Experience is power

Feb. 22, 2022
Salary Survey confirms education, certification key to SPD recognition and career success

The average annual salary of Central Service/Sterile Processing & Distribution (CS/SPD) department professionals is up 5% again this year, according to the results of the 2022 Healthcare Purchasing News CS/SPD Compensation Survey. As we enter the third year of the COVID-19 pandemic, job security remains high with fewer lay-offs and furloughs, but those in the field report the continued struggle to secure salaries and respect reflective of the vital role they play in patient safety.

The average annual salary for SPD Technician/Coordinators in 2022 is $49,083, up 23% from $39,833 in 2021. While CS/SPD Directors too saw a huge leap in pay, $139,867 in 2022, up 32% from $105,656 in 2021, the figure is likely skewed by a few respondents in this category who reported salaries on the very high end of the range.

CS/SPD Managers reported a modest pay increase with an average annual salary of $86,756, up 8% from $80,518 in 2021, as did Surgical Instrument Technicians with $55,055 in reported annual earnings, up 7% from $51,500 last year. CS/SPD Supervisors experienced a slight bump at $58,863, up 2% from $57,778 in 2021.

Lower pay was reported among CS/SPD Educators with average annual pay at $65,500 in 2022, down 15% from $76,944 in 2021, which could be a correction to the huge pay leap reported in this job category between 2020 ($63,846) and 2021 ($76,944). Reported pay for CS/SPD Technicians dropped as well, with an average annual salary of $41,176, down 9% from $45,156.

Overall, 70% of survey respondents said their salaries had grown over the previous year, up from 64% in 2021, and 24% expect bonuses in 2022, up slightly from 22% last year.

“Overall, my view on SPD salaries is they are still way too low,” said Debra Bohlman, CRCST, CIS, CHL, Sterile Processing Supervisor, ThedaCare Regional Medical Center, Appleton, WI. She also serves as Secretary-Treasurer for the Healthcare Sterile Processing Association (HSPA).

“The trend is to up the starting pay, but many organizations still aren’t adjusting salaries for seasoned workers who have stayed through the years and the pandemic,” Bohlman continued. “Sterile Processing is a physical, demanding and complicated profession, and salaries need to catch up. SPD staff members can improve the state of the profession by getting certified and taking a proactive approach to their own education.”

Many healthcare staff members have been compensated by their employers for the extra work they have taken on during the pandemic, but CS/SPD professionals seem to have been overlooked in many cases.

“Salaries continue to [stagnate] as many SP professionals still struggle to gain the focus and recognition we all feel is deserved,” said Tony Thurmond, CRCST, CIS, CHL, FCS, Sterile Processing Manager, Dayton Children’s Hospital, HSPA Past-President and member of the HSPA Board of Directors. “Over the past two years, SP professionals have shown their versatility and flexibility, with many stepping out of their departments to provide additional help to those departments providing patient care. While other specialties have provided that same help, it seems that those on the front lines have an increased opportunity for pay raises.”

While fewer CS/SPD professionals said they were laid-off or furloughed because of the pandemic, 15% in 2022 versus 26% in 2021, job security dipped slightly, with 85% of respondents reporting they felt very or somewhat secure in their jobs in 2022, compared with 90% in 2021.

Staffing shortages in healthcare because of the COVID-19 pandemic have prompted many healthcare facilities to hire travel professionals to fill temporary needs. Although the media spotlight has been largely focused on the nursing shortage, CS/SPD professionals too are in high demand and traveling has become a popular and lucrative option.

For example, a recent traveler job listing on Sterile Processing Staffing, Interim Management & Consulting Firm Moab Healthcare’s website offered $2,200/week, $50 an hour overtime and benefits.

“While in the past CS/SPD professionals may have chosen not to travel because these positions lacked insurance benefits, today there are now great packages that offer benefits or pay enough for the traveler to purchase their own insurance,” said Ofoe Amevor, CRCST, CIS, Sterile Processing Manger & Operations Leader , Six Sigma Black Belt, Traveling Consultant. “Hospitals must consider the consequences of the popularity in travel positions, including high turnover in their departments and the cost of training new staff members.”

