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By Kathy Dix
Sterile processing department (SPD) educators have a weightytask determining what education is necessary to make their staff competent,to maintain competency, and how to secure the resources necessary to make ithappen
Deficits in current knowledge among SPDstaff members are disparate from facility to facility. Ensuring that all areasare included in their education requires innovation, the ability to useunconventional approaches, and the embracing of technology that enables easierlearning and testing.
Don Gordon, CRCST, FCS, network director for central serviceat North Bronx Healthcare Network and also the president of the InternationalAssociation of Healthcare Central Service Materiel Management (IAHCSMM), shareshis thoughts. It is difficult to try to pinpoint the current knowledgedeficits among SPD practitioners to one particular subject or category,Gordon reflects.
The knowledge and lack of knowledge differs from person toperson. What we can do as a profession is push for consistency of knowledge. Thebest way to accomplish this is through mandatory certification throughout thecountry. The other positive outcome from having all people in the fieldcertified is that it requires them to continue their education, since one isrequired to have continuing education units (CEUs) each year to maintain theircertification. It is almost like having Big Brother tap you on the shoulder andremind you to continue your education.
Utilizing new means of instruction and guidance for each groupof practitioners goes hand-in-hand with the initial goal, to obtain the requiredcertification. Securing this education can be achieved through severalapproaches, 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 thiscourse to their members over the last four years. The course includes differentinstructors with special expertise in the various subject areas, and a full dayworkshop/seminar is added to the course. The difficulty becomes having people take the course andgetting everyone certified. This becomes an individual goal.
Colleges that offer degrees online also contribute, offeringcourses via the Internet. IAHCSMM has an affiliation with Purdue University to make thispossible in its online training program for central service technicians. The curriculum features online discussions with amentor/instructor and a chat room with others participating in the course.
This is a unique and modern solution to the problem oftraining in rural areas. Urban and suburban communities have much easier accessto hands-on training and medical/health science libraries. Since most CScourses are often available in populated areas, this venue provides anopportunity for those in rural areas to secure the education necessary to becomeproficient in their field and pass the certification exam, Gordon concurs.
Along those lines, the computer has become an importanteducational tool. IAHCSMMs Web site features a discussion forum that providesongoing discussion threads on various issues pertaining to the profession, he continues. It is drawing participation from sterileprocessing professionals worldwide. And various companies have produced selflearning CD-ROMs on various topics another important component in thequest for knowledge.
However, Gordon maintains, I still believe that seminarsand conferences are the best means of education since they offer the CSprofessional the opportunity to network and discuss challenges and solutionswith each other as well as learning from the experts. IAHCSMM in the past has had two conferences per year and willbe 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, therebyrestricting support for attendance at educational conferences. By offeringregional educational meetings, IAHCSMM will provide an opportunity to reach CSpersonnel, especially technicians who need educational support and a way toaccumulate CEU hours for recertification. The plan for regionalization (targetedfor 2006) would divide IAHCSMM chapters into six regions, providing easieraccess to national conferences.
The SPD is obligated to stay abreast of the latesttechnological advances because of its essential role in patient safety, Gordonsays.
Nancy Chobin, RN, CSPDM, SPD/CS educator for Saint BarnabasHealth Care System in New Jersey, sees surgical instrumentation as the singlegreatest gap in current SPD knowledge. Its the one area where you have to know all of theinstruments, whereas even in the operating room (OR), youre probably assignedto one specialty, she points out. There arent a lot of training materials specifically forcentral sterile people, so that further complicates the issue. It takes a longtime to learn all those different widgets, and of course the OR is always makingchanges to them , so surgical instruments are really a major priority.
The second major issue is the ability of the sterileprocessor to perform critical thinking and interpret the manufacturersinstructions so they can properly process the device, she adds. This hasmany legal and safety ramifications. I dont know how to say this diplomatically, but we have alot of people for whom English is not the first language, and they cant speakit fluently, they cannot read it fluently, and yet they are hired into theposition. Its extremely difficult when the OR is trying to get something fromthe department and the person doesnt understand the OR, or vice versa. Some of them cannot read, so they cannot interpret themanufacturers instructions. This is a critical issue, because if we do notfollow the manufacturers instructions explicitly, we are liable for thatdevice, and it may not be safe for the patient, which is not acceptable.
Chobin, who is also executive director of the CertificationBoard for Sterile Processing and Distribution (CBSPD), notes that theorganization will be potentially causing controversy by not offering itscertification exam in Spanish. We feel that is not supporting the individual who needs toread and interpret English. The certification board, in consultation with ourprofessional testing agency, does not support this practice. If the candidatewishes to study with Spanish materials, we have no problem with that. But wewill not offer our exam in anything other than English. You need to read andinterpret English in order to function adequately in the SPD. We took a lot ofheat for that, but we stand by our decision. We are accredited by the NationalCommission for Certifying Agencies; we have to comply with their guidelines andthey do support our decision, she adds.
