Short Staffing Can Trigger Risky Shortcuts
By Craig Robinson
Editor's Note: This article is part one of a three-part series focusing on staffing issues in the central sterile department. The rest of the series will appear on our Web site, www.infectioncontroltoday.com, in June and July.
In today's healthcare environment, hospitals must find effective ways to do more with less, including resolving staffing issues. Forced to contend with numerous financial challenges, hospitals are hoping to boost their bottom lines by reducing expenses and trimming staff. Does a reduction in staff within the sterile processing department have any direct bearing on patient care, surgical procedures and safety?
"You bet it does," claims Wade Collins, director of sterile processing at Texas Scottish Rite Hospital for Children in Dallas. "In the sterile processing department, there are many tasks that require an assured level of skill," Wade adds. "The main objective is to provide the right item to the right place at the right time and in the proper condition. The quality of work performed in sterile processing must be of the highest level at all times."
The effect of reduced staffing on job performance in sterile processing is evident. Some staff members are in positions of management without the benefit of adequate training. They are promoted based on tenure, not on their technical knowledge necessary to guarantee the quality of work.
"All sterile processing staff should have the benefit of technical training, so that quality standards are consistently met," Wade says. However, if the department is short staffed, how does one find the time to perform necessary training to maintain quality?
Quality is defined as "a degree of excellence." During the years, we have seen many changes in the arena of quality management. We are familiar with the terms total quality management, quality circles, quality assurance, quality control and performance improvement. Since sterile processing plays a critical role in maintaining quality at every level, this department should be part of a hospital's quality management team.
"This department is responsible for cleaning, decontamination, inspection, assembly, wrapping, sterilization, storage and distribution of reusable patient-care items, ranging from feeding pumps to surgical instrumentation and implants," Wade says. "It is a job requiring attention to detail and the technical knowledge necessary to consistently ensure patient safety."
When the sterile processing department is short staffed, disastrous consequences can occur. When running full tilt, the staff becomes stressed out and shortcuts are taken to keep up with the workload. It is these shortcuts that can lead to patient harm. An example of a dangerous shortcut is assuming a surgical instrument tray had not been used, strictly by visual signs, and not sending it through decontamination.
"Decontamination is more than cleaning for visual effects," Wade says. "It is the reduction/elimination of microbial life, those very microbes that can prolong a patient's stay or maybe cause death."
Another example of a risky shortcut is not changing the sonic wash water until the end of the day. This results in the possibility of the wash water contaminating the instruments with bio-burden. Other shortcuts involve the hasty assembling of surgical trays, resulting in missing instruments. An excuse commonly used is that there was not enough time to look for a replacement. In the sterilization area, loads may be pulled out of the sterilizers too quickly, not allowing for adequate drying and cooling.
These examples point to a lack of time for proper training, rapid turnover, as well as unmotivated, underpaid and stressed healthcare workers.
Efforts must be made now to address these issues. This three-part series of articles will address how various hospital departments -- including surgery, infection control, emergency and materials management -- are affected by staffing problems in sterile processing. The series will discuss solutions that will help move the sterile processing department into the forefront in the continued effort to maintaining quality in the healthcare environment.
Craig Robinson is president of Medsupport Solutions, a marketing and consulting division of Careforce, Inc., a Dallas-based healthcare staffing company focusing on nursing and sterile processing staff. Robinson has worked in sterile processing departments for more than 15 years, specializing in department flow, equipment solutions and continuing education.