Educating SPD Staff

September 1, 2005

Educating SPD Staff

By Kathy Dix

Sterile processing department (SPD) educators have a weighty
task determining what education is necessary to make their staff competent,
to maintain competency, and how to secure the resources necessary to make it

Deficits in current knowledge among SPD
staff members are disparate from facility to facility. Ensuring that all areas
are included in their education requires innovation, the ability to use
unconventional approaches, and the embracing of technology that enables easier
learning and testing.

Don Gordon, CRCST, FCS, network director for central service
at North Bronx Healthcare Network and also the president of the International
Association of Healthcare Central Service Materiel Management (IAHCSMM), shares
his thoughts. It is difficult to try to pinpoint the current knowledge
deficits among SPD practitioners to one particular subject or category,
Gordon reflects.

The knowledge and lack of knowledge differs from person to
person. What we can do as a profession is push for consistency of knowledge. The
best way to accomplish this is through mandatory certification throughout the
country. The other positive outcome from having all people in the field
certified is that it requires them to continue their education, since one is
required to have continuing education units (CEUs) each year to maintain their
certification. It is almost like having Big Brother tap you on the shoulder and
remind you to continue your education.

Utilizing new means of instruction and guidance for each group
of practitioners goes hand-in-hand with the initial goal, to obtain the required
certification. Securing this education can be achieved through several
approaches, through correspondence courses and online courses from IAHCSMM/
Purdue, private independent central service (CS) courses and some CS chapters,
which are now providing this opportunity within their region, Gordon adds.
The Long Island Association for Central Service has been providing this
course to their members over the last four years. The course includes different
instructors with special expertise in the various subject areas, and a full day
workshop/seminar is added to the course. The difficulty becomes having people take the course and
getting everyone certified. This becomes an individual goal.

Colleges that offer degrees online also contribute, offering
courses via the Internet. IAHCSMM has an affiliation with Purdue University to make this
possible in its online training program for central service technicians. The curriculum features online discussions with a
mentor/instructor and a chat room with others participating in the course.

This is a unique and modern solution to the problem of
training in rural areas. Urban and suburban communities have much easier access
to hands-on training and medical/health science libraries. Since most CS
courses are often available in populated areas, this venue provides an
opportunity for those in rural areas to secure the education necessary to become
proficient in their field and pass the certification exam, Gordon concurs.

Along those lines, the computer has become an important
educational tool. IAHCSMMs Web site features a discussion forum that provides
ongoing discussion threads on various issues pertaining to the profession, he continues. It is drawing participation from sterile
processing professionals worldwide. And various companies have produced self
learning CD-ROMs on various topics another important component in the
quest for knowledge.

However, Gordon maintains, I still believe that seminars
and conferences are the best means of education since they offer the CS
professional the opportunity to network and discuss challenges and solutions
with each other as well as learning from the experts. IAHCSMM in the past has had two conferences per year and will
be replacing their fall meeting with regional meetings (two-day conferences),
with the last fall meeting to be held in Norfolk, Va. this November.

Today, hospitals are facing budgetary constraints, thereby
restricting support for attendance at educational conferences. By offering
regional educational meetings, IAHCSMM will provide an opportunity to reach CS
personnel, especially technicians who need educational support and a way to
accumulate CEU hours for recertification. The plan for regionalization (targeted
for 2006) would divide IAHCSMM chapters into six regions, providing easier
access to national conferences.

The SPD is obligated to stay abreast of the latest
technological advances because of its essential role in patient safety, Gordon

Nancy Chobin, RN, CSPDM, SPD/CS educator for Saint Barnabas
Health Care System in New Jersey, sees surgical instrumentation as the single
greatest gap in current SPD knowledge. Its the one area where you have to know all of the
instruments, whereas even in the operating room (OR), youre probably assigned
to one specialty, she points out. There arent a lot of training materials specifically for
central sterile people, so that further complicates the issue. It takes a long
time to learn all those different widgets, and of course the OR is always making
changes to them , so surgical instruments are really a major priority.

