQUIPMENT WS sourcing General BP Machine BE EEE BEE Refrigerator Gas el Kerosene Solar Weighing Scales 0 Suction Machines e Ultrasonic Nebulizer Basic Oxygen Concentrator ee Jf Oxygen Cylinder and Flowmeter Electronics Diagnostic B Equipment General esac X maono a ml a Ultrasound Scanner Basic Electrosurgical Unit Diathermy ec Tables OT and Delivery Hydraulic Tams e Anesthesia Machine Basic eo Infant Incubator oe Infant Warmer oe 43 No CATEGORY EQUIPMENT nur sourcing Sterilization Basic 207 HotAir Oven Disinfector Boiler Diagnostics ee T zu GER BCE en E are ee Pwicroscope eo Laboratory Incubator Besc Coionmeer ee Hematology Analyzer Basic ee 30 CD4 Counter Basic Flow Cytometry type Denta Dental Unit and Dental Basic Chair Solar System Basic 7 7 Setting Up a Maintenance System All RWs will strive to implement PPM and where possible set up a computerized PPM schedule This will require an up to date medical equioment inventory at all times Each RW shall maintain a computerized medical equipment inventory database for each health facility At the minimum a Microsoft Excel based database will be maintained by each RW All relevant information about the equipment must be entered including its location serial identification number manufacturer
75. ment vendors Hospital Administrators Regional Workshop Management Committee RWMC In order to bring together all stakeholders each RW shall hold a RWMC meeting at least twice a year in December and April Purpose The RWMC meeting will be a forum where stakeholders come together to share experiences and evaluate the performance of the RW The work plan budget and 28 maintenance schedules will be reviewed and approved for each year and or quarter The meeting will be chaired by District Hospital hosting the meeting while the RW will be secretariat for the meeting Frequency The RWMC meeting shall take place at least twice a year to coincide with the review of the quarterly annual report prepared by the workshop Manager Recommended participants The following stakeholders will constitute the RWMC membership gt gt gt gt gt Medical Superintendents Hospital Administrators of the beneficiary Hospitals DHOs of the beneficiary Districts 25 of the Heads of Health Sub Districts on a rotational basis Workshop Manager Representative of HID MOH Proposed Agenda for RWMC Meeting The following Agenda is proposed for the meeting VVVV WV Call to order and opening prayer Adoption of Agenda Self introduction Communication from the Chair Review of minutes of previous meeting and maters arising Report on maintenance activities by the Workshop Manager including quarterly work plan and budget
76. n express approval of the RRH Director and can be drawn from the petty cash and replenished immediately 4 3 Management of Medical Equipment Maintenance In the management of RW operations and Equipment Maintenance it is important to involve stakeholders especially the Users and Administrators This will helo each player to have a good understanding of WHAT to do WHEN to do it WHO is to do what and to agree on the necessary MEANS to do it The following scheduled reports and meetings will provide opportunities for engagement and sharing experiences and challenges of medical eauipment management e Quarterly reports e Workshop Managers meetings e RWMC meetings e RW Staff meetings RWs will implement 5S activities designed to improve the work environment safety and work flow This Manual has a Summarized description of 5S implementation steps for the workshop environment and it is attached at Annex 6 The detailed description of 5S implementation can be found in the 5S Hand Book and Implementation Guidelines produced by MOH 26 4 3 1 Preparation of Quarterly Reports The Workshop Manager shall prepare and submit Quarterly Reports to the ACHS HI through the Hospital Director every 15 day of the months of April July October and January of each year The quarterly report shall highlight the overall progress in implementation of planned activities and performance The quarterly report will contain the following gt P
77. ndex sticker calendar system or a computer programme may be used Where card sticker system is adopted it will be placed on the equipment in such a way that it Is visible Surveillance After the programme has been set up each RW will put in place a periodic surveillance system to ensure that records are legible and that all entries are being made Copies of Job cards and index cards shall be stored near the equipment Standard Maintenance Work Formats Maintenance records shall be collected and maintained using standardized formats that facilitate easy compilation of important information The formats will include the following information Reference ID number as per Inventory 2 Equipment Name 3 Manufacturer 4 Serial Number 5 Date of installation 6 Maintenance Frequency 7 Date of maintenance 8 Date for next Maintenance 9 Cost of maintenance and detail 2 Remarks on Functional status 46 7 7 6 Special Test Equipment Each RW will have a range of test equipment and tools to check the correct functioning of medical equipment and its compliance with electrical and other safety standards 7 7 7 Technical library Each RW shall maintain a fully stocked technical library with manufacturers maintenance manuals for various medical equioment and other relevant biomedical engineering literature and publications 47 Chapter 8 Periodic maintenance checklist for common equipment 1 Sphygmomanometer
78. ne reflect echoes back to the probe while pockets of liquid pass the ultrasound straight through The echoes are picked up and arranged into an image displayed on a screen The machine offers a number of processing options for the signal and image and also allows the user to measure physical features displayed on the screen This requires the machine to incorporate a computer Maintenance Checklist Care Wipe dust off exterior and cover equipment after use and Remove any items or foreign body from equipment Handling Wipe probe with alcohol free tissue or cloth Remove clean and dry external filter if present 70 Visual e Check that all fittings and accessories are mounted Checks correctly e Check that cables are not twisted and probe is safely stored Check that mains plug screws are tight Check that mains cable has no bare wire and is not damaged Function e If machine has not been in use run and test briefly Checks Troubleshooting a __ Sul DEE Equipment No power from Check power switch is on is NOT mains socket Replace fuse Check mains running power is working Electrical cable Repair or exchange the fault cable Try cable on another piece of equipment blowing cable fault technician 3 Probe head Possible internal Exchange probe damaged or fault noisy Image Gel insufficient Use more ultrasound gel quality poor Controls set Check controls for correct incorrectly positioning and operation refer
