Infection Control Today - 04/2004: OR Topics

The 21st Century Tech
The Surgical Technologists Expanding Role in the OR

By Tina Brooks

Advancements in technology continue tochange the field of surgery. Robotics, computers and imaging are being integrated intooperating rooms (OR) for optimum patient care.

But while the usage of this technology grows, so does the needfor staff that understands the basic function, application, and troubleshootingof it. Who is best poised for such a task? None other than the surgicaltechnologist.

Traditionally, surgical technologists, also called scrubs andsurgical or OR technicians, assist in surgical operations by organizing sterilesupplies and instruments, preparing patients and passing items to the surgeon asneeded. Their role, however, is quickly expanding.

Our last analysis of the field was conducted in 2002,says Dawn Vinson, executive director for the Liaison Council on Certificationfor the Surgical Technologist (LCC-ST). It indicated significant changes inthe field. We showed that surgical technologists are doing more perioperativework more pre-op and post-op than they had done in the past. We alsoshowed a significant increase in the role of technology in their job. Moresurgical technologists are involved in robotics, lasers and highly technicalequipment used in the OR, which was unheard of five or 10 years ago.

LCC-ST is the certifying agency for surgical technologists. Itconducts a poll every five years to insure that its certifying examinationreflects what is being required in the field.

Its the technology that is driving the increased roleand the increased complexity of what were asking our surgical techs to do, says Frank Vicari, MD, FACS, FAAP, attending surgeon atChildrens Memorial Hospital and professor of surgery at NorthwesternUniversity, Feinberg School of Medicine in Chicago.

Barbara K. Okamoto, MD, FACS, of the Ohio Permanente MedicalGroup in Cleveland, says, Were great when it comes from the surgicalstandpoint because thats what were trained in, but the set-up and so forthoften goes to the nursing staff, the surgery techs, the PAs, etc. The ancillary staff is absolutely crucial in order to make asurgery successful. As we look into the future, teamwork in this realm is going tobecome more important as the technology gets more complicated.

Okamoto, like others, acknowledges that even the most advancedtechnology does not run smoothly all of the time. Machinery can break down,she says. Unfortunately, when machinery breaks down and theres a patienton the table it means something a little bit different than when your dishwasherbreaks down or you have problems with your car.

Here is a list of Web sites to investigate for moreinformation:

Association of SurgicalTechnologists
www.surgicalassistant.org

AccreditationReview Committee on Education in Surgical Technology
www.arcst.org

Commission on Accreditation of Allied HealthEducation Programs
www.caahep.org

LiaisonCouncil on Certification for the Surgical Technologist
www.lcc-st.org

Surgical technologists in the military as well as in somecivilian facilities are responsible for the management of equipment in the OR,says James Richey, CST, school head for the Naval School of Sciences inPortsmouth, Va. We have to be able to troubleshoot right there because ifsomething happens in the middle of the case there is no one there to do itbesides us, he says.

Their role as troubleshooter will be even more pronounced astelemedicine becomes commonplace. A year ago the daVinci Robot performed asurgery, says Susan Wallen, RN, MS, CRNSA, CNOR, program director forperioperative nursing, surgical technology and hospital central service atGateWay Community College in Phoenix. The surgeon was sitting in a computerconsole in the United States. The patient was on the table in London for alaparoscopic cholecystectomy. The surgeon that commandeered that surgery was notwith the patient, but the surgical technologist was.

The Next Round of Tech Graduates

The old days of on-the-job training or 16-week programs forsurgical technology are long gone. Programs vary from nine months to 24 months,providing classroom instruction and supervised clinical experience. They are offered by community and junior colleges, vocationalschools, universities, hospitals and the military.

Associate degrees were real top shelf 20 years ago and nowwere looking at maybe 13 percent holding a bachelors degree, Vinsonsays. Twenty years ago, bachelors degrees in surgicaltechnology didnt exist. I definitely say that were moving in the directionof lots of education and training.

