In alliance with the national initiatives to reduce healthcare acquired infections, the theme of this year’s Summit was "Getting to Zero." The attendees collaborated together in a series of interactive sessions focused on sterilization best practices.

One of the emerging themes from the summit was the need for a motivated and effective staff to handle the many challenges faced by the Sterile Processing Department (SPD).

The distinguished writer and aviation expert, John Nance, JD, author of Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care delivered the Summit’s keynote lecture. In his opening remarks, Nance compared sterile processing to the "engine room" because it gets going when the pressure is on and there is no substitute for what SPD does. However, he suggested, we must reduce the need to make quick decisions without prior critical thinking skills through proper education and training.

One of Nance’s main messages was the need to empower staff at all levels and the need for personal accountability. Staff must feel confident expressing their ideas to their superiors. When they feel something is just not right, they need to feel comfortable enough to do something about it. If you allow wrongs to go unnoticed you are also promoting them. Nance’s proclamation, "If you see it – you own it" was echoed by participants throughout the conference.

All staff must be encouraged by their superiors to address problems and concerns as they see them. They also need to trust those in authority will listen to their subordinates with respect and address the issues.

According to attendee Lisa Huber, sterile processing manager, Anderson Hospital, Maryville, IL, a manager’s most important role is to inspire, empower and always stand by the staff. She empowers her staff by making sure they have the knowledge, education, and tools to do their job.

Huber’s mantra, "WE are the sterilization experts" gives staff authorization to say no to improper or unsafe customer requests regarding reprocessing of surgical and medical devices. Being the experts in sterilization takes training and education that includes the what, the how and the why behind every process they perform.

Patient safety cannot be left to chance. All of the policies and procedures in Anderson Hospital SPD are based on the Association for Advancement of Medical Instrumentation (AAMI) recommendations to ensure they are doing the right thing when it comes to cleaning, disinfection and sterilization. The staff has access to the AAMI standards manual at all times. "It is like their security blanket because they know where to go to get the answers," said Huber.

Standardization is powerful. By understanding and sticking to the manufacturers written direction for use, the SPD staff is authorized to follow each step and leave nothing to chance. If a staff member does make a mistake, Huber uses it as a teaching moment to ensure this error isn’t repeated.

SPD certification helps:

• develop a basic level of understanding and knowledge,

• encourage consistencies and standardization in processes,

• add a professional element to the department,

• encourage self-esteem, confidence and authority for the staff, and

• protect the patient from harm.

AAMI recommends that all personnel performing SPD functions be certified as a condition of employment or at a minimum within two years of being hired, and that they maintain the certification throughout their employment.1

Huber believes the person running the department must also be certified to their level of responsibility. Having these credentials gives credibility and helps inspire staff to become certified.

Having the SPD staff do rounding or huddling with the OR staff daily gives Huber’s staff exposure and helps build critical staff alliances. Other team building initiatives she uses are meeting with the OR management team monthly and holding informal one-on-one conversations with the OR staff.

"Show me the money!" declared Nancy Chobin, corporate consultant/educator, Saint Barnabas Health Care System, West Orange, NJ. Chobin’s panel discussion offered advice on how to make a formal business case for instituting a competency based, tiered ladder career path, which rewards certified employees. Chobin’s advice when talking to Administration and Human Resources must include real data that spells out the return on investment, cost savings, or cost avoidance.

A study conducted by Chobin and published in Surgical Services Management in 1998, showed it cost approximately $30,000 to train an SPD staff member. Using this study she calculated the hospital would save money by increasing the salaries, rather than replacing the staff. Updating the study to reflect today’s dollars, Chobin hopes to have a new study published soon.

Developing a professional competency based career path motivates individuals to do a good job and encourages them to take on more responsibilities.

The capstone presentation of the Leadership Summit was a motivating lecture titled Getting to Zero Through Risk Reduction and Best Practice presented by Tracey Rapp, CSR manager, Dartmouth-Hitchcock Medical Center, Lebanon, NH. Due to her leadership capabilities, and undying efforts towards process improvement and safe patient care, Rapp’s department was rightfully named Healthcare Purchasing News’ 2009 CS/SPD Department of the Year.

Soon after being hired, Rapp conducted a six week audit of processes and documentation related to instrument reprocessing. She and her staff identified 579 issues that needed to be improved in order to make the department compliant with AAMI recommendations. Rapp and her team began the daunting task of addressing all the issues by prioritizing projects based on their impact to patient safety.

The biggest area of concern and therefore, the first addressed, was cleaning and decontamination of surgical instruments. By the end of the day the decontam room was so jam-packed you could not turn around in it. The staff complained about not having the tools (such as basic brushes or manufacturer’s instructions) they needed to do a good job. "No one ever wanted to go to ‘the pit’. They felt it was punishment if they were assigned to work there," exclaimed Rapp.

Dartmouth-Hitchcock wanted to see rapid process improvements in the decontam functions. Rapp’s first step was to assign a decontam service leader as a role model, educator, and leader, who would be relentless about strict adherence to the written manufacturer’s recommendations.

They brought in all the necessary supplies, gathered the manufacturer’s written recommendations, standardized the work and sink areas, placed automatic detergent feeders on the sinks, installed an automatic pump system and monitors for all of the mechanical cleaners, as well as, standardized how the instrument and cart wash racks were loaded to ensure maximum efficiency.

In addition to ensuring the staff had all necessary supplies, a detailed training plan for cleaning and decontamination was put into place and is now mandatory for staff assigned to the newly organized decontam area.

Building an alliance with the OR Director and the Infection Preventionist (IP) helped Rapp to convince the OR to purchase more instruments to help decrease the need for daily flashing. She also assigned a SPD liaison to each of the OR services, which was instrumental in building relationships and streamlining communications.

Ms. Seavey is a consultant to 3M, and is an RN, BS, MBA, CNOR, CRCST, CSPDT and the President/CEO of Seavey Healthcare Consulting, Inc, and former Director of Sterile Processing at The Children’s Hospital of Denver.