Cover Story

Full steam ahead for sterile processing

Despite challenges, CS professionals making headway

by Julie E. Williamson

After many years of little recognition, fading support and even fewer career growth opportunities, it seems the one-time “bodies in the basement” are finally beginning to earn some respect — and a more secure place alongside other healthcare professionals long applauded for their contribution to quality care.

Although sterile processing departments may still be battling age-old obstacles, such as staff shortages, dwindling resources and sagging salaries, to name a few, a growing number are reveling in positive changes, exploring new territory, and in some cases, using challenges to their advantage.

In fact, one 20-year sterile processing veteran said he can’t recall a time more promising for CS, and is seeing improvements that are ultimately, albeit incrementally, reshaping the profession.

“This is a very exciting time,” said Michael Festa, director of sterile processing for HealthEast Care System, St. Paul, MN. 
“I’m seeing opportunities for growth and advancement that weren’t really available until recent years. It seems it’s finally becoming our time to shine.”

Festa isn’t the only one putting such a positive spin on the profession. Numerous sources shared their lofty predictions with Healthcare Purchasing News, with some going so far as to say they have a newly-restored sense of pride in their roles and are finally seeing a light at the end of what used to be a very dark tunnel.

Greater visibility
So what has prompted the seemingly sudden turnaround in the sterile processing sector? Ironically, some industry professionals credit legislation, such as the Balanced Budget Act of 1997, for laying the foundation for several key advancements.

While the BBA prompted reduced healthcare spending, which in turn translated into wage, staff and capital budget cuts, it also gave departments a unique opportunity to prove their value to hospital administrators. What’s more, new quality initiatives set forth by the Centers for Medicare and Medicaid ervices, coupled with intense media coverage and heightened consumer awareness, have spurred even more opportunities for CS staffers to market themselves to their facilities, highlight their contributions and lobby for additional support.

And hospital administrators seem to be taking notice. Many are making a more concerted effort to support SPDs by encouraging more close-knit relationships among various disciplines and forking over funds for continuing education and tuition reimbursement.

CS manager Terry Jackson, West Virginia University Hospitals, Morgantown, said his department is experiencing that support firsthand. “Staffing is an issue, but because of the push for [ongoing] education, we’re finding that the people we do have are better equipped to handle the job,” he explained, adding that nearly all of his technicians are certified. “Although, like most other facilities, we could use more people, I think it’s more important that the ones we do have are properly trained and understand the appropriate techniques.”

Jackson said his department has also forged a successful relationship with surgical services and even has technicians rotating through the OR weekly to handle flash sterilization and offer additional support, whenever necessary. The department has also been given complete control over flexible scope processing.

“We’ve found the majority of our responsibilities are back on the processing side, with the distribution portion going away. That’s freed us up to offer more support where it’s needed most,” he continued.

Of course, not all facilities are streamlining sterile processing duties. In fact, as administrators become more aware of CS’s value, some departments are taking on an even broader role. But you won’t hear many complaints from Bruce Bird, central processing manager at IHC Urban Central Region Hospital, Salt Lake City.

Like Jackson, Bird said his department works closely with the OR and has seen its services expand to encompass “more complete support.” However, at IHC, the staff is also becoming increasingly responsible for all aspects of equipment management.

“Our goal is provide [comprehensive] support to the OR, as well as offer leadership in all areas of instrument processing,” he said. “Although the expanding role is challenging, particularly because of staffing issues, we are pleased we are recognized and appreciated by the management staff, and viewed as valuable contributors. When you have a voice, the extra responsibilities seem more manageable.”

Festa says his department’s increasing responsibilities are both logical and necessary from an infection control and best practices perspective. Along with all processing responsibilities, HealthEast SPDs also handle instrument purchases, coordinate repairs and loaner programs across the care system, manage case carts, and consult and support clinical staff.

“It’s important to offer support in areas that allow those involved with clinical functions to focus their attention on clinical areas. When departments stick with what they do best, patients and departments benefit, as does the overall [organization].”

Technological support
Advancements in technology, driven in great part by increased use of minimally invasive surgical techniques, more stringent health and safety guidelines, and the need for faster turnaround times, is providing SPDs with myriad options to help them manage tasks more efficiently, effectively and safely. 

Much anticipated gas plasma sterilizers are now available, promising speedier cycles and effective sterilization of even the most delicate instruments – without heat, moisture or potentially toxic chemical residues. The new technology makes it possible to sterilize both metal and non-metal instruments, including fiber optic cables, endoscopes, microsurgical equipment, power and electrical equipment, ceramics and glassware, which were previously limited to either steam or ethylene oxide sterilization.

“Some facilities want to move away from ethylene oxide and are looking for technology that can improve the effectiveness of their cycles,” said Anne Cofiell, president, Cofiell Consulting Services, Mt. Laurel, NJ. “Because of that, [gas plasma] technology is getting a lot of attention.”

