The Hidden Hazards of Undertrained Personnel

Is your state-of-the-art department missing new skill sets?

Published: Tuesday, June 1, 2010 - 10:02

A surgical technician prepares her back table for the next laparoscopic surgery. Instruments are removed from their containers and packages, and placed neatly on the back table. Chemical indicators show that sets and instruments are sterilized; the patient is prepped. The surgeon begins the procedure. It progresses smoothly until a particular dissector is requested. The surgeon takes hold of the grasper to place it in the port, and then notices blood dripping from it into the port. The blood must have come from the last patient, because the surgeon hasn’t used this instrument yet. Clearly, it was not disassembled or sterilized.

Lesson: Just because the sterilizer was capable of sterilizing doesn’t mean it did so. Sometimes technicians or personnel don’t disassemble graspers because they don’t know that they are made to come apart or how to disassemble them. Sometimes techs are requested to keep them together for any number of reasons. 

How did this happen? Following instructions provided by any instrument’s manufacturer is the most basic good practice. It’s known by most operating room and sterile processing department (SPD) managers and technicians. However, they are not always aware of what their staff may actually be practicing. This is true for hospitals, surgical centers, dentists, and other clinics where procedures are performed. Sterile processing functions are conducted by technicians who are often hired without prior experience. Managers of these imperative departments are often promoted from elsewhere in the facility when a position becomes available. 

New process, old skill sets

This example can readily translate into any business or health care specialty. Roles, functions, and processes change all the time. However, how often do we take a hard look at the people required to function within a changed environment? Maybe technicians and managers are perfectly suited for the previous requirements of their department when its purpose was different. Have their skill sets been updated to meet the new requirements? Are training programs designed and refreshed with new needs in mind? Have the right type of experienced and skilled people been hired for an evolving department or function? Have we even begun to question whether an evolution has occurred that may be unnoticed by those in decision-making positions?

For the example of the unsterilized grasper, the oversight might have occurred because the function of sterile processing has grown—during the last two decades in particular. Formerly, the place where nurses could retrieve disposable supplies, from bedpans to gauze, for their patients, SPD now focuses on preparing surgical instruments for use. In many instances, although the department’s role has changed, the types of technicians and managers who staff it have not. This department has complex responsibilities, but the skill set for managing them has not kept pace with SPD’s new role in infection prevention. 

Any SPD staff is usually trained, although not always by as competent or supported an individual as is now needed. Technicians know to follow instructions, but not many SPD decontamination rooms have sufficient space to conduct all the necessary steps appropriately, or even to post instructions. How is this possible? Because the department is not always valued or viewed as the infection-prevention necessity it should be. Instead, it’s seen as an entry-level position in most facilities. This perception must change, and it should change at the top of every health care entity, beginning with its executive team. 

Challenging the status quo really means admitting we might not know all the turns our businesses have taken under the guise of improvement. We are eager to take new and bold steps and secure our places in an organization, but that doesn’t necessarily mean we are instantly prepared to do so. Neither does it mean that when we streamline functions and cross-train members for the sake of reducing redundancies, we have improved our chances for as-good or better outcomes.

Years ago, when SPD began preparing surgical instruments to reduce expenses and allow registered nurses (RNs) to focus more on their patients, someone should have questioned the real cost of the under-challenged assumptions that went along with this change. As the sterilization example demonstrates, patients continue to be affected by a process change that’s inadequately optimized. Both RNs and SPD techs behind the scenes are now directly and indirectly affecting patients. Health care organizations made the right decision in having the SPD take on these new responsibilities, but I firmly believe the change wasn’t as simple as it might have seemed to those who initiated it years ago. Furthermore, the health care industry has been slow to realize and subsequently best support this department.

The ripple effect

There is a real lesson to be learned here by all industries: Never assume anything, but know that it is never too late to regroup and begin the improvement process over again. 

I am in the business of sterile processing consulting for many reasons, and this issue is one of them. Challenges that surface from changes can be overcome. The SPD is still evolving, as are other imperative departments and functions in modern health care facilities and businesses across different sectors. The key to successful business growth and outcomes includes a better understanding of all the interdependencies within a system and how they relate to each other. Change for the sake of assumed improvement in one area might cause a ripple effect elsewhere that no one can accurately predict or anticipate.

Question everything. Include everyone. Be transparent. Improvements in quality will occur when the system continues to function seamlessly. All of its parts must move in unison toward the same understandings and goals.

About The Author

Michele DeMeo

Michele DeMeo, CRCST, CSPDT is an independent consultant and manger for sterile processing for Memorial Hospital, York, PA. With 18 years experience in SPD, she is active in related associations and is a voting member for several AAMI working groups. In addition, she has authored numerous articles in various publications and currently has a column in IAHCSMM's Central Source electronic publication.