Below are written reports from selected sessions presented at the 2012 Annual Conference and Expo in Albuquerque, New Mexico:
SATURDAY, April 28, 2012
- Developing a Staff Education Program
- Review of IAHCSMM’s Loaner Policy Template, Position Paper and he Role of the Orthopedic Council
SUNDAY, April 29, 2012
- Oh No! We Have a Sterilization Process Failure
- The Importance of Surface Disinfection and Departmental Housekeeping
- Training and Mentoring the Adult Learner in the CSPD
MONDAY, April 30, 2012
- President’s Welcome/Opening Remarks
- Keynote Address
- Medical Device Manufacturers’ IFU: What, Where, Why, and How?
- Rising to Excellence: Incorporating CSSD Best Practices into Each Work Area
TUESDAY, May 1, 2012
Wednesday, May 2, 2012
Staff education is the cornerstone of quality in the Central Sterile Supply Department. But as many managers and educators can attest, educating in a way that resonates, properly conveys an important message and makes a lasting impression isn’t always easy. It’s a point that Patti Koncur, IAHCSMM’s Educational Specialist and Professional Development Resource Council co-chair, addressed during the workshop “Developing a Staff Education Program. With some 40 years of experience in delivering staff education, she certainly knows firsthand what works – and what doesn’t. What does work? Dedication. “If you keep at it, you’ll be successful,” she assured, while launching into a practical lesson about the three basic, easy ways to develop a formal staff education plan.
First and foremost, she explained, it’s essential to develop a roadmap – one that outlines where you are currently, where you plan to go and who will be traveling along in the educational journey. This begins with educational topic selections. These can cover anything from mandatory or regulatory topics to information gleaned from customer surveys, complaints, quality issues, and staff input. Put simply, there’s no one right or wrong topic, as long as it’s message is delivered effectively.
Determining the topic and when and how to tackle it requires significant thought and planning, according to Koncur. If a topic is more challenging, for example, it’s prudent to give it ample time. “If a topic will warrant an hour of education, don’t try and cram it into 15 minutes or even a half hour,” she said, adding that it’s also important not to try and break an hour-long program into four 15-minute lessons. “You won’t be successful.” Topics should also be addressed by the right person – an individual who is both knowledgeable and possesses the teaching style required to address a certain group of individuals (whether they’re new technicians, OR staff, vendors, or others).
“In the beginning, this takes time. Training isn’t magic – it takes a lot of work and dedication,” stressed Koncur.
Step two in the process involves actual program development; that is, establishing the time, place and audience (messages and teaching approaches will differ depending on the target audience), and also determining whether the training will be conducted in a formal or informal way. While an hour or longer will be beneficial for more challenging, detailed lessons, don’t underestimate the value of 30 minutes, ten minutes or even five minutes during daily “huddles,” she explained. The key is to use whatever time is available wisely, over plan and never rush.
Step three involves monitoring the success, and it’s a step that most hospitals fail to do adequately. “The key to successful education is follow-up,” she continued, noting that it takes 21 consecutive days of constant reinforcement for a message to stick. Monitoring can be accomplished through post tests, verbal communication, simple checklists, competencies and demonstrations, and even point systems.
And don’t forget the other important ingredient in successful staff training and education: fun. “Making learning fun – in an appropriate way – is a great way to increase its effectiveness,” said Koncur.
Loaner instrumentation consistently ranks high on Central Sterile Supply professionals’ list of challenges. Fortunately, IAHCSMM’s Orthopedic Council is committed to helping facilities better manage the process and, in turn, enhance quality, customer service and patient safety.
A great deal has been accomplished since the Council’s inception in 2007 – most notably, the development and dissemination of the IAHCSMM Sample Policy & Procedure for Loaner Instrumentation and the Loaner instrument Position Paper. The policy, which is a recommendation, not a standard, serves as a beneficial template by which CSSD professionals may customize and tailor to their unique facilities. [Note: The two documents are located on IAHCSMM’s website at www.iahcsmm.org, under the ‘IAHCSMM News’ icon.]
