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Just how far do ICPs need to go in gaining understanding of SPD’s functions? No one expects an ICP to perform SPD’s job, but they do need to understand SPD’s work every single step of the way. It’s important to realize that sterile processing begins at point-of-use and continues through transport, decontamination, preparation and packaging, sterilization, storage, and sterile transport back to the point-of-use, because if any of those steps are performed inadequately, staff and patients may be at risk.

"The healthcare system is currently dealing with an increase of multidrug- resistant organisms and decreasing public tolerance for healthcare-associated infections," said Earl. "With the increase in healthcare-associated infections and antibiotic-resistant organisms, it is important that every healthcare facility commit to meet best practices. When reprocessing medical devices and instruments, the biggest challenge is that every step must be done right every time."

Learning about SPD’s responsibilities is best broken into manageable chunks. First, ICPs need to get the big picture: the who, where, and what of it all. Who is performing sterile-processing activities? At which locations in the facility is sterilization being performed (eg, operating room, labor/delivery, endoscopy, etc)? Exactly what is being done? Only when these answers are attained can an ICP work toward standardization of processes, products, policies, and procedures.

Earl believes that "Effective policies and procedures play an important role in patient safety. Policies and procedures should be clear, concise, and accurate. Utilizing flow charts, including photographs, is useful in order to provide graphic representation of the process, so the staff can visualize all the steps and not miss a step. Policies and procedures must comply with current regulatory requirements, current standards, recommended practices, and medical-device manufacturer’s guidelines."

Yes, it gets technical. Former ICP Mary Kundus, supervisor for technical services, sterilization assurance, 3M, St. Paul, MN, explained that ICPs need to understand the nuts and bolts of sterilization. "ICPs need knowledge of biological indicators and chemical indicators. They need to understand monitoring and documentation, and they need to know what they’re looking for."

Linda Clement, marketing manager, sterile processing, STERIS Corporation, Mentor, OH, strongly suggested reading product labels and product instructions for use as part of sterile-processing education. "Know when and how to use products. Using a logical approach to surveying processing areas can assist ICPs with what to look for. If you don’t know what to look for, you could walk right by something that needs attention and not know it," she said.

Ralph Basile, vice president of marketing, Healthmark Industries Co., St. Clair Shores, MI, advised setting up a quality-assurance program that includes routine audit of reprocessing, noting that sterilization is monitored and documented in most facilities to a high degree. "SPD should be keeping logs on the machines and processes; so, ICPs should be able to locate the complete history of all instruments sterilized," said Basile, explaining that this is more important than ever with the Joint Commission now employing the ‘tracer method,’ to determine the source of hospital-acquired infection. "Make sure tests are documented, and get reports regularly. It’s becoming more widely adopted that both machinery and devices should be randomly tested, and ICPs can help move that practice along."

What ICPs should look for in sterilization quality assurance is well-documented. ICPs are expected to ensure that industry standards and recommended practices are followed during the entire sterilization process, so keeping abreast of industry regulations and recommended guidelines is crucial. The Joint Commission and the Association for the Advancement of Medical Instrumentation (AAMI) are good places to start.

Knowledge and observance of industry standards are vital, but something that may be missing in the SPD equation is the human element. The ICP can help SPD employees to understand just how important their work is and how it relates to patient morbidity and mortality. 3M’s Kundus pointed out that the rise in antibiotic-resistant organisms is shining light on why sterilization is so important, noting that certification, with built-in expectations for improved outcomes, is raising the bar for SPD. "The ICP adds the human aspect, to help SPD understand how they can have a part in improving patient safety and outcomes."

Basile explained: "ICPs may understand the importance of the decontamination process as critical to delivering quality patient care, but an SPD staff worker may not. An ICP could do an inservice for SPD, which Healthmark could help with, so the employees can see where they fit in the bigger picture." Basile recommended visiting www.healthmark.info/proformance.html  and taking advantage of their many resources on reprocessing. Calling Healthmark Industries to speak with their clinical educator, who has 20 years’ SPD experience, is also a useful option.

It can be an intimidating task, learning the whys and wherefores of SPD, but it’s something best done before you need it, as in the case of a recall. Kundus explained: "ICPs need to understand the process of cleaning, decontamination, and sterilization, and their role in recall of instruments when sterilization has failed."

STERIS’s Clement served up some very strong advice for ICPs: "You don’t want to wait until you get The Phone Call. The Phone Call happens when there’s been a sterilization failure. It’s a bad time to try to figure it all out. ICPs don’t want to look foolish and not know what’s going on."

Unfortunately, nurses’ training doesn’t include sterilization, observed Clement; so, when ICPs get that phone call alerting them to a possible sterilization failure, it can leave them scrambling for footing in unfamiliar territory. "As nursing students, future ICPs are not educated on sterilization; yet, they need to know how sterilizers are monitored. Unfortunately, learning that takes time ICPs don’t have to spare. It can’t all be learned at once; in fact, it’s important not to try to understand it all at once," said Clement.

