RESEARCH STUDY ON THE FACTORS THAT LEAD TO

FAILURE AND BREAKDOWN OF ANESTHETIC MACHINES

AT KILIFI COUNTY HOSPITAL,

KILIFI, KENYA.

BY:

SHEILA IMINZA

D/UPMET/17012/042

THIS RESEARCH IS SUBMITTED TO THE MEDICAL

ENGINEERING DEPARTMENT KMTC KILIFI CAMPUS IN
THE PARTIAL FULFILLMENT OF THE AWARD OF A
DIPLOMA IN MEDICAL ENGINEERINKENYA MEDICAL
TRAINING COLLEGE

P.O BOX 95,80108.

KILIFI.

SUPERVISOR: MR.KIMANI

i
DECLARATION
I Sheila declare that is my original work. It has never been submitted to any
academic/research institute. No part of this work should be stored, transmitted,
duplicated in any electronic means without the prior permission of the author and/or
KMTC kilifi Campus

.Student: SHEILA IMINZA

Sign: ……………………………….. Date: ………………………………

Supervisor: Mr. KIMANI…………..Date: …………………………………

ii
DEDICATION
I dedicate this work to my family, thanking them for the support they have provided
to me till this time. My fellow medical engineering students are also not left behind
for their team spirit and support. May the Almighty God shower you with blessings in
abundance.

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ACKNOWLEDGMENT
First and foremost, sincere gratitude goes to God for His grace to bring me this far.

These special thanks also go to my supervisor Mr. Kimani for his immense and
worthy guidance throughout the research. May the Almighty continue blessing the
work of his hands.

Last but not least, I would like to express my thanks to my beloved family,
colleagues, Medical Engineers from Kilifi county hospital and KMTC fraternity
thanking them for their help during my time of research.

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Table of Contents

DECLARATION .................................................................................................................................... II

DEDICATION ....................................................................................................................................... III

ACKNOWLEDGMENT ........................................................................................................................ IV

LIST OF FIGURES .............................................................................................................................. VII

LIST OF TABLES ............................................................................................................................... VII

LIST OF ABREVIATIONS ................................................................................................................ VIII

ABSTRACT ........................................................................................................................................... IX

CHAPTER ONE: ..................................................................................................................................... 1

1.0 INTRODUCTION .............................................................................................................................. 1

1.1 BACKGROUND INFORMATION OF THE STUDY ...................................................................... 1

1.2 PROBLEM STATEMENT ................................................................................................................ 3

1.3 OBJECTIVES OF THE STUDY ....................................................................................................... 3

1.3.1 BROAD OBJECTIVES .................................................................................................................... 3

1.3.2 SPECIFIC OBJECTIVES .................................................................................................................. 3

1.4 JUSTIFICATION OF THE STUDY .................................................................................................. 3

1.5 SIGNIFICANCE OF THE STUDY ................................................................................................... 3

1.6 OPERATION DEFINITIONS............................................................................................................ 4

1.7 SCOPE OF THE STUDY. ................................................................................................................. 4

LIMITATION……………………………………………………………………………………………………………………………………4

CHAPTER TWO…………………………………………………………………………………………………………………………………5

2.0 LITERATURE REVIEW ................................................................................................................... 5

2.1 INTRODUCTION .............................................................................................................................. 5

2.1.1 FAILURE RATE ............................................................................................................................. 6

2.1.2 FAILURE ANALYSIS ..................................................................................................................... 7
2.1.2.1 Improper Storage and Transportation ................................................................................ 8
2.1.2.1 INNAPPROPRIATE HANDLING……………………………………………………….…………………………..10
2.1.2.3 Inadequate Maintenance ..................................................................................................... 9
2.1.2.4 Production Deficiencies ...................................................................................................... 9
2.1.2.5 Inappropriate Repair Techniques ..................................................................................... 10

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CHAPTER THREE: ............................................................................................................................... 12

3.0 RESEARCH METHODOLOGY ..................................................................................................... 12

3.1 STUDY DESIGN ............................................................................................................................. 12

3.2 THE STUDY SITE .......................................................................................................................... 12

3.3 THE STUDY POPULATION .......................................................................................................... 12

3.4 SAMPLE SIZE ................................................................................................................................. 12

