For others, sterile processing also represents a calling and a viable career path.

But Toms River, NJ-based Community Medical Center adds a third component by regarding what they do as a crusade for how sterile processing and distribution departments and professionals should act, operate and be valued.

That’s just the way Terri Matthews, R.N., CNOR, CSPDM, director of patient care services CSP, wants it.

Some of the staff, including Director Terri Matthews, front center, of The Central Sterile Processing dept.
of Community Medical Center in Toms River, NJ

"The work that this department does exceeds the expectations of the management team," Matthews said. "We have not impacted the OR or any of our customers by delaying their needed instruments or equipment. This is a testament to the caliber of the associates in this department. They are proud of their work and understand the importance of their positions.

"We are involved in the care of our patients from the moment they are admitted into our institution through their discharge," she continued. "People acknowledge that almost every patient that comes through our doors has used some item that we processed. We acknowledge we are a service department and strive to be the best that we can be. If we have any questions we communicate with our customers to get it correct the first time."

Certainly, the nursing staff appreciates SPD. "They know that if they call for something we will deliver it as quickly as we can," Matthews added.

Further, Gerry Clark, CSP’s equipment technician with more than 30 years of experience at Community, serves as CSP’s resident public relations promoter, according to Matthews. "He does rounds on the floors constantly and is the one who is telling everybody about us and what we do," she quipped.

"We indeed are the ‘heart’ of this hospital," she insisted.

Most noteworthy is that such an attitude doesn’t emanate from a large, reputable teaching hospital or notable urban medical center, but a local, suburban facility. Meaning: Most likely, it represents the majority of hospital organizations in operation. Such a passionate attitude that reaches beyond SPD can be contagious.

Matthews suggested that SPD departments can catch it this way:

"Be aware of everything you do no matter how small and how it impacts the patients experience in your facility," she advised. "This also includes the physicians. We want our hospital to be his primary site for his patients and surgeries, so we try to make any interaction with them professional and courteous."

Yet sporting such a stellar attitude, demonstrated by commitment and dedication, represents only one step, if not the first step, in defining and shaping a first-class SPD operation. Attitude must breed action. And Community delivers.

Vesna Petric scans packages while pulling the case cart

Matthews’ team of certified SPD professionals maintains a near-symbiotic working relationship with the OR that seems to lance through any mutual problems, managing production by service line, automating inventory and performance tracking, redesigning and renovating its footprint for process improvement, developing and implementing a clinical ladder program, as well as a formal strategic plan, and even influencing a prominent supplier to add a component to a popular product made accessible to the entire industry.

For these reasons, Healthcare Purchasing News selected Community Medical Center as its 2010 Sterile Processing & Distribution Department of the Year.

Jerome Hester pulls patient care equipment

What makes it so challenging specifically? "[Such communication] can take minutes to hours depending on the day and the issues we have identified," she noted. "For example, if we have to change the order of cases we have to call the doctors offices to get approval because of block scheduling, or reassign staff to facilitate trays vs. delivery of items or pulling cases."

CSP reviews the OR schedule 24 hours in advance to identify needed instrumentation, and works with the OR to resolve conflicts by switching cases around, splitting sets up, or expediting the processing of the needed sets.

But this productive relationship could have derailed before it progressed on track. Matthews and CSP Supervisor Patty Roe, LPN, CSPDS, both worked in the OR prior to coming to CSP so they already had a relationship.

"When I first came to CSP I still had the mentality of an OR nurse that I knew it all," Matthews recalled. "I was the assistant director at the time and asked to cover CSP as an Interim role. Who knew I would end up loving it? When I started working in CSP I soon came to realize that I didn’t know anything about CSP."

Evangeline Juane loads the Autoclave cart

Olive Callender and Scott Phengson inspect tools on the assembling tray

As an active participant of the perioperative team, various CSP staffers, including Matthews, Roe and several technicians huddle with OR service line leaders to review trays, revise count sheets, find acceptable substitutions for instruments, coordinate and implement the preventive maintenance schedule for all trays, as well as yearly analyze the sets that were expedited or "flashed" each year and recommend those trays that need to be purchased for capital the next year.

But that doesn’t mean the process always is tension-free. Matthews indicated that she and Roe may handle much of the diplomatic heavy lifting but several technicians "who feel comfortable enough to show the OR service line leaders pick lists that need to be corrected or to ask them questions to clarify which case to pull" also contribute.

"On weekends it’s staff talking to staff dealing with the add-on cases, loaner trays and instrument questions," she continued. "My staff will go down to OR to ask questions, and the OR staff is great in helping them."