"As an ICP, you must make a conscious effort to schedule time to learn about SPD functions. You must understand industry standards and stay current. For instance, AAMI’s document ST79 (2006) should be in every ICP’s library. It is a document that is under continuous revision and is reviewed every year because of rapid changes in sterilization and monitoring technology, whereas most of their documents are reviewed every 5 years. ICPs must spend time in the SPD and have dialogue with the manager. Some think SPD staffers are glorified dishwashers, but in fact SPD is the central hub of the hospital with responsibility for performing decontamination, preparation, packaging, and sterilization of all reusable medical devices, many of which are complex and difficult to clean," said Clement.

Basile concurred: "Surgical instruments are complicated, and workers may be paid only minimum wage. There is a move to certification, but many facilities won’t pay for it. The worker may have travel expenses and may have to use a vacation day to take the examination."

"There is no substitute for proper education," said Earl. "A key part in improving the process is certification of the SPD staff. This approach will raise the level of understanding and knowledge. Sterile-processing certification demonstrates a level of competency that the ICP can rely upon. Certification and continuing education, including competency assessments, are key to success."

When she was an SPD manager, Clement took the smart route: she made an ally out of the ICP manager at her institution. She and the ICP manager worked together and taught each other. The ICP took her on infection control rounds; Clement taught the infection control department the importance of sterilization as it relates to staff and patient safety. Continued communication between Clement and her ICP mentor over the years has resulted in the development of a simple but effective tool to educate ICPs to survey SPDs, including a comprehensive check list for the ICPs to use when surveying sterile-processing practices throughout the hospital.

Clement found that forming a partnership with the infection control department can lead to improvements that SPD may not have been able to push through themselves. For example, Clement noted: "SPD staff encounter unrealistic expectations for the turnover of instruments. SPD doesn’t always have the voice they need within the hospital. ICPs can be an advocate for the SPD, to get the resources they need for effective sterile processing, whether it’s time, money, education, or equipment. Furthermore, infection control committees should have an SPD representative on their committees. For the physicians on the committee, it can be an educational opportunity for learning about sterile processing."

Basile added: "Most often the ICP defers to the SPD supervisor, because it is their business, after all, to know about cleaning, disinfection, and sterilization. However, there are times when SPD could use a liaison to help drive home a point to decision-makers, such as when they’re being pressured to use a washer with a quick cycle. The quicker cycle may cut 20 minutes off the cycle time, but it may not be effective in thoroughly removing organic residue and pathogens. ICPs may be in a position to help educate administration as to the need for adequate time for proper reprocessing. An ICP can remind administration that quality does not just cost, it pays back."

"In healthcare facilities, the ICC routinely reviews sterilization quality-assurance reports from SPD, standardizes policies and procedures, and functions as a resource," explained Earl. "The ICP and the ICC can play a significant role in ensuring that the process is in place for good work practices and that proper protocols are developed and followed. The committee’s support for SPD education and meeting AAMI educational recommendations can help increase administration’s awareness of the SPD role in infection prevention and the need for specialized education. The ICP can lend support to SPD in partnering to meet these challenges by implementing policies to address issues as they arise and provide support for safe processing of high-tech instrumentation," continued Earl. "Therefore, it is essential that the ICP and the ICC have a complete understanding of the SPD’s functions."

Clement’s advice is not to sit back and wait for illumination on the subject
to find its way to you. "It’s a matter of seeking out information and education." Clement strongly suggested checking with vendors, because they often have programs already available just for the occasion. For instance, STERIS offers a CD entitled "An Infection Control Practitioner’s Survival Guide to Understanding Sterile Processing," which was presented at STERIS’s APIC 2007 Breakfast Meeting. The objectives of this presentation include understanding activities performed by healthcare professionals working in SPDs and preparing to survey an SPD to ensure work practices are carried out following regulatory standards and industry-recommended practices.

STERIS’s educational offering also includes two self-study courses for continuing - education contact hours: "HPN Study Guide: Steam Sterilization Failure Investigation: A Systematic Line of Attack", and "STERIS Study Guide: Preparing Instruments, Utensils, and Textiles for Sterilization and Wet Pack Problem Solving."

3M also is strong on education. "Education and inservices raise awareness of roles and best practices," said Kundus. 3M’s offerings include seminars, continuing-education articles, and updates from organizations such as AAMI and AORN. Kundus highlighted a new provision from 3M: "We’re launching a new web site with this information and more. Go to www.3Matteststerileu online.com for a wealth of information on sterilization."

Earl encourages ICPs to take advantage of their field representatives’ knowledge: "Metrex Research Corporation ensures that their product representatives in the field are knowledgeable about cleaning protocols, high-level disinfection, and sterilization-industry standards and proper infection-prevention processes. Additionally, Metrex provides educational newsletters and wall charts on instrument and endoscope reprocessing."

Healthmark Industries’ Basile believes SPD groups are an invaluable resource. "It would be wise for ICPs to join SPD groups; many geographic areas have them. In Michigan, we have three or four meetings a year; one is statewide. The organization, the International Association of Healthcare Materiel Management (www.iahcsmm.org) is an excellent resource, but local groups are a good place to start. Attending a local meeting is likely much less expensive than traveling to a national meeting."