3.5 SAMPLING TECHNIQUE ........................................... ERROR! BOOKMARK NOT DEFINED.

3.6 DATA COLLECTION INSTRUMENTS/TOOLS .......................................................................... 13

3.7 DATA COLLECTION PROCEDURE ............................................................................................ 13

3.8 DATA ANALYSIS .......................................................................................................................... 13

3.9 ETHICAL CONSIDERATIONS ..................................................................................................... 14

CHAPTER FOUR: ................................................................................................................................. 15

4.1 DATA ANALYSIS AND PRESENTATION .................................................................................. 15

4.2 DEMOGRAPHIC DATA................................................................................................................. 15

CHAPTER FIVE: ................................................................................................................................... 18

5.0 DISCUSSION& INTERPRETATION............................................................................................. 18

5.1 INTRODUCTION ............................................................................................................................ 18

5.2 HOSPITAL MACHINE MAINTENANCE AND PRACTICES CHARACTERISTICS (BIOMED,

PROCUREMENT OFFICERS, NURSES) ............................................................................................ 18

CHAPTER SIX: ..................................................................................................................................... 19

6.1 CONCLUSIONS .............................................................................................................................. 19

6.2 RECOMMENDATIONS ................................................................................................................. 19

APPENDIX I: BUDGET........................................................................................................................ 19

APPENDIX II: TIME FRAME .............................................................................................................. 20

APPENDIX III: QUESTIONNAIRE .................................. ERROR! BOOKMARK NOT DEFINED.

REFERENCES………………………………………………………………….…..24

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LIST OF FIGURES
Pie chart 4.1 Sex of the respondents ............................................................................ 15
Bar graph 4.1 Percentage on determinants on machine purchasing ............................ 16

LIST OF TABLES
Table 4.1 Age distribution ........................................................................................... 15
Table 4.2 Education level ............................................................................................ 16
Table 4.3 PPM rate ...................................................................................................... 16
Table 4.4 Level of technical knowhow of the machines ............................................. 17

vii
LIST OF ABREVIATIONS
KMTC-Kenya Medical Training College

DMET-Diploma in Medical Engineering Technology

viii
ABSTRACT
Break down of anesthetic machine is very common in kilifi county hospital surgical
sites. The current study is focused on the breakdown and failure of anesthetic machine
in kilifi county hospital (kch).The study is focused on use of questionnaire method
and interview method to determine the causes of these problems. The study findings
indicate that the main causes of failure ere: improper storage, improper handling, and
inadequate maintenance among others. The study shows that this amongst other could
be improved, but the improvements will require identification of the tasks performed
by this machine and development of new monitoring devices that can solve this
problems.

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 CHAPTER ONE:
1.0INTRODUCTION
1.1 Background information of the study
An anesthetic machine is equipment found in a special room where major surgical
corrections are performed. This special room is called operating room-found in theatre
of a hospital. On the other hand; it is also used in medical procedure to provide
adequate analgesia, sedation and neuromuscular relaxation to the patient to enable
surgery and other medical treatment to be performed. The anesthetic machine is
operated by anesthetist to induce unconsciousness into the patient. The machine
supplies various gases such as either Halothane or Nitrous oxide for the anesthetic
use. After the surgery is over, the anesthetist brings back the patient to normal with
oxygen which is either supplied by a central supply system or by cylinders. This
verification system is a part of anesthetic machine (yentis,2013).

The advancement of technology has necessitated the need of anesthetic machine in

theatre a hospital, due to the fact all theatre operations/activities are performed with
the aid of a machine. This advancement of technology has made better delivery of
services, lessening burden on nurses hence rescuing lives.

Anesthesia machine, itself has evolved from a simple pneumatics a complex way of
mechanical, electrical and computer controlled components. Much of the driving
force for the changes have been to improve patient safety and user convenience
(kromback ,2015).

Though may modification have been brought out still the basic design of the
anesthesia machine is a must for all the practicing anesthesiologists to understand the
modern anaesthetic workstation (olympio , 2013).

After anesthesia was invented and introduced with the public’s demonstration of
either anaesthesia by WIG mouton in 1846, for many years anaesthesia to the patients
until O2 and N2O were introduced as compressed gases in cylinder by 19thcentaury.
Metals skeleton was required for mounting those cylinders (sinclair,2006).