Monique Jelks, MSOL, BA, CRCST, Sterile Processing Area Director, Central Surgical Support Services, Indianapolis, and member of HSPA’s Board of Directors, agrees that travel positions are putting pressure on hospitals to compete for CS/SPD talent, stating:

“[There is a] rising need for traveling SP techs who fill the staffing gaps in many SPDs. Although traveling SP techs are an excellent resource to help SPD productivity and ensure instrument sets are available for surgery, they are not permanent. SP directors and managers must be intentional and aggressive with recruiting and training both experienced and inexperienced SP technicians. Hospital executives will also have to figure out how to compete financially with the healthcare traveling companies who recruit SP technicians.”

Significant gender pay gap

Again, this year, the survey found male CS/SPD professionals earning significantly more on average than their female counterparts. The average annual salary for males surveyed was $88,170, compared with $59,468 for females; a $28,702 pay gap. Two likely reasons for this discrepancy are the much higher percentage of female survey respondents, which was 72% of total respondents compared with males at 27% (1% of respondents chose not to disclose their gender), and a handful of male respondents who reported very high salaries this year.

The degree debate

As in past years, average annual salary increases with level of higher education attained.

Those with post-graduate degrees reported the highest pay ($103,384), followed by Bachelor’s degrees ($81,354), Associate degrees ($66,519) and high school diplomas ($56,310).

The CS/SPD profession has been making strides in expanding higher education opportunities in some parts of the U.S., according to Lucas Bonner, a Sterile Processing Consulting Director based in Houston.

“More hospitals are working with colleges in their communities to develop sterile processing course curriculum that is relevant to their CS/SPD operations. I have seen this trend growing in Miami, Seattle and Dallas in particular, with hospitals in those areas banning together to invest in higher education and offering student internships in their sterile processing departments.”

But education is also a hot button issue among CS/SPD leaders, and staff members without formal degrees who have worked many years in the field earning extensive hands-on experience that cannot be gained in the classroom setting. Some in the field report that they have seen seasoned CS/SPD professionals being passed over for leadership positions in favor of individuals with college degrees but little experience in the field.  

“I’ve seen cases where a hospital is hiring for a CS/SPD director or manager position and will choose an individual with a degree and only a couple of years’ experience over someone who has been working in the profession for years,” said Amevor. “How can someone in a leadership position teach technicians when they don’t understand the department or know how to do the job?”

Facility type, location matters

The type of facility and its geographic region continues to play a central role in how CS/SPD team members are compensated. Once again, those working in integrated delivery networks (IDNs) report the highest average annual salary of $89,148, followed by those working in teaching hospitals with a reported average salary of $79,535. CS/SPD professionals working in standalone hospitals earn $58,070 on average annually, followed by those in surgicenters/ambulatory centers at $52,261.

Facilities in urban locations pay the most when it comes to the CS/SPD, with staff earning an average of $73,224 in 2022, followed by suburban facilities at $68,500 and lastly those in rural areas at $53,075.

While CS/SPD professionals in the Pacific region of the U.S. reported the highest average salary at $86,916 in 2022, they were not the biggest pay gainers, with pay remaining about the same compared with 2021 ($86,521). That designation goes to those in the Central Region with a 17% pay leap to $62,974 in 2022 from $53,539 in 2021. Those in the second highest region for pay, the Northeast, also saw a significant bump at $70,000 in 2022 up from $63,743 in 2021, a 10% increase.

The average annual CS/SPD salary in the Southeastern region saw the biggest drop at $53,541 in 2022 compared with $57,569 in 2021, a 7% decrease. Those in the Mountain region, which continues to be on the high range of CS/SPD pay, also reported a decline in annual salary at $67,148 in 2022 from $69,806 in 2021, a 4% decrease.

“Certain regions of the country pay far lower than they should,” Bonner commented. “It is not surprising when a sterile processing technician making $13 per hour in a hospital quits and takes a job at a retail store paying $3 more per hour. Hospitals need to pay attention to salaries in their markets and compensate their CS/SPD staff fairly to maintain them.”