79. no improvement refer to a Technician 23 Pulse Oximeter Function A pulse oximeter is a device that non invasively monitors the oxygen saturation of a patients blood It measures the amount of oxygen in a patient s arterial blood during operations and diagnosis This level of oxygen or oxygen saturation is often referred to SpO gt measured in and this is displayed on the pulse oximeter A pulse oximeter also displays pulse rate How it works The coloured substance in blood haemoglobin is a carrier of oxygen and the absorption of light by haemoglobin varies with the amount of oxygenation Two different kinds of light one visible one invisible are directed through the skin from one side of a probe and the amount transmitted is measured on the other side The machine converts the ratio of transmission of the two kinds of light into a oxygenation Pulse oximeter probes can be mounted on the finger or ear lobe Maintenance Checklist Care and Clean the probe with alcohol wipe after each use Handling Unplug clean outside with a damp cloth and dry off Visual Check that all parts are present and connected Checks Check that cables are not twisted and remove from service if any damage is visible Tighten any loose parts If plug cable or socket are damaged replace Function Check operation of all lights indicators and visual Checks displays Check probe disconnection alarm 92 Equipment is NOT running S
80. o 125 Annex 6 5S Activity s Instruction for RWs 1 What is 5S 55 IS a management tool which originated from the Japanese manufacturing sector It is used as a basic fundamental systematic approach for productivity quality and safety improvement in all tyoes of organizations 5S is literally five abbreviations of Japanese terms with five initials of S There are Seiri Seiton Seiso Seiketsu and Shitsuke In English 5Ss were translated as Sort Set Shine Standardize and Sustain These are explained briefly below 1 Sort Remove unused stuff from your venue of work and reduce clutter 2 Set Organize everything needed in proper order for easy operation 3 Shine Maintain high standard of cleanness 4 Standardize Setup the above three So as norms in every section of your place by use of Standard Operating Procedures and checklists 5 Sustain Train and maintain discipline of the personnel engaged The five steps of Sort Set Shine Standardize Sustain are a sequence of activities to improve the work environment to be as convenient and comfortable as possible and thereby also improve service contents with respect to preparedness Standardization and timeliness 2 Practical hints for five steps The basic actions and practical hint for implementing5S are shown in the following page The principal example and practical hints are shown in the following page for every step of 5S 126 1S SORTING Elimination Basic
81. ol and strong chemical agents should not be applied to the hood Maintenance Checklist Cleaning Unplug clean outside with damp cloth and dry off Clean the access ports and temperature sensor Wash replace the air filters dry thoroughly for reuse Disinfect water chamber of humidifier Visual Check all fittings and accessories are mounted Checks correctly Check mains cable has no bare wire and is not damaged Check doors cable and tray Repair if damaged 80 Function Drain off the water tray Run machine for 30 minutes Checks to dry the tray Refill tray with sterile water before use Check all controls operate correctly Check the readings of thermometer and oxygen sensors change when breathed upon Check that batteries are working properly Troubleshooting EEE Incubator is No power from Check power switch is on NOT running mains Replace fuse socket Check mains power Electrical cable Try cable on another piece fault of equipment Repair by electrician if required bounas eame iaut gt vounlesnootsropery blowing cable fault troubleshoot properly Alarms NOT Alarm battery Replace the battery and working dead recheck Alarm off setting Check alarm setting Temperature Temperature Check the temperature NOT probe and sensor probes and sensor properly not working connections Replace the controlled temperature probe or sensor if required Incubator placed Move incubator if placed indirect sunlight or n
82. ounding and manual indicator flashing Manual indicator flashing accompanied by monotone alarm Manual indicator flashing accompanied by rapid pulsing two tone alarm Power failure Wrong Skin temperature reading Unable to provide stable control of skin temperature when In baby patient mode Troubleshooting Software has detected a fault Thermal cut out in head has switched open circuit due to overheating Fault in the control or power board Power switch is off internal fuses mains lead and internal harnesses defective Skin sensor Is damaged not inserted fully or not the right type Skin sensor is poorly attached to patient or heat path between patient and element is disrupted Alarm is sounding and mute button is not being pressed 83 Use information mode to obtain error code Reset thermal cut out and identify cause Replace defective PCB Switch on power replace fuse defective part or PCB Replace skin sensor Attach skin sensor in the correct position and ensure there is no heat path disturbance Press mute when warmer alarms This ensures heat is restored to the patient 19 Autoclaves Function Sterilization is the killing of micro organisms that could harm patients It can be done by flame or steam air flame or boiling or by chemical means Autoclaves use high pressure steam and sterilizers use boiling water mixed with chemicals to achieve th
83. out after stipulated time or workload e g bearings tubings All RWs shall endeavor to implement PPM and scheduling based on the principle of Problem oriented maintenance planning and budgeting to optimize utilization of the limited funds and human resources 39 Effective planning for preventive maintenance will involve careful selection of the equipment to be included in the plan Evidence based decisions must be made while deciding equipment to include in the maintenance schedule in order to reduce costs Maintenance planning shall always ensure that essential medical equioment for basic diagnosis infection control surgery and treatment are kept in good working condition The overriding considerations will always be safety efficiency and cost effectiveness 7 3 Corrective Maintenance Services Corrective maintenance refers to corrective actions undertaken in the event of breakdown of a piece of equipment In this case the equipment is repaired or calibrated after failure At all times medical equioment in use should be free from any fault regardless of how minor the fault is and all repair work should be performed by a competent technician The user department should 1 Record details of the defect 2 Fill in a Complaint Form Refer to Annex 10 3 Contact the RW technician who should in turn decide whether to carry out the repairs or to contact the maintenance contractor 4 Ensure that information regarding