Consists of pressurized gases supplied by cylinder in pipelines to the anaesthetic

machine, which controls the flow of gases before passing them through vaparization
and delivering the resulting mixture to the patient through the breathing circuit. It has

1
five elements; high pressure supply for gases, flow meters, metal and glass vaporizer
bottle for either and a breathing system (Ann,2003)

The anesthesia machine is continuous flow machine in which all the components are
mounted on the table. Box shaped section of welded steel or aluminum provides a
rigid metal framework mounted on the wheels with antistatic tires and brakes.
Antistatic measures improve flow meters performance and where flammable vapors
are used to reduce the risk of ignition (Thadsad, 2006).

It has provision for fixing two oxygen cylinders and two nitrogen cylinders through
the yoke assembly with piss. There is also a provision for connecting the pipelines gas
sources of oxygen and nitrogen. A pressure gauge is mounted on the yoke assembly to
load pressure in the cylinder pressure regulation are located down the yoke to reduce
high pressure in the cylinder to a low and contest pressure of 45-60 psiG.

At the end of the back ban, there is the common gas outlet to which the breathing
circuit are connected to provide the anesthetic vapor containing vapour containing
oxygen gasses to the patient.

It can be conveniently divided into three parts, the high pressure system, which
receives gases at cylinders pressure, reduces the pressure and make constant,.

The intermediate pressure system, which receives gases from the regulation as
hospital and deliver them to the flow meter on oxygen flushes value and low pressure
system, which takes gas from the flow meter to the machine outlet and also contain
vapourizer.

However the machines are found to experience frequent breakdown and failure in
many hospitals, with kilifi county hospital being no exception. Thus interfere with the
delivery of services to the patients hence loss of lives. Equipment may fail even if it is
correctly installed in the appropriate environmental conditions, and appropriately used
and maintained. Failure of a machine refers to its inability to perform its required
function. Equipment failure occurs because certain components (or parts) that make
up the equipment deteriorate or break down (dorsch,2008).

2
It’s for the above reasons and many more that it becomes important for the study to
determine the factors that are contributing to the numerous breakdowns/failure of
anesthetic machine in kilifi county hospital.

1.2 Problem statement

When anesthetic machine have frequent breakdowns, they lead to taxes overburden,
misuse of finances, staff layoffs, death of patient, closing down of theatre etc. When
keen observations are made, the breakdowns are due problems caused by the end
users. To avert such occurrence it becomes prudent to discover why the machines
breakdown before their time elapses.

1.3 Objectives of the study

1.3.1 Broad Objectives

To determine the factors that plays a role in the breakdown/failure of anesthetic
machine.

1.3.2Specific objective

To find out causes of failure of anaesthetic

To establish the practices of maintaining anaesthetic machine .

To Establish the remedies to breakdown of anaesthetic machine

1.4 Justification of the study

Failure of anaesthetic machine due to frequent breakdown may lead to death of
patients, patient not treated and spread of infection. Kilifi county hospital being a well
equipped hospital in Kenya, any problems become a concern to the general public and
as a research student, it stood a better chance to do research on why anaesthetic
machine do breakdown and fail in it.

1.5 Significance of the study

The research findings will be helpful in hospital workshops for better maintenance of
anaesthetic machine. It will help other researchers who may need to do similar studies
on the failure and breakdown of anaesthetic machine. The findings will help in
seminars on the failure of anaesthetic machine and maintenance.

3
1.6 Operation Definitions
Factors that lead to: these are events that lead to occurrence of an event, in this case
breakdown

Breakdown/Failure: it’s when a machine fails to perform its tasks efficiently or

completely

Anesthetic machine: This is a machine used in medical procedure to provide adequate

analgesia, sedation and neuromuscular relaxation to the patient to enable surgery and
other medical treatment.

Analgesia: Free from pain/pain management

Sedation: Absence of awareness

1.7 Scope of the study.

This study was done at Kilifi county hospital to identify the factors that lead to failure
and breakdown of anesthetic machines

1.8limitation
Are calibrated to be accurate at sea level.

