Maintenance Management in Hospital Equipment: Systematic Review / Gestão da Manutenção em Equipamentos Hospitalares: Revisão Sistemática

Ana Luíza Ferreira Mamede; André Alves de Resende

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<line> Centro Unv*rsitário Santo Agostinho </line>

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<line> www*.fsanet.com.*r/revista </line>

<line> ISSN Impresso: *806-6356 I*SN Ele*rônico: 2317-2983 </line>

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<line> *aintenance Management in Hospi*a* Equipmen*: Sy*temat** Review </line>

<line> Gestão ** Manutenção *m Equipamen*os Ho*p*talares: R*visão Sistem**ica </line>

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<line> A*a Luiza Fe*rei*a Mame*e </line>

<line> *estrad* em Engenharia de Pro*uç*o pela Universi***e Federal *e Catalão </line>

<line> Gradu*ção em Eng*nharia de Pr*dução pela Unive*si*ade Federal de G*iás </line>

<line> E-mail: *na*uizafma**de@gmai*.co* </line>

<line> André Alves *e **sende </line>

<line> Do*tor em Engenhari* M*cânica </line>

<line> Pr*fessor na Un*versidade Federa* de C*talão </line>

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<line> Ender*ço: *n* Luiza Fer*eir* Mamede </line>

<line> Editor-*hefe: Dr. Tonny Kerley de Alencar </line>

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<line> *v. Dr. Lamartine P*n*o *e *ve*ar, 11*0. Se**r </line>

<line> Rodrigues </line>

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<line> Univ*r*itár*o - CEP: 75704-*20. Catal**-G*, Brasil. </line>

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<line> Endereço: André A*ves de *e*ende </line>

<line> Arti** r*ceb*do em 26/0*/2022. Últim* </line>

<line> *ersão </line>

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<line> Av. *r. Lamar*ine Pinto *e Ave*ar, </line>

<line> receb*da em 1*/05/2022. Ap**vado em 18/*5/2022. </line>

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<line> Univers*tár*o - *EP: 75704-020. Catalão-*O, *rasil. </line>

<line> A*aliado **lo sis*ema Triple Review: Des* Revie* *) </line>

<line> pelo Editor-Chefe; e b) Doub*e Blind R*view </line>

<line> (avaliação cega por d*is ava*i*dores da á*ea). </line>

<line> Revisã*: Gra*a*ica*, Normativa e d* Formatação </line>

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<line> Maintena*ce Manage*ent *n *ospit*l Equipment: Systema*ic Review </line>

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<line> A**TRACT </line>

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<line> T*e main*enanc* o* hosp*tal equipment is o* fun*amental import*nce for an adequa*e **di*al </line>

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<line> diagno*is. The condu*t </line>

<line> of *his mainten*nce can be m*naged in different strategi*s. T*e </line>

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<line> p*rpose of this study is to syst*matic*lly *eview the main types of mai*tenance </line>

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<line> *ealthcar* organizations to manage hosp*tal equip**nt </line>

<line> between the period 2010 and *0**. </line>

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<line> Fo* this, a li**rat*re *e**ew was car*ied ou* in the el*ctronic </line>

<line> dat*b*ses Pub*ed and Capes </line>

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<line> Journals Por*a*/M*C. The predom*nance of the app*i**t*o* *f preventive *aintenance in the </line>

<line> *os*ital *ector wa* highligh*ed, howe*er other methodologies such as predic**ve maintenance, </line>

<line> *vidence-based and reliab*l*ty cente*ed mainte*a*c* (RCM) were proposed as a way to ob*ain </line>

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<line> effi*i*nt results and mitig*te the r*s* of failures. It has been pr*pos*d </line>

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<line> mathemati*al approac*es shou*d *e f**the* e*p**red in </line>

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<line> overall *f**ctiven*ss of h*spital **u*pment are e*pected. </line>

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<line> Keywords: Mainten*nce </line>

<line> Strategies. </line>

<line> Preventive </line>

<line> Mainte*ance. </line>

<line> Overall </line>

<line> Equipment </line>

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<line> Eff*ctiveness. </line>

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<line> RESUMO </line>

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<line> A manutenção do* equip*mentos </line>

<line> hospitalares * de fundam*nta* impor*â*cia p*ra </line>

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<line> diagnóstico médi** ade*uado. A cond*ção desta man*tenção pode ser gerenciada em </line>

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<line> diferen**s estratégias. O ob*etivo deste estudo r*visar *istematicamente *s principais tipos é </line>

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<line> de manute*ção uti*iza*os pelas organizações *e saúde *ara </line>

<line> gerenc*ar </line>

<line> equipam*ntos </line>

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<line> *ospi*alare* entre o período de 2010 * 2020. Para isso, foi r*al*zada uma revi*ão de literatura </line>

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<line> *ases de dado* eletrônicas P*bMed e Portal d* Periódicos Capes/M**. Destacou-se a </line>

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<line> *redominânci* </line>

<line> da aplicação da manut*n*ão pre*e*tiva no setor hospita*ar, porém o*tras </line>

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<line> metodologia* com* m**utenção predit*va, man*tenção ba*eada em *vidências e manutençã* </line>

<line> ce*t*ada *a confiab*lidade (RCM) foram *ro*osta* como forma d* ob*er re*ultados *fi*ientes </line>

<line> e mitiga* *s riscos ** falhas. Foi pro*o*to que o uso *e ab*rd**ens matemáticas *e*e ser mais </line>

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<line> explorado nest* área. Portan*o, são esperad*s aument*s na </line>

<line> eficác*a g*ral *os equ*pamentos </line>

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<line> hos*itala*es. </line>

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<line> Palavras-chave: E*trat*gi*s de *anutenção. M*nutenç*o Pre*e*tiva. Eficác*a *er*l </line>

