Federal Democratic Republic of

Ethiopia
Ministry of Health
 Pharmacuetical and Medical Equipment Management Directorate

Pharmacuetical and Medical Equipment Ma

January,2018
Addis Ababa
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Pharmacuetical and Medical Equipment Management Directorate

Forward
Modern health care services are very much dependent on the use of proper medical devices for diagnosis and
treatment. The majority of these devices and equipment are manufactured in developed countries and needs skilled
man power to manage and use them lifelong. Because they are applied on human being they need rigorous care and
handling for the sake of patient safety and utilize them effectively and efficiently. Even with normal and careful
use, they are subject to malfunction.

It is important to take good care of them and employ timely preventive maintenance to keep them
working last long and decrease downtime. The proper handling and maintenanceof these devices can be
achieved by deploying the well trained and competent biomedical Equipment Engineers/ Technicians to
the respective health facilities. In line with this, it is also important to provide continuous on job training
to build their capacity and introduce them to a new technology. Therefore, this training package is
developed to provide TOT for biomedical education training provider institute instructors as well as
professional who are working at health facilities to fill their Knowledge, attitude and skill gaps on some
selected MCH medical devices.

Regasa Bayisa
Pharmaceutical and medical equipment management directorate director
Pharmacuetical and Medical Equipment Management Directorate
Acknowledgment
The Federal Ministry of Health acknowledges the commitment and technical support of the MCH
Medical devices participant manual development team members(listed below) along with their
organizations and key contributors who made the development of this Training manual are:
 BihanechWorku, Bsc, (RasDesta Hospital)
 Demoz Kebede, BSc, (FMHACA)
 DemeruYeshitla, MA, (Jhipeg/FMHACA)
 Ermias Haymmanot, BSc, (Zewditu Memorial Hospital)
 Getaneh Girma, (Jhpiego)
 Helen Tiruneh, (Jhpiego)
 Samuel Mengistu, Dr, (Jhpiego)
 Addisu Taso (FMOH)
 Andualem Wube (ICAP)

The write up of this material has been done by three individuals listed above (consultant) with guidance
from jhpiego Ethiopia S-HRH Project Education, DOCRORS WITH AFRICA CUAMM and training
Advisors team. The printing of this manual was done in collaboration with Doctors with Africa CUAMM
with the support of Italian Cooperation Development Agency.

The Ministry would like to thank and acknowledge S-HRH Project funded by technical assistance in the
preparation of this Participant manual.
Pharmacuetical and Medical Equipment Management Directorate

List of acronyms and abbreviations

MCH Maternal and Child Health

CPAP Continuous Positive Airway Pressure

LCD Liquid Crystal Display

PPE Personal protective equipment

CPU Central Processing Unit

FHR Fetal Heart Rate

RF Radio Frequency

JU IT Jimma University Institute of Technology

AAU IT Addis Ababa University Institute of Technology

AAT PC Addis Ababa TegbareidPolytechnique College

HBC Human Bridge College

KPTC KombolchaPolytechnique College

HTM Health Technology Management

HRDD Human Resource Development Directorate

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 Pharmacuetical and Medical Equipment Management Directorate

Table of Contents
Forward II
Acknowledgment III
List of acronyms and abbreviations List
of Figures VIII
Introduction to the manual IX
Course syllabus for MCH equipment X
Course description XII

CHAPTER 1: Caring, Respectful and Companionate Healthcare Service 1

1.1. Introduction to Compassionate, Respectful and Caring (CRC) 2
1.1.1. Definition of CRC 2
1.1.2. Why CRC a Transformation Agenda 2
1.1.3. The Benefits of CRC 3
1.1.4. National Strategy and Approch of CRC 4
1.2. Healthcare Ethics 4
1.2.1. Prenciples of Health Care Ethics 4
1.2.2. Confidenitiality and Informed Consent 6
1.2.3. Preventive Ethics in the Aspect of CRC 7
1.2.4. Ethics and Law as Enablers of CRC 7
1.3. Principles and Standards of Compassionate Care 9
1.3.1. Qualities of compassionate care 9
1.3.2. Elements of compassionate care
1.3.3. Principles of compassionate care
1.3.4. Threats to compassionate care 12
1.4. Respectful care 13
1.4.1. Definition of Concepts of Respectful and Dignified Care 13
1.4.2. Principles of Respectful Care 15
1.4.3. Characteristics of Disrespectful Care 15
1.4.4. Factors affecting Respectful Care Provision 16
1.5. Compassionate leader 18
1.5.1. Quality of Compassionate Leadership 18
1.5.2. System Thinking for CRC 20
1.5.3. Organizational Culture 21
1.5.4. Leading CRC Health Teams 22
 Pharmacuetical and Medical Equipment Management Directorate
CHAPTER 2: Infant incubator 25
2.1. Introduction 26
2.1.1 Purpose / clinical application
2.2 . Working principle
2.3. Basic parts and function 27
2.3.1 The major components of an infant incubator system are 27
2.3. 2. Function of Incubator components 28
2.4. Classification 28
2.5. Safety and care of the device 29
2.6. Troubleshooting techniques 29
2.6.1. Preparatory steps of troubleshooting technique 29
2.6.2. Troubleshooting procedures to detect major component failures 30
2.7. Maintenance and Repair procedure
2.8. Preventive Maintenances
32
2.9. Performance test for Infant Incubator 33
2.10. summary 33

CHAPTER 3: Infant radiant warmer 3.1.

Introduction 35

3.2. Purpose / clinical application 35

3.3 Working principle 35
3.4 Basic parts and function 36
3.5. Infant radiant warmer components function 36
3.6. Classification 37
3.7 Safety and care of the device 37
3.8. Troubleshooting techniques 38
3.8.1. Preparatory Steps of Troubleshooting Technique 38
3.8.2. Troubleshooting Procedures to Detect Major Component Failures 39
3.9. Maintenance and Repair 39
3.9.1. Preventive maintenance procedure 40
3.10. Performance test for Infant Radiant Warmer 41
3.11. Summary 41
CHAPTER 4:
Fetal monitor 42
4.1.Purpose/clinical application 43
4.2. Working principle 43
4.3. Basic parts and function 44
4.3.1. Basic Parts 44
Pharmacuetical and Medical Equipment Management Directorate
4.3.2. Basic Parts Function 44
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 Pharmacuetical and Medical Equipment Management Directorate
4.4. Safety and care of the device 45
4.5. Troubleshooting Techniques 45
4.5.1. Receives Maintenance Request 45
4.5.2. Troubleshooting Procedures 46
4.6 Maintenance and Repair 46
4.7. Preventive maintenance procedure 47
4.8 Performance Test for Fetal Monitor 47
4.9. Summary 4
CHAPTER 5: CPAP Machine

5.1. Purpose / clinical application 50

5.2 Working principle 50
5.3 Basic parts and function 51
5.3.1 Basic parts 51
5.3.2 Parts function 51
5.3.3. Classification 52
5.3.4. Safety and care of the device 52
5.4. Troubleshooting Procedure 53
5.4.1. Receive maintenance request 53
5.4.2 Physical Inspection 53
5.4.3. Power supply check up
5. 4.4. System verification
5.4.5 Volume control and transducer checking
5.4.6. Maintenance and Repair
54
54
5. 5. Preventive maintenance procedure 55
5.5.1. Performance Test for CPAP Machine

5.6. Summary 56

Annex 1. Learning guide for MCH Medical devices

Annex 2. Trainee Performance Evaluation Check list for Infant Incubator
Annex 3. Trainee Evaluation Check List for Infant Radiant Warmer Annex 4.
Trainee Evaluation Check list for fetal Monitor
Annex 5. Trainee Evaluation Check list for CPAP Machine References

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Pharmacuetical and Medical Equipment Management Directorate

List of Figures
Figure 1. Infant incubator
Figure 2. Block diagram of Infant Incubator
Figure 3. Infant radiant warmer
Figure 4.Block diagram of Infant radiant warmer
Figure 5.Block diagram of fetal monitor
Figure 6.Block diagram for CPAP system
Figure 7.CPAP Machine components

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Pharmacuetical and Medical Equipment Management Directorate

Introduction to the Manual

The Federal Ministry of Health’s Growth and Transformation Plan (GTP) indicates that by 2018,16
specialized governmental hospitals, 80 general hospitals, 800 primary hospitals, and 3,200 health centers
will be established. Additionally, there are more than 200 private hospitals and diagnostic centers
operating in the country. The FMOH reports that these healthcare facilities will need 4,000 newly trained
biomedical equipment technicians and 600 biomedical engineers. Ensuring that existing technicians and
engineers are equipped with adequate skills is also a challenge. Ethiopia lacks systems to manage the
lifecycle of emerging healthcare technologies and medical devices, but has developed a plan to address
this.

The current biomedical engineering programs at JU ,IT, and AAUIT, and the vocational biomedicaltechnician
program at AATPC, HBC, KPC and other newly merging regional TVET Colleges are tasked with producing
technicians and engineers to meet the very high demands for trained professionals throughout Ethiopia.
Program gaps include a lack of adequate hands-on, practical training opportunities and laboratory/ industrial
skills for students, and an acute shortage of academically/industrially/vocationally trained faculty and staff.
The existing faculty and staff lack access to modern biomedical training equipment, modern training
methodologies, as well as evidence-based information on biomedical devices that is in line with international
standards and best practices. This deprives students/trainees of standardized protocols and training in devices
maintenance and management and leads to an unstructured career path for students.

The HRH Project through its close working relation with those institutes has made discussions with
teaching staff’s and biomedical departments to gather the information regarding the training demand and
discussed with the FMOH, HRD directorate and decided to develop these standard training packages for
the purpose of conducting technical update training on some selected medical devices. The HRH project,
Core biomedical Engineers coordinate this training package development activity in collaboration with
FMOH technical experts, we hope this will be a good opportunities for faculty, staff, and HTM
personnel’s to fill the skill gap on the selected medical devices and as a result improves the faculty
teaching learning process.

THE FOLLOWING ARE THE CORE COMPETENCE OF THIS TRAINING MANUAL.

• To explain operation principles of some selected MCH medical devises
• To identify the basic components of the selected operation MCH equipments
• To familiarize the proper handling and safe use of MCHmedical devices
• To study appropriate troubleshooting procedures for each equipment.
• To perform preventive and corrective maintenance as per the manufacturer manual
• To perform performance test and calibration as demanded

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Pharmacuetical and Medical Equipment Management Directorate

Course syllabus
COURSE DESCRIPTION
This a 4 days, MCH medical equipment’s training course is designed to equip biomedical engineers/
technicians to maintain MCH medical equipment’s (infant incubators, infant radiant warmer, CPAP and
fetal monitor)

COURSE GOAL:
To provide the participants with knowledge, skill and attitude needed for maintenance of MCH medical
equipment.

COURSE OBJECTIVES:
At the end of this course Participant will be able to:-
 Describe purpose of MCH medical equipment
 Explain working principle of MCH medical equipment
 Differentiate basic parts and function of MCH medical equipment
 Perform troubleshooting of MCH medical equipment
 Perform calibration of MCH medical equipment
 Practice safe handling of MCH devices
 Perform preventive ,curative maintenance and performance test of MCH medical equipment
 Maintain preventive and curative MCH medical equipment
 Test the performance of preventive and curative MCH medical equipment

TRAINING METHOD
 Brainstorming
 Interactive presentation
 Group based exercise ( Case scenario,, group discussion …)
 Demonstration and coaching
 Simulation and observation
 Troubleshooting exercise

TRAINING MATERIAL AND INSTRUMENT

 Trainees manual
 Facilitator’s guide
 Reference manuals
 Training video tape
 Infant incubators, infant radiant warmer, CPAP, and fetal monitor
 Hand tools, measuring and testing tools
 Stationary materials
 PPT

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PARTICIPANT SELECTION:
Participant for this course should be biomedical engineers/technicians and registered professional
working on medical device maintenance

METHODS OF EVALUATION
 Participant o
Formative
- Pre-test
- Group exercises/ demonstration using
checklists o Summative
- Knowledge assessment (30 %):
- Practical assessment (70%):

COURSE EVALUATION
o Daily Evaluation
o Daily trainers feedback meeting
o End of Course Evaluation

TRAINERS’ SELECTION CRITERIA

 The facilitators of this course will be consultants (TWG) who have developed the course or who
has a minimum of BSc Degree in Biomedical Engineering and has the relevant practical experience
on MCH devices preferably at Health facility,
 TOT on MCH Equipment,
 Basic training on MCH Equipment with Training Facilitation skill.

