Non-functional Equipment Research Articles

Service Availability and Readiness of Primary Care Health Facilities Offering Hypertension Diagnosis Services in Wakiso District, Uganda, 2019.

Hypertension is a growing burden in Uganda and other low- and middle-income countries. Appropriate diagnosis services are needed at primary care health facilities to identify, initiate treatment for, and manage hypertension. This study assessed service availability and readiness as well as facilitators and barriers in primary health care facilities for hypertension diagnosis services in Wakiso District, Uganda. In July and August 2019, we conducted structured interviews at 77 randomly selected primary care health facilities in Wakiso District. We used an interviewer-administered health facility checklist modified from the World Health Organization's service availability and readiness assessment tool. We also conducted 13 key informant interviews with health workers and district-level managers. Readiness was measured by availability of functional diagnostic equipment, related supplies and tools, and health provider attributes. Service availability was measured by assessing hypertension diagnosis services. Most (86%; 66 of 77) health facilities offered hypertension diagnosis services and 84% (65 of 77) had digital blood pressure measuring devices; only 69% (53 of 77) had functional blood pressure measuring devices. Lower-level facilities lacked appropriate blood pressure cuffs for use across age groups: 92% (71 of 77) lacked pediatric cuffs and 52% (40 of 77) lacked alternative adult cuffs. Facilitators for diagnosing hypertension included partners that built health facility staff capacity and funds for purchasing hypertension diagnostic supplies; common barriers were nonfunctional equipment, delays in receiving training, and inadequate staffing. The results highlight the need for an adequate supply of devices, routine replacements or repairs, and frequent refresher training for health workers.

Readiness of rural health facilities to provide immediate postpartum care in Uganda

BackgroundNearly 60% of maternal and 45% of newborn deaths occur within 24 h after delivery. Immediate postpartum monitoring could avert death from preventable causes including postpartum hemorrhage, and eclampsia among mothers, and birth asphyxia, hypothermia, and sepsis for babies. We aimed at assessing facility readiness for the provision of postpartum care within the immediate postpartum period.MethodsA cross-sectional study involving 40 health facilities within the greater Mpigi region, Uganda, was done. An adapted health facility assessment tool was employed in data collection. Data were double-entered into Epi Data version 4.2 and analyzed using STATA version 13 and presented using descriptive statistics.ResultsFacility readiness for the provision of postpartum care was low (median score 24% (IQR: 18.7, 26.7). Availability, and use of up-to-date, policies, guidelines and written clinical protocols for identifying, monitoring, and managing postpartum care were inconsistent across all levels of care. Lack of or non-functional equipment poses challenges for screening, diagnosing, and treating postnatal emergencies. Frequent stock-outs of essential drugs and supplies, particularly, hydralazine, antibiotics, oxygen, and blood products for transfusions were more common at health centers compared to hospitals. Inadequate human resources and sub-optimal supplies inhibit the proper functioning of health facilities and impact the quality of postpartum care. Overall, private not-for-profit health facilities had higher facility readiness scores.ConclusionsOur findings suggest sub-optimal rural health facility readiness to assess, monitor, and manage postpartum emergencies to reduce the risk of preventable maternal/newborn morbidity and mortality. Strengthening health system inputs and supply side factors could improve facility capacity to provide quality postpartum care.

SERVICE AVAILABILITY, AND READINESS OF PRIMARY CARE HEALTH FACILITIES TO OFFER HYPERTENSION DIAGNOSIS SERVICES IN WAKISO DISTRICT – UGANDA

Objective: To determine the availability of hypertension diagnostic services, the readiness of health center IIs, health-facility associated factors, facilitators and the barriers in provision of hypertension diagnosis services. Design and method: A cross sectional study design was used, 79 health facilities were sampled randomly. Health facility checklists were administered to the health facility in-charges, individual semi-structured questionnaires to health workers and key informant interview guides to a purposive sample of health workers and personnel at Wakiso district. Chi-square and the Fisher's exact test were used to assess associations between categorical variables. Service availability was measured by assessing the provision of blood pressure (BP) measurements, weight measurements and the scheduling of regular check-ups. Readiness was measured by assessing the availability and functional status of the BP apparatus and other hypertension diagnostic equipment and supplies, and yet also the presence of a trained health care provider. Results: The majority (86%) of the primary care health facilities offered all the hypertension diagnosis services and 13% of the health centre IIs were ready to offer comprehensive hypertension diagnosis services. There were significant associations between the level of the health facility; BP measurements (P = 0.005), managing newly diagnosed cases of hypertension (P = 0.001), and scheduling of regular check-ups (P = 0.003). The health workers were facilitated by the availability of equipment, primary health care funds and implementing partners, whereas the barriers faced were the lack of equipment, availability of non-functional equipment, delays in receiving trainings’ and inadequate staffing. Conclusions: The study showed that the majority of the health facilities offered hypertension diagnosis services including the Health Centre IIs which are lowest in the tier. There were gaps in the readiness to offer hypertension diagnosis services, thus equipment should be routinely calibrated, replaced and routine continuous medical education sessions should be provided to the health workers.

