Systematic literature review on improving healthcare through proactive maintenance and fault detection in medical equipment

Adequate equipment maintenance is necessary to ensure efficient dental care facilities and satisfactory medical equipment performance. This study aimed to assess maintenance practices and manpower adequacy in private dental centres (DCs) across Riyadh, Saudi Arabia. A questionnaire was designed to evaluate equipment maintenance and manpower strength based on international and national standards. Thirty-three private DCs were visited in-person with the designed questionnaire to conduct the study. The Chi-square test and t-test were performed. Only 21 dental centres had a scheduled maintenance plan for medical equipment, whereas the rest had no plan. Furthermore, only 22 DCs maintained equipment maintenance records, while 11 DCs did not have any records. Additionally, the study found a lack of trained personnel to handle medical equipment and overall inadequate maintenance practices. Significant differences were observed between the responses for many questions (p< 0.05). These findings increase health risks to both the patient and the user. To address these issues, DC administrators should implement stricter measures to adhere to local DCs standards and hire qualified personnel who can periodically maintain and repair medical equipment.

In the medical field, to ensure the use of large medical equipment, it is necessary to carry out regular maintenance on large medical equipment. In the process of maintenance and maintenance of large-scale medical equipment, most medical personnel have not established a corresponding quality management system, neglecting daily maintenance and maintenance, resulting in many hidden dangers of medical accidents. To this end, the quality control of large medical devices should be strengthened, the control before, during, and after the event should be done well, and a comprehensive analysis of the operation methods of the equipment should be carried out to achieve reasonable maintenance of the equipment. Therefore, this paper discusses the maintenance, management, maintenance, and quality management of large medical equipment under the function of information fusion technology. This paper summarizes the problems encountered in the maintenance of medical equipment in the past and creates a medical quality control system to manage the maintenance and quality control of medical equipment. In the maintenance system of medical equipment, scientific management theories and methods are used to predict, adjust, inspect, and account for the quality of the entire production process of the equipment, and establish a complete quality monitoring and management system. To achieve optimal maintenance and economic benefits, the overall quality of medical equipment can be comprehensively improved. The data shows that the actual number of monitors for quality control testing in 2020 is 502 units, 496 units have passed the initial inspection, and 502 units have passed the maintenance, which shows that the maintenance and quality control of medical equipment based on information fusion technology is effective.

The qualification of CE, incorporating both engineering and medicine, was first established in 1987. The CE is a health care professional who ensures the safety and effectiveness of medical equipment. A basic duties guideline for CEs was devised in 2010. The main duties of the CE are classified as respiratory therapy, cardiopulmonary bypass , dialysis units, intensive care units, cardiac catheterization, hyperbaric oxygen therapy, pacemakers and medical equipment management. To enhance the ability of CEs to engage in more extensive duties and develop specialties, there is a certification system in each field. The CE plays a role that is socially important by ensuring the safety of medical equipment and its effective maintenance. Purpose of establishment of CE Recent progress with medical equipment has extended the range of medical care, and specialists who can operate and maintain many complex pieces of equipment are required. The qualification of CE, incorporating both engineering and medicine, was first established in 1987, and CEs began to work in Japan from 1988. The CE is a health care professional who ensures the safety and effectiveness of medical equipment. Current state of CE education A CE must graduate from a CE training school (university, junior college, or technical school) and pass a national examination. The training schools devised guidelines for the national examination to maintain a certain standard of CE education. The examination covers questions from the fields of medicine, engineering, and medical technology. The number of questions is 180 (90 in the morning and 90 in the afternoon) and the examination is carried out over 2 sessions of 2.5 hours each. There are some universities setting up graduate schools for CE education, and there are some CEs who already have a master’s degree or a doctorate in the field of BME. Present status of CEs As of 2012, there are approximately 12,000 CEs in Japan. A basic duties guideline for CEs was devised in 2010[1]. The main duties of the CE are classified as respiratory therapy, maintenance of cardiopulmonary bypass units, dialysis equipment, and surgical equipment, intensive care Koichi Umimoto Department of Biomedical Engineering Osaka Electro-Communication University, Osaka, Japan (Tel: 072-876-5376, Fax: 072-876-5281 e-mail: umimoto@isc.osakac.ac.jp). units, cardiac catheterization, hyperbaric oxygen therapy, other treatment (defibrillators, pacemakers, and implantable cardioverter defibrillators) and medical equipment management. A team of CEs are involved in dialysis. The duties of CEs in the dialysis unit are preparation of the dialysis sets, blood access, operation of the equipment and monitoring patient during treatment, and maintenance of the dialysis equipment. Certification for CEs in each field To enhance the ability of CEs to engage in more extensive duties and develop specialties, as well as provide better health care services, there is a certification system in each field. This involves certification by the Japanese CE Society and the Associated Societies. Regarding certification by the Japanese CE Society, there is a CE certification system for specialization in blood purification, a pacemaker-related CE specialty, and a respiratory treatment specialty. Regarding certification by the Associated Societies, there are qualifications in dialysis technology, extracorporeal circulation technology, respiratory therapy, clinical medical engineering equipment technologist, hyperbaric oxygen therapy, and apheresis treatment. Future prospects Since the CE was born in 1988, 24 years have passed. The CE plays a role that is socially important by ensuring the safety of medical equipment and its effective maintenance. In addition to technology, we must develop managerial skills for medical equipment like CEs in the USA. Therefore it is important to establish an advanced CE education system in Japan like that of the American College of Clinical Engineering[2].