84. pO gt Or pulse rate NOT displayed or unstable Probe off displayed on screen Error displayed on screen Continuous alarm sounds EN STE No power from mains socket Battery if present is discharged Electrical cable fault Probe is not mounted correctly Probe not able to read through dirt nail polish etc Patient movement Patient s SpO gt value is too low to be measured Probe is not connected properly The connection between the probe and oximeter is loose Faulty probe or control circuit Alarm limits set too low or high Power disconnected 93 Check power switch is on Replace fuse Check mains power is present at socket using equipment Known to be working Recharge or replace battery Try cable on another piece of equioment Connect probe and cable oroperly Remove grease dirt nail polish and clean probe Request patient to remain still Further clinical examination of patient Recite probe if necessary Connect the sensor Exchange cable Refer to user manual and troubleshoot by technician Set appropriate alarm limits Connect power cable 24 Slit Lamp Function A slit Lamp is used for observing the patient s eye The eyelid and anterior segment cornea iris ciliary body anterior chamber posterior chamber crystalline lens lens zinn s zonule anterior vitreous anterior sclera is observed in the low magnification Posterior segment posterior scle
85. r Depress the Foot Control to operate the activated hand piece Pressure is shown on the gauge for the hand piece being used To adjust the pressure to each hand piece turn the adjustment screw clockwise to decrease pressure or counter clockwise to increase pressure CAUTION When adjusting the hand piece pressure do not over tighten the screws To activate water spray turn the water ON OFF Toggle to the ON position Flow adjustment to the wet hand pieces is controlled by the controls labeled Flow Control To release the air of the unit arm activate the momentary toggle valve and adjust the height of the flex arm to desired position When desired position is achieved release the momentary toggle switch to lock the height of the flex arm CAUTION Do not attempt to adjust the height of the flex are without releasing the air brake valve Failure to release the air brake valve may cause damage 109 Cleaning Daily Cleaning Weekly Maintenance Checklist Purge the unit with air Remove hand pieces from the tubing Empty the water bottle then reinstall it if water bottle is applicable when using city water turn off water from the source Hold the hand piece tubing and syringe over a pail Turn the unit on wait a few moment and then operate the flush toggle syringe and foot control unit water is purged form the system Turn unit off Disinfecting the bottle Fill the bottle with 1
86. ra retina choroid posterior sclera is observed in high magnification with Ruby lens How it works By changing the slit width control knob or turning the aperture and slit length control wheel ideal slit width slit length and spot size can be achieved By turning the illumination unit or operating slit rotation control ring the desired position of the slit image can be obtained Before use diopter compensation and interpupillary distance adjustments are married out A focusing test rod is used to establish the proper microscope setting for each use The test rod is inserted in the hole in chin rest with the flat surface at the top of test rod facing the microscope 94 Care and Handling checks Function Checks Maintenance Checklist e Remove dust from the mirror and eye piece lens using camel hair brush Finger marks can be removed if necessary with minimum isopropyl alcohol and a cotton swab Dry with a facial tissue e Clean exterior surfaces especially the joystick glide plate by wiping with a soft dry cloth Do not use commercial or household cleaners e f the glass envelope is blackening replace the Halogen lamp e Slit width control adjustment loosen or tighten the small screw at the center of the control to change the amount of force required to turn the knob Should be tight enough to ensure that the slit does not close spontaneously e Check the applanation tonometer atOg 2g and6g positions e
87. rators procurement personnel accounts personnel and other Staff responsible for safe custody of hospital stores This category is involved in planning assets stores management procurement of spares and financial management e Medical equipment manufacturers and vendors The role of this category is to offer spare parts for the equipment they manufacture or sell and offer After Sales Services including contract maintenance services for specialized equipment 10 1 5 Definition of Medical Equipment Maintenance Medical equioment maintenance refers to a set of activities conducted on a medical equipment to keep it in optimum working It is divided into two major categories namely e Planned Preventive Maintenance PPM This refers to regular safety and performance inspection carried out on medical equipment to evaluate risk and reduce failure so as to enhance Its safety efficiency and reliability It involves cleaning regular function safety tests and making sure that any problems are picked up before they cause a breakdown PPM is recommended for most of the medical equipment lt will enhance the efficiency effectiveness and reliability of medical equipment and must be carried out at appropriate frequency as suggested by the manufacturer or workload e Corrective Maintenance or repair Corrective maintenance is a task performed to identify and rectify a fault on a broken down equipment machine or system to restore to
88. raws air from a bottle The reduced pressure in this bottle then draws the fluid from the patient via a tube The fluid remains in the bottle until disposal is possible A valve prevents fluid from passing into the motor itself Maintenance Checklist Care and e Wipe dust off exterior of the equioment and bottle cover Handling e Wash bottle and patient tubing with sterilizing solution e Wipe round bottle seal with damp cloth replace if cracked e Remove dirt from wheels moving parts Visual e Check if all fittings amp accessories are mounted correctly Checks e Check if filter is clean e Check if parts are fitted and replace any cracked tubes e Check if mains cable has no bare wire and is not damaged Function e Check that all switches and vacuum control operate Checks correctly e Check for air and liquid leakage 58 Troubleshooting 1 Machine is No power from NOT running mains socket Fuse blown Electrical cable fault Tube seal bottle leaking or Disconnected Air outlet valve blocked Control valve stuck Internal or control error Blocked filter or tube Poor fluid flow pressure gauge low 2 3 Poor fluid flow oressure gauge high Filter discolored Electrical shocks Manual suction Is jammed 59 Check power switch is on Check mains power Check for leaks or short circuits causing the fuse to blow and correct this Replace fuse Try cable on another piece of equioment to rul
