Crystal Heishman, MBA, MSN, RN, ONC, CIC: “You don’t ever want to go into a sterilization department and say, ‘You’re doing this wrong’. Because they’re the subject matter experts. You want to learn. You want to learn the process. You want to work together because it makes a stronger partnership.”
Though to our knowledge there’ve been no studies to confirm this, it’s a safe bet that everybody in health care has had to work outside their comfort zones during the COVID-19 pandemic. There’s certainly Although, to our knowledge, there have been no studies to confirm this, it’s a safe bet that everybody in health care has had to work outside their comfort zones during the COVID-19 pandemic. There’s certainly plenty of anecdotal confirmation of that development. Experts have told Infection Control Today® that IPs have had to quickly acquaint themselves with the infection prevention and control challenges that exist in each hospital department.1 Now, as the pandemic (hopefully) ebbs, comes a reassessment of the boundaries of an IP’s comfort zone in normal times. Crystal Heishman, MBA, MSN, RN, ONC, CIC, director of infection prevention and control and vascular access at UofL Health – Jewish Hospital, presented at the Cleaning, Disinfection, and Sterilization Conference last month, hosted by the Association for Professionals in Infection Control and Epidemiology. Her presentation was titled “From Concept to Reality: Development and Implementation of a Disinfection and Sterilization Program.”
ICT®: Let’s dive in. How do you go about developing and implementing a disinfection and sterilization program? What’s the first thing you must think about?
Crystal Heishman, MBA, MSN, RN, ONC, CIC: The first thing you [must] think about when [developing] a disinfection and sterilization program is the need. [Also] get a pulse check on what’s going on and how that’s being monitored. Once you get an idea behind that, work up a business plan. A lot of things compete for time and money. What we think is important…everyone else thinks their ideas and needs are important as well, and they are. How do we make [our idea stand out]? How do we show that business plan?
ICT®: Are these programs already in place in hospitals? Who’s your audience? Who are you gearing your message to?
Heishman: Yes, some facilities already have this program started. Some are just beginning their journey on implementing a disinfection and sterilization program. When we’re working on that process, our key stakeholders are our procedural areas, our sterile processing departments, and those we’re working with to bring the program forward. It might be your quality directors, your CMO, your CEO, your CFO, surgical services leaders, [or] physicians. There’s a broad range of [people] you [must] work with to get these started.
ICT®: Have infection preventionists historically been involved in what goes on in the sterile processing department?
Heishman: Over the years, the role for infection prevention has expanded greatly. Even in the time I’ve been in infection prevention—which has been over 10 years—that role has just gained momentum. Traditionally, infection prevention worked side-by-side with sterile processing, but it wasn’t something they had to delve into or know completely. It’s more of a collaborative environment these days. But they [must] know issues with sterilization and disinfection that they did not [previously] have to know as deeply.
ICT®: Unfortunately, COVID-19 crops up in almost every conversation about health care these days. Has COVID-19 made that partnership between infection preventionists and sterile processors stronger or even forced that partnership to happen in some instances?
Heishman: No, I don’t think COVID-19 had a great role in that. This was already rolling before COVID-19. The pandemic may have delayed some progress. But…for at least 5 to 6 years, we’ve been partnering with sterile processing, learning more, helping each other, [and] monitoring those processes.
ICT®: You use the word partnering, so it’s not as if an infection preventionist will walk into the sterile processing department and say, “You’re doing this wrong. You’re doing that wrong.” What would be the proper approach for infection preventionists or an infection prevention department to monitor what’s going on?
Heishman: Let’s say I’m going to sterile processing. The first thing I do is talk to them about what they’re doing and ask the whys. Why do we do this as opposed to this? Why are we doing that as opposed to that? Let them walk through the process. You want to learn their role and why they do the things they do. Then you start looking for deviations in that process and investigating more. You don’t ever want to go into a sterilization department and say, “You’re doing this wrong.” Because they’re the subject matter experts. You want to learn. You want to learn the process. You want to work together because it makes a stronger partnership. You get a lot more accomplished.
ICT®: How much homework do infection preventionists need to do before they venture forth into a sterile processing department?
Heishman: A lot of homework. Just starting off with the whys. You don’t have to know everything walking in. It’s more of an observation experience and just asking the whys, then you go back and learn those processes. There are a lot of resources out there on sterile processing [and] high-level disinfection. You don’t have to know it walking in, but you can’t walk in with the mentality that you’re doing this right or that wrong. It’s more of a collaboration. You’re learning from them. Then you go back and do your homework.
ICT®: What’s the question you get most after you do a presentation on this subject?
Heishman: The question I receive the most is: How do we go about presenting the plan on how to create a disinfection and sterilization program? That’s usually my top question. And then: How do you go about it? How do you do these audits? How do you put those together? Putting the business plan together is probably the easy part for me, personally. Just because we’re using data [and] presenting the plan. Putting together the program is the hard part because you have to figure out: Where are all these processes occurring? What are all the regulations and guidelines behind these processes? And then the larger facilities. The more you expand, the harder that is because you are going to see those deviations clearly between different facilities. I think that’s the hardest part; actually putting the program together.
ICT®: Wherever there are departments, there are inevitably turf battles. Is that something infection preventionists who want to follow your guidance and implement a sterilization and disinfecting program have to look out for?
Heishman: It can be. But if you come in with an open mind and let them know you’re there as a resource to help them make their workflow easier [and] to help be their voice for whatever they need, they’re going to tell you what their barriers are. You don’t see that as much. It’s more like a collaborative environment because you are helping them. You’re being their voice and helping escalate the needs of their departments.
ICT®: Is there something I neglected to ask you about this subject that you want your fellow infection preventionists or other health care professionals to know?
Heishman: When putting together a proposal for a program—whether it be disinfection, sterilization, construction and renovation, anything like that—having that data together and having that initial pulse check [is crucial]. What’s actually going on? What’s that gap look like? What’s the impact? Is it on patient safety [and/or] employee safety? How does it tie into those organizational goals and strategic plans? That’s usually the 1 piece of information I like to provide. Then just believe in yourself and your capabilities. Excitement is contagious. If you are excited and passionate and you can show the value in something, other people are going to see it as well.
This interview has been edited for clarity and length.
Diamond F. Infection preventionists will be needed even more after COVID. Infection Control Today®. March 31, 2021. Accessed November 2, 2021. https://www.infectioncontroltoday.com/view/infection-preventionists-will-be-needed-even-more-after-covid