By I. Francis Kyle III, DMin, ThM, MDiv, BA, CRCST, CIS, CHL
At the two hospitals where I work, the sterile processing departments (SPDs) are located in the basement and near the morgue. To think that people are literally dying to be closer to the SPD is a unique feature that not just any hospital department can claim!
The only people who frequent the basement are the deceased, undertakers, medical examiners and coroners, visitors who are lost, electri-cians, plumbers, exterminators, Joint Commission staff and hospital employees like me who must labor for a living below ground if we want to see our thin wallets and purses become thicker come pay day. The emergency room, operating rooms (ORs), ICU, PACU, human resources de-partment, more palatable dining options, ATM machines, parking garage and other places of seemingly greater significance are all literally situ-ated above. Being among the non-zombie living who work forty hours a week at the subterranean level surrounded by concrete walls and artificial lighting, my SPD co-workers and I—and other basement staff who have no windows to distract us from our work—look forward to going “up, up and away” and onto seemingly more significant places and activities when our shift ends.
In a similar way, every sterile processing technician I have worked with or know would also like to go “up, up and away” regarding his or her hourly wage. However, I do not see this happening in the industry as a whole until the occupation becomes more professionalized and no longer one of the last hospital jobs that is entry level. The traditional way, of course, to ascend from any financial basement is to work hard, put in your time and ascend the career ladder. With promotions come higher pay.
Because of bills that need to be paid and, for some, a family that needs to be fed, seeking to climb the SPD career ladder as a supervisor and then manager is understandable and noble. Plus, and in addition to a higher wage, if you work as a SPD supervisor or manager you most likely will not have to work weekends or do such oft-viewed unpleasant technician tasks as donning personal protective equipment (PPE) in the bio-burden-saturated decontamination area.
With the numerous perks that come with SPD leadership, why would a SPD technician ever want to remain “just” a tech? Why would he or she intentionally stay in the metaphorical career basement and not seek to ascend?
Money aside—and as hard as that might be to imagine—I believe there are many benefits to being, and remaining, a career SPD technician. While not downplaying the important role that leaders have on the SPD team, I nevertheless contend that there is a measure of greatness that the frontline, in-the-trenches SPD technician has over his or her bosses.
The following reflection is based on my own work context as a two-year sterile processing technician—9:00 a.m. to 5:00 p.m., then third shift and now first shift—at Louisville’s 462-bed Jewish Hospital (est. 1905) and, more recently, the nearly adjacent 404-bed, Level I trauma Uni-versity of Louisville Hospital (U of L, est. 1817). Both historic downtown hospitals are owned (2012– ) by the non-profit KentuckyOne Health, a subsidiary of the Colorado-based Catholic Health Initiatives. As featured in the front cover story in IAHCSMM’s Communiqué (Septem-ber/October 2015, “Triple Crown Certification: How One CS Department is Winning the Race for Quality, Safety and Professionalism”), Jewish Hospital’s SPD is ranked third in the world for employing IAHCSMM triple-certified technicians (CRCST, CIS, CHL).
Greater job necessity. Even with advanced technology, sterile processing will always have a hands-on human component. No hospital in the civilized world can perform surgeries while significantly reducing the risk of patient infection if not for in-the-trenches sterile processing techni-cians. A hospital SPD with just supervisors and a manager but no technicians is like a military army full of ranked officers but with no ground-level combat soldiers. “We are the heart of the hospital,” says Shirley L. Raque, CRCST, CIS, CHL, a veteran Jewish Hospital sterile processing and quality assurance technician who is still going strong at age sixty-eight. I agree.
Greater practical knowledge of surgical instrumentation. Since it is SPD technicians who literally handle surgical instruments in the decontam-ination area and during the prep-and-pack processing stage prior to sterilization, storage and eventual OR delivery, it is they whom supervisors and managers—and even the full-time instrument specialist at the hospitals where I work—frequently rely on for practical knowledge. In addi-tion to physicians and OR scrub technicians, frontline SPD technicians are an indispensable human resource to SPD leaders, instrument manufac-turers and others.
Greater liberty from dreaded administrative duties. Employee schedules, taking inventory and ordering merchandise, written reports and budgets to the hospital’s C-Suite, constantly checking and responding to emails and a plethora of other administrative job duties—the SPD technician is free from all, if not most, of them.
