Infection Control Today - 04/2004: OR Topics

The 21st Century Tech
The Surgical Technologist’s Expanding Role in the OR

By Tina Brooks

Advancements in technology continue to change the field of surgery. Robotics, computers and imaging are being integrated into operating rooms (OR) for optimum patient care.

But while the usage of this technology grows, so does the need for staff that understands the basic function, application, and troubleshooting of it. Who is best poised for such a task? None other than the surgical technologist.

Traditionally, surgical technologists, also called scrubs and surgical or OR technicians, assist in surgical operations by organizing sterile supplies and instruments, preparing patients and passing items to the surgeon as needed. Their role, however, is quickly expanding.

“Our last analysis of the field was conducted in 2002,” says Dawn Vinson, executive director for the Liaison Council on Certification for the Surgical Technologist (LCC-ST). “It indicated significant changes in the field. We showed that surgical technologists are doing more perioperative work — more pre-op and post-op — than they had done in the past. We also showed a significant increase in the role of technology in their job. More surgical technologists are involved in robotics, lasers and highly technical equipment used in the OR, which was unheard of five or 10 years ago.”

LCC-ST is the certifying agency for surgical technologists. It conducts a poll every five years to insure that its certifying examination reflects what is being required in the field.

“It’s the technology that is driving the increased role and the increased complexity of what we’re asking our surgical techs to do,” says Frank Vicari, MD, FACS, FAAP, attending surgeon at Children’s Memorial Hospital and professor of surgery at Northwestern University, Feinberg School of Medicine in Chicago.

Barbara K. Okamoto, MD, FACS, of the Ohio Permanente Medical Group in Cleveland, says, “We’re great when it comes from the surgical standpoint because that’s what we’re trained in, but the set-up and so forth often goes to the nursing staff, the surgery techs, the PAs, etc. The ancillary staff is absolutely crucial in order to make a surgery successful. As we look into the future, teamwork in this realm is going to become more important as the technology gets more complicated.”

Okamoto, like others, acknowledges that even the most advanced technology does not run smoothly all of the time. “Machinery can break down,” she says. “Unfortunately, when machinery breaks down and there’s a patient on the table it means something a little bit different than when your dishwasher breaks down or you have problems with your car.”

Surgical technologists in the military as well as in some civilian facilities are responsible for the management of equipment in the OR, says James Richey, CST, school head for the Naval School of Sciences in Portsmouth, Va. “We have to be able to troubleshoot right there because if something happens in the middle of the case there is no one there to do it besides us,” he says.

Their role as troubleshooter will be even more pronounced as telemedicine becomes commonplace. “A year ago the daVinci Robot performed a surgery,” says Susan Wallen, RN, MS, CRNSA, CNOR, program director for perioperative nursing, surgical technology and hospital central service at GateWay Community College in Phoenix. “The surgeon was sitting in a computer console in the United States. The patient was on the table in London for a laparoscopic cholecystectomy. The surgeon that commandeered that surgery was not with the patient, but the surgical technologist was.”

The Next Round of Tech Graduates

The old days of on-the-job training or 16-week programs for surgical technology are long gone. Programs vary from nine months to 24 months, providing classroom instruction and supervised clinical experience. They are offered by community and junior colleges, vocational schools, universities, hospitals and the military.

“Associate degrees were real top shelf 20 years ago and now we’re looking at maybe 13 percent holding a bachelor’s degree,” Vinson says. “Twenty years ago, bachelor’s degrees in surgical technology didn’t exist. I definitely say that we’re moving in the direction of lots of education and training.”