Certification makes a difference

While the drive for certification among CS/SPD professionals is largely backed by the desire to perform reprocessing safely and effectively, as well as hospital mandates, putting some cash behind certification efforts doesn’t hurt.

There was a slight uptick in survey respondents who are already certified at 91% in 2022, compared with 89% in 2021. The average annual salary for certified CS/SPD professionals is $68,049, compared with $60,000 for those who are not certified. On the flip side, while 70% of those surveyed said their employers require certification, only 19% said they are compensated for earning certification units/points.

“In my system as well as the rest of the country, I’m seeing that if you tie quality outcomes and key performance indicators (KPIs), along with certification and education, there tends to be a rise in salaries of SP professionals,” said Damien Berg, BA, BS, CRCST, AAMIF, HSPA’s Vice President of Strategic Initiatives. His previous role was Regional Manager, Sterile Processing, for UCHealth in Northern Colorado, where he continues to serve in a consultant role.

Siri Sorensen, MA, CAE, PMP, CMP, HSPA’s Director of Certification and Membership, said the organization continues to see certification numbers trend upward, stating:

“In 2020, when the pandemic started, we did see almost a 25% loss in applications due to the inability for applicants to test, as testing centers were closed in light of the pandemic. In 2021, though, we were just shy of a 30% increase over 2020. Currently, we are closing in on our pre-pandemic 2019 levels.”

Those holding certification from HSPA (formerly IAHCSMM) jumped to 76% in 2022 from 69% in 2021, a 10% increase, while those certified from the Certification Board for Sterile Processing & Distribution (CBSPD) held steady at 28%. Association for the Advancement of Medical Instrumentation (AAMI) certification, which is high on the list, dropped slightly at 21% in 2022 compared with 23% in 2021.

“The push of certification by accreditation bodies and the focus of the Sterile Processing areas throughout the medical industry has brought a new awareness that wasn’t present prior to the pandemic,” said Jan Prudent, BA, CRCST, CIS, CHL, CER, CFER, FCS, Sterile Processing Manager for Eastern Idaho Regional Medical Center in Idaho Falls and HSPA Board Member. “The issue now is that there is a shortage of qualified applicants and a need for bodies to perform the tasks at hand. Although I pride myself on raising the bar with certification, it is my opinion that with the staff shortage, quality and certification may be overlooked and corners could be cut.”

A continued focus on continuing education

When asked about continuing education courses/lessons, 88% of respondents said they participate in 10 or more each year, which is about the same response as last year. But looking at those who participate in 20 or more annually, the percentage jumped to 44% in 2022 up from 35% in 2021, a 26% increase.

“As technologies advance and we learn more about the intricacies of the science of sterilization, the need for education continues to grow,” said Natalie Lind, CRCST, CHL, FCS, HSPA’s Director of Education. “Initial education and continuing education are critical to help ensure our practices provide the safest experience for our patients. Many Sterile Processing professionals have used this time to further their education, become certified, and enhance their skills.  If there is one thing the pandemic has done for education, it has driven home the importance of infection prevention.”

But not all continuing education courses/lessons are equal, cautions Thurmond.

“While more offerings are available, I am seeing some watered-down or especially brief content being offered for continuing education (CE) credits, which dilutes the value of education and diminishes the benefits for technicians. Patient safety and positive outcomes are our priorities, so it is important that SP professionals avoid taking the easy way when seeking education and CEs and instead pursue education that furthers their knowledge and professional development,” he said.

There has been a shift to more virtual education because of the pandemic, which is a double-edged sword, explains Berg:

“Especially in light of the pandemic, we have seen more virtual education and training than ever before, which presents both positives and negatives. The positive it that it can be on-demand, occurring whenever the team has time; however, one of the negatives is we lose the human touch as well as the return demonstration or hands-on learning that is so vital to our profession. I believe a good mix of both virtual and in-person education is the new future of education, and HSPA will continue offering both to meet the needs of our members, certification holders and others within the SP profession.”

