By Kelly M. Pyrek
ICT spoke with Patti Koncur, CRCST, CHMMC, ACE, education specialist, and Natalie Lind, CRCST, CHL, education director, both of the International Association of Healthcare Central Service Materiel Management (IAHCSMM), about the challenges professionals face when working in the sterile processing (SPD) and central sterile supply (CSSD) departments.
Q: What are the top two or three challenges that are most difficult for SPD/CSSD professionals to tackle and why?
A: We still have a long way to go to change the perception of what we do and its importance to patient care. Medical devices are complex and the decontamination, preparation and sterilization processes required to make them safe for use are very complex. Its no longer (and perhaps it never was) a simple job. That (incorrect) perception often plays a part in the salary associated with the job. We are seeing positive strides in the salary area, but we arent there yet. We need to work to increase the awareness of the importance of the job. Patient care is more than the direct caregivers. Quality patient care requires a skilled team providing direct patient care and a skilled team working behind the scenes to provide quality support services. When we all start to see ourselves as one team, our collaboration and outcomes will be better. One very important factor in reprocessing of medical devices is ensuring that the device is cleaned, inspected, tested and sterilized according to the device manufacturers instructions for use. Oftentimes, obtaining those instructions is difficult. Following them can also be difficult if the process is not one that can be replicated in the healthcare facility. As an industry, and in partnership with medical device manufacturers, we need to work to make access to information easier and to ensure that instructions for use are as clear as possible. We also need to educate manufacturers on the processing methods most commonly available in healthcare facilities.
Q: What can infection preventionists, facility administration and other stakeholders do to help address these challenges?
A: We need people within our facilities that understand what we do and the challenges we face. Those people can act as advocates to ensure that we have the resources we need to meet the demands of the job. Visiting and touring a CSSD during a busy surgery day will certainly help everyone understand what the department does, actually following the process and how complex it has become will help them understand the need for time, equipment and collaboration.
Q: What is the current state of education/certification for the average SPD/CSSD professional? What are the barriers to improved professional development? What can be done to rectify this situation?
A: We are seeing increases in the number of people becoming certified and in the number of healthcare facilities that require their employees to be certified. ANSI/AAMI ST79:2012 Section 4.2.2, recommends that all personal that perform sterile processing duties be certified within two years of hire and that they maintain that certification. I think as people become more aware of the role that CSSD professionals play in infection prevention they will recognize certification as vital to the preparation of CSSD professionals. Some CSSD professionals face barriers in their professional development process such as lack of support from the healthcare facility. Many facilities have been slow to realize that the increase in complexity of medical devices coupled with the increase in regulations and standards has made this job much more complicated.
Q: Do facilities still struggle to reconcile the different issues and priorities of SPD/CSSD with the OR when it comes to instrument turn-over and delivery, etc.? Can improved education and training facilitate better communication and collaboration?
A: To some degree there will always be a bit of a push/pull between CSSD and the OR when it comes to turnover issues and priorities. The OR is under tremendous demands to use time efficiently and unfortunately, most CSSD departments have limited resources (instruments, processing equipment, and staff). I think that great progress has been made to identify ways to reduce these stresses. Instrument tracking systems, computerized preference card systems, and emphasis on scheduling enhancements and work processes has helped to smooth out many of the bumps in the road. The push to reduce immediate use steam sterilization has also helped as it has encouraged facilities to track what they were processing using IUSS and identify ways to reduce that. In many cases that resulted in additional instrumentation or scheduling adjustments that increased time allotted for reprocessing of turnaround items. We are seeing a lot of facilities work diligently to enhance communications between the two departments and those efforts have proved successful in reducing some frustration. However, the very nature of surgery and its rapidly changing needs due to emergencies, unanticipated procedural needs and schedule changes, will not change and that sets up situations where there will always be some degree of stress associated with the work of the two departments and their relationship.
Q: As the complexity of the work evolves and as the challenges increase, what must SPD/CSSD professionals themselves do to rise to the mandates of improved outcomes and patient safety?
A: Education is key if CSSD professionals are to meet todays challenges and the challenges of the future. An understanding of the science of decontamination and sterilization as well as the standards and regulations that impact work practices helps individuals make good decisions that protect the patient. As with all healthcare professions, change is the norm. CSSD professionals must be able to adapt to change quickly and implement new work practices that improve safety and efficiencies. That is easier said than done. Initial education combined with continuing education is critical to help CSSD professionals meet the new technologies and challenges they face. With the increased focus on SSIs, HAIs and the increase in the complexity of surgical procedures and instrumentation it is more important today than ever before to build an understanding of the needs of Infection Prevention and Control, the Operating Room and CSSD. These three departments need to partner and become comfortable in each others area where they can see the challenges that must be faced daily. Meeting, as a team, touring, and collaborating on a regular basis, in the departments where you can see the processes from all sides will certainly help build understanding. From understanding and the increased communication will come the insight of what we can do to assist each other in providing excellent patient care. Often simple changes or the offer of a helping hand and the understanding of how we impact each other can help us effect change for the better.