Medical equipment maintenance in modern hospital management is an emerging marginal discipline which is one of the important branches of hospital management with the dual function of management and technology. The good or bad management of medical equipment directly affects the quality of hospital work. With the development of science and technology, the scale of hospitals continues to expand and develop; hospitals are equipped with more and more medical equipment and its technical content is getting higher and higher, which makes the medical equipment management and maintenance practitioners more demanding. However, the situation of existing medical equipment management and maintenance personnel is not optimistic. For this reason, this paper designs a good database structure, which can effectively reduce data redundancy and better avoid the problems that may occur during the database operation. As a reference guideline for database design, the three database paradigms can be studied and understood in depth to help software designers design more “robust” databases, enabling effective maintenance and management of medical imaging equipment.

This paper deals with the development of standard In-service Training and Education of Users and Maintenance personnel on Medical Imaging Equipment in the health services of Bangladesh. Users and Maintenance personnel of equipment should be trained to do routine simple maintenance on equipment. This will increase user care of equipment and cooperation with maintenance technicians to reduce equipment breakdowns. At the same time, this will promote the culture of equipment care and maintenance to improve the quality of health care. Proper use and maintenance of medical equipment are essential to obtain sustained benefits and to preserve capital investment. In-service education and training have a direct impact on the quality of care. Various obstacles for expanding medical equipment use and maintenance capabilities in Bangladesh have been discussed. Proper operation and maintenance problems are complicated by the ever-increasing use of medical imaging equipment as health care is modernized. To date, the operation and maintenance situation in Bangladesh are getting worse and requires special attention. Use and maintenance capabilities are considered during the initial stage of making a decision to acquire equipment. Proper use and maintenance problems can be minimized through in-service training and education. The mission is to ensure that equipment used for patient care is safe, available, accurate, and affordable. In this paper, it has been described the problems and methodology to improve the existing in-service training and education of users and maintenance personnel on MIE. In this study, we designed a framework of in-service training and education of medical imaging equipment (MIE) uses and maintenance system used for in-house clinical engineering department.

Objective: To assess the application effect analysis of nurse's equipment management standardized in ICU equipment management. Method: This study included 56 related medical staffs who are working in ICU department and they used the medical equipment in their working. the data of 2018 was defined as control group, that the medical equipment was receive common management methods in 2018. In intervention group, we collected related data in 2019, that the medical equipment was receive nurse's equipment management standardized in this year, the intervention contrasts Standardize management, set up instrument management team, formulate instrument management system, instrument maintenance and repair system, instrument training system, and regularly organize study and training for all staff in the ward. We evaluated the differences between the two groups in terms of instrument repair rate, instrument maintenance cost, nursing staff's mastery of instrument and equipment skills, instrument maintenance quality, instrument and equipment maintenance rate, and instrument management mode satisfaction. Result: In terms of the frequency and cost of instrument and equipment maintenance, the frequency and cost of maintenance are both higher than the standard management, and the results are statistically significant. In the survey results of instrument and equipment standard management, except maintenance efficiency, the other data are statistically significant. The p value of nursing staff's satisfaction with instrument and equipment skills, instrument maintenance quality, instrument and equipment maintenance, the p-value instrument management mode was all less than 0.005, the difference was statistically significant. Conclusion: Standardized management of ICU equipment can reduce equipment failure rate and maintenance cost.