But if conversations go south? "We are lucky here that they do respect my staff for their knowledge," Matthews assured. "If I need to step in my staff will page me to talk to OR. When I call most of the time it’s to reiterate what my staff has said and to give the rationale behind what we are doing."

In fact, such communication and teamwork has helped reduce "flashing" to less than 1 percent of cases per month from a high of 8 percent in 2008, according to Matthews.

But if and when the OR has to flash something, CSP is there to serve as a resource and provide manufacturers’ directions so that it is done correctly, she added.

In addition, each year CSP helps to educate the OR on sterilization, AAMI standards, decontamination, CJD and beginning last year, toxic anterior segment syndrome (TASS).

"We feel that educating the OR staff to our processes helps them understand why we need the time to process the trays and this facilitates the cohesiveness of the departments," Matthews said. Furthermore, she credits the OR management team, specifically Gina Gillet, Barbara Gebler and Donna Davison, for learning and understanding the subjects, which are included in their annual competencies.

Dan Ramos unloads the Autoclave cart

However, subject accountability doesn’t include compensation. "We don’t have salaries tied into evaluations at this time," she noted. "We are switching to a merit-based system next year so that will be the process, I hope. For right now, if they don’t pass a competency [exam] they have to get re-educated and pass or go on an action plan."

One of the areas where CSP’s communication skills are continually tested involves the loaner tray process, which calls for clear cooperation between CSP, OR, surgeons and vendors.

"We developed a policy with the minimum hours prior to surgery that we will accept trays and a form that all must follow," Matthews said. "The OR notifies us in writing which trays we are to expect in. When we receive the trays the vendors fill out our form. We color code for the day of the week. We then document on the case carts that loaner trays were received in and on our loaner communication board. During the change of shift report the loaner trays are reviewed. If they’re not received in by 6 p.m. the day prior the OR is notified and they contact both the vendor and the surgeon and report back to us the resolution."

The loaner communication board is a white dry erase board hanging in CSP’s sterile storage area to which the team tapes the vender sheets and links them to the appropriate cases. In time, Matthews said she hopes to develop a system interface to monitor this process electronically.

During the last several years CSP’s inventory management system (Sterile Processing Microsystem from Materials Management Microsystems Inc.) has helped them boost productivity to 90 percent or more from 60 percent while maintaining an error rate of less than 1 percent, according to Matthews. The inventory system enables CSP to bar code all trays and patient care equipment. Matthews acknowledged that the system has "held our staff accountable to certain productivity standards for all trays. The staff also keeps track of all the tasks that they perform through out the day." Full-time equivalent reduction due to Medicare reimbursement cuts financially motivated CSP to make the move, too, without compromising quality.

Furthermore, Matthews said she hopes they can interface the SPM system with the OR’s scheduling system from SIS "to resolve conflicts prior to cases being booked and to have complete traceability to all patients" and potentially to track where instruments and trays are in the production process. She also would like to equip her team with Vocera wireless communication devices.

Diana Feinstein unloads instrument carts to be put in the washer

Much of CSP’s current performance originated from a strategic plan unveiled four years ago. Back in early 2006, Matthews developed a plan to map out capital purchases, workflow redesign and centralization of all high-level disinfection to CSP except for the gastrointestinal endoscopy suite.

Matthews developed the strategic plan by reviewing her plant log, comparing existing equipment to available new technology, analyzing OR volume trends to anticipate space, washer capacities, sterilizer loads and turnaround time. She built in some flexibility, too, as they are in the middle of the plan. "I keep current on any new regulations, case mixes or new technology and adjust the plan accordingly," she added.

The GI endo suite remained the exception based on simple logistics. "We are too far away from the endo suite to turn over the equipment in the same time as they do it in endo," she admitted. "We would have to add more scopes, which is why I monitor their processes."

But that’s not all. Community Medical has plans for CSP to teach a sterile processing course to all endo technicians and will require them to pass the certification exam within two years. Currently, they are required to pass the annual competencies in scope care and handling, she noted.

As part of upgrading the department’s equipment and footprint, one of the first changes involved replacing three STERIS System One units with a Sterrad NX sterilizer, which also enabled them to remove several flexible scopes sterilized in ethylene oxide. CSP also relocated high-level disinfection activities and pasteurization to a clean room adjacent to decontamination. They replaced an old ultrasonic cleaner with a newer model that also handled devices with lumens so they could retire two machines at once. One of the units was traded in and the other was donated to another hospital in Community Medical’s system for parts for their equipment, according to Matthews.

