By Stephen Kovach
People across the United States now know that hair dressers need some form of certification to do their jobs but if you are cleaning surgical instruments for surgery, unless you live in New Jersey, you are not required by law to have some basic knowledge to do the task at hand -- cleaning and sterilizing medical devices in a medical facility.
Within 15 minutes of NBCs Today Show airing the segment, "Today Investigates: Dirty surgical instruments a growing problem in the OR" on Feb. 22, 2012, a close friend called me and asked if it was true that people cleaning instruments are not required to be certified. I said, Yes it is true. He said, Steve, that person cleaning the surgical instruments really isnt required by law to have special training? Yes that is correct, I told my friend again. He was shocked and said, Is that what you have been talking about all these years? and I also replied yes both to the certification and the issue of dirty instruments.
Soon after the call I sent out an alert to many of my fellow central sterile service department (CSSD) professionals to make sure they viewed this segment. My email was titled, The Tipping Point for Certification is Now." The focus of the Today segment was about the difficulty CSSD staff had cleaning various items, but the end of the segment talked about the need for certification for the staff who works in the bowels of the hospital. The responses I got back were unbelievable; here are a few of them:
...I believe that the presidents from both the IAHCSMM and CBSPD need to somehow collectively get a message to the public that there are thousands of competent, educated and caring sterile processing personnel that perform complex processes everyday to assure that their surgical instruments are clean, sterile, and safe for use and that national certification would ensure these processes are always being done... --Anna Grayson, MS, RN, CRCST, SPD manager
...I certainly believe that all staff should be certified. However, being certified is only one step. We as managers need to make sure that our staff are competent in what they are doing as well as providing training, education and in-services regularly. I question my follow managers if they are doing that. Certification has to be more than a title... -- Al Spath, SPD manager
....Management certification is just as important as technician certification. Managers are responsible for getting their staff pay raises. Managers develop competency programs for their staff and make sure they develop staff rather than just used competency programs as a human resource tool... the manager works with administration, OR managers and surgeons to identify and solve problems as well as marketing central service staff. I think without certified mangers we will have frustrated certified technicians...Technician certification is important. A certified technician understands the rational behind what they are doing. This helps them become a critical thinker. There are many situations in which the technician has to make a decision because no support staff is available. It's these situations an educated staff person can make the difference. I do some consulting in ambulatory care facilities now that I'm retired. I tell you from my experience that there is a significant difference in a certified technician from a non certified technician..." -- Tony Monaco, healthcare consultant
Certification allows for a means to standardize a baseline of core education and a basic knowledge base for those performing these complex tasks. It will require continued education....in order to stay current in a ever changing and evolving field. Without certification, a means to measure a set knowledge base, training and the continuation of misinformation has a greater potential of reaping history over and over. -- Michele DeMeo, retired SPD manager
I had felt the tipping point for certification was when Tony Monaco and the many CSSD professionals from New Jersey were successful in passing state certification back in August 2004. I truly believed that all the states would follow, but it has not happened.
So why do I now feel this is the possible tipping point? This news report has had an impact on the public that has never happened before. Public awareness usually generates interest of lawmakers. Allied healthcare professionals are discussing the merits of central certification. People across the nation are taking a positive position regarding central service certification. People in general think that certification in the healthcare environment has a purpose and that purpose is to:
- Enhance quality patient care,
- Promote personal satisfaction for those that are certified,
- Recognize that CSSD are professionals who have met an accepted level of expertise and demonstrated a standard of knowledge specific to their profession
- Show accountability to the public
With certification comes accountability on the person certified. Their certification does reflect achievement beyond a basic level of knowledge and then demands continued skill and learning development to maintain certification.
Mary Velasco, manager of sterile processing, says, We need to commit to certification and on-going education for our sterile processing staff. They need to have the knowledge and skills required to produce quality work and ensure that our customers receive clean, sterile and functioning instruments for their surgeries. We are the patients advocate and we need to assure that they receive the best quality product possible by being educated in what we do.
Requiring certification is a must, but does certification guarantee no mistakes?
There is no certification program in any profession that could ever guarantee that. What certification will do is cut the odds of making a mistake and reduces risk of infection or injury from a reprocessed medical device. Education is the first step in prevention. As many of the comments have stated, certification is not just for the technicians it must be for the director/manager/supervisor of the department as well. The time is now to seize the moment and get it done as the saying goes. Why? Not because the public now knows our dirty little secrets, but because proper patient care demands this level of professionalism. It is time for all of us to say I am certified.
Stephen Kovach is director of education at Healthmark Industries.
Certification Issue Gets Experts Talking
In light of The TODAY show coverage, ICT asked members of the sterile processing community to share their thoughts on certification of technicians.
Over the years and with my close work with the CBSPD certification, I have identified several critical issues:
1. Managers are entrusted with the responsibility to produce safe and effective products as any other manufacturer
2. Training and competencies for SPD staff is a major responsibility of the manager; yet this component is frequently sub-standard
3. Inadequate, non-dependable processing equipment should not be permitted especially when staff cannot comply with manufacturers instructions for use (IFU).