COURSE VENUE
• Accredited in-service training centers with functional internet service and With convenient facilities
(equipment for practice preferably hospitals)

COURSE DURATION
 4days

COURSE COMPOSITION (30/70)

 20 – 25 participants at a time
 4 trainers

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Course Schedule
Day 1 Time Activity Duration Facilitator Moderator
8:30 – 9:30AM Registration 1 hr.
Welcoming /Opening
9:30- 9:45 AM 15 minutes
remark
Participants self-introduce All All
Morning 9:45 – 9:55 Am and expectation 10 minutes participants facilitators
9:55 - 10:30AM Pretest 35 minutes
10:30- 10:45 Coffee Break
Chapter 1: CRC 160 min
10:45- 12:30 PM Introduction to CRC 30 mns
12:30- 1:30 Lunch
1:30- 8:00Pm Health Ethics 30mns
8:00-8:40 Compassionate care 40 mns
8:40-9:10 Rescpectfull care 30 mns
9:10-9:35 Compassionate care 25
Afternoon 9:35-10:5 Respectfull care 30
10:5-10:20 Coffe 10 mns
Break
10:20-10:45 Compassionate leader 25mns
10:45-11:00 Summary 5mns
All
5:20- 5:30PM 10 Minutes
facilitators
Day 2 Time Activity Duration
All the
8:30 – 8:45 Recap 30 minutes participants Facilitators
Chapter 2: Infant Incubator 385 mns
Introduction to Infant
8:45 - 10:15 30mns
Incubator
10:00- 10:15am Coffee Break
Morning Purpose/clinical
10:15- 10:25 PM application 10 mns
10:25-4:40 Working principle 15 mns
4:40-5:10 Basic parts 30 mns
5:10-5:15 Classification 5 mns
5:15-5:25 Safety and care of device 10 mns
5:25_6:30 Preventive maintenance 55 mns
12:30- 1:30 Lunch
Trouble shooting & repair
1:30- 5:00 PM 3:30 hrs
procedures
Afternoon 5:00-5:30 pm Summary 30 mns

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Pharmacuetical and Medical Equipment Management Directorate
Day 3 Time Activity Duration
8:30 - 9:00 Recap 30 minutes Participant
Chapter 3:Infant Radiant 370 mns(7
Warmer hrs)
9:00 - 9:20 Introduction 20 min
Purpose/clinical
9:20-9:30 application 10 mns
Morning 9:30-9:40 Working principles 10 mns
9:40-4:00 Basic Parts 20 mns
10:00- 10:15 Coffee Break
10:00- 10:35 Type/classification 35 min
10:35-10:45 Safety and care of device 15 mns
10:45-12:00 Preventive maintenances 2:25 mns
12:30- 1:30 Lunch
Troubleshooting
1:30- 3:30 2:10 mns
techniques
4:30- 4:45 Coffee Break
Afternoon Performance test for
4:45- 5:15 30 mns
Infant Radiant Warmer
5:15-5:40 Summary 30 mns
Time Activity Duration
Day 4 8:30 - 9:00 Recap 30 minutes
Chapter 4:Fetal Monitor
9:00 – 9:15 Introduction 15 mns
Purpose/clinical
9:15- 9:25 am application 10 mns
Morning 9:25-9:35 Working principles 10 mns
9:35-4:05 Basic parts 30 mns
4:05-4:20 Coffee Break 15 mns
4:20- 12:30 Preventive maintenances 80 mns
12:30-1:30 Lunch
1:30-3:30 Troubleshooting and repair 2:20
3:30-4:00 Summary 30 mns
Afternoon
Time Activity Duration
Day 5 8:30 - 9:00 Recap 30 mns
Chapter 5:CPAP Machine
9:00 - 9:15 Introduction 15mns
Purpose/clinical
9:15-9:20 application 5 mns

Morning 9:20-10:00 Working principle 45 mns

10:00- 10:15 Coffee Break
10:15- 5:30 Basic parts 45 mns
5:30-12:00 Classification 30 mns

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Safety and care of the
12:00-12:15 15 mns
device
12:30- 1:30 Lunch
1:30- 2:15 Preventive maintenances 45 mns
Troubleshooting
2:15-4:30 2:15
Afternoon techniques and Repair
4:30- 4:45 Coffee Break
4:45- 5:20 Summary 35 minutes
5:20- 5:30 Closing and Final speech 30 mns

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Chapter 1:
Caring, Respectful and Companionate
Healthcare Service
CHAPTER DESCRIPTION:
This chapter is designed to equip healthcare professionals and senior management in health facilities to
increase core competencies of compassionate, respectful, holistic, scientifically and culturally acceptable
care for patients and their families.

CHAPTER OBJECTIVE:
By the end of this chapter the participants will be able to:
 Describe Compassionate, respectful and Caring (CRC) healthcare service delivery

ENABLING OBJECTIVES:
By the end of this chapter participants will be able to:
• Describe Compassionate, respectful and caring (CRC)
• List principles of health care Ethics
• Discuss components of compassionate care
• Explain principles of respectful care
• Discuss characteristics of Compassionate leader

CHAPTER OUTLINE
1.1. Introduction to CRC
1.2. Healthcare Ethics
1.3. Compassionate care
1.4. Respectful care
1.5. Compassionate leader
1.6 Summery

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1.1. INTRODUCTION TO COMPASSIONATE, RESPECTFUL AND CARING (CRC)
Individual reflection
What is Compassionate, Respect and Caring (CRC)? Time Allowed 15 minutes

1.1.1. DEFINITION OF CRC

Compassion (ሩህሩህ)
Is a feeling of deep sympathy and sorrow for the suffering of others accompanied by a strong desire to
alleviate the suffering? Therefore, we can say it is being sensitive to the pain or suffering of others and a
deep desire to alleviate the suffering.

Respectful (ተገልጋይንየሚያከብር)
Is the kind of care, in any setting, which supports and promotes, and does not undermine a person’s self-
respect, regardless of any differences?

Caring (ተንከባካቢ)
Caring is an intensification of the affective dimension of empathy in the context of significant Suffering.
It is coupled with effective interventions to alleviate that suffering.

Compassionate, respectful and Caring (CRC) -

Means serving patients, being ethical, living the professional oath, and being a model for young
professionals and students. It’s a movement that requires champions who identify with their profession
and take pride by helping people.

•Why CRC a transformational agenda? Time Allowed 10 minutes

1.1.2. WHY CRC A TRANSFORMATION AGENDA?

Helping health professionals’ to become compassionate and respectful practitioners remains a major
challenge for the healthcare. Compassionate and respectful care is not only morally and financially
essential, but it is required in many countries through national legislation and/or national health policy.
The notion that healthcare services must be expanded beyond the prevention of morbidity or mortality is
only one aspect of the agenda. It must encompass respect for patients’ basic human rights, including
respect for patients’ autonomy, dignity, feelings, choices, and preferences. It must include choice of
companionship wherever possible.

Taken from the United Nations human rights declaration, ‘All human beings are born free and equal in
dignity and rights.’ The Ethiopian constitution of human rights article 25 and 26 states that the rights to
equality and privacy.

In the Ethiopian health system, there are many health professionals who have dedicated their entire career
to public service and are respected by the public they serve. However, a significant proportion of health
professionals see patients as just ‘cases’ and do not show compassion. Lack of respect to patients and
their families is also a common complaint.

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A three-year report of the Ethics Committee and relevant documents in Addis Ababa showed that 39
complaints were related to death of the patient and 15 complaints were about disability. The committee
verified that 14 of the 60 claims had an ethical breach and/or negligence and other study also indicated that
forwarding bad words, shouting on patients, mistreatment, insulting and hitting of clients are some of
unethical practices showed by the health professionals.

STUDIES SHOWED THE NEED FOR CRC

Lack of role models in many health facilities.
Measuring the worth of a profession by how much it pays.
Senior physicians cancel their outpatient clinics without informing their patients.
Elective surgeries get cancelled.
Admitted patients are by default getting the care they need from relatives.
Nurses, for various reasons, have limited their role to providing injections and securing IV lines.
Proper counseling during dispensing of drugs is also becoming a rarity.
The quality of lab tests and the quality assurance process that lab professionals have to take before issuing results is
Lack of compassion, respect and care is the common source of grievances in health facilities.

1.1.3. THE BENEFITS OF CRC

Table 1.The benefits and beneficiaries of Compassionate and Respectful Care

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1.1.4. NATIONAL STRATEGY AND APPROACH OF CRC
The development of caring, respectful and compassionate health workers requires a multi- pronged
approach in order to make CRC as a culture, self-driven inner motive and a legacy that the current
generation of practitioners leaves to their successors.

NATIONAL STRATEGY AND APPROACHES FOR CRC

• Reforming the recruitment of students for health science and medicine programs.
• Improving the curriculum of the various disciplines.
• Ownership and engagement of the leadership at all levels of the system.
• Inspirational leadership that aims to create an enabling environment.
• National, regional and facility level ambassadors.
• An advocacy campaign through mass media will also be launched to project
positiveimages of health professionals.
• Patients and the general public will also be engaged in this movement.
• An annual health professional recognition event will be organized
• Putting in place a favorable legislative framework to reinforce CRC which would include
regulation on patients’ rights and responsibilities (PRR)
• Measurement of health care providers on CRC
• Comprehensive projects will be designed.
• Conducting national assessment related to CRC.
• Provision of continuous CRC trainings.
• Engagement and ownership of professional associations.
• Experience sharing from national and international best practices.
1.2. HEALTHCARE ETHICS
1.2.1. PRINCIPLES OF HEALTH CARE ETHICS
Individual reflection
What is ethics?
What is health care ethics? Time: 5 Minutes

Ethics:
Ethics is derived from the Greek word ethos, meaning custom or character. Ethics is the study of
morality, which carefully and systematically analyze and reflect moral decisions and behaviors, whether
past, present or future. It is a branch of philosophy dealing with standards of conduct and moral
judgment. Health care ethics:

It is a set of moral principles, beliefs and values that guide us to make choices about healthcare. The field
of health and healthcare raises numerous ethical concerns, including issues of health care delivery,
professional integrity, data handling, use of human subjects in research and the application of new
techniques.

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Ethical principles are the foundations of ethical analysis because they are the viewpoints that guide a decision. Th
Autonomy
Beneficence
Non-maleficence
Justice

1. AUTONOMY
Autonomy is the promotion of independent choice, self-determination and freedom of action. Autonomy implies
independence and ability to be self-directed in one’s healthcare. It is the basis of self- determination and entitles the
patient to make decisions about what will happen to his or her body.
Case one:
A 49-year-old client with diabetic finding came with right foot second finger gangrene to a hospital. The surgeon de
Time: 5 Minutes

2. BENEFICENCE
Beneficence is the ethical principle which morally obliges health workers to do positive and rightful
things. It is “doing what is best to the patient”. In the context of professional-patient relationship the
professionals are obliged to always and without exception, favor the wellbeing and interest of their
patients.
Case two:
Ms. X was admitted to adult surgical ward with severe excruciating right flank pain with presumptive diagnosis of r
Question: What should the attending nurse do for Ms. X?
Time: 5 Minutes

3. NON-MALEFICENCE
The principle refers to “avoid doing harm”. Patient can be harmed through omitting or committing
interventions. When working with clients, healthcare workers must not cause injury or distress to
clients. This principle of non-maleficence encourages the avoidance of causing deliberate harm, risk of
harm and harm that occurs during the performance of beneficial acts. Non-maleficence also means
avoiding harm as consequence of good.
Case Three:
Mr “X” is admitted to internal medicine ward with cardiac failure. The physician admitted Mr “X” and prescribed s
Question: What should the ward nurse do for Mr “X”
Time: 5 Minutes

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4. JUSTICE
Justice is fair, equitable and appropriate treatment. Justice refers to fair handling and similar standard of care for
similar cases; and fair and equitable resource distribution among citizens. It is the basis for treating all clients in an
equal and fair way. A just decision is based on client need and fair distribution of resources. It would be unjust to
make such decision based on how much he or she likes each client.

Example:
• Resource scarcity is the common issue in healthcare settings. For example, there may be only one or
two neurosurgeons and many patients on the waitlist who need the expertise of these neurosurgeons. In
this case we need to serve patients while promoting the principle of justice in transparent way.
Example, the rule of first come first serve could be an appropriate rule.
• Justice requires the treatment of all patients equally, irrespective of their sex, education, income
or other personal backgrounds.

1.2.2. CONFIDENTIALITY AND INFORMED CONSENT.

CONFIDENTIALITY
Confidentiality in healthcare ethics underlines the importance of respecting the privacy of information
revealed by a patient to his or her health care provider, as well the limitation of healthcare providers to
disclose information to a third party. The healthcare provider must obtain permission from the patient to
make such a disclosure.

The information given confidentially, if disclosed to the third party without the consent of the patient,
may harm the patient, violating the principle of non-maleficence. Keeping confidentiality promotes
autonomy and benefit of the patient.

THE HIGH VALUE THAT IS PLACED ON CONFIDENTIALITY HAS THREE SOURCES:

• Autonomy: personal information should be confidential, and be revealed after getting a
consent from the person
•Respect for others: human beings deserve respect; one important way of showing
respect is by preserving their privacy.
• Trust: confidentiality promotes trust between patients and health workers.

THE RIGHT OF PATIENT TO CONFIDENTIALITY

• All identifiable information about a patient’s health status, medical condition, diagnosis,
prognosis and treatment and all other information of a personal kind, must be kept confidential,
even after death. Exceptionally, family may have a right of access to information that would
inform them of their health risks.
• Confidential information can only be disclosed if the patient gives explicit consent or if expressly provided
for in the law. Information can be disclosed to other healthcare providers only on a strictly “need to know”
basis unless the patient has given explicit consent.
• All identifiable patient data must be protected. The protection of the data must be appropriate to the
manner of its storage. Human substances from which identifiable data can be derived must also be
protected.

EXCEPTIONS TO THE REQUIREMENT TO MAINTAIN CONFIDENTIALITY

• Routine breaches of confidentiality occur frequently in many healthcare institutions. Many individuals
(physicians, health officers, nurses, laboratory technicians, students, etc) require access to a

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patient’s health records in order to provide adequate care to that person and, for students, to learn
how to practice care provision.
• Care providers routinely inform the family members of a deceased person about the cause of death.
These breaches of confidentiality are usually justified, but they should be kept to a minimum and
those who gain access to confidential information should be made aware of the need not to spread it
any further than is necessary for descendants benefit. Where possible, patients should be informed
ahead that such a breach might occur.
• Many countries have laws for the mandatory reporting of patients who suffer from designated diseases,
those deemed not fit to drive and those suspected of child abuse. Care providers should be aware of the
legal requirements to be able to disclose patient information. However, legal requirements can conflict
with the respect for human rights that underlies healthcare ethics. Therefore, care providers should look
carefully at the legal requirement to allow such an infringement on a patient’s confidentiality and assure
that it is justified.
Case four:
An HIV-positive individual is going to continue to have unprotected Sexual intercourse with his spouse or other par
How do you manage such an individual?
Discuss situations that breach confidentiality.
Time: 5 Minutes

Ethiopia Council of ministers’ regulation 299/2013, Article 77 Professional Confidentiality

INFORMED CONSENT
Informed consent is legal document whereby a patient signs written information with a complete
information about the purpose, benefits, risks and other alternatives before he/she receives the care
intended. It is a body of shared decision making process, not just an agreement. Patient must obtain and
being empowered with adequate information and ensure that he/she participated in their care process.

