Mandatory Certification: Raising the CS Bar

Mandatory Certification: Raising the CS Bar

By Kris Ellis

Last June, the New Jersey Healthcare Advisory Board approved the first regulations in the United States requiring certification for central service (CS) professionals. Viewed by most as a triumph for the profession, New Jersey has set a precedent that could potentially influence the way CS operates for years to come.

Though ultimately rewarding, the process of developing the regulations and guiding them toward approval required a great deal of patience and diligence. “Getting the rules passed was a long and arduous task,” recalls Anthony T. Monaco, MA, coordinator for New Jersey’s Department of Health and Senior Services, who has been a central figure in this effort. “It took longer than I expected, not because of external factors, but because the bureaucracy in our system delayed it almost a year and a half.”

Monaco explains that three years elapsed from the time that the regulations were completed to when they were officially enacted. “That’s something important that CS directors and other people in the industry need to understand — every state government has its own bureaucracy that holds things up, and it takes extremely long periods of time to enact any laws, regardless of whether or not they’re CS rules and regulations.”

The review period involved legal review, department review, and governor’s review, after which the proposed rules went to the Office of Administrative Law, where they were prepared for publication. The public and any interested parties then had the right to comment on the proposed rule. “Then when the proposed rule was published, we had to respond to every comment that was received,”

Monaco explains. “If there were any substantial changes, it had to go back out for comment again. We did get a number of questions and comments, and we had to answer each and every one of them. Each one had to be prepared, each one of them had to go through the whole review process again, and then they were finally published. So, the bureaucracy within any system is a cumbersome thing.

“When an outside group is lobbying to have state government enact something like this, that’s one effort, and it’s a major effort,” Monaco continues. “But then once the wheels start turning and you start working on rule development, that whole process takes time in itself. That’s important to understand — if something’s proposed today, it may be a year or two years before you actually see it enacted. The importance of that is once a rule is enacted, it carries the force of law; if you don’t meet it, then there are consequences, so it has to be right on target.”

Although the new rules are currently still in the implementation phase, Monaco has established procedures for inspection. “When I go in to do an inspection, I get a list of all the employees in CS who are processing within the hospital,” he says. “You may have some OR techs there processing upstairs, doing decontamination, and they would have to be certified as well. We get a list of all those employees, the date they were hired, and whether or not they’re certified. Any new hires after the rule, which was adopted Aug. 2, 2004, have three years to get certified. Anyone who was hired before the rule was enacted has five years.”

The time frames in which technicians and managers are required to obtain certification were carefully considered before being established as part of the regulations. “We did that for a couple reasons,” Monaco explains. “First, to give them the opportunity to pass the exam; we’re bending over backwards to make sure they’re not going to lose their jobs for failing to pass the exam — that’s one of the major things. Two, you have to give them time to get the training and study groups and all of that to pass the exam, so right now a lot of courses are going on in the state of New Jersey. This is our first year, and already we’ve seen an increase in tech courses in the state, and that’s a positive thing. There are more courses being given, and we have better attendance at the courses.”

Under the new regulations, CS professionals in ambulatory care settings have two years to obtain certification. All ambulatory arenas are required to have at least one CS technician. “We wanted to give them some formal training in reprocessing, but what we found is that there’s such a difference in what is going on in ambulatory care,” Monaco says.

“If you have an eight-room OR, their needs are going to be different from a family planning clinic. So we’re trying to develop training programs specific to their needs and certify them in ambulatory care.”

Monaco certainly understands the work involved in such an effort as well as anyone. “You need time to get systems up and running and for them to be effective,” he says. “Then once you have everything up and running, you need to have a continuing education (CE) program out there that can support the number of FTEs that are going to need CE credits over the next five to 10 years. You also what them to be meaningful programs that target their needs, especially for ambulatory care.

It’s a big project and there’s a lot of work to it. Hopefully, it will result in a better understanding of processing and we won’t have as many problems as we have today.”

“New Jersey’s certification law, in my opinion, will go down in CS history as a major event in ‘raising the bar’ of our profession,” says Don Gordon, CRCST, FCS, president of the International Association of Healthcare Central Service Materiel Management (IAHCSMM), and central service network director for North Bronx Healthcare Network. “My view of mandatory certification is all positive, and I think it will only add to the status of CS personnel, raise the quality of care for patients, and in the future, increase salaries of those working in our field.”

Gordon explains that certification in other professions documents the capabilities of the practitioner and establishes expectations about the level of performance within those professions. “Certification assists in developing standards within an industry,” he continues. “Training programs with a standard curriculum are developed for those that wish to enter the industry. Certification is also an indication that one has attained a certain level of achievement. Certification also leads to continuing education.

In a fast-changing field such as CS, one must be kept up to date on a number of topics and techniques. Maintaining certification requires continuing education and this is one of the important aspects of mandated certification. It requires an individual to continue his or her quest for knowledge.”

Gordon contends that lack of certification in the CS profession affects existing and future professionals in that it contributes to particular areas of concern in the field. “First, CS professionals are not always given the same respect as others in the hospital/medical field,” he says. “And second, compensation is generally lower than in the related fields that do require certification.”

Additionally, state-mandated CS regulations are now seen as a viable option for those in other parts of the country. “When New Jersey passed the law mandating certification last August, it set a precedent for other states that have already started their voyage toward mandatory state certification and gave hope of the possibility that the sterile processing personnel in their states will follow suit,” Gordon says.

Monaco has also been particularly encouraged by the interest other states have recently shown in considering similar regulations. “I think other states are using the New Jersey model as a stepping stone for themselves, which is very proactive,” he says. “It’s something that’s needed — CS is so important to infection control and to the hospital.”

In New York, Gordon has been part of the effort to advocate mandatory certification for several years now. “We have been on this road towards mandatory state certification since 2001, when the various state chapters met in a Denny’s restaurant in upstate New York to form a state association to organize and set up a plan for achieving this important goal,” he recalls.

Other states have also been inspired by New Jersey’s success. “After hearing the news, Texas entered into the hunt, where 18 CS professionals from across the state met to discuss the issue of mandatory certification,” Gordon says. “Those in attendance believed they would not be able to present a unified front at the state level without representation of a formal effort of all CS professionals in the state. As a result, like New York, Texas decided to form the Texas State Association of Central Service Professionals. As in New York State, the new association provides an opportunity for all CS personnel, regardless of their association affiliation, to become actively involved in achieving mandatory certification in their state.”

Monaco suggests that those in other states who are interested in advocating for CS laws or regulations first become familiar with the intricacies of their state bureaucracy and the important players therein, as each state has different policies and processes. For example, whereas he was dealing with state regulations, in other states, actual legislation may be the correct vehicle. In either case, healthy amounts of patience and determination are certainly recommended in supporting and advocating for this worthy cause.