While the documents are a significant accomplishment, the Council -- comprised of CSSD professionals, vendors and other stakeholders – is certainly not resting on its laurels. As Committee Chair Mark Duro, CRCST, FCS, explained, “there is even more that will be coming from the group to help professionals in the field,” including , but not limited to, as-needed revisions and additions to the loaner policy template; the development of interactive learning modules; specific loaner forms; a Frequently Asked Question resource; a compilation of success stories; dedicated articles and columns; manufacturer training and communication to drive Instruction for Use improvements and improved product design; and more.
The overarching goal is to provide a more comprehensive collection of resources to help facilities rise above the challenges associated with loaner instrumentation. As these resources are developed by the Orthopedic Council, there are plans to include them under their own dedicated section on the IAHCSMM website.
“We have a lot of things in the works,” said Duro. “Stay tuned because we’ll be announcing some of these new additions and changes in the near future.”
Central Sterile Supply Department professionals can all agree that dealing with a sterilization process failure is no easy undertaking. In fact, as Rose Seavey explained during her technical track, “Oh No! We have a Sterilization Process Failure,” depending on the situation, such an occurrence can ruin the day, or even a week.
Getting to the root of a sterilization process failure takes some diligent sleuthing. Likewise, preventing future failures (or at least reducing the risk for a repeat failure) requires ongoing dedication and a comprehensive approach that involves, among other things, proper process monitoring (looking at physical monitors, chemical and biological indicators), competent staff, and consistent adherence to ANSI/AAMI ST79 and other disinfection and sterilization recommendations, standards and best practices.
“If a BI, CI or physical monitor fails, that demonstrates failure of the entire load and it should be reported immediately to the supervisor and infection preventionist,” said Seavey, RN, MBA, MS, CNOR, CRCST, CSPDT, president and CEO of Seavey Healthcare Consulting. A written report should also follow and include, among other details, the date and time of the load; the type of sterilizer used; the contents of the load; and the results of the physical monitoring and external CIs, as appropriate.
Sometimes, CSSD staff can immediately (or relatively quickly) identify the cause of the failure. In most cases, sterilization failures stem from operator error, said Seavey, referring to statistics from sterilization expert Charlie Hancock that human error accounts for 85% of failures. This might involve incorrect use and interpretation of monitoring tools, improper documentation of results, improper placement of monitoring tools, defective indicators, overcrowding of contents, and incorrect incubators, to name just a few. Equipment malfunction accounts for another ten percent, followed by utilities at 5% (poor steam quality, for example). Pressure gauges in need of calibration, clogged steam lines, filters or strainers, or poorly engineered piping, among other factors, may all contribute to poor steam quality or quantity.
If a faulty sterilizer is to blame for the failure, it’s important to promptly identify and correct the problem. “You can’t just extend the cycle or increase cycle temperature [to compensate],” Seavey stressed. CSSD staff should be well-versed on equipment maintenance history, using reports from maintenance staff to stay apprised of minor or major repairs.
“If a major repair was made, the sterilizer needs to be requalified,” she continued, adding that the requalification process involves three consecutive BI test packs (and a subsequent negative result for each) and three Bowie-Dick tests for prevac cycles.
Because sterilization is a real science, and a lot can go wrong and lead to a sterilization process failure, CSSD professionals may want to rely on some beneficial, user-friendly tools. Two such tools, Seavey pointed out, is AAMI ST79 Table 8 (2009 amendment), a checklist to help staff determine what might have happened to contribute to the process failure, and ST79’s Figure 12 “Decision Tree,” a flow chart that walks professionals through the process failure investigation. Seavey suggested that CSSDs enlarge the chart and post it in their department so it’s readily accessible if or when a process failure occurs.
And don’t forget the value and importance of quality controls and risk analyses to determine the probability that a process failure might occur. It’s also vital to inform the OR and ICP of the details of the risk analysis, Seavey explained.
“You want to be proactive with risk assessments. You don’t want to wait until a process failure occurs.”