For consent to be valid, it must be voluntary and informed, and the person consenting must have the
capacity to make the decision. These terms are explained below:

A. Voluntary: the decision to either consent or not to consent to treatment must be made by the
person him or herself, and must not be influenced by pressure from medical staff, friends or family.
This is to promote the autonomy of the patient.
B. Informed: the person must be given all of the information in terms of what the treatment involves,
including the benefits and risks, whether there are reasonable alternative treatments and the consequences
of not doing the treatment. This will help to avoid harm—patients may harm themselves if they decide
based on unwarranted and incorrect information.
C. Capacity: the person must be capable of giving consent, which means they understand the
information given to them, and they can use it to make an informed decision.

GENERAL PRINCIPLE OF INFORMED CONSENT

Should be given by a patient before any medical treatment is carried out.The ethical and legal rationale behind
this is to respect the patient’s autonomy and their right to control his or her life. The basic idea of personal
autonomy is that everyone’s actions and decisions are his or her own.

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The principles include:
1. Information for patients
2. Timing of consent process
3. Health Professionals responsibility for seeking consent
4. Decision making for incompetent patients
5. Refusal of treatment
Ethiopia Council of minister’s regulation 299/2013, Article 52. Patient’s informed consent

1.2.3. PREVENTIVE ETHICS IN THE ASPECT OF CRC

WHAT IS PREVENTIVE ETHICS?
Preventive Ethics is a systematic application of ethical principles and values to identify and handle ethical
quality gaps, dilemmas, challenges and errors to appropriately and fairly. It could be carried out by an
individual or groups in the health care organization to identify prioritize and systematic address quality
gaps at the system level.

WHY IS PREVENTIVE ETHICS IMPORTANT FOR CRC HEALTHCARE WORKERS?

First and foremost, the CRC health workforce, patients, families and the community at large should have
a common understanding that the experience of illness and the practice of medicine lead to situations
where important values and principles come to conflict and ethical dilemmas and challenges arise
everywhere. Moreover, the CRC health worker should always understand the context in which She/he
operates (like the services, the clients, the providers, values, norms, principles, culture, religions, socio-
economic-geographic…) as the way in which ethical dilemmas are handled vary from case to case and
place to place.

Preventive ethics helps the CRC health workforce to predict, identify, analyze, synthesize and manage ethical
dilemmas, challenges and errors to make the appropriate and fair decisions. Hence, preventive ethics enhances
honesty and transparency between healthcare workers, patients, families and relevant others to make a
deliberated joint decision. Moreover, it inspires mutual understanding and trust amongst the healthcare
provider, recipient and the community at large.

Preventive ethics brings all efforts together productively and leads to the satisfaction of clients, providers and the
community even if when the decisions are sometimes painful and outcomes are negative.

1.2.4. ETHICS AND LAW AS ENABLERS OF CRC

THE RELATION BETWEEN ETHICS AND LAW
Individual reflection
What is the relationship between ethics and law?
Time: 5 Minutes

ETHICS as discussed in the previous sessions, is considered as a standard of behavior and a concept of
right and wrong beyond what the legal consideration is in any given situation.

LAW is defined as a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling
authority. Law is composed of a system of rules that govern a society with the intention of maintaining social order,
upholding justice and preventing harm to individuals and property. Law systems

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are often based on ethical principles and are enforced by the police and Criminal justice systems, such as
the court system.

Ethics and law support one another to guide individual actions; how to interact with clients and colleagues to
work in harmony for optimum outcome; provision of competent and dignified care or benefits of clients/
patients. Ethics serves as fundamental source of law in any legal system; and Healthcare ethics is closely
related to law. Though ethics and law are similar, they are not identical.

Often, ethics prescribes higher standards of behavior than prescribed by law; and sometimes what is legal
may not be ethical and health professionals will be hard pressed to choose between the two. Moreover,
laws differ significantly from one country to another while ethics is applicable across national boundaries.

The responsibilities of healthcare professionals and the rights and responsibilities of the patient is
stipulated in legal documents of EFMHACA like regulation 299/2013, directives and health facility
standards.

1.3. PRINCIPLES AND STANDARDS OF COMPASSIONATE CARE

1.3.1. QUALITIES OF COMPASSIONATE CARE
Compassion can be defined as: “sensitivity to the suffering of self and others with a deep wish and
commitment to relieve the suffering”.

Developing more compassion can be a way to balance emotions to increase the well-being of patients, healthcare
professionals and facilitation of healthcare delivery. For patients, compassion can help prevent health problems and
speed-up recovery. Compassion can improve staff efficiency by enhancing cooperation between individuals and
teams and between patient and healthcare professionals.
Individual reflection
Can compassion be trained and learned? Time Allowed: 5 Minutes

Qualities of Compassionate Care

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Role play on qualities of compassionate care:

Instructions:
One participant will take the role of a healthcare provider and another participant will take
the role of a mother [with limited mobility] of a sick child with a feeding problem. Other
participants should observe and note the discussion.

Roles
Healthcare provider
A mother (with limited mobility) of a sick child:

Situation:
A mother with limited mobility brings her 3-month-old baby girl with cough and fever
to the outpatient clinic. The healthcare provider seemed tired. By the time the mother
enters the examination room, he was talking with his subordinate about last night’s
football game. He had already noticed her but did not let her to sit. Her child was
crying and she was trying to quiet her.
All of a sudden the healthcare provider shouted loudly at the mother to quiet
her child or they would have to leave.

While waiting and calming her child, the mother told the healthcare provider
that her child is very sick and needs an urgent care. While facing to his friend,
the healthcare provider told the mother that he would see her child in five
minutes.

After waiting for 10 minutes, the healthcare provider started to examine the
child and felt sad about the condition of the child; apologized to her for having
let her wait so long. The healthcare provider evaluated the child gently, gave
the child a proper treatment, reassured the mother, and the child went home
better.

Discussion Questions
Did the health provider demonstrate the characteristics of compassion? If not,
what are the areas /conversation that show poor characteristics of compassion?

If yes, what are the areas /conversation that show good characteristics of
compassion?

Time allowed: 30 minutes

1.3.2. ELEMENTS OF COMPASSIONATE CARE

According to researches the key elements of compassionate care has categories, each contains theme and
subthemes.
1. Virtue: It is described as ‘‘good or noble qualities embodied in the character of the health
care provider
2. Relational space: is defined as the context and content of a compassionate encounter where the
person suffering is aware of and is engaged by, the virtues of the health care provider.

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THE CATEGORY OF RELATIONAL SPACE COMPRISED TWO THEMES.
• Patient awareness which describes the extent to which patients intuitively knew or initially sensed
health care provider capacity for compassion.
• Engaged care giving which refers to tangible indicators of health care provider compassion in the
clinical encounter that established and continued to define the health care provider- patient
relationship over time.

3. Virtuous Response: It is the “Enactment of a virtue toward a person in suffering,’’ and it is both an
individual category and an overarching principle of care that functions as a catalyst to the three core categories
of compassionate care giving: ‘‘seeking to understand, relational communicating, and attending to needs’’ The
category of virtuous response contain three broad themes within it:

• Knowing the person refers to the extent to which healthcare providers approached their patients
as persons and view their health issues and suffering from this point of view.
• Seeing the person as priority involves healthcare providers’ ability to priorities patient needs, setting
aside their own assumptions and healthcare system priorities in the process.
• Beneficence refers to healthcare providers wanting the best for the patient, informing the three
more targeted core categories of compassionate care giving.

4. Seeking to Understand: refers to healthcare providers trying to know the patient as a

person and his or her unique needs.

The need to understand a person’s desires and tailor his or her care is identified by most patients as a
fundamental feature of compassion.
• Seeking to Understand the Person.
• Seeking to Understand the needs of the Person

5. Relational Communication: isan important element of compassion identified by patients

consisting of verbal and nonverbal displays conveyed by the healthcare provider’s engagement with
the person suffering.

There are four specific themes and associated subthemes that convey compassion within clinical
communication:
• Demeanor (‘‘being’’)
• Affect (‘‘feeling for’’)
• Behaviors (‘‘doing for’’)
• Engagement (‘‘being with’’)

ATTENDING TO NEEDS
It refers to ‘‘a timely and receptive desire to actively engage in and address a person’s multi- factorial
suffering’’. Attending to patients’ needs has three interrelated themes:

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• Compassion-Related Needs: refers to the dimensions of suffering that patient feel
compassion: physical, emotional, spiritual, familial and financial.
• Timely refers to addressing suffering in a ‘‘timely’’ manner.
• Action refers to the initiation and engagement of a dynamic and tangible process aimed at
alleviating suffering. Compassion is more action.

1.3.3. PRINCIPLES OF COMPASSIONATE CARE

Individual reflection
What are the principles of compassionate care?
Time Allowed: 5 Minutes

The universal principles of compassion will help us know one another in a more meaningful way where
we discover one another respectfully. They create the conditions that allow a person who is suffering to
experience the healing power of compassion.

1. Attention: is the focus of healthcare provider. Being aware will allow the healthcare
provider to focus on what is wrong with a patient; or what matters most to the patient.
2. Acknowledgement: is the principle of what the healthcare professional says. The report of the
examination or reflection on the patient’s message. Positive messages of acknowledgment are buoyant;
they let someone know that you appreciate them as a unique individual.
3. Affection: is how healthcare providers affect or touch people. Human contact has the ability to
touch someone’s life. It is the quality of your connection, mainly through warmth, comfort, kindness
and humor. Affection brings joy and healing.
4. Acceptance: is the principle of being with mystery – how you stand at the edge of your
understanding or at the beginning of a new experience, and regard what is beyond with equanimity. It
is the quality of your presence in the face of the unknown, in the silence. Like the sun in the north at
midnight, acceptance welcomes the mysteries of life and is at peace with whom we are and where we
are, right now. It is the spirit of Shalom.

•The principle of acceptance is: being at peace with the way things are allows them to change.

1.3.4. THREATS TO COMPASSIONATE CARE

There are factors preventing compassion and compassionate behavior for individual members of staff,
teams and units and health facility. Most research discusses compassion at the individual level. In general,
the most common threats for compassionate care are:
• Compassionate fatigue: Physical, emotional and spiritual fatigue or exhaustion resulting from
care giving that causes and a decline in the caregivers’ ability to
experience joy or feel and care for others.
 A form of burnout, a kind of “secondary victimization” what is transmitted by clients or
patients to care givers through empathetic listening.
• Unbalanced focus between biomedical model (clinical training) and person: Effective clinical
care is clearly fundamentally important, but human aspects of medicine and care must also be
valued in training and in terms of how to be a good healthcare professional.

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• Stress, depression and burnout:
 Self-reported stress of health service staff is reported greater than that of the general working
population.
 Burnout (or occupation burnout) is a psychological term referring to general exhaustion and
lack of interest or motivation to work.
• Overall health facility context: Attention by senior managers and health facility boards to
achieve financial balance that affects priorities and behaviors of staff in health facility.
ADDRESSING THREATS OF COMPASSION
Overcoming compassion fatigue
Developing an inner compassionate self
Compassion to yourself
Teaching compassion to professionals through, training and education
Dealing with staff stress and burnout
Dealing with wider health facility context

1.4. RESPECTFUL CARE

1.4.1. DEFINITION OF CONCEPTS OF RESPECTFUL AND DIGNIFIED CARE
Can you share us your experience with regard to respect and dignity in the health care setting?
What does respectful care mean to you? Time Allowed: 10 minutes

Definition of Dignity (ልእልና)

The word dignity originates from two Latin words: ‘dignitus’ which means merit and ‘dignus’
meaning worth. It is defined from two perspectives:
• Dignity is a quality of the way we treat others.
• Dignity is a quality of a person’s inner self.

Types of Dignity
There are four types of dignity: dignity of human being, personal identity, merit and moral status.
1. Dignity of human being
This type of dignity is based on the principle of humanity and the universal worth of human beings their
inalienable rights-which can never be taken away.
2. Dignity of personal identity
This form of dignity is related to personal feelings of self-respect and personal identity, which also
provides the basis for relationships with other people.
3. Dignity of merit
This is related to a person’s status in a society.
4. Dignity of moral status
This is a variation of dignity of merit, where some people have a personal status because of the way they
perceived and respected by others. (N.B. Refer to Hand-out 3.1 for details.)

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Attributes of Dignity
There are four attributes of dignity:
1. Respect: self-respect, respect for others, respect for people, confidentiality, self-belief and believe
in others
2. Autonomy: having choice, giving choice, making decisions, competence, rights,
needs, and independence
3. Empowerment: Feeling of being important and valuable, self-esteem, self-worth, modesty and pride

4. Communication (may be verbal or non-verbal): explaining and understanding information, feeling

comfort, and giving time to the patients / families

Definition of Respect (አክብሮት)

• It is a term which is intimately related to dignity
• It is probably the most important action verb used to describe how dignity works in practice.
THE ACTION MEANINGS OF THE WORD RESPECT ARE:
Pay attention to
Honoring
Avoiding damage e.g. insulting, injuring
Not interfering with or interrupting
Treating with consideration
Not offending

People can vary by their skills, educational background, gender, age, ethnicity, and experiences. But, as
human being, all are entitled to get dignified and respectful care. Every human being must respect others and
get respect from others. Therefore, dignity is brought to life by respecting people:
• Rights and freedoms
• Capabilities and limits
• Personal space
• Privacy and modesty
• Culture
• Individuals believes of self-worth
• Personal merits
• Reputation
• Habits and values

DIGNITY AND RESPECT IN THE HEALTH CARE SETTING

Treating clients with dignity implies treating them with courtesy and kindness, but it also means:
• Respecting their rights
• Giving them freedom of choice
• Listening and taking into consideration what they say and
•Respecting their wishes and decisions, even if one disagrees.