89. ray is removed and water is drained out to allow for a fresh procedure to take place Maintenance Checklist Care and After every use wash and clean with vim Handling Scrub scale lime deposits and wash with vim Change water every after use Clean and dry boiler when not in use Visual Check for scaling on element and chamber checks Check for loose nuts on cover and drain tap Check firmness of electrical connections of top plug and socket Function Checks Use trouble shooting guide step by step approach Ensure thermostat operates and element heats Ensure switches are functional Check functionality before next use Troubleshooting Equioment NOT heating Water takes long to boil Heating elements keep blowing frequently Much steam escapes No power at mains socket Fault on electric cable Heating element blown Thermal safety switch tripped One element faulty for more than one element Scale deposits on the element Thermostat wrongly set Much scale deposits Little water in the chamber Faulty safety switch Faulty thermostat Lid cover does not close well Drain valve does not close well Many items in the boiler chamber 89 Replace fuse Replace power cable Replace heating element Reset circuit breaker Switch on mains Reset safety switch Check one of the elements replace Remove scale deposits Adjust thermostat setting De scale heating
90. repair iv Subsistence costs while on maintenance trips i e Per diem lunch allowances v RWMC Meetings vi Workshop Managers Meetings vii Training for users and workshop technicians viii Replacement of essential tools and consumables ix Office stationery and supplies x Maintenance of office equipment xi Payment for telephone water and electricity bills Preparation of Quarterly Maintenance Schedules As one of the planning tools each RW will prepare a quarterly maintenance schedule The maintenance schedule will identify the Health facilities to be visited allocated time and human resources The quarterly schedule shall be prepared after confirming the available funds and prioritized planned activities for the quarter The RW manager shall send out the maintenance schedule in good time to allow the Health facility managers plan and mobilize the staff to avail the equipment that needs maintenance The maintenance schedule should be followed as much as possible by the RW to ensure efficiency and cost effectiveness 25 4 2 4 Budgeting for Emergency Works There will always be cases of critical equioment breaking down and the RW would be expected to respond immediately To cater for such incidences a contingency 10 to15 of the overall quarterly budget allocation should be provided for in the quarterly work plan to cater for emergency callouts The contingency funds should be spent on a case by case basis o
91. s Record all accidents absences sickness and other health related events Plan annual work schedules including sufficient training periods 5S training for all staff members TO Holding monthly WIT meetings helps 5S facilitators organize engaging 5S maintain 5S activities workshops 133 Annex 7 Quarterly Report General Form Hoima Medical Equipment Maintenance Workshop Date D M Y 10 01 2014 To Assistant Commissioner Health Infrastructure MOH Thru Director of Hoima Regional Referral Hospital CC All Medical Superintendent and Hospital Administrator of Health Facilities in Hoima Region Re Hoima Medical Equipment Maintenance Workshop Quarterly Report This is a Summary report of the activities of Hoima Workshop during October December 2013 This report is composed of 1 Activities carried out during the last quarter 2 Expenditure during the quarter 3 Work plan and budget requirement for the pending work Annex 1 Job Card Records Summary Annex 2 Job Card Record for each health facilities Annex 3 Work Plan for next quarter 1 Report on Maintenance Activities A number of maintenance activities were carried out in the following health facilities during the period RRH Hoima Kiboga Mashindi Kagadi Kiryandongo Buliisa Bwijanga Kibaale Kakumiro Kakindo Bukomero Kikuube Detailed activities are shown in the attached Work Record 2 Report on Other Activities Other activitie
92. s were carried out during the period as described below RWCM meeting Meeting held in Kagadi Hospital Inventory update 2 GHs and 3 HC IVs were updated 5S activities in WS The spare parts store was cleaned and improved User Tech training User training was held for 20 nurses on theater equipment 2 technicians were trained on Laboratory equipment in Fort Portal 3 Report on Expenditure The following table shows all expenditure for the period and details are in Annex 1 RWMC Meeting User Training Seminar Reference Amount Revenue Annual work plan allocation for Quarter Annex 1 Spare Parts Annex 1 Fuel Expenditure Operalionalcost D Electricity Water Office stationary Paper Toner Grand Total Grand Tota Detailed information on fuel consumption is available on previous quarterly report work plan 134 4 Work Plan and budget requirement for the next quarter Work plan for the next quarter is attached for perusal Annex 2 The cost of necessary spare parts for pending work is available in the work record Annex 1 Maintenance needs for health facilities is based on the latest health facility equipment inventory update The estimated cost of spare parts for the planned activities is indicated in the list Any emergency repair shall be handled on a case by case basis Total budget requirement for next quarter activities is summarized below Revenue PS fe Annex 1 Spare parts Annex
