Inside Sterile Processing Leadership: HSPA President Arlene Bush on Advocacy, Certification, and the Future of Patient Safety

As sterile processing continues to gain visibility across health care, few voices are as direct and grounded as Arlene Bush, CRCST, CER, CIS, CHL, SME, DSMD, CRMST, the 2025 president of the Healthcare Sterile Processing Association (HSPA). In this wide-ranging conversation with Infection Control Today^® (ICT^®), Bush reflects on advocacy, leadership, certification, and the evolving recognition of sterile processing as a profession critical to patient safety.

Bush’s presidency comes at a time of momentum for HSPA, with growing membership, increasing advocacy efforts, and renewed attention to the role of sterile processing in preventing harm. “We’re small but mighty,” she said, pointing to the association’s growth and expanding influence. “We’re on a comeback in sterile processing because gone are the days that we’re down in the basement, hidden in our profession.”

Advocacy on Capitol Hill

One of the defining efforts of Bush’s presidency has been direct advocacy at the federal level. She recently joined HSPA leadership on Capitol Hill to push for stronger recognition and certification requirements for sterile processing professionals.

“It was an honor and a privilege… to go to Capitol Hill and tell people what we do in our profession,” Bush said.

Despite progress, she emphasized that awareness remains a major barrier. “Some people have no clue whatsoever what sterile processing is,” she noted.

For Bush, the argument is straightforward. “Your hairdresser has a license. Your barber has a license… but not the person handling surgical instruments,” she said, underscoring the need for mandatory certification.

HSPA continues to pursue state-level legislation, though progress varies. “We are still pushing… because it’s just best practice,” Bush said.

Elevating the Profession

Bush repeatedly returned to one theme: sterile processing is no longer a behind-the-scenes function. It is a clinical, technical, and safety-critical discipline.

“What we do touches every patient, every time,” she said.

She challenged health care leaders to better understand that reality. “Come walk the floor with us and see what we do behind the scenes,” Bush said.

This call for visibility extends to hospital leadership. Bush believes sterile processing must have a stronger voice in decision-making spaces, especially when it comes to staffing, equipment, and infrastructure.

“It really takes someone who can paint that picture for the C-suite… that the need is now,” she explained.

Leadership That Shows Up

Bush’s leadership philosophy is rooted in presence, accountability, and humility.

“Leadership doesn’t end when the clock says it’s 3:30,” she said.

She emphasized that leaders must be willing to step into operational challenges alongside their teams. “If you’ve got time to lean, you’ve got time to assemble,” she said, encouraging leaders to stay engaged in daily work.

Equally important is communication. “Make sure expectations are clear… and ask, ‘What do you need to be successful?’” Bush said.

She also highlighted psychological safety and respect across departments, particularly between sterile processing and perioperative teams. “Stay humble. You don’t know what somebody’s fighting on the other side of that phone,” she said.

Certification and Workforce Challenges

Certification remains a cornerstone of Bush’s vision for the field. She sees it as essential not only for professional recognition but also for patient safety.

“Our certifications mean something,” she said.

At the same time, she acknowledged ongoing workforce challenges, including access to training and the need for institutional support. Bush stressed that certification should not be a barrier but a standard supported by employers.

“We need skilled technicians… eyes and boots on the ground,” she said.

Looking Ahead

As Bush’s presidency enters its final weeks, her focus remains on advancing the profession and preparing the next generation of leaders. She described the role as “the greatest thing I’ve ever done in my career,” reflecting both pride and humility.

Looking forward, she hopes the field continues to build on recent progress, from stronger standards to greater recognition across health care systems.

“We don’t talk enough about the wins,” she said. “We process millions of instruments… we support thousands of surgeries. That matters.”

For infection prevention and control professionals, Bush’s message is clear: sterile processing is not ancillary. It is foundational. And as health care continues to evolve, the need for skilled, supported, and recognized sterile processing teams has never been greater.

Q: What has HSPA been focused on recently?

Bush: It’s an exciting time for HSPA. [Voting is happening now.] Please get involved. This is your time to let your voice be heard and vote [on who sits in the boardroom.] It's a wonderful opportunity to be involved with the Association and a key part of our active membership.

I've had the privilege to serve the president last year, and it's been extremely long morning for me to be involved in the aspect of the association at the president level. And I've already been a board member, a regular member of the Committee on committees. I was a chair for the nomination committees. I had a lot of experience before I ran for the presidency or even for the board of the association.

It's a great way to get involved with our membership, and it's an opportunity open to all of our members of the director's seat, please, open opportunity.

As we gear up for our annual conference in Baltimore, Maryland, from April 25 through the 28th this year. It's my conference as president of our amazing Association, so I'm looking forward to it. Our conference is part of our annual family reunion in sterile processing. We're there to empower people. We're there to learn. We're there to see the latest and greatest in our industry and what it has to offer for sterile processing and beyond. It's not just for sterile processing; we're working with vendors on new products, and everyone looks forward to the conference every single year. We’re happy to see it come around.