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Treating clients with dignity implies being sensitive to clients’ needs and doing one’s best for them,
but it also means:
• Involving them in decision making
• Respecting their individuality
• Allowing them to do what they can for themselves and
• Giving them privacy and their own personal space

1.4.2. PRINCIPLES OF RESPECTFUL CARE

Individual reflection
Think of a person who gave you the most respectful care/service.
Describe the situation?
What are the qualities of that person?
What did you value most?
Time: 5 Minutes

The principles of respectful care guide actions and responsibility of care providers in ensuring
dignified care for their service users. Dignified care has seven core principles.
• Recognize diversity and uniqueness of individuals
• Uphold responsibility to shape care
• Meaningful conversation
• Recognize the care environment
• Recognize factors affecting dignity
• Value workplace culture
• Challenge dignity barriers

1.4.3. CHARACTERISTICS OF DISRESPECTFUL CARE

The situation where you received disrespectful care?
Describe the incident?
What was your reaction?
Time: 5 Minutes

THE SEVEN CATEGORIES OF DISRESPECT AND ABUSE

Category example
Physical Abuse Slapping, pinching, kicking, slapping, pushing, beating,
Non-consented care Absence of informed consent or patient communication, forced
procedures
Non-confidential care Lack of privacy (e.g. Laboring in public or disclosure of patient
information
Non-dignified care Intentional humiliation, rough treatment shouting, blaming,
treating to withhold services laughed at patients, provider did
not introduce themselves, patients not called by their names
throughout the interaction.

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Discrimination based on specific Discrimination based on ethnicity, age, language, economic
patient attributes status, education level, etc.
Abandonment of care Women left alone during labor and birth Failure of providers to
monitor patients and intervene when needed
Detention in facilities Detention of patients/family in facility after delivery, usually due
to failure to pay
1.4.4. FACTORS AFFECTING RESPECTFUL CARE PROVISION
Individual reflection
What do you think hinders you from providing respectful care in your health facility?
What are the factors that facilitates provision of respectful care in your health facilities?
Time: 5 Minutes

Different Factors have a significant impact on hindering or facilitating the provision of respectful
careservice. These factors can be broadly classified in to three major groups; Health care environment,
staff attitude & behavior and patient factors

Positive attributes of the physical environment which helped health professional to provide dignified care
are related to aspects maintaining physical and informational privacy and dignity, aesthetically pleasing
surroundings and single sex accommodation, toilet and washing facilities. Aspect of the environment that
maintain physical and informational privacy are listed below

• Environmental privacy (for example curtains, doors, screens and adequate separate rooms
for intimate procedures or confidential discussions (auditory privacy).
• Privacy of the body: covering body, minimizing time exposed, privacy during undressing and clothing
are some of the enabling factors to ensure bodily privacy done by health professionals.
• Aesthetic aspects of the physical environment (for example space, color, furnishing, décor,
managing smells); and the provision of accommodation, toilet and washing facilities
• Managing peoples in the environment: such as other patients, family and ward
visitors/public contribute positively to maintain dignity in the health
• Adequate mix and proficient Staffing: adequately staffed with appropriate number and skill mix, as
high workload affects staff interactions, and have strong leaders who are committed to patient
dignity.
Physical environment which hinders health professional form providing respectful care are related to the
overall health care system, lack of privacy, restricted access to facility /service and lack of resources. Aspect
of the environment that hinders the provision of respectful care are listed below,
• The healthcare System: Shortage of staff, unrealistic expectations, poorly educated staff, ‘quick
fix’ attitude, low wage, pay ‘lip service’ to dignity, low motivation, lack of respect among
professionals, normalization/tolerance of disrespectful care, lack of role model, management
bureaucracy and unbalanced staff patient ratio and skill mix.
• Lack of privacy: Lack of available single rooms, bath rooms and toilets without nonfunctional locks,
use of single rooms only for infectious cases and lack of curtains or screens
• Restricted access to facility/service: Badly designed rooms, inadequate facilities (e.g. toilets, bath
rooms), Cupboards with drawers that does not open, toilet and bath rooms shared between male and
females.

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• Lack of resource: Run out of hospital, gowns and pyjamas, Lack of medical equipment and supplies

The A, B, C, of respectful health care, is a tool designed to consider the attitudes and behaviors of health
care providers

A –ATTITUDE ACTION TO BE TAKEN

Ask yourself:
How would I be feeling if I was this person?
Why do I think and feel this way?
•Are my attitudes affecting the care I provide and, if so, how?
•Are my personal beliefs, values, and life experiences influencing my attitude?

Reflect on these questions as part of your everyday practice.

•Discuss provider attitudes and assumptions and how they can influence the care of patients with the care team.
•Challenge and question your attitudes and assumptions as they might affect patient care
Help to create a culture that questions if and

B- BEHAVIOR C-COMMUNICATION
Introduce yourself. Take time to put
the patient at ease and appreciate their circumstances.
Be completely present. Always include respect and kindness.
Use language the patient/family can understand

Communication revolving around the patient’s needs.

Patient centered communication with defined boundaries

TEN MECHANISMS TO MITIGATE THREATS TO RESPECTFUL CARE -

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Support clients with same respect you would want for yourself or a member of your family
Have a zero tolerance of all forms of disrespect
Respect clients’ right to privacy
Maintain the maximum possible level of independence, choice, and control
Treat each client as an individual by offering personalized care
Assist clients to maintain confidence and a positive self esteem 7.Act to alleviate clients’ loneliness and isolation
Listen and support clients to express their needs and wants
Ensure client feel able to complain without fear of retribution
Engage with family members and care givers as care partners?

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1.5. COMPASSIONATE LEADER
1.5.1. QUALITY OF COMPASSIONATE LEADERSHIP
Group exercise
Discuss in a group of 4-5 and share your experience to the larger group.
What does it mean for you to lead, and manage?
Can you give an example of a leader whom you know in your professional or personal life? What makes him or her good lead
Do you know of any individuals in high positions or authority who demonstrate compassionate, respectful and carin
Duration: 20 minutes

BRIEF DESCRIPTION OF LEADERSHIP THEORIES

Introduces transactional, transformational, and servant leadership theories. It will also provide a better
understanding of qualities of CRC leaders, which will enable participants to provide better service and
increase awareness of CRC leadership.

• Transformational leaders: lead employees by aligning employee goals with their goals. Thus,
employees working for transformational leaders start focusing on the company’s well- being rather
than on what is best for them as individual employees.
• Transactional leaders: ensure that employees demonstrate the right behaviors because the
leader provides resources in exchange.
• Servant Leadership: defines the leader’s role as serving the needs of others. According to this
approach, the primary mission of the leader is to develop employees and help them reach their goals.
Servant leaders put their employees first, understand their personal needs and desires empower them
and help them develop their careers.

CHARACTERISTICS OF COMPASSIONATE LEADERS

• ‘In-tune’ feeling: Their actions abide by their words – and they always have the time to
engage with others.
• Manage their moods: They know feelings affect others and they use positive emotions to inspire,
not infect others with negative feelings.
• Put people before procedures: They are willing to set aside or change rules and regulations for the
greater good.
• Show sincere, heartfelt consideration: They genuinely care for the well-being of others and have a
humane side that puts other people’s needs before theirs.
• Are mindful: They are aware of their own feelings and their impact on others. They are also
attentive and sympathetic to the needs of others.
• Are hopeful: They move others passionately and purposefully with a shared vision that focuses
on positive feeling of hope.
• Courage to say what they feel: They communicate their feelings, fears, even doubts which
builds trust with their employees.
• Engage others in frank, open dialogue: They speak honestly with humility, respect and
conviction, and make it safe for others to do the same.

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• Connective and receptive: They seem to know what other people are thinking and feeling.
• Take positive and affirming action: They carry out compassion. They do not just talk about
it; they make a promise, act on it and keep it.

WHAT DOES COMPASSIONATE LEADERSHIP DO FOR THE ORGANIZATION?

• Positively affects sufferers, clients, employees
• Increases people’s capacity for empathy and compassion
• Promotes positive relationships
• Decreases the prevalence of toxic viral negative emotions and behavior
• Increases optimism and hope
• Builds resilience and energy levels
• Counteracts the negative effects of judgment and bias

SELF-EVALUATION OF COMPASSIONATE BEHAVIOR

Good leaders can evaluate their own behavior using different methodologies. The self- assessment of
compassionate leaders should be conducted every six months to enhance self- compassion through
mindfulness.

Mindfulness begins with self-awareness: knowing yourself enables you to make choices how you respond to
people and situations. Deeper knowledge about yourself enables you to be consistent, to present yourself
authentically. You will learn and practice different ways to develop mindfulness and explore how it can
contribute to developing compassionate leadership practices through:
• Enhancing attention and concentration
• Increasing creativity and flexibility
• Working efficiently in complex systems and uncertain environments
• Creating meaning and purpose
• Making effective and balanced decisions
• Responding effectively to difference and conflict
• Acting with compassion and kindness
• Enhancing relationships and partnerships
• Enabling genuine and courageous action
• Working ethically and wisely
• Developing cultural intelligence

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1.5.2. SYSTEMS THINKING FOR CRC

Group activity in healthcare system thinking

Discuss in a group of 4-5 and share your experience to the larger group.
Discuss concepts of Health System and how it relates with your Health Facility /Hospital and Health Center/ functio
Take your Health Facility/Hospital and Health Center/ and list the various department/core processes/support processes.
Take in to account the CRC concepts and identify gaps you may have experienced in your facilities?
Duration: 20 minutes

System: A system is a set of interacting or interdependent components forming an integrated whole.

Health System: A health system consists of all the organizations, institutions, resources and people
whose primary purpose is to improve health.

Fully functional health system: A point which various management systems and subsystems are
connected and integrated to provide the best possible health services to all the intended beneficiaries of
those services.

Management systems: The various components of the overall health system that managers use to
plan organize and keep track of resources. Management systems are run by people living in different
contexts.

INTEGRATE CRC INTO EXISTING SYSTEM

Integration of new initiatives into existing system has paramount importance in expediting the process of
implementation and ensuring sustainability of CRC in a health system. Integration can be done using
“AIDED” model.

Assess: Understand the capacity of the unit structure, especially in regards to the availability of
resources, as well as human resource; also to assess the level of human capability when integrating and
sustaining the CRC by determining the level of support the unit requires before or after carrying out CRC.

Innovate: Design and package the CRC to fit with the existing quality of unit structure and their
environmental context to spread the CRC throughout the hospital departments.

Develop: Build upon existing knowledge of main stakeholders and opinion leaders by encouraging hospital policies,
organizational culture, and infrastructure to support the implementation of principles of CRC.

Engage: Use existing roles and resources within the hospital units to introduce, translate, and integrate
CRC principles into each employee’s routine practices.

Devolve: Capitalize on existing organizational network of index user groups to release and spread the
innovation to new user groups.

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1.5.3. ORGANIZATIONAL CULTURE
Organizational culture consists of the values and assumptions shared within an organization. Organizational
culture directs everyone in the organization toward the “right way” to do things. It frames and shapes the
decisions and actions of managers and other employees. As this definition points out, organizational culture
consists of two main components: shared values and assumptions.

1. Shared Values: are conscious perceptions about what is good or bad, right or wrong. Values tell us
what we “ought” to do. They serve as a moral guidance that directs our motivation and potentially our
decisions and actions.
2. Assumptions: are unconscious perceptions or beliefs that have worked so well in the past that they
are considered the correct way to think and act toward problems and opportunities.

Five key systems influence the hospital’s effective performance with respect to improving the
safety and quality of patient care, as well as sustaining these improvements. The systems are:
1. Using data
2. Planning
3. Communicating
4. Changing performance
5. Staffing

LEADERS CREATE AND MAINTAIN A CULTURE OF SAFETY AND QUALITY

THROUGHOUT THE HOSPITAL. RATIONALE
• CRC thrives in an environment that supports teamwork and respect for other people,
regardless of their position in the organization.
• Leaders demonstrate their commitment to CRC and set expectations for those who work in the
organization. Leaders evaluate the culture on a regular basis.
• Leaders encourage teamwork and create structures, processes, and programs that allow this
positive culture to flourish. Disruptive behavior that intimidates others and affects morale or staff
turnover can be harmful to patient care.
• Leaders must address disruptive behavior of individuals working at all levels of the organization,
including management, clinical and administrative staff, licensed independent practitioners, and
governing body members.

CREATING AN ORGANIZATIONAL CULTURE OF EMPOWERING EMPLOYEES FOR CRC

Having empowered employees is the aim of many leaders. Literature has reported that creating an
organizational culture will empower employees to increase customer satisfaction levels, as well as to
improve employee morale and productivity.

Employee empowerment encourages communication, participation in shared decision-making and enabling

physicians and staff to reach their full potential by creating and optimal healing environment.

There are many different ways to build employee empowerment and engagement, but all share six
fundamental actions to promote CRC on the part of leadership:

Share information and communication: Sharing information with employees is important because
it not only helps to build trust; it gives employees important information to allow them to make the best
possible decisions in critical situations when providing CRC services.

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Create clear goals and objectives: Inspire employees to embrace the mission or changes of the
organization by appealing to their innate desire to help patients and provide an efficient CRC service.
Great leaders share important information in a structured and consistent manner.

Teach, accept and encourage: If you empower employees to make decisions that will help keep customers happy,
then you have to be willing to allow them to make mistakes and learn from those mistakes.