Water, Sanitation, and Hygiene (WASH) Situation in Bicol University, Albay, Philippines

The Philippines is committed to “achieve universal and equitable access to adequate, safe, affordabledrinking water and equitable sanitation and hygiene for all by 2030” (SDG 6). Thus, this study attemptedto assess the water, sanitation, and hygiene (WASH) situation of Bicol University (BU) in terms of existingwater facilities and water quality, sanitation, and hand washing facilities; the ratio of female and malestudents and personnel to WASH facilities; and the risks for contamination of wells with mechanizedpumping. This study employed the descriptive survey of WASH facilities utilizing spot-checking andobservation checklists based largely on School Sanitation and Health Services Guidelines and SanitaryInspection Form from the Department of Health (DOH) as well as document analysis of the existing DOHmicrobiological test report. Of the 15 colleges and three support units of the university, six (33%) had wellswith mechanized pumping (Level 1), 10 (56%) were being served by water districts (Level 3) and two (11%)had both Levels 1 and 3. Water from the aforesaid wells was unsafe to drink based on the DOH 2018–2019 microbiological test report of fecal contamination, which corroborates the moderate risk assessmentfindings. The sanitation facilities were not sufficiently maintained and proper hygiene not strictly observeddue to non-functioning equipment, inadequate water supply, and non-provision of cleaning materialsand toiletries, hence students and personnel are at risk for WASH-related infections. The present ratio offemale and male students and personnel to WASH facilities meet the Code on Sanitation of the Philippinesstandards. It is therefore advocated to increase financial investment in operation and maintenance ofexisting WASH facilities through sustainable budgetary allocation for repair, janitorial services, cleaningmaterials, and toiletries.

Cloud Computing and Internet of Things Concepts Applied on Buildings Data Analysis

Abstract Used and developed initially for the IT industry, the Cloud computing and Internet of Things concepts are found at this moment in a lot of sectors of activity, building industry being one of them. These are defined like a global computing, monitoring and analyze network, which is composed of hardware and software resources, with the feature of allocating and dynamically relocating the shared resources, in accordance with user requirements. Data analysis and process optimization techniques based on these new concepts are used increasingly more in the buildings industry area, especially for an optimal operations of the buildings installations and also for increasing occupants comfort. The multitude of building data taken from HVAC sensor, from automation and control systems and from the other systems connected to the network are optimally managed by these new analysis techniques. Through analysis techniques can be identified and manage the issues the arise in operation of building installations like critical alarms, nonfunctional equipment, issues regarding the occupants comfort, for example the upper and lower temperature deviation to the set point and other issues related to equipment maintenance. In this study, a new approach regarding building control is presented and also a generalized methodology for applying data analysis to building services data is described. This methodology is then demonstrated using two case studies.

Problems with systems of medical equipment provision: an evaluation in Honduras, Rwanda and Cambodia identifies opportunities to strengthen healthcare systems

A substantial amount of equipment is out-of-service in the developing world. Out-of-service equipment limits access to important medical procedures. We measured the amount of out-of-service donated, purchased and loaned medical equipment and documented the barriers to returning them to service in hospitals in Honduras, Rwanda and Cambodia. From 2010 to 2012, we completed a cross-sectional survey of 3421 pieces of medical equipment in five departments from 64 hospitals. The time since arrival, source (donated, purchased or loaned), service contract status and functionality were determined. For any partially or non-functional equipment, the barriers to placing the equipment back into service were documented. In the first year, donated equipment was significantly more likely to be out-of-service than purchased and loaned equipment combined (p < 0.01), where the latter presumably gets more hospital scrutiny before acquisition. But, purchased equipment was more likely to be out-of-service than donated equipment 5 to 6 years after arrival (p < 0.05). Loaned equipment had the highest in-service rates. Service contracts did not significantly decrease out-of-service rates, except for high-complexity equipment (p < 0.001). The largest barrier to placing equipment back into service, according to technicians, was access to spare parts, accessories and consumables. Given the considerable out-of-service rates, the most sustainable and efficacious points of intervention could be the training of local technicians and leasing (rather than donating or purchasing) equipment in order to improve the availability of medical equipment and thus increase access to medical procedures.

