Evaluating medical device safety, equipment lifecycle management, and clinical technology optimization in health systems: a systematic review of primary research involving healthcare technology engineers, biomedical engineering specialists, and healt

Abstract Background and objective: Safe medical technology depends on equipment selection, maintenance, repair, replacement, and professional oversight throughout its operational life. Evidence concerning engineering contributions is dispersed across workforce research, hospital improvement projects, and decision models. This review examines primary research addressing medical device safety, equipment lifecycle management, and clinical technology optimization involving healthcare engineering personnel. Methods: Ten primary reports published before the eligibility cutoff of 31 May 2026 were examined through narrative synthesis. Studies addressed technician training, failure analysis, maintenance processes, replacement prioritization, computerized management, and predictive analytics. Findings were organized by intervention, operational outcome, and relevance to clinical safety. Results: A Rwandan comparison reported equipment out of service at 10.2% in hospitals with trained technicians versus 17.8% in comparator hospitals, alongside higher technician productivity. A Jordanian improvement project reported a 35% reduction in downtime. Predictive maintenance research reported potential diagnostic and repair savings reaching 25% in one analyzer application. A Malaysian study classified maintenance and replacement priorities using records for 13,352 devices. Other reports demonstrated structured failure assessment, replacement ranking, inventory digitization, and lifecycle-specific maintenance planning. Outcomes primarily concerned equipment performance and management processes, limiting conclusions about patient harm. Conclusion: Engineering involvement supports organized maintenance, technical workforce development, and transparent lifecycle decisions. Evidence of operational benefit exceeds evidence of clinical benefit. Comparative evaluations linking engineering interventions with patient outcomes remain necessary. Keywords: Clinical engineering; biomedical engineering; medical device safety; equipment lifecycle; maintenance management; healthcare technology management.