Designed to function in an upright position within gravitational field

4
 CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 Introduction
Anesthetic machine may fail even if it is correctly installed in the appropriate
environmental conditions, and appropriately used and maintained. Failure of
equipment refers to its inability to perform its required function. Equipment failure
occurs because certain components (or parts) that make up the equipment deteriorate
or break down. The failure phenomena and failure mechanisms of the components are
clarified by developers and researchers in the field of equipment components
(Murray, 2011)

In addition, the failure rate of each component based on extensive data and
experiences is presumed or determined. Research shows that many failures of
anesthetic machine occur two or three years after installation. Moreover, a further
increase in failures can be expected again after another two to three years. The pattern
of these failures (failure occurrence distribution) practically conforms to statistics and
theoretical failure prediction (e.g. failure rate curves and reliability predictions). On
the other hand, causes of anesthetic machine failures vary and in some cases overlap.
This is confirmed by analyzing individual failures. The causes of equipment failures
are considerably influenced by the machine’s installation environments, equipment
usage, maintenance and inspections, etc. According to statistics for anesthetic
machine failures, about 80% of all failure cases are caused by preventable factors. For
instance, failures due to inadequate maintenance account for about 60% of all the
failure cases (Henrichs,2009)

In this case, most failures arise from deterioration of accessories and consumable
components. The deterioration time of the accessories and consumable components
can, however, be predicted by carrying out maintenance and inspection. Therefore,
60% of all these failures can be prevented by replacing such ‘consumable parts’ on a
regular basis, or replacing them immediately when the equipment becomes defective.
These are not real breakdowns of the equipment. In addition to this, failures due to
inappropriate handling, environmental stress and wear-out account for about 20% of
all the failure case (langhan ,2009).

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Most of these can also be prevented by carrying out appropriate measures based on
MMS. It can be said that 80% of medical equipment failures are, therefore,
preventable. 60% Inadequate maintenance (deterioration of consumable parts)
Preventable factors, 80% 20% Inappropriate handling etc 20% Initial failure, random
failure, etc. Anesthetic machine breakdown according to causes: 80% of all the
failures are preventable. Unpreventable factors This Part will first describe the time
distribution of equipment failures without maintenance, and will then describe the
case study, analysis, classification and statistics of the equipment failures. As a result,
the conformity between the actual failure occurrence and the theoretical and statistical
failure occurrence can be recognized. In addition, it describes maintenance and
management issues for equipment based on the problems with the operating
environment and technical service, and the importance of in-house services carried
out by the hospital itself. Based on these, we can consider the root cause of problems
in medical equipment failure (Robertson,2010).

2.1.1 Failure Rate

Equipment failures can be categorized into three stages according to the occurrence
rate with the passage of time. That is, since the causes and phenomena of the failures
in each stage are different, these are called Initial Failure, Random Failure and Wear-
out Failure respectively.

The failure rate is high during the initial stage. This may occur as soon as the
operation of equipment is begun, resulting from inappropriate circuit design, improper
choice of components, faults in the production process, etc. Such defects generally
may not be detected by the user, because such shortcomings are often observed and
rectified during examinations/inspections after manufacturing in the factory or at the
installation process (williams,2005).

In addition, progress in reliability engineering in recent years has remarkably

decreased the initial failure rate. However, because unexpected initial failures
occasionally occur, reputable manufacturers set the one-year guarantee after the
equipment installation.

In the second stage, the state of the equipment changes , and the equipment failure
rate decreases. During this period, failures occur at random, however the failure rate is
low. This can be said to be a period of stability (thomas, 2008).

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In the third stage ,it shows that the equipment’s condition has deteriorated. Here, the
failure rate starts rising again resulting from the deterioration, wear-out or breakdown
of components of the equipment with the passage of time. However, during this
period, the failure rate can be reduced through replacement of worn-out or faulty
components, and by their proper adjustment. Note that this will extend the lifespan of
the equipment as. When failures appear repeatedly, the budget expenditure on repairs
increases and the equipment’s reliability and safety cannot be guaranteed anymore.
This should indicate the end of the equipment’s life. Equipment failures can be from
many other causes besides the above-mentioned failures. In the case of anesthetic
machine, there is usually a zero tolerance of breakdowns. The maintenance that
prevents a breakdown of anesthetic machine, therefore, must be carried out even in
the period of stability (Arnot-smith,2010).