I was one of those people who stood in the background during my first conference, and at the second one, I realized, I'm sorry, we don't sit in the background anymore. Yeah, other people might say to me that I should really grab their hand and ask, 'What are you doing right here? Why are you sitting in the back? Let's sit in the front row so we can be seen, heard, and ask questions. But mainly, we want to empower each other. We want to learn—what's in the standard? What are the new changes? What are the new products out in the world? Health care is always changing. It seems like it's changing overnight, right? AI features nowadays are interesting.

Q: You recently traveled to Washington, DC. What was the focus of that visit?

Bush: DC was a wonderful trip. I feel it was extremely fruitful. We had the opportunity to go to Capitol Hill in the Senate to speak to legislators and senators about the importance of employer certification. It's been an ongoing effort—this is our third year visiting Capitol Hill. It’s truly an honor and a privilege for the board of directors to participate in lobbying and learning more about our fantastic profession. I mean, it really doesn't get much better than that. I also had the privilege of attending the State of the Union with Durex.

Overall, it was a good trip. We made great progress; people had meetings all day. We split up, divided, and conquered. It was also valuable to see the new board members gain their first experience in this setting. I couldn't be more pleased with the new members who joined us this year; they did very well, even when put on the spot. They remembered us from last year, which gave us hope

Overall, it was extremely productive, and I'm so thankful for the opportunity to explain to people what we do in our profession. It's amazing—some people have no clue about this work. For example, I tell people, 'I’m the dentist who had surgery.' Your hairdresser has a license, your barber has a license, your groomer has a license, and your veterinarian is licensed. But the person performing surgical procedures isn’t licensed for that, so that's really what our mission was at Capitol Hill. We went there to inform policymakers about what we're doing. Mandatory certification for dental assistants won’t remain in place unless we make the case.

I also want to mention that the entire board, including our strategic planning team, met with Susan Adams. We had a face-to-face board meeting and a session with Capitol staff, both of which were great opportunities to connect.

States are really discussing issues related to climate effects. We’re making significant media efforts, particularly in states that are still developing legislation. Florida, for example, has introduced a shortage-of-legislation—an industry shortage—that’s unusual. It's usually impossible to get a bill through in Florida in just 60 days. Sometimes even the newspapers move faster. It’s very challenging to pass legislation there within such a short window, and I was surprised to learn this. But I also had the chance to meet other newcomers this year—people new to politics and different offices—which is always good. Sometimes you need fresh faces. Overall, the trip was extremely fruitful. We are still working on multiple states, and we don't want to forget the huge progress made last month. Throughout my time with the association, we have always pushed for required certification—it’s been part of our mission at HSPA—and we will continue to advocate for it. Required certification in every state remains a priority because it's best practice.

Q: Why is certification such a central issue for the profession?

Bush: Because what we do matters. Our certifications mean something. We work hard for them, and they represent real knowledge and skill.

I think that's where our association is heading within the mission. Like I said, with the required certification now part of our membership, we'll have over 70,000 certified voters before the end of the year, which is huge. We've seen significant growth in our membership. We're small but mighty, and we're making an impact.

We've been on a path in sterile processing, honoring the days we've spent in the basement and shining a spotlight on our profession over the past 5 to 6 years. The untimely pandemic really tested our profession, but it also helped us establish some much-needed standards, especially for water quality, materials, fabrics, and tattoos. Previously, we didn't have standards for tattoos or tattoo guns, which is a huge development. In the dental field, we've made significant progress with standards for processing instrumentation, as it was largely unregulated before.

Q: What do you want hospital leaders to better understand about sterile processing?

Bush: The one message CEOs need to understand is that what we do is critical. Without us, delivering exceptional care is impossible without sterile processing, and you need educated, skilled technicians, [with] eyes and boots on the ground, to perform suction, servicing, and ensure every patient is cared for every time.

I need stock to serve any patient with the right instrumentation. We need the right people engaged, and I need staff to do it. I can't manage this with just skills during a break, and everyone must understand that our work impacts every future

CEOs should walk the floor with us and see what we do behind the scenes, handle the volume that comes through here, and understand what technicians must know to thrive—not just survive—in sterile processes. I challenge CEOs to spend a day in front-line shoes, to see firsthand what we do.

We may not be aware of what CEOs do, but they need to know what we do and what happens when we don’t. It’s not just a matter of routine; it could be someone visiting a loved one or other critical activity. If you don't have the right instruments or skills, that’s a serious risk. Medical errors often affect our own families. Therefore, I need you to understand our work and support me in the boardroom by advocating that sterile processing is doing A, B, and C, and emphasizing that skilled technicians are essential. Perhaps we should require certification for departments handling trauma.

Sterile processing impacts more than just our daily routines. It also affects the patients we have the opportunity to see, and that's what makes it rewarding. When there's a case that was flawless and resulted in a great patient outcome, allowing them to go home earlier, that's when we know we've succeeded.

We often focus on the defects, right? But we tend not to celebrate the wins. We don't usually mention completing 9000 surgeries in a quarter or processing 4 million instruments during that time. Instead, we focus on setbacks, not achievements. The key is volume- more surgeries are being performed, though the pace is slowing down.

Meanwhile, procedures are becoming more minimally invasive, which means creating more instrumentation to reach places we couldn't before. We need to adapt to this and keep up with our education, whether you're a technician, leader, vendor, or anyone involved in surgery, by continuously enhancing your skills, staying focused on the patient, and maintaining your determination.