The second major issue is the ability of the sterile
processor to perform critical thinking and interpret the manufacturers
instructions so they can properly process the device, she adds. This has
many legal and safety ramifications. I dont know how to say this diplomatically, but we have a
lot of people for whom English is not the first language, and they cant speak
it fluently, they cannot read it fluently, and yet they are hired into the
position. Its extremely difficult when the OR is trying to get something from
the department and the person doesnt understand the OR, or vice versa. Some of them cannot read, so they cannot interpret the
manufacturers instructions. This is a critical issue, because if we do not
follow the manufacturers instructions explicitly, we are liable for that
device, and it may not be safe for the patient, which is not acceptable.

Chobin, who is also executive director of the Certification
Board for Sterile Processing and Distribution (CBSPD), notes that the
organization will be potentially causing controversy by not offering its
certification exam in Spanish. We feel that is not supporting the individual who needs to
read and interpret English. The certification board, in consultation with our
professional testing agency, does not support this practice. If the candidate
wishes to study with Spanish materials, we have no problem with that. But we
will not offer our exam in anything other than English. You need to read and
interpret English in order to function adequately in the SPD. We took a lot of
heat for that, but we stand by our decision. We are accredited by the National
Commission for Certifying Agencies; we have to comply with their guidelines and
they do support our decision, she adds.

The third issue is an unmistakable understanding of the
importance of their jobs. Maybe this should be No. 1, she considers. For years, sterile processors have been treated with this
attitude We know you have to be there; well tolerate you, but we
dont want to hear from you. Just do your job, says Chobin. When I speak to people about manufacturers
instructions, theyve actually said to me, We cant do that. I couldnt
have my people changing the sterilization cycles all day long because theyre
going to make mistakes. Then we have some bigger issues. If the staff has
proper training, a manager should not have to stand over staff to make sure theyre
not making mistakes. They should be completely knowledgeable in the operation of
all the equipment theyre using, including sterilizers, so if they have to run
a special cycle, they know how to do it. And I dont allow anyone to operate
the sterilizers unless they know how to do it.

The sterile processors, because they are treated like
second-class citizens, really believe they are. Until we can change that,
nothing is going to change. They have to be acknowledged for the importance of
the job theyre doing. Once that acknowledgement comes, then we can get
salaries that are commensurate with the awesome responsibility that comes with
this job, she observes.

Administrators and hospital staff in other departments do not
grasp the true importance of this job, which leads to lack of support for
education in sterile processing. I dont think administration and hospital
people in general really understand how the science and technology of
sterilization has changed, Chobin muses. People still think were back
in the 1970s, when we disinfected glass thermometers and sterilized bedpans and
put charge slips on items. Yet all they have to look at is the surgery with
robotics and minimally invasive equipment.

Who do they think is processing that equipment? But somehow that doesnt click.

These are the same people you are paying McDonalds
wages, and in some places, they make more at McDonalds. These are people who
in some cases cannot read or understand English. So weve got to get the
message out that this job has changed dramatically; there is no department that has more of an impact on direct
patient care, even though we are not directly with the patient. Human resources
(HR) will send you anybody as long as theyre breathing. They need to get the
message, as do the CEOs, that if you want surgeons and patients to be happy, if
you want patients to come to this facility, if you want the surgeons to bring
patients to your facility, you need competent, well-compensated people in that
department who understand how important the job is, who are thoroughly trained,
and are going to do that job correctly, so the surgeons can be successful, so we
can get good patient care. I tell my employees all the time, A surgeon cant
cut with his fingers. He needs instruments to do that. You provide that kind of
equipment to the surgeon so he can be successful. Without that equipment being
in the right condition and functioning properly, he cannot do his job.

So education is not only for the SPD staff; it is also crucial for other hospital employees including
the CEO to realize how essential this department is and how necessary it is
to hire and educate the best possible employees.