Reward Self-Improvement: Create an environment that celebrates both successes and failures. A good leader
celebrates successes; and employees who take risks for the benefits of patients/client; also, a good leader will assist
employees to develop a plan for growth and reward them as they advance.

Support a learning environment: Listen to the voice of physicians, nurses and other staff to
understand key barriers, issues, and opportunities to allow them to have a voice in crafting solutions for
CRC challenges.

Create a clear role of autonomy: Enable frontline workers to execute change by supplying resources
(education, funding, access to other skill sets within the health facility, etc.) and removing obstacles
themselves.

1.5.4. LEADING CRC HEALTH TEAMS

Group activity
Discuss in a group of 4-5 and share your experience to the larger group.
What principles do you think of when implementing CRC?
Do you think there are differences between your current “leading” style and leading based on CRC? If yes, list the d
Duration: 10 minutes

Health facility leaders have intersecting roles as public servants, providers of health care, and managers of
both healthcare professionals and other staff.

• As public servants, health facility leaders are specifically responsible for maintaining the public
trust, placing duty above self-interest and managing resources responsibly
• As healthcare providers, health facility leaders have a fiduciary obligation to meet the healthcare needs
of individual patients in the context of an equitable, safe, effective, accessible and compassionate health
care delivery system.
• As managers, leaders are responsible for creating a workplace culture based on integrity,
accountability, fairness and respect.

ETHICAL HEALTHCARE LEADERS APPLY AT LEAST THE FOLLOWING SIX SPECIFIC

BEHAVIORAL TRAITS:
1. Ethically conscious: Have an appreciation for the ethical dimensions and implications of one’s
daily actions and decisions or, as described by author John Worthily, the “ethics of
the ordinary” (reference?).
2. Ethically committed: Be completely devoted to doing the right thing.
3. Ethically competent: Demonstrate what Rush worth M. Kidder, president and founder of the
Institute for Global Ethics, calls “ethical fitness,” or having the knowledge and understanding
required to make ethically sound decisions (reference).

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4. Ethically courageous: Act upon these competencies even when the action may not be
accepted with enthusiasm or endorsement.
5. Ethically consistent: Establish and maintain a high ethical standard without making or
rationalizing inconvenient exceptions. This means being able to resist pressures to accommodate and
justify change inaction or a decision that is ethically flawed.
6. Ethically candid: Be open and forthright about the complexity of reconciling conflicting values;
be willing to ask uncomfortable questions and be an active, not a passive, advocate of ethical
analysis and ethical conduct.

PROBLEM-SOLVING IN HEALTHCARE
Steps of Scientific Problem Solving Skills
1. Define the problem
2. Set the overall objective
3. Conduct a root cause analysis
4. Generate alternative interventions
5. Perform comparative analysis of alternatives
6. Select the best intervention
7. Develop implementation plan and implement plan
8. Develop evaluation plan and evaluate

BEST PRACTICE IDENTIFICATION

Criteria to select best practices
• New/Novel idea- not much practiced in other hospitals in Ethiopia
• Effectiveness: has brought empirical change to the implementation of CRC specifically to
patient satisfaction and quality of service provision. The practice must work and achieve results that
are measurable.
• Relevant/impact: improved CRC and quality of patient experience (Explain the
relevance of the innovation using a clear baseline and current performance of CRC)
• Diffusible: implemented at low cost in other facilities or implemented innovation in other hospitals.
• Sustainable: Innovation is easy to understand, easy to communicate and works for long time.
• Political commitment: The proposed practice must have support from the relevant
national or local authorities.
• Ethical soundness: The practice must respect the current rules of ethics for dealing with
human populations.

By definition, “Best Practices” should be “new/novel”, “effectiveness” and “relevance”.

MONITORING AND EVALUATION OF CRC HEALTH TEAM

Potential focus areas where leaders focus to evaluate their CRC staff
• Quality of work: Provide accuracy and thorough CRC service
• Communication and interpersonal skills: listening, persuasion and empathy to
clients/patients and teamwork and cooperation in implementing CRC
• Planning, administration and organization: setting objectives, and prioritizing CRC practice

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• CRC knowledge: knowledge-base training, mentoring, modeling and coaching
• Attitude: dedication, loyalty, reliability, flexibility, initiative, and energy towards implementing CRC
• Ethics: diversity, sustainability, honesty, integrity, fairness and professionalism
• Creative thinking: innovation, receptiveness, problem solving and originality
• Self-development and growth: learning, education, advancement, skill-building and career planning

1.6 SUMMARY
Dignity of human being is the basis for healthcare delivery
Clients should be treated as human being not as cases
Disrespect and abuse is a problem in Ethiopia.
Zero Tolerance to Disrespectful care shall be a motto for all health workers in the health facilities.
Improving the knowledge of ethics is important to boost the ethical behavior in practice

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Chapter 2:
Infant incubator
CHAPTER DESCRIPTION:
This Chapter describes MCH medical devices designed to equip biomedical engineers/technicians to
maintain MCH medical equipment’s specifically infant incubators.

PRIMARY OBJECTIVE:
At the end of this chapter the participants will be able to:
 Maintain infant incubator based on the acquired knowledge, skill and attitude.

SPECIFIC OBJECTIVES:
At the end of this chapter the participants will be able to:
 Describe purpose of infant incubator
 Explain working principle of infant incubator
 Differentiate basic parts and function of infant incubator
 Perform troubleshooting of infant incubator
 Perform preventive ,curative maintenance and performance test of infant incubator
 Perform calibration of infant incubator
 Practice safe handling of infant incubator

CHAPTER OUTLINE
2.1. Introduction
2.2. Working principle of infant incubator
2.3. Incubator component’s function
2.4. Basic parts and function of infant incubator
2.5. Safety and care of the device
2.6. Troubleshooting techniques
2.7. Maintenance and Repair procedure
2.8. Preventive Maintenances
2.9. Summary

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2.1. INTRODUCTION
Infant incubator is a medical device which provides Warmth, Humidity and Oxygen all in a
controlled environment by circulating heated air over the skin, the heat is then absorbed into the body
by tissue conduction and blood Convection. Ideally, both the skin and core temperatures should be
maintained with only minor variations.
Group activity 2.1

Explain the purpose and clinical applications of infant incubato

Time Allowed: 5 Minutes

Figure 1.infant incubator

2.1.1 PURPOSE / CLINICAL APPLICATION

Infant Incubator is generally used to provide a safe and stable environment for newborn infants, often
those who were born prematurely or with an illness or disability that makes them especially vulnerable
for the first several months of life.

Infant incubator provides Protection, as fully enclosed and controllable environments; incubators can be
used to protect babies from a wide range of possible dangers.

Oxygenation is a therapeutic process in which oxygen is administered directly to facilitate breathing.

Oxygenation is often administered via the infant incubator environment as a treatment for infant
respiratory distress syndrome

Monitoring and observation equipment is often built into the infant incubator unit;these instruments can
include cardiac monitors, brain-scan equipment, blood-monitoring equipment, thermometers and other
instruments for observing vital signs.

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2.2. WORKING PRINCIPLE
 An infant incubator is normally in the form of a trolley with a small mattress onthe top
covered by a rigid clear plastic cover.
 Incubator chamber provides a clean environment, and helps to protect the baby from noise,
dust, infection, and excess handling.
 Then, a temperature sensor is taped to the baby’s skin, and the incubator heater adjusts to maintain
the baby at a constant temperature or, the temperature is controlled by a thermostat in the heated air
stream.
 Underneath the baby is an air-blown electric heating system and humidification system which
circulates heated humid air at a desired temperature and humidity through the incubator
chamber.
 Additional oxygen may also be introduced into the chamber if it is needed.
Figure 2.Block diagram of Infant Incubator

Group activity 2.1

Learning activity 2.2
Discuss the working principle of infant incubator and the functionof(incubatorchamber,temperaturesensor, thermostat

2.3. BASIC PARTS AND FUNCTION

2.3.1 THE MAJOR COMPONENTS OF AN INFANT INCUBATOR SYSTEM ARE:
1. Main body
2. Control panel
3. Hand inlet with sleeves
4. Access door with lock
5. Baby board/tray with a mattress.
6. Thermostat
7. Cable with top plug.

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8. On/Off Switch.
9. Humidifier tray
10. Fresh air inlet/outlet.
11.Thermometer
12. Bulbs/lamps
13. Oxygen inlet.
14. Skin sensor

2.3. 2. FUNCTION OF INCUBATOR COMPONENTS

Power Supply: This provides the necessary voltage for the operation of the Incubator
Main body: Contains main parts
Control panel: used to interface with the machine to get the desired operation and
Contains The control buttons .
Access door with lock: Door to open/close the chamber
Baby board/tray with a mattress: Baby care unit
Filter: protect the infant from airborne bacteria and other impurities
Fan: is used to circulate air in the Incubator
On/Off Switch: Button to turn on/off
Humidifier: The heated airs pass through the humidifier to be humidified to desired level
Fresh air inlet/outlet: To allow air to enter/out
Thermometer: To measure the room temperature
Bulbs/lamps: For lighting purpose during examination
Oxygen inlet: To allow oxygen to enter
Skin sensor: To detect the skin temperature
Learning activity 2.3: Group
List the major components of infant incubators and discuss about their functions
5:Mns

2. 4. CLASSIFICATION
Portable: Easily movable from place to place.
Fixed: Installed at a fixed place.
Learning activity 2.4: Individual activity
List and discuss the major classification of infant incubators

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2.5. SAFETY AND CARE OF THE DEVICE
 Do not leave any patient inside the Incubator unattended for a long time.
 Humidifier compartment should be fixed even if it is not used.
 Do not place the Infant Incubator in direct sunlight or other source of light as it might
overheat the infant.
 If ambient temperature is higher than the set value then Incubator will be in effective.
 When oxygen is administered always check the level using an independent oxygen monitor
 Never oil or grease the oxygen inlets if Incubator is cleaned with flammable agents like
ether, alcohol etc, it should be air dried before being put to use.
 The air filter should not be cleaned and should be replaced at least every three months or when it
is dirty.
 Avoid moisture or contact with water, excessive humidity and temperature. The Incubator should
be kept in a clean and dry place whenever not in use.

Learning activity 2.5: Individual activity

List the appropriate safe handling procedures for infant incubator
3:Mns

2.6. TROUBLESHOOTING TECHNIQUES

2.6.1. PREPARATORY STEPS OF TROUBLESHOOTING TECHNIQUE
Before directly the conducting trouble shooting technique one has to perform the following tasks:
Receive maintenance request o
Prepare
o PPE (personal protective
equipment ) o Cleaning material
o Melt meter to check electrical parameters
o Mechanical and electrical tool kits to trouble shoot
o Service manual
o Checklists to check qualitative and quantitative data
o Gather information about the equipment and the problem
• Understand the equipment’s design and operation
• Draw out or locate schematic of device
• Obtain and review history records to check for any recurring problems

PHYSICAL INSPECTION
 Observe state of all components, for example:
 Relays energized or not
 Which lamps are lit
 Auxiliary equipment running or not
 Look for obvious visual clues to the cause

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 Evidence of mechanical damage:
 Impact
 Chafed wires
 Loose components
 Parts lying in bottom of chamber
 Overheating: Wiring
 Smell: Burned insulation/wiring
 Sound: To find the problem area and Can indicate mechanical failures
Touch (Carefully!); Hot areas indicate over heating
o check status of Dust and Bacterial
filter

2.6.2. TROUBLESHOOTING PROCEDURES TO DETECT MAJOR COMPONENT

FAILURES I. power supply check up
o check if there is a power from power out let , power supply cable and trace all power flowing
path o check the electrical status of
• Air temperature control
• Infant temperature control
• Integral humidification
• Access doors
• Alarm system

II. Check the status of all sensors

 Check the status of temperature sensor, oxygen sensor, humidifier sensor, display unit and the
connection with patient probe

III. Check fan and motors for proper functioning

 Check the proper function of fans and motors by measuring input/output voltage,
continuity, etc… using digital melt meters.

IV. Check the status of heating element

 Check the proper function of heating element using digital melt meters and measure
continuity, input/output voltage.

