INTRODUCTION:

Since the outbreak of COVID-19 pandemic in Ethiopia on 13 March 2020, there has been a gradual increase in the number of cases. Since then the Federal Ministry of Health (FMOH) have been taking several measures to expand number of facilities treating patient with COVID-19 and equipping them with essential medical devices. Even though many efforts have been exerted to avail the essential medical devices needed for COVID-19 treatment, there were shortages of resources which were a global concern due to the pandemic^1–3. According to the rapid national assessment conducted by FMOH, there were about 197 non-functional mechanical ventilators available in public hospitals. Besides, there were several numbers of non-functional patient monitors, oxygen concentrators, suction pumps, defibrillator, thermal scanners and electrocardiogram (ECG) machines.

To overcome these challenges, the Pharmaceutical and Medical Equipment Directorate (PMED) at FMOH has taken the roles of coordinating and collaborating with various stakeholders. In this regard, Biomedical Engineering Team under PMED conducted a pilot rapid assessment to identify the availability functional medical devices and capacity of health facilities in Addis Ababa. Finally, PMED initiated the medical devices maintenance campaign on 25 April 2020 at three maintenance sites in Addis Ababa.

RATIONALE:

The purpose of the campaign was to organize the maintenance stakeholders and to perform rapid maintenance for medical devices enlisted by World Health Organization (WHO) for COVID-19 treatment⁴. The ultimate goal was then to increase the functionality of these medical devices and avail them to be ready for treatment of patients with COVID-19.

METHODOLOGY:

Before the initiation of the campaign, we have conducted an assessment in 16 Addis Ababa hospitals where the functionality status and the failure details of the devices were identified. By analyzing the assessment data, list of medical devices were prioritized and potential suppliers were identified for supply of spare parts and accessories. Then, three maintenance sites (Ethiopian Airlines Aviation Academy Maintenance (ET-AMT) Workshop, National Meteorology Institute (NMI) and Addis Ababa Tegbarid Polytechnic College) were selected based on their capacity of skilled man power, availability of repair tools and suitability of working environment. The 16 healthcare facilities in Addis Ababa were then officially communicated to collect non-functional medical devices and deliver them to one of the dedicated maintenance site. Later on, the maintenance campaign was extended to the regions where they were communicated to deliver the non-functional mechanical ventilators through free transport offered by Ethiopian Airlines.

Upon arrival of the medical devices at the maintenance sites, they were cleaned and decontaminated before disassembling into parts and components. Then, the devices were disassembled and decontaminated internally. After decontamination, the problems for failure and non-functionality were checked for each medical device. Based on the troubleshooting findings, the devices were then maintained with all possible corrections and repair activities. After repair, the functionality and performance of each medical device were checked. Upon the completion of the maintenance and performance checks, the medical devices returned back to the respective facilities. The maintenance activities were performed by team of biomedical engineers/technicians volunteers, engineers/technicians at the selected maintenance sites with coordination and facilitation by Biomedical Engineering Team from PMED. The figure below shows the summary of procedures followed during the medical devices maintenance campaign.

Figure 1: Medical devices maintenance campaign workflow

RESULTS AND DISCUSSIONS:

During this maintenance campaign, total of 146 medical devices were maintained and made ready for service. The repaired medical devices were: - mechanical ventilators, patient monitors, suction machines, ECG machine, infrared thermometers, oxygen concentrators and defibrillator. Functionality and performance tests were performed for mechanical ventilator to ensure the proper operation of each parameter including gas analyzers, electrical safety and ventilation settings. The maintenance activities performed saved an estimated total cost of 12,054,404 ETB. Table 1 summarizes the number of maintained medical devices and their estimated costs.

Table 1: Number of medical devices maintained at three sites and the estimated cost

Devices maintained	Repaired quantity	Saved Cost (ETB)
Mechanical ventilator	60	11,616,000
Patient monitor	42	334,404
ECG	4	10,000
Defibrillators	1	2,500
Suction machine	6	15,000
IR thermometer	3	1,500
Oxygen concentrator	30	75,000
Total	146	12,054,404

At ET-AMT Workshop 54, mechanical ventilators were repaired in collaboration with Ethiopian Airlines maintenance engineers, biomedical engineers from hospitals and WMG Biomedical Engineering plc. The performance tests of repaired ventilators were performed by Biomedical Engineers from Tegbar-id Polytechnic College and Assist International. Few of mechanical ventilators maintenance activities are shown below.

