21 Jul How Lifelong Learning Impacts Sterile Processing
5 Key Points
- The OR leader must have a thorough scientific understanding of sterile processing
- The amount and complexity of instruments processed by SPD has dramatically expanded over the years
- C-suite should think of SPD as an integrated part of surgical services
- When making decisions about purchasing new equipment, SPD should be included in those conversations
- SPD clinicals should be completed in a large OR to get applicable experience
Full Conversation Below
What is the impact of life-long learning in sterile processing on patient care?
Lifelong learning is distinguished from the concept of continuing education. It can be best described as being a voluntary process with the purpose of achieving personal and professional fulfillment and can be the product of both informal or formal education. On a personal level, one finds themselves self-motivated to improve some aspect of their life. Professionally, it inspires a natural progression of learning that takes place over time whether it be the interactions with others or the world around us. The pursuit of gaining knowledge can have a profound impact on our lives and those around us. The level of education, experience, and comprehension of sterile processing professionals, can be one of the key factors in the delivery of safe quality healthcare or an organization making headline news for negative patient outcomes. Hospital administrators need to understand that SPD is just as important as the areas of the hospital it supports. Regrettably though, far too few hospitals make an investment in developing their sterile processing staff.
There are many things hospital administrators could do to invest in the lifelong learning of their SPD staff. Investing in a dedicated educator in SP that employs broader educational programs will enhance both new and tenured staff. An educator can develop competency-based training programs that ensures employees know not only the tasks of the job, but the science behind what they do. An educator can also enhance cross training initiatives that give SPD leaders greater flexibility to deploy employees where the greatest needs are for the department to function at a high–level. Additionally, implement a no–cost certification program that builds SPD staff’s confidence and provides recognition for their efforts. Support and encourage professional conference attendance (local, regional, and/or national) so SPD staff can network and learn from other experiences. Lastly, supply memberships into professional organizations. All these incentives build on the concept of lifelong learning and can improve employee satisfaction, retention, and reduce the risk of becoming headline news.
How does one enter the sterile processing field? What education is required?
Very few formal SPD educational programs exist throughout the U.S. A handful of health career high schools have developed official training programs which include a didactic, lab and clinical component. Most sterile processing personnel entered the career field with little or no healthcare background. It is unknown what the education level is for the majority of those working in SPD. Based on my years as a surgical services leader, a sizable percentage have high school diplomas, followed by those who obtained their GED. A smaller percentage have obtained some college education, and fewer have graduated college with a degree. Those who have obtained college degrees, in my experience, have left healthcare to pursue a different career path.
Typically, those entering the profession did not plan on a career in SP with one exception. Surgical technologists, who are looking for a career change for various reasons and want to stay in a healthcare related field. A large majority of SPD staff come from diverse backgrounds and career fields, often applying to a job posting for this department. I have seen many of the open positions filled by environmental services (EVS) personnel. EVS personnel hired for a position in SPD can increase their hourly wage, and although the increase is nominal (in some case just $0.25-.0.50/hour) it provides a career move they would not have had in their previous department. Those individuals hired into SPD are often trained on the job. It is not usual for employees with no educational background or training as preceptor to orient and train new SPD employees. They are told what to do and how to do it, but never educated on the “why” and science behind what they do.
How has technology changed the nature of sterile processing?
When I began my career in surgical services, sterile processing was a part of my daily workflow. At the end of the day, we handled reprocessing for our own instrument sets. If I did not properly reprocess the instruments I used, it would have a negative impact on the department the next day. There was a sense of accountability because we saw first–hand the end results of our work. Over time, the scope and responsibility of sterile processing increased and became a separate department with its own management team and most of them continue to report directly to the OR. When this transition occurred, hospitals created two distinctive teams, each with separate roles and responsibilities. Because each unit had competing agendas, concerns about quality began to emerge, accountability changed, and it became more difficult to trace issues back to the source.
Another change is that we have more instrument sets than before because of the technological advancements in surgery. When I would circulate a procedure during the 80s, my surgical back table was approximately six square feet, roughly 3 feet by 2 feet. Now, it is common for the back table to be 3 feet by 9 feet and be multi-tiered. Artificial intelligence, machine learning, and the robotics industry are also moving forward rapidly. When these advances transform procedures, it also transforms SPD. But the challenge is that SPD is usually an afterthought.
What can the C-suite and other administrators do to better support sterile processing more effectively?