For example, in Japan where the depreciation and cost management system have
progressed, the lifespan of medical equipment is generally set at four to seven years
depending on the type of equipment ( ‘Illustrated Medical Equipment Dictionary’
Sangyo Chosakai, Japan). On the other hand, electronic circuits used in equipment
have a long lifespan of ten years or more. For this reason, if maintenance to replace
deteriorated components by new ones is carried out, actual lifespan of the equipment
becomes ten years or more(Baird,2009).

2.1.2 Failure Analysis

At surgical sites, an anesthetic machine faces various stresses, and these stresses can
lead to its failure. In addition, anesthetic machine might already have been exposed to
some stresses before arriving at the site. These stresses can result in both preventable
and unpreventable breakdowns. The evaluation and analysis of these abnormalities is
very important. At the hospital level, the failure analysis helps to maintain reliability
and safety of medical equipment through:

Technical feedback to the equipment manufacture

Measures against environmental conditions

Improvement of maintenance and inspection methods

. Failure analysis at the hospital level looks at the cause of equipment failure from
aspects of the installation and operating environments, symptom, fault locating, faulty

7
components, equipment history. Based on this, maintaining the reliability and safety
of equipment positively contributes to the effective provision of healthcare services in
the hospital. At the equipment manufacturer, the mechanisms of failure are studied in
more detail. Continuing the failure analysis can help to maximize hospital service and
to prevent medical accidents even if equipment failure happens. Equipment failures
occur due to various causes. One method of classification uses nine chronological
categories:

Improper storage and transportation

Inappropriate handling

Inadequate maintenance

Production deficiency

Inappropriate Repair technique

In certain cases, some of the above-mentioned failures overlap. One of the reasons is
that although most of the failures could be prevented by implementing MMS, use of
equipment continues without maintenance. If this is not rectified, equipment will be
exposed to various stresses from inappropriate environment, inappropriate handling,
wear and deterioration, etc. These overlapping stresses cause the equipment failure.
Most causes of the failures and breakdown can be theoretically and technically
analyzed(sinha,2011).

2.1.2.1 Improper Storage and Transportation

When anesthetic machinesare exposed to various stresses from the time of leaving the
manufacturer and agency to arriving at the end-user, the equipment is possibly
exposed to vibration, high temperature and high humidity due to inadequate
infrastructure such as roads, storage facilities, etc., and such exposure can cause
equipment breakdown. On the other hand, medical equipment can possibly break
down due to improper storage and transportation even after arriving at the
hospital.(Russell, 2005).

2.1.2.2 Inappropriate Handling

In the case of imported equipment, the operators are not able to read the operating
manuals either because of the foreign language or because they may not have any

8
interest to read it. As a result, handling and operation of equipment is improper, and
this causes equipment to break down. It must be remembered that equipment failure
caused by inappropriate handling often results in significant impact upon the hospital
budget. On the other hand, improper operation of anesthetic machine increases risk of
accidents to operators, patients and surroundings. Therefore, operators’ skills in
handling medical equipment should continuously be improved by conducting user
training on operation and maintenance. Appropriate operation and application of
medical equipment ensure reliability and safety, thus helping to achieve correct
diagnosis and therapy(Merry,2008).

2.1.2.3 Inadequate Maintenance

Generally speaking, anesthetic machine cannot be used without accessories and
consumables. The lifespan of such ‘consumable components (excluding daily
consumables such as recording papers, disposable catheters, gels and reagent)’ is
shorter than that of the actual equipment. In addition, some isolated components used
for equipment assembly also deteriorate in a short time. These lifespans, of course,
depend on the equipment usage. The lifespan of consumable components is mostly
predictable. Procuring these in advance can prevent equipment failures. As a result,
the hospital will get better service from its equipment. To achieve this, carrying out
regular maintenance and inspection of equipment is essential. On the other hand, such
a concept is sometimes not understood. People only notice that consumable
components are out of stock when the necessary components are required to service
or to repair faulty equipment. Even if a local agency exists, procurement is very
difficult and expensive. Equipment considered as ‘broken down’ is, therefore, left or
abandoned in the corner of a storeroom. In fact, the purpose of maintenance is to
monitor and maintain the performance, reliability and safety of the equipment.
Replacement of deteriorated components is not always necessary for carrying out
maintenance. For instance, carrying out user calibration (e.g. zero point, reference
point and line voltage adjustment), which is important for accurate therapy. Once the
equipment develops a malfunction as a result of such inadequate maintenance, a high
restoration cost may be required(osborn,2005).

