Special Edition on Sterile Processing Imperatives Special Edition- Sterile Processing Imperatives | Page 19

time, staff and resources needed to ensure that their work
is performed correctly. We must put into place the quality
assurance framework, because if technicians do everything
they know they should – from proper decontamination,
cleaning and sterilization, to leak testing, visual inspection,
and validation — now they have an
objective measure that says ‘We met
this goal, and if we didn’t, it is about
I think the root the testing and not about the individual
not doing a good enough job.’ If
of successful and
you are looking through a borescope
sterile processing and you see damage or bioburden in
scope, now you have an objective
is to empower a measure
that I’m hoping will empower
professionals to technicians to take a stand and do what
secure the time, staff is right for the equipment and for the
patients. I hope it also protects them
and resources needed in the case of an opinion battle, where
to ensure that their they might say, ‘I tried to get it clean
and it won’t come clean, and I think the
work is performed scope is damaged.’ Let’s blow it up with
correctly.” a magnifying glass or a camera to show
to decision-makers that it is not intact,
we cannot get it clean, so it failed the cleaning verification
test, and here are the numbers. It makes sense to me to put
in place the basic framework of quality assurance. After all,
we have been doing it in sterile processing for a very long
time. We must also conduct our quality assurance processes
through the framework of infection prevention, and they
will highlight where we have issues. Say you conduct a test
for organic soil, and it comes back positive – most would
say that the technician failed to get it cleaned. I want to
see it as a shift to, ‘Fantastic, we just identified a situation
where the soil did not come off easily.’ We should celebrate
when a technician notices that a scope is damaged or
retains debris. It’s probably not about what they did at that
moment, but it is about validating a procedure and, in the
process, perhaps identifying a scope that is old and beat
up and removing it from inventory. If all quality assurance
pillars are conducted every time, it will provide the sterile
processing department with the data that can be shown to
hospital administration to make the argument for additional
resources and personnel.

HHM What do you believe is the biggest barrier
to implementation science in the sterile processing
department?

CO:  I think it is the lack of institutional and provider buy-
in. These technicians are located in the basement and tend to
be treated as sidelined individuals. They are not provided with
what they need, yet they work in a department that is the
foundation of patient safety.  They tend to be under-staffed
and under-resourced because in many healthcare institutions,
all emphasis is placed on the ‘front of the house,’ so to speak.
The hospital may be beautiful in the front of the house,
but its hidden sterile processing department is not nearly
adequately staffed and resourced to function properly. We
have these hard-working individuals that are literally down
in the basement of the hospital. They’re doing everything
they can to handle their workload stemming from procedure
volumes that are increasing, doing so with inadequate tools,
supplies, education and training. They are often working
in a hostile environment, socially and financially. So, if
you have people working in unpleasant spaces, wearing
uncomfortable personal protective equipment, working
with smelly, hazardous chemicals, bending over sinks and
lifting heavy equipment and performing repetitive motions,
and then you ask them to perform complex tasks rapidly,
and many of them are being bullied, you are going to have
massive turnover and performance problems.

HHM Can increased education and training help at all?

CO: I wish education and training could turn this around,
but I don’t think it will. I think alone won’t work because it
is not in touch with the reality of technicians’ predicament
and the managers being under-resourced.  It makes people
stressed out and they then feel like they can’t do the right
thing. In my view, we must step back and ask ourselves, how
do we create an environment where it is easier and more
rewarding to do the right thing. We must turn it around so
that we are rewarding technicians if they identify a scope
that is not clean or a surgical instrument that is damaged,
instead of blaming them. Until we’ve created an environment
where we emphasize quality, I just don’t think education
and training will work. 

HHM What is your opinion of the role that certification
and competencies play?

CO: I am in favor of certification. Sterile processing is a
profession requiring an incredible level of competency and
attention to detail, so certification is essential. Here’s how I
see the lack of certification playing out: We have conducted
many studies and worked with frontline staff, and let’s look
at an example relating to vaccination. In a healthcare facility,
medication is administered by a licensed nurse or a certified
medication technician, both of whom receive specialized
training, practice it, are tested on it, and must maintain
competency. Say one of these nurses or technicians starts a
new job working in a clinic, hospital or nursing home, and
the manager instructs that individual to administer flu shots
to 200 people. He says, ‘Here is one vial of medication and
one syringe and needle.’ The nurse or technician should say,
‘There are 200 people, so I need 200 syringes and needles.’
If the manager says ‘No, we just use the one syringe for
everyone,’ the nurse or technician should say, ‘No, I cannot
do that because it is a patient safety risk.’ And the manager
says, ‘This is how we’ve always done it and we have never
had any problems; if you want this job you will do it this
way.’ Hopefully the nurse or the technician would say, ‘No, I
have been trained in proper procedure and I am not willing
to break the law and do that; it is not up to standard and it is
a patient safety risk. I will also report you to the state.’ In the
vaccination world, this scenario actually happened. You would
hope the people who have training would have enough
knowledge, commitment and dedication to the profession
to be able to stand their ground for what is right and proper.
They know what the standards are because they have been
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