Introduction: Medical equipment is an indispensable part of hospitals. It is the basic condition and guarantee for the hospital to carry out medical services, scientific research, teaching, and other activities, and it plays an irreplaceable role in the entire medical process of the hospital. Therefore, the maintenance management of equipment is also the focus of our attention. In the past, traditional management methods such as paper were mainly used for equipment maintenance management, and it was difficult to share data.Methods: In today’s era of rapid development of information technology, we will use information technology to maintain and manage medical equipment. Through big data analysis and other technologies, the drawbacks of the existing traditional management methods are improved, so that medical equipment can be managed scientifically. By maximizing its functions, it can ensure the normal operation of medical facilities, improve the utilization rate and integrity rate of equipment, and reduce maintenance costs and unnecessary losses.Results: According to the research findings, based on the background of big data, a de-Bayesian network is used for data mining to build a medical equipment maintenance platform. Through the data in the platform, we can better discover the distribution and reasons of equipment maintenance, and at the same time conduct an analysis to provide reference for the formulation of preventive maintenance plans, reduce equipment failure rate and maintenance costs and improve equipment utilization. Through the survey of medical staff, we can also find that at least 40% of the people feel that the work distribution is more reasonable, and 45% of the people feel that the equipment failure rate and the time required for maintenance have been greatly reduced.Discussion: We can see that the network platform for medical equipment maintenance management built through big data is very feasible, which can help us work more effectively and improve work efficiency.

Medical equipment is implemented in highly complex hospital environments, such as operating rooms, in hospitals around the world. In operating rooms (ORs), technological equipment is used for surgical activities and activities in support of surgeries. The implementation of government policies in hospitals has resulted in varying implementation activities for (medical) equipment. These result in varying lead times and success rates. An integral and holistic protocol for implementation does not yet exist. In this study, we introduce a protocol for the implementation of (medical) equipment in ORs that consists of implementation factors and implementation activities. Factors and activities are based on data from a systematic literature review and an explorative survey among surgical support staff on factors for the successful implementation of technological and (medical) equipment in ORs. The protocol consists of five factors and related implementation activities: the establishment of a project plan, organisational preparation, technological preparation, maintenance, and training.

The continuous progress in modern medicine is not only the level of medical technology, but also various high-tech medical auxiliary equipment. With the rapid development of hospital information construction, medical equipment plays a very important role in the diagnosis, treatment, and prognosis observation of the disease. However, the continuous growth of the types and quantity of medical equipment has caused considerable difficulties in the management of hospital equipment. In order to improve the efficiency of medical equipment management in hospital, based on cloud computing and the Internet of Things, this paper develops a comprehensive management system of medical equipment and uses the improved particle swarm optimization algorithm and chicken swarm algorithm to help the system reasonably achieve dynamic task scheduling. The purpose of this paper is to develop a comprehensive intelligent management system to master the procurement, maintenance, and use of all medical equipment in the hospital, so as to maximize the scientific management of medical equipment in the hospital. Scientific Management. It is very necessary to develop a preventive maintenance plan for medical equipment. From the experimental data, it can be seen that when the system simultaneously accesses 100 simulated users online, the corresponding time for submitting the equipment maintenance application form is 1228 ms, and the accuracy rate is 99.8%. When there are 1000 simulated online users, the corresponding time for submitting the equipment maintenance application form is 5123 ms, and the correct rate is 99.4%. On the whole, the medical equipment management information system has excellent performance in stress testing. It not only predicts the initial performance requirements, but also provides a large amount of data support for equipment management and maintenance.