Central Sterile Supply Professionals tackle a wide range of responsibilities – all of which play a very real and direct role in patient safety and infection prevention. Unfortunately, surface disinfection and departmental housekeeping is one oft-overlooked task in many CSSDs. It’s a potentially dangerous oversight considering that the decontamination area is the dirtiest space in the hospital, explained Lisa Huber, CRCST, FCS, sterile processing manager at Anderson Hospital, Maryville, IL.
It was an important message heard by a large crowd during Huber’s Sunday morning session “The Importance of Surface Disinfection and Departmental Housekeeping.” While Environmental Services professionals may be responsible for certain aspects of cleaning in the CSSD, Huber said that the role of EVS in the CSSS may be limited. In fact, at Huber’s hospital, EVS staff are only responsible for floor cleaning and disinfection; the rest is left to CSSD professionals.
So which surfaces deserve CSSD’s daily, ongoing attention? High-touch surfaces, such as light switches, telephones, IV poles and other patient care equipment, door knobs, and computer keyboard are some of the key items that can harbor microorganisms. If surfaces are not properly cleaned and disinfected, these infection-causing organisms can then be passed to other devices, equipment, staff, and patients.
“A case study of 23 acute care facilities showed that only 49 percent of surfaces that were supposed to be disinfected actually were. That’s an [alarming] percentage,” stressed Huber.
According to the Centers for Disease Control and Prevention, cleaning and disinfection of environmental surfaces is fundamental in reducing the potential for surfaces’ contributing to the incidence of hospital-acquired infections, explained Huber. She referenced a study that showed that, in the absence of proper cleaning and disinfection, microorganisms can survive on environmental surfaces for a month or more. If an IV pump, for example, is used on a MRSA patient and not appropriately cleaned between patients, a nurse or other caregiver who touches that pump or takes it into another patient room can subsequently infect another patient. What’s more, even the best handwashing practices become ineffective when hands touch a surface that hasn’t been disinfected.
Cleaning is always the first step of the disinfection and sterilization process. As savvy CSSD professionals know, determining if something is “clean” isn’t always easy. “You can’t always tell if a surface or piece of equipment is clean or not,” stressed Huber.
To ensure that patient care equipment, such as IV poles, were properly cleaned and disinfected between uses, Anderson Hospital began using green tape on equipment to specify that it had undergone cleaning and disinfection; the tape, which does not leave any residue, is placed in a prominent location where caregivers can’t use the equipment without removing the tape. That way, there’s no question to the equipment’s cleaning and disinfection status. In addition, the CSSD assumes a leadership role by monitoring and cleaning the equipment.
Keeping the CSSD environment as clean as possible is, of course, critical. Reaching this goal involves ongoing education of CSSD and EVS staff. Keeping prep and pack areas of decontamination clean and ensuring that items are disinfected to avoid recontamination is essential, said Huber, as is ensuring that everyone involved in cleaning and housekeeping duties clean from “clean” to “dirty” areas. Horizontal surfaces should be cleaned and disinfected before and after each shift; spills should be immediately cleaned; floors should be cleaned and disinfected daily; and biohazardous waste must be removed each day. Documenting the cleaning process is also vital because it promotes accountability and ensures that essential cleaning and housekeeping tasks aren’t being overlooked.
“If ‘somebody’ is supposed to clean, then ‘nobody’ probably will,” reasoned Huber. Staff assigned to cleaning and housekeeping tasks each day should sign off on the checklist.
Of course, all the cleaning and disinfecting won’t be effective if the right products aren’t used for the task – or if they aren’t used according to manufacturer instructions. Alcohol, for example, is fast-acting, but it requires “wet contact” of at least five minutes. Floors should only be wet mopped – not dry- or dust-mopped, noted Huber. Chemical dilution rates are also vital for disinfection success, and proper personal protective equipment is needed to ensure staff safety.
Collaboration and communication among departments (i.e., CSSD, EVS and nursing) can also not be overvalued. “It really is vital to success,” Huber stressed.