93. ssed through forming an image of the interior of the body Bone appears nearly white because few X rays strike the corresponding part of the film leaving it largely unexposed soft tissue allows much more radiation to pass through darkening the film in those places Users must ensure proper radiation safety protocols and supervision Is in place Control panel and transformer not shown 68 Maintenance OEA Handling Clean all dust and dirt from the X Ray machine and room Visual Check that all parts are present and connected Checks Check that cables are not twisted and remove from service if any damage is visible If any plug cable or socket is damaged refer to distributor Check lead aprons for any defects Check table cassette holder amp grids for smooth movement Function Switch on power and check all indicators function Checks If machine has not been in use wear lead apron and check whether exposure indicator lights on switch operates Check collimator bulb replace with correct type if needed Check power supply voltage and regulation Check protection earthing for the Equipment Check that internal earth connections are firm LTSUBIEENSOUNS M ee se X Ray unit Mains power not Check the machine is plugged into does NOT connected the mains socket and that all switch on switches are on Replace fuse Check if mains power is present at socket using equipment known to be working Rewiring by electrician Safety interloc
94. sts of two lenses the objective and the eye piece and a light source with a condenser Rays from a light source are directed into a condenser which then brings them to a common focus on the specimen The light rays then pass through the objective and produce a primary image in the focal plane of the eye piece The eye piece magnifies the primary image and brings it into focus with the retina of the eye The objective and eye piece are systems of lenses where the distance from each other is fixed by the mechanical length of the tube To adjust to form a clear image either the specimen stage or tube as a whole has to be moved by means of coarse and fine adjustment drives The light source of a microscope can be either natural or artificial light 98 Storage Care and Handling Maintenance Checklist Should be kept in a dry room at temperature between 5 C to 35 C After use cover it with dust covers Dust can be brushed off with a small paint bush Clean dirty lenses with lens tissue or soft clean cloth Breathe on the lens before wiping It If the pollution of the lenses is heavy use 2 to 3 drops of xylene on tissue paper Check all cleaned lenses with a magnifier inverted eye piece Clean oil immersion objective immediately after use with absorbent paper Clean the body and housing with a soft cloth Apply petroleum jelly on the rack and pinion when required Troubleshooting BEINEN SEEN DE BEINE ESSEN re Light source e Ch
95. t Staffing levels for medical equipment maintenance in Districts is stil quite low There is also a country wide shortage of Biomedical Engineering human resource in both private and public health institutions The RWs support health facilities in the relevant districts to carry out periodical maintenance and repair of medical equipment 17 Chapter 3 Function Operation and Role of RWs In line with the 1999 policy recommendations of NACME a maintenance structure consisting of the CW and RWs was established in Uganda to cater for medical equipment maintenance in Health facilities countrywide A RW is established as one of the support services sections under the RRH In terms of set up it consists of Workshop building with office space stores and work area See Annex 1 for Standard Floor Plan of a RW Mobile workshop vehicle Tools Test Equipment and Office Furniture See Annex 2 for List of Tools Test Equipment and Furniture Staff consisting of Assistant Engineering Officers Engineering Technicians and Artisans MOH Hospital Director nd Nursing Clinical tion Department Department E Finance amp Procurement General rh Accounts amp Store Administration ring Officer Assistant ring wie Fig 3 RWs Macro Organogram 18 Operationally the teams of technicians from the RW visit Hospitals DHO s stores and HCIV to carry out equipment maintenance on site For HCII and HCIll the faulty medical equipment is
96. t for Common Equipment 32 types of Equipment teere 48 Standard Floor Plan of a Regional Workshop Recommended WS Tools Test Equipment and Furniture stickers Form Equioment Condition A F Medical Equipment Inventory Form Template of Work Plan Preparation 5S Activity s Instruction for RWs Quarterly Report General Form Job Card Form Support Supervision amp Monitoring Sheet Complaints Form Foreword The main mission of the Ministry of Health is to ensure provision of comprehensive Healthcare Services to the Ugandan population and the Government is committed to ensuring efficient safe and effective Healthcare delivery A substantial proportion of the Health Sector budget is spent on acquisition of Medical Equipment To ensure that available Medical Equioment safely serves for a long time it must be managed efficiently The way in which it is used and maintained may greatly affect its reliability and hence the quality of Healthcare delivered to patients Appropriate periodic preventive and corrective maintenance is key to achieving safe and cost effective management of medical equipment It is important therefore that measures are taken to ensure that medical equipment is maintained and cared for by the Healthcare workers in order to maximize the investment made in its acquisition For effective maintenance to be carried out by the maintenance team adequate operation and maintenance funds should be budgeted and allocated Th
97. t simultaneously measures counts and analyses multiple characteristics of single cells or particles such as CD4 One of the lymphocyte The CD4 count data provides important information for staging and monitoring patients infected with HIV AIDS The software provides an automated analysis without operator s intervention The normal CD4 count is 1 000 cells mm3 and this count is lower for HIV infected patients How it works The tissue sample is broken up into single cells and held in a test tube which is placed into the flow cytometer The liquid containing the cells is drawn up from the test tube and pumped to the flow chamber flow cell Cells flow through the flow chamber one at a time very quickly and are presented to one or more light sources Lasers A small laser beam of very bright light hits the cells as they pass through the flow chamber The pattern of light scattering is dependent on cell size and shape giving relative measurements of these cellular morphological characteristics as cells flow through the beam Forward scatter measures light scattered in the direction of the laser path and measures the size of the cell Side scatter measures scattered light at 90 degrees to the laser path and measures the cell granularity The light detector processes the light signals and sends the information to the computer Each type of cell in the immune system has a unique combination of forward and side scatter measurements allowing count o
