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 happen
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 says.
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 leaders.
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 www.sterileprocessing.org, 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 http://www.ashcsp.org/ashcsp/education/conferenceinformation.html
The 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 http://www.iahcsmm.org/norfolkmeetinginfo.htm.