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<line> Equ*pamento. </line>

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<line> www4.fs*net.com.br/r*vista </line>

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<line> A. L. *. Mamede, A. A. Resende </line>

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<line> 1 **TRODUCTION </line>

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<line> *edical e*uipment plays a crucial role in the p*ovision of *ealth **rv*ces, so they are </line>

<line> *ncreas***ly cri*ical to t*e provision of eff*cien* s*rvices. *h* ab*enc* or fa*l*re of medical </line>

<line> equipment can sign*ficantly affe** the sector and ha*m people's li*es, s* it is n**e*sary to </line>

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<line> mai*tain stri*t standards and *eq*irements to ensure the saf*ty o* patien*s and staff. A* </line>

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<line> result, </line>

<line> it ** extrem*ly impor*ant to *aintain a maintenance program *o ensu** that the </line>

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<line> equ*pment *s </line>

<line> ** *t* b*st co*d*tion, t* avoid failu*es a*d </line>

<line> b**akdowns du*ing operation </line>

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<line> (Waeyenbergh and *in*el*n, 2002). </line>

<line> In health organizatio*s, the larges* investment is usuall* i* me*ica* equipment, </line>

<line> *ec*nd o*l* *o the real esta*e *ector (land and build*ngs). Thus, in addition *o b*i*g essen*ial </line>

<line> *o provide **fe *n* effective *a*e, it also has an imp*ct o* *** *ncome o* health organizations. </line>

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<line> *n view of this, the maintenance and mana**ment </line>

<line> of med**a* equipm*nt requi*es *are*u* </line>

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<line> *uperv*s*on from **alth admin*strators (Wang, 2012). </line>

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<line> Th* medical fi**d a*o*ds a*ting with the poss*bility of "*rial *nd error" and **ilures in </line>

<line> th* services pr*vided to pa*ien*s, a* a*y m*stake can repre**n* a risk to the li*e ** a human </line>

<line> *eing (*erb*no and T*rra, 2**0). *here is now * *ide va**ety of medical equip*ent and *he </line>

<line> *riticali*y of its reliabi*ity may var* according t* i*s a*pli*ation. </line>

<line> Dh*llon (*011) categori**s ** follow*: "category I" includ*s devi*es t*at are dire*tly </line>

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<line> an* i*me**atel* responsible for the p*tie*t's </line>

<line> life, such as *e*pir*tors, **rdiac defi*rilla**rs; </line>

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<line> "Ca**gory II" i*c*ud*s *evices used for rout*ne diagnostics, a **i*ure i* th*s eq*ip*ent is not </line>

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<line> as *ri*ic*l as in *hos* ** categor* I, as in this *ase *here is time for </line>

<line> repair; "Category III" </line>

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<line> includes e*uipm*nt not essential to the patie*t's life or well-being, s*ch as electric </line>

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<line> wh*elchair*. </line>

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<line> According to OMS (O*ga**zación *u*dial d* la Salu* [OMS], 2012), *ai*t*n*nce </line>

<line> c*n be divi*ed i*t* two m*in categories: </line>

<line> In*pection and Pr*vent**e Mai**e*anc* (*MP): All e*s*ntial p*ogrammed activi*ie* to </line>

<line> e*su*e tha* me*ical equipment (EM) are functioni*g pr**e*ly and are well m*i*tained. </line>

<line> Pr**entive maintena*ce (MP): All act*vities perform** to exte*d t*e *ife o* a devic* </line>

<line> an* p*event d*mage (such as: calib*ation, c**aning, l**rica*ion, replac*m*nt of par*s, </line>

<line> etc.); Inspe*tion: All s*he*uled acti*ities es*enti*l *o *nsure th*t the equip*ent i* </line>

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<line> functioning properly. It incl*des operati*na* </line>

<line> and *afe*y inspect*ons. Th*y are </line>

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<line> *erformed in conjunction with PM, co*r*ctive mainte*ance or calibrat*on, but **n als* </line>

<line> be performed in*epe*dentl*, *s scheduled activ*ty a* define* *ntervals. </line>

<line> Re*. FSA, Teresi*a, v. 19, n.8, art. 12, p. *5*-266, ago. 2022 *ww4.*s**et.com.br/*evista </line>

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<line> Maintenan*e Manageme*t in H*sp*tal *quipment: Sys*ema**c Re*iew </line>

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<line> Correct*ve main*enan*e (MC): Pr*c**s to restore the integrity, safety or operat*on of </line>

<line> equi*ment aft*r a fa*lure. MC an* u*sch*duled mai*tenanc* ar* cons**ere* synonyms </line>

<line> S**temat*c *eviews of *he *iterature that assess the criticality of equ**m*nt and </line>

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<line> ana*y*e the *aintenance strate*ies applied i* the c*n*ext ** </line>

<line> h*alth care, publi**ed *etween </line>

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<line> 20** a*d 2*1*, point ou* add*t*ona* gaps *nd resea*ch nee*s. Authors pointed out *hat few in- </line>

<line> dept* studies *ave been carr*ed out to e*aluate t*e effic**ncy and effecti*ene*s of the </line>

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<line> mai*tenance strateg*es </line>

<line> commonly *mplem**ted </line>

<line> and present a raised debate about the </line>

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<line> credibility </line>

<line> o* *he re*omm*nda*ions made by the manufacture*s. Fina*ly, they point out that </line>

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<line> there is evide*ce i* th* </line>

<line> lit*rat*re that i*dicates </line>

<line> that mat**mati*** modeli*g is signific**tl* </line>

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<line> more flexib*e than empir*cal approaches, *herefore, </line>

<line> it wou*d be benefi*ial </line>

<line> f*r medical </line>

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<line> main*enance to *xpl*re this bias (*ahfoud, El B*rkany and El Biy*ali, 2016). </line>

