What's Wrong With CS?
What’s Wrong With Central Services in Today's Hospitals
There is this perception of respect, or the lacks of, which hospital CS departments live under and is the root cause to our disease. At annual conferences year-after-year we hear it over-and-over again,
“Central Service People Get No Respect.”
This almost never ending sob-story is only aggravated by the fact that we are our own problem. We are divided amongst ourselves and draw lines in the sand that are easily trampled on with new ones drawn almost daily.
The fact is that if you have been in one hospital, then you have been in one hospital, no two are a like.
This in its self is the problem.
Moreover, we have three organizations, IAHCSMM, AORN, and AAMI who talk to each other, even collaborate and co-author papers to show support towards each other. We have standards supported or recommended by AAMI, ANSI, CDC, ISO, FDA, and AORN that are potentially enforced by The Joint Commission or now more so with CMS.
Read Your State License
If you have some time one evening try “Googling” your state hospital license and find out what it states as to the department of central services or sterilization.
In some states there is no mention, unlike like
We are up against another group of people that also have several organizations that seem to work together yet cannot agree on a simple management structure to support the largest revenue generating division in any hospital, AORN, OR Manager, and now Magnet.
The number of acronyms added to ones business card or e-mail address lately seems to be more important then the ability to manage people and operating budgets.
Honestly, having RN, BSN, ACE, MBA, CST, and CRCST at the end of your name truly means that you can pass a multiple choice test or write a paper. However, it does not indicate the ability to manage a business or department let alone lead and retain staff.
As it stands complaints are abundant but long term solutions are absent.
The bandaid just around the corner is mandatory CS certification.
Get a copy of the AIA guidelines for further disappointment and knowledge as to why sterilization departments are so poorly designed and constructed.
Dig a little deeper and your find out how off site for-profit sterilization companies get away with transporting contaminated and sterilized instruments to-and-from hospitals.
Sit in on an expansion project at your hospital and ask why sterilization will not be expanded to keep up with the increased bed count and surgical suite construction.
Where I am I heading with all this you ask…we have more problems then solutions that CS certifications cannot fix.
We have two certifications organizations with read-test-and-forget processes, in place of competenceny based programs on the job training.
With one all you do is pay a fee, read a book, and take a test. Which opens the door for all kinds of individuals passing a test and wanting to get the job without the extensive on-the-job knowledge base it requires.
“Certification could not be completed voluntarily, so now we are going to make it mandatory?”
The sad reality is that staff certification will not solve a single thing.
If we, as CS professionals truly want to gain the respect then we need to get our acts together. We have to be consistent form hospital to hospital. We all need to agree on a process and stick to it.
It should be that no matter what hospital you work in the decontamination and sterilization processes are the same. We need to pick a service, fix it state wide, and then move on to the next service.
Starting with decontamination, which is the backbone of a well ran CS department. We will need to agree on one method to complete low-level hand washing of instruments. A process that minimizes contact, allows staff to complete the work without fear, utilizing the latest techniques.
Absolutely NO pre-stringing with little hand washing of instruments in sinks filled with sharps just waiting for an accident happen.
The process must also complement our automated instrument and cart washers. There is a product that does support that but we cannot talk about it on the IAHCSMM forum.
We would include the proper use of a sonic washer along with how to use various high corrosive chemicals so as not to cause breakdown in the instruments protective passivations layers. Included we would cover every instrument that requires special handling and address process. We need to teach how high impingement washers function and stress the importance of daily maintenance on them.
Furthermore, we need to develop standard policies, procedures, and job discriptions along with video instructions that would complement CS annual educational requirements, more competency based then multiple choice test and forget. Information needs to be at the techs work area incorporated into touch screen computer systems.
That would be a really good start!
After all of this has been completed we would then tackle prep-n-pack assembly and sterilization. With the decontamination side running smoothly this process will fall right into place. Next would be delivery and stocking alone with case cart management which would include supply management.
Along the way we would enforce recommended competencies and make them part of the CS certification process. Before starting an in-house certification process we would get the department certify or accredited, (5-star rating of some kind).
Nursing may have the Magnet program but we would have a seal approval that states that our decontamination and sterilization process have met national and state standards allowing us to have a license or certificate that promotes a sense of security for our patients.
Now do you want to have surgical procedures complete in a Magnet hospital where they will still have problems with decontamination and sterile processing that will cause infection rates to go up. Or, would you want your community to know that you have received the highest achievement necessary that insures patient safety and physician satisfaction.
Just a few more thoughts.
Please remember that we could not get certification completed nationally when it was not mandatory. So how could mandating it be any better? We need competency based certification not a multiple-choice read-test-and-forget process.
Hands on learning is what makes us the best at what we are, CS professionals
I have, as have you heard over and over again that we all must follow hand washing standards and HIPAA standards as well as AORN standards. What I have never heard, is that we must follow decontamination and sterilization standards nation wide.
New York City issues restaurant cleanliness certificates as do most states yet hospitals do absolutely nothing. Please do not tell me that JCAHO enforces decontamination and sterilization standards. I have completed seven JCAHO surveys and I have never been asked if I follow mandatory CS standards.
And yes we have been JCAHO accredited all seven times.
Pay-Read-Test-Forget, What a Deal
Now to add insult to injury let’s take an individual who failed at their pervious job (even with a sufficient number of acronyms, one of them being CS certified) and gets hired by a healthcare company to be a CS consultant (because of the acronyms).
This person sells him or herself as the real-deal for sterilization to a hospitals administration even though they have a lack of leadership in CS. The game here is to get everyone certified and make a little money not solve the problem.
In comes the consultant to save the day only to help her/his company secure a multi-year repair/service agreement attached to ever phase of the sterilization operation costing the hospital hundreds of thousands for years.
This is not made up, it happens more often then you think.