Training the adult learner is a challenging, but very rewarding experience for the CSSD educator. If managed properly, the adult learner can bring unique and valuable skill sets to the team, explained Wayne McPeek, director of education for Prezio Health, during his session “Training and Mentoring the Adult Learner in the CSPD.”
“To have the opportunity to share what you know and what you have a great passion for is a privilege,” he said, before launching into a series of tips to help educators and mentors more successfully teach the adult learner.
Although the adult student differs in their learning approach and may not learn as easily as their more youthful counterparts, McPeek assured that they still learn just as well…as long as educators apply sound teaching techniques and tailor their lessons to their unique audience, so they fit with the students’ lives and lifestyles.
“The adult learner brings a broad, rich experience base by which to relate new learning,” he continued. “Often, they are more internally motivated. We have to figure out how to teach these adults at different rates and make sure they can get the information they need to know quickly, appropriately and efficiently.”
McPeek offered some direct, user-friendly tips for helping educators make the most of adult learning and education:
- Provide purpose to the training. Show the adult learner the value of the new learned skill and how it can enhance their current job.
- Engage in learning processes that help students maintain or improve their self-esteem. If students are studying for their certification, for example, make sure that when they pass their certification exam they include the CRCST in their title.
- Ensure that the content of the lesson challenges the learner. If a staff member is well-skilled in robotics, for example, continue to keep them apprised of new information to help them stay sharp.
- Recruit staff with specialized skill sets to assist with staff education and mentorship.
- Make new training programs relevant to current learner skill sets. This aides in retention of key concepts.
- Keep lessons more narrowly focused, as opposed to creating a competency checklist of dozens of ‘to learn’ items. Bite-sized chunks permit mastery of a subject.
- Ensure educational programs are current and relate to learners’ everyday experiences.
- Make learning personal and engage learners in the lesson. Hands-on learning can be very effective, so try and simulate the workplace in the classroom by bringing in props (such as specific instruments, for example).
- Develop a rapport with students and be accessible. Validate their questions at the end of the session, and determine another time to address their questions in greater detail.
- Lead the student to ask questions. Having them become more involved and question the training content will advance their learning potential.
- Understand that every student learns at a different rate. Work to support those who may require a bit more effort or follow-up (but address their need for additional help privately!).
- Recognize that the adult learner is a colleague and also has a lot to teach and significant knowledge to impart.
“An educator should never stop learning,” said McPeek. “Learning is a continuous process and we can all learn from each other. You don’t need to have ‘educator’ in your title to help others learn.”
Although the President’s Welcome got started promptly at 8am, hundreds of attendees were already filing in by 7:30am – each wishing to secure their seats well before President Bruce Bird ever took the stage. That anticipation, excitement and eagerness to learn has been palpable throughout the meeting, thus far, and IAHCSMM is pleased to have such wonderfully dedicated CSSD professionals, vendors and other experts present for the 2012 Annual Conference & Expo. One important statistic worth mentioning: the Conference has drawn more than 940 attendees in all (and that number may continue to climb as final figures are tallied). This represents the greatest attendance in IAHCSMM Annual Conference History! And many of these attendees have put the “I” in “International.” Attendees came from all corners of the globe, including Bahamas, England, Scotland, Japan, Singapore, Thailand, China, Germany, Belgium, Saudi Arabia, Canada, and more.
“It takes people to make dreams a reality,” said Bird, noting that because of attendee involvement – including CSSD professionals from all titles and walks of life , and vendors who offer their ongoing support – IAHCSMM has been able to provide the very best education and professional resources to those in the industry.
Bird went on to pay tribute to some of the many individuals who work tirelessly to impact the Association and profession, at large, including IAHCSMM staff, chapter representatives, allied association representatives and liaisons, IAHCSMM Fellows, vendors and speakers. He then stressed the need for more IAHCSMM members to become more involved in committees and other IAHCSMM- and CSSD-related opportunities that aim to advance education, knowledge, growth and professionalism in the discipline.
“People are the greatest untapped resource of any organization,” Bird noted. “At IAHCSMM, you are our greatest resource. We need you.”