In his work with CS/SPD departments across the U.S., Bonner has seen a greater focus on education, with more hospitals establishing permanent educator positions.

“Education became a very strong focus in early 2020 when the pandemic hit and has remained a priority in many institutions,” said Bonner. “The need for CS/SPD departments to expand their roles and take on new responsibilities such as the reprocessing of single-use devices has been one driver.”

“Another driver is state funding to hospitals for investing in education during the pandemic,” he added. “California and Oregon have been leaders in this effort when it comes to sterile processing. For example, the University of California has hired permanent CS/SPD educators, in addition to directors and managers, in its San Francisco, Irvine and Los Angeles medical centers.”

Department structures stable as roles change

There has been little reported change in CS/SPD reporting structure in the past year, with the following functions reporting directly to the CS/SPD head in their facility: Sterile processing (97%), decontamination (93%), case carts (64%), medical equipment cleaning/disinfection (43%) and GI/endoscopy (30%).

But COVID-19 has added new responsibilities and concerns related to the pandemic. When asked if they had implemented any new processes or procedures in their departments in light of the pandemic, survey respondents noted a number of changes. These include:

  • Processes and equipment to reprocess single use N95 masks, powered air purifying respirators (PAPR) and controlled air-purifying respirators (CAPR)
  • Rationing of supplies due to backorders/shipping issues
  • Mandatory COVID-19 screening, mask wearing and vaccination
  • Limited time off due to staff-shortages
  • Guidelines for decontaminating equipment used in COVID-19 positive cases

“The biggest change I have seen is greater flexibility (changing shifts, hours, duties) due to the changing work and personal challenges and environment,” said Berg. “Our workflow has not changed but it has created more of a focus on getting back to the basics and doing what we know works best in our profession. I have also seen more recognition on what Sterile Processing does in healthcare facilities. This is the time to embrace that for positive changes in our pay, education and certification.”

While the roles and responsibilities of CS/SPD professionals have changed over the years, many departments are still operating on outdated policies according to Bonner. Over the past two years, he has worked with 15 sterile processing teams across the country to update their policies and procedures, including salary updates that reflect cost of living and the increasingly advanced skills required to perform reprocessing on today’s complex instrumentation.

“Hospitals are still working off CS/SPD policies set in the 1990s/early 2000s, including pay structures set decades ago,” said Bonner. “Many have never even thought about updating them because they do not have a CS/SPD educator or manager to guide them, or leaders have been promoted from within and have limited visibility to what is happening to the field outside of their four walls. For those hospitals unwilling to change I ask, ‘If Joint Commission came into your facility today would you be able to tell them your CS/SPD policies are up-to-date?”

Amevor has been a Sterile Technician Manager been for 11 years and frequently consults with U.S. CS/SPD departments, both remote and on-site, providing coaching, project management and other services.

“You need someone very knowledgeable to update the policies and a good team to help ensure they are passed through,” he said. “Policies must go through review from so many different committees within the hospital and are typically approved by someone not in sterile processing. CS/SPD leaders must be prepared to answer questions from these stakeholders as to why things must be done in a certain way.”

Salaries need to keep pace with technological development, according to Prudent. “As technology of instruments and complexity of cleaning/sterilizing equipment evolves, the amount of knowledge and work increases for the Sterile Processing technician,” she said. “Salaries have increased but so have the other [salaries] throughout the employment scene. I feel that the increases that happened at the beginning of the pandemic were timely and much needed. The problem is that time has elapsed, and we are now lagging behind again.”