2.1.2.4 Production Deficiencies

According to WHO regulations, medical equipment manufacturers should launch their
high quality products in accordance with national or international standards as well as
9
internal quality control. However, malfunctions and failures of equipment of uncertain
cause occasionally occur several years after equipment is put to use. This is as a result
of inadequacy in the design, improper choice of components, improper manufacturing
process, etc., and this is called production deficiency. When anesthetic machine has a
defect caused by a production deficiency is found, the reputable manufacturer makes
it public according to PL Law (Product Liability Law), and responds by offering a
free repair or recalling the product. However, such announcements do not reach third
world countries easily(McKenzie,2009). The defect of the equipment is recognized,
but the equipment is continuously used despite malfunctioning, or it might be
assumed to have broken down and be irreparable. Even if there is an ME engineer,
he/she may not be able to judge whether it is a production deficiency until he is
familiar with the malfunction in other identical items of equipment. Considerable
technology and effort are necessary to communicate and negotiate with the equipment
manufacturer or agency for the confirmation and measures to be taken when the
defect due to production deficiency occurs. For example

■ Anesthetic machine with a patient Monitor Five identical models were introduced
at the same time. About two years after installation, sphygmomanometer values from
all five pieces of equipment became abnormal. When an inquiry was made to the
manufacturer, it was found that the air tubing used in the sphygmomanometer module
deteriorated prematurely causing air leakage, resulting in abnormal measurements. All
modules were sent back to the equipment manufacturer, and the replacement of the air
tubing and its sphygmomanometer calibration were done at no cost. [National
Maternal and Child Health Centre, Cambodia]

2.1.2.5 Inappropriate Repair Techniques

Logical troubleshooting using wide-ranging knowledge of operating principles,
structure of the equipment, comprehension of electronic circuits, functions of
electronic parts, etc. is required to repair anesthetic machine . However, failure often
happens because of human error, including imitation and application of non-genuine
parts. In addition, often no record of the repair process is kept, making it difficult or
impossible to restore the item even after engaging an excellent engineer. On the other
hand, even well experienced repair engineers sometimes make simple mistakes.
Avoiding such ‘Human Error’ is one of the important issues when servicing any
anesthetic machine. (Desakl, 2011).
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 CHAPTER THREE:
3.0RESEARCH METHODOLOGY
Research has its special significance in solving various operational and planning
problems. The main aim of this chapter is to describe the research method in a broad
way, determines its type, the methods used to collect data and how it will be analyzed.
This chapter represents the methodology of the study from being the research title as
an idea till the analysis of data, tools used and results which were obtained during the
research period.

3.1 Study Design

A Research design is a set of methods and procedures used in collecting and
analyzing measures of the variable specified in the research problem research
(Creswell, 2014).A descriptive cross -sectional study to gather data on the methods
used to procure maintenance and factors that leads to failure and breakdown of
anesthetic machine in kilifi county hospital

3.2 The Study site

The research setting can be seen as the physical, social and cultural site in which the
researchers conduct the study.

The study shall be conducted in kilifi county hospital. It is located in kilifi, kenya

3.3 The study population

It is generally a large collection of individuals or objects that is the main focus of
scientific query and researcher can apply their conclusions. The study population
shall involve the procurement officers, nurses, biomedical engineers ,casuals and
anesthetist. Due to the fact that they are the ones that majorly handle the machine.

3.4 Sample Size

Is the act of choosing the number of observation or replicates to include in a statistical
sample. The sample size is an important feature of any empirical study in which the
goal is to make inferences about a population from a sample (Hubrecht, 2010).

P=proportion in the target population (0.5)

Z= standard normal deviation (1.96)

d = level of statistical significance (0.05)

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Nf= n/1+n/N

384/1+384/50=44

44people

3.5 data collection instruments/tools

The study will be conducted in kilifi county hospital The researcher will rely on self-
administered questionnaires and observation to acquire findings.

A questionnaire is a research instrument that gathers data over a large sample. The
advantages of using questionnaires are; the person administering the instrument has
an opportunity to establish rapport, explain the purpose of the study and explain
meaning of vague term(Gillhams,2008)s. The main purpose of a questionnaire is to
communicate to the respondent what is intended and to elicit desired response in
terms of empirical data from the respondent in order to achieve the research objective.