To insure that future surgical technologists can meet therigors of the OR, educational institutions are instituting a new curriculum fromthe Accreditation Review Committee on Education in Surgical Technology (ARC-ST). On the basis of compliance with the standards and recommendation of ARC-ST, aprogram receives its accreditation from the Commission on Accreditation ofAllied Health Education Programs (CAAHEP).³

The new curriculum consists of three primary components:

• Science. Exploresbasic science (i.e., anatomy and physiology, pathophysiology and microbiology);related science (i.e., pharmacology, anesthesia and medical terminology); andbiomedical science (i.e., computers, robotics, physics and electricity).

• Fundamentals. Focuseson all aspects of surgery, from preoperative to post operative. Also, specifiesthe types and number of clinical experience cases that students are to completeprior to graduation.¹

• Practice. Addressesthe professional issues of surgical technology, including professionalmanagement, self management, communication, professionalism, standards ofconduct, risk management and legal issues. ²

The new technology in the OR is moving rapidly towardminimally invasive techniques and robotics, says Paul Price, CST, MBA,executive director of ARC-ST. The primary reason that we changed the corecurriculum and made it mandatory for CAAHEP-accredited programs is that itaddresses these necessary changes and gives a basis for understanding how allthis complex equipment works.

Price emphasizes that future graduates as a whole will bebetter educated since they will receive an equivalent education no matter theinstitution they attend. The core curriculum was always an option foraccredited programs; however, ARC-ST changed the standards to state that it wasrequired as an instrument for curriculum design for all CAAHEP- accreditedprograms, he says. The reason that we did this was so we could standardizethe education, very similar to the way that nurses do it in their educationalprocess.

Donna Hess, CST, instructor at the KAW Area Technical Schoolin Topeka, Kan., says, Surgical technologists are highly specialized as faras what they learn for the OR. They get very in-depth training in the operatingroom, surgical procedures and surgical techniques. Even right out of school theycan start working in the OR immediately.

The outlook for graduates from surgical technology programs isgood. Employment of surgical technologists is expected to grow faster than theaverage for all occupations through the year 2010, according to the U.S.Department of Labors Bureau of Labor Statistics. Hospitals will continue tobe the primary employer of surgical technologists, although much fasteremployment growth is expected in offices and clinics of physicians, includingambulatory surgical centers.

In Phoenix, there is a big need for surgical technologists,Wallen says. Every day in the newspaper there is an ad for a surgicaltechnologist. Our students dont have a problem with finding work.

Surgical technologists may obtain voluntary professionalcertification from LCC-ST by graduating from a CAAHEP accredited program. They may then use the designation of certified surgicaltechnologist, or CST. Continuing education or reexamination is required tomaintain certification, which must be renewed every four years. Hess says thatcertification demonstrates a surgical technologists commitment to acquiringthe necessary skills as well as professionalism. Its not just another job;Its a career, she says.

Vinson notes that more and more hospitals across the countryare requiring minimum education levels for surgical technologists andcertification as proof of proficiency. Some states, such as Texas and Illinois,even require licensure.

What we do is not nursing, Price says. We are a veryintegral component of the operative team and our primary role is intraoperative,meaning that we are intimately involved with the procedure itself. The one thingthat were trying to do is position ourselves to handle some of the complexequipment. We want to be the equipment specialist in the operating room, thebiomedical technicians who understand all of the technical aspects of not onlythe intraoperative role but the perioperative role as well. Because there issuch a shortage of nurses in the operating room these days, we have to fill someof the areas that they filled before. So, we want to be properly trained to stepinto any role within the operating room.

Did you Know...

• The Liaison Council on Certification for the SurgicalTechnologist (LCC-ST) is the certifying agency for surgical technologists.

• 78 percent of certified surgical technologists (CST) and 67 percent of certified first assistants (CFA) are female.

• 36 percent of CSTs have an associates degree or higheras opposed to only 22 percent of CFAs ¡ General surgery and orthopedics areamong the most frequent specialty areas for CSTs and CFAs.

• The rarest specialty area is organ procurement and transplant, with only 1 percent of CFAs specializing in it.

• 66 perecent of CSTs and CFAs either are required to holdcertification as a condition of employment or receive higher pay for beingcertified.

• More than half of all CSTs and CFAs work in hospitaloperating rooms.

• Average certification compensation for a CST is $4,000 per year, while a CFA receives $10,000 per year.