CS/SPD technology and process trends

HPN continues to track growing trends in the CS/SPD profession, asking survey respondents if they have implemented new and emerging technologies and processes aimed at reprocessing effectiveness, efficiency and safety. Here is what those surveyed reported this year:

  • Big changes in IFU methodology: The most significant reported change was in instructions for use (IFU) methodology, with 16% of those surveyed saying their facilities have made changes, which is double the number from last year (8%). Below are some of the reported changes:
    • Reviewing IFUs prior to purchasing new products
    • Referring vendors and physicians to IFUs when discrepancies arise
    • IFUs required for all loaner sets
    • The addition of new sterilization, extended wash and ultrasonic cycles
    • Efforts to convince leadership that other departments beyond the CS/SPD are also responsible for following IFUs
  • Track-and-trace system usage holds steady: The majority of those surveyed say their facilities use such a system (62%) or are currently in the process or planning stage (6%), which is unchanged from 2021.
  • Efforts on emerging disease safety dip slightly: Two years into the COVID-19 pandemic, fewer survey respondents said they have a safety training program in place for handling instruments for patients with suspected emerging diseases (46% in 2022, 49% in 2021), and there was a slight dip on those in the planning stages (3% in 2022, 4% in 2021).
  • Sterile processing workflow management systems grow in popularity: More departments reported using workflow management systems this year, with 53% saying “yes” compared with 46% in 2021.
  • Reprocessing related outbreak measures continue: Similar to last year, nearly half (46%) of survey respondents reported that their facilities had put new measures in place.
  • While the survey did not include questions related to robotic surgery, those interviewed commented on increased use of the technology and its impact on the CS/SPD department.

“We do continue to modify our workflows to be more efficient and we are seeing some more technology, such as robots for total knees and DaVinci robot rooms, increasing,” said Bohlman.

“Robotic instrumentation is booming, with the promise of a new surgical procedure standard that produces faster surgery with less hospital stay,” said Jelks. “Even smaller community hospital surgeons are trained to this technology. Robotic instruments require more critical thinking skills for technicians as they have very complex reprocessing steps from decontamination to sterilization.”

Strengthening the sterile processing profession

While the CS/SPD profession is making tremendous strides in generating increased recognition and respect within the healthcare field, it is clear that much work still needs to be done, particularly with regards to compensation.

CS/SPD professionals offer their thoughts on what needs to be done to further advance the profession.

Call on hospital leaders

“While most hospitals recognize the efforts of nursing staff during National Nurses Week (NNW), they rarely acknowledge Sterile Processing Week,” said Bonner. “I call on hospital leaders to acknowledge the important work of their CS/SPD teams. Most hospitals also fail to reward sterile processing staff members who maintain their certification, while the award annual bonuses to nurses who do. While hospitals may invest in sterile processing education, they neglect the compensation part of the equation.”

Thurmond agrees. “SP professionals should continue to provide excellent service and look for opportunities to show their worth to their organizations,” he said. “They should invite members of the C-Suite to the department for a visit and present their successes and challenges and share what keeps them awake at night. For so long, we have been the ‘unseen heroes.’ It is more than time that we are seen and recognized for our role in patient care, and there are many things we all can do to move the needle in a positive direction.”

Demonstrate value

“We must continue to improve ourselves and our profession daily, said Berg. “Yes, it is about the patient and about providing the best in reprocessing, but we need to tell our story through data and quality outcomes. We must be known for our knowledge and expertise regarding instrumentation and reprocessing, and how we make a positive and proven impact to the hospital, department and profession.”

“Once we show this worth, asking for better things and more recognition becomes easier,” he added. “I can say from personal experience that showing your team how important they are and listening to feedback and ideas is critical and will help with staff satisfaction and retention.”

Stay on top of the game

“The biggest statement an SP technician can make to improve the state of the profession is to become certified,” said Jelks. “Second to certification is joining an SP professional organization such as HSPA (myHSPA.org).  Last but not the least, to improve the state of the profession, we must stay educated and current with trends and standards, which can be achieved by reading recommendations and journal and magazine articles, including HSPA’s PROCESS magazine.  Whatever becomes the latest trend for surgery also becomes our responsibility to keep patients safe.”

Prudent encourages CS/SPD professionals to empower themselves. “Communicate with others, stand up for the patient and what is right, pursue your own education and promote the profession,” she said. “Become a member of Healthcare Sterile Processing Association and join the team of committees to raise the bar on patient safety. There is safety in numbers and everyone in the field has something to contribute.  Become passionate and become a volunteer and patient advocate. You are needed!”