Amy Roloff of TLC Network’s “Little People Big World” fame delivered a super-sized message to a packed ballroom, officially kicking off the IACHSMM Annual Conference in grand fashion.
As she spoke, it became clear just how many similarities Roloff shared with CSSD professionals. She worked very hard to prove herself, but sometimes struggled to gain respect and be visible to others. Despite her efforts, she didn’t always get the accolades and much-deserved pats on the back for a job well done. And through it all, she continued to do her best – striving for quality and excellence because, even without the recognition, doing the right thing and working hard mattered.
In meeting CSSD professionals and IAHCSMM Annual Conference attendees, Roloff discovered just how much the profession matters, too. Having spent many days in the hospital dealing with surgeries and many other procedures for both her and her son, she admits she had no idea just how much goes on behind the scenes in a hospital or medical center that could impact outcomes.
“Like many other people, I focused on the doctor or nurse and just assumed that all this other stuff was taken care of,” she reflected. “It’s interesting to learn about what you do. You all deserve a lot of credit. You follow technology that changes and adhere to policies and procedures each and every time to do the best job you can.”
Roloff shared many personal stories of trials and tribulations associated with growing up disabled and trying to fit into a world that didn’t always so easily embrace her. She worked very hard, rarely asking for help because she felt compelled to prove to the world that she was more than capable of tackling anything that came her way. At times, she built a wall around herself for protection, making it difficult for those who met her to break through. After some time, though, she discovered the importance of letting go and just being herself. She didn’t stop working hard (in fact, she’s working harder than ever!) – she just stopped putting such unrealistic expectations on herself and focused on just being Amy.
Through her journey, she even acknowledged that the reason she and her son have had successful procedures and positive outcomes is largely because of “behind the scenes people” like those in CSSD. “It’s clear that despite the hard work, you love your job and care about what you do. And for that, I thank you!”
Most Central Sterile Supply professionals are keenly aware of just how vital manufacturers’ instructions for use are to their job. If IFUs are missing, ambiguous or outdated, that limits technicians’ ability to perform their job safely effectively, and in accordance with national standards and recommendations. This shortcoming can have dire consequences for patients on the receiving end of the instrumentation or equipment.
Despite this importance, many CSSD professionals can attest that getting current, complete IFUs isn’t always easy. Some may rely solely on their vendor representatives to provide the instructions – a strategy that doesn’t always work in their favor, explained Chuck Hughes, general manager and lead educator for SPSmedical, and Matt Beauchaine, corporate accounts representative for SPSmedical. In their session “Medical Device Manufacturers’ IFU: What, Where, Why, and How,” the two addressed the critical importance of attaining and adhering to IFUs to meet recommended practices and standards, and survive and thrive during surveys from The Joint Commission and the Centers for Medicare & Medicare Services.
While some vendor representatives may be terrific resources and are committed to providing IFUs with their devices, Hughes said a good – and, perhaps, better – bet is to contact the manufacturer’s corporate office and speak directly with someone from Quality Controls or Regulatory Affairs. “They are already familiar with the documents and should be eager to provide them,” he assured. Another option is to hire a company to search for IFUs on your behalf. Whichever route a CSSD uses, Hughes stressed that the documents must be updated and complete – and also shared with any others who need them.
Beauchaine reminded that surveyors are now being trained on national standards and recommendations, and are coming into facilities more knowledgeable – and with the expectation that those standards and recommended practices will be followed. Documents such as ANSI/AAMI ST79 and the AORN recommended practices clearly state that written instructions from device manufacturers must always be followed. Further, it’s recommended that IFUs be obtained and evaluated by staff prior to purchasing to determine whether the facility has the resources and capability to fully comply with those instructions.
“Surveyors are going to come in and ask for the IFU for the device they’re following. With the tracer [methodology], they’re going to read it and watch you through each step to see that you’re following that IFU,” Beauchaine noted.
