Short Staffing Can Trigger Risky Shortcuts

May 1, 2002

Short Staffing Can Trigger Risky Shortcuts

Short Staffing Can Trigger Risky Shortcuts

By Craig Robinson

Editor'sNote: This article is part one of a three-part series focusing on staffingissues in the central sterile department. The rest of the series will appear onour Web site, www.infectioncontroltoday.com,in June and July.

In today's healthcare environment, hospitals must find effective ways to domore with less, including resolving staffing issues. Forced to contend withnumerous financial challenges, hospitals are hoping to boost their bottom linesby reducing expenses and trimming staff. Does a reduction in staff within thesterile processing department have any direct bearing on patient care, surgicalprocedures and safety?

"You bet it does," claims Wade Collins, director of sterileprocessing at Texas Scottish Rite Hospital for Children in Dallas. "In thesterile processing department, there are many tasks that require an assuredlevel of skill," Wade adds. "The main objective is to provide theright item to the right place at the right time and in the proper condition. Thequality of work performed in sterile processing must be of the highest level atall times."

The effect of reduced staffing on job performance in sterile processing isevident. Some staff members are in positions of management without the benefitof adequate training. They are promoted based on tenure, not on their technicalknowledge necessary to guarantee the quality of work.

"All sterile processing staff should have the benefit of technicaltraining, so that quality standards are consistently met," Wade says.However, if the department is short staffed, how does one find the time toperform necessary training to maintain quality?

Quality is defined as "a degree of excellence." During the years,we have seen many changes in the arena of quality management. We are familiarwith the terms total quality management, quality circles, quality assurance,quality control and performance improvement. Since sterile processing plays acritical role in maintaining quality at every level, this department should bepart of a hospital's quality management team.

"This department is responsible for cleaning, decontamination,inspection, assembly, wrapping, sterilization, storage and distribution ofreusable patient-care items, ranging from feeding pumps to surgicalinstrumentation and implants," Wade says. "It is a job requiringattention to detail and the technical knowledge necessary to consistently ensurepatient safety."

When the sterile processing department is short staffed, disastrousconsequences can occur. When running full tilt, the staff becomes stressed outand shortcuts are taken to keep up with the workload. It is these shortcuts thatcan lead to patient harm. An example of a dangerous shortcut is assuming asurgical instrument tray had not been used, strictly by visual signs, and notsending it through decontamination.

"Decontamination is more than cleaning for visual effects," Wadesays. "It is the reduction/elimination of microbial life, those verymicrobes that can prolong a patient's stay or maybe cause death."

Another example of a risky shortcut is not changing the sonic wash wateruntil the end of the day. This results in the possibility of the wash watercontaminating the instruments with bio-burden. Other shortcuts involve the hastyassembling of surgical trays, resulting in missing instruments. An excusecommonly used is that there was not enough time to look for a replacement. Inthe sterilization area, loads may be pulled out of the sterilizers too quickly,not allowing for adequate drying and cooling.

These examples point to a lack of time for proper training, rapid turnover,as well as unmotivated, underpaid and stressed healthcare workers.

Efforts must be made now to address these issues. This three-part series ofarticles will address how various hospital departments -- including surgery,infection control, emergency and materials management -- are affected bystaffing problems in sterile processing. The series will discuss solutions thatwill help move the sterile processing department into the forefront in thecontinued effort to maintaining quality in the healthcare environment.

Craig Robinson is president of Medsupport Solutions, a marketing andconsulting division of Careforce, Inc., a Dallas-based healthcare staffingcompany focusing on nursing and sterile processing staff. Robinson has worked insterile processing departments for more than 15 years, specializing indepartment flow, equipment solutions and continuing education.