Because two of CSP’s STERIS 7 cube tunnel washers had more than 100,000 cycles on them, Matthews and several colleagues visited a few facilities in New York, Connecticut and Tennessee to determine which washers might best suit their needs. But no luck. "None on the market was acceptable at that time," she lamented.

The Pack & Prep room in CSP

So Matthews approached STERIS with an idea. "We worked with STERIS to add a sonic chamber to their Vision washer. They agreed and submitted the plans to the FDA to get a revised 510K for a washer with the sonic built-in," she said. "I found Steris to be very receptive to work with them. They listened to me, saw where I was coming from and was able to help."

More than a year later, STERIS installed the washers in November and December 2008, which helped CSP improve productivity and cleaning capabilities in terms of increased tray throughput to the prep-and-pack side of the department. Besides STERIS (for steam and EO sterilization) and Advanced Sterilization Products (for low-temperature hydrogen peroxide gas plasma sterilization, CSP relies on OPA for manual and Custom Ultrasonics for its washer disinfector.

After revamping the decontamination area, CSP moved to sterile storage next, expanding the layout to accommodate the increase in trays and disposable products provided to the OR. CSP renovated an existing office and constructed a new breakdown room, along with an addition next to the department. To house the disposables, CSP added InterMetro high-density shelving. Each staff member in the sterile storage area also carries cordless phones. This year, they’re also converting the old breakdown room to additional sterile storage space with more high-density shelving, as well as completing the new breakdown room, according to Matthews. She also plans to replace three pass-through steam autoclaves, likely with STERIS Evolution units, she added.

Because New Jersey mandates sterile processing certification, Community CSP staffers all sport a series of letters behind their names and highly value education.

Monthly staff meetings are an open forum where everyone has the opportunity to ask questions and voice concerns, as well as share and discuss continuing education articles for CEU credits. "We also discuss AAMI standards and any new process that we must follow," Matthews added. "We pride ourselves on being one of the first to conform to any new standard."

Among the current CSP staff, all of whom are certified, 12 were educated and trained on the job. Within two years they all took the exam and passed. In fact, some of the staff have been certified since 1990 so it has been encouraged for 20 years to become certified here with CSP’s clinical ladder program, according to Matthews.

For career-minded sterile processing professionals, CSP’s clinical ladder program includes four levels: Entry (spanning orientation until competent), processing technician (spanning competency but without taking the exam), certified processing technician (after passing the certification exam) and finally lead technician (responsible for all actions and serves as departmental mentor and resource).

"We are very proud of the fact that six staff members have gone to school and graduated from CSP to have careers in the OR as LPNs, R.N.s, and even a RNFA," Matthews noted. To encourage such development, "the hospital gives tuition reimbursement, I have changed schedules for people, other staff members will switch their days off to help their peers or even change their shifts temporarily to assist them," she added.

In fact, the graduates all continue to work in the OR as staff members, according to Matthews. Also, one staff member remained in CSP on a per-diem basis while he took a job as a supervisor in a surgicenter about 40 miles away from Community. He works on weekends or off-shift when his surgicenter is closed. "He feels the training and education he received while maintaining a full-time position enabled him to pursue a career as a manager," she said. Currently, two staff members attend school to further their education and graduate from CSP.

Matthews’ team isn’t OR-centric. CSP also counts the nursing units for patient care equipment, cardiology services for TEE probes, ultrasound for vaginal and rectal probes, anesthesia for blades and flexible scopes, sleep lab for all sleep study equipment, and various other units for cleaning and sterilization of all non OR trays as internal customers. CSP also handles house-wide delivery of equipment every two hours with "stat" orders in between, she indicated.

But it doesn’t stop there.

"While we are doing our pick-ups and deliveries of equipment, should we see a call bell on in any patient’s room, we stop and see if we can assist the patient’s needs," she said. "But if it is above our level of care, we notify the nurse in charge to follow through with aid. "The culture of our institution is ‘we are part of the team that has the best interest of the patients we serve.’"

The teamwork philosophy pervades CSP, too, by staff members "treating each other with respect, assisting co-workers as needed and communicating between the shifts concerning items that need to be processed," she said. "We have a staff that is always willing to stay to complete trays that are urgently needed or if the workload is overwhelming on the other shifts."

Admittedly, the motivational attitude took several years to develop and isn’t perfect. "Once in a while the ‘what did they do on their shift’ still rears its ugly head, and we deal with this at staff meetings and on an individual level," she noted.