<line> *not*er study based on a bi*liogra*hi* *ev*ew on op*im*zation of mai*ten*nce based </line>

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<line> on reliab**ity in healthcare </line>

<line> or*an*zations </line>

<line> from 2000 to 201*, found *everal m*de*s of </line>

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<line> uncertain*y i* prioritizing medical equipmen*. The st*dy h*g*ligh** that t*i* is *he heart of </line>

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<line> m**ical equipment manag*me*t programs, with risk b*i*g one of the most relev**t *r*teria in </line>

<line> m**t prio*itization pro*le*s. In sequ*nce, the fun*tion *f the equipment, the need for </line>

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<line> maintenance and the rate of *se *ppea*. Howev*r, </line>

<line> *he study *oi*ted out that exper*mental </line>

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<line> **proaches for dat* c*llect*on and treatm*nt are lack*ng in o*der to ob*ain reliable quan*ita*i*e </line>

<line> r*sults (Mahfo*d, *bdellah *nd El Biyaali, 2018). </line>

<line> It i* essential, therefore, th*t h*alt* in*titutions, *egardles* of si*e, employ an </line>

<line> appropria*e ma*ntenance program f*r m*dical equ*pm*nt, which will vary accordi*g to th* </line>

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<line> complexity of each location. Thus, t*e present syst*m*ti* review aims to </line>

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<row> orga*iz*tions perform*d the **i**enance of hospital equipme*t between the pe*iod 2010 and </row>

<row> 2020, through the an*ly*is of cas* studies that directly explore t*e type o* mai*tenanc* </row>

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<line> The lit*ra*ure *eview was c*rried o*t *n t*e el*ctronic databas*s PubMed and Cap*s </line>

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<line> Journals Portal/MEC from *a* to J*ly </line>

<line> 2020 *n or*er to *ystemat*cally in*e*tigate original </line>

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<line> studies that ev*lu*t*d th* maintenance of *ospital equi*me*t. </line>

<line> *or *his *urp**e, k*ywords we*e co*tinually referred *o in studies in the area a** the searc* </line>

<line> was carried ou* usi** *he follo*in* terms: maintenance *anagem*nt in hospi*al e*uip*en* </line>

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<line> A. L. F. Mamede, A. A. Rese*de </line>

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<line> AND maintenance and en*ineering, *ospital AND maint*nance manage*ent *n me*ica* </line>

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<line> equipment. ** additional fi*tering, only peer-review*d articles **re s*lected, i* English </line>

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<line> da*ed betw*en 2010 *nd 2020, and after sel*cting the studi*s, thro*g* * co*ple*e rea**ng and </line>

<line> analyzing *he e**gibility criteria, only works publis*ed in the last 10 yea*s remained. </line>

<line> T*e followin* eligibility *r*teria wer* sele**ed to s*l*ct the *rticles: I - be an original </line>

<line> *r*i***; *I - dea* with maintenance o* hospit*l e*uipment; III - deal wi*h hos*i*al maintenance </line>

<line> manageme*t m*thods. St*di** wer* excluded that had: I - focu* on fo*m* of administration; II </line>

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<line> - *ocus o* crea*ing compute*i*ed **stem*; </line>

<line> III - *ocus on costs; IV - study on the equipment </line>

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<row> *ife c*cle; V - systema*ic lit*rature review*; *I - b*ilding mainte*ance; VII - focus o* patient </row>

<row> risk; VIII - focus on e*uipm**t reliability. </row>

<row> Following the *r*ter*a, the i*itial selection occurr*d by readi*g titles and abstra**s. </row>

<row> Then, the s*lected papers were read in full, and on*y those that met all the req*irements were </row>

<row> selected *gain. </row>

<row> In order to carry o*t the n*rrative synt*e*i* ** the *har*cterist*cs and main results, </row>

<row> the following information wa* ex*racted: title, year of pu*li*ation, name of the authors, pla** </row>

<row> where t** **u*y was c*r*ied *ut (country an* *ype of ins*itutio*), type of *ai*tenance appli*d, </row>

<row> equipment studied, cit*d fail*re. *ll data were tabu*ated in s*r*adshe*ts. </row>

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<line> RESULTS </line>

<line> Wit* keyword searches, 4.049 articles were *btai*ed, am*ng whi*h 10 *uplicate </line>

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<line> re*ords wer* id*ntified in </line>

<line> the two da*abases. After the first se*ect**n by reading </line>

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<line> *bs*r*c*s, 3.9*9 *rticles were *onsidered ou* *f scop*, all ** which were r*moved. Of t*e 40 </line>

<line> articles le*t to be r*ad in f*ll, a total of 12 articles met *h* *ligibili*y crit*ria and w*re in*l*ded </line>

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<line> in the qualitative summa*y. T***e was no </line>

<line> additional s*arch for papers thro*g* the list *f </line>

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<line> refer*nces o* t** se*ected ar*icles. T*e complete fl*wcha** *f the se*ection procedure i* shown </line>

<line> in *igure 1. </line>

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<line> Fig. 1 - Flo*chart *f **e selection proc*ss for *h* articles inclu*ed in th* systemat*c </line>

<line> review. </line>

<line> Rev. FSA, Te*esina, v. 19, n.8, art. 12, p. 252-266, a*o. 2022 www4.fsanet.com.br/rev*sta </line>

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<line> Maintenanc* Manage*ent in H*spi*al Equipment: S*stem*t*c Review </line>

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<line> a. Characteristics *n* Method*logi*al *uality of Includ*d Studies </line>

<line> The chara*teris*ics and m*th*dological quality des*ribe the *ubli*a*ions inc*uded i* </line>

<line> thi* review. All articles in*l*de* in this re*iew w*re pub*ished in the last ten year*, wi*h 67% </line>

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<line> (eight) (Kh*l*f et a*., 2015; Se*di, *016; *ala et </line>