V. Test if the battery is functional

 Check the proper function of battery using digital melt meters, and measure input/output voltage.
Group activity 2.7
Arrange yourself in a group where each group can have a maximum of five trainers and perform a troubleshooting a
Power supply unit
All sensors
Fan and motors
Heating element
Battery

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2.7. MAINTENANCE AND REPAIR PROCEDURE
Symptoms Probable causes Solutions Symptoms
Loose connection Tight the power cable properly
The machine not turned on No power Check the power /from wall outlet
Burnt cables fix/ change it
Low air through the Dust filters might be dirty Replace dust filter
chamber Bacterial filters dirty Replace bacterial filters
Failure in Air temperature Temperature not set Reset temperature
control Board burnt Fix/change temperature circuit board
Loose temperature sensor Check on the temperature sensor
Failure in infant
Temperature sensor Replace with new one
temperature control
Damaged/worn out
Failure in integral Humidifier sensor fail Change the humidifier sensor
humidification No distilled water Add distilled water, if no water
Failure in access doors/ Mechanically broken/ Fix /change broken /cracked door/
port cracked port
The machine not turned on Turn on the system/ make sure if the
battery is functional
The Infant Incubator not No power from power out let
run power supply cable failure Fix/Change another power cable
power flowing path maintain or replace components
component defect including fuses
Loose connection Tight it properly
failure in temperature
Inappropriate temperature fix/change temperature sensor
sensor
sensor
oxygen sensor failure Exhausted sensor change oxygen sensor
No power Check and fix the power
Display control board fail trace the display control board
If there is a failure of and substitute or fix any defected
display unit components including data cables
Patient/temperature probe, and fix/
change
high oxygen concentration Filters/ fans problem Check the air filter and fan and replace
if filters are dirty and clean fan.
access door and air inlet filter the position of access door and air inlet
low oxygen concentration problem filter should be fixed
If there is an alarm in air Air block/fan motors failed Clear the blockage in air outlet or if fan
flow motor is failed replace it.
If there is high seat gasket problem fit/fix hood seat gasket properly
temperature concentration
If there is low temperature access door/skin probe Close access door and check skin
concentration connection problem probe connection.
If there is no heat inside Heating element burnet replace heating element
the incubator

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Learning activity 2.7
Arrange yourself in a group where each group can have a maximum of five
trainers. Trainers will arrange nine different maintenance scenarios per group
on a set of different infant incubator. Each maintenance scenarios are created
by creating fault on infant incubators due to different system component
failures (use maintenance and repair table as reference). The maintenance
scenarios are due to one of the following system component failures; i.e.
failures due to:
 Power unit failure
 Temperature control
 Integral humidification
 Oxygen sensor
 Access door/skin probe connection failure
 Bacterial and dust filter failures
 Fan and motor failure
 Heating element failure
 Gasket problem
Then within your group perform a troubleshooting activity and repair
the failures of each of the six patient monitoring devices.
15:Mns

2.8. PREVENTIVE MAINTENANCES

 Cleaning Fan, Filters/ Replace
 check & calibrate Sensors
 Safety test & all other functional check
 Bearings of Motor (Fan)
 Heater coil resistance & its contacts
 Casters & Wheels Consumables- Iris Port covers, sensors, Air Filters

Cleaning procedure
 Cleaning should be done at least once a week or every time the patient is changed.
 The heater rod can be hot enough to cause severe burns. So switch off the machine, unplug the
power cord and allow the unit to cool down before disassembly or cleaning.
 Clean all porthole seals and Hood seals parts with a solution of general purpose neutral
detergent and warm water.
 Clean frame, mattress and accessories with a solution of general purpose neutral
detergent and warm water, applied with a disposable wipe.
 Clean the oxygen inlet with mild cleaning solution.
 Reusable Patient probes can be cleaned by soaking the probe tip and wire in a cleaning solution.

Disinfection
 If the incubator used by infected babies, after cleaning, wipe over with a chlorine-
releasing agent rinse and dry thoroughly.

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 If there is contamination with blood or faces, clean then wipe it with a chlorine releasing agent,
rinse and dry.
 Phenolics or alcohols should not be used as they will damage the waterproof coating of the
mattress cover
Learning activity 2.8
What are the major preventive maintenance procedures that are commonly applied on infant incubators?
3:Mns

2.9. PERFORMANCE TEST FOR INFANT INCUBATOR

Check point Check content Result
Yes No
1. physical All external components are stetted
properly
2. filters Dust filter and bacterial filters are clean
3. electrical unit Turn on the machine and check the
machine is running
4. sensor temperature sensor, oxygen sensor and
humidifier sensor are working
5. oxygen and temperature level Oxygen and temperature concentration
are accurate
6. heating element Chamber is getting heat
7. battery Battery is functional

2.10 Summary
Infant incubator is a medical device which provides Warmth, Humidity and Oxygen.
Infant incubator provides fully enclosed and controllable environments.
Incubator chamber helps to protect the baby from noise, dust, infection, and excess handling.
Portable: Easily movable from place to place.
Classifications of Infant Incubator
Portable: Easily movable from place to place.
Fixed: Installed at a fixed place.
Troubleshooting procedures to detect major component failures
power supply check up
Check the status of all sensors
Check fan and motors for proper functioning
Check the status of heating element
Test if the battery is functional

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Chapter 3:
Infant radiant warmer
CHAPTER DESCRIPTION:
This Chapter describes MCH medical devices designed to equip biomedical engineers/technicians to
maintain MCH medical equipment’s specifically infant radiant warmer.

PRIMARY OBJECTIVE:
At the end of this chapter the participant will be able to:
 Maintain infant radiant warmer based on the acquired knowledge, skill and attitude.

SPECIFIC OBJECTIVES:
At the end of this chapter the participant will be able to:
 Describe purpose of Infant radiant warmer
 Explain working principle of Infant radiant warmer
 Differentiate basic parts and function of Infant radiant warmer
 Perform troubleshooting of Infant radiant warmer
 Perform preventive ,curative maintenance and performance test of Infant radiant warmer
 Practice safe handling of Infant radiant warmer

CHAPTER OUTLINE
3.1. Introduction
3.2. Purpose of Infant Radiant Warmer
3.3. Working principle of Infant Radiant Warmer
3.4. Basic parts and function
3.5. Infant radiant warmer components function
3.6. Classification of Infant Radiant Warmer
3.7. Safety and care of the device
3.8. Troubleshooting techniques
3.9. Maintenance and repair
3.10. Summary

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 Pharmacuetical and Medical Equipment Management Directorate
3.1. INTRODUCTION
Radiant warmer is a microprocessor controlled unit with heater placed on the overhead panel. It consists of a
biocompatible bed on which to place the infant, and anover head heater that delivers radiant heat. A skin
temperature probe monitors infant temperature. Heat output can be controlled manually or through baby mode
(feedback mode) for thermoregulation. Visual and audio alarms are present for safety. Infant radiant warmer is
intended to maintain the thermal balance of an infant by direct radiation of energy in the infrared region of the
electromagnetic spectrum

3.2. PURPOSE / CLINICAL APPLICATION

Infant radiant warmer is medical equipment used for keeping the babies warm and maintaining the body
temperature. These devices are commonly used to provide thermal support for newborns in the delivery
suite, for critically ill infants who require constant nursing intervention, and for infants undergoing
treatment that prolongs exposure to a cool environment. Prolonged cold stress can overwork heat
producing mechanisms, drain energy reserves, and result in hypoxia, acidosis, hypoglycemia, and, in
severe cases, death.
Learning activity 3.1: Group or individual?
Explain the purpose and clinical applications of infant radiant warmer
Time: 5mns

3.3 WORKING PRINCIPLE

 The heating element generates a significant amount of radiant energy in the far IR wavelength region
(longer than three microns to avoid damaging the infant’s retina and cornea). The radiant output of the
heating unit is also limited to prevent thermal damage to the infant.
 The IR energy is readily absorbed by the infant’s skin; increased blood flow in the skin then transfers
heat to the rest of the body by blood convection (heat exchange between the blood and tissue surfaces)
and tissue conduction(heat transfer between adjacent tissue surfaces)..

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 Pharmacuetical and Medical Equipment Management Directorate

Figure 4.block diagram of Infant radiant warmer

Learning activity 3.2:Discuss the working principle of infant radiant warmer (heating element, temperatu
2:Mns

3.4 BASIC PARTS AND FUNCTION OF INFANT RADIATOR WARMER

1. Cable with top plug
2. Power on/off switch
3. Power indicator lamp
4. Heater Module or Halogen Bulb
5. Heater Output Control
6. Skin sensor
7.Pillars/Bars
8. Retaining screw for fixing the pillar
9. Slide base bracket/slide panels
10. Conductive mattress
11.Knobs for tilting the table
12. Treatment table
13. Bassinet (slide pad)
14. Shelf
15. Drawer with a resuscitation set
16. Pedestal/Casters

3.5. INFANT RADIANT WARMER COMPONENTS FUNCTION

Cable with top plug: It is power cable and used to transferring power Power
on/off switch: Used to switch on/off the machine
Power indicator lamp: Indicates the availability of the power
Heater Module or Halogen Bulb: Giving lights during/after examination
Heater Output Control: To control the amount of heat to be delivered to the infant

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Skin sensor: To detect/sense the skin temperature
Pillars/Bars: Having the displays, On/Off switch, and other parameters
Conductive mattress: For infant safety and comfort
Treatment table: For infant bed and treatment purpose
Pedestal/Casters: For ease of movement of the machine/ Infant Radiant Warmer
Think-Pair-Share 3.3:
List the major components of infant radiant warmers and discuss about their functions
Time :5mns

3.6. CLASSIFICATION
Types
Fixed: Installed at a fixed place.
Mobile (Heater and Integral Models): Easily movable from place to place.
Learning activity 3.4:
List and discuss the major classification of infant radiant warmer
3:Mns

3.7 SAFETY AND CARE OF THE DEVICE

1. Do not use the warmer in the presence of flammable anesthetics; a possible explosion hazard
exists under this condition.
2. Do not touch the protective grill under the radiant heater or the top of the heater assembly.
3. Disconnect power to the warmer and allow the heater rod to cool before cleaning to avoid
the possibility of a burn.
4. Never oil or grease oxygen equipment. Oils and grease oxidizes readily, and in the
presence of oxygen, will burn violently.
5. Do not place items on top of the heater assembly as they can fall and injure the patient.
6. Inspect all patient connected tubes before and after moving the bed as any movement can pull
tubing or leads connected to the patient.
7. Prolonged exposure to the light emitted by the observation lamp in this unit may harm
the unprotected eyes of the infant. For safety, cover the infant’s eyes.
8. Do not use the warmer system if the system failure alarm is activated.
9. When using a radiant warmer, change the patient’s diapers frequently.
10. Do not leave the patient unattended while using the warmer. 11.The
I.V. pole should not be overloaded –maximum weight 2kg.
Learning activity 3.5:
List the appropriate safe handling procedures for infant radiant warmer
Time: 5mns

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Pharmacuetical and Medical Equipment Management Directorate
3.8. TROUBLESHOOTING TECHNIQUES
3.8.1. PREPARATORY STEPS OF TROUBLESHOOTING TECHNIQUE
Before directly the conducting trouble shooting technique one has to first perform the following tasks:

Receive maintenance request

o Prepare
o PPE(personal protective
equipment ) o Cleaning material
o Melt meter to check electrical parameters
o Mechanical and electrical tool kits to trouble shoot
o Service manual
o Checklists to check qualitative and quantitative data
o Gather information about the equipment and the problem
• Understand the equipment’s design and operation
• Draw out or locate schematic of device
• Obtain and review history records to check for any recurring problems

Physical inspection
 Observe state of all components, for example:
 Relays energized or not
 Which lamps are lit
 Auxiliary equipment running or not
 Look for obvious visual clues to the cause
 Evidence of mechanical damage:
 Impact
 Chafed wires
 Loose components
 Parts lying in bottom of chamber
 Overheating
 Wiring
 Smell
 Burned insulation/wiring
 Sound
 To find the problem area
 Can indicate mechanical failures
 Touch (Carefully!)
 Hot areas indicate over heating

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Pharmacuetical and Medical Equipment Management Directorate
Group activity 3.6:
Arrange yourself in a group where each group can have a maximum of five trainers and perform a tr
Power supply unit
All sensors
Heating element
After finishing the troubleshooting identify the system failures/ problems (if there is any) of the
Time:10Mns

3.8.2. TROUBLESHOOTING PROCEDURES TO DETECT MAJOR

COMPONENT FAILURES

I. Power supply check up

o check if there is a power from power out let , power supply cable and trace all power
flowing path
o Check the electrical status of Control pane and Phototherapy warning light

II. Check the status of all sensors

 Check the status of temperature sensor, Halogen Bulb ,display unit and the
connection with patient probe

III. Check the status of heating element

 Using digital melt-meter check the working status of the heater

3.9. MAINTENANCE AND REPAIR

Symptoms Probable causes Solutions
loose connection Tight the power cable properly
No power Check the power/wall outlet
The machine not turned Burnt cables fix/ change it
on power flowing path component maintain or replace components
defect including Internal fuses, mains lead and
internal harnesses defective.
Software set up error Check Software set up and fix problem
Alarm sounding and Temperature sensor error Check the temperature sensor Or fix/
manual indicator change it
flashing. Other parameters error Use information mode to obtain error
code
Skin temperature failed Check if Skin sensor is damaged, and
fix it
Wrong readings Loose connection of sensor Insert it properly
cables
not the right type Replace the correct skin sensors

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Manual indicator Defective control board Check the control board
flashing accompanied by Defective power board Check the power board
rapid pulsing two tone
Defective PCB replace the defective PCB
alarm
Defective components, trace the display control board and
including data cables Patient/ substitute or fix it
temperature probe
Failure of display unit Defective of display board correct/ change the defected
components, including data cables
Patient/temperature probe
Loose Heater connecters Tight/fix it properly
No heat inside baby Temperature sensor button set Set temperature sensor button to high
chamber to zero
The heating element is burned Replace/fix heating element

Group activity 3.9:

Arrange yourself in a group where each group can have a maximum of five
trainers s. Trainers will arrange five different maintenance scenarios per group
on a set of different infant radiant warmer devices. Each maintenance scenarios
are created by making the infant radiant warmer devices malfunctioned due to
different system component failures. The maintenance scenarios are due to one
of the following system component failures; i.e. failures The maintenance
scenarios are due to one of the following system component failures; i.e. failures
due to:
o Power unit
o Cable connection
o PCB board
o Heating element
o Patient temperature probe
Then within your group perform a troubleshooting activity and repair the
failures of each of the case infant radiant warmer.
Time:15mns

3.9.1. PREVENTIVE MAINTENANCE PROCEDURE

 Turn off the power switch and disconnect power from the mains.
 Ensure the brake lock is on top to prevent movement of the unit
 Clean the main frame with a mild detergent solution.
 The mattress, x-ray grid and side panels may be cleaned without immersing by using a suitable
disinfectant agent.
 Clean the skin temperature probe by gently wiping with a soft, damp cloth containing
detergent or disinfecting solution.

