Sterile Processors, Infection Preventionists Need to Team Up

When Tanya Lewis, CRCST, takes the helm as president of the International Association of Healthcare Central Service Materiel Management (IAHCSMM) this month, she will bring with her good memories of working with infection preventionists (IPs) at Wellstar North Fulton Hospital in Roswell, Georgia. Lewis supervises the sterile processing department at the hospital and has had a great working relationship with the IPs there. “Now, I can say in the past that I haven’t had good relationships with my infection preventionists, because they didn’t really know what we did,” Lewis tells Infection Control Today® (ICT®). “And some of them—I don’t know if it was fear, or what—but because they didn’t know, they never came to see what we did.” There’s a lesson there for IPs: Visit the sterile processing department when you can because the job has gotten more challenging than in the days when all that needed disinfection were knives, scalpels, forceps, and other classic tools of surgery. For instance, “there are a lot of steps in cleaning robotic instruments,” says Lewis. She says that one of her main goals when she becomes IAHCSMM’s president will be to lobby states to mandate that anybody who works in sterile processing be certified. Now, that’s a goal many infection preventionists can relate to.

ICT®: Is that assumption correct? Did COVID-19 change how sterile processing is done? Or is it basically the same thing?

Tanya Lewis, CRCST: Oh no, it changed it dramatically. We were having to reprocess disposable masks, the N95 masks, and we didn’t have to do a lot, but at some of my other sister facilities, they did. But here at North Fulton, we didn’t have to do hardly any. But yes, it absolutely did change the dynamics of sterile processing. Because we were always [saying], “No, we can’t reprocess unless we have validated or anything like that.” We weren’t used to reprocessing disposable items. But when COVID-19 came along, it took a whole new turn for a lot of things; our respirators and N95 masks and things of that sort.

ICT®: What are the major challenges you see for IAHCSMM as a whole going forward?

Lewis: I think that as we move forward, we’re going to have to look at a lot of ways that we’re doing things differently. For instance, the reprocessing of disposable items that we have not done in the past. I think that we have to actually give our members real-life situations where what we’re doing right now, in this pandemic, reprocessing things that we normally wouldn’t

Tanya Lewis, CRCST

reprocess, we have to give them the information and the tools that they need in order to be able to do that and do it successfully. There are going to be a lot of different changes going forward. I’m so sure of that. And because I don’t believe that with the pandemic…. We’re not sure when it’s going to end or what else [will happen] with all the different variants and everything. We just want to make sure that we give our members the tools that they need to do their jobs successfully.

ICT®: You mentioned disposable medical instruments. I know that duodenoscopes were in the news because more of them were becoming disposable. Do you welcome disposable medical instruments in your job? Or do you think your members might feel that, “Well, if everything becomes disposable, will they need us as much anymore?”

Lewis: That’s always a question that comes up, and I really think that, regardless if we have disposable this and disposable that, because we do have a lot of disposable tools now. We also have reusables, like you said the duodenoscopes, the disposable ureteroscopes and things of that sort. We have those, but we’re going to always have to have our reusable products where we have the disposables as a backup. It may come to a point where we have the reusables as a backup due to manufacturer back orders or whatever. So no, I don’t think we’re going away anytime soon.

ICT®: Disposable and reusable—might they sometimes intersect? In other words, you could have a reusable instrument but at a certain point you have to dispose of it. That’s up to the sterile processing expert, right?

Lewis: That’s correct. Yes, they really do intersect. I’ll use an example of a flexible, reusable ureteroscope. And you know, if you have an issue with that scope, and you don’t have another one available right at that time, then you can open up a disposable one. Disposable and reusable at some point will intersect.

ICT®: And everything is disinfected after use, correct?

Lewis: Everything that is used we absolutely do clean and then disinfect, if the instructions for use say so. Some things are hand washable. Some cameras, you cannot disinfect them, so you can sterilize them, but you have to manually clean them and clean them thoroughly in order for them to be processed and sterilized. You can’t get anything sterile unless it’s clean.

ICT®: You’re the head of the sterile processing department there. What worries you in terms of being a manager of other people and what they might miss or what they might rush through, especially during a pandemic? Everybody was working many hours and exhausted. What set off alarms for you?

Lewis: Let’s see. I don’t like to brag, but I have to say that my team is really, really conscientious. And they really understand that our patients are our top priorities. I don’t really stay up at night…if they think that they have something they’re not really sure about, they’re always able to call me or go to the manufacturer for different things. We use 1 source a lot. That being said, if there’s something that they’re not sure about, they’re going to reach out to [me] or they’re going to go to the manufacturer and see what they need to do to make sure that that item is clean and processed properly.