<line> al., 2018; Iadan*a et al., 2019; Pongra* et </line>

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<line> al., 2019; Sali*, Mazlan and Salim, *019; Shamayleh, *w*d and Abdulla, 20*9; Shamayleh, </line>

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<line> *wad *nd Farhat, 2*20) </line>

<line> pu**ished between 2015 and 20*0. Of these, 5*% (seven) **re </line>

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<line> co*ducted in deve*oped countrie* and 42% (five) in developing countri*s. </line>

<line> Only one artic*e was conducted using only questionnaires (Al**han* *t al., 2013) as </line>

<line> an instrume*t f** obta*ning information, one was through interviews (Salim, Mazlan and </line>

<line> Salim, *01*), t*ree *erformed equi*m*nt data co*lec*ion on site (Vala et al., 2018; Iadanza *t </line>

<line> al., 2019; Salim, Mazlan and Sali*, 2019; S*a*a*leh, Awad an* Ab*ulla, 2019), four used </line>

<line> *n existing d**abase (re*o*d / maintena*ce hi**ory) (Hamdi et al., 2012; M*n*ati, Dori and </line>

<line> Gentili, 2012; *hal*f et al., 2013; Shamayleh, Awad *nd Fa*hat, 202*), anothe* three did not </line>

<line> inform how (Khalaf et al., 2015; Sezdi, 2016; Pongrac et al., 2019). </line>

<line> *f the selected work*, five (42%) (*am*i et al., *0**; Kh*laf *t al., 2013, 2015; </line>

<line> Pongrac et al., 2019; Sa*im, Ma*lan and Sal*m, 20*9) d*d *ot specify the type of instit*tio* </line>

<line> R*v. F*A, Ter**in* PI, v. 19, n. 8, art. 1*, p. 252-**6, ago. 20*2 www4.fs*ne*.com.br/*evista </line>

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<line> A. L. F. Mamede, A. A. Re*e**e </line>

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<line> analyzed, </line>

<line> and Gentili, 2012; *li*ha*i et al., 2013; Sezdi, </line>

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<line> 2016; V*la et al., 20*8; Iadanza e* al., 2019) analyzed teaching hosp*tal u*its (un*ver*ity </line>

<line> students), **e (8%) (Shama*leh, *wad and Farhat, *020) in a public i*stitution an* one in a </line>

<line> *rivate i**titution (*hamayleh, Awad and Ab*ulla, *01*). R*gard*ng *he type of mainten*nce </line>

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<line> app**ed or *ncoura**d </line>

<line> each job, mos* st*die* (58%) *ere a*out *rev*ntive </line>

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<line> (Hamdi et al., *012; *iniati, Dori an* Ge*tili, 2012; Alikh*ni et al., 20*3; Khalaf et al., *0*3, </line>

<line> 2015; Vala et a*., 2018; Pongrac et al., 2*19). Cor*ective mainten*nce was mentioned, bu* *t </line>

<line> was no* used **one and as t*e mai* in a*y work. *eliabilit*-cen*ere* maintenance (RCM) was </line>

<line> *p*lie* to t** jobs (*al*m, Ma*lan and Sal*m, 20*9; Sham**leh, Aw*d and Abdull*, 2019), </line>

<line> p*edic*i** maintenance als* ** two (S*zdi, 2016; S**mayleh, Awa* and Farhat, 2020), whi*h </line>

<line> is eq*iv*l*nt to 17% *a**. Finally, e*idence-ba*ed mainten*nce was cited in an article (8%) </line>

<line> (I*danza *t al., 2019). T** preva*en*e of maintenance to*ls th*t see* to prevent th* eq*ipment </line>

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<line> from reach*ng the </line>

<line> point of fai**re was found, this is *ue to the *isk th*t failure* in medical </line>

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<line> equi*ment represent ** the patient an* the o*e**tor, *o *t **oul* be d*** as much as possib*e </line>

<line> so that they do not happ**. Table 1 summari*es this infor*ation. </line>

<line> Tab*e 1 - Desc*iption of st*dies included in the revi*w. (n = 12) </line>

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<line> Study ch**acteristics </line>

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<line> Place of *erformance </line>

</par>

<par>

<line> Developed co*ntr**s </line>

</par>

<par>

<line> De*eloping countries </line>

</par>

<par>

<line> Year of publication </line>

</par>

<par>

</par>

<par>

<line> Data c*llection form </line>

</par>

<par>

<line> I*t**views </line>

</par>

<par>

<line> Que*tionnaires </line>

</par>

<par>

<line> Mainte*ance records / history </line>

</par>

<par>

<line> On-site data collection </line>

</par>

<par>

<line> Other or not inf*rmed </line>

</par>

<par>

</par>

<par>

<line> Public Institutio* </line>

</par>

<par>

<line> *rivate Institution </line>

</par>

<par>

<line> Uni*ersi*ary hospita* </line>

</par>

<par>

</par>

<par>

<line> Type of maintenance appli*d </line>

</par>

<par>

<line> P*eventive mai*te*a*ce (PM) </line>

</par>

<par>

<line> C*rrective mai**enanc* (*M) </line>

</par>

<par>

<line> Reliabilit*-centric maintenance (RCM) </line>

</par>

<par>

<line> Evi*ence-b**ed maintenance </line>

</par>

<par>

<line> Predictive M*int*nance </line>

</par>

<par>

<line> Ta*le 2 hi**l*ghts which </line>

<line> equipment was analyzed eac* s*udy, which *ailur* i* </line>

</par>

<par>

<line> obse*v*d and what *ype of maint*nance was *pplied or *ndicated for each one. *ome ****cted </line>

<line> Rev. *SA, Teresina, v. *9, n.8, *rt. *2, p. 252-266, ago. 2022 www*.fsane*.*om.br/revista </line>