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 Pharmacuetical and Medical Equipment Management Directorate
Learning activity 3.9
What are the major preventive maintenance procedures that are commonly applied in infant radiant warmer devices?
Time: 5mns

3.10. PERFORMANCE TEST FOR INFANT RADIANT WARMER

Result
Check point Check content Yes No
1. physical All external components are stetted properly
2. Alarm sounding and manual indicator
Alarm sounding and manual indicator are accurate

3. electrical unit Turn on the machine and check the machine is running

4. sensor Skin sensor is normal , inserted fully or the right type

5. heating element Chamber is getting heat

3.11. SUMMARY
Radiant warmer is a microprocessor controlled unit with heater placed on the overhead panel.
Infant radiant warmer is medical equipment used for keeping the babies warm and maintaining the body temperatur
Classification
Fixed: Installed at a fixed place.
Mobile (Heater and Integral Models): Easily movable from place to place.
Troubleshooting procedures to detect major component failures
power supply check up
Check the status of all sensors
Check fan and motors for proper functioning
Check the status of heating element
Test if the battery is functional

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Pharmacuetical and Medical Equipment Management Directorate

Chapter 4:
Fetal monitor
CHAPTER DESCRIPTION:
his Chapter describes MCH medical devices designed to equip biomedical engineers/technicians to
maintain MCH medical equipment’s specifically fetal monitor.

PRIMARY OBJECTIVE:
At the end of this chapter the participant will be able to:
 Maintain fetal monitor based on the acquired knowledge, skill and attitude.

SPECIFIC OBJECTIVES:
At the end of this chapter the participant will be able to:
 Describe purpose of fetal monitor
 Explain working principle of fetal monitor
 Differentiate basic parts and function of fetal monitor
 Perform troubleshooting of fetal monitor
 Perform preventive ,curative maintenance and performance test of fetal monitor
 Practice safe handling of fetal monitor

CHAPTER OUTLINE
4.1. Purpose/clinical application
4.2. Working principle
4.3. Basic parts function
4.4. Safety and care of the device
4.5. Troubleshooting Techniques
4.6. Maintenance and Repair
4.7. Performance Test for Fetal Monitor
4.8.Summary

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 Pharmacuetical and Medical Equipment Management Directorate
4.1. PURPOSE / CLINICAL APPLICATION
Fetal monitoring provides graphic and numeric information on fetal heart rate (FHR) and maternal uterine
activity (UA) to help clinicians assess fetal well-being before and during labor.

Fetal Monitor is intended for non-invasive monitoring of single or twin fetuses during ante partum
examination, labor and delivery. FHR often exhibits decelerations and accelerations in response to uterine
contractions or fetal movements; certain patterns are indicative of hypoxia. Examination of these patterns,
the baseline level, and variability characteristics can indicate the need to alter the course of labor with
drugs or perform an operative delivery
Individual activity 4.1
Explain the purpose and clinical applications of the Fetal Monitor device.
Time: 3mns

4.2. WORKING PRINCIPLE

Fetal monitors detect FHR externally by using an ultrasound transducer to transmit and receive ultrasonic
waves; the frequency (or Doppler) shift of the reflected signal is proportional to the velocity of the reflecting
structure—in this case, the fetal heart. A transducer contains one or more piezoelectric elements that convert
an electrical signal into ultrasonic energy that can be transmitted into tissues. When this ultrasonic energy is
reflected back from the tissues, the transducer reconverts it to an electrical signal that can be used to create a
waveform for display and recording and an audible FHR (sound created by the frequency shift of the
ultrasonic signal).
Learning activity 4.2
Discuss the working principles of the Fetal Monitor device.
Time: 3mns

Figure 5.block diagram of fetal monitor

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Pharmacuetical and Medical Equipment Management Directorate
4.3. BASIC PARTS AND FUNCTION
4.3.1 BASIC PARTS
 Touch screen display
 Powers LED
 Paper drawer
 Paper drawer release
 Connectors
 ON/OFF switch
 Power connector
 Carrying handle
 Built-in stand
 Display release
 Fetal sensor sockets

4.3.2. BASIC PARTS FUNCTION

Touch screen display
 This unit of fetal monitor is to display the information of all parameters.
Powers LED
 This part of the fetal monitor is used to indicate power availability.
Paper drawer
 This part of the fetal monitor is door of printer
Paper drawer release
 Use for releasing printer door
Connectors
 This unit of fetal monitor is used for connecting the cables
ON/OFF switch
 This part of the fetal monitor is used to turn on/off the device.
Power connector
 For connecting the power cables
Carrying handle, Built-in stand and Display release
 To handle the machine , For standing purpose, and to release the display unit
Fetal sensor sockets
 This part of the fetal monitor is uses for sensor inlets
Learning activity 4.4.
Discuss the functions of the components of the Fetal Monitor device.
Time: 6mns

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 Pharmacuetical and Medical Equipment Management Directorate
4.4. SAFETY AND CARE OF THE DEVICE
1. This device is not intended for use in intensive care units, operating rooms or for home use.
2. EXPLOSION HAZARD- Do not use this device in the presence of flammable anesthetic
mixture with air, with oxygen or with nitrous oxide.
3. Shock Hazard–The power receptacle must be a three-wire grounded outlet. A hospital grade outlet is
required. Never adapt the three-prong plug from the monitor to fit a two-slot outlet.
4. Do not apply this monitor and other ultrasonic equipment simultaneously on a same patient,
due to the potential of leakage current superposition.
5. Do not apply this monitor simultaneously with other PATIENT-connected equipment, such
as, a cardiac pacemaker or other electrical stimulators.
6. Do not use the monitor with RF surgical equipment.
7. Do not switch on device power until all cables have been properly connected and verified.
8. Do not touch the signal input or output connector and the patient simultaneously.
9. Equipment and devices that connect to the Monitor should form an equipotential body to ensure
effective grounding.
10. Disconnect power cord before changing fuses. Replace the fuses with those of the same
Specifications only.
11. SHOCK HAZARD- Do not attempt to connect or disconnect a power cord with wet hands.
Make certain that your hands are clean and dry before touching a power cord.
11. SHOCK HAZARD- Do not remove the top panel cover during operation or while power is connected.

Learning activity 4.5

List the appropriate safe handling of the Fetal Monitor device.
Time: 4mns

4.5. TROUBLESHOOTING TECHNIQUES

Generally troubleshooting is a problem solving techniques, often applied to repair a failed process
of a system or a device.
4.5.1 RECEIVE MAINTENANCE REQUEST
o Prepare
o PPE(personal protective
equipment ) o Cleaning material
o Melt meter to check electrical parameters
o Mechanical and electrical tool kits to trouble shoot
o User manual
o Service manual
o Checklists to check qualitative and quantitative data

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4.5. 2 TROUBLESHOOTING PROCEDURES
I) Physical Inspection
o Observe if there is physical damage

II) Power supply check up

o check if there is a power from power out let , power supply cable and trace all power flowing path
o Check the electrical status of Control panel.

III) System verification

 Verify the system is on and information is displayed on LCD.

IV) Volume control and transducer checking

 Checks the status of volume control and Check that the correct transducer is connected.

V) Recorder checking
 Check that the recorder checking is turned on; paper is inserted into the recorder correctly.
 Check recorder door is correctly closed and paper moves out of the recorder at the correct rate.

Learning activity 4.5:

Make a group of 4/5 and perform troubleshooting activity/ steps of the Fetal Monitor device.
Time: 5mns

4.5 MAINTENANCE AND REPAIR

Symptoms Probable cause Solutions
Not the system is switched on Check/ Verify the system is on
No display No power from power out let Check the power out let and fix the problem
1 information on Burnt cables fix/ change it
LCD Burnet fuses Replace the blown fuses
power board failure Repair/ change the power board
If Keyboard does Not the system is switched on Verify the system is on and that the fuses
are intact.
not respond
The system busy/stacks Reset system by turning off then back on.
2 No FHR inappropriate transducer select and connect correct transducer
information on selection
display
3 FH trace printed Transducer failure/loose Check for audio FH complex and reposition
on recorder. connection transducer until clearly heard.
Not the recorder turned on Check that the recorder is turned on. ·
The paper is not inserted Check paper is inserted into the recorder
If there is No correctly correctly.
4
chart printed. The door is not closed  Check recorder door is correctly closed ·
appropriately  Check that paper moves out of the
recorder at the correct rate.

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 Pharmacuetical and Medical Equipment Management Directorate

The system is not turned on Verify the system is on and that the fuses
are intact.
If there is No
Low volume Set volume control high.
5 sound from
loudspeaker inappropriate transducer Select the correct transducer.
selection
Loose transducer connection connect the transducer appropriately

Group activity 4.6:

Make a group of 4/5 and perform maintenance activity of the failed part of the Fetal
Monitor device.
3:Mns

4.6. PREVENTIVE MAINTENANCE PROCEDURE

 Clean the device and check the device and electrode.
 Maintain the device and the electrode clean by rubbing the device with an alcohol cloth at least
 Once a month. Please do not use lacquer, thinner, ethylene, oxide.
 Keep the cable away from dirt or filth, cleanse it with a cloth soaked with warm water
 (40˚C/104 F) and cleanse it with clinical alcohol once a week.
 Please do not soak the probe cable in liquid or cleanser and keep the device and cables from any
types of liquid.
Group activity 4.7:
Make a group of 4/5 and perform preventive maintenance procedure of the Fetal Monitor device.
Time: 5mns

4.7 PERFORMANCE TEST FOR FETAL MONITOR

Result
Check point Check content Yes No
1. physical All external components are stetted properly
2. chart printer paper moves out of the recorder at the correct rate, door is correctly close and open

3. electrical unit Turn on the machine and check the machine is running

4. FHR information on display audio FH complex and position of transducer

5. loudspeaker Sound from loud speaker

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 Pharmacuetical and Medical Equipment Management Directorate

Group activity 4.7

Make a group of 4/5 and perform performance test of the Fetal Monitor device.
Time: 3mns

4.8.SUMMARY
Fetal monitoring provides graphic and numeric information on fetal heart rate (FHR) and maternal uterine activity (
Fetal monitors detect FHR externally by using an ultrasound transducer to transmit and receive ultrasonic waves.
Basic parts
Touch screen display
Powers LED
Paper drawer
Paper drawer release
Connectors
ON/OFF switch
Power connector
Carrying handle
Built-in stand
Display release

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Pharmacuetical and Medical Equipment Management Directorate

Chapter 5:
CPAP Machine
CHAPTER DESCRIPTION:
his Chapter describes MCH medical devices designed to equip biomedical engineers/technicians to
maintain MCH medical equipment’s specifically CPAP Machine.

COURSE GOAL:
At the end of this chapter the participant will be able to:
 Maintain CPAP machine based on the acquired knowledge, skill and attitude..

SPECIFIC OBJECTIVES:
At the end of this chapter the participant will be able to:
 Describe purpose of CPAP machine
 Explain working principle of CPAP machine
 Differentiate basic parts and function of CPAP machine
 Perform troubleshooting of CPAP machine
 Perform preventive ,curative maintenance and performance test of CPAP machine
 Practice safe handling of CPAP machine

CHAPTER OUTLINE
5.1. Purpose/Clinical application of CPAP machine
5.2. Working principle of CPAP machine
5.3. Basic parts and function of CPAP machine
5.4. Troubleshooting of CPAP machine
5.5. Preventive curative maintenance and performance test of CPAP machine
5.6. Safe handling of CPAP machine
5.7. Summary

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 Pharmacuetical and Medical Equipment Management Directorate
5.1. PURPOSE / CLINICAL APPLICATION
Nasal CPAP therapy aims to support neonates, especially pre-term and low-birth weight
newborns, who can breathe spontaneously but inadequately.
Learning activity 5.1:
Explain the purpose and clinical applications of the CPAP Machine.
Time: 3mns

5.2 WORKING PRINCIPLE

The CPAP has three major components the gas source, pressure generator and the patient interface.
The pressure generator indicates the pressure of CPAP by observing the length of the tubing that is
immersed in the water. The pressure is created in the bubble CPAP system, by placing distal
expiratory tubing in the water tank of the system.

The gas source of the bubble system contains an oxygen blender, connected to a source of oxygen and compressed
air. These two mixtures of compressed air and oxygen are used to supply an appropriate concentration of oxygen.
The new blended oxygen is the circulated through corrugated tubing. The patient interface consists of nasal
prongs, which are basically the nasal interface between the infant’s airway and circuit. To prevent nasal traumas it
is very important that the nasal interface is applied to the infant without air leakage while measurements are being
taken. In concluding, it can be said that this particular device has a vital role to play in assisting young babies with
breathing issues.
Learning activity 5.2
Explain the working principles of the CPAP Machine.
Time: 2mns

Figure 6.Block diagram for CPAP system

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5.3 BASIC PARTS AND FUNCTION
5.3.1 BASIC PARTS
CPAP machine consists of three major components/Parts:
 Gas source
 Pressure generator
 Patient interface
PEEP/CPAP
Gas Mixing
Highly visible oxygen and air rotameters to set gas flow rates
FiO2 for quick oxygen percentage calculation
3. Humidi¬fier
User adjustable heater power for different operating environments
Humidifies gas stream to prevent drying of the airways
4. Patient Circuit
reusable silicone breathing circuit
pinch proof and kink resistant
chemically disinfectable
internal heater wire and temperature sensors included
digital temperature sensor for accurate temperature control
full PID temperature controller with advanced safety features
5. Air Compressor
integrated air compressor to avoid need for an external air source
combined power switch to turn CPAP and compressor on and o with one switch
diaphragm type for clean, long lasting air supply

Figure 7.CPAP Machine components

Learning activity 5.3

Explain the main parts and function of CPAP Machine.
Time: 3mns

5.3.2 PARTS FUNCTION

1. Gas source:
 An oxygen blender connected to a source of oxygen and compressed air is used to supply an
appropriate concentration of inspired oxygen. The humidified blended oxygen is then circulated
through corrugated tubing.