Effective management of the maintenance of medical equipment (ME), especially high-tech one, is one of the main issues for the quality of health care, for the provision of cost-effective health services and for saving , even in developed countries, insufficient resources. Medical equipment maintenance (EM) includes all activities related to ensuring an adequate level of service and limiting the downtime of medical equipment in a healthcare organization. Traditionally, EM is categorized as preventive maintenance (PM) and corrective maintenance (CM). The principle of PM is prediction. PM can be planned and predictive, ie. Just-In-Time (JIT) maintenance. Predictive maintenance can only be applied to new high-tech medical devices that have built-in self-testing. Planned preventive maintenance is carried out in accordance with the maintenance plan for a certain period of time. As a rule, when creating the plan, we follow the manufacturer's recommendations for preventive maintenance of ME given in the technical documentation of the ME, especially in the instructions for the maintenance of the ME. Predictive or JIT maintenance makes it possible to detect and solve the problem before problems and contingencies actually occur, and this is done on the basis of intelligent monitoring and analysis of the state of ME at the right moment, which ensures the optimal time for intervention, so that maintenance performed only when necessary. The information system for the management of the maintenance of ME in healthcare institutions would interconnect healthcare institutions and enable the fast and safe exchange of data and information related to the maintenance of ME and enable the optimal maintenance of ME in healthcare institutions, increasing the availability of this equipment, especially high-tech equipment, with significant reduction of the total cost of maintaining ME (of the order of 30%). One of the main reasons for the unsustainability of the existing approach to the maintenance of ME in the healthcare institutions of Serbia is that each healthcare institution independently takes care of the maintenance of its own ME. This approach is expensive and significantly affects high maintenance costs. This approach needs to change.