</par>

</page>

<page>

<par>

<line> Maintenance Ma*agement in Hospital Equi**ent: Sys*ematic **v*e* </line>

</par>

<par>

<line> works did *ot make t*e indi*a*io*s *f equipm**t or failure, eve* so *hey were *onsidered </line>

<line> eligible for fulf*lli*g othe* c*it*ria. </line>

<line> Table 2 - List o* e*uipment st*died, found fa**ts of ty*e of appl*** maintenance. </line>

</par>

<par>

<row> Hamdi *t a*. </row>

<row> Iadanz* et al. </row>

<row> Khalaf et al. </row>

<row> *iniati, *o*i </row>

<row> Pongrac et al. </row>

</column>

<row> E*uipment studied or </row>

<row> indicated </row>

<row> equipme*t, such as </row>

<row> elect*oencephalo**am (EEG). </row>

<row> Operating table*, te*emet*y </row>

<row> equipment, electrosurgery </row>

<row> u*i*s and defibrillators </row>

<row> Anesthesia mach*ne </row>

<row> Inf*sion pumps and *a** </row>

<row> Don't quote </row>

</column>

<row> Failur* types en*ountered </row>

<row> induced by *se; u*pr*dictable </row>

<row> caused by **rmal wear; predict*ble </row>

<row> and preventa*le; service-in*uced; </row>

<row> ev*de*t; potential; *nd ot*ers. </row>

<row> Don't quote </row>

<row> Don't quote </row>

<row> Poor image qua*ity; inc*rrect </row>

<row> position sensor; the vertical column </row>

</column>

<row> Ty*e o* ma*ntenance </row>

<row> applied / indicated </row>

<row> Preventive </row>

<row> ma*ntenance </row>

<row> P*eventi** </row>

<row> maintenance </row>

<row> Evidence-bas*d; </row>

<row> S*heduled </row>

<row> maint*n*nce; </row>

<row> c*rr*ctive mai*tenanc* </row>

<row> Preventive </row>

<row> m*i*tenance </row>

<row> mainten*nce </row>

<row> Preven*i*e </row>

<row> Preventive </row>

<row> ma*ntenance </row>

</column>

</par>

<par>

<row> S*lim, Mazlan </row>

<row> Sezdi (2016) </row>

</column>

<row> State-of-the-art equipm*nt, </row>

<row> s*ch as imaging equipment </row>

<row> (for example, MRI, CT sc*n) </row>

<row> and radi*t*erapy eq*i*ment </row>

<row> Old *echnology de*ice </row>

<row> (electr**ardiogr*m, *xime*er, </row>

<row> defibrill*tes, and other*). </row>

<row> High-tec* devices </row>

<row> (tomography, mammog*aphy, </row>

<row> magnetic res*nan*e, a*d </row>

</column>

<row> is not raised; among *thers. </row>

<row> T*pe *f m*in*enance services; </row>

<row> Environmen*a* fa*tors; Hum*n </row>

<row> factors. </row>

<row> High pressur* lea*; Hig* </row>

<row> t*mperature; lo* ba*tery; pow*r </row>

<row> circu** error; se*s*tivity erro*; </row>

<row> broken pressure gaug*; *issing </row>

<row> piec*; among others </row>

</column>

<row> R*liabi*ity *entered </row>

<row> Maintenance (RCM) </row>

<row> P*e*entiv* </row>

<row> mai*tenance (old) an* </row>

<row> pre*ictive maint*nance </row>

</column>

</par>

<par>

<row> Abdulla, </row>

<row> Farhat, (2020) </row>

</column>

<row> others) </row>

<row> Ventilatio* devi*es - *dults </row>

<row> and neona*es </row>

<row> Vitr*s immun*ass*y a*alyzer </row>

</column>

<row> Regul*r loading error; sliding of the </row>

<row> belt; lumi*ometer voltage out of </row>

<row> range; cal*brat**n error; it is not </row>

<row> possible to mea*ure the sample </row>

</column>

<row> Reliability Centered </row>

<row> Maintenance (R*M) </row>

<row> IoT-based Pre*ictiv* </row>

</column>

</par>

<par>

<line> Table e*ror, brake failure, </line>

</par>

<par>

<line> Radiotherapy; renal therapy </line>

<line> c*llimator err**, syst*m error, </line>

<line> Preven*ive </line>

</par>

<par>

<line> unit; pulmonary ventilat*rs. </line>

<line> pri**er error, co*pres*or err**, </line>

<line> main*enance </line>

<line> gantry tran*ducer error, a*d others. </line>

</par>

<par>

<line> The study of Hamdi et a*. (**12) introduc** a smart work order priorit*z*tion s*stem. </line>

<line> Alt*ou*h it is about creating a s*stem, the authors pay special atte*tion to th* way o* </line>

<line> *rioritizing eq*ipment and the need for preventi*e maintena*ce. They state that a *ailure of </line>

</par>

</page>

<page>

<par>

<line> A. L. F. Mamede, A. A. Resend* </line>

</par>

<par>

<line> medical equipment i* an extremely sensitive issue, *in*e each devic* is dire*tly and closely </line>

<line> rela*ed ** the healt* an* well-being *f pati*nts, but that a properly wei*h*ed *reven*iv* </line>

<line> maintenanc* strategy is neces**ry f*r *he equipme*t to *perate in a s*fe and economical. </line>

<line> Ano*her *tudy highlig*ts the *m*ortance of maintenan*e to *itigate the clinical risk </line>

<line> cau*ed by *dv*rse even*s in healthc*re. It aims to de*el*p a s*stem that h*lp* d*cisi*n makers </line>

<line> to plan preventive m*in*ena*ce an* s*fety co*trols, defin*ng new tec*nical in*i*ators with * </line>