Greater team comradery and tighter bond. Though part of the same SPD team and with the same goal of ultimately serving the patient, there is a hierarchy and resultant social separation between SPD leaders and followers/technicians. Because of this justifiable separation, the raw fact is that technicians spend more time “in the trenches” together and get to know each other more as we work side-by-side and con-verse in the non-V.I.P. cramped employee locker room and tiny break room. It has been fascinating for this technician to be part of the SPD “United Nations” at Jewish Hospital and U of L Hospital where over forty technicians—from ages twenty to sixty-eight and with varying religious backgrounds, life experiences and interests—hail from such places as Bosnia, Canada, Cuba, Haiti, Panama, Philippines, South Africa, Turkey and even the Republic of Texas.
Greater freedom away from work. When a crisis occurs on third shift at 3:00 a.m., it is a supervisor or the manager who is called at home. It is the SPD technician, therefore, who has a greater chance of still “having a life” outside of work.
Greater usefulness in breaking the Chain of Infection. Infection control experts and clinical educators agree that frontline SPD technicians play a primary role in breaking the six-fold Chain of Infection: causative agent, reservoir of the agent, portal of exit of the agent from the reser-voir, mode of transmission, portal of entry into the host and susceptible host. “The role that sterile processing plays in the healthcare system cannot be overstated,” says Jay Shreve, RN, BSN, clinical educator at Louisville’s 634-bed Norton Hospital. “Successful sterilization and processing of surgical instrumentation is a key component of reducing healthcare-associated infections (HAIs).”
Greater adrenaline rushes and sense of accomplishment. Who more than hands-on SPD technicians experience the exciting “high” that comes with having to quickly process a “loaner” or “turnover” surgical instrument tray for an impending surgery, yet not compromising quality in the process? Not the SPD supervisor or manager, OR staff or the medical “loaner” sales representative.
Greater hospital asset as a future SPD traveling technician. When a hospital’s SPD is short on staff, some hire per diem traveling technicians. Surgeries would be in jeopardy if it was not for these important transient workers. If a technician chooses this financially lucrative and adven-turous career option, and as a suggestion, it is best if he or she is able to first gain local hospital experience working with a variety of surgical instrumentation, work all four components of sterile processing (decontamination, dispatch, prep-and-pack and sterilization), work all three shifts, work solo on weekends or holidays and earn all three IAHCSMM certifications. He or she ought to be the Swiss Army knife and confident baseball utility player of a hospital’s SPD.
Greater decrease in stress and pressure. The SPD technician’s job is hard enough and has its own inherent stress and pressure. But how much more that of SPD supervisors and managers because of the additional job responsibilities and expectations. These include mediating con-flicts among the technicians, readying the department for a Joint Commission visit and dealing with sometimes not-too-happy physicians and OR staff when major instrumentation problems occur before or during a surgery.
Greater physical activity. Rather than a sedentary desk job, the SPD technician’s work is physical, requiring bodily movement. This fact assists in producing better overall health. As evidence, I do not know too many severely out-of-shape technicians. From walking miles when assigned to dispatch, to lifting aluminum surgical instrument containers when sterilizing, to sweating and burning calories when decontaminating instru-ments, the full-time SPD technician experiences a somewhat decent physical workout five days a week and gets paid for it!
Greater “street cred” and hospital asset as a future SPD leader if first a veteran technician. For the technician seemingly forced into (be-cause shortage of candidates) or aspiring to an eventual SPD leadership position, what better way to gain respect and “street cred” from those future technicians under you than by first being a veteran SPD technician yourself? Having experienced first-hand what it is like doing frontline, in-the-trenches SPD work, how much greater will a seasoned technician-turned-supervisor or manager be able to identify and sympathize with—and earn the respect of—subordinate technicians when they, for instance, make inevitable mistakes.
I. Francis Kyle III, DMin, ThM, MDiv, BA, CRCST, CIS, CHL, is a sterile processing technician and safety coach at Jewish Hospital and University of Louisville Hospital in Louisville, Ky. To read online his “Reflections on My First 18 Months as a Sterile Processing Technician” in Infection Control Today (August 2015, pages 8, 10), visit http://digital.infectioncontroltoday.com/i/544280-aug-2015/8.