Factors Influencing the Adoption of Minimally Invasive Surgery

Background : Cost is a major concern for delivery of minimally invasive surgical technologies due to the nature of resources required. It is unclear whether factors extrinsic to technology availability impact on this uptake. Objectives : To establish the influence of institutional, patient and surgeon-related factors in the adoption of minimally invasive surgical technologies. Methods : Eighty surgeons in tier 4 hospitals in Nairobi were subjected to questionnaires and key informant interviews between January and May 2015. The respondents were required to cite one surgical procedure for which they had the option of either open or minimally invasive surgical approach (MIS). Of the factors presented, they were required to grade them from 1 for least recurring to 5 for most recurring. Results : The response rate was 100%. A total of 9 surgical interventions emerged from the respondents. The most common impediment to MIS was unavailability of the required equipment and non-functional equipment (mean score, 2.61). The most common patient related factors that led to an open approach were patient presentation, obesity, co-morbidities and age (mean score 2.87). The most common surgeon related factor was lack of confidence in the MIS approach (mean score, 2.55). Conclusions : Absence of enabling functional equipment or device at the time of surgery is the most significant institutional factor that impedes the adoption of MIS. Intraoperative complications and the surgeon’s comfort emerged as the most significant patient and surgeon factors respectively. Keywords : Minimally Invasive Surgical Approaches, Health System Pillars, Service Delivery.

Assessment of Acute Burn Management in 32 Low- and Middle-Income Countries.

The purpose of this study is to ascertain whether acute burn management (ABM) is available at health facilities in low- and middle-income countries (LMICs). The study used the World Health Organization situational analysis tool (SAT) which is designed to assess emergency and essential surgical care and includes data points relevant to the acute management of burns. The SAT was available for 1413 health facilities in 59 countries. A majority (1036, 77.5 %) of the health facilities are able to perform ABM. The main reasons for the referral of ABM are lack of skills (53.4 %) and non-functioning equipment (52.2 %). Considering health centres and district/rural/community hospitals that referred due to lack of supplies/drugs and/or non-functioning equipment, almost half of the facilities were not able to provide continuous and consistent access to the equipment required either for resuscitation or to perform burn wound debridement. Out of the facilities that performed ABM, 379 (36.6 %) are capable of carrying out skin grafts and contracture release, which is indicative of their ability to manage full thickness burns. However the magnitude of full thickness burns managed was limited in half of these facilities, as they did not have access to a blood bank. The initial management of acute burns is generally available in LMICs, however it is constrained by the inability to perform resuscitation (19 %) and/or burn wound debridement (10 %). For more severe burns, an inability to perform skin grafting or contracture release limits definitive management of full thickness burns, whilst lack of availability to blood further compromises the treatment of major burns.

The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape

Introduction The failed or difficult airway is a rare, but life-threatening situation. Alternative airway devices to direct laryngoscopy are essential aids to manage these scenarios successfully. The aim of this study was to determine which alternative airway devices are currently available in public emergency centres in the Western Cape Province, South Africa. Methods A cross sectional study was conducted in 15 emergency centres. Data regarding the availability of different classes of alternative airway devices were documented on a standardised data collection sheet by a single investigator via direct observation. Incomplete or non-functional equipment was classified as unavailable. Summary statistics were used to describe the data. Results Twenty-six different types of alternative airway devices were documented. Three centres (20%) had no alternative airway device. Five centres (33.3%) stocked only one device, three centres (20%) had two devices and four centres (26.7%) had more than two devices. Most centres ( n =12, 80%) stocked supraglottic airways (only one centre (6.7%) had paediatric sizes). Tracheal tube introducers were available in five centres (33.3%). Four centres (26.7%) had video-laryngoscopes, but none had optical laryngoscopes. Retroglottic devices and needle cricothyroidotomy equipment were available in two centres (13.3%). Although surgical cricothyroidotomy equipment was available, the equipment was widely dispersed and only three centres (20%) had pre-packed sets available. None of the specialised paediatric centres had needle cricothyroidotomy equipment readily available. Discussion The study demonstrated that Western Cape public emergency centres are currently inadequately stocked with regard to alternative airway devices. A guideline regarding the procurement and implementation of these devices is needed.