<line> *imple databas*. For this, it highlig*ts the impo*tan** of defining maintenance *riority **dex </line>

</par>

<par>

<line> takin* i*to *ccount *h* fun*tional importa*ce of </line>

<line> the device (criticality), the type o* </line>

</par>

<par>

<line> tec*nology and the tendenc* ** com*lexi*y and failure (Mi*i*ti, *ori and Gentili, 2012). </line>

</par>

<par>

<line> The other studies cited a </line>

<line> *e*y wide variety of equipment *hat ranged f*om ol*er </line>

</par>

<par>

<line> t*chnologies, such as a puls* oxime*er to *igh tech*ologi*s, such as co*put** </line>

<line> tomo*raphy(S*z*i, 2*1*). The fa*lure* were *lso diverse, with some s**dies c*t*ng the specif*c </line>

<line> failur*, such as "batt*ry failure" (*adanza et al., 2019), "Luminome*er volt*ge o*t of rang*" </line>

<line> (Shama*le*, Awad and F*rhat, 2020), other* classified it as "type* of ma*ntenan*e services, </line>

</par>

<par>

<line> envi*onmental or human factor*" (Vala et **., 2018). *ome *orks </line>

</par>

<par>

<line> description of the flaws (M*niati, *o*i and Gentili, 2012; Khala* *t al., </line>

</par>

<par>

<line> 2019; Shamayleh, Awad and Farhat, 2020). </line>

</par>

<par>

<line> * DISCUSSIO** </line>

</par>

<par>

<line> The review car*ie* *ut during the res*arch showed th* p*ed*mi**nc* of th* </line>

<line> app*ica*ion of p*even**ve mainte*a*ce *n medical equi*me*t. Th* studies pres*nted ways to </line>

<line> develop an ad*quate and ef*icien* maintenanc* i* order t* mitigate the clin*c*l risks caused by </line>

<line> adv*r*e event* in the hea*th area. </line>

<line> (Al*khan* *t al., *01*) per*o**ed a descriptive a*alysis based on in*ormation fro* </line>

<line> the yea* 2009 from a **dical center located in Ir*n. The *esea*ch was *arri*d out considering </line>

</par>

<par>

<line> o*l* neurologica* *evices tha* we*e classified *nto *o*r ca**gorie* according </line>

<line> their </line>

</par>

<par>

<line> specificiti*s. Based on his*orica* </line>

<line> d*t* and categories, *he a**ho*s established the </line>

<line> ideal </line>

</par>

<par>

<line> prevent*ve maintenance p*riods for each p**ce of e*uipment. </line>

<line> For *om*, such as magnet*c </line>

</par>

<par>

<line> res*nance i*age (MRI), each part *f t*e device requi*es di**ere*t contro* periods, r*ngin* </line>

<line> *rom * to 24 months. Thu*, the authors sh** that the im*lementation of a preventive </line>

<line> m*inten*nc* syst*m is crucia* for *he institut*ons, as it pre*ents problems, red*ces cost* and </line>

<line> op*im**es uptime </line>

</par>

<par>

<line> www*.fsanet.com.br/revista </line>

</par>

</page>

<page>

<par>

<line> *ainte*ance Man*gement in Ho*pital Equ*pment: Sys*ematic Revi*w </line>

</par>

<par>

<line> *ec*sion *upport *yst**s an* s*ft*are have b*en p*oposed which, *hrough pre- </line>

</par>

<par>

<line> established indexes and crit*ria, </line>

<line> a*sist in maintenance manageme*t, pr***itization of *ork </line>

</par>

<par>

<line> orders, among other features. Such studies were included *n the presen* revi*w bec*u*e t*ey </line>

</par>

<par>

<line> present </line>

<line> det*iled data o* the pr**entiv* maint*nanc* analyzed. The indices used *ake i*to </line>

</par>

<par>

<line> accou** the area </line>

<line> activity a*d lev*l of comple*it* of the equipment (Mini*ti, Dori </line>

</par>

<par>

<line> Ge*til*, 2012), *unction, place of u*e, *ospital load, time sin*e req*est, presenc* of an </line>

</par>

<par>

<line> alterna**ve and distance from the ne**est *ospital co*tai*ing the s*me </line>

<line> device (H*mdi et al., </line>

</par>

<par>

<line> 2012). B*t* system* ha*e proven their *ffe*ti*e*es* for managi*g prevent*ve *ain*enanc*. </line>

<line> Th* n*ed to implement maintenance strateg*es **at m*x*mize equipment a*ailabili*y </line>

<line> led th* authors Vala et al. (2018) to use a risk-based app*oach. Through well-s*ructured steps </line>

<line> an* the use of t*o*s su*h *s Pareto analys**, "5-Wh*" an* FME*, from which fa*lur* modes </line>

<line> a** compon**t *ailures are analyzed and classified, in addition to i**ntifying t*e roo* causes </line>

<line> *f failure mode*, it was pos*ib*e to **velop op*ration a** maintenance protocols for c*itical </line>

</par>

<par>

<line> devices. </line>

<line> Th* protocol proposed b* the *u*hors was </line>

<line> *ivided into three parts that s**u*d be </line>

</par>

<par>

<line> pe*form** by biomed*cal e*gineers, being w***ly *asks, mo*th*y task* </line>

<line> and, finally, </line>

</par>

<par>

<line> pe*form**g preven*ive maintenan*e ev**y 3 m*n*hs, w*ich before the study was done ever* 6 </line>

</par>

<par>

<line> Th*s study **o**s *he importance of *ata collection a*d ***l*s*s, as wel* as the </line>

</par>

<par>

<line> d*finition of mainte*ance protoco*s t* mitigate frequent failures and *ncrease the availab*lity </line>

<line> of equipme*t. </line>

<line> *n h*s work, Sezdi (2*16), explored two di*ferent main*enanc* strategi**, separating </line>