Observation refers to the systematic examination of real-time process or operation

with the goal of identifying needs/challenges or improving process and practices. The
main advantage of observation is that one gets truthful information(Williams,2004).

3.7 Data collection procedure

The researcher will administer the questionnaires to the respondents to collect primary
data. The researcher will also observe the day to day operations of anesthetic
machine. Oral interview will also be used.

3.8 Data AnalysiS

Saunders, Lewis and Thornhill(2009)defined data analysis as the process of data to
make meaningful information.

Collected data will be checked to ascertain their accuracy and identify those items
wrongly responded to. The data will then be analyzed with computer programs to
conform to the objectives in relation to the topic.

13
3.9 Ethical Considerations
According to mugenda and mugenda (2003)pribacy and ethical consideration should
be prioritized when one is conducting a research. This is meant to avoid
embarrassment and ridicule that will lead to failure to achieve.

The nature, purpose and procedure of the study will be explained to each participant
and they will be free to refuse to answer any question or drop out of the study at any
time and will not affect them in any way. Consent will then be obtained from each
participant in the study. Participants will then be assured of their confidentiality or
personal information and written materials.

The respondents will also benefit from the study since they have an opportunity to
express their viewpoints and experiences.

14
 CHAPTER FOUR:
4.1Data analysis and presentation
The chapter involves analysis and presentation of data and putting the data into
consideration of the objectives of the study.

The analyzed data is presented data is presented in tables, graphs and pie charts. The
sample rate was 100% and all the 38 respondents sampled to be included in the study
reached

4.2Demographic data

4.1.1 Pie Chart showing sex of the respondents

male at 53%
female at 47%

Pie chart 4.1 Sex of the respondents

4.1.2 Table showing Age distribution of respondents

AGE(YEARS) NO. OF RESPONDENTS PERCENTAGE

2 5 - 3 4 1 2 3 2
3 5 - 4 4 1 4 3 7
4 5 - 5 4 8 2 1
55 and above 4 1 1
T O T A L 3 8 1 0 0

Table 4.1 Age distribution

15
4.1.3Table showing level of education of respondents

Level of education No.of respondents P e r c e n t a g e

P r i m a r y 2 5 %
S e c o n d a r y 1 4 3 7 %
T e r t i a r y 2 2 5 8 %
T o t a l 3 8 1 0 0 %

Table 4.2 Education level

Table showing when PPM is done on the machines( Biomed only)

When is PPM carried out on the machines No. of respondents P e r c e n t a g e

N o t a t a l l 2 2 0
A s p e r s c h e d u l e 3 3 0
When the machine fails 5 5 0
T o t a l 1 0 1 0 0 %
Table 4.3 PPM rate

4.1.4 Graph showing the factors to be considered when purchasing/ordering for

anesthetic machines (Biomed, Procurement officers, Medics)

14

12

10

8
Versatility at 21%
6
Price at 41%
4 Durability at 38%
2

0
Versatility Price Durability

Bar graph 4.1 Percentage on determinants on machine purchasing

16
Table showing the level of technical knowhow of the machines by the user( Biomed,
Medics, Casuals)

How well do you the machines No. of respondents P e r c e n t a g e

W e l l 7 2 4
Q u i t e w e l l 5 1 7
N o t r e a l l y 1 7 5 9
T o t a l 2 9 1 0 0 %
Table 4.4 Level of technical knowhow of the machines

17
CHAPTER FIVE:
5.0 DISCUSSION& INTERPRETATION
5.1 Introduction
The chapter considers the findings gathered on the sample from the study population
and discusses it in line with the objectives, literature review and the key variables of
the research

5.2 Hospital machine maintenance and practices characteristics (Biomed,

Procurement officers, Nurses)
It was found that when purchasing/ordering for new machines price was major
determinant at 41%, then durability at 38% and lastly versatility at 21%. It also came
out a majority of the end users of the machines had little knowledge.

18
CHAPTER SIX:
6.1 CONCLUSIONS
Out of the 38 respondents who were interviewed on factors contributing to the failure
and breakdown of anesthetic machines in kilifi county hospital and researchers own
observations.

Based on these observations and interviewing through questionnaires and orally, the
research found out that:

PPM despite being a major factor in the longevity of a machine, was carried out
majorly when the anesthetic machines do fail or when repairing the machine.

