Propose Module to Introduce of Hospital In-house Clinical Engineering Department for 1000 bed Hospital of Bangladesh”

¹MdAnwar Hossain,

“Abstract”

 Clinical Engineers Association of Bangladesh (CEAB) is unknown to Institute of Engineers Bangladesh (IEB) although all other engineers’ forum was opened.  Due to lack of research facilities of IEB and less awareness of medical professionals clinical engineering association was not developed in Bangladesh. National Electro-Medical Equipment Maintenance Workshop & Training Center (NEMEMW & TC) has been asked several times by Governmental Services and/or Educational Organizations to set out the present and future role of clinical engineers in Bangladesh hospitals, which are themselves in the process of changing their organization and financing system. This paper describes the main features of the profession and its present position in Bangladesh, notably from a survey ran in 2006, 2008, 2010, 2013  and from the current work of its Present  status about future and new opportunities, and attempts to draw some lines about its possible development, driven by general trends of the technology, the   Khulna University of Engineering & Technology, Bangladesh, Electro-Medical Engineering Association(BEMA), OSAK Jieki College, Japan   and hospitals organization. This paper will explore to develop modeling to produce 1000 bed capacity Hospital In-house clinical engineering department for medical equipment management and as a result a safe operational and cost effective maintenance will be established through the CEP professions. A cost effective safe and sound health services will be developed in Bangladesh. 

Key words: Clinical Engineering Manager; Clinical Engineer; Clinical Engineering Technologist; Biomedical   Equipment Technician; Workshop; In-service education & training, Biomedical equipment; Medical devices; medical equipment management. 

1. Introduction: National Electro-Medical Equipment Maintenance Workshop Training Center (NEMEMW&TC) was introduced under Health Ministry, government of Bangladesh since 1983 with 65 technical staffs to manage the maintenance management of hospitals equipment in Bangladesh through the assistance of World Bank and according to necessity in addition 18 Regional Electro-Medical Workshops were introduced in 1987 through Asian Development Bank with 90 technical staffs. All technical staffs were conventional electrical and mechanical trade. Among them more than 85% technicians’ staffs were mechanical engineering back ground and mechanical trade inferior educated technicians [1. Project Management Book of Medical Equipment Management of Public Hospitals in 1987,Mr. Monsun Hambur Rahman, Mr. Nazrul Islam and B. Babudra Volume 2, p13-16.]. These two organizations have been asked several times by Governmental Services and/or Educational Organizations to set out the present and future roles of clinical engineers in Bangladesh for hospitals, which are themselves in the process of changing their organization and financing system[ Government order no. memo:MoH&FW/2011/3374 date 12/11/2012 and memo: kuet-2012]  .Medical equipment and devices are the most costly property in the hospitals among other assets and these assets are very important tools and logistic to diagnosis the diseases and therapeutic of patients in the modern technological dependable world[3. M& A]. Medical technologies are rapidly developing like of other technologies in the world. Other technologies have scope of time to correct error for operation and application but correct application of medical equipment is defined as safe health services. Improper and error full implementation of medical equipment/ devices are the causes of wrong treatment or death of the patients. From a lot of publication, it is found that a lot of patients suffered due to wrong diagnosis and died due to unprofessional conduct of medical equipment. The medical equipment/devices are very complex and multi -technology based tools for diagnosis and treatment of patients. New complex diseases are increasing due to world environmental, life style pattern and foods. The percentages of critical diseases such as cardiac, cancer, renal failure, diabetics, ophthalmological diseases, hearing problems and early orthotics, neurological disorder, brain stroke, lungs diseases ,  hypertension, lever  diseases, rheumatic fever, gastro –ties are increasing rapidly and such types of diseases seemed to be common phenomena[4,5,6]. To prevent such types of diseases and therapeutic to the patients, it is the pre-requisite to get accurate diagnosis result from the medical equipment/devices and accordingly need to apply medicine or equipment therapy. So it is not possible to deliver proper medication to patients without the accuracy and safe function of medical equipment. Equipment accuracy and safe functional condition is depended on Hospital in-house Clinical engineers, Clinical engineering technologists and biomedical technicians. Most of the developed countries made medical devices and they included these professionals in their hospitals and established an individual CED every hospitals in their country such as Japan, Canada, America, Australia, all European countries. On the other hand most of the developing countries such as Malaysia, Indonesia, South Africa, India, Pakistan, Philippines, and Nepal Etc established HIHCED in every hospital and continuously CEP are producing and introducing by the government.  Middle-East also established CED since the long with help of developed countries. But in the low and middle income countries like Bangladesh could not establish CED in any hospitals. Only breakdown and on call services were providing from the central level. From the government or local vendors have not developed any system to provide the emergency support from the regional also. The practical situation of medical devices in any hospitals is in the worst condition. No scope to calibrate and perform routine maintenance through HIHCED in any of hospitals in Bangladesh. Some private hospitals such as BIRDEM, United and Square hospitals Etc, established CED only within few years but in public hospitals have no any CED. So nobody knows the present condition of existing medical equipment of public hospitals of Bangladesh due to absence of CED. Only two graduate electrical engineers and one M.Sc in biomedical engineer, 72 diploma engineers in mechanical trade, and about 36 general technicians are conducting only on request breakdown repaired of basic equipment from central level.  18 regional level medical workshops could not perform the maintenance work due to lack of policy and logistic support and on the other hand 95% employees of these organization are aged and average age is more than 55 years. They have no capability to learn and earn modern technology on medical equipment.  Most of equipment has been repaired by Vendors or out sourcing staffs with high cost. From some analysis, it is found that repairing cost was crossed the purchase value of equipment [analysis report prepared by CTM and published by Mukti news paper January 8, 2015]. Bangladesh is dense populated country and near about 160 million people lives in Bangladesh. More than 80% poor people lived in rural areas and they are very dependable for the treatment on public hospitals. In the urban area more than 70% poor people have taken medication from the district hospitals or medical college hospitals. There are more than 25 public medical hospitals in seven division of Bangladesh and which are providing the medication to the patients. Among the medical college hospitals 8 numbers are near about 1000 bed capacity of hospital. For this reason, 1000 bed hospitals was chosen by author to propose a modeling to introduce  HIHCED and it was taken as baseline standard. All kinds of modern facilities departments are present in 1000 bed hospitals. These types of hospitals are called at tertiary level hospitals and Post graduate medical college hospitals. Every hospital is well medical staffed. Costly modernized medical equipment/ medical devices were supplied by the government of those hospitals. Experience medical doctors and research facilities were provided by the health Ministry. Environment, hospital need based utility support were provided. Yearly fund, medicines and logistic support to be provided as need based. More than 70% facilities to run the hospitals were provided by the government except Clinical engineering professional staffs. The remaining part of the paper will described other related information such as section II will be used for present status of medical equipment management system in Bangladesh; in section III will describe the present situation of HIHCED, section IV will be described proposal to introduce HIHCED in 1000 bed hospital, section V will be used for Require staffing for HIHCED and Section VI will be described the method to produce HIHCED for 1000 bed Hospital.

1. Present Situation of Engineering Management of Medical Equipment in 1000 BED Public Hospital of Bangladesh: In order to develop any new model, it is very important to understand and review past and present modeling of engineering management of medical equipment of 1000 bed public hospitals of Bangladesh, developed countries and developing countries. In this regards, more than 10 modules of different countries are read by authors and data has been collected from public hospitals in Bangladesh. After literatures reviewed and data analysis by author and a proposal to develop a module of hospital in-house clinical engineering department for 1000 bed public hospitals in Bangladesh to be submitted.