Increasingly, CSSDs are faced with IFUs that are lengthy and time-consuming, involve extended cycles, conflict with other IFUs or industry standards, are not up-to-date, or, in some instances, were not validated. Some vendors may even copy an IFU from a similar product from another vendor, said Hughes.
If extended cycles are required (a common requirement for larger trays, such as orthopedics), Beauchaine says it’s important to know which and how many devices require non-standard time and/or temperature settings.
“If a device requires extended cycles, ask the manufacturer if a protocol using a standard cycle is also available,” he recommended. If the actual IFU doesn’t include this, he said company letterhead could suffice.
It’s not enough for CSSD professionals to just have access to and follow the IFU, either. Hughes and Beauchaine pointed out that IFUs (particularly those for complex instruments where more reprocessing steps are involved) should also be shared with other departments (i.e., operating room, endoscopy, infection control) so they understand why they can’t have instruments turned around on a dime.
“Often, they don’t understand why it takes so long to process instruments, so showing them the IFU will help educate them,” said Hughes. “The only way to process in shorter time than what is required on the IFU is to take shortcuts.” And any safety- and quality-focused CSSD knows that’s not an option.
Best practices really do live up to their name. Their application in the Central Sterile Supply Department helps promote quality and excellence, drive practice and policy consistency, and contribute to great customer service, operational efficiencies and positive patient outcomes.
It’s a message expertly delivered by IAHCSMM Educational Specialist Natalie Lind and Col. Betsy Vane, a U.S. Army nurse of 23 years who has educated on OR, infection control, patient safety, and surgical instrument processing topics.
A “best practice” is a method or technique that has consistently shown results superior to those achieved with other means. And it might very well be the best way to do something in one’s own CSSD, Lind and Vane explained.
“If you’re proactive about what you do, that will lead to more positive experience and work environment,” said Vane, adding that this, in turn, will advance quality and performance improvement.
There are many ways CSSD professionals can access best practices and stay abreast of pertinent changes. These ways include:
- Laws and regulations (FDA, OSHA, EPA, DOT; state and local)– professionals can stay abreast of the latest changes through literature, including IAHCSMM’s Communique (columns such as Washington Update directly address this); AAMI newsletters, OSHA/CDC website; various trade publications and journals; local chapters, educational meetings, and more.
- Industry standards (AAMI ST79, AORN Recommended Practices, CDC’s Guide for Disinfection and Sterilization in Healthcare Facilities, 2008 (CDC’s may be accessed for free at www.cdc.gov).
- AAMI Technical Information Reports – a TIR on water quality is just one of many reports available.
- Current scientific knowledge – again, attained from journals, standards/guidelines/TIRs, and other means. “If your facility doesn’t have the money for these documents, many facilities have libraries where you can access some of these journals,” noted Vane. “If the journal you need isn’t available, ask if they can put it on the subscription list.”
- CSSD textbooks, such as the Certified Registered Central Service Technical Manual, Seventh Edition (translated in Japanese and a soon-to-be-released Chinese version);
- Online education – can be a great and convenience fit for busy lifestyles.
- Advice and information from colleagues. “If you get wind of knowledge or need to ask questions, don’t hesitate to seek out information from others. You can do this on Discussion Forums, such as IAHCSMM’s and AORN’s,” said Lind.
Despite the availability and accessibility of great resources to help drive best practices, a number of obstacles continue to get in the way. Lack of awareness, reluctance to break old habits, and the age-old complaint of limited time and money are all common barriers – as is feeling overwhelmed and unsure of where to start. Add to that limited or complete lack of support from administration who see no value in allocating resources to recommended practices, standards and other documents, and it becomes clear why some CSSDs continue to be stuck in a rut.
One of the first steps in breaking through these pervasive barriers is committing to quality and performance improvement through the development of written policies that stipulate that the department will follow regulations, standards and industry best practices across all areas of sterile processing and surgical support.
“By doing this, you help build a justification for the resources you need,” said Lind. From there, the standards, regulations and best practices will help validate the need for changes.