That’s not to say traditional sterilizers have fallen off the map, however. Modern steam sterilizers are becoming increasingly automated, ergonomic and even more cost-effective, thanks to designs that reduce the amount of time and water needed to complete each cycle. At the same time, instrument manufacturers are embarking on redesigns to help items withstand steam cycles.

Ric Rumble, vice president of global marketing for STERIS Corp., Mentor, OH, said the industry has had to find ways to maximize CS resources, increase throughput and enhance cycles’ overall effectiveness.

“You have to make processes more friendly and [match] training provided [to staff] with an increased level of automation,” he said, stressing that automation is key to helping SPDs meet higher demands despite limited staff and rapid turnover requirements.

Of course, form must also meet function. Manufacturers are now designing washer and sterilizer systems that feature fewer moving parts, as well as ergonomic features that limit physical strain and increase efficiencies. They are also meeting SPD’s demands by offering both space-saving systems and those that can handle larger, more complex loads. STERIS, for example, is in the process of rolling out its Synergy washer, which uses less water and cuts cycle times by approximately 30 percent. The company’s AMSCO Century model steam sterilizer also runs on less water and utility consumption and features a larger chamber to house more instruments. The model is also equipped with a newly designed door – built with more than 100 fewer parts – that can be easily opened with a 30° latch.

Systems that double as information and documentation tools are also picking up steam. According to Bob Von Kaenel, vice president of marketing for Getinge, Rochester, NY, giving CS professionals data-driven technology goes a long way in helping them validate their processes and quantify their value to their facilities.

“Coming up with information technology capabilities that enable sterile processing professionals to track instrument use and repairs, and document quality measurements is becoming more critical,” Von Kaenel explained. “Sterile processing isn’t just about cleaning and sterilization. More than ever, they need to have the [data] to back of the processes.”

IT capabilities that go beyond individual systems are also becoming more prevalent. HealthEast, for example, is about to embark on system-wide IT integration built upon barcoding and computerized tracking – a move that Festa said will help all sterile processing departments throughout the organization capture data on sterilization functions, pinpoint the location and processing progress of instruments and trays, and follow items that were loaned to other facilities or sent out for repair.

“Administrators are data-driven, but in the past we haven’t been able to benchmark and provide specific data to support our functions,” he noted. “This system will allow us to do that.”

Future priorities
With a growing emphasis on quality and tighter regulatory control by federal agencies, CS departments have seen some major changes unfold regarding the level of processing performed in their facilities, with reprocessing of single-use devices being a prime example.

Increased oversight by the FDA on the practice has made most hospitals previously partaking in the practice seek out the services of a third party reprocessor. Although that’s good news for CS professionals who had challenged the decision to reprocess in-house, some are concerned their facilities may try to offset the costs of the third party reprocessing services by cutting back further in other areas.

“It’s been a real challenge to meet the increasing demands with less money and personnel, and I have a hunch it’ll get worse,” said one CS director.

By and large, sources predicted CS professionals across the board will remain pressured to streamline processes, demonstrate their effectiveness, and at the same time, keep costs to a minimum. That said, prioritizing and protecting investments will become increasingly important. SPDs that are able to adopt the latest, most innovative technology may have to do so at the expense of other new instrumentation. At the same time, capital budget cuts may force some departments to stick almost entirely with older systems. Regardless of the type – or year — of systems and instrumentation in place, departments will have to find ways to stretch the dollar further.

One strategy likely to gain momentum revolves around repair and preventive maintenance of instrumentation and equipment, according to Rick Schultz, president of Stow, OH-based Spectrum Surgical.

“With budgets being squeezed, facilities must be smarter about protecting their investments. Preventive maintenance just makes sense, particularly when you see you can pay $2.20 to restore a pair of scissors or spend $38 to buy a new pair.”

To better meet repair demands, Spectrum Surgical’s onsite and mobile repair labs now operate seven days a week. The company has also added more service assistants in the regional market to help pick up and deliver instruments.

Perhaps the most effective way to maximize investments, both in terms of personnel and capital equipment, is for facilities to encourage and support staff education to ensure personnel are informed about appropriate processing practices and knowledgeable about equipment used. Although more hospitals are recognizing the value of education, many are still lagging behind. In fact, departments using the latest instrumentation may not know how to take items apart and clean them. Schultz, who dedicates a great deal of time to consumer education, said he’s even educating CS professionals on the care and maintenance of laparascopic instruments – items his company doesn’t even sell.

Contributing to the problem is the unwillingness by some manufacturers to provide detailed care and processing instructions for complex medical devices.

“This is one area that really needs to be resolved going into the future. CS is driven to do the right thing, but if manufacturers aren’t willing to provide detailed instructions on reprocessing, quality may be compromised,” Cofiell said.

“There may be a trend for facilities to educate and improve quality, but they can’t do it alone. If commitment to quality is the goal, everyone should be held to the same standards.”

HPN

April