ICT®: What would you say offhand are the 5 things that you have to disinfect the most?

Lewis: I would say cameras, laparoscopic cameras, general cameras, Cisco cameras, laparoscopic instruments. And they have to go through the process that they go through…. I guess the robotic instruments not so much as the cameras, but there are a lot of steps in cleaning robotic instruments. You hand wash them, you flush them, you soak them, you rinse them, and then you attach them to the ultrasonic and then you send them through the disinfector—the washer disinfector. There are a lot of steps involved with that. Everything that we get in that’s new or that we’ve not seen before, I try my best to make sure that my team has an in-service [training]. They’re educated, and they’re competent, and they complete a competency [test] once they’ve completed their in-service to make sure that they are very confident with what they’re doing. So, like I said, a lot of cameras are laparoscopes, and our robotic [instruments].

ICT®: Medical television shows where the surgeon is asking for a scalpel, scissors, or knife….

Lewis: That’s what we do. We reprocess all of those items, we reprocess the knife handles that you put the scalpel blade on, and we reprocess the scissors, and we just try to do our best and make sure that we’re giving our patients 100% of what they need.

ICT®: It sounds like the reprocessing is more difficult with the more sophisticated instruments. I’m assuming that scalpels and scissors have been done for decades. You have that down pat. It’s the new stuff that’s a bit of a challenge, right?

Lewis: Correct. You’re absolutely correct, the new things are a challenge. They’re a challenge for us. And that’s why it’s so important for us to make sure that we get our instructions for use from the manufacturer, because we can never just guess. We’re not ever going to guess on how we would clean an item, or a camera, or a scope, or anything of that sort. We have to have that information. And we have to be able to do it according to the manufacturer’s instructions because if we don’t, then we’re setting our patients up to fail. And we’re setting our patients up for infection. And that we’re never going do. Not intentionally.

ICT®: A core of our readership comprises infection preventionists. Does your department and infection prevention have much back and forth? Or further, whom do you interact with the most in terms of
other departments?

Lewis: OR [the operating room]. Of course, OR, we interact with them. But my infection control practitioner is excellent. She knows…this is the first one—well, maybe the second—I’ve known, who really understands what we do, why we do it, and why we have to do it correctly every single time. And so, she’s been in this arena before. She worked in the GI [gastroenterology] lab. We have a very great relationship. Now, I can say in the past that I haven’t had good relationships with my infection preventionists, because they didn’t really know what we did. And some of them—I don’t know if it was fear, or what—but because they didn’t know, they never came to see what we did. But for…I’m going to say the last 2 IP professionals I’ve worked with, we have a really close relationship. And they know exactly what we do, because they’ve come down, and they’ve come to see exactly what we do. I think that’s a great thing. I think you should always have a great working relationship with your IP person.

ICT®: We’ve written articles here at Infection Control Today® about how, when this pandemic happened, all of a sudden infection preventionists were people to whom different departments would go to seek information about how to protect yourself as a health care worker from getting COVID-19. Was that what happened in your case?

Lewis: Oh, yes. She was very adamant about trying to make sure that we had everything that we needed. Everything we [needed] to protect ourselves, first and foremost. She wanted to make sure that we protected ourselves. And so, if we were short—which I have to say thank you, that we were not short—but had we had any limited supplies of PPE [personal protective equipment] or anything, she was right on it, because she knew exactly what we needed to do. And she knew that our job was just as important as making sure that the OR had the things that they needed. So, you know, she really did a great job during the pandemic. And of course, we’re still in the pandemic. She’s still keeping in contact, checking in on us to see if we need anything. And I just think that’s the relationship that you should have with your infection preventionists.

ICT®: Whom do you report to when you have to give a report about how things are going in your department? A hospital administrator?

Lewis: Well, we have an IC [infection control] committee, and we meet quarterly. We’ve probably been meeting on some Zoom calls, of course, since the pandemic. But we have quarterly meetings…composed of OR and pharmacy, housekeeping, IP, and nursing. There are others that are there as well but those are the main departments. We do talk about our infection rates and talk about our instructions for use and IUSS [immediate-use steam sterilization], which is very, very minimal; little to none. We do not [use] IUSS, unless it’s an extreme emergency….

ICT®: IUSS?