Figure 2: Biomedical Engineers and Ethiopian Airlines Engineers working on ventilator repair

At Tegbar-id Polytechnic College 37 patient monitors, 23 oxygen concentrators, 01 defribrillator, 03 infrared thermometer and 03 electrocardiogram machines were maintained. The activities performed during the maintennace campaign are shown below.

Figure 3: Biomedical engineers/technicians performing maintenance of oxygen concentrators and patient monitors at Tegbar-id Polytechnic College

At NMI six mechanical ventilators, 06 patient monitors, 07 oxygen concentrators, 01 ECG and 06 suction machines have been maintained. The figures below shows few activities done at NMI during the maintenance campaign

Figure 4: Biomedical engineers/technicians performing ventilator and patient monitor repair at National Meteorology Institute

CHALLENGES:

The major challenges faced during this maintenance campaign were:

· Delay in medical devices distribution to the maintenance sites

· Unavailability of service manuals for some medical devices

· Unavailability of spare parts, accessories and consumables for repair

· Facilities deliver non-repairable and non-disinfected medical devices

· Facilities poor equipment handling practices

· Lack transportation vehicles during facilitation

CONCLUSION:

During this maintenance campaign total of 147 medical devices enlisted by WHO for COVID-19 treatment were maintained. The maintained medical devices were returned back to their respective health facilities and are providing services for COVID-19 patients. The maintenance campaign was performed by voluntary teams and saved more than 12 million ETB. From this maintenance campaign we have learnt that a lot can be achieved where functionality of medical devices can be increased by closely working with Biomedical Engineers/Technicians and stakeholders. Moreover, the campaign has played an important role in combating COVID-19 pandemic during this uncertain time as medical devices resources are limited globally. Hence, great experiences have been captured from this maintenance campaign. Cascading this kind of experience to regions and health facilities will improve the functionality and overall management of medical devices even during post COVID-19 pandemic period.

On the other hand, we have identified and observed several gaps in medical devices management during this campaign. Absence of proper medical devices management policies, strategies and guidelines at national, regional and health facilities levels lead to improper utilization of medical equipment. These in turn cause poor handling, use and operation of medical equipment in hospitals which are the major problems for failure of the medical devices. To solve these challenges in medical devices, proper planning and budgeting for spare parts, accessories and consumables procurement at national level is important. Equipping the maintenance workshops, provision of skill based training to Biomedical Engineers/technicians, developing strategies and guidelines on operation, utilization, maintenance, and overall management of medical devices at national, regional and health facilities levels are highly recommended.

ACKNOWLEDGEMENT:

We would like to thank the following volunteer teams, private, governmental and non-governmental organizations for their collaboration and cooperation during this maintenance campaign to combat the outbreak of COVID-19 pandemic.

· Team of volunteer Biomedical Engineers/Technicians

· Ethiopian Airlines

· National Meteorology Institute

· Tegbarid Polytechnic College

· Rotary Club, Addis Ababa West

· Assist International

· Addis Ababa Science and Technology University

· WMG Biomedical Engineering PLC

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

REFERENCES:

1. McMahon, D. E., Peters, G. A., Ivers, L. C. and Freeman, E. E. Global resource shortages during COVID-19: Bad news for low-income countries. PLoS Negl. Trop. Dis. 14, (2020).

2. Gereffi, G. What does the COVID-19 pandemic teach us about global value chains? The case of medical supplies. J. Int. Bus. Policy 3, 287–301 (2020).

3. Ranney, M. L., Griffeth, V. and Jha, A. K. Critical supply shortages - The need for ventilators and personal protective equipment during the Covid-19 pandemic. New England Journal of Medicine 382, E41 (2020).

4. List of priority medical devices for COVID-19 case management. Available at: https://www.who.int/publications/m/item/list-of-priority-medical-devices-for-covid-19-case-management

Received on 03.10.2020 Modified on 10.12.2020

Research J. Pharm. and Tech 2021; 14(10):5475-5478.

DOI: 10.52711/0974-360X.2021.00955

Medical Devices Maintenance Campaign: An Experience of COVID-19 Emergency Response in Ethiopia