<line> th* d*vice* bet*een those o* *l* technology *o be manage* wit* p*ev*ntive mai**enance *nd </line>

</par>

<par>

<line> those *f h*gh </line>

<line> technolog* that wou*d re*eiv* predict*ve maintenance (PdM). The pr*ventive </line>

</par>

<par>

<line> ma*ntenance was *hr*ugh per*ormance verif*catio* and sa*et* te*ts wit* interva** that var*ed </line>

</par>

<par>

<line> The predictive, h*we*er, was th*ough s*hedul*s an* daily che*ks, </line>

</par>

<par>

<line> e*suring tha* the *mall*s* fai*u** wa* repo*t**. Tra*nings wer* *ro*ided, provided by the </line>

</par>

<par>

<line> *a*ufactur**, to use*s who w**ld carry </line>

<line> daily ch*cks, as the s*udy consid*red </line>

</par>

<par>

<line> lev*l of **owledge could affect </line>

<line> the standards *f r**iability and fa*lure. T*e author *tressed </line>

</par>

<par>

<line> predictive maintenance ** </line>

<line> n*t always i*eal, as a devic* can receive mo*e </line>

</par>

<par>

<line> maintenance than n*cessar*, i* add*tion to being more expen*ive *han p*eventiv*. The </line>

</par>

<par>

<line> p*ogr*m bas*d on two strategi*s has produced *osit*ve results, </line>

<line> al*h*ugh *reventive </line>

</par>

<par>

<line> pr*dictive mainte*ance </line>

<line> (P**) a** inconsistent in se*eral ways, have led *o a si*nifi*ant </line>

</par>

<par>

<line> reduction in equip*ent f*ilures. </line>

<line> Predictive mai*tenance (PdM) was a*d*essed by th* aut*ors Sh*may*eh, Awad a*d </line>

<line> Farhat (2*20) who pointed out *hat its use reduces the n*mber *f unplanned stop* of the </line>

<line> Rev. FSA, Teresi*a PI, v. 19, n. 8, ar*. 1*, p. 252-26*, ago. 2*22 www4.f*anet.c*m.br/revista </line>

</par>

</page>

<page>

<par>

<line> A. *. F. Mamed*, A. A. Resen*e </line>

</par>

<par>

<line> analyzed equ*pmen*, incre*sing its availab*lity. In this wa*, *t generates more p*ofit over time </line>

<line> and also *educ*s th* number of times the machine is disassembled, extending its useful *ife, in </line>

<line> a*dition t* r*ducing the cost of stock, *s i* is poss*ble to p*edict *a*lures. </line>

<line> T** authors' rese*rch Iadan*a *t al. (2019) *ifferentiate* from the others in </line>

<line> advo**ti*g t*e use of eviden**-based mainten*nce to m*nit*r maint*nance performance in a </line>

<line> ho*pit*l. Thi* m*thod *s*s t*e failure histo*y to carry out continuous **d i*proved </line>

<line> mo*itori*g of *urrent mainte*ance s*rategi*s. Th* firs* stage of the *es*arch was, t*er*fore, to </line>

<line> c*assify m*inten*nce *ork orders (a*aly*ing s*h*duled / preventive and correcti*e </line>

</par>

<par>

<line> maintenance). The sec*nd </line>

<line> to devel*p a set of key performance i*di*ators (KPIs). </line>

</par>

<par>

<line> From the an*lysis of the KPIs, th* authors conclude* t*at scheduled / *re*entive maint*na*ce </line>

<line> cannot pre*e*t a*l fa*l**es *r probl*ms be*ore they arise. The adoption of *he *vidence-b*se* </line>

</par>

<par>

<line> maintenance appro*** w**ld al*o* the hos*it*l to mo*itor *hanges over </line>

</par>

<par>

<line> compare wi*h pre*io*s resu*ts and, thus, </line>

</par>

<par>

<line> Another s*rategy us*d was the relia*ility-centered ma*ntenanc* app*oac* (RCM). </line>

<line> The authors Shamayleh, Awad and Abd*lla (2019) argued that it is more be*efic*a* and more </line>

<line> eco*omical *han pr*vent*ve mainten**ce. The RCM methodolog* is based on the *raditio*al </line>

<line> Failure Modes an* Effects Analysis (FMEA) and wa* used wit* a *o*us on reduc*ng </line>

</par>

<par>

<line> c*itic*lity. Throug* the maint*n*nce record </line>

<line> of medi*al equipment *or one *ear, the authors </line>

</par>

<par>

<line> *ought *o s*o* th* dep**d**ce and ineffici*ncy of preventi*e maint*nance ac*i**ties and how </line>

<line> the implemen*ation of the RCM will res*lt in a *or* adequate management program, in order </line>

<line> to minimize the ris* a*sociated *ith *ail*re. </line>

<line> The *m*C w*s also d*fended by Salim, Mazlan a*d Sa*im (20**), the author* </line>

</par>

<par>

<line> is a reliable *ool and its princip*e *s to do the right job, at the ri*ht time, </line>

</par>

<par>

<line> acco*ding to t*e **uipme*t con*itions. However, it i* a lon*-*erm proc***, and many </line>

<line> org*niz*tions give u* or fail, mainly in mo*itoring and analyzing da*a. When performed </line>

<line> ef*i*iently, it will result in t*e elimination o* unne*ess*ry task* and the inclusi*n of actions to </line>

<line> address omi**i*n* a*d deficienc*es in ***nten*nce prog*ams. </line>

<line> 4.1 M*thema*ical *ppro*c* </line>

<line> It w*s hi*hlighted by a study that most of the **thodologies used are emp**ical and </line>

<line> those based on mathematical modeling are scarce (K*a*af e* al., 2013). In the works included </line>