To think of SPD as a separate but an integrated unit within surgical services. It is much more than just cleaning instruments. Sterile processing departments handle thousands of reusable surgical instruments and devices — ranging from knife handles and forceps, to arthroscopic shavers and fiberoptic endoscopes — daily. And each one of those items requires meticulous care to ensure they are cleaned and sterilized properly for reuse. The consequences can be disastrous for patients, staff, clinicians, and the organization when SPD does not have the resources to complete the job as intended. If SPD cuts corners and a soiled instrument is discovered before it is used on a patient, there could be procedure delays while the healthcare team waits for new instruments, resulting in costly delays. For example, when you think about how much you can lose or gain per minute in an OR, and when you consider that surgical services contribute upwards of 60% of a hospitals margin, much can be lost in terms of revenue when SPD and the OR do not work harmoniously. Administration will often use OR minutes as a unit of measurement for SPD’s budget. This often puts SPD is a tricky situation when they measure productivity in that department. Transferring OR minutes to SPD does not measure up equally and often puts the SPD leaders in a difficult position. What is often not understood are the differences between the surgery department and SPD. What might take a surgeon an hour in a surgical procedure using 10 instrument sets, is 30 hours’ worth of work for SPD. When you measure out the number of FTEs necessary, that equates to 5 employees working 6 hours to reprocess the sets from that single procedure.
It is also critical for administration to include SPD in the decision-making process when the OR and procedural areas are considering the purchase of new equipment. With dozens of healthcare organizations making headline news for not properly terminally disinfecting and sterilizing reusable equipment and instrumentation, experts all agree that there is an increase in the number of cases where improperly processed instruments are reaching the patients causing significant injury and even death. One of the main reasons is changes in technology. Before the introduction of minimally invasive surgery, most of the instrumentation used in surgery were made of stainless steel and reprocessed with standardized methods. Today, instruments for procedures ranging from colonoscopies to robotic-assisted laparoscopic surgery, are more complex and often have movable parts that require disassembly before the narrow channels can be cleaned.
As an example, if administration is considering the purchase of a $2 million-dollar robot, they may want to engage with an SPD professional who will know what will be required to clean those robotic arms. Administration may not know that it will take specialized cleaning equipment that can add a significant dollar amount to the initial purchase, as well as an increase in the SPD budget to manage the newest technology.
What can a Director of Surgical Services do to better support sterile processing?
A director should know the intimate details of running an SPD. Having these skill sets can have a profound impact on the overall health and safety of the community, as well as improving the bottom line. With the average cost of running an OR at $62/minute, a 60-minute delay can cost a hospital approximately $3,720. Add in a 30-minute delay for missing instruments, and that just increased your loss to $5,580. If this happens just four times a day, a hospital could be losing $669,600 a month. Multiply that by a year and the losses could be in the millions of dollars.
What kinds of certifications are available in sterile processing?
I know of two certification programs: IAHCMM and CBSPD. I have experience working with excellent people who have had either certification and they do quite well in their careers. However, in the last few years I have found that IAHCSMM is becoming the industry leader in SPD because they, generally, have the most engagement in the SPD community.
Unfortunately, only 4 states (Connecticut, New Jersey, New York, and Tennessee) have certification requirements. Obtaining these by-ins from legislators has been an uphill battle and taken years. It is difficult to understand why the healthcare industry and legislators are not making certification requirements a national standard. When you consider nearly every state requires a barber and hairdresser, tattoo artist, and dog groomer to have a license, certainly legislators would think individuals reprocessing critical items that enter body cavities would at least require a certification. SPD is a job that requires unique skills that at present cannot be done by machines alone and is often looked down upon and not seen as important. My view is SPD is one of the most important departments of any hospital or ambulatory surgery center (ASC).
How do tuition costs and community access, particularly in rural areas, impact the advancement of sterile processing?
Tuition costs and access to formal learning environments are often out of reach for most people seeking a career in SPD. Living in a rural area makes it even harder. Across the U.S. there are currently 1,844 rural hospitals and 1 in 4, or 25%, are at risk of closing. Most SPD employees make minimum wage and cannot afford tuition costs unless they are subsidized by their employers. Because so many SPD technicians are trained on the job, healthcare institutions are not investing in the lifelong learning of their SPD employees.
What are your recommendations for lifelong learning and educational opportunities in sterile processing?
There are a lot of discussions happening about creating sterile processing programs. A few colleagues and I are brainstorming ideas on this. A major challenge is the large amount of capital required to develop these programs to hire and train staff, in addition to purchasing the equipment (facility, various sterilizers, washer disinfectors, instrument sets, and other related equipment) to outfit a training center with little data to demonstrate financial feasibility.
Hospitals are desperate for trained staff but who is going to pay for it? In parts of the country, eligible employees can make upwards of $15/hour working in the fast food industry and hospitals barely pay minimum wage. Working SPD is not without risks. All those risks for so little monetary reward do not inspire people to pay for an education that will not increase their annual income.