Infection Control Today - 12/2003: Perspectives

Professional Infection Control Management or GlorifiedDishwashers?

By Becki Harter, CST, RCST, CRCST, FEL

I had the pleasure of speaking at the Indiana Regional IAHCSMMmeeting in October and was very proud to see so many certified central service(CS) technicians there. It has been an uphill battle getting healthcare to seehow valuable professional certification in this area really is. I know mycolleague, Nancy Chobin, also is a champion of certification and it is so goodto see so many starting to reach for professional certification in nationalorganizations for such a critical step in infection control.

At conferences, I get the opportunity to speak to many in the profession andlisten to their views and concerns. One thing rang clear to me at this regionalmeeting. The profession of central service is largely discredited or rarelyrecognized as one of the singularly most important steps in the infectioncontrol process that it is.

In many healthcare systems, the central service area is referred to asglorified dishwashers and Christmas-package wrappers. I can say I was a bitappalled at that prospect, but on the other hand, I can see why healthcaresystems feel that way since non-skilled labor is generally hired for centralservice positions. A person can make more at a fast-food restaurant with lessrisk than an individual who works in a CS department. There seems to be less emphasis on this critical area than there reallyshould be. I would like that to change.

I have been encouraged by the record number of CS personnel that have growinginterest in being professionally certified. It would be wonderful, however, ifhealthcare systems would recognize this as a step up and pay accordingly. Afterall, if you are a graduate nurse, your pay is increased once licensed, and ifyou are a scrub technologist, your pay is increased once you receivecertification. The same should be true for certified central service technicians. Currentlythis is not always true, if at all, in some areas. Perhaps the problem lies inthat there is not a clear understanding of what is required to become acertified central service technologist.

The course of study for CS is as follows:

• General field studies where and what the function ofCS is
• Medical terminology
• Human anatomy
• Microbiology
• Infection control asepsis, regulations concerning OSHA, JCAHO, CDC forinfection control and other related infection control practices for CS.
• Decontamination and disinfection practices, to include procedures and commonly used solutions and their kill properties.
• Equipment management

• High-temperature sterilization and sterilization solutions

• Low-temperature sterilization

• Surgical instrumentation

• Sterile packaging and storage protocols

• Total quality management and QA

• Safety and risk management

• Regulations and recommended practices

• Purchasing practice

• Inventory management and distribution

• Information technology

• Human relations skills and professional development

• Healthcare trends and the impact on CS

This represents 19 areas of study that I can assure no on-the-job training can teach. This is not to say that some who were trained on the job cannot do the job successfully. However, there are pieces to the puzzle missing that are readily available in someone who has studied, practiced and certified specifically for CS. It is very easy to detect a certified CS employee vs. one who is not. The mindset and professional seriousness to the job is verypresent in a certified technician. There is a clear understanding of the job andwhat is needed to do it safely. There is less incidence of taking shortcuts because there is an inherentunderstanding of the risk that is taken when this practice is allowed. Thein-depth understanding and study has taught sober respect for the profession andthe major role it plays in the overall safety to patients. If the CS departmentdoes not do its job correctly with great vigilance, any aseptic or steriletechnique employed after that is to no avail. If contamination or questionablepractice happens in CS, the entire system of infection control is compromised.Your patient is at risk.

So why is this area treated with such laissez fair? Perhaps becausethere is not a clear understanding of how critical this area is to the infection control process and the implementation of a successful positive patient caredirective. Just as you would not want a person giving you nursing care who wasnot registered or a scrub nurse that was not certified, the same should holdtrue for CS. Why is registration or certification so important that unless youhave it you will not be hired? It tells an individual that this person hasundergone a course of study and has shown proficiency in the choice of study byreceiving registry or certification. I am a certified surgical technologist bytrade, in addition to being a certified registered central service technicianand I can say, knowing what I know about both professions, I would be verynervous to depend on a non-certified anything to take care of me. The two professions are too in depth and can have great affect on a patientif either one is not given due resolve. Why rely on the on the job trained?

Most healthcare systems suffer from the lack of qualified availablepersonnel, so they are forced to train in-house. As much as I have met RNs thatcan scrub with the best of them, give me a CST any day because their course ofstudy is more in depth and specific to the role. The same is true with CS. Giveme a staff of certified CS technicians any day over those who are not.

The more CS personnel who aspire for certification, the better the chance ofgetting the pay that is consistent with that professional vocation. Choose any one of the professional CS organizations in your area and go forit! Your services are needed and your knowledge is required. In a perfect worldI see every healthcare system hiring only certified central service techniciansand requiring certification for those who are already in house. I also see thefinancial rewards for such a professional accolade and honor. I see greatstrides being made in infection control practices that include CS as the driverof such efforts. I see infection rates dropping and infections prevented as theprofessional element is raised to this wonderful profession. We can do it, onehealthcare facility at a time. Before you know it, we will have achieved ourgoal. What is that goal? That every CS department would be filled with professional certified CSpersonnel earning pay equivalent to the necessity of that role.

We have work to do. We must set our sights on a new standard and workdiligently to obtain it for our patients sake. Require certification as aprerequisite for any CS position. For information on how you may be certified,feel free to contact Sterilization By Design, Inc. for the professional organizations that offer such a time-honoredprofessional certification program or go to the web by searching CSorganizations. Then get started on the professional recognition you deserve andyour patients rely on.

Becki Harter CST, RCST, CRCST, FEL, is president and CEO ofIndianapolis-based Sterilization By Design, Inc.