Assessment of cesarean delivery availability in 26 low- and middle-income countries: a cross-sectional study

We sought to assess the capacity to provide cesarean delivery (CD) in health facilities in low- and middle-income countries. We conducted secondary analysis of 719 health facilities, in 26 countries in Africa, the Pacific, Asia, and the Mediterranean, using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. A total of 531 (73.8%) facilities reported performing CD. In all, 126 (17.5%) facilities did not perform but referred CD; the most common reasons for doing so were lack of skills (53.2%) and nonfunctioning equipment (42.9%). All health facilities surveyed had at least 1 operating room. Of the facilities performing CD, 47.3% did not report the presence of any type of anesthesia provider and 17.9% did not report the presence of any type of obstetric/gynecological or surgical care provider. In facilities reporting a lack of functioning equipment, 26.4% had no access to an oxygen supply, 60.8% had no access to an anesthesia machine, and 65.9% had no access to a blood bank. Provision of CD in facilities in low- and middle-income countries is hindered by a lack of an adequate anesthetic and surgical workforce and availability of oxygen, anesthesia, and blood banks.

Response to Pyott re fair trade and ophthalmic instrumentation

Sir, We thank Pyott1 for his interest in our article.2 He rightly echoes concerns regarding the immoral exploitation of workers associated with manufacturing practices in the developing world.3 Although this concern and subsequent fair-trade comments are worthy of consideration, it should be remembered that the original article specifically documented our practical problems with inadequate instrument processing.4 In this context, the commonly voiced criticism of single-use instruments being more expensive than reusables is inaccurate if the sterilisation process leads to damaged, unreliable and non-functioning equipment. Guaranteed reliability of high-quality microinstruments is invaluable in the emergency setting. If this reliability cannot be guaranteed through the current sterilisation practices, or delays patient care, it is unsurprising that there is growth in the single-use market. Dr Pyott's interesting comments regarding outsourcing of the sterilisation process may provoke further discussion, particularly regarding the cost effectiveness of such an approach. Creating a platform for such original independent debate was the intention of our controversy article regarding Green Issues and Ophthalmology.2, 5 We hope that the various issues raised will lead to clarity of thought and position among ophthalmologists, and promote open and honest debate regarding the way forward in these uncertain financial times. Both patients and doctors need to engage management to influence a long-term perspective on the investment/disinvestment agenda to safeguard clinical care.

Performance Improvement: A Topic Whose Time Has Come—Again

In the last “Accreditation News & Views” column, I wrote about the priorities of elements of performance (EPs) that were unique to medical equipment management. In this column, I’m writing about a small group of standards that are in common to all functions in a hospital—performance improvement (PI). The Joint Commission (JC) added PI standards to their accreditation manuals quite a few years ago. When they initially did this, PI became a major theme. Over the years, there have been relatively minor changes to the wording and the placement of the PI requirements, but their essence has remained the same: collect and analyze data, plan and take action, evaluate, and report results. Then do it again, in a perpetual, performance improvement cycle. When PI standards were added to JC accreditation manuals, they made a big splash. The hospital staff who oversaw JC standards compliance put major effort into training and motivating departmental leadership into doing PI projects. How many of you remember “story boards?” In those days, a JC survey looked like show and tell day in elementary school. In the years since, however, there have been other, newer “initiatives” from the JC, and PI standards have become second tier. Perhaps this is because hospitals do a good job with PI and it no longer requires special attention. Perhaps it’s because the JC realizes that they, and hospitals, can only concentrate on a limited number of high priority standards at a time, and other issues have become more important (analogous to the way that National Patient Safety Goals come and go). For whatever reason, I believe that clinical engineering departments never put the emphasis on PI that the rest of the hospital did—even when PI was in its heyday. Now that it is not emphasized in the hospital as a whole, it appears to me that most CE departments barely even pay PI lip service anymore. Putting PI on the back burner may not be hazardous to your standards compliance health, but it definitely leads to a missed opportunity. A couple of well-chosen PI projects can pay huge dividends to your relationships with your staff, your boss, and your customers. PI projects deserve to be a favorite tool in your management tool box.