By Kris Ellis
Last June, the New Jersey HealthcareAdvisory Board approved the first regulations in the United States requiringcertification for central service (CS) professionals. Viewed by most as a triumph for the profession, New Jersey hasset a precedent that could potentially influence the way CS operates for yearsto come.
Though ultimately rewarding, the process of developing theregulations and guiding them toward approval required a great deal of patienceand diligence. Getting the rules passed was a long and arduous task,recalls Anthony T. Monaco, MA, coordinator for New Jerseys Department ofHealth and Senior Services, who has been a central figure in this effort. Ittook longer than I expected, not because of external factors, but because thebureaucracy in our system delayed it almost a year and a half.
Monaco explains that three years elapsed from the time thatthe regulations were completed to when they were officially enacted. Thatssomething important that CS directors and other people in the industry need tounderstand every state government has its own bureaucracy that holds thingsup, and it takes extremely long periods of time to enact any laws, regardless ofwhether or not theyre CS rules and regulations.
The review period involved legal review, department review,and governors review, after which the proposed rules went to the Office ofAdministrative Law, where they were prepared for publication. The public and anyinterested parties then had the right to comment on the proposed rule. Thenwhen the proposed rule was published, we had to respond to every comment thatwas received,
Monaco explains. If there were any substantial changes, ithad to go back out for comment again. We did get a number of questions andcomments, and we had to answer each and every one of them. Each one had to be prepared, each one of them had to go through the whole reviewprocess again, and then they were finally published. So, the bureaucracy withinany system is a cumbersome thing.
When an outside group is lobbying to have state governmentenact something like this, thats one effort, and its a major effort,Monaco continues. But then once the wheels start turning and you startworking on rule development, that whole process takes time in itself. Thatsimportant to understand if somethings proposed today, it may be a year ortwo years before you actually see it enacted. The importance of that is once arule is enacted, it carries the force of law; if you dont meet it, then thereare consequences, so it has to be right on target.
Although the new rules are currently still in theimplementation phase, Monaco has established procedures for inspection. WhenI go in to do an inspection, I get a list of all the employees in CS who areprocessing within the hospital, he says. You may have some OR techs thereprocessing upstairs, doing decontamination, and they would have to be certifiedas well. We get a list of all those employees, the date they were hired, andwhether or not theyre certified. Any new hires after the rule, which wasadopted Aug. 2, 2004, have three years to get certified. Anyone who was hiredbefore the rule was enacted has five years.
The time frames in which technicians and managers are requiredto obtain certification were carefully considered before being established aspart of the regulations. We did that for a couple reasons, Monaco explains. First,to give them the opportunity to pass the exam; were bending over backwards tomake sure theyre not going to lose their jobs for failing to pass the exam thats one of the major things. Two, you have to give them time to get thetraining and study groups and all of that to pass the exam, so right now a lotof courses are going on in the state of New Jersey. This is our first year, andalready weve seen an increase in tech courses in the state, and thats apositive thing. There are more courses being given, and we have betterattendance at the courses.
Under the new regulations, CS professionals in ambulatory caresettings have two years to obtain certification. All ambulatory arenas arerequired to have at least one CS technician. We wanted to give them someformal training in reprocessing, but what we found is that theres such adifference in what is going on in ambulatory care, Monaco says.
If you have an eight-room OR, their needs are going to bedifferent from a family planning clinic. So were trying to develop trainingprograms specific to their needs and certify them in ambulatory care.
Monaco certainly understands the work involved in such aneffort as well as anyone. You need time to get systems up and running and forthem to be effective, he says. Then once you have everything up andrunning, you need to have a continuing education (CE) program out there that cansupport the number of FTEs that are going to need CE credits over the next fiveto 10 years. You also what them to be meaningful programs that target theirneeds, especially for ambulatory care.
Its a big project and theres a lot of work to it.Hopefully, it will result in a better understanding of processing and we wonthave as many problems as we have today.
New Jerseys certification law, in my opinion, will godown in CS history as a major event in raising the bar of our profession,says Don Gordon, CRCST, FCS, president of the International Association ofHealthcare Central Service Materiel Management (IAHCSMM), and central servicenetwork director for North Bronx Healthcare Network. My view of mandatorycertification is all positive, and I think it will only add to the status of CSpersonnel, raise the quality of care for patients, and in the future, increasesalaries of those working in our field.
Gordon explains that certification in other professionsdocuments the capabilities of the practitioner and establishes expectationsabout the level of performance within those professions. Certificationassists in developing standards within an industry, he continues. Trainingprograms with a standard curriculum are developed for those that wish to enterthe industry. Certification is also an indication that one has attained acertain level of achievement. Certification also leads to continuing education.
In a fast-changing field such as CS, one must be kept up todate on a number of topics and techniques. Maintaining certification requirescontinuing education and this is one of the important aspects of mandatedcertification. It requires an individual to continue his or her quest forknowledge.
Gordon contends that lack of certification in the CSprofession affects existing and future professionals in that it contributes toparticular areas of concern in the field. First, CS professionals are notalways given the same respect as others in the hospital/medical field, hesays. And second, compensation is generally lower than in the related fieldsthat do require certification.
Additionally, state-mandated CS regulations are now seen as aviable option for those in other parts of the country. When New Jersey passedthe law mandating certification last August, it set a precedent for other statesthat have already started their voyage toward mandatory state certification andgave hope of the possibility that the sterile processing personnel in theirstates will follow suit, Gordon says.
Monaco has also been particularly encouraged by the interestother states have recently shown in considering similar regulations. I thinkother states are using the New Jersey model as a stepping stone for themselves,which is very proactive, he says. Its something thats needed CSis so important to infection control and to the hospital.
In New York, Gordon has been part of the effort to advocatemandatory certification for several years now. We have been on this roadtowards mandatory state certification since 2001, when the various statechapters met in a Dennys restaurant in upstate New York to form a stateassociation to organize and set up a plan for achieving this important goal,he recalls.
Other states have also been inspired by New Jerseyssuccess. After hearing the news, Texas entered into the hunt, where 18 CSprofessionals from across the state met to discuss the issue of mandatorycertification, Gordon says. Those in attendance believed they would not beable to present a unified front at the state level without representation of aformal effort of all CS professionals in the state. As a result, like New York,Texas decided to form the Texas State Association of Central ServiceProfessionals. As in New York State, the new association provides an opportunityfor all CS personnel, regardless of their association affiliation, to becomeactively involved in achieving mandatory certification in their state.
Monaco suggests that those in other states who are interestedin advocating for CS laws or regulations first become familiar with theintricacies of their state bureaucracy and the important players therein, aseach state has different policies and processes. For example, whereas he wasdealing with state regulations, in other states, actual legislation may be thecorrect vehicle. In either case, healthy amounts of patience and determinationare certainly recommended in supporting and advocating for this worthy cause.