4. Sufficient staffing is needed to effect those IFUs every time.
It is the managers responsibility to bring these matters to the attention of administration. If there is no response, then solicit support from the Operating Room, Infection Prevention, Risk Management and Quality Improvement. All of these are patient safety issues. It is somewhat disturbing to see managers collect a salary and feel they are not empowered to make change. Where is their responsibility to the patient? On the other hand, it was unfortunate that the article made it appear as though all SPDs are substandard. There are many warriors out there who run fantastic departments and who work collaboratively with other departments to ensure patient safety. We are all talking about certification, especially for managers but when a majority of the managers do not even know what an AAMI document is , how can they effectively lead the practice in their departments? You have to start with people who CARE and are willing to do whatever it takes to get the job done. That is the foundation for everything else. With a manager who sets the tone for the department that failure is not an option then we can proceed.
No one will fix this for us; we are all individually responsible for our patients and staff members. It is time to come up to the plate and get the job done.
-- Nancy Chobin, RN, CSPDM, AVP of Sterile Processing Services at Barnabas Health, and co-executive director of the CBSPD, Inc.
Technician certification is important. A certified technician understands the rational behind what they are doing. This helps them become a critical thinker. There are many situations in which the technician has to make a decision because no support staff is available. It's these situations an educated staff person can make the difference. I do some consulting in Ambulatory care facilities now that I'm retired. I tell you from my experience that there is a significant difference in a certified technician an a non certified technician. The Technician certification programs offered today have excellent content for the experienced technician, but getting someone off the street and putting them though a course without practical experience is a waste of time. So work needs to be done on this level as well. Certification is the first step in getting central service recognized as a professional health science occupation. Once that happens it will provide opportunities for your profession to grow and flourish. Nothing is easy and especially for central service. Congress only needs to move CMS to adopt certification as a condition of participation. If CMS would write the rule then all the certification agencies would have to follow CMS lead. Thus it would become a national standard for both acute and ambulatory care. No need to lobby each state which is costly and very time consuming.
-- Tony Monaco, retired SPD manager
Sterile processing professionals in New York state have been campaigning for over nine years for a change in healthcare law that requires a certification for those working in the sterile processing field in a hospital or free-standing surgery center. Our current effort also includes a requirement for a set level of education annually. I believe it is apparent that the time has come for our elected officials to recognize this and move forward. I realize that surgical site and hospital-acquired infections are difficult to trace back to an SPD, however we do have an important part nonetheless. Any effort to lessen the approximately 300 daily deaths due to HAIs is an effort well made.
-- Steve Maley, CHL, CSPDM, president of the New York State Association of Central Service Professionals
With the many articles written on the breaches of reprocessing equipment for patient use, whether they are high-level disinfection or sterilization too many patients are being hurt unnecessarily, as you may recall there has been many recent articles on cross contamination on the reprocessing of flexible endoscopes. Just like the TODAY show pointed out, the state and governmental agencies require licensing or certifications for hairdressing and similar occupations -- although I have never heard of anyone dying from a bad hair cut or coloring. Unfortunately people and patients do die from improperly sterilized instrumentation, estimated 90,000 per year, one should be enough for our state and government to take notice. The organizations themselves are requesting mandatory certification but are being turned away by state officials. I hope that the media stays on the subject helping the consumers to be educated and aware of this situation.
-- Bruce Krolikowski, CRCST, CHL, central sterile supply manager for Oswego Health
As an educator for teaching the sterile processing course I am a true advocate for employing staff in British Columbia, Canada. I see so many changes in technology regarding sterilizers and technology regarding the design of instruments. Its amazing over the years, the change. Staff absolutely need to know the basics of why they are doing something and the way it must be done in order to effectively clean and reprocess medical devices. I would love to see this mandated in BC, but the nearest we have got with this from our ministry is a strong encouragement. It is not enough to protect patient safety.
-- Penny Brawn, regional coordinator of sterile processing for Northern Health
As a supervisor of a sterile processing department of a 500-bed hospital in Michigan, all of our staff members are required to be certified. I also teach the IAHCSMM curriculum at one of our community colleges here in Michigan. While certification presents certain advantages to employers, namely, they know before offering a position the candidate has a minimal level of technical knowledge for the position, I am somewhat ambivalent about the issue. I do advocate for certification among my peers, hospital administrators, and my students. In fact, my students have a better than 95 percent pass rate on the certification exams! I do, however, believe the more important concern is maintaining, and improving, technical knowledge and understanding. While certification demonstrates a minimal level of technical knowledge, continuing education through in-services, workshops, seminars, and conferences will demonstrate the CS professional possesses an evolving and expanding base of knowledge. That is what I feel is most important to ensure the safety of our patients.
-- Ken Warnock, CST/SFA, CHMMC, supervisor of central sterile processing at Oakwood Hospital and Medical Center