The third issue is an unmistakable understanding of theimportance of their jobs. Maybe this should be No. 1, she considers. For years, sterile processors have been treated with thisattitude We know you have to be there; well tolerate you, but wedont want to hear from you. Just do your job, says Chobin. When I speak to people about manufacturersinstructions, theyve actually said to me, We cant do that. I couldnthave my people changing the sterilization cycles all day long because theyregoing to make mistakes. Then we have some bigger issues. If the staff hasproper training, a manager should not have to stand over staff to make sure theyrenot making mistakes. They should be completely knowledgeable in the operation ofall the equipment theyre using, including sterilizers, so if they have to runa special cycle, they know how to do it. And I dont allow anyone to operatethe sterilizers unless they know how to do it.
The sterile processors, because they are treated likesecond-class citizens, really believe they are. Until we can change that,nothing is going to change. They have to be acknowledged for the importance ofthe job theyre doing. Once that acknowledgement comes, then we can getsalaries that are commensurate with the awesome responsibility that comes withthis job, she observes.
Administrators and hospital staff in other departments do notgrasp the true importance of this job, which leads to lack of support foreducation in sterile processing. I dont think administration and hospitalpeople in general really understand how the science and technology ofsterilization has changed, Chobin muses. People still think were backin the 1970s, when we disinfected glass thermometers and sterilized bedpans andput charge slips on items. Yet all they have to look at is the surgery withrobotics 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 McDonaldswages, and in some places, they make more at McDonalds. These are people whoin some cases cannot read or understand English. So weve got to get themessage out that this job has changed dramatically; there is no department that has more of an impact on directpatient 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 themessage, as do the CEOs, that if you want surgeons and patients to be happy, ifyou want patients to come to this facility, if you want the surgeons to bringpatients to your facility, you need competent, well-compensated people in thatdepartment 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 wecan get good patient care. I tell my employees all the time, A surgeon cantcut with his fingers. He needs instruments to do that. You provide that kind ofequipment to the surgeon so he can be successful. Without that equipment beingin 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 includingthe CEO to realize how essential this department is and how necessary it isto hire and educate the best possible employees.
Chobins health system is implementing a unique approach foreducation based on popular television programming. Were doing ExtremeMakeover SPD, she says. It involves all the hospitals in the system. This is a multidisciplinary committee with a physician on thecommittee the chief of the medical staff of our nine hospitals,perioperative directors, sterile processing directors, and other departmentleaders.
Not only that, but HR is also becoming involved. They arebeginning with a salary suvey, standardized job descriptions, and development of a career ladder. We want a higher salary toattract a different caliber of people. We want the time and staff to trainpeople with a formal training program like they do for perioperative nursing,where they will have clinical time as well as classroom time, so when theyredone, they can go right into the department and function.
Chobins system is also insisting on language competency inconjunction with other training requirements. In our job description, it willsay, Must read, interpret, and speak English fluently. This is not denyinganybody. If you dont, we can get some courses in English as a secondarylanguage, but if you want to work in this department, you need to be able tocommunicate effectively with the physicians and the nurses, because the patientslife can be in jeopardy. I have been paged by the OR because they had called thedepartment 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-basedCS course. They also learn on the job. However, Chobin says, Theyre doingall their training during orientation. Ive had people call me and say theyhad been on the job two days and left alone in the department not in mysystem, but these are the kinds of calls I get because the department was sodesperate. Thats no way to do this.
Learning all of the necessary information for proficiency inthe SPD is time-consuming. Youre not going to learn every surgical instrumentduring that training time. We estimate its going to take six months for thebasic training with the classroom and clinical time, but certainly theyllhave enough knowledge to at that point be able to function with a coworker,she adds.
St. Barnabas does intend to publish its results when theproject is complete, so other facilities may use the template they established. Our motto is that failure is not an option. We must succeedin 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 outsideeducation, and the managers need to fight for this, Chobin says, pointing outan additional deficit. However, The CBSPD just announced a major partnershipwith 3M, which has always been supportive of our certification, not only in theU.S. but internationally. They now are going to provide 18 scholarships for the Octobercertification exam, and 18 scholarships for the April exam, for anyone who wantsto take the technician or ambulatory surgery exam, not any of the managementexams. For anyone whose hospital will not pay for it and who wants to becomecertified, 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 materialsor even to offset the cost of a central sterile course.
Were hoping that other companies will step up to theplate and do what 3M has done, she adds. Chuck Hughes from SPS Medical hasbeen offering three scholarships a month for quite a time.
The CBSPD/3M scholarships are now open for applicants. (Moreinformation can be found at www.sterileprocessing.org, and 3M is also makinginformation available through its sales representatives.) Chobin anticipatesother states following New Jerseys lead requiring certification forcentral sterile personnel. I think the No. 1 thing that will help more thananything else is mandatory certification, she says. You cannot getcertified unless you have met measurable standards, and this puts everybody onthe same playing field. Because youre certified, you must continue youreducation. That is going to drive education, that is going to drive thecontinuing education, and that is certainly going to drive the competency.
Fall 2005 Educational Events for CS/SPD Personnel
The American Society for HealthcareCentral 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 tohttp://www.ashcsp.org/ashcsp/education/conferenceinformation.html
TheInternational Association for Healthcare Central Service Materiel Management(IAHCSMM) annual fall meeting will be held Nov. 6-9, 2005 at the NorfolkWaterside Marriott in Norfolk, Va. For details, go to http://www.iahcsmm.org/norfolkmeetinginfo.htm.