Infection Control Today - 09/2004: Perspectives

September 1, 2004

TheBest Kept Secret in the South

By Becki Jenkins, CST, RCST, CRCST, FEL

That is the credo of the NorthMississippi Medical Center (NMMC) in Tupelo, Miss. Janet Tidwell, RN, MSN, CNOR,administrative director of surgical services, aims many accolades toward hercolleagues. Kim Davis, who is the department manager of the central sterile (CS)department at NMMC, recognizes her staff as the stars they are ininfection control and sterile processing customer service.

As a consultant to healthcare and to industry, I am oftenfaced with having to tell my colleagues that some of their processes areerroneous or need work to get them up to standards of practice, and this is notthe fun part of the job. It is often met with opposition and althoughrecommendations are accepted for the most part, it is with a degree of perceivedpersonal offense rather than raising the consciousness to the best practicethat best supports the common positive patient safety goals.

I was asked to help NMMC with a few of their process issuesthey felt needed tweaking. I was expecting the usual initial hesitancy to allowan outsider to come in and dissect daily processes one by one to see where itcould be improved, stay the same or completely changed.

I was unexpectedly surprised by the anticipated reception.

Tidwells attitude of lets work together makes aconsultants job much easier. As Tidwell and Davis took me through eachprocess and discussed openly with me the different areas of concern, I began torealize that this was a group of dedicated, team-oriented people. As the visitprogressed there was opportunity to speak with the central service staff,operating room (OR) nurses and the surgical technologist. Each area of expertiseseemed to express the same team concept in word and in deed.

At the end of the first day I realized that this hospital wasawesome. The job of addressing their issues would be much easier because oftheir obvious support of one another as they embarked upon caring for theirpatients each day. I realized this hospital indeed was the best-kept secret inthe South as I pored over the processes that NMMC wanted me to look at: prep andpack; instrument usage, damage and loss; communication development between ORand CS; staff education; and record-keeping for CS.

The organization of departments was impeccable; this includedtwo areas that were off-site but supported by this very large hospital. Prep andpack had a tremendous tracking system in place which allowed for a complete viewof the daily workings in CS, on-site and off-site. The infection controlconcepts that were implemented daily seemed effortless to this CS staff. It wasclear they were looking for a way to increase their level of patient care ratherthan trying to get to a basic standard. This was a family working together for acommon goal patient safety.

In the investigation period there were only two areas thatneeded more intensive attention instrument damage and communication betweenOR and CS that included issue resolution. These are very common needs in manyOR/CS departments across the country. The OR does communicate with CS, butusually on a need level rather than working together to solve issues on bothsides. All too quickly, this kind of relationship can foster feelings offrustration and an overall opinion that CS is there to be seen, not heard, anattitude of Give me what I need but dont talk to me about it. Inaddition, instrument damage or loss is thought to happen only in CS. These areerroneous views that can be costly in:

  • Lost revenue in replacement or repair of instrumentation

  • Lost morale and decreased productivity related to lack of appreciation and recognition, leading to frustration and bad attitudes

  • Higher rates of hire related to low job satisfaction

  • Overall decrease in patient safety directives or concerns

There was a meeting set to discuss how to solve the mainissues of concern. Each area of service orthopedics, general surgery,neurology, plastic surgery, ophthalmology, and ENT had a team leader thatwas asked to attend. The expectation was that there would be the need to mediatebetween the two factions in the OR and CS a common occurrence whereprocesses need to change on both sides to get the job done. With great surprise,this wonderful group of people came to work with attitudes that made workingwith each other very easy. They asked many questions and heard the answers. Theprocess toward making their already wonderful programs work better was underway.These individuals believe in working together to obtain a common goal of thevery best patient care. They came together and began to employ facets of therecommendations for better communication and instrument care/handling that wouldmake their operations run much more smoothly, such as:

  • Development of a survey form between OR and CS so that issues could be addressed without pointing fingers, but stayed along the lines ofpositive moving resolution of processes that needed improvement in CS that wouldhelp the OR.

  • Development of a survey form between CS and OR that would be used to help OR complete their processes with CS processing requirements in mind.

  • Development of CS team specialist that would mirror thosein OR so the OR leaders had specific expert go-to persons when they needed help. This is critical to reducing frustration and lost time in trying to find someone who knows what you need to know. The CS team would remainuniversal but be expert in one area as a resource to OR and to CS.

  • Development of a physician forum that would allow OR, CS and surgeons to work together concerning realistic turnaround and case block times.

  • CS team tours of OR so the CS can understand the processesthat are needed to make the operations in OR go smoother. It is recommended thateach CS employee see a surgical case so that the CS employee can see howcritical it is that sets are ready, put together correctly and with all piecesfunctioning properly. It is important that CS staff see how their work canpositively or negatively impact patients. If this were truly understood, therewould only be certified registered central service technicians (CRCSTs) in CS. CSpersonnel are not the glorified dishwashers that infection control andproductivity managers think they are. CS is the single most ignored and leastunderstood department in hospitals today, but it is the most critically neededfor all patient care. This cycle of ignorance must change.

It was a joy to work with this spectacular healthcare team.Its members care about their patients, each other and their doctors. Anyadministrator would be proud to have them on their team.

Additionally, it was good to hear that those in CS who werenot certified were studying for or getting ready to be certified as centralservice technicians. This was largely due to members of management that supportedtheir staffs efforts, and celebrated and appreciated their excellent work.Now, these staff members have certification as a part of their professionaldevelopment, coinciding with the goal of the best possible patient care.

I left NMMC wondering how I could bottle them and show them toas many healthcare systems as possible as the shining example of positivepatient and interpersonal relationships between staff and departments that theywere.

It was a pleasure to work with this great staff ofprofessionals. I share them with you so everyone can see that if we worktogether, our patients can receive the very best care we can deliver. If wecould get on the same page with positive patient-care directives, what awonderful thing that would be.

Becki Jenkins, CST, RCST, CRCST, FEL, is president/CEO ofSterilization by Design, Inc. in Indianapolis.