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 Pharmacuetical and Medical Equipment Management Directorate
2. Pressure generator:
 Pressure in the bubble CPAP system is created by placing the distal expiratory tubing in water.
Designated pressure is determined by the length of tubing immersed.

3. Patient interface:
 Nasal prongs are used as the nasal interface between the circuit and the infant’s airway. Short and wide
nasal prongs allow for a low resistance to air flow. It is important that the nasal interface be applied to the
infant without air leakage while taking measures to prevent nasal trauma.

5.3.3. CLASSIFICATION
1. Complete advanced nasal CPAP system
2. Bubble CPAP system
 Complete advanced bubble CPAP system, it is composed of the following components
1. Monitoring Gas Mixer (the flow driver)
2. Control panel and adjustment display
3. Patient interface (nasal prong or a nasal mask)
4. Circuit security pressure relief valve
5. Active humidifier and accessories
6. Pressure regulating valve
7. Nasal tubes
8. Gas hoses and connectors
Learning activity 5.4
List the types/classification and explain each of the CPAP Machine.
Time: 2mns

5.3.4 SAFETY AND CARE OF THE DEVICE

o Do not use the humidifier in the presence of inflammable anesthetic gases because there is the
explosion risk
o Always regulate the gas flow before applying the system to the patient o Make
sure the humidifier water reservoir is on the correct water level.
Learning activity 5.5
Discuss the safety of the CPAP Machine. Time:3mns

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Pharmacuetical and Medical Equipment Management Directorate
5.4. TROUBLESHOOTING PROCEDURE
5.4.1. RECEIVE MAINTENANCE REQUEST
o Prepare
o PPE(personal protective
equipment ) o Cleaning material
o Melt meter to check electrical parameters
o Mechanical and electrical tool kits to trouble shoot
o Service manual
o Checklists to check qualitative and quantitative data

5.4.2 PHYSICAL INSPECTION

i. Physically observe (Smell for burning cables and components, Hear for abnormal noise,
Look physical breakage, if any)
ii. Check if there is a power from power out let , power supply cable and trace all power flowing path
iii. Check the entire circuit from wall to baby to outlet to ensure that it is functioning correctly.
iv.Check for leaks and/or broken connections.
v. Check the status of
• Air temperature control
• Integral humidification
• Alarm system
vi. Check the status of temperature sensor, oxygen sensor, humidifier sensor display unit and the
connection with patient probe
vii. check for Blended air/oxygen gas supply
viii. check whether the Flow is between 5-10 liters/min
ix. check whether the Humidifier temperature is correct (36.8-37.3 °C)
x. check whether the Humidifier water level is correct
xi.check whether the Oxygen analyzer correctly set
xii.Corrugated tubing correctly placed
xiii. Once the system is applied, check that the prongs are positioned appropriately and that the CPAP
system is bubbling at 5 cm H20.
xiv. Check the CPAP delivery system for proper functioning and the system bubbling properly

5.4.3. POWER SUPPLY CHECK UP

i. Check if there is a power from power out let , power supply cable and trace all power flowing path
ii. Check the electrical status of Control panel.

5. 4.4. SYSTEM VERIFICATION

 Verify the system is on and information is displayed on LCD.

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Pharmacuetical and Medical Equipment Management Directorate
5.4.5 VOLUME CONTROL AND TRANSDUCER CHECKING
 Checks the status of volume control and Check that the correct transducer is connected.
Learning activity 5.4:
Discuss the activity/ steps troubleshooting of the CPAP Machine.
Time: 3mns

5.5.5 MAINTENANCE AND REPAIR

Symptom Possible cause Solution
i. Not plugged in 1. Check to see that the CPAP is
plugged in and that the outlet is
CPAP does not turn
1 switched
on.
ii. Power switch is not in the 2. Check to see if the power switch is in
on position the “on” position
1. circuit problem and/or 1. Systematically check and tight the
The machine is not circuit
2
bubbling 2. prongs problem from the 2. occlude the prongs with your
nose fingers
Humidifier is Lack of energy on the out let Try to connect known AC source
connected to an AC AC
3
source, but doesn’t
turn on
Gas entry line with 1. verify the air/o2 entry pressures in
unbalanced pressure the CPAP must be equalized in 3,5
4 Sound alarm in the kgf/cm2
CPAP module 2. verify difference in the entry
pressures, they must be lower than
1,4kgf/cm2
Little water in the humidifier Fulfill the humidifier jar with water
water
Signal of water low
5 Poor contact between Clean and/or dry the lodging of the
level on the humidifier
humidifier pitcher and the humidifier pitcher
base
power supply cable Change another power cable
6
failure
• Check air/o2 sources tubing
connections.
There is no air/O2
7 • Make sure the air/o2 sources
flow.
is on and the nozzle is completely
attached.
i. The prongs may be too small -
replace with a larger size.
Water does not bubble ii. Reposition the prongs.
8 when the prongs are iii. Air may be leaking out of the
placed in the airway mouth; gently close the baby’s mouth
for a few moments to encourage
nose breathing.

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Pharmacuetical and Medical Equipment Management Directorate
connections and tubing for Check connections and tubing for
The airflow is weak
leaks leaks.
9 and cannot reach 10
• If connections are loose, tighten
L/min them. If leaks are found, fix them.
temperature sensor is failure in temperature sensor fix/change temperature sensor
10 not working
Water level sensor is failure in Water level sensor fix/change Water level sensor
11 not working
oxygen sensor is not failure in oxygen sensor fix/change oxygen sensor
12 working
5.5 PREVENTIVE MAINTENANCE PROCEDURE
o Clean the exterior and interior parts
o Proceed the cleaning of the water level sensor point every 24 hrs.
o Cleaning water level sensor
o Evaluation of air/O2 system
o Checking O2 system
o Calibrate after each maintenance
Group activity 5.5
Make a group of 4/5 and perform the main preventive Maintenance of the CPAP Machine.
Time:2mns

5.5.1. PERFORMANCE TEST FOR CPAP MACHINE

Result
Check point Check content
Yes No
4.1 physical All external components are stetted properly
4.2 Nasal prongs Nasal prongs size is correct and positioned
correctly
4.3 electrical unit Turn on the machine and check the machine
is running
4.4 sensors temperature sensor, water level (humidifier)
sensor, oxygen sensor are working properly
4.5 oxygen and temperature level Oxygen and temperature concentration are
accurate
4.6 air/O2 blender The blender is set at the appropriate
Percentage of inspired oxygen.

4.7 humidifier The humidifier holds the correct Amount of

water.
4.8 temperature The inspired gas temperature is Appropriate.
4.9 outlet bottle The outlet bottle is bubbling.
5.0 oxygen analyzer The oxygen analyzer reads the same as the
blender setting

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 Pharmacuetical and Medical Equipment Management Directorate
5.1 tubing in the outlet bottle The tubing in the outlet bottle is fixed at 5 cm
of water
5.2 flow meter The flow meter is set between 5 and 10
liters/minute.
5.3 corrugated tubing The corrugated tubing does not contain water
and correctly placed.
Learning activity 5.9
Make a group of 4/5 and perform performance test of the CPAP Machine.
Time: 2mns

5.7. SUMMARY
The CPAP has three major components the gas source, pressure generator and the patient interface.
CPAP machine consists of three major components/Parts:
Gas source
Pressure generator
Patient interface
Classification
Complete advanced nasal CPAP system
Bubble CPAP system

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Pharmacuetical and Medical Equipment Management Directorate

Annex 2. Trainee Evaluation Check List for Infant Incubator

Course Title: Infant Incubator
Learning Objective: To develop the capacity of Biomedical
Engineers/Technicians to maintain Infant
Incubator based on the acquired knowledge,
skill and attitude.
Date of assessment:
Venue of assessment:
During the demonstration of knowledge, skills and Yes No
attitude, the learner has:
1. Demonstrated the correct handling of Infant
Incubator
2.Identified all parts of Infant Incubator
3. Prepared the required hand tools, Instruments
and materials
4 .performed preventive maintenance procedure
 Cleaning Fan, Filters/ Replace
 Safety test & all other functional check
 Heater coil resistance & its contacts
 Casters & Wheels Consumables- Iris Port
covers, sensors, Air Filters
B.Oxygen and temperature concentration are
accurate check & calibrate Sensors.
C. Bearings of Motor (Fan)
5.performed corrective maintenance procedure:
5.1 Gathering information about the failure
5.2 Physical observation
5.3 power supply system check up
5.4 Alarm sounding and manual indicator flashing
check up
5.5 check the status of all sensors
5.6 check the status of heating element
6. safety rules Followed in performing the activities
The trainee’s demonstration and performance Satisfactory Not
was: Satisfactory
Trainee’s Name signature: Date:
Trainer’s Name signature: Date:

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Pharmacuetical and Medical Equipment Management Directorate

Annex 3. Trainee Evaluation Check List for Infant Radiant Warmer

Course Title: Infant radiant warmer
Learning Objective: To develop the capacity of Biomedical
Engineers/Technicians to maintain Infant
radiant warmer based on the acquired
knowledge, skill and attitude.
Date of assessment:
Venue of assessment:
During the demonstration of knowledge, skills Yes No
and attitude, the learner has:
1. Demonstrated the correct handling of Infant
radiant warmer
2.Identified all parts of Infant radiant warmer
3. Prepared the required hand tools, Instruments
and materials
4 .performed preventive maintenance procedure
a. Clean the main frame with a mild detergent
solution.
b. The mattress, x-ray grid and side panels cleaned
without immersing by using a suitable disinfectant
agent.
C. Clean the skin temperature probe by gently
wiping with a soft, damp cloth containing detergent
or disinfecting solution
5.performed corrective maintenance procedure:
5.1 Gathering information about the failure
5.2 Physical observation
5.3 power supply system check up
5.4 Alarm sounding and manual indicator flashing
check up
5.5 check the status of all sensors
5.6 check the status of heating element
6. safety rules Followed in performing the activities
The trainee’s demonstration and performance Satisfactory Not
was: Satisfactory
Trainee’s Name signature: Date:
Trainer’s Name signature: Date:

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Pharmacuetical and Medical Equipment Management Directorate

Annex 4. Trainee Evaluation Check list for fetal Monitor

Course Title: CPAP Machine
Learning Objective: To develop the capacity of Biomedical
Engineers/Technicians to maintain Infant
Incubator based on the acquired knowledge,
skill and attitude.
Date of assessment:
Venue of assessment:
During the demonstration of knowledge, skills Yes No
and attitude, the learner has:
1. Demonstrated the correct handling of CPAP
machine
2.Identified all parts of CPAP machine
3. Prepared the required hand tools, Instruments
and materials
4 performed preventive maintenance procedure
a. Clean the main frame with a mild detergent
solution.
b. The humidifier, outlet bottle cleaned without
immersing by using a suitable disinfectant agent.
C. Clean the skin temperature probe by gently
wiping with a soft, damp cloth containing detergent
or disinfecting solution
5.performed corrective maintenance procedure:
5.1 Gathering information about the failure
5.2 Physical observation
5.3 power supply system check up
5.4 Alarm sounding and manual indicator flashing
check up
5.5 check the status of all sensors
5.6 check the status of heating element
6. safety rules Followed in performing the activities
The trainee’s demonstration and performance Satisfactory Not
was: Satisfactory
Trainee’s Name signature: Date:
Trainer’s Name signature: Date:

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Pharmacuetical and Medical Equipment Management Directorate

Annex 5. Trainee Evaluation Check list for CPAP Machine

Course Title: Fetal Monitor Machine
Learning Objective: To develop the capacity of Biomedical
Engineers/ Technicians to maintain Fetal
Monitor Machine based on the acquired
knowledge, skill and attitude.
Date of assessment:
Venue of assessment:
During the demonstration of knowledge, skills Yes No
and attitude, the learner has:
1. Demonstrated the correct handling of Fetal
Monitor Machine
2.Identified all parts of Fetal Monitor Machine
3. Prepared the required hand tools, Instruments
and materials
4 .performed preventive maintenance procedure
a. Clean the main frame with a mild detergent
solution.
b. The LCD displays cleaned without immersing by
using a suitable disinfectant agent.
C. Cleaned the transducers probe by gently wiping
with a soft, damp cloth containing detergent or
disinfecting solution
5.performed corrective maintenance procedure:
5.1 Gathering information about the failure
5.2 Physical observation
5.3 power supply system check up
5.4 Alarm sounding and manual indicator flashing
check up
5.5 check the status of all sensors
5.6 check the status of heating element
6. safety rules Followed in performing the activities
The trainee’s demonstration and performance Satisfactory Not
was: Satisfactory
Trainee’s Name signature: Date:
Trainer’s Name signature: Date:

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 Pharmacuetical and Medical Equipment Management Directorate

References
1. SRM University, unit 1incubater, radiant warmer, phototherapy unit. Pdf
2. The Republic of Uganda, MINISTRY OF HEALTH, Training guide for National and
Regional User Trainers volume 1, uga_04.pdf
3. The Republic of Uganda, MINISTRY OF HEALTH, Training guide for National and
Regional User Trainers volume 2, uga_05.pdf
4. warming_unit_radiant_infant.pdf
5. ONTOP-IN 2012: Radiant Warmer job aids.pdf
6. Medical Equipment maintenance manual, Ministry of Health and Family Welfare, New Delhi, October
2010
7. FETAL MONITOR GIMA FC1400 Operation Manual, 688.pdf
8. sonic aid Fetal Monitoring,20110615151756.pdf
9. EDANUSA F9 Manual, service manual.pdf
10. Philips Avalon Fetal Monitor FM20 / FM30 / FM40 / FM50 User Manual.pdf
11.XT Auto CPAP System Instruction Manual.pdf
12. Schematic-diagram-of-bubble-CPAP-circuit https://www.researchgate.net/figure/10772354
13. Bubble nasal CPAP manual Riyadh AL-Kharj Hospital Program Neonatal intensive care, 2005