(Hospital Engineering) . .

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(Hospital Engineering)
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Bioengineering Biomedical engineering Medical
engineering Hospital engineering Clinical
engineering
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Bioengineering
Basic research oriented activity -
biotechnology - genetic engineering -
modification of animal or plant cells
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Biomedical engineering
Apply electrical, chemical, optical,
mechanical, and other engineering principles to
understand, modify, or control biological systems
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Activity
1. Application of engineering system analysis -
physiologic modeling - simulation - control
biological problems
2. Detection, measurement, monitoring -
physiological signal
3. Diagnostic interpretation - signal processing
techniques
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4. Devices - replacement - artificial organs
5. Computer analysis of - patient-related
data - clinical decision making
6. Medical imaging
7. Creation of new biological products -
biotechnology - tissue engineering
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Interrelationship between engineering and medicine
Engineering Science
Health Science
Engineering application - instruments -
devices - control system - facility design
Health application - diagnosis - therapy -
Clinical medicine
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Hospital or clinical engineering

• Information technology and data system
• Hospital facility
• Code, Standard and Regulation
• Hospital safety program
• Equipment acquisition
• Maintenance of equipment
• Hospital engineering program
• Risk management in hospital and medical equipment
• Management and assessment medical technology
• Training

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1. Management of information technology and data

• Information system
• Clinical records
• Financial management
• Interconnection between hospital facilities
• Medical computer system

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2. Hospital facilities

• Facility analysis
• Functional system
• Large equipment
• Fire protection
• Safety system
• Information system

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Facility Analysis

• Functional system
• Analysis from Architecture
• Analysis of supporting system
• Analysis from Interrelationship

• Functional system
• - Usage
• - Materials
• - evaluation

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X-ray department
10 yrs plan Population growth Hospital visit 150
visit/1000 populations/yr. Fluoroscopy Chest
x-ray General examination Special examination -
work load 75 -------- 9.00 -------------16.00 -
room usage 85
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Architectural Analysis

• Space relationship
• Air pressure in proximity area, air flow
• infection control
• smell control
• fire protection

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Facilities

• Operating room
• Clinical lab.
• Intensive care unit
• X-ray room
• Others e.q. nursery, physical therapy

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Operating room system system in
operating room

• Surgical support system (environment)
• Traffic and Commerce (activities)
• Communication and information (record)
• Administration (management)

Factors to be controlled

• Air exchange and pressure
• Temp. and humidity
• Electrical system

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1. Air exchange
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X-ray Department
Facility for Radiology Equipment 1. Floor
space 2. Floor loading capacity 3.
Ceiling loading capacity - overhead tube 4.
Lead shielding 5. Electrical power voltage,
single or three-phase current, size of
breaker tolerance of line voltage variation
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6. Room temperature and humidity control
7. Water (heat exchange) - max. and min.
gallon/min - proper pressure (psi) - maximum
incoming temp. - adequate drain capacity 8.
Room air - Room air flow (CFM) - incoming air
filtration - pressurization 9. Adequate
fire protection
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Electrical power
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Clinical Lab.
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Intensive care unit (ICU)
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4. Hospital Safety
Types of hazard 1. Electrical hazard 2.
Mechanical hazard 3. Environmental hazard
4. Biological hazard 5. Radiation hazard
6. Medical gas hazard
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1. Electrical hazard and Safety
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Electrical Safety Requirements
1. Emergency power system locations 2.
Anesthetizing locations - nonflammable -
flammable - mixed 3. Ambulatory care facility 4.
Critical care locations 5. General care
locations 6. Nonpatient care locations 7. Wet
locations
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Safety programs basic elements

• Periodic checks of equipment and environment
• Electrical safety requirements new equipment
• Staff orientation and training
• Investigation of reported electrical hazards

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Recommended steps for implementing an effective
program

• Classify of different areas
• Implement the recommended schedules, procedures,
  and report forms
• New equipment appropriate safety standard
• Review current electrical safety orientation and
  training
• Review activities of hospital safety committee

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Electrical Receptacles

• gt800,000 receptacles, 1987 1994 (ECRI)
• gt13 - failed (1 or more, criteria)
• Power plug Receptacle
• Safe, reliable connecting disconnecting
• Permit only devices intended
• Allow one orientation of plug contact
• Low electrical contact resistance
• Withstand normal use and mechanical abuse
• Grounding pin first to engage, last to
  disconnect
• Strain relief
• two-pole, three-wire, parallel blade
  grounding-type receptacle

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Tests-
1. Line voltage 210 250 V gt200 V heavy
load lt200 V no load 2. Ground
potentials general care critical care New
construction lt20 mV lt10 mV Existing
construction lt500 mV lt40 mV difference gt
20 3. Neutral-to-ground resistance lt1.0 ohm 4.
Ground resistance lt0.1 0.2 ohm 5. Contact
tension retention force gt 4 oz
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2. Mechanical hazard
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Tissue damage
Pressure sore - immobility - sensory inpaired,
loss Pressure - time curve - unacceptable -
acceptable Materials - assistive technology
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3. Environmental Hazard
External and internal Internal environment -
staff, personnel - traffic - water source,
cleanliness - waste disposals disposible -
air pollution - chemicals
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1. Waste disposal waste 15 lb/bed/day 200 bed
? 1.5 ton - disposable - infection and
radiation 2. Noise 50 85 dB lt 80 dB ,
better lt 70 dB 3. Water 4. Building structure 5.
Medical gas sources - cylinder 6. Non-ionized
radiation - A.C - UV - microwave -
laser
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5. Radiation Hazard
1. Therapeutic x-ray 1.1 External
source effective shielding Cobalt 60
shutter random radiation measurement 1.2
Internal source brachytherapy - cesium,
radium shielding patient transport
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6. Medical Gas and Vacuum System

• Central supply
• Pipeline distribution system
• Station outlet
• Alarm unit

Central supply - piping system - automatic gas
flow control, 2,000 ? 50 psi - gas sources
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Station outlet - pin index safety system
(PISS) - diameter index safety system (DISS) -
quick couplers
Medical gas pressure (psig) flow
(L/min) Oxygen 50-55 ? 100 Nitrous
oxide 50-55 ? 100 Medical air 50-55 ?
100 Carbon dioxide 50-55 ? 100 Nitrogen ?
160 ? 145
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Risk management in hospital and medical equipment
1. Management system 2. Life cycle cost - 20
purchase and installation - 80 others 3. Risk
management strategy - reactive - failure code
100 ? 108 100 medical equipment operation error
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Proactive risk management tools
1. Static factors - equipment function -
physical risk 2. Dynamic factor - maintenance
requirement - risk point - positive -
negative - average 3. Annual risk point -
change quickly months - fast component of
dynamic risk factor
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Biomedical engineering equipment management
system (BEEMS)
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Management and assessment medical technology
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Technology strategic planning project
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Static risk components
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Dynamic risk components
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New Equipment
Assign Severity Rating
Assign PM Interval
Assign PM Procedure
Develop User Training
Device Replacement
Research Benchmarks Severity/Reliability
Root Cause Analysis
Risk management flowchart
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The future

• Computer support
• Local area network (LAN)
• Hospital information system
• Telecommunication
• Data transmission capability
• Telemedicine
• Educational conference
• Facilities operation
• Strategic planning