Lewis: Immediate-use steam sterilization. I guess back in the old times they used to say a flash sterilization, like…when you have a one-of-a-kind…but we don’t have that anymore. But if you had a one-of-a-kind or if you had some loaner instruments that were brought in for a patient and the surgeon dropped that instrument, then—once it was cleaned—it would be run on an immediate-use cycle, which is a 3-minute or 4-minute cycle with no dry time. And then it’s run in a container that’s used to transport it back into the room. We hardly have any of that going on here at North Fulton.

ICT®: Stepping back a little to talk about your position as the upcoming president of IAHCSMM, what do you see as the priorities in that position?

Lewis: Communication should be first, I think, for our membership. My goal is…with the staff at IAHCSMM to really work on trying to get more states with mandatory certification. Now, we’ve done a great job; IAHCSMM has done an excellent job. But I think we can move just a little bit on a quicker level. They may not agree with me at headquarters, but I just think that we should be moving just a little bit faster with trying to…. And it’s a process; they have to go before the legislature in that state and everything. It really is a process. But I think it’s a process worth moving forward with in trying to expedite where more states are requiring mandatory certification in order to work in sterile processing. That’s one of the things; I think we have a great membership. And I want to make sure that our members are qualified and educated to do the jobs that they do every day. We try really hard to give them education, things that they can Zoom in on or they can do a podcast. And we have lots of [training opportunities] for them. I think we’ve come a long way with that. And moving forward, I’m sure we’ll be having a lot more education-wise for our members. But I think, to this point, even with the pandemic, we didn’t have our IAHCSMM conference last year, but we did have a virtual conference. We’re just trying to do what we can to make sure that our members know that we’re fine. And we want to make sure that they get the education that they need.

ICT®: What you said about lobbying to mandate certification for sterile processing employees sort of mirrors what’s going on with infection preventionists. They’re also lobbying states so that anybody who’s called an infection preventionist should have certification. How many states have you convinced so far?

Lewis: Let’s see, New York, Massachusetts, Denver [Colorado]….

ICT®: What does certification involve? Do you have to go to school for a year or take a certain number of hours of a course of some sort?

Lewis: Well, IAHCSMM has a certification course…. Well, we have several as a matter of fact—but where you can actually purchase your book and your workbook, and you work through that…at your own pace. And when you feel like you’re ready to take the examination, then you can go through Prometric. We are partnered with Prometric Testing for them to take their tests through the certification exam. We have several different options for them. We have the sterile processing [technician], and then we have the instrument specialists. We have the endoscopic specialist certification. We have several certifications. And it’s just a matter of people really sitting down reading, understanding. I think a lot of places have schools where you can go…anywhere from 4 months to a year at a technical college and take a class, and courses are for sterilization, too. After you complete that class you can then sit for the sterilization certification exam, whichever one you choose to sit for.

ICT®: What would you tell your fellow sterile processing professionals about how to further get through this pandemic? The numbers look good, as you know, right now, but the variants are out there. What advice do you have for your fellow sterile processing professionals?

Lewis: I have this to tell my coworkers—because that’s what I think, we’re all one big family. We should just continue doing what we’re doing and follow CDC [Centers for Disease Control and Prevention] guidelines. Just maintaining wearing your masks, and those of us who want a vaccine—I would like to think a lot of them would, but you know, some people don’t. But if you want a vaccine, make sure that you get it when it’s available to you. Keep your hands washed, wear your mask, social distance, just all the basic things. We have to stay safe. We have to stay safe for ourselves, our families, and our patients. Right now, those are the things that we have to do to stay safe. I just think that they’re doing what they’re doing. Just keep doing it.

ICT®: I’m always a little shocked about vaccine hesitancy among health care professionals. And it’s a real concern.2 Have you had conversations with your team about vaccination?

Lewis: I’ve talked to my team, and some of them have had the vaccine already. I took it in December, and then I took my second dose in January, but some of them have had the vaccine already. And then some of them are still a little leery. You can’t force them, but I just keep trying to explain the positive part of it. It may not be 100% effective. But if you get it, you will not get a real severe case of COVID-19. So that in itself…. I don’t have a lot of millennials, but the ones I have, they’re like, “No. I don’t know what’s in that vaccine. I’m not taking it.” You can’t force them. Maybe at some point it might be mandatory, but most of my people have received a vaccine.

ICT®: Is there anything I neglected to ask you, that you think is pertinent that you want sterile processing professionals and infection preventionists to know?

Lewis: No, I just think that infection preventionists and sterile processing should always work as a team. It should always be a team effort. It’s not them or us. It’s not sterile processing. It’s not infection prevention, but it’s us as a team. And that’s the way we’re going to keep our patients safe.

This interview has been edited for clarity and length.