To insure that future surgical technologists can meet the rigors of the OR, educational institutions are instituting a new curriculum from the Accreditation Review Committee on Education in Surgical Technology (ARC-ST ). On the basis of compliance with the standards and recommendation of ARC-ST, a program receives its accreditation from the Commission on Accreditation of Allied Health Education Programs (CAAHEP).³

The new curriculum consists of three primary components:

• Science. Explores basic science (i.e., anatomy and physiology, pathophysiology and microbiology); related science (i.e., pharmacology, anesthesia and medical terminology); and biomedical science (i.e., computers, robotics, physics and electricity).
• Fundamentals. Focuses on all aspects of surgery, from preoperative to post operative. Also, specifies the types and number of clinical experience cases that students are to complete prior to graduation.¹
• Practice. Addresses the professional issues of surgical technology, including professional management, self management, communication, professionalism, standards of conduct, risk management and legal issues. ²

“The new technology in the OR is moving rapidly toward minimally invasive techniques and robotics,” says Paul Price, CST, MBA, executive director of ARC-ST. “The primary reason that we changed the core curriculum and made it mandatory for CAAHEP-accredited programs is that it addresses these necessary changes and gives a basis for understanding how all this complex equipment works.”

Price emphasizes that future graduates as a whole will be better educated since they will receive an equivalent education no matter the institution they attend. “The core curriculum was always an option for accredited programs; however, ARC-ST changed the standards to state that it was required as an instrument for curriculum design for all CAAHEP- accredited programs,” he says. “The reason that we did this was so we could standardize the education, very similar to the way that nurses do it in their educational process.”

Donna Hess, CST, instructor at the KAW Area Technical School in Topeka, Kan., says, “Surgical technologists are highly specialized as far as what they learn for the OR. They get very in-depth training in the operating room, surgical procedures and surgical techniques. Even right out of school they can start working in the OR immediately.”

The outlook for graduates from surgical technology programs is good. Employment of surgical technologists is expected to grow faster than the average for all occupations through the year 2010, according to the U.S. Department of Labor’s Bureau of Labor Statistics. Hospitals will continue to be the primary employer of surgical technologists, although much faster employment growth is expected in offices and clinics of physicians, including ambulatory surgical centers.

“In Phoenix, there is a big need for surgical technologists,” Wallen says. “Every day in the newspaper there is an ad for a surgical technologist. Our students don’t have a problem with finding work.”

Surgical technologists may obtain voluntary professional certification from LCC-ST by graduating from a CAAHEP accredited program. They may then use the designation of certified surgical technologist, or CST. Continuing education or reexamination is required to maintain certification, which must be renewed every four years. Hess says that certification demonstrates a surgical technologist’s commitment to acquiring the necessary skills as well as professionalism. “It’s not just another job; It’s a career,” she says.

Vinson notes that more and more hospitals across the country are requiring minimum education levels for surgical technologists and certification as proof of proficiency. Some states, such as Texas and Illinois, even require licensure.

“What we do is not nursing,” Price says. “We are a very integral component of the operative team and our primary role is intraoperative, meaning that we are intimately involved with the procedure itself. The one thing that we’re trying to do is position ourselves to handle some of the complex equipment. We want to be the equipment specialist in the operating room, the biomedical technicians who understand all of the technical aspects of not only the intraoperative role but the perioperative role as well. Because there is such a shortage of nurses in the operating room these days, we have to fill some of the areas that they filled before. So, we want to be properly trained to step into any role within the operating room.”

Did you Know...

• The Liaison Council on Certification for the Surgical Technologist (LCC-ST) is the certifying agency for surgical technologists.
• 78 percent of certified surgical technologists (CST) and 67 percent of certified first assistants (CFA) are female.
• 36 percent of CSTs have an associate’s degree or higher as opposed to only 22 percent of CFAs �¡ General surgery and orthopedics are among the most frequent specialty areas for CSTs and CFAs.
• The rarest specialty area is organ procurement and transplant, with only 1 percent of CFAs specializing in it.
• 66 perecent of CSTs and CFAs either are required to hold certification as a condition of employment or receive higher pay for being certified.
• More than half of all CSTs and CFAs work in hospital operating rooms.
• Average certification compensation for a CST is $4,000 per year, while a CFA receives $10,000 per year.