98. t the mains cable has no bare wire and is not damaged Before use run a brief function check before clinic Check that adequate supply of printing paper oil batteries etc are available Check that all switches operate correctly Troubleshooting i IE Equipment is NOT running No power from Check power switch is on mains socket Replace fuse with correct voltage and current rating if blown Check mains power is present at socket using equipment known to be working Contact electrician for rewiring If power not present Try cable on another piece of equipment Contact electrician for Electric cable repair if required fault 2 Fuse keeps Part malfunction Refer to a technician ee De shocks 67 11 General X Ray Machine Function X Ray machines are used for imaging bones and hard tissues and diagnosing fractures joint defects choked lungs etc Sometimes contrast agents are also used to highlight any defects in the abdomen under X rays How it works X rays are high energy electromagnetic waves The transformer produces a high voltage that directs electrons onto a target in the machine head X rays are produced by the target and are directed Into beams by a collimator towards the human body Soft body tissue absorbs less X rays i e more radiation goes through whereas bone and other solids prevent most of the X rays from going through A photographic film or electronic sensor displays how much X ray has oa
99. ted or low oxygen or obstructed alarm is on Defective capacitor Concentrator is humming but can NOT start Dirty filters light persists for more than 5 min with or without audible alarm 63 Check mains switch is on and cable inserted Replace fuse Press reset button if present Replace battery and test as above Place tube under water and look for bubbles If bubbles emerge steadily gas is indeed flowing Check tubing and connectors are fitted tightly Remove tubing flush through and dry out before replacing Replace meter bottle or refer to a technician Remove any obstruction caused by drapes bedspread wall Clean filters Turn unit off using standby oxygen system Restart unit after 30 min Electric shocks Wiring fault Refer to an electrical technician Test with a multi meter and replace Clean or replace the filters 9 Oxygen Cylinders and Flow meters Function Medical gases such as oxygen nitrous oxide etc are intended for administration to a patient in anaesthesia therapy or diagnosis An oxygen cylinder is a cylindrically shaped metal container used to store oxygen that has been compressed to a very high pressure Oxygen cylinders which come in different sizes are usually coloured black with a white top In some cases it may be a small cylinder that is entirely black The black colour helos to differentiate it from other gases that are stored in similar containers Cylinders are fitted
100. tem not charging or regulator has over heated Low battery charge Charge regulator short circuiting The inverter could be off The circuit breaker could have tripped 113 Replace the fuse Check the regulator functionality and ensure solar panels are not shaded or clogged by dirt Disconnect loads and allow the battery enough time to charge and if it fails replace the battery Replace the charge regulator Switch on the inverter Put back the breaker to the on position Trace for overload and disconnect Annexes Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 Annex 7 Annex 8 Annex 9 Annex 10 Standard Floor Plan of a Regional Workshop Recommended WS Tools Test Equipment and Furniture stickers Form Equipment Condition A F Medical Equipment Inventory Form Template of Work Plan Preparation 5S Activity s Instruction for RWs Quarterly Report General Form Job Card Form Support Supervision amp Monitoring Sheet Complaints Form 114 Annex 1 Standard Floor Plan of a Regional Workshop MAIN WORKSHOP EQUIPMENT STORE VERANDAH 115 Annex 2 Recommended WS Tools Test Equipment and Furniture Tools and Test Equipment Tool Kit Electronics Tool Kit Plumber 2 Tool Kit Refrigeration Welding machine heavy duty Workshop stool EA BAR ecm 9 Workshop protective wear pant and shirt 10 ale Era 13 Workshop shoes Heavy
101. the RRH monitor the activities of the Workshop 13 In your view is this Suppor Supervion adquate 4 Is 5S implemented well inthe Workshop TT Comments on Support Supervision FINANCING 1 Does the Workshop receive enough funds for maintenance i 2 Does the Workshop provide accountabity of funds received Re 3 In your view are funds received for maintenance adquate el Comments on Support Financing REFERENCE MANUALS 1 Does the Workshop access operation manuals for All equipment Ft 2 Does the Workshop have access to service manuals of major equipment 3 Is there a technical reference library in the workshop a Comments on Refernce Manunuals 137 Annex 10 Complaints Form Complaints Form Date Hospital Health Unit Complaint No Department Room Name of Equipment Model Serial No Sticker on the Equipment A B C D E F to be circled Complaint being Reported Reported by Name Title Date 138
102. ties under their catchment area To date there are nine 9 RWs located at Arua Lira Gulu Soroti Mbale Hoima Fort Portal Kabale RRHs and Central Medical Equioment Maintenance Workshop Wabigalo in Kampala The Central Medical Equioment Maintenance Workshop CW was established under HID and is a referral workshop for all other RWs ARUA RW LIRA RW BEE RW FORT PORTAL RW asica NN Fig 2 Location and Catchment Areas of RWs 16 2 4 National Referral Hospitals NRHs At the National Referral Hospital level the Engineering and Administration Departments are responsible for equipment management The Hospitals have a fully fledged Engineering Department that works independent of the RWs 2 5 Regional Referral Hospitals RRHs At RRHs the management of medical equipment is the responsibility of the Hospital Administrator and respective RW Manager While the RWs are part of the Hospitals they have responsibilities to maintain medical equipment in all the health facilities in their catchment area This is one of the outreach services of the RRHs 2 6 District Health Services At the District level the management of medical equipment is the responsibility of the DHO and the respective in charges of the Health Facilities District Engineers in Local Governments assist the DHO to plan for health infrastructure development and managemen
