I would argue that all that (and, indeed, most if not all of 60601-1) is a document aimed at equipment designers and manufacturers. In short:- "type testing". Even the section headed "Repairs and modifications" (5.6) talks about "the testing laboratory" ... implying an agreed modification carried out during testing to achieve a "pass" next time (and then carried forward into production). Obviously, all that is done before the equipment is released for sale.
Brief history lesson (off the top of my head):- ever since the days of HTM-8 (...then BS-5724, then striding onward into international waters) biomed engineers and technicians (aka maintainers of in-service medical equipment) have felt the need to pick out bits and pieces from type testing documents in order to develop strategies applicable to routine in-service work, with great emphasis on electrical safety testing. To my mind, very little of these efforts are applicable to everyday repair and maintenance activities.
Once equipment has been through the process of accreditation (that is, passed the "type tests", and allowed onto the market), and subsequently purchased for use by qualified bodies (that is, the medical professions), then responsibility within the law (for example, the Electricity at Work Regulations (EWR) and the Health and Safety at Work etc. Act (HASAWA)) is carried by the owner (eg:- Hospital Trust). Within the confines of the law - that is, Common Law - the owners of equipment (any equipment I would say) can do anything they like with it.
In a well managed situation, the owners (Trust boards, or whomever) may delegate certain tasks down the chain ... repair and maintenance activities fall to the biomeds, for example. But Senior Management still carries the can if or when things go wrong (that's one of the reasons they are paid so well). That's because, they - the Corporate Body - are still the owners of the equipment; not the biomeds, nurses, nor anyone else. And that includes, of course, the manufacturers.
So, if Senior Management is kept aware of what their foot soldiers are doing ... be it affixing P-clips or any other sensible in-service procedure aimed at preserving the assets of the organisation, and keeping them available for their intended purpose, then so be it. If they are kept abreast of what is going on (repair and maintenance practices), and don't object to any of it, then we must assume they are happy with the situation ... especially if the kit is continually being kept safely in the hands of the clinical users.
This is where the well known attribute of the seasoned biomed comes into play:- CYA.
1) Policies and Procedures (reviewed at least annually)
2) Risk Assessments (especially for "controversial" issues)
Both should be and submitted "up the chain" for endorsement (agreement, or not) ... they (Senior Management) must never be able to say "ah, but we didn't know".
PS: for "cord", read "cable" (we are British, you know).