There was poor handling of the machines

Most of the anesthetic machines in kilifi county hospital were donations, which had
outlived their lifespan

6.2 Recommendations
The following recommendations are made:

The government and kilifi county hospital administration should limit the number of
donations to the hospital.

Adequate PPM should e carried out on the machines, at least per schedule

During installation, commissioning and repairing of an equipment, skilled personnel

ought to be involved

Kilifi county hospital should embark on training its personnel on changes in

technology i.e. provide funds for training, seminars, that will thoroughly equip their
biomed staff with appropriate skills

Departments should be required to inventory their medical equipment semi-annually

for the purpose of count, location, preventive maintenance labels, and estimated date
replacement

Ensure that all anesthetic machines are not to be used without safety check label fixed
to the equipment

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APPENDIX I: BUDGET.

NO ITEM QUALITY COST/ITEM AMOUNT(KSHS)

1 Writing pens 3 15 45
2 Pencil 2 15 30
3 Rubber 1 10 10
4 Ruler 1 20 20
5 Fool scarps 1 500 500
6 Research files 1 50 50
7 Internet charges 6GB 1000 Ksh 3G 2000
for 30 days
8 Proposal typing printing 2 copies 800 1600
And binding
9 Transport 2000 2000
10 Ream of photocopy 1 550 550
papers
TOTAL 6795

APPENDIX II: TIME FRAME

ACTIVITY September October November December January 2018
2018 2018 2018 2018
Proposal
writing
Proposal
presentation

Data
collection
Data analysis

Research
presentation

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APPENDIX III: QUESTIONNAIRE
A QUESTIONNAIRE ON THE FACTORS THAT LEADS TO FAILUIRES AND

BREAKDOWN OF ANAESTHETIC MACHINE IN KILIFI COUNTY HOSPITAL

Yours precious time and cooperation in filling the questionnaire will help me

Do a research on factors leading to frequent breakdown of machines at

Kilifi County Hospital .The completion of this will help in fulfilling the requirement

For the award of Diploma in Medical Engineering at the Kenya Medical Training
college.

I will be thankful and more gracious for your cooperation and support in those
regards.

INSTRUCTIONS

 Please tick in the above boxes

 Please fill your blank according to your understanding
 Do not write your name on the paper
 Please ask where you do not understand
 Please tick where it is appropriate for you

1. Sex

o Male
o Female

2. What is your age?

o 25-34
o 35-34
o 45-54

3. Whats your highest level of education?

o Primary
o Secondary
o College

4. What is your occupation?

o Nurse

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 o Biomedical engineer
o Doctors
o Procurement
o Casuals
o
SECTION B.
1. When is the planned preventive maintenance carried out on the anesthetic
machine?
o Not at all
o As per the schedule
o When the maintenance fail.
2. How well do you know the machines?
o Well
o Quite well
o Not really
3. How long do you take to report the anesthetic machine failure to the
technical in charge?
o Immediately
o Sometimes
o Never
4. If immediately , then after how long does it take to respond to your
request.
o Immediately
o After sometime
o After several follow ups
o Never
5. How do you rate the performance of the machines
o Excellent
o Good
o Average
o Poor

QUESTIONS FOR THE BIOMEDICAL ENGINEERS.

1. How often do you carry out planned preventive maintenance on the

anesthetic machines?
o When the machine fails
o As per the schedule
o Never
2. What are the factors to be considered when purchasing /ordering for
the new anesthetic machines?

o Durability

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 o Price
o Versatility
3. What are the causes of the failure of anesthetic machine?
………………………………………………………………………………
………………………………………………………………........................
............
4. What are the practices for maintaining the anesthetic machines?
o 1 day
o 1 week
o 1 month
o 1 month
5. How well do you know the machines?
o Well
o Quite well
o Not really

23
REFERENCES
Illustrated Medical Equipment Dictionary, Chosakai, Japan, 2005.

Sanjay Gandhi Post-graduate Institute of Medical Sciences, India, 2005.

National Maternal and Child Health Center, Cambodia, 2005.

Kompong Cham Referral Hospital, Cambodia, 2007.

Tribhuvan University teaching Hospital, Nepal, 2001.

University Teaching Hospital, Zambia, 2009.

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