103. tify HP RWS Trip Contingency Other identify Spare Parts GRAND TOTAL BEE Se New equipment sticker A B C D E F pin oe Hospital stamp Endosed by Hits Signature Note 1 Cost of spare parts and other costs are for monitoring maintenancce cost only 136 Annex 9 Support Supervision amp Monitoring Sheet Name of RW elek Name of RW Manager a2 ee Evaluation Period a eee eee ees Dale nen a re Name of Evaluator x eee eee ee eee Designation zer sanieren Areasto be evaluated Evaluation Criteria Yes Monitored MAINTENANCE WORKSHOP 1 Is Workshop Space adquate OO A 2 Are the Workshop premises clean E 3 Does the Workshop have basic tools and equipment WEN Comments on Workshop premises MAINTENANCE SERVICES 1 Does the Workshop maintain Inventory TS 2 Does the Workshop maintain a record of alljobs done 3 Does the workshop hold RWMC Meetings S 4 Are there Quartely ReportstoH ss Comments on Maintenance services MINTENANCE PERSONNEL 1 Is the available personnel according to MoH establishment i 2 Does the staff have minimum academic qualifications ie E 3 Does the staff attend regular refresher training N Comments on Maintenance Personnel SPARE PARTS 1 Does the Workshop receive regular supplies of spare parts a 2 Are spare parts availabel in Uganda a ii Comments on Spare parts SUPPORT SUPERVISON 1 Does the Workshop receive Support Supervision fromHI 2 Does
104. tion of Annual Work Plans and Budgets Preparation of RW Annual and Quarterly Budget Preparation of Quarterly Maintenance Schedules Budgeting for Emergency Works Management of Medical Equipment Maintenance Preparation of Quarterly Reports Workshop Managers Meetings Regional Workshop Management Committee Internal Workshop Staff Meetings at Workplace Procurement and Disposal of Goods and Services by RWs ae a a Ya nie EA AA A EONA ee a 32 Management of Procurement by RWs Determination of Spare Parts Needs Procedure of Purchasing Spare Parts Stores Management by RWs Disposal of Un Necessary Items Support Supervision Monitoring and Evaluation of RWs Sills ay Sah Uae Sn Sel EEE fl E ad se i E oak ah a VEN TTD 37 Support Supervision Policy for RWs Chapter 7 1 1 Tae 1 8 7 4 1 9 7 6 Eel Caen Folie le 7 7 4 1 1 8 1120 Peek Chapter 8 Annexes Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 Annex 7 Annex 8 Annex 9 Annex 10 Guidelines for Medical Equipment Maintenance 39 Introduction Planned Preventive Maintenance Corrective Maintenance Services Maintenance Policy Levels of Maintenance Range of Medical Equipment that can be maintained by RWs or Outsourcing Setting up a Maintenance System Routine Maintenance Procedures and Work Flow Charts Personnel Reminder System Surveillance Standard Maintenance Work Formants Special Test Equioment Technical Library Periodical Maintenance Checklis
105. to user manual Mains voltage Is Use voltage stabilizer too low 5 Display software fault Turn machine off and restart computer If problem persists refer to error distributor s technician Electrical Wring problem Rewiring repair by a shocks technician 71 13 Electrosurgical Units ESU Diathermy Function Electrosurgery is the application of a high frequency electric current to biological tissue as a means to cut coagulate desiccate or fulgurate tissue Its benefits include the ability to make precise cuts with limited blood loss in hospital operating rooms or in outpatient procedures Cautery or electrocautery is the application of heat to tissue to achieve coagulation Although both methods are sometimes referred to as surgical diathermy this chapter avoids the term as it may be confused with therapeutic diathermy which generates lower levels of heat within the body How it works In electrosurgical procedures the tissue is heated by an alternating electric current being passed through it from a probe Electrocautery uses heat conduction from an electrically heated probe much like a soldering iron Electrosurgery is performed using an electrosurgical generator also referred to as power supply or waveform generator and a hand piece Including one or several electrodes sometimes referred to as an RF Knife or informally by surgeons as a Bovie knife after the inventor Bipolar electrosurgery has the outward and r
106. ulty regulator Cylinder is not connected to regulator properly Faulty or missing washer Flow meter seal damaged or loose Cylinder faulty Leakage too small to be heard Faulty flow meter Faulty pressure gauge 65 Replace cylinder Open valves then check flow meter registers flow Close all valves and replace regulator Tighten all fittings Replace washer Tighten flow meter Label Faulty and return to manufacturer Apply detergent solution NOT oily soap to joints Bubbles will show at leak point Clean replace washer and tighten at that joint Close all valves disconnect flow meter and clean inside Reconnect and test Refer to biomedical technician for Replacement 10 Electronic Diagnostic Equipment General Function There are many pieces of equipment in a hospital that use electronics for operation The maintenance of such equipment is a task for specialized and trained staff However regular inspection and cleaning will helo such equioment last for a long time and operate safely These are tasks that the equipment user can carry out and should be done regularly as laid out on the checklists The type of equipment that is included in this category are for instance audiometers blood gas analyzers cardiac monitors cryoprobes infusion pumps and stimulators The steps in this section can also be applied to most laboratory equipment How it works The electrical part of the machine is th
107. unior Hammer ball pein 100gr 1 oz Key hexagon metric set 9pc 1 5 10mm Key hexagon set imperial 9oc 5 64 3 8 Magnifying glass pocket type Mirror inspection Pliers combination 180mm 7 screwdriver flat blade 3 5mm shaft 75mm Screwdriver flat blade 5 5mm shaft 100mm Screwdriver flat blade 6 5mm shaft 100mm Screwdriver flat long shaft blade 4 0mm shaft 250mm Screwdriver flat screw gripping blade 6mm shaft 200mm screwdriver Pozidriv No 0 60mm Screwdriver Pozidriv Long shaft No 1 250mm Screwdriver Pozidriv Long shaft No 2 250mm Screwdrivers jewellers set crosshead Screwdrivers jewellers set flat blade Shears light duty L 190 D 4 5 Spanner adjustable small 155mm 6 jaw 20mm Spanner ring flat metric set 8pc 8 19mm Brush cleaning 12mm 260mm Snipper set 8 Allen key set metric amp imperial 9 Precision screw driver set No CH Te Ex 119 No 4 Tool Kit Medical Equioment 1 1 Sg Pliers long nose 170mm 8 Stripper wire standard 170mm 10 1 1 1 brief 1 1 ei O t1 r lt 1 1 1 Box tool brief case type 500 x 380w x 150h mm File half round second cut 150mm 15 Hacksaw Junior 16 Key hexagon metric set 9pc 1 5 10mm 17 Magnifying glass pocket type 1 12 13 14 18 Mirror inspection Pliers combination 180mm 7 Wrench adjustable medium 350mm _