Chobins health system is implementing a unique approach for
education based on popular television programming. Were doing Extreme
Makeover SPD, she says. It involves all the hospitals in the system. This is a multidisciplinary committee with a physician on the
committee the chief of the medical staff of our nine hospitals,
perioperative directors, sterile processing directors, and other department

Not only that, but HR is also becoming involved. They are
beginning with a salary suvey, standardized job descriptions, and development of a career ladder. We want a higher salary to
attract a different caliber of people. We want the time and staff to train
people with a formal training program like they do for perioperative nursing,
where they will have clinical time as well as classroom time, so when theyre
done, they can go right into the department and function.

Chobins system is also insisting on language competency in
conjunction with other training requirements. In our job description, it will
say, Must read, interpret, and speak English fluently. This is not denying
anybody. If you dont, we can get some courses in English as a secondary
language, but if you want to work in this department, you need to be able to
communicate effectively with the physicians and the nurses, because the patients
life can be in jeopardy. I have been paged by the OR because they had called the
department and nobody was able to understand what the OR wanted. That is a major safety issue, she recounts.

In addition to the Extreme Makeover SPD, St. Barnabas is also incorporating a traditional classroom-based
CS course. They also learn on the job. However, Chobin says, Theyre doing
all their training during orientation. Ive had people call me and say they
had been on the job two days and left alone in the department not in my
system, but these are the kinds of calls I get because the department was so
desperate. Thats no way to do this.

Learning all of the necessary information for proficiency in
the SPD is time-consuming. Youre not going to learn every surgical instrument
during that training time. We estimate its going to take six months for the
basic training with the classroom and clinical time, but certainly theyll
have enough knowledge to at that point be able to function with a coworker,
she adds.

St. Barnabas does intend to publish its results when the
project is complete, so other facilities may use the template they established. Our motto is that failure is not an option. We must succeed
in this process, Chobin says.

Chobin has lauded the benefits of certification since 1986,
when the CBSPD was founded. But the needs of the technicians are not being met, she says,
and pricing for education is not technician-friendly.

There are very few hospitals that will pay for outside
education, and the managers need to fight for this, Chobin says, pointing out
an additional deficit. However, The CBSPD just announced a major partnership
with 3M, which has always been supportive of our certification, not only in the
U.S. but internationally. They now are going to provide 18 scholarships for the October
certification exam, and 18 scholarships for the April exam, for anyone who wants
to take the technician or ambulatory surgery exam, not any of the management
exams. For anyone whose hospital will not pay for it and who wants to become
certified, the first 18 people who meet the criteria will get up to $300
$150 for the exam, and the balance to be used for additional training materials
or even to offset the cost of a central sterile course.

Were hoping that other companies will step up to the
plate and do what 3M has done, she adds. Chuck Hughes from SPS Medical has
been offering three scholarships a month for quite a time.

The CBSPD/3M scholarships are now open for applicants. (More
information can be found at, and 3M is also making
information available through its sales representatives.) Chobin anticipates
other states following New Jerseys lead requiring certification for
central sterile personnel. I think the No. 1 thing that will help more than
anything else is mandatory certification, she says. You cannot get
certified unless you have met measurable standards, and this puts everybody on
the same playing field. Because youre certified, you must continue your
education. That is going to drive education, that is going to drive the
continuing education, and that is certainly going to drive the competency.

Fall 2005 Educational Events for CS/SPD Personnel

The American Society for Healthcare
Central Service Professionals (ASHCSP)s 38th annual Conference &
Exhibition will be held at the Hyatt Regency in Albuquerque, N.M. Sept. 17-20,
2005. For details, go to 

International Association for Healthcare Central Service Materiel Management
(IAHCSMM) annual fall meeting will be held Nov. 6-9, 2005 at the Norfolk
Waterside Marriott in Norfolk, Va. For details, go to