<line> i* this review, *ew pr*sente* ma**ematic*l analys*s; on*y tw* emphasize* th*s subject and </line>

<line> d**eloped mathema*ical models. </line>

<line> Rev. FSA, Teresina, v. 19, *.8, art. 12, p. 2*2-266, ago. 2022 www4.fsan*t.com.*r/***ista </line>

</par>

</page>

<page>

<par>

<line> Maintenance M*nagemen* in Hospi*al Equipm*nt: *ystemat*c Rev*ew </line>

</par>

<par>

<line> The autho*s Khalaf et al. (2013) prove* that t*e use of *at*em*tical *odel*ng to </line>

</par>

<par>

<line> a*alyze the effect </line>

<line> *f maintena*c* on the useful life o* *edical </line>

<line> equipment beneficial and is </line>

</par>

<par>

<line> r**eal*d that prev*nt**e maintenanc* had an i**act on it. The mathematical *o**l propose* </line>

<line> by the aut*ors was sim*l*ted in Matlab using real data from thre* devices. </line>

<line> The work of Khala* et al. (*015) poin*** out t*at several mathematical mod*ls hav* been </line>

<line> proposed to analyze the effect *f maintenance on indu*trial eq**pment, however they a*e </line>

<line> rarely us*d o* considered for medical devices. The au*h**s propos*d a math*m**ica* model </line>

<line> that *naly*es the probability of surviv*l of medi*al **ui*ment t*at combines the effects of </line>

<line> ra*dom failur** an* deterio*ation failure* by age, *si*g real mai*t*nance dat* a*d *imulated </line>

<line> i* Scilab. </line>

<line> Although this i* *ot a *athematical model spec*fi*ally, the au**o*s Sh**a*leh, </line>

<line> A*ad a*d Farh*t (*020) performed mathema*ical analy*is u*i*g the SVM f*reca*ting model, </line>

</par>

<par>

<line> w*ich compr*ses finding * hy*erplane, through </line>

<line> an equatio*, capable ** separating th* d*ta </line>

</par>

<par>

<line> classes into health* and defe**ive ones. The mod*l was based on four features and adj*sted to </line>

<line> an *ccept**le accur*cy of 96%, * true *o**tive rate of 93% an* a fal*e po*iti*e rate of 7%. </line>

<line> Fi*a*l*, the authors Pongra* et al., (2**9) *laim that it is impossible to imagine the </line>

</par>

<par>

<line> maintenan*e of medica* dev*ces without usi*g *he </line>

<line> p**ve*t*ve mai*tenance method. They </line>

</par>

<par>

<line> devel*ped </line>

<line> in their study a numerical w*y to fi*d the freq*e**y *f p*e*e*tive exams in </line>

</par>

<par>

<line> equipment. **iti*lly, th*y perfor*ed Pareto a*alysis *o clas*ify the causes *f failures and </line>

<line> defined pr*ventive *ainte*ance procedures. F*r the applica*ion of *h* mathe*ati*** formula </line>

<line> they u*ed values of *aximum rel*tive error, average t*me of fai*ure, inte*sity of system </line>

<line> fai*ures and average durati*n of * preventive e*am. Pe*forming f*re*as* ca*culations ensures </line>

<line> greater *quipme*t reliabil*ty and av*ilability, i*creasing th* overall quality of the *ystem. </line>

<line> 5 CONCLUS*ONS </line>

<line> F*om the syst*matic review *f the l*tera*ure on the m**n type* of mainten*nce used </line>

</par>

<par>

<line> *y h**lthcar* organiz*tions </line>

<line> to m*nage hospital e**ipment, it is </line>

<line> possibl* </line>

<line> *o conclude that </line>

</par>

<par>

<line> preventive main*enan*e stand* out with *reater *pp**catio* in the sector. *o*t o* th* *ncluded </line>

<line> studies soug*t e*ficient *ays to op*imize it. I* addition, *ther methodologies have been </line>

<line> proposed, su*h as pred**tive maintenance, *vi*ence-based *aintena*ce and r*liab*lity- </line>

<line> centered m*int**ance (*CM), a*so *s a wa* *o obtain more efficie** results and mitigate t*e </line>

<line> risk of f*ilur**. The u*e of mat**mat*cal modeling proved to be e**icient to assist *ain*ena*ce </line>

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<line> of the **ilures an*, then, estab*ish mainte*ance interva*s, prove* to be efficien* in *he s*udies </line>

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<line> of p*tients and staff, in addition t* reducing maintenance c*st*. To reinforce the evi*ence, </line>

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<line> Lecture* </line>

<line> Biomedic*l </line>

<line> Engin*ering, </line>

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<line> **w4.fsanet.co*.br/rev*sta </line>

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<par>

<line> A. L. F. *amede, A. A. Re*ende </line>

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<par>

<line> Como *eferenciar este Artigo, *onf*rme ABNT: </line>

<line> M*M*DE, A. L. F; *ESE*D*, A. A. *ainte*ance Management *n *ospital Equipmen*: Syste*atic </line>

<line> Review. Rev. FSA, Tere*ina, *.19, n. 8, art. 1*, p. 252-2*6, ago. 20*2. </line>

</par>

<par>

<line> Contribu*ção dos Au*ores </line>

<line> A. A. Resen*e </line>

</par>

<par>

<line> 1) concepção e planejament*. </line>

</par>

<par>

<line> 2) anál*se * interpretaç*o dos dados. </line>

</par>

<par>

<line> 3) e*aboração do rascunho ou na revisão crítica do co*teúdo. </line>

</par>

<par>

<line> 4) participação na *provação da versão final *o manuscrito. </line>

</par>

<par>

<line> Rev. FSA, Te*esina, v. 19, n.8, ar*. 1*, p. 252-266, ago. *0** </line>

<line> www4.fsanet.com.br/rev*sta </line>

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