108. velooment Partners 23 4 2 1 Process of Preparation of Annual Work Plans and Budgets The budgeting process starts in October of every year when the MoFPED sends out a budget call circular Each RRH makes an annual work plan and the RW work plan and budget is part of it The RRH submits the work olan and budget to MOH for onward submission to MoFPED which makes budgetary allocation for various Ministries and or Departments During this time the Workshop Manager should prepare and submit the RW priorities and budget requirements to the Hospital Director for incorporation in the overall work olan for the RRH 4 2 2 Preparation of RW Annual and Quarterly Budget since funds are disbursed to RWs on a quarterly basis planned activities should be scheduled across the year in a logical manner Identify routine activities that are repetitive and spread them across each quarter and add other activities that can be carried out in the available time and allocated funds for each quarter While it is usually normal to divide the annual budget allocation by 4 it IS Important to critically look at the processes and inouts i e time human resources and finances needed to realize planned activities The RW budget should provide for the following i Procurement of spare parts and maintenance workshop supplies ii Labour cost including outsourced services 24 4 2 3 ii Mobile workshop operational costs i e fuel tyres servicing and
109. ventilation hole a timer ee a thermometer are also fitted For the Lab the thermometer controls the required temperature with the ventilation hole open to allow steam escape During sterilization the temperature Is set high for a longer time to allow complete destruction of bacteria Maintenance Checklist Care and Disconnect from power supply prior to cleaning Handling Clean the exterior case and interior chamber with a moist cleaning cloth Dry the equipment thoroughly Remove shelves and immerse in water and clean completely and then dry shelves thoroughly Never use benzene or paint thinner for cleaning Visual Use a properly grounded electrical outlet checks Ensure that outside of unit and power cord are clean and not damaged Ensure that internal chamber is clean 86 Ensure that the Heater element air inlets vent outlets control enclosures door latches and hinges are clean Function Check that Temperature control sensor is not Checks damaged Check that circuit breakers amp switches are operational Check predetermined setting and temperatures Significantly higher temperature could indicate temperature controller is failing Troubleshooting Fault Possible causes Solution 1 Erratic Defective circuit board Repair or replace new temperature one Dirty sensor Clean the sensor 2 Can NOT Defective circuit board Replace new one heat Burnout heater Replace heater Defective triac Replace triac Air leakage Lo
110. vercharge too much current into the battery of the battery by automatically disconnecting the solar panels when the battery is fully charged It disconnects loads to prevent battery discharge draining of the battery beyond safe levels Battery t stores electricity generated by the solar panels for use when required Inverter t converts the direct current DC from the battery into alternating current AC and supplies it to operate AC appliances AC and DC loads Appliances These are the AC and DC loads that use electricity Other Accessories Distribution board Circuit breakers Cables These are used to interconnect control and protect different components against damage 112 Care and Handling Maintenance Checklist Clean the surface of the panels with water and soft cloth to remove any dirt Clean the battery terminals of any dust sulohate deposits and apply a thin layer of Vaseline to avoid corrosion Ensure that all the lights are switched off every morning Visual Check that all LED lights are functional checks Check that the solar modules are not cracked or shaded Function Check that the LED lights system operation Checks information light and state of charge on battery light in the morning and evening are green Troubleshooting system operation Status LED light in Red Both LED lights are green but no power output 2 Battery status light in Red Fuse is blown Sys
111. y by all staff of the workshop on a rotational basis including the workshop manager Note 1 Daily meetings should last not more than 30 Minutes 2 Meetings held on Weekly basis should not last more than 1 hour 31 Chapter 5 Procurement and Disposal of Goods and Services by RWs While RWs will get involved in procurement and disposal of medical equipment this is not their core function This is the function of the respective Heads of the Health facilities and the Procurement and Disposal Units PDU Their role in medical equipment procurement should be limited to e Review and or provision of technical specifications e Inspection and testing to confirm conformity to contract technical specifications and functionality e Installation and commissioning e Recommending medical equipment for decommissioning and disposal based on technical considerations e g age obsolescence lack of spare parts reliability and safety For day to day workshop operations the RWs will be involved in procurement of medical equipment spare parts and maintenance services In this case the workshop staff will be involved in procurement processes as a User Department 5 1 Management of Procurement by RWs Procurement of spare parts and services by RWs will be guided by the Public Procurement and Disposal of Public Assets Authority PPDA the Regulation thereto and guidelines in force All RW managers need to acquaint themselves with PPDA guidelines
112. yokes Cylinders not technician seated properly Over tightening of the Repair by technician or needle valve or sticking outsourcing service of the float ball Electrical Wiring fault Rewiring repair by electrician shocks immediately 79 4 Machine Poor seal commonly Clean leaking seal or gasket has leaks occurring around tubing replace if broken 17 Infant Incubator Function Infant incubators are classified into closed type and open type An infant incubator is intended to hold a neonate born prematurely or with some disabilities for life support The closed type of incubator is applied in the case of treatment of neonate jaundice The open type Is often used to facilitate the surgical treatment for neonates who have undergone surgical operation Humans feature excellent homeostasis of body temperatures Since homeostasis of neonates is lower keeping of the body temperature is essential for the neonates Premature and impaired neonates have further lower homeostasis and thus incubators are indispensable for sustaining their life How it works In practice Incubators cannot be applied in the environment where the outside air temperature exceeds the body temperature TO keep a certain temperature every incubator is furnished with a heater and a fan motor for air circulation For the motor hour meter management is essential Note The hood in the closed type incubators is often made of acrylic material therefore alcoh

MINISTRY OF HEALTH Health Infrastructure Division

Contents

Download Pdf Manuals

Related Search

Related Contents