By David Taylor, MSN, RN, CNOR
Literature shows that certification can advance the knowledge and expertise of an individual. Having increased awareness and knowledge about one’s job can have a direct impact on patient safety and directly impact the care patients receive. Current practices, a lack of education and training along with engineering factors are what keep central sterile/sterile processing departments (CS/SPD) from being a high-reliability department. In nearly every state your dental hygienist, dog groomer, hair dresser, barber and tattoo artist are required to have a license or, at the very least, complete a training course or pass a competency exam in order to enter the occupation.1 At the time of this publication only four states require CS/SPD technicians be certified, New York, New Jersey, Connecticut and Tennessee. Two states, Massachusetts and Pennsylvania, have introduced similar legislation in February and June 2017 respectively.2 The knowledge and skills of the CS/SPD team members are critical differentiators, yet many organizations put little emphasis on developing their staff. In some CS/SPD, only a small subset of core team members can support the instrumentation used in all procedures, which can have a negative effect on service to procedural areas. Effective perioperative leaders understand the availability of continuous staff education as an essential leadership technique to improve services and care for patients. Education is a key factor in a CS/SPD success, yet far too few health care organizations invest in their employees’ education and training. If you are a registered nurse (RN), organizations have well-defined career paths and opportunities. However, for the typical CS/SPD staff member these opportunities are far and few between. Often, they receive on-the-job training (OJT) from the staff member who happens to be present on that particular day or shift. In addition, the staff members doing the training may have never been to a preceptor training course or have the knowledge necessary to develop educational development plans. This OJT by whomever is available for that day and the dilution of knowledge from one staff member to another is why so many CS/SPD departments fail. Staff lack the basic skills and the only thing they are told is to hurry and get these instruments turned over.
The first step in developing a staff education program is for the perioperative director to evaluate current team members’ capabilities. Because there are so few official CS/SPD training programs, and the majority are trained on the job, grouping team members with similar skill levels will help perioperative leaders establish a base line and begin developing a state-of-the-art, evidence-based education program that is efficient and cost-effective. Areas to focus on could include effective onboarding and orientation programs, creating a competency-based training program, cross-training initiatives, regularly scheduled in-service and education days, as well as “train-the-trainer” programs that create subject matter experts (SME).
A SME could become part of an educational team that might include lead or service line coordinators. Advanced transformational learning approaches can help team members take greater individual responsibility for their professional development through certification. An individual who dedicates time to certification can have an influence on their peers to be accountable for their own practice and self-development. A next step in educating team members is to provide preceptor training to individuals who are interested in precepting new employees. Effective preceptors are important because their efforts can cut employee orientation time dramatically, ensure that the same training standards are applied to each employee, and eliminate variables in training. This type of approach allows staff members opportunities to review their current practices and revise them as needed, thus avoiding faulty assumptions and costly errors.3
In addition to investing in educational development programs it is equally important to provide opportunities such as professional conferences and memberships in professional organizations. This can be very effective because it provides incentives to employees who seek to improve their individual practice. These incentives can also encourage more team members to take an active role in their department and encourages others to become active in professional organizations, seek certification or be the next staff member to attend a regional or national conference.
Health care organizations that have done away with department-based educators should strongly consider reinvesting in an experienced, master’s-prepared perioperative educator to lead their education, training and development programs. A dedicated educator can be a tremendous asset by bridging the OR and CS/SPD departments and allow team members to master service-related activities. At the very least, the educator can be a resource that reviews the latest guidelines and helps retrain employees who are affected by constant changes in the industry. The cost of this full-time-equivalent can be offset by reducing orientation times and help avoid reimbursement issues related to problems associated with instrumentation cleanliness, preparation and sterilization, which can have a direct impact on procedure times, surgical site infections (SSIs), extended lengths of stay (LOS) and other complications.4
Only a handful of organizations have developed clear paths for their CS/SPD employees. Developing opportunities such as career ladders, certification prep courses and offering reimbursement and financial incentives for those who become certified can create higher reliability that is embraced from all levels of the organization. By creating an environment that promotes education, safety, accountability and collaboration, organizations can mitigate failure and optimize innovation that improves the delivery of safe and effective care, while avoiding the barriers that prevent CS/SPD from achieving high performance.
No longer can hospitals afford to neglect the importance of their central sterile/sterile processing departments. The role it plays is just as important, if not more, than the procedural areas it supports, and today’s perioperative leaders play a critical role in whether CS/SPD is successful or not. Quality is what drives today’s health care business, and forgoing quantity has huge financial ramifications for the health care industry and the organizations struggling to keep their doors open or provide the same level of services to their communities. Although sterile processing is often misunderstood, it plays a critical role in today’s health care environment. Hospital administrators and nurse leaders who are responsible for CS/SPD areas must understand the value of proactively managing the day-to-day operations not only to improve performance but to proactively prevent the transmission of dangerous and sometimes deadly diseases, healthcare-acquired infections, or become the latest segment of a national news story. Formal education and the development of an effective educational process is one way to mitigate these risks. Investing in the training of employees while monitoring performance can be the keys needed to open new opportunities while improving quality, safety and financial performance.
1. Torpey, E., September 2016, Will I need a license or certification for my job? https://www.bls.gov/careeroutlook/2016/article/will-i-need-a-license-or-certification.htm Accessed January 26, 2018.
2. International Association of Healthcare Central Services Materiel Management https://www.iahcsmm.org/advocacy/legislative-map.html Accessed October 17, 2017.
3. McNaron ME. Using transformational learning principles to change behavior in the OR. AORN J. 2009;89(5): 851-860.
4. Taylor, D.L., Surgical Services Leadership: Insights, Priorities and Tools for Managing Change in the OR, AORN Journal July 2014, VOL 100, NO 1.