Standards I'd Like to See

A hospital that wants to participate in Medicare must meet its standards—Medicare Conditions of Participation for Hospitals, 42 CFR §482—and receive accreditation from an organization that the U.S. Centers for Medicare &amp; Medicaid Services (CMS) approves as a “deeming authority.”In September 2008, CMS approved DNV Healthcare for that role, and it is now the third accrediting organization for hospitals that want to be reimbursed by Medicare and most other third-party players. The other two such groups are The Joint Commission and the American Osteopathic Association.Here's a look at the DNV program and how it compares to that of The Joint Commission.DNV Healthcare is a subsidiary of Det Norske Veritas, a private, non-profit, Norwegian-based foundation. More than 100 years old, Det Norske Veritas says its purpose is to “protect life, property, and the environment” by advising and setting standards for many industries. It uses or incorporates International Organization for Standardization (ISO) standards as the basis for most of its work. While it has been involved with healthcare for about 20 years, DNV only got started in hospital accreditation with its acquisition of TUV Healthcare Specialists in 2007.To date, more than 120 U.S. hospitals have either achieved DNV accreditation, are awaiting their first survey, or are in the process of contracting with DNV. Recently, DNV has started expanding their hospital accreditation program to other countries.DNV's accreditation program is called National Integrated Accreditation for Healthcare Organizations (NIAHO). For now, its standards are applicable to hospitals only, although it is planning to develop accreditation programs for other healthcare specialties. Perhaps the most unique feature of NIAHO accreditation is that it incorporates the ISO 9001 Quality Management System Standards, one component of the ISO 9000 standards family. Getting an ISO 9001 certificate is an extra-cost option, but it's a major reason some hospitals choose to obtain DNV accreditation.Another unique feature of NIAHO accreditation is that the accreditation surveys, which are unannounced, are annual. The length of a survey and the number of surveyors are determined by the size and complexity of the organization being surveyed. All survey teams include at least two members—a nurse or physician, and a physical environment specialist. Another unique feature of NIAHO accreditation is that the standards and related literature are available free at: http://www.dnv.com/industry/healthcare.The DNV's accreditation standards for hospitals are published in National Integration Accreditation for Healthcare Organizations Accreditation Requirements (AR). The current version, only 53 pages, was published in September 2009. The standards were developed by specialists in each subject area in the AR. Since the standards are tied to the CMS Conditions of Participation and to ISO 9001, they are subject to change only when the Conditions of Participation or ISO 9001 change.The DNV's AR contains only their standards, unlike The Joint Commission's Comprehensive Accreditation Manual for Hospitals (CAMH), which includes standards plus explanatory materials. Separately, DNV does publish NIAHO Interpretive Guidelines and Surveyor Guidance (IGSG), which is also available free online. Educational programs are available, with the schedule posted on the DNV website.The AR has 25 chapters, including one entitled “Physical Environment,” which is analogous to the “Environment of Care” chapter in The Joint Commission's accreditation manuals. The “Physical Environment” chapter includes a section called Medical Equipment Management System.There are seven standards for medical equipment management in the AR. They are:Overall, the DNV standards for clinical engineering are very similar to the JC standards (Figure 1). The JC CAMH has 15 elements of performance that are specific to clinical engineering; the AR has seven requirements for clinical engineering. The AR doesn't have a written requirement for an equipment inventory or for equipment repairs. The CAMH doesn't have a requirement for equipment user training in its equipment standards. (It used to be there, but is now covered in the more general education and training standard in the “Human Resources” chapter.)In DNV's IGSG, the difference from JC standards becomes more distinct. In the interpretive guidelines section, it specifies that inspections and maintenance must be in accordance with the manufacturer's recommendations, along with federal and state laws and regulations. It requires that the medical equipment plan address the use and training for demonstration and rental equipment. Information on equipment repairs and periodic maintenance is included in the surveyor guidance section. This section states that “all medical devices and equipments are routinely checked by a clinical or biomedical engineer.” This section also contains a number of requirements for supplies—for both operational and emergency needs—even though there is no mention of supplies in the AR itself.Good standards should be well written, justifiable, and complete. I can find fault with all three aspects of the DNV standards for clinical engineering.The standards are not written clearly. Perhaps the best (worst?) example of a poorly written standard is SR.2. Besides being a poorly worded sentence, this standard appears to apply only to “issues related to” rental or physician owned equipment. Nowhere else in the standards is there any requirement for incoming inspections or for user training of all other medical equipment. I asked for clarification on the intent of this requirement from DNV staff. They explained that the intent of the requirement is that when equipment is purchased, there is an initial service inspection and orientation. In addition, if the equipment is rented or physician owned, there must be a demonstration. I believe that the wording of the requirement is too easily misinterpreted.I also have an issue with the fact that there is no mention of biomedical equipment technicians. The interpretive guidelines state that “a clinical or biomedical engineer or other qualified maintenance person” must maintain equipment. As stated in the surveyor guidance, all medical equipment must be routinely checked by a clinical or biomedical engineer. BMETs are better qualified by education, training, and experience to do all medical equipment maintenance—scheduled or unscheduled. There is no group more qualified to maintain medical equipment than BMETs, and they outnumber clinical and biomedical engineers in hospitals more than 100 to 1.As stated in the interpretive guidelines, manufacturers' testing and maintenance recommendations must be followed. But I believe manufacturers' recommendations are often a waste of time (e.g., when they require too frequent or too detailed inspections). Experience shows that all medical equipment does not need routine inspections, and evidence-based inspection procedures are more effective and economical.The DNV's AR standards are not complete. They do not explicitly require an equipment inventory or equipment repairs. One could probably argue that these are implicit in other standards, but requirements shouldn't be implied. An equipment inventory and equipment repairs are among the more important aspects of a clinical engineering function, and should be explicitly required. It isn't until you read the surveyor guidance section that you find out that the surveyors will be looking for a repair program. The surveyor guidance also requires “maintenance logs for significant medical equipment.” This suggests an inventory, but only for “significant” equipment. It includes some examples of significant equipment, but no definition, so this would obviously be open to interpretation. Do they want hospitals to develop their own list of significant equipment? If so, would this amount to something similar to the JC's inventory based upon risk categorization? We shouldn't have to guess.Randall Snelling is the chief physical environment officer at DNV Healthcare. He interprets the standards and trains surveyors pertaining to the “Physical Environment” chapter. I had a lengthy discussion about the medical equipment standards with Snelling. He explained that all NIAHO standards were written to comply with the CMS conditions of participation requirements and ISO 9001 standards. He emphasized that their physical environment standards, including for medical equipment, are collaborative, not prescriptive. Hospitals can establish their own medical equipment management programs if adequately described, explained, and justified. He believes that clinical engineers and BMETs know what needs to be done. He said that, during surveys, they always interview the clinical engineering manager. Their most common findings are that BMET training is not documented and that non-hospital owned equipment is not inspected.It was very interesting that we agreed on the fundamentals of medical equipment management programs: There should be a plan, the plan should be implemented, performance should be measured, and there should be continuous improvement. He reiterated that this is what surveyors looked for. However, I argued that their standards and their guidelines were not written that way. I believe that both the standards and the guidelines are prescriptive, and leave no room for alternatives. He said that this was not the intention, and that he would review them in light of my comments. He feels that SR.1, which requires a medical equipment management system, requires hospitals to develop a comprehensive program while allowing them to develop one that meets their unique needs. He said that anyone with questions or comments about the medical equipment management standards could contact him at Randall.Snelling@dnv.com.The people with whom I discussed the DNV standards clearly believe that it is appropriate for hospitals to develop their own programs that meet their unique needs and that are based on their expert experience. Unfortunately, CMS conditions of participation require hospitals to follow manufacturer recommendations for maintaining medical equipment. So, DNV would appear to be caught between a rock and a hard place. They have written their standards to comply with CMS's prescriptive requirements, but claim to interpret them more flexibly.