Conducting a review to identify the need for improvement and change will also go a long way toward advancing best practices in the department. In the short-term, CSSDs can focus on short-term, less resource-intensive goals, such as committing to compliance, procedure updates, education and training, and equipment repairs. In time, that will help lay the foundation for long-term goals and benefits, such as new equipment, renovation and increased staffing.
“Adopting best practices and performance improvement is a journey – and one that never ends,” said Lind. “But success starts with small steps.”
One glance into the sprawling Expo space and it became clear that IAHCSMM has grown to the point where a full-blown convention center is needed. And the Expo is the Albuquerque Convention Center certainly did a terrific job of comfortably housing hundreds of vendors and attendees (and some increasingly elaborate and eye-catching booths and demonstrations).
Attendees eagerly set their sights on the latest and greatest products and services, and spoke with and learned from some of the greatest, more prominent and well-respected vendor experts in the industry. In addition to the 181 exhibit booths, attendees were also treated to a hearty selection of Vendor Learning Annexes (11 in all), which allowed them to get direct education in private rooms right on the expo floor.
Vendor repair and education vehicles displays were also available, bringing attendees and vendor experts together for hands-on education or demonstrations of the instrument repair process. Educational poster presentations were another Expo perk, allowing attendees to review and explore a broad range of topics and success stories related to the profession.
Aside from networking, exploration and an energy-boosting boxed lunch provided by 3M, attendees were also treated to the Balloon Race Raffle. Participants visited as many vendor booths as possible, acquiring stickers that were traded in for a raffle ticket – and the chance to win one of many valuable vendor-donated prizes. The grand prize winner, Genan Holder-borga, won airfare, hotel and registration for the San Diego 2013 Annual Conference & Expo!
Surgical instruments and equipment are critical components of patient safety, positive outcomes and good customer service. Unfortunately, devices often don’t get the attention they deserve – and the consequences can be, at best, frustrating for the surgeon, and, at worst, devastating for the patient.
Instruments in need of sharpening, for example, can tear skin, while also increasing the risk for additional damage to the device. Instruments that can’t be taken apart and easily cleaned can harbor bone, blood and other bioburden that makes it difficult for a surgeon to operate the device properly (and, even more importantly, can contribute to hospital-acquired infections). Keeping instruments in tip-top shape requires a proactive approach – one that addresses issues before they become a liability.
“When you get items back from the OR with a repair tag, it’s already too late. Something has gone wrong,” said Rick Costello, MBA, CCSVP, president and chief operating officer of Spectrum Surgical Instruments Corp. While repair tags are necessary, he stressed that relying on this type of reactive approach is neither prudent nor cost-effective. He also explained that it’s not enough to just send out broken devices without practicing due diligence and embracing quality processes to ensure that the broken or otherwise malfunctioning device isn’t subjected to the same damage in the future.
“Any time a tagged instrument comes down from the OR, write it down in a log – the doctor’s name, the problem -- and see if it’s a ‘self-inflicted wound,’ something that was done to cause the damage that could have been avoided,” he noted. “Diagnose what happened and take corrective action to make sure it doesn’t happen again.”
Costello also shared some enlightening data from two 50-hospital studies: one where preventive maintenance was followed according to tray rotation; the other, based on time. For nearly 7,500 trays (across nine major services) that underwent tray rotations, the average number of uses before being sent out for preventive maintenance was 48. For the time-based study that assessed 13,000 trays and 400,000 instruments (across 21 different specialties), most services in the hospitals only performed preventive maintenance two to three times a year (and some hospitals were even fewer than that).
Education and communication plays an important role in the quality improvement process, he explained, and repair companies and device manufacturers can and should play a key role.
“Whoever is doing the preventive maintenance on your instruments needs to communicate what they’re doing and what they’re finding, in as much detail as possible, so you can find the right solutions,” Costello reasoned, adding that CSSD and OR professionals also benefit from ongoing education on care and handling of instrumentation. This education can be found in the Certified Instrument Specialist (CIS) textbook, among other resources.
