**3. Performance measurement and maintenance productivity in medical equipment**

Performance measurement is a key management tool. In terms of maintenance management, an essential issue is to ensure that the planned and executed maintenance activities have given the expected results. Efficient use of indicators can facilitate this fact. Such an indicator, represented by key performance indicators (Kpi) is able to evaluate important aspects of the maintenance function. To this end, it has been shown that the measurement of maintenance performance is dominated by delay indicators (equipment, maintenance costs and safety performance).

The reduced use of the peak indicators in the maintenance process can also be observed. The obtained results did not show direct correlations between the maintenance objectives pursued and the Kpi used. Subsequent analyzes revealed that only a small part of the companies involved have a high percentage of decisions and changes caused by the use of Kpi and only a few are satisfied with their performance measurement systems. By analyzing the correlation, a strong positive linear relationship was identified between the degree of satisfaction and the changes/decisions of the process that are triggered by the use of Kpi, the people least satisfied with the least decisions and changes triggered by the use of Kpi. These observations indicate some inefficiency of performance measurement systems in improving driving performance [11].

The components of a system, such as pumps, electric or hydraulic motors, transmission systems, etc. as integral parts of it, must operate at optimal parameters to ensure that the overall performance of the device is achieved. Addressing the maintenance problems and establishing the procedures and the maintenance strategy for equipment must therefore take into account both monitoring and diagnosing at the level of each component, but also the influence of the system variables. Most of the time, the cause of a defect is found in the variations of the process parameters, and a nonintegrative approach to monitoring and diagnosing the system can lead to inefficient actions. Thus, in addition to the most popular techniques of monitoring and diagnosis (vibration monitoring, thermography and tribology), other parameters of a system such as flow rates, voltages, currents, temperatures, etc. must be considered.

In systems equipped with computer control or semiautomatic control, most of these parameters are purchased and used in the command and control process. Their type and number vary from system to system, but the algorithm for applying the monitoring and diagnostic procedure is similar. The collection of these parameters, together with the application of the traditional technologies of predictive maintenance, will provide all the necessary data for the analysis of the state and the performances of the system [12].

Since a large part of the equipment used in the medical field belongs to the category of electromechanical systems, the analysis of the maintenance technologies will focus on these, from the simplest (examples: electric motor-pump type drive systems) to complex devices.

It should be kept in mind that, in any system, the maintenance program will focus on its critical components. A critical component is defined as the element directly involved in the proper functioning of the device, on which the entire system depends, its efficiency and, last but not least, the quality of the product.

Some of the technologies for monitoring and diagnosing the state of a system are set out in the following. Vibration analysis is one of the most widely used detection methods to diagnose defects in electromechanical systems. This method measures the vibrations of the system, usually with an accelerometer, and then examines the frequency spectrum generated to identify significant frequencies from the point of view of the state of the equipment. Certain frequencies are typical of the system in normal operation. Changing the amplitude of certain harmonics, for example, can mean the presence of a defect. The data can be collected periodically, using a portable system, or continuously, by installing a continuous monitoring system. A major advantage is that the measurements are fast and noninvasive, and the functioning of the tested system is not disturbed [13].

Another key parameter that can provide information about one's status of equipment/system is temperature. This is an important indicator of the mechanical, electrical or load conditions applied to a component. Thermography is a predictive maintenance technique that uses instruments that can monitor infrared energy emission to determine operating conditions.

Infrared scanning is recommended as a regular maintenance procedure in many situations, extracting solid results as quickly as possible and without interrupting process flow, a key benefit to the industry, regardless of the age of the equipment. As an advantage of scanning a large area in a very short time, the ease with which data can be stored and processed for further analysis of images, the high mobility of the thermography camera that can be positioned at any time and place, the thermographic evaluation that is done uninterrupted and equipment inspection staff who are out of danger are emphasized.

Lubrication fluid analysis can be used to determine mechanical wear, lubrication or fluid condition. The presence of metallic particles in the lubricating fluid suggests the existence of a wear, their analysis providing information on the part subjected to wear. For fluid analysis, it uses complex equipment, which is why this method is not so often used in practice.

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*A Modern Approach for Maintenance Prioritization of Medical Equipment*

**4. Classification and prioritization of medical equipment for** 

This strategy prioritizes the training of technicians to maintain an optimal number of actions, very important for essential medical equipment frequently used

Prioritization of medical equipment maintenance should be performed for each new type of device during the inspection received when the device is added to the inventory. The device will then be assigned a test frequency. Subsequently, the maintenance history of the device will be monitored to evaluate the effectiveness of

The end point of providing an organizational tool to the biomedical or clinical engineer would ensure the safe and efficient performance of medical equipment.

• Implementation and management of quality and safety protocols and proce-

• Routine procedure planning, such as acceptance testing, preventive mainte-

cal staff including biomedical engineer or clinical engineer [14]

• Management and monitoring of training provided by manufacturers or techni-

The risk assessment was divided into four main areas: clinical function, failure avoidance probability, history of incidents and regulatory or manufacturer requirements. Devices would be evaluated on the aforementioned criteria and be assigned a score. The values would be added and a cumulative score is given for each device type. The total score would act as a quantifiable indicator for the maintenance policy. A total score of 12 or more would indicate a semiannual testing, a score between 9 and 11 would require annual testing, whereas a score of 8 or less would suggest a lesser necessity for annual testing, either biannual or no schedule, depending on clinical use. The end result would be an increase in the cost-effectiveness of the test program, less equipment downtime leading to improved patient care and a higher

To illustrate the applicability of risk assessment criteria, we evaluated two types of devices extensively used in healthcare: the defibrillator and the enteral feeding pump. Defibrillators are devices that correct or prevent arrhythmias (e.g., ventricular fibrillation and ventricular tachycardia) by sending an electrical impulse to the heart. External defibrillators, in particular, send high electrical impulses through the thoracic wall, stopping the independent action of the individual myofibers, so that the intrinsic pacemaker can take over. A set charge, between 0 and 360 J, is generated and delivered through paddles or disposable electrodes through the chest wall to the heart, determining a global contraction. Most defibrillators include an electrocardiograph to monitor the patient's rhythm, while others even include the

• Data management for medical devices, manufacturers and suppliers

*DOI: http://dx.doi.org/10.5772/intechopen.92706*

in medical institutions.

**maintenance activities**

the maintenance program.

• Acquisition conditions

The system must be evaluated on criteria such as:

dures, including necessary documentation and data

• Carrying out corrective maintenance activities

nance, quality and safety inspections

financial return to direct patient care activities.

*A Modern Approach for Maintenance Prioritization of Medical Equipment DOI: http://dx.doi.org/10.5772/intechopen.92706*

This strategy prioritizes the training of technicians to maintain an optimal number of actions, very important for essential medical equipment frequently used in medical institutions.