Healthcare systems and, more specifically, public sector healthcare systems are complex hierarchical entities. Delivering quality healthcare services is a challenging task facing several key hurdles. Equipment maintenance and availability is one of the key issues since the non-functionality of medical equipment degrades service provision in public sector hospitals. In this case, we discuss the situation of primary and secondary healthcare services in Punjab, Pakistan, focusing on the current condition of equipment functionality and maintenance across thirty-six districts of Punjab. The healthcare sector in Punjab is organized in a tiered manner, with primary health care facilities providing basic medical services to the masses and secondary healthcare facilities providing referral and specialized services to the patients. Providing medical services requires an efficient network of medical professionals, adequate medical equipment, physical infrastructure and sufficient supply of medicines at all levels of the healthcare system. This case identifies and discusses the issue of non-functionality and maintenance of medical equipment in Punjab. Demand for medical equipment is generated on a central and district level, followed by a combination of central- and facility-level procurement. Maintenance of equipment is done by the facility without any standard operating procedures. The purpose of this case is to observe the current maintenance options in practice and to assess the impact of a decentralized maintenance system on the functionality status of biomedical equipment across districts. The objective is also to highlight the need for an efficient maintenance regime in accordance with the nature of the equipment to ensure cost and downtime minimization.

Proactive maintenance is a policy aimed at identifying the root cause of failure and correcting it before it causes other problems and leads to machinery failure and breakdown. Implementing this policy can enhance reliability, availability, maintainability, and safety (RAMS) at low cost. A digital twin (DT) is a digital copy of a physical object and its applications will play a leading role in the future of smart manufacturing. DT concept is increasingly appearing in industrial applications including proactive maintenance, enabling accurate identification of equipment condition, proactive prediction of faults, and enhanced reliability. This review paper focuses on the performance and applications of different aspects of DTs in proactive maintenance polices. The review of literature focused on the applications of DT in maintenance management for improving equipment RAMS. The literature review shows that the application of DT techniques in proactive maintenance remains very important for managing the maintenance of critical equipment and production systems. Several DT frameworks for proactive maintenance have been discussed. Furthermore, this study provides a comprehensive roadmap for future research initiatives aiming to fully utilize the capabilities of technology design teams. Finally, the results of this study will be of value to professionals who want and aspire to implement technological design to achieve maintenance excellence.

Medical equipment (ME) maintenance retains an asset's original anticipated useful life and preserves its reliability and cost-effectiveness. This study developed and implemented a multicomponent program to improve ME use and maintenance in nine Sri Lankan hospitals from May 2020 to May 2021. This pre-post implementation study involved an initial baseline assessment of existing ME maintenance systems, the development and implementation of a multicomponent improvement program, and a 3-month postevaluation. Five targets ME were selected for the study: oxygen regulator, electrocardiogram (ECG) machine, suction apparatus, blood pressure apparatus, and mini autoclave. A pretested questionnaire was administered to randomly selected nursing officers (n = 101) and health-care assistants (n = 120) to obtain baseline ME maintenance data. Six focus group discussions and 24 key informant interviews were conducted with key stakeholders to codesign the multicomponent interventions, which included: developing a standard operating procedure targeting preventive maintenance activities; establishing focal points to provide technical and logistic support; staff training; and the introduction of institutional ME maintenance documents. Program effectiveness was assessed at 3 months postimplementation using the seven predefined outcome variables. Baseline assessment identified no ME maintenance programs implemented in any of the hospitals. The highest availability was observed for oxygen regulator (62% to 82.3%) and ECG machine (66.1% to 84.7%). The highest functionality improvement was observed for ECG machine (40.4% to 79.7%). The positive perception of maintenance process of ME achieved the highest (33% to 80%) improvement. Following program implementation, improvements were noted in: the availability (P = 0.00) and functionality (P = 0.00 to P = 0.02) of all selected ME; equipment maintenance processes (P = 0.000); as well as staff knowledge, skills, perceptions, and satisfaction. The program improved the use and maintenance of ME and was widely supported by the key stakeholders. The approach is relevant to other resource-poor hospital settings, as inadequate ME maintenance causes health system inefficiencies.