While some facilities may be reluctant to engage in proactive preventive maintenance, there’s plenty of data to show that spending a small amount on the front end is far better on the budget than enduring big repairs and premature replacement on the backend. Just a cataract set alone will cost $2,495 new, whereas a completely restored set will run about $225 – less than 10% the cost of replacement. Even more savings can be seen on more complex sets.
Preventive maintenance is important for all instruments, but it makes good sense for facilities to put the most time, effort and money into their most valuable equipment. “This is a good place to start,” Costello said.
Good news, CSSD professionals: there’s a flurry of activity at the individual state level regarding certification legislation – and much of it is showing real promise. Josephine (Jo) Colacci, JD, IAHCSMM’s Government Affairs Director, gave a spirited legislative update Wednesday morning, addressing certification advocacy efforts and providing two mock meetings with legislators to demonstrate what CSSD professionals could experience when they meet elected officials face-to-face.
Progress is being made in New York and Colacci hopes to have the bill passed out of the Senate by the end of May. “The bill is looking very good,” she said. While the bill’s language changed from last year’s version and now states that certification will only be required for CSSD professionals just entering the field, it does require that all CSSD professionals must maintain the 12 hours of continuing education credits each year. This change, although not ideal, was required because it was the only way to get the unions’ support (a must for getting the bill passed through the legislature). Also, all other healthcare professions that have sought credentialing bills in New York exempt current workers, which means requiring certification retroactively for all current CSSD professionals would simply not happen, Colacci explained.
On March 29, 2012, a bill was introduced in the Pennsylvania legislature with 26 representatives co-sponsoring the bill. “That is huge support when introducing a bill,” raved Colacci. The Pennsylvania legislature is in session until December 31. Although the hospital association is opposing the bill, Colacci remains confident because of the strong sponsors in support of the bill.
Colacci gave a brief rundown of other states in various stages of the legislative or educational process (including Ohio and Washington, two states that are currently on hold, and Oregon which may have a bill introduced in 2013; she also briefly discussed activities and status in California, Arizona, Colorado, Florida, Virginia, Maryland, Connecticut, Iowa, and South Carolina). She directed attendees to the Legislative Map (located under the “Government Affairs” tab on IAHCSMM’s website) for an at-a-glance picture of where states are in the process.
Colacci stressed that she needs help spreading the message with email action alerts sent to state elected officials and newspaper editors. 2011 statistics for action alerts/emails sent to state elected officials were devastatingly poor; of 10,567 members who received the action alert, only 34 actually sent the letter, representing a response rate of just .32%. The number that sent the emails to their local newspaper editors was also alarmingly low. Of 10,563 emails, only 149 letters were sent. Of those 149, five letters were published.
“I can’t stress enough that I need your help! These letters explain who we are and what we do, and they literally take just a couple clicks to send,” said Colacci. The letters to elected officials and editors are already written, so all CSSD professionals need to do is type in their name, address, email address and then click ‘send.’ “I get reports on these action alerts and that allows us to then follow up on the ground and start setting the stage for our next steps. I need more activity from you or we won’t be effective or successful. Please help me help you.”
Session attendees were treated to two mock legislative meetings, with Colacci acting as the elected official and National Government Affairs Committee members Carolyn Mattley, Steve Adams and Don Williams serving as the team of CSSD professionals educating the official on the issue. The first mock meeting was an eye-opening example of what can go wrong during a visit with a state elected official. The official was disconnected from the discussion – even dismissive -- and seemingly uninterested in the issue as she scrolled through messages on her phone and rudely answered a call mid-meeting. Worse, she likened the group’s pursuit of CSSD certification to a family that requested a speed limit change following a fatal accident involving their loved one.
“This mock meeting may seem extreme, but it actually happened,” said Colacci. Fortunately, positive exchanges can and do happen, as well, as the second mock meeting demonstrated. In this example, Colacci, the “elected official,” was interested in the information presented, was engaged in two-way discussion, asked pertinent questions and requested follow-up information.
“This isn’t easy, but our efforts will be worthwhile,” assured Colacci. “If we all work together, we will be successful.”